Inclusive

Early Childhood
Development
and Disability

UNICEF Country Office

Programme Guidance Notes

UNICEF_NYHQ2010-0173_Noorani

Coordination:
Anna Lucia DEmilio, Regional Education Advisor
Maria Elena Ubeda, Regional Early Childhood and
Development Specialist
Author: Garren Lumpkin, International Consultant in
Early Childhood and Disabilities
Edition Coordinator Gladys Hauck, Documentation
and Information Assistant
Editor: Alison Raphael
Graphic design: Kwame Boyce / Oliver Duarte
Design and printing: Early Childhood and Development team,
UNICEF New York Headquarter 2015
United Nations Childrens Fund, UNICEF
Cover photo: UNICEF_NYHQ2012-1913_Dorminio
Latin America and Caribbean Regional Office
Building 102, Alberto Oriol Tejada Ave.
City of Knowledge
Panama, Republic of Panama
PO Box 0843-03045
Telephone: +507 301 7400
Fax: +507 317 0258
www.unicef.org/lac

The opinions expressed are those of the authors and

editors and do not necessarily reflect the policies or views
of UNICEF.
This publication may be reproduced for use in research,
advocacy and education only, provided the source is
acknowledged (UNICEF). This publication may not be
reproduced for other purposes without the prior written
permission of UNICEF. Permissions will be requested to
Communication Unit, comlac@unicef.org.

Inclusive
Early Childhood
Development
and Disability

UNICEF Country Office

Programme Guidance Notes

Preface and Acknowledgements

This Programme Guidance Note focuses on providing
UNICEF country offices with background information
and inputs to assist UNICEF staff in programming and
advocacy work on the multiple topics of Inclusive
Early Childhood Development and Disabilities. The
initial design for these guidelines prioritizes support
for UNICEF country staff working in the Latin
American and Caribbean context, recognizing that
suggestions and recommendation included in this
document are also appropriate for most UNICEF
Country Programme situations outside the LAC
region. Document content targets specific elements
to strengthen UNICEFs capacity to mainstream
disability components within its overall child rights
programming and to utilise existing entry points to
incorporate related interventions. Special priority is
given to using existing institutional frameworks
(UNICEF Strategic Plan 2014-2017) and building on
the recently launched WHOUNICEF publication:
Early Childhood Development and Disability: A
discussion paper.

holistic Inclusive Early Childhood Development

approach is required for UNICEFs work, going beyond
a focus on inclusive pre-school and primary education
services to include a wider range of activities,
environments and contexts that impact on all young
children including those with a disability.
Given the increasingly wider range of initiatives in the
disability field, a wealth of information is emerging for
use by cooperation agencies and partners. The
challenge is to transform this information into
appropriate strategies and programmes, and to move
forward with proven participatory approaches. In
addition, further efforts are required to recover and
utilise lessons learned from past experiences targeting
the design and implementation of inclusive ECD and
disability actions, and to document and evaluate
emerging strategies and programmes.
During the course of developing these guidelines,
important inputs and contributions were provided by
numerous UNICEF staff, external consultants and
country counterparts as well as experts in the field:
Anna Lucia DEmilio (UNICEF LACRO); Lus Angela
Melo (UNICEF TACRO); Rosangela Berman-Bieler,
(UNICEF NY); Amy Farkas (UNICEF NY); Pia Britto
(UNICEF NY); Maria Elena Ubeda (UNICEF LACRO);
Barbara Kolucki (Independent Consultant/USA); Claudia
Pacheco (Independent Consultant/Paraguay); Heila
Molina (Independent Consultant/Chile); Marigold
Thorburn (Independent Consultant/Jamaica), Hector
Collado (Physical Therapist and CBR expert/Nicaragua);
Carolina Cuevas (Fundacion Saldarriaga
Concha/Colombia), and Ruth Elisondo (former National
Special Education Director and co-founder of Los
Pipitos Parents Organisation/Nicaragua). In addition,
important inputs were provided from the following
UNICEF Country Offices: UNICEF Brazil, UNICEF
Cuba, UNICEF Chile, UNICEF Jamaica, UNICEF
Guyana, UNICEF Nicaragua, UNICEF Panama, and
UNICEF Eastern Caribbean Area Office. Finally,
selected publications of the UNICEF Regional Office
for CEECIS authored by Gerison Lansdown and
documents prepared by Diane Richler (Joseph P.
Kennedy, Jr. Foundation International Fellow) provided
important background information for this material.
Alison Raphael provided editorial support.

The increasing priority placed by national

governments, civil society and cooperation agencies
on fulfilling the commitments framed in the
Convention on the Rights of Persons with Disabilities
(CRPD) respond to growing recognition that the
achievement of international goals for all children and
adolescents is directly related to how national and
local efforts reach and include the most excluded
children and their families. For the LAC region,
consideration is also given to the importance of
complying with the Inter-American Convention on the
Elimination of all Forms of Discrimination against
Persons with Disabilities.
An increasing number of UNICEF country offices are
exploring or undertaking initiatives to support
government and NGO actions to fulfil CRC and CRPD
commitments by incorporating specific ECD and
disability components within existing health,
education, child protection and social policy
programmes. Specific actions include such elements
as: early detection and intervention, with family
involvement; community-based rehabilitation (CBR);
inclusive education and child-friendly schools (CFS);
rights promotion; and monitoring compliance with the
CRPD. But more is required to achieve sustainable
policies and strategies capable of addressing a wider
range of inclusion and rights issues across the
life-cycle, particularly: increased focus on the early
years, heightened commitment to family
competency-building and support and an expanded
emphasis on strengthening parent/primary
caregiver-child relationships and spaces. A more

Table of contents
Acronyms
1. Introduction: ECD, inclusion and young children with disabilities

1-4

1.1. Importance of the topic and timing of discussion

1.2. Expanded vision of early childhood inclusion

1.3. The case for action, intervention and inclusion of young children with disabilities

1.4. Importance of inclusive ECD for UNICEF policy and programme development

2. Young children with developmental delays and disabilities: their numbers and situation

5-12

2.1. Estimated prevalence and characteristics of young children with disabilities

2.2. Key issues facing young children with disabilities and their families

2.3. Rights of children with disabilities in global conventions, frameworks and commitments

10

3. Actors, strategies and actions for promoting development and inclusion

of young children with disabilities

13-16

3.1. Past UNICEF strategies and actions in the LAC region and lessons learned

13

3.2. Overview of selected lessons learned in the LAC region

15

3.3. Existing and emerging priorities on global and regional levels

16

4. Areas of support for the development and inclusion of young children with disabilities

17-29

4.1. Strengthening policies and interventions across the early life-cycle and for transitioning periods

17

4.2. Preparing key environments and components for inclusion

24

4.3. Increasing support for and competency building of family and other caregiver skills

27

4.4. Expanding involvement of DPOs and organisations of families of children with disabilities

28

5. Mainstreaming of actions within existing programme priorities and interventions

29-46

5.1. Initial introduction on entry points

29

5.2. Entry points through Conventions and other international commitments

30

5.3. Twin-Track Approach

32

5.4. Entry point based on commitment to support the CRPD

34

5.5. Entry points for mainstreaming disability actions based on UNICEF Strategic Plan (2014-2017)

35

5.6. Entry points focusing on key spaces and actors-across the life cycle

38

5.7. Entry points for mainstreaming disability building on existing cooperation actions

42

5.8. Entry points building on existing actions at different operational and policy levels

46

Conclusions

47

References and Endnotes

48

ii

Acronyms
CBR
CEDAW
CBM
CFS
CRC
CRPD
CWD
CNWD
DFID
DPO
ECCE
ECD
ECLAC
EFA
GMR
IASG
ICF
IDB
HI
IE
IDA
IMCI
LAC
LAMI
MICS
MDGs
M&E
NGO
OAS
OEI
OHCHR
OOSC
PAHO/WHO
RI
UN
UNFPA
UNDG
UNDP
UNESCO
UNICEF
WB
WFFC
WHO

Community-based rehabilitation
Convention on the Elimination of all Forms of Discrimination against Women
(Formerly) Christian Blind Mission
Child-friendly school
United Nations Convention on the Rights of the Child
United Nations Convention on the Rights of Persons with Disabilities
Children with disabilities
Children not with disabilities
UK Department for International Development
Disabled peoples organisation
Early childhood care and education
Early childhood development
Economic Commission for Latin America and the Caribbean (United Nations)
Education for All
Global Monitoring Report
Inter-Agency Support Group for the Convention on the Rights of Persons with
Disabilities (United Nations)
International Classification of Functioning, Disability and Health
Inter-American Development Bank
Handicap International
Inclusive education
International Disability Alliance
Integrated management of childhood illness
Latin America and the Caribbean
Low and middle income (countries)
Multiple Indicator Cluster Survey
Millennium Development Goals
Monitoring and evaluation
Non-governmental organisation
Organization of American States
Organization of Ibero-American States for Education, Science and Culture
Office of the High Commissioner for Human Rights
Out-of-School Children Initiative
Pan-American Health Organization/World Health Organization
Rehabilitation International
United Nations
United Nations Population Fund
United Nations Development Group
United Nation Development Programme
United Nations Educational, Scientific and Cultural Organization
United Nations Childrens Fund
World Bank
World Fit for Children
World Health Organization

iii

UNI102936

1
Introduction: ECD, inclusion and
young children with disabilities
1.1. Importance of the topic and
timing of discussion
As defined by a wide range of experts in the field,
early childhood is the period from the prenatal stage
to eight years of age, a time period of extreme
importance for the childs development and crucial for
preparing the foundation for life-long learning and
participation.

protection, frequently increases the impact of delays

or disabilities, leading to lifetime consequences,
increased poverty, abuse and profound exclusion.1
The CRC and CPRD make it clear that children with
disabilities have the same rights as their peer to
health, care, nutrition, education, social inclusion and
protection. Through a more comprehensive,
multi-sector approach across all life-cycle stages
and with family involvement the provision of
required family support, early intervention and
education can help to guarantee all rights of all
children leading to the achievement of the childs
potential and inclusion in all activities and contexts.

During this life-cycle stage, young children are

influenced by the responsiveness and support of their
family and surrounding home/community
environment, along with the quality of a range of
health, early childhood development (ECD) and
education services. All provide an initial opportunity to
promote development, while preventing exclusion
and potential blocks to development, in addition to
having a lasting impact on the childs future learning
and participation.

Children with disabilities and their

families constantly experience
barriers to the enjoyment of their
basic human rights and to their
inclusion in society.

For young children with developmental delays and/or

disabilities, this period is even more critical when
timely and systematic early intervention actions
undertaken with family involvement provide the
critical support needed to reduce the potential impact
of an impairment, while guaranteeing the necessary
conditions for the child to start on a path to achieve
his or her full potential. These are also the years when
assisting the childs family is critical to addressing
both the physical and emotional needs arising from
their caregiving roles.

Their abilities are overlooked, their

capacities are underestimated and
their needs are given low priority.
Yet, the barriers they face are more
frequently as a result of the
environment in which they live than
as a result of their impairment.

Globally and in the region, increased recognition is

being given to the importance of the early years and
expansion of ECD (preschool) coverage. However, the
required supply of family and centre-based services
and support for children under three remains limited,
and only recently have efforts to strengthen the
transition process at critical moments begun to
emerge: from the family/home setting to ECD
services, and from home or ECD programmes to, and
through, the first grades of primary. As mentioned,
this is the period of the life-cycle when development
takes place at an accelerated rate, and is heavily
influenced by family and external factors. The most
vulnerable children with developmental risks, delays
and/or disabilities are all too often the most invisible,
and are denied access to already limited ECD
services for the 03 age group. Not providing timely
and appropriate early intervention, support and

Source: Promoting the Rights of Children with

Disabilities, Innocenti Digest No. 13, UNICEF
Innocenti Research Centre, Florence. 2007.

These Programme Guidance Notes aim to assist

efforts by UNICEF country offices in LAC to achieve a
more inclusive and holistic focus for ECD programme
actions and support, including increased attention to
the multiple aspects of childhood disabilities and the
mainstreaming of early childhood disability
components within existing programme areas and
implementation. This expanded vision within ECD
efforts is a priority, and represents a critical step for:
initiating the inclusion of disability priorities within
programmes and policies; demonstrating how like

prevention, early detection, and inclusive early

intervention programming changing family,
community and service staff attitudes about disability
is a crucial component; strengthening the capacities
of health, ECD and education staff to promote and
guarantee inclusive services for children with
disabilities and their families; and supporting families
to initiate and maintain inclusive and stimulating
home environments the first critical space for
influencing development, inclusion and rights
achievement. Emphasising family competency
building and involvement must become a UNICEF
and counterpart priority.

Early childhood inclusion embodies

the values, policies, and practices that
support the right of every infant and
young child and his or her family,
regardless of ability, to participate in a
broad range of activities and contexts
as full members of families,
communities, and society.
The desired results of inclusive
experiences for children with and
without disabilities and their families
include a sense of belonging and
membership, positive social
relationships and friendships, and
development and learning to reach
their full potential. The defining
features of inclusion that can be used
to identify high quality early
childhood programs and services are
access, participation, and supports.

Current UNICEF initiatives provide appropriate entry

points throughout this period of the life-cycle that
should be considered for more intensive efforts:
Integrated Management of Childhood Illness (IMCI)
and ECD actions, including the Care for Child
Development (C4CD) Intervention initiative; child
friendly school (CFS) promotion and inclusive
education (IE) including the emerging focus on
strengthening transitioning; family/parenting
capacity-building and rights promotion, and others.
This effort recognises the renewed commitment of
UNICEF to this critical area, while taking advantage of
a moment when the international community is
expanding actions for advancing rights achievement
for children with disabilities. Preparation of this
material is an initial follow-up action to the
WHO/UNICEF discussion paper on Early Childhood
Development and Disability, with an aim to promote
and support concrete actions to advance more
inclusive ECD programming and implementation.

Source: Early Childhood Inclusion: A Joint

Position Statement of the Division for Early
Childhood (DEC) and the National Association
for the Education of Young Children (NAEYC),
officially approved by both organisations,2009.

settings in the community, with the family and home

environment considered a key priority.
During the course of future UNICEF-supported
actions to promote inclusive ECD, specific efforts will
be required to design and implement strategies that
provide the same health, education and social
services for all children and their families, while
guaranteeing the additional inputs required for
meaningful inclusion, beyond the provision of direct
services. Using an ecological approach, the full range
of influences on the child must be considered,
including cultural and linguistic factors and the
interactions between the family environment and
other key settings. The 2009 NAEYC and DEC
definition of Early Childhood Inclusion (at right)
provides a starting point for constructing a clearer
vision within UNICEFs programming framework as to
what is Inclusive ECD.

1.2. Expanded vision of early

childhood inclusion
A review of the literature highlights the range of
definitions of inclusion and its main dimensions. In
the LAC region, most counterpart and UNICEF
actions have focused on inclusive primary education,
with an increasing effort to include children at the
preschool stage. However, as stated by Odom (2002),
increased recognition is being given to an expanded
vision which argues that inclusion extends beyond
the boundaries of classrooms and into a broad range
of activities and settings that involve typically
developing children in their homes, neighbourhoods,
communities and cultures.2 For UNICEF and its
partners, recognition of and planning for
implementation of this expanded vision has
significant implications, requiring mainstreaming of
actions within multiple programme areas to focus on
strengthening, in a coordinated manner, a wider
range of interacting health, ECD and education

1.3. The case for action, intervention

and inclusion of young children with
development delays and/or
disabilities

boys with disabilities to attend ECD and primary

school. Approaches combining centre-based
programmes and parenting interventions, including
home visiting programmes, may help parents and
professionals to detect developmental delays early,
improve childrens development, prevent abuse and
neglect, and ensure school readiness.

Children with disabilities are likely to be the most

vulnerable members of their communities, whose
rights are consistently overlooked. This is especially
true in developing countries, where the situation of
young children with developmental delays and/or
disabilities is often more alarming and invisible. The
importance of investing in ECD, especially during the
early years, is supported by research and
multi-country experiences, especially for the most
disadvantaged children. Few studies have been
undertaken in low- and middle-income countries
(LAMICs) to identify the results of specific early
intervention actions. The rationale for early
intervention for young children with developmental
delays and disabilities builds on more in-depth
knowledge gained from a range of experiences with
ECD initiatives in higher-income countries. The
foundation for more profound action in early
intervention can be found in the following rationale:3

1.4. Importance of inclusive ECD for

UNICEF policy and programme
development
UNICEF has taken important steps towards
expanding actions for children and adolescents with
disabilities and their families. Institutional Disability
Goals highlight a firm pledge to direct internal
energies and increased efforts towards supporting
country counterparts in achieving CRC and CRPD
commitments, through the targeting of three main
UNICEF Goals: (1) Mainstream disability across all
of our policies and programmes, both in development
and humanitarian actions; (2) To develop leadership
on the rights of children with disabilities and build
capacity among our staff and our partners; and (3) Be
an inclusive organisation for all.4 More recently, the
proposed UNICEF Strategic Plan (2014-2017)
re-emphasises the desired impact of institutional
efforts to contribute to the realisation of the rights
of all children, especially the most disadvantaged.5

Human rights rationale: Both the CRC and the

CRPD state that all children with disabilities have the
right to develop to the maximum extent possible.
Within this context, actions must focus on the
surrounding family, community and service
environment, in relation with the childs health
condition or impairment.

For UNICEF and other agencies, gearing up internal

and external commitments and capacities to support
CRPD fulfilment comes at a critical time, as countries
and agencies near the end of the present EFA and
MDG 2015 commitment cycle, and significant
initiatives are underway to discuss Post-2015
priorities, strategies and targets. In addition to its
important role on the global stage, UNICEF can play a
more significant role at the country and regional
levels to raise awareness and mainstream disability
interventions for young children and their families
within regional initiatives, including such important
actions as the Global Education First Initiative and
A Promise Renewed in the Americas Reducing
Inequalities in Reproductive, Maternal and Child
Health.

Economic rational: Children with disabilities who

receive good care and developmental opportunities
during early childhood are more likely to become
healthy and productive adults. Early intervention and
family support can also help to reduce the more
immediate factors leading to family poverty, along
with addressing potential future costs related to
education and medical care.
Scientific rationale: The first three years of a
childs life are a critical period. They are characterised
by rapid development particularly of the brain and
thus provide the essential building blocks for future
growth, development and progress.

Earlier reviews and evaluations of global and internal

cooperation have identified both successes and gaps
in efforts to guarantee rights achievements for all. As
indicated by the observations of DPOs and support
agencies, disability issues including targets and
specific rights-based components were missing
from global MDG planning and within UNICEF MTSP
designs, except for specific efforts within the EFA
movement.

Programmatic rationale: Home and centre-based

inter-sectoral ECD programmes can lead to
improve rates of survival, growth and development;
and ensure later education programmes are more
effective. Well-organised inclusive ECD programmes
for young children with disabilities can provide
parents and other family members with more time
to engage in productive work and enable girls and

This emerging commitment to address the lingering

rights abuses against young children with disabilities
and their families is in harmony with on-going
UNICEF global, regional and country ECD initiatives,
in coordination with key partner agencies. Joint
collaboration with WHO (both WHO/Geneva and
PAHO) has resulted in advancing this joint topic
through the design and preparation of related
materials such as: Early Childhood Development and
Disability: A discussion paper and the updated
WHOUNICEF Care for Child Development
Intervention Package, which for the LAC region
includes specific information on strengthening
family-child interactions, including children with
developmental delays or disabilities. In addition, the
launching of the 2013 SOWC on Children with
Disabilities demonstrated an important step toward
mobilisation by achieving increased internal and
external awareness.

Early Childhood Intervention: Early

childhood intervention (ECI) programmes
are designed to support young children
who are at risk of developmental delay,
or young children who have been
identified as having developmental
delays or disabilities. ECI comprises a
range of services and supports to
ensure and enhance childrens personal
development and resilience, strengthen
family competencies, and promote the
social inclusion of families and children.
(1)
Children with disabilities: refers to
children up to the age of 18 who have
long-term physical, mental, intellectual
or sensory impairments which in
interaction with various barriers may
hinder their full and effective
participation in society on an equal basis
with others. (2)

Terminology
Early childhood: Early childhood spans
the pre-natal period to eight years of
age. It is the most intensive period of
brain development throughout the
lifespan and therefore is the most critical
stage of human development. (1)

Developmental difficulties: refers to a

range of difficulties experienced by
infants and young children, including
developmental delay in the areas of
cognitive, language, social-emotional
behavioural and neuromotor
development. (3)

Early Childhood Development: Early

childhood development (ECD) is a
generic term that refers to a childs
cognitive, communication, social,
emotional and physical development.
The same term is often used to describe
a range of programmes which have the
ultimate goal of improving young
childrens capacity to develop and learn
and which may occur at many different
levels such as child, family and
community, and across different sectors
such as health, education, and social
protection. (1)

Community-based rehabilitation: A
strategy within general community
development for rehabilitation,
equalisation of opportunities, poverty
reduction and social inclusion of people
with disabilities. (4)
*Source: (1) UNICEF WHO Early Childhood
Development and Disability: A discussion paper; (2)
Convention on the Rights of Persons with
Disabilities. Article 1; (3) WHO Developmental
Difficulties in Early Childhood Prevention, early
identification, assessment and intervention in
low-and middle-income countries; (4) WHO and
World Bank World Report on Disability.

Developmental Delay: Developmental

delay refers to children who experience
significant variation in the achievement
of expected milestones for their actual
or adjusted age.

2
Young children with developmental
delays and disabilities estimated
numbers and their situation
2.1. Estimated prevalence and
characteristics of young children
with disabilities.
differences in definitions used, along with variations
of methodologies and instruments applied. In
addition, studies conducted often do not meet the
required quality standards.9

The situation of so many young children facing

multiple factors of poverty, discrimination, exclusion
and violence is alarming, with risks of death,
underdevelopment and disability. UNICEF and WHO
recognise the significant threats to survival and
development faced by young children in poor
countries across the world. An estimated 7.6 million
children under the age of five worldwide die each
year. More than 25 times that number over 200
million children survive but do not reach their full
human potential.6 Some children will be born with a
disabling condition or impairment, while others may
acquire a disability as a result of illness, injury or poor
nutrition followed by limited family-focused early
intervention services and increased exclusion within
families and communities. These disadvantaged
children are often excluded from school or do poorly
when enrolled and subsequently face poor
self-esteem, limited work skills, low incomes, high
fertility, high criminality, and provide poor care for
their own children.7 As a result, millions of young
children are denied their rights as stipulated in the
CRC at a critical time of their early development.

Although survey results are often questionable,

certain global studies help to provide some clues as
to the degree of prevalence of young children with
disabilities. A 2012 WHO publication highlights some
examples:10
In the six countries (19 per cent) of the
Developmental Difficulties in Early Childhood
Survey (DDEC) where there had been such
surveys, the prevalence of developmental
difficulties in young children ranged from 5 per
cent to 12 per cent.
Although the true prevalence of
developmental difficulties in children aged 0-3
years is unknown, a recent Lancet series
provides an estimate of the percentage of
children screening positive for or at risk of
disability in Multiple Indicator Cluster Surveys
(MICS) carried out in 18 countries in 2005-2006,
based on the use of the 10 question instrument.
The analysis found that a median 23 per cent
(range 3 per cent to 48 per cent) of children
aged 2-9 years screened positive for disability.

For countries and international agencies, the

challenge of addressing the multiple risks facing
millions of disadvantaged children is significant, and is
combined with higher estimates of persons with
disabilities more than previously projected. WHO
and the World Bank estimate that more than a billion
people live with some form of disability;
approximately 15 per cent of the worlds population.
Among these, between 110 million (2.2 per cent) and
190 million (3.8 per cent) adults have very significant
difficulties in functioning. Based on the same study
information, an estimated 106 million children aged
0-14 had moderate or severe disability.8 In 2005
UNICEF estimated that 150 million children
worldwide are living with a disability.

In the United States, one study showed that

13 per cent of children aged 317 years had a
developmental disability. In 1988 a national
survey found that 17 per cent of children aged
0-17 years had a developmental disability.
More recently, in the United States it is
estimated that 10-20 per cent of children have
developmental difficulties.
Because LAMI countries have high rates of
risk factors that affect young childrens
development, such as poverty, malnutrition,
and related deficiencies, intrauterine growth

Most experts in the field agree that there are

currently no reliable estimates of the number of
children with disabilities. Prevalence estimates vary
between and within LAMICs, due to significant

retardation, chronic illness and deficiencies in

pyscho-social stimulation, the prevalence of
developmental difficulties is almost certainly
higher than in high-income countries.

The most recent publication of WHO and the World

Bank brings to the debate and advocacy effort a more
detailed picture of the estimated prevalence of
moderate and severe disabilities throughout the
world with more disaggregated information by
region, sex and age, as indicated in the attached
table. In the Americas (LAC), prevalence data for lowand-middle-income countries are slightly better than
world estimates, but significantly worse than those
of higher-income countries.11

Some authors have speculated that, while

the overall prevalence of disability in LAMI
countries has remained constant over the past
ten years, there has been a shift from more
severe disabilities to milder problems related
to cognitive impairment, behavioural problems,
and hearing and communication impairments.
The commonly used screening tools may not
adequately detect these disabilities.

ESTIMATED PREVALENCE OF MODERATE AND SEVERE DISABILITY, BY REGION, SEX AND AGE
(GLOBAL BURDEN OF DISEASE ESTIMATES FOR 2004)

The Search for Reliable Data

WHO has underscored the expanded

vision of disability impacts,
emphasising that the implications of
disabilities can extend beyond the
once estimated 10 per cent of the
population with a disability (now
estimated at 15 per cent), reaching as
high as 25 per cent of the population,
due to the multiple consequences
associated with disability, such issues
as poverty and exclusion . Achieving
a more in-depth understanding of this
expanded vision is important to
design appropriate strategies that
address both the rights and needs of
those children and adolescents with
disabilities, along with supporting the
family and surrounding environment
to tackle the multiple factors of
exclusion and to facilitate the childs
development, learning, protection and
participation.

Studies on prevalence are difficult to

conduct in LAMI countries. There is
already sufficient evidence that the
prevalence of developmental
difficulties in young children is high
enough to warrant widespread
prevention and intervention efforts in
all countries. Provision of services to
prevent and manage such difficulties
should not be constrained by lack of
data on epidemiology
Source: Developmental Difficulties in Early
Childhood: Prevention, early identification,
assessment and intervention in low-and
middle-income countries A Review;
WHO Geneva, 2012, p. 17

As previously mentioned, the identification and

analysis of disability prevalence is a complex task
with multiple factors influencing results. For
programming purposes aimed at supporting countries
for CRC, CPRD, EFA and MDG achievement, a wider
vision must be sought to guarantee the identification
and implementation of appropriate, participatory and
sustainable strategies and solutions. One critical
issue is related to how calculations or estimates are
made concerning the combined direct and indirect
impacts of a disability, which should go beyond just
the direct effects on the individual with a disability.
WHO has pointed out that disabilities can impact on
an estimated 25 per cent of the population.

Impact of Disabilities on the

Population (Estimation)
Old and New Projections

DIRECT
AND INDIRECT
IMPACT

2.2. Key issues facing young

children with disabilities and their
families

10%*

In the world, there

are more than 650 million
persons who live with a
disability

Despite the increasing importance given to reaching

young vulnerable children and striving to fulfil CRC
and CRPD targets, young children with disabilities
and their families are often overlooked in existing
health, education and social protection services. All
too often, children with disabilities of poor families
or those of indigenous origin are confronted with
multiple exclusion factors: inadequate legislation and
policies to meet their needs, negative attitudes of
service providers and community members and
services that are neither inclusive nor accessible.

25%

if this % is added to the number of

extended family living with persons with
disability (and other significant health
impairments), the impact of disabilities can
impact on an estimated 25% of the population.
* In the recent World Report on Disability (2011), projections were
given that over a billion people (or about 15% of the worlds
population) were estimated to be living with disability. Of this around
110 to 190 million experience significant difficulties in functioning

Young children from birth-to-three years face a wide

range of risk situations and lack of specific services
for those identified with a developmental delay or
disability. As indicated in a recent WHO publication,

mothers and poor children face multiple risk factors

during the early years of the life-cycle (as illustrated
below).13

SPECIFIC RISKS THAT CAN AFFECT CHILDREN UP TO THREE YEARS OF AGE

Stages of the Life-Cycle
Preconception
Problems/deficiencies in
maternal health and nutrition
Inadequate child spacing
Unwanted pregnancy
Parental consanguinity

Prenatal/perinatal
Maternal mortality
Perinatal asphyxia
Low birth weight
Prematurity
Perinatal complications,
infections
Congenital chromosomal
abnormalities

New-born

First years of life

Inadequate
caregiver/new-born
relationship and interactions
Neonatal infections,
complications
Developmental/ sensory
impairments

Lack of appropriate child care

Child health problems/ chronic
illness
Inadequacies in nurturing and
stimulating qualities of the
environment Iron deficiency
Lodine deficiency
Malnutrition
Micronutrient deficiencies

Across all stages of the life-cycle

Exposure to environmental toxins
Problems in caregiver physical and mental health
Deficiencies in the social and economic environment: nutrition, housing, environmental hygiene, living-wage jobs, gender equality,
caregiver education, child care, preschool opportunities, schools access to public and private goods and services, health care,
exposure to violence/war.
Source: Developmental Difficulties in Early Childhood: Prevention, early identification, assessment and intervention in low-and
middle-income countries A Review; WHO Geneva, 2012, p. 17.

In the World Report on Disability, a set of findings

were presented on the most serious barriers faced by
persons with disabilities. For young children and their
families, the situation can be even more difficult to
address. The following chart compares WHO and
World Bank findings, with a more detailed description
of what young children with disabilities and their
families often face in the region as seen in many
countries of Latin America and the Caribbean (LAC).

For young children with a disability and their families,

significant institutional and local barriers are faced,
which have a direct influence on the childs ability to
enjoy his or her rights to development, participation
and inclusion. In addition, parents of children with
disabilities are confronted with a range of challenges
that impact on their role as advocates for their
children, managers for using and coordinating
between required services (when available) and
organisers of the multiple learning environments
for their child with a disability. Even in countries
where multiple services are provided, the
time-consuming effort required by families to use
available services and to guarantee the link
between the required attitude of service providers
and their childs best interest is a major test.

WHAT ARE THE DISABLING BARRIERS? COMPARISON BETWEEN WHO AND WORLD BANK GLOBAL
FINDINGS AND SITUATION IN LAC REGION FOR YOUNG CHILDREN WITH DISABILITIES AND THEIR FAMILIES
Examples barriers
Global Report: Policy design does not always take into account the needs of people with disabilities, or existing
policies and standards are not enforced.

Inadequate policies
and standards

Negative attitudes
(or incorrect
attitudes)

Lack of provision
of services

LAC: Important advances have been made in designing policies for children with disabilities especially in education
but policy application remains limited for national coverage while specific policies and programmes for young children
and their families are scarce, coverage is limited, inter-sectoral cooperation is poor and accountability to the public is
lacking.
Global Report: Beliefs and prejudices constitute barriers when health-care workers cannot see past the disability,
teachers do not see the value in teaching children with disabilities, and family members have low expectations of their
relatives with disabilities.
LAC: For most education, health and rehabilitation staff, the tendency is still to function within a medical model
framework. The charity vision continues often reinforced by national fund-raising campaigns while parents and family
members continue to suffer different forms of exclusion. Perhaps the most damaging attitude remaining is the limited
actions by governments and cooperation agencies to address the lingering invisibility of children with disabilities
especially those who are young and face multiple exclusion factors.
Global Report: People with disabilities are particularly vulnerable to deficiencies in services such as health care,
rehabilitation, or support and assistance.
LAC: The lack of timely follow-up services (assessment and initial orientation) for young children identified with
developmental delays and disabilities is a limiting factor for advancing more holistic, family-based early intervention
services. This is combined with the limited availability of and access to inclusive ECD and primary education services.
Global Report: Issues such as poor coordination among services, inadequate staffing, staff competencies, and training
affect the quality and adequacy of services with persons with disabilities.

Problems with
service delivery

LAC: As indicated in the global report, inter-sectorial coordination between services and during the transition periods
(home to ECD to and through early primary grades) is poor. In most countries, services are concentrated in the major
cities, require transport for use, are not inclusive in nature and are weak in processes of involving and preparing parents
and other family members (especially for indigenous families).
Global Report: Resources allocated to implementing policies and plans are often inadequate. Strategy papers on
poverty reduction, for instance, may mention disability but without considering funding.

Inadequate
funding

Lack of
accessibility

LAC: Funding for ECD services is often less than required for expanding quality services. The situation for children with
disabilities is more dramatic. International funding for education has either concentrated on regular primary education
and/or focused on ECD services for the 3-6 population but not with a disability. For most countries, international
cooperation for children with disabilities and their families is project-based, but not always sustainable.
Global Report: Built environments (including public accommodations) transport systems and information are often
inaccessible. Lack of access to transport is a frequent reason for a person with a disability being discouraged from
seeking work or prevented from accessing health care. Even in countries with laws on accessibility, compliance in public
buildings is often very low. The communication needs of people with disabilities are often unmet. Information is
frequently unavailable in accessible formats, and some people with disabilities are unable to access basic information
and communication technologies.
LAC: Physical accessibility is a major issue for young children and their families living in rural areas to access services,
while ECD and school accessibility remains a challenge for advancing inclusive education, especially impacting on girls.
Accessibility to appropriate curriculum and communications continues to be a major barrier for guaranteeing learning and
participation in different settings. Indigenous families often face exclusion due to the lack of culturally appropriate services
and language barriers.
Global Report: Often people with disabilities are excluded from decision-making in matters directly affecting their lives.

Lack of consultation
and involvement

LAC: Improvement is seen in the participation of DPOs of adults, but young children remain invisible without a voice and
vote. Except for a few countries, families with children with disabilities are not consulted or involved in decision making,
adding to exclusion of those especially vulnerable young children.
Global Report: A lack of rigorous and comparable data on disability and evidence on programmes that work often
impedes understanding and action.

Lack of data
and evidence

LAC: Data on disability prevalence is absent for young children, as seen globally which continues to influence advocacy
and policy work. Documentation and evaluation of national programmes and innovative strategy development are
extremely limited, especially in regard to the long-term impact of service and inclusion interventions. Instruments,
methodologies and definitions vary significantly within and between countries.

2.3. Rights of children with

disabilities in global conventions,
frameworks and
institutional commitments

For young children with development delays and

disabilities, rights fulfilment and the construction of
stimulating and inclusive environments for
development, learning and participation depends
directly on:

UN Convention on the Rights of the Child

(CRC)

An involved and supportive family

environment, with parents, family members
and other caregivers receiving support to
acquire the required competencies and
self-confidence;

The CRC is the main framework guiding UNICEFs

work, including actions focusing on children with
developmental delays and disabilities. Two CRC
articles make reference to disability: Article 2 (the
principle of non-discrimination, which explicitly
includes disability as an issue for protection from
discrimination) and Article 23 (focused on the rights
of children with disabilities to education, health, and
rehabilitation) highlights that any special efforts
needed to secure these are first and foremost an
obligation of States Parties.14

Better understanding of and support for

culturally appropriate child rearing practices;
Integrated health services that respond to
the childs health and nutritional needs, while
preparing families for gaining improved
developmental monitoring and caregiving skills
to promote development and inclusion within
the home and community environments;

General Comments 7 and 9 of the CRC underscore a

critical point related to young children with
disabilities: that they are entitled to active
participation in all aspects of family and community
life and equal opportunities to fulfil their rights, and
should be treated with dignity at all times. Obligations
are clear: State Parties must protect children with
disabilities from discrimination and provide access to
a range of services specifically designed to help them
achieve their full potential.15

Coordinated inclusive ECD services that

strengthen the developmental and learning
process, preparing family members to support
learning in all spaces and the transitioning
process from home to ECD services to
primary and linking up with health services for
specific early detection and screening actions;
Inclusive primary education services
(especially for the first grades) that supports
the transitioning and inclusion process, is
child-focused and flexible, and encourages and
prepares families as critical partners of the
learning team;

Also important is the recognition given to the

significant role and responsibility of families and other
caregivers. Families are considered best able to
provide the supportive and caring environment
needed for children with developmental delays and
disabilities. However this responsibility is linked to
the obligation of government and NGO services to
prepare, support and empower families.

Appropriate attitudes and awareness of staff

and public as to the rights of children with
disabilities and their families, and the
important role that each can play in supporting
development, learning and participation.

Making visible young children with disabilities often

invisible in efforts to achieve rights commitments.

As noted, the extended family and community play a

key role in supporting child development, learning and
inclusion across all stages of the early life-cycle, with
the support of multiple sectors, involved at different
times and in different spaces. Other community
services like community-based rehabilitation (CBR)
assist in linking centre-based services to
home-based actions, while the media and other
communication channels can play an important role in
motivating and empowering families, promoting
positive public and service provider attitudes and
providing opportunities for children and adolescents
to share experiences and voice their views.

Experience shows that this is especially true for young

children with disabilities at an early age before school
enrolment, when their voices are not heard, and when
survey processes miss them and underestimate their
numbers.
In the same way that it is important to render children
with disabilities visible in the context of the CRC, a
generic treaty relating to children, so it was important to
render children with disabilities visible in the CRPD, a
generic treaty relating to disability. Without this explicit
focus, there was a danger of the specific realities of
children with disabilities being submerged.
Source: Using the human rights framework to promote the rights
of children with disabilities: Discussion Paper, UNICEF NY, 2013.
P.11.

10

UN Convention on the Rights of Persons

with Disabilities (CRPD)

references in the CRPD to raise their profile and

strengthen their rights.16

The CRPD, the first treaty focusing exclusively on the

rights of people with disabilities adopted by the
General Assembly, provides additional direction to
UNICEFs work for children with disabilities. As stated
in past guidelines: evidence from monitoring the
implementation of the CRC shows that in the past,
governments have not given consideration to the
rights of children with disabilities except in regard to
the provisions of Article 23, i.e. education and social
welfare. It is for this reason that UNICEF, in
coordination with the International Disability Caucus,
advocated for the inclusion of child-specific

Article 7 of the CRPD is dedicated specifically to

children. It spells out governments obligation to take
measures to ensure the enjoyment of all rights by
children with disabilities, to consider their best interest
and to ensure their right to express their views. Several
other articles address the rights of children with disability
beyond those mentioned explicitly in the CRC, such as
the right to participation, information, family life, and
freedom from violence. The CRPD reinforces and
complements the CRC by giving visibility to the rights of
children with disabilities and imposing obligations on
governments to fulfil these rights.17

SUMMARY OF MAIN CONVENTION ARTICLES DIRECTLY RELATED TO CHILDREN WITH DISABILITIES

CRC
Two articles, in particular, render children with
disabilities visible and place explicit obligations
on States to introduce measures to promote
inclusion and freedom from discrimination.
Article 2 states that no child should encounter
discrimination on the grounds of race, colour,
sex, language, religion, political or other opinion,
national, ethnic or social origin, property,
disability, birth or other status [emphasis
added]. The CRC was the first human rights treaty
to include disability as a ground for protection
from discrimination. It therefore broke new
ground, establishing the right to protection and
imposing obligations on States to take all
necessary measures to ensure protection for all
children with disabilities.
Article 23 is dedicated to children with disabilities and emphasises their right to a full and
decent life in conditions which ensure dignity,
promote self-reliance and facilitate the childs
active participation in the community. It imposes
obligations on States to provide special care and
assistance to enable the child to achieve the
fullest possible social integration and individual
development, including his or her spiritual or
cultural development.

CRPD
UN Convention on the Rights of Persons with Disabilities
Preamble:
Recognising that children with disabilities should have full enjoyment of
all human rights and fundamental freedoms on an equal basis with other
children, and recalling obligations to that end undertaken by States
Parties to the Convention on the Rights of the Child
Article 3, General Principles:
Respect for the evolving capacities of children with disabilities and
respect for the right of children with disabilities to preserve their
identities.
Article 4, General Obligations:
In the development and implementation of legislation and policies to
implement the present Convention, and in other decision-making
processes concerning issues relating to persons with disabilities, States
Parties shall closely consult with and actively involve persons with
disabilities, including children with disabilities, through their representative organisations.
Article 7, Children with Disabilities:
1. States Parties shall take all necessary measures to ensure the full
enjoyment by children with disabilities of all human rights and fundamental freedoms on an equal basis with other children.
2. In all actions concerning children with disabilities, the best interests of
the child shall be a primary consideration.
3. States Parties shall ensure that children with disabilities have the right
to express their views freely on all matters affecting them, their views
being given due weight in accordance with their age and maturity, on an
equal basis with other children, and to be provided with disability- and
age-appropriate assistance to realise that right.

Source: Using the human rights framework to promote the rights of children with disabilities: Discussion Paper An
analysis of the synergies between CRC, CRPD and CEDAW, UNICEF NY, 2013.

World Fit for Children (WFFC)

steps were made to highlight specific goals related to

disabilities in two of the Plan of Actions goals:18

Although not normally discussed at the country level,

recognition should be given to efforts made by
UNICEF, others partners and governments to include
the issue of childhood disability in the WFFC Plan of
Action goals. Governments and UNICEF committed
themselves to the 2002 World Fit for Children (WFFC)
Plan of Action. Governments affirmed they would
integrate its goals into national policies as well as
national and subnational development programmes,
poverty eradication strategies, multi-sectoral
approaches and other relevant development plans. Of
the international frameworks mentioned, important

Discrimination: () make every effort to

eliminate discrimination against children,
whether rooted in the childs or his or her
parents or legal guardians race, colour, sex,
language, religion, political or other opinion,
national, ethnic or social origin, property,
disability, birth, or other status. [emphasis
added]

11

 Equal rights of children with disabilities: () take all

measures to ensure the full and equal enjoyment of all
human rights and fundamental freedoms, including
equal access to health, education and recreational
services, by children with disabilities and children with
special needs, to ensure the recognition of their dignity,
to promote their self-reliance, and to facilitate their active
participation in the community.

However, people with disabilities are not referred to in the

MDGs, or in material developed for implementation of actions
aimed at achieving the goals. Recent discussions and attention
have acknowledged that governments and cooperation agencies
must recognise the significant links between disability, poverty
and development, and that MDGs will not be achieved if people
with disabilities, including children, are excluded.The following
chart was prepared by UNICEF headquarters in 2007 to highlight
the link between MDGs and disabilities.19

Convention on the Elimination of All Forms of

Discrimination against Women (CEDAW)

Education for All (EFA) and Salamanca Agreements

EFA represents a global commitment to ensure that all children

and adolescent receive a basic education of good quality.
Specific targets also include early education opportunities for
young children especially those most disadvantaged. However,
EFA monitoring processes indicate that limited progress has
been made for including the most excluded children especially
those with a disability. Attempts were made at two specific
moments to address this situation. In 1994 UNESCOs
Salamanca Statement and Framework for Action was signed by
92 governments.The commitment to inclusive education was
launched. In 2002 a related EFA flagship was adopted The
right to education for persons with disabilities:Towards inclusion
with the aim to promote more aggressive actions and
partnership for addressing the right of children with disability to
be included in EFA plans. Progress has been made in promoting
inclusive education in LAC countries, however only limited
advances have been made for the under-five population group
(based on the limited information available for analysis). More
recently, in the Global Partnership for Education strategic plan
(2012-2015), specific reference was made to tracking goal III
reaching every child through the use of indicators that include
monitoring disability factors.21

The CEDAW was adopted by the UN in 1979. Its main objective

is to ensure gender equality between women and men.The
CEDAW does not focus on any age-specific group; rather its
provisions apply to females at all stages of the life-cycle and it
does not make any explicit reference to disability. However, the
Committee has made two general recommendations that do
relate to the topic of disability, but do not address young children
with disabilities:
Recommendation 18: Obliges State Parties to make
reference to the situation of women with disabilities in
their country reports, with a specific reference to the
areas of education, employment and social security.
Recommendation 24: Requires commentary and
analysis on the health status of women with disabilities.

Millennium Develop ment Goals (MDGs)

The MDGs are a set of development objectives, with specific

targets aimed at addressing the needs of the poorest and most
excluded populations with a 2015 target for goal achievement.

LINKS BETWEEN DISABILITY AND SELECTED MILLENNIUM DEVELOPMENT GOALS

Unless disabled people are brought into the development mainstream, it will be impossible to cut poverty in half by 2015
or to give every girl and boy the chance to achieve a primary education by the same date - goals agreed to by more than
180 world leaders at the United Nations Millennium Summit in September 2000. (Former World Bank President James
Wolfensohn, December, 2002
MDG 1: Eradicate extreme poverty and
hunger

Disability and poverty are mutually reinforcing and disabled people and their families represent a
substantial proportion of the poor, especially the extremely poor. The World Bank estimates that
people with disabilities account for as many as one in five of the worlds poorest people.

MDG 2: Achieve universal primary

education

With less than 2 per cent of the estimated 150 million children with disabilities attending school
worldwide (UNESCO) it will be impossible to achieve this goal unless they are explicitly brought into
the equation.

MDG 3: Promote gender equality and

empower women

Women and girls with disabilities face a complex and layered experience of discrimination and
disadvantage. The target of eliminating gender inequality in all levels of education by 2015 will not be
reached without considering disability.

MDG 4: Reduce child mortality

In the developing world mortality for disabled children under five can be as high as 80 per cent. Early
detection and follow up of childhood disability has to become a routine part of under-five primary
health care if MDG 4 is to be achieved.

MDG 6: Combat HIV/AIDS, malaria & other

diseases

An international survey commissioned by the World Bank concluded that HIV/AIDS is a significant
and almost wholly unrecognised problem among disabled populations worldwide. Young people
with disabilities were found to be excluded from prevention and care services and appropriate
information on the main issues.

Source: Programme Guidelines Children with Disabilities Ending Discrimination and Promoting Participation, Development
and Inclusion; UNICEF NY, 2007, p.5.

12

3
Actors, strategies and actions for
promoting development and inclusion
of young children with disabilities
3.1. Past UNICEF strategies and
actions in LAC region and lessons
learned

Guiding principles for a

strategy of disability
prevention and rehabilitation

Globally, UNICEFs involvement during the 1980s and

early 90s was guided by an initial report prepared by
Rehabilitation International for UNICEFs Executive
Board. The guiding principles for the proposed
strategy of disability prevention, early detection and
community-based intervention (rehabilitation)
provided the foundation for UNICEFs involvement in
the field, influencing UNICEFs work in the Central
America sub-region and other countries. A review of
this framework prepared for UNICEFs response to
the International Year of Disabled Persons (1981)
contains important elements, strategies and lessons
learned that remain valid for todays efforts, despite
the important shift from the previous medical
approach to a more rights-based, social model.

UNICEFs early involvement in the

childhood disability field was based on
a set of guiding principles that in
many cases remain valid for todays
work, but with the need to shift from a
medical/rehabilitation focus, to a more
inclusive, social model.
The previous guiding principles:
1. Expanded and more effective efforts
to prevent childhood impairments are
essential. They should be, for the most
part, components of more general
programmes for the development of
health, nutrition, welfare and education.

For more than three decades, the prevention of

childhood disabilities has been integral to UNICEF
programmes; with the aim of focusing on key
outcomes of health, nutrition and water and
sanitation interventions. However, programming to
promote the rights of children with a disability, did not
receive sufficient attention during the mid-1990s and
early 2000s despite UNICEFs previous experiences
and mandate regarding the most vulnerable children
and commitments to promote CRC fulfilment. Only a
few country offices worked on disability rights in the
past, although some programme experiences
focused on such areas as: early intervention, inclusive
education; child care system reforms to reduce the
use of institutional care for children with disabilities
and assistance to landmine victims.

2. Primary attention must be given to

the preservation of the normal process
of child development to the greatest
extent possible.
3. The family is the most important
instrument for the preservation of the
normal child development process, and
its capabilities to deal with the
problems of impairment must be
strengthened and supported.
4. Community-level resources and
actions, if motivated and fed with
improved information, can provide
most of the support needed by families
to overcome the difficulties resulting
from childhood disabilities.

UNICEFs involvement in childhood disability

interventions in the region paralleled global
experiences, with active involvement in Central
America and selected Caribbean countries during the
80s and early 90s, followed by limited UNICEF
actions during the 1995 2005 programme period.

Source: Childhood disability: Its prevention

and rehabilitation, Report of Rehabilitation
International to the Executive Board of
UNICEF, UNICEF, NY E/ICEF/L. 1410, 26
March 1980.

UNICEF in Central America took an important step

towards designing and implemented programmes in
the seven countries of the sub-region, building on the
emerging UNICEF-Rehabilitation International (RI)
framework of prevention, early detection, and timely

13

family-based intervention of childhood disabilities,

along with expanding the focus to include a wider
range of advocacy, mobilisation, capacity-building and
inter-country cooperation. Global-level support from
UNICEF was based on the above-mentioned surge
within UNICEF during the early 80s, stimulated by
the 1981 International Year of Disabled Person and in
response to the clear vision and challenges
expressed in the RI policy document, as well as the
United Nations Decade of the Disabled.22
The UNICEF Central America approach for early
childhood disability interventions placed special
emphasis on:
Coordinating the activities of different
sectors to maximise effectiveness of actions
aimed at early detection and family-based
interventions;
Meaningful involvement of parents and the
broader community in the effort to improve the
lives of children with disabilities; and
Supporting advocacy work to bring the
difficulties faced by disabled children to public
attention.

A brief review of lessons learn from past experiences

can add to discussions and planning processes,
recognising that numerous strategies are still
applicable today, if adapted to a rights-based
framework. The following box provides examples of
experiences gained and progress made, combined
with the presentation of additional issues and gaps
that need to be addressed.

14

UNICEF_NYHQ2010-0063_RogerLeMoyne_Haiti

At that time, the principal aim was to increase the

integration of children with disabilities into society
not only by supporting the prevention or overcoming
of disabilities, but by better preparing society to
accept them and provide equal opportunity for their
future participation as citizens. The first signs of an
inclusive focus were emerging, but the emphasis on
integration still prevailed. However, key to the
learning process was the important lesson learned
that institutional services alone cannot possibly meet
the multiple needs and rights of children with
disabilities and promote inclusion. Parents, other
family members and the broader community must be
involved. Parents, in particular, should receive the
required information, guidance, and support at an
early stage to enable them to play a significant role in
supporting their childrens development and serve as
active advocates for their children.

3.2. Overview of a selection of

lessons learned in the LAC region

LESSONS LEARNED IN LAC AND REMAINING GAPS

Experience and progress gained

Issues/gaps

Examples specific to the topic of ECD and Disabilities

Over the past 30 years, UNICEF has gained a significant level of
experience in the disability field, especially during the 1980s and early
90s in programme areas pertaining to prevention, early detection,
family/community-based interventions for children with disabilities, and
more recently, inclusive education.

However, further advances were hindered due to a significant shift

away from supporting different aspects of childhood disability
initiatives by some governments and international agencies (from the
mid-90s through the early 2000s). Guaranteeing sustainability of
policies, efforts, and support should be a key priority for future actions.

Past experiences concentrated on early detection of and intervention

for children with developmental delays and/or disabilities, including
family support, focused on inter-sectoral work (health, education and
rehabilitation), linking with on-going growth and developmental
monitoring and community-based identification processes.

But strategies utilised to build on growth and developmental

monitoring (health), CBR (rehabilitation) and community-based ECD
(education) faced instability since these strategies tended to be
weak programming areas in national ministries impacting on the
expansion and sustainability of services (which still constitutes a
bottleneck).

Important steps have been taken by UNICEF, other cooperation

agencies and country partners in the region to promote stronger
life-cycle and transitioning approaches for most young children, with
family support and involvement.

However, limited progress has been achieved to include and address

in a more holistic manner the rights, developmental needs and
required interventions of young children with developmental delays
and/or disabilities within regional ECD initiatives or as part of
international partner priorities.

In certain countries, the promotion of specific disability initiatives has

received important support from high-level political figures (often
including First Lady support for young children and
adolescent-based initiatives).

However, this positive support is often of short duration (linked to the

political cycle), and may be lost or reduced when governments
change. This is also true for many ECD initiatives, when sustainability
is linked to political support rather than a rights-based policy position.
The main approach is usually a medical, or charity-based model.

Examples related to more global childhood disabilities issues

Based on the CRC and CEDAW, significant efforts have been made to
identify and highlight the situation of children and adolescents facing
discrimination, abuse and exclusion and promote a focus against
discrimination especially for indigenous and Afro-descendent children
and adolescents.

However, in the past, the situation of children with developmental

delays and disabilities was not included in institutional SITANs and
numerous international documents focusing on MDGs and EFA.
Children with disabilities remained invisible since programme
priorities did not refer to them or their families. In addition, strategies
and instruments were not developed to address discrimination
against children and adolescents with disabilities.

Regional priorities have been placed on efforts to identify and address

multiple risks and rights abuses faced by the significant number of
indigenous and Afro-descendent children and adolescents in LAC
countries.

But disabilities and their impact were not included as one of the
additional, or multiple factors of exclusion and discrimination facing
these same indigenous and Afro-descent children - especially in
relation to girls with a disability. In addition, cooperation actions
focusing on the prevention of and response to violence against
adolescents do not include elements related to disabilities.

UNICEF in LAC has placed significant priority on achieving primary

education for all, with increased efforts to reach and include children
and adolescents excluded from school-based services. This is
combined with a gradual increase in implementation of other
community-based learning opportunities.

But few countries have supported large-scale expansion of inclusive

education (IE) for children with disabilities, and limited emphasis on
using community sport, recreation and cultural actions as a space for
inclusion, participation and additional learning opportunities for children
and adolescents with disabilities.

An increase has been seen in the participation of DPOs (representing

adults with disabilities) in the promotion and monitoring of CRPD
initiatives.

Yet the participation and voice of children with disabilities are missing,
with some advances in the participation of parents/families with
children with disabilities as advocates or spokespersons.

Increased participation by DPOs and organisations of families with

children with disabilities in multiple advocacy, planning and service
implementation roles is taking place.

But the increased involvement of these organisations in service

provision - through the use of government funds - creates a complex
situation in regard to maintaining their autonomy to monitor and
demand government commitments to the CRPD when abuses or
limitations are uncovered.

Source: G. Lumpkin, Legal Frameworks, Policies, Programmes and Practices for Children and Adolescents with Disabilities in the Latin
American and Caribbean Region An Overview of the Regional Situation and Ideas for Action, UNICEF LACRO, Panama, 2013, p. 82.

15

3.3. Existing and emerging priorities

on global and regional levels

SUMMARY OF GUIDING POINTS:

RECOMMENDATIONS FOR MOVING FORWARD
World Report on Disability (WHO and World Bank)24

Global Priorities: With the adoption of the CRPD and

based on reviews of existing gaps in EFA and MDG
achievement, UNICEF and other UN agencies have
become increasingly aware of the rights and
development issues faced by the majority of persons
with disabilities. Young children with disabilities and
their families are often the most neglected and
excluded.

Enable access to all mainstream policies, systems and

services
Invest in specific programmes and services for people
with disabilities
Adopt a national disability strategy and plan of action
Involve people with disabilities
Improve human resource capacity
Provide adequate funding and improve affordability
Increase public awareness and understanding of disability
Improve disability data collection
Strengthen and support research on disability

Recognition is now given to the need to mobilise and

support all parties to develop inclusive ECD
programmes and strategies included as integral parts
of health, education and social service systems.
Coordinated and sustainable responses are required
from a range of stakeholders at all levels to ensure
that the rights and needs of young children with
disabilities and their families are met. Critical are
family members, other caregivers and those service
providers who deal directly with young children to
meet their health, education, protection and other
needs. Essential are those who contribute to the
development, implementation and monitoring of
policies, budgets and services (e.g. governments,
NGOs, professional organisations, media, private
sector, and parent and disability advocacy
organisations).

Source: WHO & World Bank, (2011) World Report on

Disability, WHO Geneva, pp. 263-267

State of the Worlds Children (SOWC) - Children

with Disabilities25 (UNICEF)
Ratify and Implement the Conventions
Fight discrimination against children with disabilities
Dismantle barriers to inclusion
End institutionalisation
Support families
Move beyond minimum standards
Coordinate services to support children
Involve children with disabilities in making decisions
Global promise, local test (children with disabilities
included in all development programmes).
Source: The State of the Worlds Children 2013 Children
with Disabilities, UNICEF NY, 2013 pp. 75-85

UNICEFs new Strategic Plan (2014-2017) aimed at

advancing the rights of every child, especially the
most disadvantaged23 includes a sharper equity
focus that addresses rights abuses of children and
adolescent with disabilities. Within this framework,
special attention to the youngest children with
developmental delays and/or disabilities and their
families will be essential, requiring the mainstreaming
of disability components within the key outcome
areas of the UNICEF Strategic Plan.

MAIN AREAS OF ACTION FOCUSING ON EARLY

CHILDHOOD DEVELOPMENT AND DISABILITIES26
Inclusion of children with disabilities in mainstream
policies, systems and services which support and
maximise their development potential.
Programmes and services which specifically target young
children with disabilities and their families
Involvement of children with disabilities and their families
in all early childhood development activities including
policy development, service design and programme
monitoring.
Capacity development of human resources across relevant
sectors to address disability.
Public awareness and understanding about children with
disabilities.
Data collection and research.

Recent WHO, World Bank and UNICEF publications on

global disabilities issues provide a set of
recommendations and potential priorities for
cooperation agencies and countries to guide global
and country-level disability efforts in line with the
CRPD: Based on the guidance provided in the World
Bank-WHO World Report on Disabilities, more
specific areas for action were recommended in the
WHO-UNICEF publication, in relation to a focus on
young children with disabilities and the promotion of
related ECD interventions. The following actions were
proposed for further consideration and discussion in
planning efforts (with more specific details in the
above-mentioned document):

Source: Early Childhood Development and Disability: A

discussion paper, UNICEF NY and WHO Geneva, 2012, pp.
32-33.

16

4
Areas of
support for the
development
and inclusion of
young children
with disabilities

Regional Priorities: In the LAC region, the emerging

priorities for actions directed towards young children
with disabilities are linked to those main programme
areas already identified in the region. Education has
been and remains a priority for LAC countries, with a
strong emphasis linked to promising Out-of-School
Children (OOSC) initiatives. Numerous countries have
gained experiences in the application of the CFS
model (or similar strategies), with some countries
initiating support for more inclusive education
strategies.
Support for ECD efforts continues to be a major
priority area. Some countries have begun to discuss
the development of strategies for young children with
developmental delays and disabilities, while others
(on a limited basis) are providing programme
assistance for interventions related to early detection
and family-based. More recently, building on
utilisation of the Care for Child Development (C4CD)
intervention package has provided a potential
opportunity for more specific mainstreaming of
disability components within an established UNICEF
ECD priority initiative, focusing on improving
parenting competencies for the most disadvantaged
families and young children.

4.1. Strengthening policies and

interventions across the early
life-cycle and for transition periods
During the early years of the life-cycle, children with
developmental delays and/or disabilities and their
families require the same services and supportive
environments as all children and families, with the
provision of additional assistance based on their
specific situation. This twin-track approach recognises
that these children must have access to mainstream
health, ECD and education services required for all
children along with more specific services of early
intervention, inclusive early education and
family-based support. The involvement of all sectors
and services in a coordinated manner is essential
to provide systematic and holistic support at all
stages of the life-cycle. No one sector is able to
respond to all rights and needs of the child and family,
in addition to assisting in the promotion of more
inclusive home, community and service
environments for the child with specific
developmental and/or health needs.

CRPD ratification by most Latin American countries,

including a growing number of English-speaking
Caribbean countries, has stimulated more interest
within UNICEF COs to address childhood disability
issues. Combined with the important launch of the
UNICEF State of the Worlds Children Report on
Childhood Disabilities, this has led to more emphasis
being placed on reviewing the situation of children
with disabilities and corresponding policy
development at both the country and regional levels.

The organisation of an essential package of services

and supports that fulfil the rights and requirements of
young children with development delays and
disabilities, and their families, needs to recognise and
respond to the unique characteristics of each stage of
the life-cycle and the specific characteristics of each
child and family. In addition to the implementation of
targeted prevention-related interventions in health
and social sectors, a comprehensive approach
requires a connected and continuous provision of
early detection, assessment, family-based early
intervention, inclusive ECD and early primary
education services elements that benefit all children
at some point in time. These specific interventions
should form part of existing health, ECD and
education services: IMCI, growth and developmental
monitoring, care for child development interventions,
ECD and transitioning to and through the first grades
of primary.

17

family-focused communication mechanisms

(like use of a child passport) are providing
public and family education and
awareness-building efforts to assist families
and community members to identify
potential risks, delays and/or disabilities
within the home and community
environment.

This document stresses that to achieve inclusion; the

appropriate provision of these services requires an
inter-sectoral approach that builds on national policies
and capacity-building efforts while supporting local,
integrated initiatives in specific territories
(municipality, district, etc.) where systematic
coordination is feasible and required. And, based on
experiences gained in Central America and other
countries, it also stresses the important role of
parents, other extended family members and the
broader community, in addition to institutional
services. Community-based rehabilitation and/or early
childhood intervention (ECI) strategies can serve as
an important bridge between government and NGO
centre-based health and education services and
families with children with disabilities.

Considerations: Decisions to undertake identification

and screening processes should take into account the
availability of follow-up services and resources to
provide timely support and intervention planning.
However, caution should be exercised against
accepting inactivity based on the assumption that
ideal services are not fully in place. Steps should be
made to design tracking and appropriate follow-up
systems that ensure family and child support. Often,
mainstreaming actions within local integrated ECD
initiatives (in specific or defined territories) provide a
sound foundation for scaling-up initiatives.

The following are brief descriptions of what are

considered to be the key components of a holistic
(essential) package of services, of which an
increasing number are underway in the LAC region
(with significant differences of related policy
development and implementation between
countries).

Assessment

The early detection process undertaken in multiple

health, ECD and/or education settings is the initial
step to guarantee that developmental delays and/or a
disability are identified as early as possible, thus
providing children with timely and appropriate
interventions with family involvement. But to ensure
that the follow-up intervention plan responds to the
childs unique or individual needs and the specific
family/community context, a more in-depth
assessment and follow-up process is required to
better understand and anticipate what is most
appropriate for the child with a disability. The
undertaking of the assessment process should be
completed as close to the detection stage as
possible, in order to eliminate or reduce unnecessary
parent or extended family stress, frustration and/or
inactivity.

Early identification of risks, developmental

delays and/or disabilities (all areas of
screening)

With varying degrees of development, a wide range

of early identification processes have been applied In
the region through either systematic procedures
and/or sporadic actions (with different levels of
implementation within and between countries). Using
a life-cycle framework, early identification processes
have included:
Newborn screening for specific metabolic
and genetic disorders
Newborn hearing screening
Growth and developmental monitoring for
young children in health services
Developmental screening for specific delays
and/or disabilities
Hearing and visual screening procedures in
ECD and primary school services;
Developmental monitoring in nutrition and/or
ECD centres
Entrance testing for transitioning between
preschool and primary services
In addition to clinic or ECD centre-based
services, additional early identification
procedures are often undertaken through
disability surveys (including all ages) and
community-level identification processes
through CBR programmes
Increased use of media and other

For most LMIC countries and those in LAC,

institutional capacities to undertake timely or
systematic assessment by highly trained assessment
teams throughout the country is often not possible.
However, experiences have provided functional
alternatives to address limited coverage of local
assessment teams. Some of the following strategies
have been utilised and could be considered as viable
alternatives: (1) organise national or regional mobile
assessment units to support local actions (in health
and ECD services, or through CBR actions) through
the scheduling of systematic assessment visits; (2)
utilise centralised assessment services (normally in
main urban areas or capitals), combined with
preparing local staff for follow-up actions; and/or (3)
combination of both approaches. The more traditional

18

years. In past decades a wide range of operational

materials were developed for designing individual
intervention plans. In the region, specific countries
have prepared national-based orientation guides, in
addition to utilising and/or adapting screening,
developmental monitoring, and early intervention
materials prepared in high-income countries (eg.
Portage Project, Ages and Stages and others).
In all countries, parents and other family member are
key partners throughout all stages of the early
detection, assessment and intervention process, and
may require initial and on-going orientation on how to
best address the rights and needs of their young
children. Health, ECD and education staff can provide
that guidance, but additional support initiatives should
be considered and organised to strengthen family
involvement and self-esteem. Stimulating more
parent-to-parent (family-to-family) support, especially
during the early adjustment stages has produced
important results for improving child/parent
interactions, along with strengthening parents
involvement as advocates. The timing of this
multi-stage parent and family guidance process is
critical to avoid the risk and impact of labelling of
children at the early identification and assessment
stages. All efforts must be made to address the
potential for fear, frustration, stress and low
expectations on the part of parents and family
members, which can result in the denial of and/or
delay in use of needed services. Steps are also
required to avoid or mitigate intra-family conflicts and
violence.

use of centralised assessment services in larger

cities is less appropriate for promoting more inclusive
actions, considering that families often are faced with
overwhelming burdens to cover travel and lodging
costs. This is combined with the difficulties faced by
national (urban-based) assessment teams in
understanding local cultural and environmental
conditions for better analysing results and preparing
appropriate intervention and inclusion plans. With the
emerging ICT alternatives, more emphasis should be
place on the use of these tools to strengthen
systematic support and communications between
central and local teams, at lower costs.

Early childhood intervention (ECI)

Undertaking early detection and assessment actions

heightens requirements for a significant effort to
develop family-focused, early intervention and
support mechanisms to follow-up and respond to
developmental delays and/or disabilities identified. As
described by international experts in the ECD field,
early intervention systems are critical services aimed
at strengthening family competencies and
involvement in their childs development process,
along with providing other required health,
rehabilitation and early education services. The
following definitions, cited in a 2009 UNICEF study,
help to clarify what is considered to be the main
focus and potential of early intervention services: 27
Early intervention is a system designed to support
family patterns of interaction that best promote child
development.

Examples: Application of Portage and Ages and

Stages in the region

Early childhood intervention consists of

multidisciplinary services provided to children from
birth to 5 years of age to promote child health and
well-being, enhance emerging competencies,
minimise development delays, remediate existing or
emerging disabilities, prevent functional deterioration,
and promote adaptive parenting and overall family
functioning. These goals are accomplished by
providing individualised developmental, educational
and therapeutic services for children in conjunction
with mutually planned support for their families.

The Portage Guide provides information for

guiding parents on how to promote the
development of young children with
developmental delays and has been used in over
60 countries. The New Portage Guide includes
assessment and planning materials to support
home visits and centre-based programmes,
targeting such services as childcare, preschool,
early childhood special education, and inclusion
in classrooms. Programmes focus on children
from birth to six years. In the LAC Region during
past decades, The Portage Project has been used
in early intervention and community-based
rehabilitation initiatives in numerous countries,
with more extensive use in Jamaica, Nicaragua,
and Dominican Republic. More recently, the
Government of Jamaica, in partnership with
UNICEF and the Early Intervention Programme
at the University of Oregon, is developing an
effective screening system at different levels,
including the use of the Ages and Stages
Questionnaire, as a screening tool completed by
parents or caregivers that can identify children
at-risk for developmental delays.

Early intervention services vary from

country-to-country, including differences in age
coverage, sector involvement (and leadership) and
geographic extension. In general, age coverage
includes actions starting after birth and continuing to
the initial primary grades. Strategies can include a
combination of centre- and home-based services, but
in almost all ECI cases, services focus on
family-based supports and competency building
recognising their key role in supporting development
and promoting inclusion during the most critical early

19

Although still limited, efforts are now underway to

implement inclusive pre-school strategies (often as
pilots), based on results of more intense application
and extension of inclusive primary schooling experiences. These inclusive services offer children with
disabilities with a vital space to ensure optimal
development by providing opportunities for: child-focused (flexible) learning schemes, quality play experiences as an important learning process, active
participation, peer interactions (between young
children with and without disabilities) and the development of friendships.
Article 24 of the CRPD stipulates that children with
disabilities should not be excluded from the general
education system on the basis of disability and
should have access to inclusive, quality and free
primary and secondary education on an equal basis
with others in the community in which they live.28
However, experience reveals two tendencies that
need to be addressed: (1) in most LAC countries,

children with disabilities often wait until the legal age

to enter primary school and/or special education
services which is too late. Children with developmental delays and disabilities should be identified
early as a priority group for access to inclusive ECD,
pre-school and early primary schooling to ensure
optimal development; and (2) despite advances in
certain countries to increase preschool coverage and
services for young children with disabilities, steps to
improve family competencies and involvement in
centre- and home-based support services continue to
be limited, especially in rural and indigenous areas.

Early childhood inclusion embodies the

values, policies, and practices that support
the right of very infant and young child and
his or her family, regardless of ability, to
participate in a broad range of activities
and contexts as full members of families,
communities, and society. The desired
results of inclusive experiences for children
with and without disabilities and their
families include a sense of belonging and
membership, positive social relationships
and friendships, and development and
learning to reach their full potential. The
defining features of inclusion that can be
used to identify high quality early childhood
programs and services are access,
participation, and supports.
Early Childhood Inclusion: A Joint Position Statement
of the Division for Early Childhood (DEC) and the
National Association for the Education of Young
Children (NAEYC), officially approved by both
organisations,2009.

UNICEF_NYHQ2012-1923_Dormino

Inclusion in ECD services and first grades of primary

The expansion of home- and centre-based ECD
services is increasing at a significant rate, including
health, education and social protection sectors.
Research and global advocacy efforts have increased
political and policy awareness of the importance of
investing in the early years and have mobilised
noteworthy efforts to increase coverage for the
birth-to-eight population especially for those most
vulnerable and disadvantaged. The importance of
family involvement and empowerment has also
gained more visibility. In the region, advances have
been made to increase ECD and early education
services for the three-to-eight age group, with
substantial coverage for children about to enter
primary school.

DEFINING FEATURES OF INCLUSION AND RECOMMENDATIONS TO SHAPE POLICIES

AND PRACTICES/STRATEGIES (ADAPTED FROM DEC AND NAEYC POLICY STATEMENT DOCUMENT)
Defining features of inclusion
that are considered to be essential
to guarantee quality ECD programmes.
Access: means providing a wide range of activities
and environments for every child by removing
physical barriers and offering multiple ways to
promote learning and development. (NAEYC)
For the LAC region, consideration should be given to
all forms of accessibility: architectural,
communications, methodological, instrumental,
programmatic and attitudinal. (LAC)

Recommendations for use of focus to shape practices and

influence policies related to inclusion:
Create high expectations for every child, regardless of ability, to reach his or her
full potential. (NAEYC)
This includes expectations of family members, along with health, ECD and
education staff and those closest to the child in the surrounding community
environment. (LAC)
Develop a programme philosophy on inclusion to ensure shared assumptions
and beliefs about inclusion, and to identify quality inclusive practices. (NAEYC)
This effort should not be restricted to educational programmes, but should
include all forms of ECD services (health, education, social and others) and the
family/home environment.(LAC)

Participation: means using a range of instructional

approaches to promote engagement in play and
learning activities, and a sense of belonging for every
child. (NAEYC)

Establish a system of services and supports that reflects the needs of children
with varying types of disabilities and learning characteristics, with inclusion as
the driving principle and foundation for all of these services and supports.
(NAEYC)

In line with UNICEFs emphasis on strengthening the

home environment and parenting competencies, a
focus on improved participation, learning activities
and belonging will also be prioritised within the family
environment not just in ECD and education
services.(LAC)

As mentioned, the strengthening of services and supports should include a

sound commitment to improving the quality and inclusiveness of centre-based
services, along with prioritising families and the home environment. (LAC)
Revise programme and professional standards to incorporate key dimensions of
high quality inclusion. (NAEYC)
In addition to the emerging efforts to prepare programme and staff standards in
the education field, more innovative efforts are required to incorporate the key
dimensions of inclusion within health, CBR, ECD and other social protection
areas. (LAC)

Supports: refer to broader aspects of the systems

such as professional development, incentives for
inclusion, and opportunities for communication and
collaboration among families and professionals to
assure high quality inclusion. (NAEYC)

Improve professional development across all sectors of the early childhood field
by determining the following: who would benefit from professional development
on inclusion; what practitioners need to know and be able to do in inclusive
settings; and what methods are needed to facilitate learning opportunities
related to inclusion. (NAEYC)
As previously mentioned, this effort should include all key sectors and partners
(health, education, rehabilitation, social protection, and other ECD service
providers), not just the traditional focus on education. (LAC)

Monitoring of progress to achieve these efforts and

results should be a key element of CRPD and CRC
evaluation actions, with parent/family involvement.
(LAC)

Revise national and local accountability systems, including all key sectors, to
reflect both the need to increase the number of children with disabilities
involved in home and centre-based inclusive programmes as well as to improve
the quality and outcomes of inclusion. (adapted for LAC from original focus for
the USA)

Source: Adapted from Early Childhood Inclusion: A Joint Position Statement of the Division for Early Childhood (DEC) and the National
Association for the Education of Young Children (NAEYC), officially approved by both organisations,2009.

Inclusive health and education services have a critical role to play in building
a solid foundation in which children with disabilities can build fulfilling lives
UNICEF, The State of the Worlds Children 2013, Executive Summary, New York, 2013

21

The importance given to ECD and inclusion initiatives

is not restricted to developing countries. This position
was also re-emphasised in the United States, as
highlighted in the 2009 joint position statement by
the Division for Early Childhood and the National
Association for the Education of Young Children.29
Although this effort was targeted to renewing actions
within the U.S., NAEYC has maintained contact with
some LAC countries and provided assistance in areas
related to policy, centre accreditation and training.
Elements of NAEYCs policy statement and definition
could be used in the region to guide policy
development and support advocating for
corresponding practices/strategies related to Early
Childhood Inclusion.

School Readiness
UNICEFs efforts to link school
readiness and transitioning to the
promotion and implementation of
child-friendly schools offer an excellent
opportunity for expanding inclusive
ECD actions linked with emerging
inclusive primary education initiatives.
As an integral part of strengthening the
three dimensions of school readiness,
as illustrated, addressing attitude
change and expectations of staff,
parents/family members, and students
(peers) towards children with a
disability are required. In addition,
accessibility and communication issues
may require specific attention to
guarantee full participation, while
strengthening parent/family
involvement in both school and home
learning is essential, for children with
and without a disability as already
highlighted.

Cross-cutting Issues for consideration and

discussion

Transitioning and readiness: Increased attention

has been given to the design of transitioning and
readiness strategies for children entering primary
school, from home settings and/or ECD (pre-school)
services. UNICEF, the Bernard Van Leer Foundation
and the ECD Consultative Group on Early Childhood
Care and Development have provided timely insights
and observations on this topic all emphasising the
importance of readiness for entering and succeeding
in early primary and highlighting the important
involvement of key actors influencing success: child,
family and school (including both staff and
environment). However, more discussion is required
to analyse all stages of the transition process (across
the early life-cycle) and what is required to strengthen
the development and inclusion process for children
with disabilities beyond the more traditional
approach to building readiness.

Transition: How are schools making provisions

for admitting new children into the system and
creating environments, representing individual
and social diversity?

READY
CHILDREN

Community-level support: CBR

An Important Strategy for supporting ECI and
inclusion. In 2004 the ILO, UNESCO and WHO
prepared a Community-Based Rehabilitation (CBR)
Joint Position Paper based on recommendations of a
multi-agency CBR review meeting in Helsinki,
reflecting the significant change of the CBR approach
from a service delivery model for rehabilitation to an
inclusive community development focus. It redefines
CBR as: a strategy within general community
development for the rehabilitation, poverty reduction,
equalisation of opportunities and social inclusion of all
people with disabilities and promotes the
implementation of CBR programmes through the
combined efforts of people with disabilities
themselves, their families, organisations and
communities, and the relevant governmental and
non-governmental health, education, vocational,
social and other services.30

SCHOOL
READINESS
READY
SCHOOL

READY
PARENTS

Transition: How are children able to adjust to

learning environments? How are families able to
work with school system?

Source: School Readiness and Transitions A

Companion to the Child-Friendly Schools Manual,
UNICEF, NY, 2012.

22

local communities to identify the most invisible

children; strengthening family and community
competencies to undertake early intervention
processes for their children with disabilities and
create a supportive environment for the first stages
of inclusion; and supporting the childs learning
process by reinforcing the home setting and
centre-based educational opportunities. The design
and implementation of a CBR strategy at local and
national levels should not be undertaken as a
separate or conflicting approach to existing health,
education and rehabilitation systems. As described,
actions should complement and strengthen sector
actions at the local l evel, with the clear goal of
promoting inclusion, participation and CPRD rights
fulfilment.

The new structure and the organisation of the

seven-booklet WHO CBR guidelines (as illustrated in
the CBR Matrix) and content design reflect this
profound evolution, from a traditional rehabilitation
approach to a more social or bio-pyscho-social model.
31
The booklet content covers a range of areas critical
for guaranteeing the rights and inclusion of persons
with disabilities, including such key topics as: health,
education, livelihood, social and empowerment. In
addition, the booklets provide sector programmes
and service providers with the required information
and guidance to support a Twin-Track approach, which
responds to what is recommended by donor and
cooperation agencies. For UNICEF, components
focusing on the multiple aspects of early childhood
development are cross-cutting; i.e., not restricted to
one sector programme or area.
Through the CBR approach, important advances can
be made to work across all stages of the life-cycle,
including: expanding early detection processes in

CBR MATRIX

Health

Education

Livelihood

Social

Empowerment

Promotion

Early
Childhood

Skills
Development

Personal
Assistance

Advocacy &
Communications

Prevention

Primary

SelfEmployment

Relationship
Marriage &
Family

Community
Mobilization

Media Care

Secondary
& Higher

Wage
Employment

Culture &
Arts

Political
Participation

Rehabilitation

Non-Formal

Financial
Services

Recreation
Leisure &
Sports

Self-Help
Groups

Assistive
Devices

Lifelong
Learning

Social
Protection

Justice

Disabled
Peoples
Organizations

CBR: what is it?

CBR is a multi-sectorial, bottom-up strategy which can ensure that the Convention makes a
difference at the community level. While the Convention provides the philosophy and policy,
CBR is a practical strategy for implementation. CBR activities are designed to meet the basic
needs of people with disabilities, reduce poverty, and enable access to health, education,
livelihood and social opportunities all these activities fulfill the aims of the Convention. CBR
programmes provide a link between people with disabilities and development initiatives. The
CBR guidelines target the key sectors of development that need to become inclusive so that
people with disabilities and their families become empowered, contributing to an inclusive
society or society for all. As community involvement is an essential element of development,
the guidelines strongly emphasise the need for CBR programmes to move towards
involvement of the community.
Source: Introductory module CBR, WHO, p.27.

UNICEF Belize

23

4.2. Preparing key environments

and components for inclusion

Multiple environmental and attitudinal barriers

exist to inclusion and increased participation,
including, for example:32

The process of inclusion of young children with

disabilities in all spaces and services focusing on
health, development and learning is a complex and
on-going process, requiring actions beyond the more
recognised topic of school-based inclusive education.
Related ECD research has increasingly recognised
the importance of the family and other key caregivers
in addressing the multiple aspects of ECD and
inclusion. Important changes are underway, with the
promotion of a rights-based approach to disability. A
shift from a medical model of disability, which
focuses on the childs limitations, to a social model
that recognises that barriers within society prevent
the child from developing to his or her potential,
highlight the importance of reviewing the role and
responsibility of all key actors to address barriers and
promote inclusion.

IN GENERAL
Prevailing negative attitudes and preconceptions, leading
to underestimation;
The policies, practices and procedures of local and national
government that fail to promote inclusion;
The inadequate structure of health, welfare and education
systems;
Lack of access to buildings, transport and to the whole
range of community resources and information available to
the rest of the population, in addition to elements of
access;
The impact of poverty and deprivation on the community
as a whole and more specifically on persons with
disabilities and their families.

MORE SPECIFIC TO ECD AND EDUCATION

Low priority for children with disabilities among decision makers;
Lack of community awareness and support
Reluctance to admit children with severe and complex disabilities;
Inaccessible buildings and curricula that are not adapted to the
special needs of children with disabilities;
Shortage and/or lack of appropriate training for teachers at all level
Lack of support from special schools where these exist;
Lack of target funding.

As young children progress through the first years of

the life-cycle, their development, protection and
inclusion are influenced by what happens in their
home/family environment and the quality of
relationships, as well as by the sensitivity and
responsiveness they and their families receive from
health, ECD, education and social protection services.
In all cases, attitudes towards disabilities on the part
of family members, service providers and the
community in general can play a significant role in
promoting positive expectations. This combines with
the quality and inclusiveness of services, which is
influenced by national policies, institutional and staff
capacities, material support and the sustainability of
assistance. UNICEF and others can use existing
institutional experiences and capacities to promote
inclusive policies and strategies, along with assisting
efforts to increasing public awareness and positive
attitudes. Below are brief highlights for some of the
key focus areas requiring attention for the promotion
of inclusion.

Source: Promoting the Rights of Children with Disabilities,

Innocenti Digest No. 13, UNICEF Innocenti Research
Centre, Florence. UNICEF, 2007 pp. 5 and 17.

In addition, parents and other caregivers are required

to manage and advocate for essential health, early
intervention, ECD and education services for their
children. Without the timely and systematic provision
of these services, children with disabilities are at risk
for not achieving optimal development and face rights
abuses and exclusion.

Focus on services for young children

Although all services impacting on children and their

families should be targeted, significant efforts should
be addressed to promoting inclusive health and
education services across all life-cycle stages and
with family involvement. CRC and CRPD
commitments highlight the rights of all children to the
highest attainable standard of health and quality
inclusive education, to reach their full potential.
However, the provision of inclusive early detection
and family-based intervention services for children
with disabilities is usually extremely limited (often not
supported by international cooperation) and coverage
of inclusive ECD programmes is significantly less
than that of primary-level IE initiatives.

Focus on families (a key priority)

Families play a crucial role in all aspects related to

promotion of child development, rights fulfilment and
inclusion. To undertake these multiple tasks, all family
members require timely assistance, relevant
information, appropriate training and, in many cases,
emotional support. The relationship between
parent/family members and health/ECD staff is critical
to guarantee the appropriate early intervention
activities and to promote inclusion, which requires
the mutual development of trust and responsiveness.
The first stage of inclusion begins in the home
environment, where positive parent/family child
interaction, relationships and stimulation are critical.

24

Focus on policies and instruments:

Over the course of the recent decade, numerous

countries have advanced in designing ECD policies
for young children, including multiple sector services
and involvement. This emerging effort, along with
CRPD promotion and monitoring, offers important
opportunities to advocate for and support the
incorporation of specific inclusive ECD elements as
part of related planning processes. UNICEF can play a
critical advocacy and technical support role for
promoting inclusion. In addition, preparation and
application of related instruments as supported by
UNESCO in the region - can serve as important
advocacy, training and monitoring tools for advancing
inclusion.

certain LAC countries. Through international

cooperation, this material prepared by the Centre for
Studies on Inclusive Education (CSIE)/UK - has been
validated and/or modified for local use in the region.
Now available in Spanish, this resource aims to
support the development of a wide range of inclusive
early childcare and development settings: nurseries,
playgroups, parent and childrens centres, crches,
homecare, clubs and play schemes. Of importance to
this process is the multi-dimensionality of this
material, which promotes: creating a culture of
inclusion; producing inclusive policies; and developing
inclusive practices.

The application of the Index for Inclusion (which

includes instruments for both primary/secondary and
early learning services) has emerged as a priority for

THE THREE DIMENSIONS OF THE INDEX FOR INCLUSION (CSIE)

po
ive
lus
nc
gi
cin
du

Creating inclusive cultures

UNICEFUNI144425Pirozzi

Pro

Mobilising resources

ce

Orchestrating play
and learning

cti

DIMENSION C: Evolving inclusive practices

pra

Organizing support for

diversity

THE
PLANNING
FRAMEWORK

ive

Developing the setting

for all

lus

DIMENSION A: Producing inclusive policies

inc

Establishing inclusive
values

ing

Building a community

lic

DIMENSION A: Creating inclusive cultures

olv
Ev

ies

THE PLANNING FRAMEWORK

Focus on Monitoring and Evaluation

Focus on Communication

Monitoring and evaluation of health and education

initiatives continue to focus mainly on service
coverage (numbers), without entering into more
in-depth monitoring procedures related to the shortand long-term impacts of interventions on the life of
children with disabilities and the level of inclusion
achieved. The lack of reliable prevalence data and the
absence of baseline information for most areas
related to programme and Convention goals hinder
more in-depth initiatives to evaluate the impact of
efforts. UNICEF can play an important role in
advancing M&E experiences at sub-national levels, as
part of more integrated approaches in selected
territories. The use of sentinel sites or building on
such innovative municipal-level monitoring
experiences as Brazils Selo Municipal, targeting a
range of child-related rights issues can provide
feasible alternatives for the disability field.

Communication plays a key role in promoting attitudinal

changes in the main environments that influence the lives
and learning of all children: home, ECD, health, school, and
other community settings. As stated by Barbara Kolucki, a
communication expert for ECD and disabilities: no matter
how inclusive are our schools if attitudes are not
addressed their presence can fulfil a right but still not
help with their integration and contribution to civil society.33
Communication is critical to strengthening outreach
activities to create more supportive and inclusive
environments. Experiences documented by Kolucki clearly
demonstrate that communication can play an important role
in reducing existing prejudice while promoting
self-confidence among children with disabilities. A
2001-2002 public education campaign in Maldives on ECD,
with specific disability components, demonstrated the
significant impact of a year-long radio and television
campaign.
An article on the World Bank Disability and Development
website highlights six reasons why the topic of disability
should be included in daily communication efforts; four
relate directly to actions aimed at strengthening community
awareness: (1) to reduce fear about disability and increase
familiarity with its issues; (2) to reduce and fight blame and
shame; (3) to reinforce- disability as just a normal part of
diversity; and (4) to place disability concerns within the realm
of civil society.35

A Monitoring Strategy to
consider; UNICEF Seal of
Municipal Approval, Brazil
The UNICEF Seal of Municipal Approval launched in the State of Ceara (Brazil) in 1999 offers an innovative and proven strategy to
develop a multi-year local (municipal) - level
monitoring of and mobilisation system for
achievement of child and adolescent nights based on the identification of a related set of
indicators, linked to rights obligations and
national/local priorities. Commitments of local
governments are monitored and results
disseminated to the public - timed to take place
during the local (municipal) election process.

ECD and Disability Campaign in

Maldives - Results
A 2001-2002 public education campaign in Maldives
on ECD, with specific disability components,
demonstrated the significant impact of a year-long
radio and television campaign.The evaluation stated:
In a significant achievement, the campaign created
awareness for children with special needs.The focus
on children with Down Syndrome helped many
(disabled) children and their families. Social
acceptance of mentally and physically challenged
children improved, and even child-to-child
interactions became increasingly positive following
the campaign. Parents with mentally challenged
children felt they needed more specialized help in
dealing with their children. Special children must be
included in play like other children, and schools
should be sensitized in dealing with them.

Over the years, a strong focus has been given to

key health, ECD and education areas - expressed
priorities for both local governments and UNICEF.
From 2009 to 2012, specific attention was
focused on identifying and tracking children with
disabilities who were not enrolled in school along with monitoring other education
indicators. One specific indicator has been
inclided to calculate the percentage of children
with disabilities receiving BPC support, and
whether they are enrolled in school.This effort
represents a concrete measure to mainstrem
disability rights issues within existing
programme areas.

Source: Barbara Kolucki, High Praise for DisabilityInclusive Early Childhood Campaign in Maldives
Disability World, No. 26 (Dec.2004-Feb.2005),
<www.disabilityworld.org/12-02_05/
children/maldives.shtml>.

Source: UNICEF Brazil

26

4.3. Increasing support for

strengthening family and other
caregiver competencies

Linking ECD, CBR and Inclusive

Education (Nicaragua)

Parents and other family members play a critical role in

the survival, development, protection and inclusion of
their children. During the early years, the quality of parent
(caregiver)-child response and interaction has a significant
impact on the development, learning, self-esteem and
participation of all young children, especially those with
developmental delays and/or disability. In addition to their
role of guaranteeing a stimulating and supportive home
environment, parents (with support of other family
members) are required to advocate for their childs rights
and oversee the use of available services.

Nasareth Montiel Marin was born in Nicaragua

in 2005, with many health complications. After
five days in the hospital of the small city of
Juigalpa, her mother was informed by the
nurse that her baby was affected by Down
Syndrome. She was also told about the
consequences this would have for her life and
family: special care, frequent medical checks,
health problems which might need special
attention, special education, etc.. After their
initial shock the parents dedicated all their
energy to caring for their child.

The timing and quality of orientation and support is

essential especially in the early moments after
detection to provide parents and family members with
the required emotional support, understanding and
guidance for promoting a good start in life and with
positive parent-child interactions. The familys response to
having a child with a disability depends on a number of
factors cultural norms, attitudes and practices, family
resources and support available to the child and family.
Guidance and service provision also need to address
potential conflict between what are viewed as the needs
of the family and the needs or best interests of the child.
How to respond to both requires appropriate policy
responses and prepared staff.

After three months they learned of the Early

Education Programme run by a local
community-based programme devoted to
inclusive education. The group began working
with Mara and her mother, using the Portage
Programme for Early Education (Bluma 1976).
Marias mother found that she really liked to
exchange her experiences with other
participants in the programme. Now she is
supporting other mothers, providing
orientation in Early Education not only in her
own community but also in the municipality,
and in parent self-help groups.

To fulfil the multiple roles of parents and other family

members, timely information and support are required (as
stipulated in both the CRC and CRPD) from all service
providers along with social protection programmes. In
addition to the direct support provided by health, ECD
and education services, organisations comprised of
parents with children with disabilities can play an
important role in strengthening the competencies of
other families through direct training and information
exchange, along with providing peer-to-peer assistance
related to emotional support and guidance (including
advocacy).

Maria learnt many self-care skills such as

walking (18 months), eating, getting dressed,
going to the bathroom independently, running
and jumping, playing with other children,
participating in home activities, asking and
answering questions. The CBR fieldworker
convinced the family to send Maria to a regular
preschool when she was five years old, and
accompanied her at pre-school as well as
helping the teacher, so that other children can
also benefit from her presence. The joint
government/community-run
Community-Based Rehabilitation (CBR)
programme also provides training in inclusive
education for teachers in preschools and
kindergarten. When she turns six years old,
Maria Nasareth will enter first grade in a local
primary school.

In efforts to increase family competencies, commitment

and involvement to fulfil their obligations, all members of
the family should be considered and included in support
and training processes. Fathers should receive more
attention than is now provided if efforts are targeted to
promoting a gender approach that relieves the significant
burden on mothers, while creating a more holistic
environment for the child. Siblings and other extended
family members or caregivers can also play an important
role in providing a supportive, caring and learning
environment, but this requires more specific preparation
and encouragement. Children should be considered and
included as active partners in change. UNICEFs

Source: Christian Blind Mission website,

Katharina Pfortner (Senior CBR Adviser, CBM
Latin America), Inclusive education needs
community, http://www.cbm.org/nicaragua

27

Child-to-Child approach to prepare children for school

offers a potential strategy for moving forward with a more
participatory focus that includes children and adolescents.

With the ever-increasing impact of the CRPD and focus

on strengthening family involvement, the empowerment
model is increasingly seen as the most appropriate
model. The model includes participation by parent
organisations in training families and providing peer
support, which continues to be an important role.
Financial and technical support for parent/family
organisations including competency building in
communication and mentoring skills - is critical, and in line
with both the CRC and CRPD:

4.4. Expanding involvement of DPOs

and organisation of families of children
with disabilities (parent associations)
The involvement of Disabled Peoples Organisations
(DPOs) and international/national organisations of families
of children with a disability in the negotiation and
advocacy process for the CRPD was evident and
significant. A clear message was sent during the CRPD
preparation and adoption process concerning the
importance and right of participation of persons with
disabilities - Nothing about us without us

The CRC recognises that (the family) should be

afforded the necessary protection and assistance
so that it can fully assume its responsibilities
within the community.
The CRPD confirms the recognition of the family
in the Universal Declaration of Human Rights and
the CRC and adds: persons with disabilities and
their family members should receive the
necessary protection and assistance to enable
families to contribute towards the full and equal
enjoyment of the rights of persons with
disabilities. 37

Concrete advocacy and civil society support for young

children with disabilities and their families in LAC is
frequently directly related to participation in initiatives by
organisations of families of children with disabilities in the
areas of: public awareness, peer support and service
provision. In numerous cases, DPOs focus more on
issues and project development for adults with
disabilities, with limited actions for younger children
(especially for those under eight). Parents and other
family members are key to guaranteeing their
participation in multiple settings and services, and
ensuring that their voices are heard.

Family Support and

Involvement (Nicaragua):
The Association Los Pipitos was founded on August
26, 1987 by a group of parents of children with
disabilities.The Association extended a public
invitation to the families of children with disability,
who were willing to organise themselves voluntarily
to work as a unified force for the development and
integration of their children.

Over the course of past decades, the role of organised

parents associations has undergone an important shift,
from an initial focus on the provision of services (due to
lack of government support) to a more balanced approach
that includes a stronger advocacy role on inclusion across
all areas of life. As is the case with DPOs, more profound
discussions are underway as to what should be the main
role of parent organisations in different contexts. As
highlighted by Diane Richler (former president of Inclusion
International), currently three different models of parent
associations are functioning in the LAC region: 36

Los Pipitos is an association for families of children

with disability, organised throughout 83
municipalities with a base of 15,000 associated
families,
The main objective of this programme is to enhance
the development of children with disabilities by
transforming each home into an Early Stimulation
Center.The programme is also geared to promote
solidarity, support and mutual help among the
associated families.

The empowerment model, that focusses on

building solidarity, supplying information and
promoting advocacy
The service model, that provides a range of
services from schools to employment to
residential services

One example of Los Pipitos initiatives is Mutual

Support Groups -- a forum where parents can share
their emotional experiences with new families
confronted with the birth or addition of a disabled
child to the family.The group supports, comforts and
builds confidence to enable the parents to face the
challenges ahead.

The partnership model, which has arisen

largely from the implementation of CBR
programmes where families, community
leaders, interested professionals and people
with disabilities come together to support
and train families.

Source: History and Programmes of Los Pipitos ,

Nicaragua (http://www.lospipitos.org)

28

5
Mainstreaming actions within existing
programme priorities and
interventions
38

UNICEF is committed to supporting the promotion,

protection and fulfilment of the rights of all children,
including those with developmental delays and
disability. Meeting the challenges of guaranteeing and
sustaining rights achievement requires a different
approach, no longer focusing just on one sector, one
age group and/or one segregated model to
addressing disability issues. An inter-sectoral
approach provides the sound foundation for
mainstreaming specific attention and interventions to
corresponding issues in all policies and programmes,
taking into account existing frameworks and
commitments.

match any given unique country programming

context.
UNICEFs mandate includes the task of working with
governments to uphold the civil, cultural, economic,
political, and social rights of all children and
adolescents, including those with disabilities.
UNICEFs Mission Statement also highlights an
institutional commitment to ensuring special
protection for the most disadvantaged children
victims of war, disasters, extreme poverty, all forms of
violence and exploitation and those with disabilities.

5.1. Initial introduction on entry

points

Recognising that each UNICEF Country Programme

has different priorities, within the global framework of
UNICEFs mandate and institutional priorities, a
review of potential entry points for programming
and mainstreaming disability could assist to identify
potential options and strategies for action that best

Increasing the involvement of UNICEF in the

promotion of rights and guarantees for children and
adolescents with disabilities does not require creating
additional programme areas or increasing internal
UNICEF CO specialised staffing two points that are

EXISTING AND POTENTIAL ENTRY POINTS FOR MAINSTREAING OF DISABILITY COMPONENTS

Existing and potential entry points and strategies
can be utilised to mainstream ECD disability
actions aimed at CRPD and CRC fulfilment
(examples for discussion):

Human
rights
instruments

Using a Twin-Track Approach to

programming.

High level
decisions &
commitment

Twin-Track
Approach

Focusing on the use of Human Rights

Instruments (CRC, CRPD and CEDAW) and
promoting synergy.

Children and
adolescents
with disability
and their
families
Levels of
interventions

Targeting and building on high-level

decisions and commitments (MDGs, EFA,
Meta 2021).
Using a life-cycle approach, starting with
emphasis on certain age groups, and
expanding impact to others including
strengthening for transitioning.

Life-cycle
Priority
groups with
Gender
perspective

Giving priority to selected vulnerable

groups, with a gender perspective, to also
incorporate disability components.
Undertaking actions at different service
locations and at different operational/ policy
levels (national, sub-national, municipal),
followed by connecting with all levels.

Potential strategies and entry points

for mainstreaming disability actions
aimed at crpd and crc fulfillment

29

5.2. Entry points through

Conventions and other International
Commitments

often cited as the main obstacles and concerns for

restarting UNICEFs participation in programme
actions focusing on children with disabilities.
However, it does require a shift to a more systematic
inter-sectoral approach (internal and external), with
consideration to the different stages of the life-cycle
and the connections between each (transitioning).

Based on the different characteristics of each country

programme, the main priority areas and entry points
for planning and implementation of related actions for
the main target populations may vary. But as
previously mentioned, increased mainstreaming of a
disability perspective across all programme areas will
provide the required flexibility and focus to reach and
include children and adolescents with disabilities in all
programme areas. As indicated below, multiple
frameworks (human rights instruments and high-level
decisions and declarations) exist in the region to
guide country-level actions and international
cooperation to address child and adolescent rights
across the life-cycle. While all human rights
instruments and high-level decisions listed below
have clear components or targets related to
education (and to a lesser extent health), more
specific elements related to young children with
disabilities and their families are not common.

As seen in a wide range of emerging international

and national cooperation plans, progress is being
made toward mainstreaming actions for support for
the CRPD within existing initiatives. The following
information highlights some potential entry points for
incorporating specific disability-related actions within
existing programmes, with a focus on specific actions
and strategies for young children with disabilities and
their families. While emphasis is placed on UNICEF
programming, the ideas and strategies identified
should be appropriate for a wide range of cooperation
plans and agencies with similar mandates, taking into
account that mainstreaming actions are not new for
certain partner agencies.

HIGHLIGHTS OF HUMAN RIGHTS INSTRUMENTS AND HIGH-LEVEL DECISIONS THAT CAN OR DO

SERVE AS ENTRY POINTS FOR ADDRESSING THE RIGHTS OF ALL CHILDREN, INCLUDING
THOSE WITH DISABILITY (USING ECD AND EDUCATION AS AN EXAMPLE)
Human Rights Instruments

Convention on the Rights of

the Child (1989)
Convention on the Rights of
Persons with Disabilities
(2006)
Convention on the
Elimination of Discrimination
against Women (1979)
Inter-American Convention
on Elimination of all Forms
of Discrimination Against
Persons with Disabilities
(1999)
United Nations Declaration
on the Rights of Indigenous
Peoples (2007)

Priority Focus including children with disabilities as

a cross-cutting priority group for all actions related to
human rights and other high-level commitments.

High-level Decisions and

Declaration
(Commitments)

All Children and Adolescents

Education for All (EFA)
Infants and young
children at-risk, with
developmental
delays and or
disabilities

Out-of-school
children and those
at-risk for repetition
and droput

Children with
disability

Millennium Development
Goals (MDGs)
Meta 2021 (in education
for Latin America)
Salamanca Framework of
Actions (on Special
Needs Education)

Adolescents
out-of-school, at-risk
for violence and
without opportunities
for particiopation

30

World Fit for Children

goals (WFFC)

with special education actions developed as a

separate process or service. Specific special education and inclusive education actions often focus only
on children with disabilities, without recognising the
need and importance to partner with and support
educational actions for/with other excluded groups.

The inclusion of children and adolescents with

disabilities in programming can be undertaken
through the use of individual and/or multiple entry
points including a focus on the use of human rights
instruments and/or through planning based on
international commitments based on high-level
decisions or declarations (EFA and MDGs). However,
past practices of addressing such commitments in an
isolated, parallel or partial manner must be replaced
by efforts to link strategies aimed at complying with
multiple commitments.

Utilising all entry points to reach and include

those with a disability (education as an
example)

A more coordinated effort is required by all key

entities or groups involved and initiatives undertaken
to achieve expanded early education opportunities,
universal primary education for all and completion of
the primary cycle, along with guaranteeing the
complete rights package (learning, participation and
achievement of optimal development). This requires
broader recognition of opportunities and long-term
benefits of utilising the multiple frameworks and
strategies already in place to address the rights and
educational needs of all children, including those with
a disability.

Global and internal UNICEF recognition aimed at

tackling the unmet rights of children and adolescents
with disabilities provides an important foundation for
restructuring the manner in which programming
and actions are undertaken. The combined participation of DPOs and cooperation agencies are assisting
in the preparation of a more disability-inclusive
development agenda towards 2015 and beyond, while
internally, important steps are being made to mainstream disability components within the UNICEF
Strategic Plan (2014-2017). These key efforts will
assist in addressing unfinished business in the
region and globally.

International and national cooperation initiatives

should promote more integrated approaches as
opposed to past and lingering tendencies to support
parallel or isolated project-based strategies. To reach
children with disabilities, planning and implementation of initiatives must take advantage of those
frameworks earmarked specifically for children with
disabilities, along with benefiting from actions to
mainstream disability aspects within more global
education and child rights-based frameworks (EFA,
MDGs, CRC). All children can benefit from this
combined strategy.

Limited efforts to use existing EFA

frameworks to include children with a
disability

In the past, most UNICEF-supported country level

EFA and MDG actions have not focused on the full
array of educational rights and needs of children with
disabilities. In many cases, actions aimed at reaching
out-of-school children and those at risk for repetition
and/or drop-out have not included children with
disabilities as a priority group although international
efforts have supported significant attention to other
excluded and at-risk populations, including children
living in rural areas and/or working, as well as girls
and indigenous children. However, new and promising efforts are underway to begin to highlight and
address in a more effective manner the lingering
exclusion of children with disabilities.

Understanding and promoting links or synergies

between existing frameworks and international
commitments is critical. Important efforts have been
taken by Save the Children UK, CBM, and, more
recently, UNICEF to feature and emphasise this
element, an obvious strategy available for organisations to strengthen rights-based actions focusing on
children with disabilities. The most recent publication
Using the human rights framework to promote the
rights of children with disabilities: Discussion Paper
An analysis of the synergies between CRC, CRPD
and CEDAW represents an important tool to
promote rights of children with disabilities through a
more constructive use of existing human rights
frameworks.

In almost all cases, existing strategies and methodologies for reaching priority excluded or at-risk groups
are the same as those required for children with
disabilities contained within an inclusive, child-focused education approach: active learning at pre- and
primary school levels, flexible curriculums,
multi-grade approaches, child-to-child support and
interaction, school reinforcement, after/out-of-school
programmes, team teaching and increased family
involvement (especially during the early years).
However country-level implementation is often
undertaken in a parallel or disconnected manner,

31

EXAMPLE: FRAMEWORKS FOR GUIDING EFFORTS TO ACHIEVE EDUCATION

RIGHTS FOR ALL CHILDREN AND ADOLESCENTS TAKING ADVANTAGE OF ALL ENTRY POINTS TO
REACH ALL CHILDREN, INCLUDING THOSE WITH A DISABILITY
Goals targeting universal
quality education for all
are key components
within the three main
frameworks listed. Since
1990, major efforts have
been made to advance
towards universal
fulfilment.
Three additional
instruments are available
to guide actions focusing
on the most excluded
populations.
For UNICEF and other
cooperation agencies, a
combined approach will
advance efforts built on
the combined entry
points, including: existing
commitments for all
children and those
instruments that consider
more specific
disability-related goals

5.3.

EFA
Salamanca
SNE

All childrenand adolescents

Out of school children
and adolescents...

Convention on
the Rights of
Persons with
Disabilities
CRPD

CHILDREN
WITH DISABILITY

MDGs

... along with those at-risk

for repetition and dropout

Inter-American
Convention
Elimination Forms
of Discrimination
Against PWD

CRC

Twin-Track Approach
(i.e., promotion of child-friendly school initiatives).
For UNICEF programming, a specific focus is required
on how the twin-track approach relates to children
with disabilities and their families, within the
framework of UNICEF programming and priorities.
The examples cited below are illustrative in this
regard.

The twin-track approach is gaining weight with

development agencies as the best and most effective
way to incorporate disability interventions into the
larger planning process for development and
cooperation. This approach involves mainstreaming
disability elements into all development activities, as
well as implementing specific projects to promote
the empowerment of persons with disabilities and
their families, especially in actions related to children
and adolescents with a disability.41

For disability-specific initiatives

Initiatives will require increased actions for skill and

self-esteem building processes for children with
disabilities, along with more opportunities for their
inclusive participation in family, school and community
settings, across all stages of the life-cycle. Child and
adolescent initiatives should be complemented by
actions to strengthen family competencies and
empowerment, considering that during the early years
families provide the first and main caring, learning and
protective environment for young children especially
those with developmental delays and/or disabilities.
The new CBR strategies can provide an important
support mechanism for home/community-based
interventions for children and families, while assisting
organisations of families with disabled children and/or
DPOs in capacity-building and out-reach.

Rights achievement, full inclusion and participation

will only be possible if specific support is provided to
persons with disabilities (empowerment), while
ensuring that all development projects include in a
sustainable manner - a disability perspective and are
inclusive. To date, application of the Twin-Track
Approach is relatively new within the UNICEF LAC
region, as part of UNICEF and other agency
programming. In cases where interventions for
children with disabilities have been included as part of
UNICEF country programming, most actions have
focused on specific disabilities projects. However,
important progress is now being made to mainstream
a disability, or inclusive, perspective within education,
as part of a more active inclusive education effort

32

EXAMPLE OF POSSIBLE APPLICATION OF TWIN-TRACK APPROACH

WITHIN FRAMEWORK OF UNICEF PROGRAMMING
Modification of original Twin-Track figure by author, to illustrate potential use of
Twin-Track Approach for UNICEF programming process (an example).

Twin-Track Approach
(for UNICEF Programming)

Disability specific initiatives/projects

Disability inclusive initiatives/projects

Aim: Increase the empowerment

and participation of children and
adolescents with disabilities,
along with their families
and/or main care givers.

Aim: Ensure that all UNICEF levels mainstream a

disability perspective in all programme/project
components and children with disabilities and
their families are recognized and considered as
one of the main priority groups.

(Disability specific actions)

(Disability as a cross-cutting issue)

Children and adolescents with disabilities are recognized and

included in all UNICEF Programme Areas-on an equal footing with
other priority groups, along with their families.

For mainstreaming of a disability perspective

in UNICEF programme actions

to architecture/infrastructure, communication,
methodology, instruments, programmes and
attitudes) and providing child-friendly, safe spaces for
children with disabilities and/or special health
conditions will also benefit other children.

Initiatives will require a more in-depth analysis and

review process during the planning and
implementation periods to identify the most logical
and appropriate entry points for incorporation of a
disability perspective within each programme area
(based on a range of considerations: the new UNICEF
Strategic Plan, a life-cycle approach, and Country
Programme and counterpart priorities). This approach
should build on what is already proposed for children
and families identified for UNICEF support. Some
examples include: building on ECD and parenting
initiatives to include detection of developmental
delays and/or disabilities and prepare health and ECD
staff to implement timely early intervention support
for children and parents (i.e. building on Care for Child
Development interventions); incorporating inclusive
child development strategies in centre-based ECD
services while expanding inclusive primary and
secondary education for all initiatives; and
mainstreaming specific assistance components to
families with children with disabilities, as part of
existing social safety net schemes. Specific initiatives
for improving accessibility in learning spaces (related

Building on
Care for Child
Development
Interventions

Building on
Child-Friendly
School and School
Readiness and
Transitions Strategies

33

INCORPORATING COMMUNICATION AND SOCIAL

MOBILISATION ACTIONS WITHIN THE TWIN-TRACK APPROACH
Twin-Track Approach
(strengthening actions and impact of UNICEF Programming)

Track 1
Disability-specific
iniciatives/projects

Track 2
Disability-inclusive
iniciatives/projects
(Disability as a
cross-cutting issue)

Cross-cutting for both tracks:

Communication & Social Mobilization
Public awareness and communication
actions to assist in creating positive
environments for all actions and to
guarantee a rights-based approach
and inclusive attitudes

Children and adolescents with disabilities are recognized and

included in all UNICEF Programme Areas on an equal footing with other
priority groups, along with their families.

UNICEFs comparative
advantage and internal
capacity at country
levels to include
communication and
social mobilisation
components in both
Tracks provides
important opportunities
for increasing public
awareness on the
rights of children and
adolescents with
disabilities and
promoting attitudinal
changes and concrete
actions to guarantee a
supportive
environment for
inclusion. Both implicit
and explicit
communication
strategies are critical.

be the only technical and/or advocate leader for

each component. UNICEF strategies and
priorities in education and ECD provide a
foundation for mainstreaming disability
components considering that both
programme areas already focus on key
strategies: inclusion, equity promotion and
family support.

Strengthening the Twin-Track Approach

through communication and social
mobilisation

For UNICEF the incorporation of systematic communication and social mobilisation actions as a cross-cutting strategy for both tracks is essential to increasing
public awareness and participation, while promoting
positive attitudes and a supportive environment to
advance towards achievement of rights and inclusion.

A clear message was sent during the CRPD

preparation and adoption process concerning
the participation of persons with disabilities:
Nothing about us without us. In line with
this, UNICEF and other agencies need to
consider specific empowerment strategies
for and with children and adolescents with
disabilities, to guarantee their participation and
that their voices will be heard.

Additional thoughts for UNICEF

programming

Using the Twin-Track Approach does not imply

that UNICEF alone has to expand actions in
two- track areas, as long as both tracks are
addressed through other cooperation
mechanisms. However, priority should be
given to moving towards a Track 2 focus,
which is more in line with the emerging
consensus. In all cases, UNICEF should strive
to achieve a better understanding of services
and cooperation available for children and
adolescents with disabilities, both to better
design its own assistance package, and to
address the larger picture of rights
promotion and fulfilment.

5.4. Entry point based on

commitment to support the CRPD
As expressed in the Joint Statement of Commitment
to the Convention of the United Nations Inter-Agency
Support Group for the Convention on the Rights of
Persons with Disabilities, a clear commitment was
made by multiple UN agencies to support countries in
their efforts to ensuring the rights and provision of
the CRPD. Based on the obligations laid out in CRPD
Articles 32 and 38, as well as in General Assembly
Resolution 61/106, the Inter-Agency Support Group
works primarily in six areas.42

Strengthening the track for mainstreaming a

disability perspective in UNICEFs cooperation
plan does not require a highly technical
process, nor does it mean that UNICEF has to

34

(1) Policies. As stipulated in Article 32(1), the

international community will undertake
appropriate and effective measures to support
the purpose and objectives of the Convention.
(2) Programmes. Article 32(1)(a) states:
ensuring that international cooperation,
including international development
programmes, are inclusive of and accessible
to persons with disabilities.
(3) Capacity-building. Article 32(1)(b) states
the obligation of facilitating and supporting
capacity-building, including through the
exchange and sharing of information,
experiences, training programmes and best
practices. An element of the strategy will be
to support capacity-building by increasing
knowledge of the Convention.
(4) Research and access to knowledge.
Article 32 (1)(c) calls for facilitating
cooperation in research and access to
scientific and technical knowledge.
(5) Accessibility. Article 32(1)(d) stipulates:
providing, as appropriate, technical and
economic assistance, including by facilitating
access to and sharing of accessible and

assistive technologies, and through the

transfer of technologies.
(6) Committee on the Rights of Persons
with Disabilities. Article 38 entitles
specialised agencies and other UN organs to
be represented before the Committee on the
Rights of Persons with Disabilities; the
Committee may invite them to give expert
advice.

5.5. Entry points for mainstreaming

disability actions based on UNICEF
Strategic Plan (2014-2017)
5.5.1. Mainstreaming based on the
UNICEF Strategic Plan 2014-2017
The approved UNICEF Strategic Plan (2014-2017)
targets UNICEFs mission to promote the rights of
every child, in all aspects of UNICEFs programming,
especially for the most disadvantaged and excluded
children and their families. This is the focus and
desired impact of UNICEFs new Strategic Plan, with
an equity strategy that translates this commitment
into concrete actions for all UNICEF levels of action,
prioritising country office actions.
The new Strategic Plan (SP) will cover the remaining
two years of the EFA and MDG timetable and provide
the framework for design of new UNICEF Country
Programmes, building on results and lessons learned
from implementation of the past MTSP (2006-2013).
For most national offices, a transitioning process was
undertaken to shift from the past MTSP targets to the
new outcomes described in the UNICEF Strategic
Plan (2014-2017).

UNICEF_UNI134972_Dormino

As an active member of the UN Inter-Agency Support

Group, UNICEFs country-level actions should focus
on how existing programme actions to promote and
support child and adolescent rights can serve as the
foundation for guaranteeing the voice of young
children with disabilities and their families in concrete
areas of UN support in one or all of the following
areas:

INITIAL IDEAS FOR MAINSTREAMING DISABILITY ACTIONS

FOR EACH OUTCOME AREA (STRATEGIC PLAN 2014-2017)
OUTCOMES

IDEAS FOR MAINSTREAMING DISABILITY ACTIONS

Improved and equitable use of high-impact maternal and child health interventions from pregnancy to
adolescence and promotion of healthy behaviours

Health

HIV and AIDS

Improve caregiver and family knowledge of high-impact interventions, including elements related to
prevention and early detection of disabilities, combined with family-based interventions.
Strengthen health systems to be more accessible and inclusive for families with young children with
disabilities, along with expanding integrated services for adolescents with disabilities.
Ensure better integration of health services with ECD, education and other community-based early
intervention and rehabilitation services provided to children with development delays and/or disabilities and
their families
Improved and equitable use of proven HIV prevention and treatment interventions by children, pregnant
women and adolescents
Increase emphasis on promoting comprehensive sexuality education and protecting the rights of excluded
adolescents, especially those with a disability who are at risk for, or affected by, HIV.
Improved and equitable use of safe drinking water, sanitation and healthy environments, and improved
hygiene practices

WASH

Guarantee adequate and accessible sanitation; promote hand-washing and good hygiene practices for all
children.
Provide safe and accessible drinking water, sanitation and hand-washing facilities for all children in schools and
health centres, including young children with disabilities.
Increase preparedness to respond to humanitarian situations, considering children with disabilities and their
families.
Improved and equitable use of nutritional support and improved nutrition and care practices

Nutrition

Support and prepare disadvantaged and excluded families to apply good nutrition and early child care and
stimulation practices, including early intervention strategies for young children with developmental delays
and/or disabilities.
Improved learning outcomes and equitable and inclusive education

Education

Focus on access, permanence and learning achievement for all children in primary education and adolescents
at secondary level, through accessible and inclusive education.
Strengthen formal and non-formal systems to provide multiple learning opportunities for disadvantaged and
excluded children, including young children and adolescents with disabilities, with an emphasis on measurable
learning outcomes.
Support inclusive ECD and transitioning strategies (to and through first grades of primary) for the most
excluded children, including those with a disability.
Support innovations with the potential to increase all forms of accessibility and improve educational outcomes
for marginalised children and those with a disability, including, e.g., universal design for learning, child-centred
pedagogy and information and communication technology (ICT).
Improved and equitable prevention of and response to violence, abuse, exploitation and neglect of children

Child Protection

Strengthen child protection systems and family support schemes for social change to improve protection of
children, especially for those with a disability.
Prevent violence, exploitation, abuse and neglect against young children with disabilities, by strengthening
support mechanisms and the protective capacities of families and communities.
Support inter-sectoral approaches, especially allied systems such as health, social protection and education
to the prevention and response to child protection concerns related to disabilities.
Improved policy environment and systems for disadvantaged and excluded children, guided by improved
knowledge and data

Social Inclusion

Identify the situation, patterns and drivers of exclusion on children and their families, including the impact of a
disability, gender inequality and other multiple exclusion factors.
Design and scale-up social protection systems, including specific interventions for children with disabilities and
their families.
Design legislation and policies that promote rights achievement and social inclusion, complemented by
systems for social and child-sensitive budgeting and related national and subnational monitoring.
Strengthen families in their child-care role, particularly for the youngest children and those with a disability,
focusing on the poorest and most marginalised families to demand and access basic services.

Note: Based on UNICEF documents for the Executive Board: The UNICEF Strategic Plan (2014-2017) and Annex: Supporting document to the UNICEF
Strategic Plan (2014-2017)

36

5.5.2. Mainstreaming based on the

UNICEF Strategic Plan (2014-2017) and a
life-cycle approach
Below are some examples of specific actions that can
be mainstreamed within UNICEF Country
Programmes, organised by the outcome structure of
the UNICEF Strategic Plan (2014 2017). Content
builds on existing UNICEF Programme Guidelines on
Children with Disabilities, with additional alternatives
and suggestions based on the LAC region context
and lessons learned.44

Based on lessons learned and new global movements, more significant efforts are directed towards
promoting an equity approach that guarantees that
all children have an opportunity to survive, develop
and reach their full potential without discrimination,
bias or favouritism. 43 In the case of children with
disabilities, as for all children, actions to guarantee all
rights indicated in the CRC, CRPD and CEDAW will
require exploring a more integrated (or mainstreaming) focus within all UNICEFs priority areas and
across the life-cycle.

ORGANISATION OF INPUTS FOR MAINSTREAMING DISABILITY ACTIONS

IN OUTCOME AREAS OF THE UNICEF STRATEGIC PLAN (2014-2017)
Examples of potential actions or components that fit within the UNICEF Strategic Plan (2014-2017)
Outcome Areas. (Text and modifications based on Annex of UNICEF Programme Guidelines on Children
with Disabilities and expanded to build-on regional opportunities).

A good start in life (early years up to primary)

Life-cycle

Structure based on Grouping of UNICEF Strategic Plan (2014-2017) Outcome Areas

Health
Nutrition
WASH

Education

HIV/AIDS

Initiate and/or expand implementation of

new-born screening procedures and
follow-up orientation support for families.

Organise coordination and follow-up

mechanisms with health sector to provide
assistance to families involved in ECD
services (including CCD interventions).

Expand processes of early identification of

developmental delays and disabilities
through center and community-based
(PHC) growth and developmental
monitoring and specific vision and hearing
screening.

Expand early identification processes within

ECD services (in coordination with health)
and support vision and hearing screening and
interventions in pre-school settings and
during transition to primary.

Support family preparation to monitor child

development in home environment along
with simple identification of sensory
impairments as part of Care for Child
Development (C4CD).

Organise joint ECD parent orientation actions

to promote on-going child-centred
identification of developmental delays/
disabilities and interventions, in collaboration
with existing CBR services.

Establish parent/family orientation based

on results of new-born screening and early
identification of developmental delays and
disabilities, in centre and community-based
settings.

Guarantee safe child development/ learning

spaces for children under six during
emergencies and natural disaster,
considering the needs of children with
disabilities.

Modify service delivery mechanisms so

that children with disabilities and their
families are assured equal and timely
access to services and are provided
additional assistance in response to their
special needs; including integration within
CBR programmes, where they exist.

Child Protection
Social Inclusion
Advocate for policies and capacity building of
service providers to support families of
children with disabilities for safe and
appropriate care for the in-home setting.

Advocate to improve
and scale-up care and
support services for
vulnerable children
affected by HIV/AIDS,
including those with
disabilities

Promote inclusion of families of children

with disabilities within support services: e.g.
child care, parenting education and
appropriate discipline, respite care, violence
prevention.
Promote support groups of parents of
children with disabilities, as part of increased
involvement of organisations of families with
children with disabilities.
Train alternative care providers and foster
care workers to provide appropriate
attention and care for children with
disabilities.

Provide additional
support for family
members affected by
HIV/AIDS who are also
Promote inclusion of children with
parents or caregivers for Build capacity of social protection/ child
developmental delays and/or disabilities in
young children with
welfare system and foster caregivers to
ECD/ pre-school settings, including specific
disabilities.
cope with different types of disability,
strategies that recognise and respect cultural
including the participation of key NGOs and
differences with specific actions to prepare
DPOs.
and include families.

Preparation of medical staff (centre and

community-based) to adequately support,
inform and prepare family members in a
timely and culturally appropriate manner
(child/family friendly services and
orientation).

Prepare educational staff for inclusion and

family support, especially for the different
transitioning processes: home- to- ECD
services and to and through early primary
grades.

Include in Facts for Life,C4CD and other

ECD materials, specific content on: early
detection, intervention, care and family
support, including other health conditions
impacting on children.

Apply inclusion index in ECD and pre-school

settings, as a monitoring, evaluation and
training tool.

Prepare information and

training materials on
HIV/AIDS and disabilities
for use by health and
ECD staff in services
and family orientation,
guaranteeing
accessibility of
information (considering
the different
impairments).

Ensure that social protection/child welfare

systems (including government, NGO and
faith-based organisations) are capable of
detecting and taking action in the case of
abuse, exploitation or neglect of children
with disabilities; such efforts should take
account children who are not able to
communicate.

Cross Cutting: Early Years Up to Primary Schooling

Expand use of social communication and mobilisation actions to increase: public awareness, non-discriminatory attitudes, a gender perspective, demand and
participation of all sectors and actors to guarantee the rights of young children with disabilities and the required support for families with disabled children;
Continues...

37

Continued...
Promote non-discriminatory attitudes and appreciation/respect for difference in the various settings where community members (public) and service providers (as well as other young
children) interact with children with disabilities and their families: ECD services, pre-school systems, hospitals, day care, parenting education programmes; community settings, religious
settings/worshipping sites; and others
Ensure that young children with disabilities are included in data collection and analysis of data trends & disparities (inclusion of disability in SITANS, census and household surveys and
other instruments, such as MICS questionnaires).
Advocate for ratification, implementation, and monitoring of the UN Convention on the Rights of Persons with Disabilities with an increasing priority given to young children with
disabilities and their families and link with application and monitoring of CRC and CEDAW conventions guaranteeing a gender perspective.

Primary School years

Life-cycle

Structure based on Grouping of UNICEF Strategic Plan (2014-2017) Outcome Areas

Health
Nutrition
WASH

Education

HIV/AIDS

Child Protection
Social Inclusion

Promote vision and hearing screening and

interventions in ECD and school settings
(possible joint actions with health and
family-based organisations)

Advocate for design and application of

inclusive education policies, with family and
community participation, as part of rights to
education mobilisation and planning

As above, but also:

As above, but also:

Introduce specific attention for disability in

WASH in School programmes (water
sanitation and hygiene education
programmes), including issues related to
guaranteeing access to appropriate and
accessible sanitary facilities.

Promote inclusive education through use of

Child-Friendly School model and other
child-centred approaches focused on
inclusive quality education programmes (pre,
primary and secondary levels).

Address the specific risk

of rape of children with
disabilities, especially in
situations of increased
vulnerability.

Encourage public discussions on abuse,

highlighting the vulnerability of children with
disabilities, especially from a gender
perspective and for those whose disability
prevents or restricts them from reporting.

Increase involvement and consultations

with DPOs in developing, designing and
monitoring WASH interventions at
household level and for institutions/schools.

Expand the concept of inclusion and

accessibility to include all children and with a
focus on learning and participation (not just
physical access).in all learning spaces: school,
community, home, media, ICT.

Prepare teachers and

school staff on HIV
aspects, especially for
working with adolescent
students in primary level
on HIV/AIDS prevention.

Support capacity building for those in a

position to identify abuse, as well as those
responding to the psycho-social needs and
other aspects of social reintegration of
children with disabilities who have been
sexually abused and exploited.

Design service delivery for children with

disabilities that assures equal access to
health services and provides additional
support in response to their special needs;
guarantee a gender-appropriate focus to
health services and promote integration
with CBR programmes where these exist.

Introduce and apply inclusion index for

primary and secondary schooling, including
evaluating/ monitoring of issues related to all
aspects of accessibility (infrastructure,
communication, etc.), safety, and gender
related participation.

Promote actions in community and school

settings to create violence-free
environments (within school grounds and
the surrounding environment).

Promote inclusive school and community

spaces for recreation, sports and cultural
activities, along with preparation in life-skills
for better health which guarantees the
participation of both girls and boys.

Incorporate inclusive education strategies

and specific attention to children with
disabilities in university-level teacher studies
and pre- and in-service teacher training
programmes

Design teacher and parent training

programmes on aspects related to
appropriate discipline strategies, aimed at
eliminating physical and emotional
punishment.

Cross Cutting: Primary School Years

Promote involvement of young people with disabilities in school and community, as well as making specific efforts to elicit their views and increase their
self-esteem reliance.
Expand use of social communication and mobilisation actions to increase public awareness, demand and participation by all sectors and actors to guarantee the
rights to inclusive primary education for children with disabilities, in addition to promoting family preparation, orientation and involvement.
Promote non-discriminatory attitudes and appreciation/respect for difference in the various settings where school-age children, community members and others
involved in childrens lives interact with children with disabilities: schools, community spaces, parenting/family education, faith-based organisational settings,
childrens recreational facilities, the media and others.
Ensure that children with disabilities are included in data collection and analysis of data trends & disparities (included in education information management
systems, EFA monitoring, inclusion of disability components in SITANS, census and household surveys and other instruments, such as MICS questionnaires).
Support the costing of inclusive education and disability-specific interventions to support advocacy and planning purposed for resource allocation in budgeting
process.
Advocate for ratification, implementation and monitoring of the UN Convention on the Rights of Persons with Disabilities with increasing priority given to
promotion and monitoring of CRPD article 24 and Articles 28 and 29 of CRC, along with promoting a corresponding gender perspective in line with the CEDAW.

5.6. Entry points focusing on key

spaces and actors across the
life-cycle

programme areas. In education the main emphasis on

primary education often neglected the importance of
the early years of child development and family
involvement, while actions for preparing children,
parents and teachers for transitioning to and through
the adolescent years and post-primary were also
limited. For children and adolescents with a disability,
providing timely and systematic support across all
stages of the life-cycle and for the critical moments of
transitions is essential for guaranteeing optimal
development and inclusion.

Globally and within UNICEF, more significant

emphasis is being placed on programme planning
that is directly linked to the life-cycle approach. This
important advance addresses a weakness of past
cooperation, which tended to emphasise specific age
groups of the life-cycle, with limited consideration for
connecting with or between other stages, whether
it be in health, education, child protection or other

38

In a recent publication on developmental difficulties in

early childhood, the life-cycle approach is used to
construct a framework of developmental risks to
assist LAMI countries to advance towards preventing
and managing development difficulties. The figure
below shows how the life-cycle approach aids in
mapping a range of age-specific and life-long risks
across all stages of the life-cycle. As described in a
WHO publication, the life-cycle approach embodies
four key concepts: 45

Often risks do not occur in isolation but

together. The cumulative number, duration
and severity of risk factors, and the adequacy
of protective factors, determine the ultimate
impact of risk factors.
Risks affect development through multiple
complex pathways, and categorisations, such
as biological and psychosocial, or nutritional,
genetic and infectious, have limited use.
Interventions to address risks must be
informed by the multifaceted complex nature
of risk and protective factors.

Risk and protective factors coexist

throughout the lifespan, respectively impairing
or helping children to develop to their full
potential.
Factors that place childrens survival at risk
are also often risks for suboptimal
development.

THE LIFE-CYCLE APPROACH TO DEVELOPMENTAL RISK FACTORS

NE
XT
GE
NE

ECIFIC RISKS
AGE-SP

N
TIO
RA

ADOLESCENCE

Family/peer/
school problems
Developmentalbehavioral
problems
Substance abuse
Early sexual
activity
Risk-taking
behaviour

In this framework, developmental risks are presented

in accordance with the life-cycle.

PRECONCEPTIONAL

Unwanted pregnancy
Inadequate child spacing
Adolescent pregnancy
Consanguinity

NG
LIFE-LO RISK
Problems in physical/
mental health of
child/family
Deficiencies in
psychosocial/educational
environment
Exposure to
substance/toxins

It describes life-long risks that can appear throughout

the life-cycle and may include a range of risks: physical
and mental health problems of caregivers, deficiencies
in the psychosocial and educational environment,
exposure to substances and toxins, and exposure to
violence, abuse or neglect.

PRENATAL/
PERINATAL

Inadequate
prenatal care
High risk
pregnancy, high
risk newborn
Inadequate
adaptation to
pregnancy or
newborn
Perinatal maternal
mortality

Actions for prevention of disabilities and intervention

during the early years must consider the multiple
age-specific risks which can appear at specific
moments of the life-cycle,: preconception, prenatal/
perinatal, infancy/early childhood, school age and
adolescence.

Exposure to violence/
abuse/neglected

SCHOOL AGE

Family/peer/school
problems
Inadequacies of schools/
teachers
Developmentalbahavioral problems
Risk-taking behaviour

INFANCY/EARLY CHILDHOOD

Source: WHO (2012), Developmental Difficulties in

Early Childhood Prevention, early identification,
assessment and intervention in low-and middle-income
countries, Geneva.

Inadequacies in nurturing and

stimulating qualities of
caregiving environment
Developmentalbehavioral problems
Risk-taking behaviour

For programme actions focusing on the inclusion of

children and adolescents with disabilities, creating
and/or strengthening the connections (bridging)
between the different stages of the life-cycle is
fundamental. This also includes preparing all actors
that influence the development and inclusion of
children, especially parents, extended family
members and educational personnel. In addition,
efforts should be made to prepare and take
advantage of all service and learning spaces and
opportunities, for development and inclusion: school,
health services, home (family setting), community,
and media.

As is the case for all children but especially for

those with a disability starting early is crucial, along
with guaranteeing on a systematic basis (across all
stages of the early life-cycle) the required services
and family support. Each stage of the life-cycle forms
the foundation for life-long learning, development,
protection and inclusion. And, as illustrated, multiple
spaces and actors play critical roles and opportunities
for guaranteeing child rights and family support. The
design of appropriate intervention strategies should
consider both the key spaces and actors.

39

IMPORTANTTO CONSIDER ALL SERVICES AND SPACES FOR INCLUSION ACROSS ALL STAGES OFTHE EARLY LIFE-CYCLE
Each stage of the life-cycle includes a series of influential spaces and actors that make a significant difference in
the development, learning, protection, participation and inclusion of children with a disability (as is the case for all
children). While the education and health sectors play a key role, preparing, supporting and involving the family at
all stages is essential.
0-2

2-3

3-4

4-5

Family... First space

5-6

6-7

7-8

8-9

9-10

Family...

ECD, Pre-schools,
Early Intervention
Services

10-11

11-12

12-13

13-14 14-15

Family...

Primary School

15-16 16-17 17-18

Family...

Post-Primary School
(Secondary and others)

Recreation, Cultural and Sports / Activities and Spaces

Health and Rehabilitation Service/Health Centres, Hospitals & Community-Based Rehabilitation

Support to Families and Organization of and for Family with Children with Disability

UNICEF-WHO

0-1

life-cycle stage (listed in what could be considered the

order of priority or influence). As previously
mentioned, priority may be given to specific actors,
spaces and interventions, but a key recommendation
is to use the most logical or appropriate entry point
for the local or country context, and build on initial
actions to achieve a more integrated life-cycle
approach.

The table below provides a very brief overview of

potential entry points for mainstreaming disability
actions with a focus on strengthening spaces,
actors (individuals) and interventions that can make a
short- and long-term difference in the development,
learning, protection and inclusion of children and
adolescents with disabilities. A wide range of
categories is included, with indications for each

EXAMPLES OF ENTRY POINTS ACROSS THE LIFE-CYCLE FOCUSING ON INTERVENTIONS,

MAIN SPACES AND KEY INFLUENTIAL ACTORS

Categories
Main spaces or
environments of
Influence
Main actors of
influence
Specific actions:
identification/
detection
Specific actions:
Interventions
(disability and
learning)

Areas of
cooperation

Level and focus of intervention (with an estimate of importance by order of listing)

The first years (birth to three)
Home environment
Health and nutrition services
Neighbourhood/community
ECD services
Parents and extended family
Health & ECD service providers
Community (NGOs, DPOs, CBR)
Media for family (radio, TV, etc.)
Health/hospital (newborn screening)
Health (developmental monitoring)
Screening (developmental .&
sensory)
Family-based early intervention
through health and ECD services
Family competency- building,
including adolescent mothers and
fathers
Special/Rehab Health services
(centre and/or community-based)
Assistive devices

Pre-school years
Home environment
ECD services (including centre and
community-based)
Health and Nutrition services
Neighbourhood/community
Parents and extended family
ECD/preschool staff
Health providers
Community. (DPOs, CBR media)
Development monitoring and/or
screening
Hearing/vision screening
School readiness assessments or
monitoring
Family-based early intervention
through health and ECD services
Inclusion in ECD centre-based
services
Special Rehab/Health services
(centre and/or community-based)
Assistive devices

Early primary school years

School setting
Home environment
Community/friends
Media
Teachers and school staff
Parents and extended family
Peers (child-to-child)
Community, DPOs & Media
Hearing/vision screening
Developmental screening (ECD)
Learning assessments

Inclusive education
Family-based support (CBR)
Support other inclusion spaces
Special Rehab/assistive device

Strengthen family support, competency-building and networking (direct services, support to DPOs, family orgs with
disabled children), including support for siblings
Policy and programme development (including situation analysis, data management, all forms of accessibility issues,
inclusion social safety networks)
Promotion and monitoring of rights achievements (CRC, CRPD, EFA, MDGs, Meta 2021, CEDAW, Inter-American
Convention)
Capacity-building (design and implementation including national decentralised systems)
Communication and mobilisation public awareness, promotion of rights, mobilisation of partners, dissemination of CRPD
monitoring results
Disaster risk reduction and response with incorporation of components related to rights/needs of children with disabilities
and families.

Note: The selection and ranking process for the above-mentioned inputs were based on a general review of time spent in the different settings with the appropriate personnel,
along with considering the possible intensity and importance of contact between children and key actors. Without a doubt, variations will be found within countries (urban/rural)
and between regional countries.

41

5.7. Entry points for mainstreaming

disability - building on existing
cooperation actions

For UNICEF and other cooperation agencies this

approach does not require a major reworking of the
programming process, nor does it demand the
development of a new set of programme lines
focusing only on disability issues. The table below
includes examples of potential disability-related
actions that could be mainstreamed or incorporated
within existing programme actions at different
stages of the life-cycle with required adjustments
based on the unique or specific characteristics of
each country situation.

The mainstreaming of disability components within

existing programmes and cooperation plans provides
an excellent opportunity to build on services and
inclusion interventions for children and adolescents
with a disability. As noted below, almost all areas of
existing health, education, protection and policy
making cooperation areas provide entry points for
including disability interventions.

Life-cycle
Stage

EXAMPLES OF POTENTIAL MAINSTREAMING OF DISABILITY COMPONENTS

BUILDING ON REGULAR PROGRAMMING
Regular
programme actions
for priority
populations

Birth to three

New-born screening
and peri-natal control
(first contact with
family).

Growth and
Developmental
Monitoring (G&DM),
along with
parent/family
orientation on child
development

Nutritional
programmes for
malnourished children

Provision of ECD
services, especially
for young children of
working mothers

Research on
Child-Rearing
Practices

Examples of additional
disability-specific actions that can be
mainstreamed into regular
programming

Comments

Strengthen family orientation and

follow-up mechanisms for those at risk
and/or with disability.
Support inclusion of new-born hearing
screening
Guarantee birth registration for all
children, including those with a disability.
Introduce child passport with
information on developmental
monitoring, disability and rights.

In many countries, new-born screening exists, but the mechanisms

and capacity required to undertake initial orientation and follow-up is
lacking, especially for poor families, adolescent mothers and fathers, of
indigenous groups and/or those living in rural areas.

Include components of screening for

developmental delays and disabilities as
part of G&D monitoring.
Strengthen family orientation and
follow-up for those with delays/disabilities
(as part of C4 CD interventions)
Link G&DM actions with CBR services.

Most countries are implementing some form of centre and/or

community-based growth and developmental monitoring, with family
orientation, but with limited guidance and follow-up for children with
disabilities. This represents an important opportunity to utilise the LAC
modified WHO- UNICEF Care for Child Development (C4CD)
intervention package.

Strengthen family orientation for

incorporation of topic on child
development (along with feeding).
Promote inclusion of young children with
disabilities in nutritional programmes,
including caregiver orientation on specific
feeding/nutritional issues related to the
disability (if required).

Many nutritional programmes are often weak on incorporating child

development issues as part of intervention plans. For children with
disabilities, contact and family support are probably far less than what
is offered for at-risk children and their families. Certain disabilities
require more specific recommendations for feeding/nutritional
orientation, including more accessible information for parents with
disabilities.

Provide support for inclusion of children

with disabilities in ECD services, for
children under three
Strengthen family support (especially for
working mothers) for those with a child
with disabilities

ECD services for children under three are limited, but extremely
important for poor families and working mothers. Poor families with
young children with disabilities are even more in need of ECD services
and support.

Include components on family attitudes

and child-rearing practices related to
young children with disabilities.
Undertake an analysis of child-rearing
practices in indigenous communities
with young children with disabilities and
their families.

Due to the lack of information on child-rearing practices for families

with children with disabilities (especially in indigenous settings), it
would be useful to include this component as part of other
research/documentation on child-rearing practices of specific
population groups. The lack of more culturally appropriate intervention
strategies reduces the impact and sustainability of early intervention
support within specific populations.

42

Regular
programme actions
for priority
populations

Examples of additional
disability-specific actions that can be
mainstreamed into regular
programming

Home and
community-based
ECD services

Link community-based ECD and family

support services with community-based
rehabilitation actions
Include parenting/family information on
early intervention and inclusion as part of
regular ECD programmes.
Include elements related to
developmental monitoring, intervention
and inclusion in a range of
communication materials and strategies.

Formal and
non-formal pre-school
programmes

Support inclusion of children with

disabilities in formal ECD services along
with screening.
Support application of ECD inclusion
index to strengthen diversity component
for all children.
Include staff, parenting/family information
on early intervention and inclusion of
children with disabilities.
Prepare preschool students and families
for inclusion process through appropriate
play and communication actions.

Transitioning
strategies for young
children pre-school to
and thru first grades
of primary

Incorporate support and ECD/primary

staff training to include inclusion of
children with disabilities as part of
transition plans.
Prepare families of children with
disabilities to be actively involved in
support of the two-stage transitioning
process: home to ECD and ECD to and
through first grades of primary.

Provision of parent/
family orientation,
with special
emphasis on
intra-family/ domestic
violence prevention.

Support strengthening of family support

services (health, education, social,
religious, etc), to include specific services
for families with children with disabilities
and/or significant health problems
(utilising culturally appropriate strategies).
Support DPOs (especially organisations
of families with children with disabilities)
to provide peer (family-to-family) support.

Comments

Support of children with disabilities in the home and community

environments, within a social model approach, is critical during the
early years the first and most important space for promoting
development and inclusion. Direct and indirect methods for the timely
and sustainable provision of family support and information is essential
aiming to guarantee unified messages and content between the
different service providers,

With the global push for inclusive education, starting young at the ECD
level is a critical step towards preparing young children for inclusion at
the primary level. At the same time, children without disabilities
become more aware and open to diversity and peers with disabilities.
But efforts must be made to prepare ECD and primary education staff
for the inclusion process, along with strengthening family
competencies for supporting process.
Innovative communication, play and theatre strategies also exist to
prepare preschool students without disabilities, for the inclusion
process ( e.g. Kids on the Block USA and in some additional
countries, ECD-TV Laos, Turma do Bairro in Brasil and others)

Research has shown the link between disability and poverty for
families. In addition, the increase in stress in the home for those with a
person with disability is well- documented. Experiences demonstrate
the importance of parent-led organisations promoting and providing
peer-to- peer support. Although limited experiences have been
achieved in the region to develop more culturally appropriate strategies,
efforts should also be made to explore the most appropriate actions
with indigenous leaders and families.

UNICEF Brazil 2016/3760U Marcelino

Pre-school years

Life-cycle
Stage

EXAMPLES OF POTENTIAL MAINSTREAMING OF DISABILITY COMPONENTS

BUILDING ON REGULAR PROGRAMMING

Primary school years

Life-cycle
Stage

EXAMPLES OF POTENTIAL MAINSTREAMING OF DISABILITY COMPONENTS

BUILDING ON REGULAR PROGRAMMING
Regular
programme actions
for priority
populations

Examples of additional disability-specific

actions that can be mainstreamed into regular
programming

Comments

Actions to reach and

enrol all children
(OOSC Initiatives)

For all OOSC or similar initiative components,

include topic/ situation of children with
disabilities as a priority
Incorporate specific institutional, media and
community-based strategies to identify children
with disabilities who are out-of-school and
document reasons for non-enrolment.

UNESCO statistics estimate that around 30 per cent of

children out-of-school have a disability. EFA and MDG
goals will not be met if children with disabilities are not
included.
Inclusive education is gaining importance in the design and
implementation of strategies to reach and include excluded
groups (not just children with disabilities).

Specific actions
aimed at attacking
repetition and
drop-out , while
improving learning

Promote inclusive education (which focuses on

all aspects of diversity including children with
disabilities), along with addressing all forms of
accessibility and parent involvement.
Strengthen strategies that promote
child-centred learning strategies that benefit all
children including those with special education
needs. and/or disabilities. Attention should be
given to the design of culturally appropriate
methodologies.
Support the inclusion of and attention to children
with disabilities as part of pre- to primary
transitioning (involving families in the process).
Expand hearing and vision screening in school
environments and surrounding communities,

Initiatives focusing on
child labour and
education

Initiatives focusing on
diversity and
education

Include in child labour initiatives, aspects

pertaining to: prevention of disabilities (caused
by child labour); assistance to children with
disabilities (caused by child labour) use of
children with disabilities for begging money;
inclusion of children with disabilities as part of
flexible curriculum use.
Support the incorporation of disability
components in actions focusing on diversity in
education (ie. bilingual multicultural).
Support the application of the Inclusion Index for
promoting and monitoring services for
responding in an appropriate way to diversity
and guaranteeing all forms of accessibility.

Promotion of
child-friendly school
models (or similar
strategies)

Strengthen inclusive education strategies within

CFS efforts, with emphasis on child-focused
actions and participation.
Include design and monitoring components
pertaining to all forms of accessibility in CFS and
other similar school models for programme,
development, training and monitoring.
Reinforce actions to prepare and include
students, parents and other family members in
the design and monitoring of
educational/learning processes, based on an
inclusive education approach.

Expansion of other
learning strategies
and opportunities

Expand the incorporation of children with

disabilities in extra and/or out-of-school activities
sports, school tutoring, cultural, (as part of
learning process and inclusion)
Expand the use of ICTs as part of the
educational/ learning process in the school
setting and other learning spaces.
Build on strategies like Special Olympics and
similar initiatives to expand learning and
participatory opportunities, while promoting
more interaction between children with and
without disabilities

44

Past and existing strategies to reach excluded and/or

vulnerable children (working, from poor families living in rural
areas, of indigenous families, with disabilities) often have
been undertaken in isolation or parallel to other initiatives.
But inclusive education strategies and CFS model
development based on a rights approach and child-centred
focus will benefit all children.
Key areas that need to be considered in this section but
are often neglected are related to: active participation of
children and adolescents with disabilities; participation of
families; attitude of school staff and peers (students at all
levels); all forms of accessibility; and bullying/violence
against the most excluded children.
Strengthening the involvement of parents and other family
members is critical to support the learning process in the
home environment. Education staff should be aware of
parent and family expectations for the childs capacity to
learn, in order to guarantee that those closest to the child
will provide positive support and encouragement.

Globally and in the LAC region, increased emphasis has

been placed on expanding and/or strengthening
programmes/ initiatives that offer additional learning spaces
and opportunities, through the use of community settings
and sports, recreation, and cultural activities. These spaces
are also critical for providing additional learning experiences
for children with disabilities and to promote opportunities
and skill building for inclusion.

Cross-cutting Years

Life-cycle
Stage

EXAMPLES OF POTENTIAL MAINSTREAMING OF DISABILITY COMPONENTS

BUILDING ON REGULAR PROGRAMMING
Regular
programme actions
for priority
populations

Examples of additional disability-specific

actions that can be mainstreamed into regular
programming

Promotion and
monitoring of Child
Rights (CRC) and
(CRPD)

As part of promoting the CRC, include advocacy

initiatives on the rights of children with
disabilities (Art. #23).
Agencies (like UNICEF) should include
promotion and advocacy of the CRPD, linked to
the CRC.
Strengthen monitoring processes for CRC and
CRPD initiatives, including specific attention to
articles directly related to the rights of children
with disabilities, along with those targeting
education and health rights.

In the past, limited efforts have been made to highlight

article 23 of the CRC, which pertains to rights of children
with disabilities. With the adoption of the CRPD, efforts
should be made to advocate for compliance, linked to the
CRC.

Monitoring situation
of children and
adolescents

Guarantee that information is included on the

prevalence of children with disabilities in SITANs,
along with more detailed information on the
level and quality of provision of education and
health services for these children and their
families.

The lack of inclusion of information on and monitoring of the

situation of children with disabilities represents a major gap
for promotion, monitoring and reporting on the CRC and
CRPD especially for programming technical and financial
cooperation.

Actions of disaster
risk reduction

Include content in DRR planning and material

development on rights of children and
adolescents with disabilities, and actions
required for these children and their families.

Persons with disabilities especially children and

adolescents are at extreme risk in situation of disaster,
conflict and emergency. DRR planning and training should
include specific components related to children and
adolescents with disabilities, including the required family
support.

Include disability components within DRR

training and materials development, focusing on
children with disabilities and their families.
Strengthen
parent/family
participation and
support

Capacity-building/staff
preparation (for all
levels)

Comments

More attention should be given to link the two monitoring

processes especially for related articles with increased
involvement of children and adolescents with disabilities and
their families in monitoring and evaluation.

Strengthen parent/family competency-building

efforts and participation through existing parent
spaces/opportunities in education and health.
Advocate for the incorporation or strengthening
of specific components for children with
disabilities and their families, as part of existing
or emerging social safety net initiatives.
Support the expanded role, involvement and
capacity building of organisations/ associations
of families with children with disabilities to
strengthen peer (family-to-family) support,
empowerment and monitoring of CRPD.

The crucial role of family support to childrens development

and learning is well researched. For children with disabilities,
the home environment is particularly crucial to
developmental and inclusion processes, during the early
years and beyond.

Incorporate elements related to rights (CRC &

CRPD), inclusion, and disabilities (including
aspects related to parent support), in all staff
training actions for health and education and for
all levels of interventions and inclusion.
Provide training on aspects related to ECD,
regular education rights stipulated in the CRC
and international commitments (EFA, MDGs) for
special education and rehabilitation staff.
Target awareness and capacity-building efforts
for key individuals at policy and legislative levels,
along with leaders and institutions in the
communication world (media) who influence
public opinion, awareness and actions.

The promotion and implementation of more inclusive and

rights-based strategies for children at risk and/or with
disabilities requires more extensive staff and public
capacity-building efforts. This is essential if more sustainable
progress is to be made.

45

The expanded use of social safety nets in LAC is significant

but does not always include children with disabilities and
their families. This should be re-considered, based on
experience in the region.
Discussions are required to review the types and forms of
parent organisation involvement in support of CRPD and the
capacity-building assistance required.

Training should aim at preparing those who work with

children with disabilities, as well as with individuals working
in regular health and education services.
In addition, more work should be undertaken with other
critical actors involved in legislative processes, policy making
and budgetary allocations. Preparing and mobilising the
wide range of media/ communication partners is also
essential.

5.8. Entry Points building on existing

actions at different operational and
policy levels

This expanded partnership also requires the active

participation of children and adolescents with disabilities and
their families, along with other individuals from their home,
ECD, school (learning), health, and community
environments. In the LAC region, increasing importance is
being given to strengthening ECD and disability actions at
the municipal level, where the promotion of more integrated
sector actions with local support and participation is feasible.
The design and implementation of solutions and strategies
at all levels require the appropriate attitudes, opinions, vision
and participation of those most involved children,
adolescents and adults with disabilities, along with their
families. The slogan nothing about us without us
expresses the profound change required.

The development and implementation of sustainable,

inclusive ECD policies and strategies for young children with
disabilities and their families require efforts at all policy and
operational levels with specific emphasis on home and
community environments. UNICEF cooperation plans
normally include multiple levels of interventions and support,
with a vision that local actions can serve as an important
field-testing and learning experiences to feed into
sub-national and national policy development, advocacy and
mobilisation, inter-sectoral coordination and capacity-building
efforts. An expanded partnership between government,
NGO, DPOs, civil society, media and other actors at all
levels, including the implementation of cross-cutting
communication and capacity-building actions, is critical to
addressing the multiple issues and commitments framed
within the CRC, CEDAW and CRPD.

Considering and connecting actions across all operational and policy levels

nd

Pa
r

al
nic
ch
te

xtended
ts E
Fa
en

edia
rch, m
chu
y,
et
ci

cation, health,
civ
edu
s
il s
ice
o
v
er

ily
m

Nati
ona
l: L
eg
Sub-na
isl
tion
at
al l
io
ev
n,
el
p
p
i
a
c
(
i
l
:
n
coord
St
Mu
ina
at
tio
e,
n,
bu
d
Community:
Lo
ca
lS

d
an

dia
me
rt,
po
t, media
up
ppor
ls
l su
ica
ca
n
ni
ch
ort media
te
supp

information s
dgets,
yste
, bu
ms
s
d
r
, tr
a
ain
nd
a
t
ing
s
,
s
,t
e
i
ec
d
g
ic
ent): Bu et, training
h
m
t
ol
r
,
a
s
p
up
De
e
,
r
vis
ce
in
io
n
ov
r
P
staff, training, s
upe
and
es
rvi
c
i
v
sio
r
e
n
,s
t
a
e
g

Child

Along with important national

actions, an emerging tendency is
seen to advance through
coordinated inter-sectoral
government civil society efforts at
the municipal or district level. This
emerging trend offers an increasing
opportunity to advance in more
integrated and inclusive ECD
approaches - across the early
stages of the life-cycle and
addressing the multiple health,
education and protection issues,
using a rights-based approach,
framed in the CRC and CRPD.
However, more is required to
prepare and create the quality and
inclusive development, learning
and protective environments that
will guarantee rights fulfilment,
especially during the early years.
Strengthening municipal or local
capacity is an essential component,
along with monitoring of progress
and disseminating results.

Challenge: to create the requiered supportive environments at all levels to guarantee a sustainable approach to rights
fullfilment, child development and inclusion for all children, including those with disability.

46

Conclusions

Internally, all UNICEF staff will need to have a more in-depth

understanding of the multiple topics related to early
childhood development and disabilities, linked to UNICEFs
programme areas and outcomes. In addition, steps are
required to strengthen programme competencies and
internal coordination between programme sections for
programming and implementing disability mainstreaming
strategies as part of country priorities. Finally, the
participation of all staff members as active advocates and
mobilisers for advancing this process is essential,
recognising that each UNICEF staff member plays an
important role in promoting appropriate attitudes and actions
within their field of influence.Externally, partnerships with
other agencies, donors, government counterparts and civil
society leaders are crucial to achieving sustainable results for
children and adolescents with disabilities. UNICEF staff can
make a difference through concrete actions and efforts to
coordinate with and mobilise others.

The LAC region is experiencing a gradual increase in public

awareness concerning the situation of persons with
disabilities, along with the expansion of actions addressing
the exclusion of children with disabilities and their families.
Parallel to this window of opportunity for the most
excluded is the growing commitment of LAC countries to
strengthen ECD policy development and programme
implementation, based on clear evidence supporting
sustainable investments and actions for this age group.
However, positive trends witnessed globally and in the
region have not necessarily resulted in more integrated
actions to reach and include younger children with
disabilities and their families. More targeted interventions
are required to promote synergy between these parallel
processes and guarantee sustainable inter-sectoral efforts,
with the participation of all stakeholders.

This document along with the recently prepared

WHOUNICEF publication Early Childhood Development
and Disability: A discussion paper should not be
considered as final stand alone products. These are
merely initial efforts by UNICEF and WHO, along with other
partners, to advance the discussions, planning and action on
issues related to disability, early childhood development and
early intervention. As a first step, these guidelines focus on
efforts in the LAC region, with the potential for modifying
the content and structure to better fit needs and demands
for global actions.

The existence of clear international commitments framed

within the CRC and CRPD, along with other development
goals outlined in EFA and the MDGs, offer an opportune
moment to make meaningful progress. At the global level,
UNICEF and other agencies have demonstrated significant
institutional commitment. For UNICEF, involvement during
the CRPD design and ratification process reignited
involvement in the disability field, as reflected in the topic
selected for UNICEFs 2013 State of the Worlds Children
report and on-going efforts to expand external partnerships
and strengthen internal programme capacity.

It is imperative to remember that: The inclusion of children

with disabilities is not a charitable act, but a matter of rights
to which UNICEF is bound by both the CRC and our
mandate.46

Translating this expressed desire into action, as an integral

part of UNICEFs country programming process, will require
both internal and external mainstreaming efforts in line with
international commitments, taking into account past country
programme results in line with 2006-2013 MTSP targets
while transforming present and future actions within the
equity framework of the new UNICEF Strategic Plan
(2014-2017).

47

Annex 1: Selected Bibliography and

References
Reference documents used for study:

Fundacin Saldarriaga Concha, Background information

from website,
<http://www.saldarriagaconcha.org/noticias-detalle.php?id
n=126>.

Booth, T., M. Ainscow, and D. Kingston, Index for

Inclusion: Developing Play, Learning and Participation in
Early Years and Childcare, Centre of Studies for Inclusive
Education, Bristol, United Kingdom, 2006.

Gerner de Garcia, B., Gaffney, C., Chacon, S., and Gaffney,

M., Overview of newborn hearing screening activities in
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(3), 2011.

Booth, T., M. Ainscow, and D. Kingston, Index para la

Inclusin Desarrollo del juego, el aprendizaje y la
participacin en Educacin Infantil, Editado y Producido
para el Reino Unido por CSIE (Centro de Estudios para la
Educacin Inclusiva), traduccin y adaptacin al castellano
en 2007 por: Francisca Gonsles-Gil, Mara Gmes-Vela y
Cristina Jenaro, 2007.

Government of Chile, Chile Crece Contigo: Presentation:

Sistema de Proteccion Integral a la Infancia Programa
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Borrajo, G. J. C., Newborn screening in Latin America at

the beginning of the 21st century, Journal of Inherited
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International Disability Alliance and International Disability

and Development Consortium, Position Paper: Make the
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Cappa, C., E. Loaisa, Measuring Childrens Disability via

Household Surveys The MICS Experience (Paper
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Kolucki, Barbara, A review of research about media and

Disability: Does it make a difference, Disability World, No
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<www.disabilityworld.org/06-08_03/arts/currentresearch.s
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Cappa, C., and A. MacKensie, Presentation: Child

Disability: definitions, models, measures, estimates and
implications of data collection. UNICEF, New York, 2012.
CBM, Make Development Inclusive: How to include the
perspectives of persons with disabilities in the project
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<www.inclusive-development.org/cbmtools/part1/resourc
es.htm>.

Kolucki, Barbara, High Praise for Disability- Inclusive Early

Childhood Campaign in Maldives, Disability World, No. 26,
December 2004-February 2005,
<www.disabilityworld.org/12-02_05/children/maldives.sht
ml>.

Centre for Community Child Health, Royal Childrens

Hospital, New Frontiers in Early Childhood Inclusion,
Noahs Ark and Centre for Community Child Health,
Melbourne, 2002.

Lansdown, Gerison, The Right of Children with Disabilities

to Education: A Rights-Based Approach to Inclusive
Education (Position Paper), UNICEF Regional Office for
CEECIS, Geneva, 2012.

Department for International Development, Disability,

Poverty and Development, DFID Issues Document,
United Kingdom, 2000.

Lansdown, Gerison, Using the human rights framework

to promote the rights of children with disabilities:
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CRC, CRPD and CEDAW, UNICEF, New York, 2013.

Ferrer, Eneida, and Ferro, Adriano, Estudio del Marco

Legal, Polticas Pblicas, Programas y Buenas Practicas
para Nios y Nias con Discapacidad dentro de los
Sectores de Educacin y Salud en Panam, Oficina
Regional de UNICEF para Amrica Latina y el Caribe,
Panam, 2012.

Los Pipitos, History and Programmes of Los Pipitos,

Nicaragua, 2012, <www.lospipitos.org>.
Lumpkin, G., The CRPD and Initial Thoughts on
Implications for Early Childhood Care & Development,
Rehabilitation International and UNICEF, One in Ten, vol.
26, 2008.

Fundacin Saldarriaga Concha, Propuesta Tcnica

Fundacin Saldarriaga Concha: Educacin Inclusiva desde
la Primera Infancia, Fundacin Saldarriaga Concha, Bogot,
Colombia, 2012.

48

Lumpkin, G., Study of Disabilities and Services for Children

in Central America Frameworks, Past History, Situation,
Tendencies, Challenges and Recommendation for
UNICEF, Discussion Document (unpublished), UNICEF
Latin America and Caribbean Regional Office, Panama,
2008.

Richler, D., The Exclusion of Families of Children with

Disabilities: A Case Example, Good Practices in Family
Policy Making: Family Policy Development, Monitoring
and Implementation: Lessons Learned, UN DESA Social
Policy and Development Division, 2012,
<www.un.org/esa/socdev/family/docs/egm12/PRESENTA
TION-RICHLER.pdf>.

Lumpkin, G., Inclusive Education for Children with

Disabilities: Linking with Child Friendly Schools, UNICEF
Latin America and Caribbean Regional Office, Panama,
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49

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End notes

1. World Health Organization and United Nations Childrens

Fund, Early Childhood Development and Disability: A
discussion paper, WHO, UNICEF, Geneva, 2012, p. 1.

United Nations, Economic and Social Council, UNICEF

Executive Board, The UNICEF Strategic Plan, 2014-2017,
(E/ICEF/2013/21), United Nations, New York, New York,
2012.

2. Centre for Community Child Health, Royal Childrens

Hospital, New Frontiers in Early Childhood Inclusion,
Noahs Ark and Centre for Community Child Health,
Melbourne, 2002, p. 2.

United Nations, Economic and Social Council, UNICEF

Executive Board, Annex: Supporting document to the
UNICEF Strategic Plan, 2014-2017, (E/ICEF/2013/21/Add.1),
United Nations, New York, 2012.

3. World Health Organization and United Nations

Childrens Fund, op. cit., 2012, p. 3.

50

4. United Nations Childrens Fund, Three Disability Goals,

UNICEF New York, 2013,
<www.unicef.org/disabilities/index_65297.html>.

18. United Nations Childrens Fund, op. cit., 2007, p. 4.

5. United Nations Economic and Social Council, UNICEF

Executive Board, The UNICEF Strategic Plan, 2014-2017,
(E/ICEF/2013/21), New York, 2012, p. 5.

20. United Nations Educational, Scientific and Cultural

Organization,
<http://portal.unesco.org/education/en/ev.php-URL_ID=38
522&URL_DO=DO_TOPIC&URL_SECTION=201.html>.

19. Ibid, p. 5.

6. World Health Organization and United Nations Childrens

Fund, Care for Child Development Kit - Improving the Care
of Young Children (Modified version for LAC), WHO,
Geneva, 2013, p. 1.

21. Global Partnership for Education, Strategic plan

2012-2015, 2012, p. 14,
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gic_Plan_2012-2015_English.pdf>.

7. World Health Organization and United Nations Childrens

Fund, Care for Child Development Kit Content and
Acknowledgement (Modified version for LAC), WHO,
Geneva, 2013, p. 2.

22. United Nations Childrens Fund Guatemala, Strategies

for combatting Childhood Disability: The Decade of the
Disabled in Central America (19831992), UNICEF Area
Office for Central America, Guatemala, 1995, p. 1.

8. World Health Organization and World Bank, World Report

on Disability, WHO, Geneva, 2011, p. 36.

23. United Nations Economic and Social Council, op. cit.,

2012, p.5.

9. World Health Organization, Developmental Difficulties in

Early Childhood Prevention, early identification,
assessment and intervention in low- and middle-income
countries (A Review), WHO, Geneva, 2012, p. 14.

24. World Health Organization and World Bank, op. cit.,

2011, pp. 264-68.
25. United Nations Childrens Fund, The State of the
Worlds Children: Children with Disabilities (Executive
Summary), UNICEF, New York, 2013, pp. 21-25.

10. Ibid, p.14-16.

11. World Health Organization and World Bank, World
Report on Disability WHO, Geneva, 2011, p. 30.

26. World Health Organization and United Nations

Childrens Fund, op. cit., 2012, pp. 32-33.

12. Department for International Development, Disability,

Poverty and Development, DFID Issues Document, DFID,
United Kingdom, 2000, p. 4.

27. Vargas-Baron, Emily, Janson, Ulf, and Mufel, Natalia,

Early Childhood Intervention, Special Education and
Inclusion: Focus on Belarus, UNICEF Regional Office for
CEE/CIS, Geneva, 2009, p. 9.

13. World Health Organization, Developmental Difficulties

in Early Childhood Prevention, early identification,
assessment and intervention in low- and middle-income
countries (A Review), WHO, Geneva, 2012, p. 21.

28. Convention on the Rights of Persons with Disabilities,

United Nations, Geneva, 2006,
<www.ohchr.org/EN/HRBodies/CRPD/Pages/Convention
RightsPersonsWithDisabilities.aspx>.

14. Lansdown, Gerison, Using the human rights framework

to promote the rights of children with disabilities:
Discussion Paper An analysis of the synergies between
CRC, CRPD and CEDAW, UNICEF, New York, 2013, p. 8.

29. National Association for the Education and Young

Children and Division for Early Childhood, Early Childhood
Inclusion: A Joint Position Statement of the Division for
Early Childhood (DEC) and the National Association for the
Education of Young Children (NAEYC), Washington, D.C.,
2009,
<www.naeyc.org/files/naeyc/file/positions/DEC_NAEYC_E
C_updatedKS.pdf>.

15. World Health Organization and United Nations

Childrens Fund, op. cit., 2012, p. 8.
16. United Nations Childrens Fund, Programme Guidelines
Children with Disabilities Ending Discrimination and
Promoting Participation, Development and Inclusion,
UNICEF, New York, 2007, p. 3.

30. World Health Organization, CBR: A strategy for

rehabilitation, equalisation of opportunities, poverty
reduction and social inclusion of people with disabilities:
joint position paper ILO, UNESCO, WHO, Geneva, 2004,
p. 2.

17. For a detailed discussion of the Disability Convention

please see the Innocenti Digest on The Rights of Children
with Disabilities, Innocenti Research Center, 2007, pp.
14-18.

51

31. World Health Organization, Community-based

Rehabilitation, CBR Guidelines, CBR Matrix, WHO
Geneva, 2010,
<www.who.int/disabilities/cbr/guidelines/en/>.

42. United Nations Secretariat for the Convention on the

Rights of Persons with Disabilities, United Nations
Inter-Agency Support Group for the Convention on the
Rights of Persons with Disabilities, Joint Statement of
Commitment to the Convention, United Nations, New
York, 2007, pp. 5-7.

32. United Nations Childrens Fund (2007), Promoting the

Rights of Children with Disabilities, Innocenti Digest No.
13 UNICEF Innocenti Research Centre, Florence, 2007,
pp. 5,17.

43. United Nations Childrens Fund, Civil Society

Partnerships What does UNICEF means by equity
approach?, UNICEF, New York, 2003,
<www.unicef.org/about/partnerships/index_60239.html>.

33. Authors conversation with Barbara Kolucki.

34. Kolucki, Barbara, High Praise for Disability- Inclusive
Early Childhood Campaign in Maldives, Disability World,
no. 26, December 2004-February 2005,
<www.disabilityworld.org/12-02_05/children/maldives.sht
ml>.

44. United Nations Childrens Fund, Programme

Guidelines Children with Disabilities Ending
Discrimination and Promoting Participation, Development
and Inclusion, UNICEF, New York, 2007.
45. World Health Organization, Developmental Difficulties
in Early Childhood: Prevention, early identification,
assessment and intervention in low-and middle-income
countries, WHO, Geneva, 2012.

35. World Bank, Communication and Disability, World

Bank, 2010, Washington D.C.,
<http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/E
XTSOCIALPROTECTION/EXTDISABILITY/0,,contentMDK:
22239124~menuPK:3699345~pagePK:210058~piPK:210
062~theSitePK:282699,00.html>.

46. United Nations Childrens Fund, op. cit., 2007, p. 22.

36. Richler, D. (2012), Presentation on The Exclusion of

Families of Children with Disabilities: A Case Example at
Expert Group Meeting on Good Practices in Family Policy
Making: Family Policy Development, Monitoring and
Implementation: Lessons Learnt, UN DESA Social Policy
and Development Division, 2012.
37. Convention on the Rights of Persons with Disabilities,
2006.
38. The major portion of this programme section was
taken and adapted from Chapter six of final draft of the
UNICEF LACRO document Legal Frameworks, Policies,
Programmes and Practices for Children and Adolescents
with Disabilities in the Latin American and Caribbean
Region An Overview of the Regional Situation and Ideas
for Action, UNICEF, Panama, 2013.
39. United Nations Childrens Fund, Mission Statement,
UNICEF, New York,
<www.unicef.org/about.who/index_mission.html>.
40. United Nations Childrens Fund, Using the human
rights framework to promote the rights of children with
disabilities: Discussion Paper An analysis of the
synergies between CRC, CRPD and CEDAW, UNICEF,
New York, 2013.
41. CBM, Make Development Inclusive How to include
the perspectives of persons with disabilities in the project
cycle management guidelines of the EC, CBM, EC, 2008,
p. 24.

52

UNICEF_UNI134954_Dormino

In countries the world over children with disabilities and their families
continue to face discrimination and are not yet fully able to enjoy their basic
human rights. The inclusion of children with disabilities is a matter of social
justice and an essential investment in the future of society. It is not based on
charity or goodwill but is an integral element of the expression and realization
of universal human rights
Innocenti Digest No. 13, Promoting the Rights of Children with Disabilities, Florence, 2007.