Validating the UNICEF/Washington Group Child Functioning Module for Fijian schools to identify seeing, hearing and walking difficulties

Abstract

Purpose: This study investigated the seeing, hearing and walking questions of the UNICEF/Washington Group Child Functioning Module and the inter-rater reliability between teachers and parents as proxy respondents.

Methods: Cross-sectional diagnostic accuracy study, two-gate design with representative sampling, comparing Module responses to reference standard assessments for 472 primary aged students in Fiji. Receiver operating characteristic curves were constructed to determine the area under the curve and optimal cut-off points.

Results: Areas under the curves ranged from 0.823 to 0.889 indicating “good” diagnostic accuracy. Inter-rater reliability between parent and teacher responses was “good” to “excellent”. The optimal cut-off determined by the Youden Index was “some difficulty” however a wide spread of impairment levels were found in this category with most children either having none or substantial impairments.

Conclusions: The diagnostic accuracy of the Module seeing, hearing and walking questions appears acceptable with either parents or teachers as proxy respondents. For education systems, use of the cut-off “some difficulty” with accompanying clinical assessment may be important to capture children who require services and learning supports and avoid potentially misleading categorization. Given the high proportion of the sample from special schools research is required to further test the Module in mainstream schools.

Implications for rehabilitation

• Identification of children who are at risk of disability in Fiji is important to enable planning, monitoring and evaluating access to quality inclusive education.

• The UNICEF/Washington Group Child Functioning Module appears to be a practical and effective tool that can be used by teachers to identify children at risk of disability.

• Children identified on the UNICEF/Washington Group Child Functioning Module as having “some difficulty” or higher levels of difficulty in relation to vision, hearing or walking should be referred for further assessment and services.

• Rehabilitation services in Fiji need to prepare for greater numbers of referrals as the Ministry of Education increasingly rolls out the inclusive education policy, which includes identification by schools of children at risk of disability.

Keywords:

• Child disability
• disability disaggregation
• inclusive education

Acknowledgements

The authors wish to sincerely thank the staff, families and students of the many schools involved in the study, partner agencies Pacific Disability Forum and the Pacific Islands Forum Secretariat, the Access to Quality Education Program, as well as Sally Baker, Colin Connelly, Mereoni Daveta, Bianca Murray, Litea Naliva, Merelesita Qeleni, Kitione Ravulo, Kitione Rawalai, Mereia Siganisucu, Roya Speight, Koini Vakasokomoce, Luisa Vuqele, Isimeli Waqa and Larissa Waters for their tremendous assistance with the study and resolute commitment to increasing access to education for children with disabilities.

Disclosure statement

The authors report no declarations of interest. The costs of field work for this study were supported through two programs funded by the Australian Government Department of Foreign Affairs and Trade: (1) the Australian Development Research Awards Scheme under an award titled Developing and testing indicators for the education of children with disability in the Pacific; and (2) the Access to Quality Education Program, Fiji.

The views expressed herein are those of the authors and not necessarily those of the Commonwealth of Australia. The Commonwealth of Australia accepts no responsibility for any loss, damage or injury resulting from reliance on any of the information or views contained in this publication.

Additional information

Funding

This work was supported by Department of Foreign Affairs and Trade, Australian Government [Grant No. 66440].