State of the World's Children 2013 - Unicef

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to education, immunization or nutritional supplementation for children with disabilities. Regular monitoring makes it possible to assess whether initiatives designed to benefit children are meeting their goals. There is a clear need to harmonize child disability measurement in order to produce estimates that are reliable, valid and internationally comparable. This would facilitate appropriate policy and programmatic responses by governments and their international partners, and thus fulfil a requirement of the Convention on the Rights of Persons with Disabilities. However, the currently fragmented state of child disability data collection is no excuse to defer meaningful action towards inclusion. As new data and analyses emerge, they will present opportunities to adapt existing and planned programmes for children with disabilities and their families. A way forward UNICEF is holding consultations to improve the methodology used to measure child disability in Multiple Indicator Cluster Surveys and other data collection efforts. This work is taking place in partnership with the Washington Group on Disability Statistics, national statistical offices and data collection agencies, academics, practitioners, disabled people’s organizations and other stakeholders. Partnership is seen as essential to achieving a reliable and globally relevant monitoring and reporting system on child disability. The Washington Group was established in 2001 under United Nations sponsorship to improve the quality and international comparability of disability measures. It has developed or endorsed questions on disability in adults that have been used by several countries in censuses and surveys and, in 2010, began work on developing a set of questions to measure functioning and disability among children and youth. Work by UNICEF and the Washington Group to develop a screening tool that reflects current thinking on child functioning and disability is based on the conceptual framework of the World Health Organization’s International Classification of Functioning, Disability and Health for Children and Youth. The screening tool under development focuses on limitations to activity and is intended to serve the purposes of any individual country in identifying those children at risk of social exclusion and reduced social participation in family life or education, for example. The collaborative effort aims to develop a survey module on child functioning and disability that would produce nationally comparable figures and promote the harmonization of data on child functioning and disability internationally. The module covers children aged 2–17 years and assesses speech and language, hearing, vision, learning (cognition and intellectual development), mobility and motor skills, emotions and behaviours. In addition to these relatively basic types of activity, the screening tool also includes aspects of children’s ability to participate in a range of activities and social interactions. Rather than rely on a simple yes/ no approach, these aspects are to be assessed against a rating scale, to better reflect the degree of disability. Also in development is a standardized overall methodology for a more in-depth assessment of disability in children. This will consist of data collection protocols and assessment tools, as well as a framework for the analysis of findings. Recognizing that specialists may be in short supply in some areas, a toolkit is being designed to enable teachers, community workers and other trained professionals to administer the new methodology. This will serve to strengthen local capacity to identify and assess children with disabilities. 68 THE STATE OF THE WORLD’S CHILDREN 2013: Children with Disabilities
FOCUS Lessons learned Since 1995, UNICEF has supported countries in tracking progress in key areas of children’s and women’s wellbeing through the Multiple Indicator Cluster Surveys (MICS). These nationally representative household surveys have been conducted in more than 100 low- and middle-income countries, and some have included a module designed to screen child disability. This information is now being built upon to design an improved measurement tool to assess child disability. Disability became part of the MICS questionnaires in 2000– 2001 (MICS2). Since then, data on disability have been collected through more than 50 surveys, making the MICS the largest source of comparable data on child disability in lowand middle-income countries. The standard disability module included in MICS surveys conducted between 2000 and 2010 is the Ten Questions Screen (TQ), which was developed as part of the International Pilot Study of Severe Childhood Disability in 1984. Its design reflects how disability was understood and measured at the time. The TQ process starts with an interview with the primary caregivers of children aged 2–9 years, who are asked to provide a personal assessment of the physical and mental development and functioning of the children under their care. Questions include whether the child appears to have difficulty hearing; whether she or he seems to understand instructions, has fits or loses consciousness; and whether she or he was delayed in sitting, standing or walking compared to other children. Response categories do not accommodate nuances, and children are classified as screening positive or negative to each question. The validity of the Ten Questions approach has been widely tested, but results must be interpreted with caution. The TQ is a screening tool, and requires follow-up medical and developmental assessment in order to yield a reliable estimate of the number of children in a given population who have disabilities. Children who have a serious disability are very likely to screen positive, but some who screen positive may be found to have no disability on further evaluation. Some children who screen positive may do so because of temporary health conditions that can be easily treated. Although the TQ comes with a recommendation that it be followed by an in-depth assessment, few countries have had the budgets or capacity to conduct the secondstage clinical assessment to validate results, and they have been further hampered by the lack of a standardized methodology for conducting the assessment. Applying the Ten Questions Screen during the 2005–2006 MICS yielded a wide range of results across participating countries: The percentage of children who screened positive for disability ranged from 3 per cent in Uzbekistan to 48 per cent in the Central African Republic. It was not clear whether this variance reflected true differences among the populations sampled or additional factors. For instance, the low reported rate in Uzbekistan might have reflected, among other things, a large population of children with disabilities living in institutions, which are not subject to household surveys. MEASURING CHILD DISABILITY 69
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THE STATE OF THE WORLD’S CHILDREN
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THE STATE OF THE WORLD’S CHILDREN
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FOREWORD Is there a child who does
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FOCUS Violence against children wit
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CHAPTER 1 INTRODUCTION Reports such
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Under the Convention on the Rights
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People with disabilities are becomi
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Education is the key to stopping th
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(continued from p. 3) the right to
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CHAPTER 2 FUNDAMENTALS OF INCLUSION
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hierarchy and traditional expectati
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to education and health-care servic
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Page 65 and 66: FOCUS (continued) Child casualties
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Page 71 and 72: CHAPTER 6 MEASURING CHILD DISABILIT
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TABLE 5 EduCATION Countries and are
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TABLE 6 dEmOGRApHIC INdICATORS Coun
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TABLE 6 dEmOGRApHIC INdICATORS Coun
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TABLE 7 ECONOmIC INdICATORS Countri
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TABLE 7 ECONOmIC INdICATORS Countri
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TABLE 8 WOmEN Countries and areas L
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TABLE 8 WOmEN Countries and areas L
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TABLE 9 CHILd pROTECTION Countries
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TABLE 9 CHILd pROTECTION Countries
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TABLE 10 THE RATE OF pROGRESS Count
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TABLE 10 THE RATE OF pROGRESS Count
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TABLE 11 AdOLESCENTS Countries and
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TABLE 11 AdOLESCENTS Countries and
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TABLE 12 disparities by residence C
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TABLE 12 dISpARITIES By RESIdENCE C
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TABLE 13 dISpARITIES By HOuSEHOLd W
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TABLE 13 dISpARITIES By HOuSEHOLd W
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TABLE 14 EARLy CHILdHOOd dEVELOpmEN
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