A visit report
In summer 2011, Tsad Kadima received an invitation from Dr. Clare Cheng, on behalf of the Social Service Guidance Centre of the CDPF (the Chinese Disabled Persons’ Federation) to participate in a Conductive Education Conference in China, concluding five year’s work of the first stage of the Cheung Kong New Milestone Project. I was invited to deliver a guest lecture on the evolution of Conductive Education in Israel, with emphasis on the latest development of adolescent programs, and impact on the model of cerebral palsy rehabilitation in Israel.
The Cheung Kong New Milestone Project is a joint venture of the CDPF and the Li Ka Hing Foundation, a charity fund in Hong Kong. The Project supports programme plans for the welfare of people with disability on a five-year term. The Project, ‘Rehabilitation of Children with Cerebral Palsy and Disability Prevention’, is one of the programme plans launched from 2007 to 2011. The Social Service Guidance Centre of the China Disabled Persons’ Federation was designated to deliver the Project, headed by the Vice-Director, Miss Cao. The Project aims at promoting Conductive Education, and helping the CDPF to establish thirty Conductive Education centres throughout China.
Tsad Kadima is nationally and internationally known as a best-practice model of implementing and developing Conductive Education outside of its motherland, Hungary, and as a source of knowledge, experience and inspiration for future plans and developments. As Tsad Kadima both welcomes and initiates joint ventures, partnerships, and knowledge-sharing and exchange, Mr Yossi Pinto, Tsad Kadima’s Executive Director, and Mrs Anete Mozes, Tsad Kadima’s Chairperson, approved the invitation, on behalf of our Board of Directors, and supported it professionally and financially
The conference, titled ‘Opportunity and Education’, was to be held on 26-27 December 2011, with three-day post-conference visits to six centres in two provinces and one metropolitan city, Shanghai.
Participants in the two-day conference were mostly professionals who practice Conductive Education in their centres, as well as physicians, directors, and representatives of the CDPF, Li Ka Shing Foundation, SAHK and others. I was the only overseas representative, as Ms. Anna Klein, a senior conductor and tutor from the International Pető Institute, unfortunately was unable to participate at the very last moment.
Lectures varied. The opening lecture was an account on the Cheung Kong New Milestone Project achievements and future, delivered by Dr Clare Cheng and Miss Cao Limin. Following on from this was a presentation from SAHK (Mr Ivan Su), a video from the Pető Institute (Prof Franz Schaffhauser), and my own presentation on the evolution and impact of Conductive Education in Israel. Then representatives from various rehabilitation centres, talked about their conductive experience. Among these, two lecturers talked about working with parents: Miss Yu Oi Ru, Director of the Provincial Rehabilitation Guidance Centre of Zhejiang Disabled Persons’ Federation, presented their Mother and Baby Group experience as a mode of early intervention, and Ms Liu Cai Hong, Deputy Director, Ji Nan Massage Hospital of Ji Nan Disabled Persons’ Federation, presented about the effect of Conductive Education on parents. Miss Tam Fung Lin, teacher from the John F Kennedy Centre of the Hong Kong Red Cross, lectured on how Conductive Education was integrated with the mainstream curriculum of Hong Kong. Others like Mr Gong Young, in charge of the CP Unit of the Guangdong Disabled Persons’ Rehabilitation Centre, and Ms Julianne Lo, the principal of Pinehill Number 3 School, Hong Chi Association, Hong Kong, talked respectively about the effect of Conductive Education on children with severe impairment, and the development of ‘body, psych and cognition’ in the education of children with severe impairment. Ms. Beverley Yiu, Senior Physiotherapist in the Central Kowloon Children Assessment Centre of Hong Kong, presented on the development profile of children with cerebral palsy.
Here are some striking data and background information, summarized from Dr Cheng and Ms Cao’s opening presentation:
- Although there are no complete official data on children with cerebral palsy in China, the estimated population under twelve years of age is 1,900,000, with an annual increase of 40,000 to 50,000 cases!!!
- An estimate of 72% of these children requires rehabilitation. The majority of them live in the less developed rural areas with difficulty of accessing to rehabilitation services.
- With the rapid migration of manpower to cities, quite a proportion of these children are left in the care of their grandparents.
- Institutes as well as professional personnel providing rehabilitation are inadequate in number, particularly in rural areas.
- Only about 14% of the total population of children with cerebral palsy receive rehabilitation, mostly in segregated approach.
- Special schools in China mainly provide special education for three types of disability, visual, hearing and intellectual. Children with cerebral palsy attempting to enrol in mainstream schools are basically required to be independent in mobility and self care.
- The concept of rehabilitation is poorly understood by parents of children with disabilities, due to the lack of public education in less developed rural areas. The majority of these parents seeks for medical cure in hospitals and can be exhausted of their resources in a few years, without any solutions. In the end, some of them probably give up.
- Parents of children with disabilities in China, tend to have low expectation for their children’s future.
The Project, Rehabilitation of Children with Cerebral Palsy and Disability Prevention, is an ambitious one, headed by two extraordinary, ambitious ladies, Ms Cao Limin, mentioned before, and Dr Clare Cheng, a physiotherapist, an Honorary Conductor since 2001, and today, an Honorary Consultant, volunteering in this China-wide project. With the long-term aim of creating a national network of Conductive Education for children with cerebral palsy, that will support their inclusion into society and provide a better opportunity for education, and the objectives of providing early screening, early intervention and early rehabilitation opportunities to children with cerebral palsy and their families, the following actions have been taken:
- Training 120 rehabilitation professionals
- Establishing thirty rehabilitation centres at the provincial level throughout China, adopting the Hong Kong model of Conductive Education
- Sponsoring 2000 children from poor families to receive Conductive Education at the provincial level throughout China for three months at these rehabilitation centres
- Establishing a system sustainable at the provincial level throughout China, by raising the rehabilitation standard for cerebral palsy at the county level through in-service training at the provincial level.
- Promoting early intervention through screening and public education on rehabilitation.
Here I should like to emphasise that for me the extraordinary interwoven achievements of this project are transforming rehabilitation centres currently working according to the medical model into centres providing comprehensive educational opportunities to children with cerebral palsy and their families. This is a real paradigm shift in service-delivery, in which physicians, therapists, nurses and teachers have abandoned the segregated individual therapeutic sessions, in which parents were left behind a closed door, and instead deliver comprehensive active group activities, throughout the day, together with parents (or grandparents), in which education and rehabilitation are unified.
What measures were taken to create this shift and enable the capacity-building of staff and family members, and network development?
In 2007, administrators and professionals from eight selected provinces in China were sent to the Jockey Club Marion Fang Conductive Learning Centre of SAHK in Hong Kong, to learn about Conductive Education. With the vision of the need to localise Conductive Education in Mainland China, the Dongguan Rehabilitation Centre, that has been both exposed to Conductive Education earlier and lies in the vicinity of Hong Kong, was chosen to become the practical base of capacity-building, and the place to host in 2008 the first course on Conductive Education principles and practice in the Chinese context, for staff from twelve provinces. Soon after, more rehabilitation centres and hospitals became practical bases of training, among these the Zhejiang Rehabilitation Centre, the Guangdong Rehabilitation Centre and the Ji Nan Massage Hospital.
As project consultant, Dr Cheng’s role was, and still is, to facilitate local practitioners to abide by the tenets of Conductive Education and yet encourage them to see themselves as owners of the system and enrich it with their own cultural, social and resource-specific practice. Those centres in which staff was identified as outstanding were empowered to be the trainers of new centres. The practice bases serve not simply for passing on knowledge and skills among local people but yet more as evidence and encouragement to get across the message that Conductive Education works within the Chinese social, cultural and resource context – and that it is also possible to get it done properly. With ownership of the system, its implementation and training, local administrators and practitioners actively seek for solutions to problems specific to China. A transdisciplinary team was trained for implementing Conductive Education through in-service training courses. Altogether, approximately four-hundred professionals attended these courses, therapists and educators being the majority. These trained professionals then delivered another in-service training upon their return to their service-units, or sent staff to the practical training bases. Attendance of 5,880 was reported for this follow-up in-service, training from twenty-seven centres within the project.
One can and should question what does the training courses comprise? What are the abilities of non-conductors to deliver practical courses on Conductive Education, and should they? What is the ‘price’ paid?
Returning home from a very intensive journey of six days in China, I had more questions than answers, which is good. I was a different kind of tourist this time, as I had not taken guided tours to those expected attractions of China but mainly to rehabilitation centres in the ‘Chinese land of Conductive Education’. I had to absorb and digest this intensive experience, while being constantly alert to the cultural and contextual variables, to limitations and opportunities. I took the tour, open-minded and optimistic, as Tsad Kadima’s staff and families always are, and did not fail.
I do not know much about the training course applied in China. My focus was on service-delivery. What I do know is that it is rather a short course (three weeks), comprising theoretical and practical elements of the conductive pedagogy, where Conductive Education is introduced as a frame of reference for service-delivery, and as a practice that offers pedagogical tools, through which mediated learning experience occurs. I also know that participants on these courses are from all disciplines, including rehabilitation doctors, neurologists, nurses, special education teachers, therapists and administrators. Along the years, the core training staff had been most instrumental in translating Conductive Education principle into a coherent educational experience and practice.
I also know that the pioneers, such as Dr Clare Cheng and her followers invested much time and creativity to study Conductive Education both at the Pető Institute’s short courses, back in 1989 as a source of knowledge and ‘know how’, as well as alongside development of the conductive services in China. The ties with Conductive Education go back to the days of the late educator, Dr Marion Fang, who was the school Principal of JFK Centre, and the one to introduce Dr Clare Cheng to Conductive Education. Others were also acknowledged for their contribution to the development of Conductive Education in China. Altogether, six professionals from Hong Kong have received the Honorary Conductor Award from the Senate of the Pető Institute and College for Conductor Training: Dr Marion Fang, Dr Clare Cheng, Sister Joan O’Connor, Mr. Ivan Su, Mr. Chris Kan, and Ms. Edith Yeung.
I had interesting discussions with professionals involved in Conductive Education in China, who could easily articulate profound essences of the conductive system, and demonstrate it in practice. I saw with my own eyes a doctor conducting a beautiful communication program. I saw it, and could not believe it that it was happening. I wish that all of us who have practised Conductive Education for many years could do that in such a natural fashion as I experienced in China.
Nevertheless, the conductor is undoubtedly, an essential and most powerful means of providing Conductive Education and training conductors is essential for full provision of Conductive Education anywhere. Yet, while non-conductors’ delivering Conductive Education courses in China is a constraint, just imagine how many conductors would be needed there to fill the gap. How long would it take before they could provide conduction to the huge population in need, and the cost?
In Andrew Sutton’s recent post (January 2012), on his blog Conductive World, titled ‘If conductors are unaffordable luxury’, he writes:
‘…the benefits of Conductive Education will never be equably available through the direct agency of conductors working with groups and individuals to all who might benefit around the world. That is a service that only the already privileged will ever be able to afford. In other words, an effective global future for András Pető’s heritage might lie less with conductors, or even conductive pedagogy, and more with upbringing. Conductive Education may have to be down to parents who probably mean mothers in most cases…useful progress, however, will come only from practice’.
Sutton reminds us, of the Károly and Magda Ákos’s long-forgotten grand plan to spread Conductive Education across Germany, with very few conductors and a lot of mothers.
Following the two-day conference, we visited several rehabilitation centres which provide full-day Conductive Education. Among the thirty centres, fifteen provide a full day Conductive Education service, others for half a day or a few times a week only. We were welcomed very warmly in all places. The staff was enthusiastic and so were the children. Following an observation in each facility, we met with the staff to discuss the activities, raise questions and provide feedback. I served mainly as a curious student, learning most of the time, although I was also asked to offer some insights, which I did.
The most striking scene was the inclusion of parents or grandparents in the daily programmes, in most places that we observed. As to family members, the following should be noted: In most if not in all rehabilitation centres throughout China, children usually receive individual therapy sessions from different health professionals OT’s, PT’s, SLT’s, and Chinese medicine based on family and local resources. While the child is in treatment, parents (mostly mothers) or grandparents (mostly grandmothers), stay outside the therapy room and wait to take their children back home. Why not make use of this opportunity and include them as members of the team around the child, as both learners and teachers? Why not build their capacities, through participation, to turn daily routines into learning and development opportunities for the child, in a group context (group of children and group of adults)? In other words, why not teach them how to turn Conductive Education into conductive upbringing?
This is exactly what the. Cheung Kong New Milestone Project does.
‘Parents are the most important members of our Conductive Education team,’ said Dr Cheng, ‘Here in China, parents work with the children in all Conductive Education programs along the daily routine. In doing so the parents are trained to teach and encourage their children in all aspects of learning. Having the parents adopt this mode of rehabilitation was not uneventful. Conducting parent workshops was the common practice in parent education. All in all, the dedication of the staff to deliver good programs was the main factor to change the mindset of the parents and see the positive side of Conductive Education’
As the majority of the children come from rural areas and on short term basis, parent empowerment in both skill and attitude towards their children become vital to ensure a continuity of learning at home. Parents of children with disability are also a vulnerable group who requires support. In addition, parents’ emotional state and attitude towards their children contribute significantly to the family ecology where in turn affect the development of the children. In the conventional rehabilitation model in China, parents are excluded from the treatment of their children, literally. Parents are to wait outside the treatment rooms. With inclusion of parents in Conductive Education programmes, the staff has to learn to interact and support the parents. The positive change of the parents’ management of their own emotional state on one hand might reflect the positive effect of supportive group environment and, on the other hand, the improved skills of the staff in communicating with parents.
The family, in Tsad Kadima’s vision, is an absolutely central feature of what conductive upbringing should be. Yet good-enough mothers (parents), according to the psychoanalyst and paediatrician, Dr Donald Winnicot, should not satisfy all the needs of children on the spot, thus preventing them from development of their own. Rather, good-enough parents should leave some space, while giving children a sense of control, and enabling transition to a more autonomous position.
As noted by Dr Cheng’s account in the panel on ‘The essence of Conductive Education’, held in at the 7th Congress of Conductive Education in Hong Kong last year:
‘Conductive Education tells us that it is not the child [needing] to be “fixed” but the adult so as to allow the child to develop as he or she can.
To support this, I refer to Ákos Károly and Magda Ákos who in their book Dina put the focus on capacity-building of mothers, rather than on that of the child.
‘It is not the disabled child who needs treatment to overcome his dysfunction, instead the mother needs competent help to enable her to establish “anthropogenic cooperation” with the infant in spite of the difficulties resulting from brain damage. This is why the infant can catch up with the normal development.’ (page 2).
For this to happen, say the authors, mothers need instructions
To my eyes, however, the presence of parents was on the one hand a great opportunity for both the children and their mother/grandmothers, but on the other hand, sometimes over-used. During the group activities, children were hardly ever alone. Mostly they were accompanied by an adult, not leaving much room for personal-problem solving or time for planning and executing the task. Built into the Chinese culture (not unfamiliar to other cultures too) a parent who does not assist the child is regarded as a ‘bad’ parent. Therefore, the shift towards a more enabling environment, and the understanding that sometimes less is more, would never appear spontaneously, and has to be taught.
The group, the adults, rhythmical intention, active transitions, the educational complex programs, active daily routines, and happy kids, all were evident in our observations. With no conductors around, teachers, therapists and doctors instructed the activities, relating both to children and parents. Nice motivations, children curious eyes, cheerful atmosphere, well designed programmes, all elements were there, nicely and professionally unified, providing a comprehensive learning opportunity to the kids and parents.
Facilitations, in my experience, are the weak link in many places that provide Conductive Education. The skills required to offer differentiated methods of facilitations, the under-use of verbal facilitations and the overuse of manual facilitations, were also evident in the centres I visited. I am sure that the qualified eye of an experienced conductor, could easily detect, instruct, and correct if and as needed, in addition to the supervision provided regularly. It is undoubtedly the case that more expertise to improve the practice is needed and those in charge of the Milestone Project operation are well aware of that need, and will most probably find creative solutions to respond to it.
Are non-conductors entitled to provide Conductive Education to children and families? Can provision of Conductive Education be possible without a conductor?
Wait and think before replying!
Your immediate default answer is most probably a “No”.
Are you a parent? A conductor? Are you of a school/rehabilitation centre director? Are you someone with cerebral palsy?
Replies would probably differ in accordance to who you are and whom you ask. When do we ask such a question? Most probably when demand for conductors is greater than the inventory, when financial restrictions deprive us the possibility to train qualified conductors, when a country is geographically very big – and, yes, when the absolute number of children with cerebral palsy is immensely huge…
This question naturally creates inconvenience. If you say ‘Yes’, you might be accused of pulling the rug from beneath your own feet. If you say ‘No’, you might find yourself depriving a whole community of the opportunity to transform their lives.
Replies may differ if you add ‘under what circumstances?’ The answer then is not simple Yes or No. The tension between the desired and the available might lead us to look for other solutions, even when we believe, as we do, that conductors could upgrade the practice that we provide.
Imagine that you live in a country where 1,900,000 children below the age of twelve have cerebral palsy, and where 4,000,000 parents have a child with cerebral palsy.
Should we worry? We should worry, of course! And we should serve as door guards and protect Conductive Education from being abused. Unfortunately we already witness Conductive Education’s abuse everywhere and every day, be this in Cyberspace or in some delivered services. Plinths and wooden chairs are not Conductive Education, singing rhymes over wooden plinths (as coined many years ago by Andrew Sutton) is not Conductive Education, and even conductors may not always deliver Conductive Education, while other professionals sometimes do, and even better. It is devastating to read on the Internet descriptions of what Conductive Education is, that distort and mislead innocent readers, whether they be they parents or professionals. It is no less devastating to learn about-service provisions that pretend to provide Conductive Education when they do not, even though having a conductor or two. Ignorance, charlatanism and opportunism, are Conductive Education’s wildest enemies.
Of course we should worry, but not in China.
I have much respect to the ambitious and rightful challenge that the CDPF has taken upon itself in general, and Ms. Cao Limin, in person, together with a remarkable group of professionals, so motivated and engaged. The challenge to offer children and families a transformative opportunity, against the evidence and in spite of reality, based upon a profound confidence in every human being’s right and capacity to construct new ways of organising life. The challenge is to offer hope to children and families, who were otherwise subject to no expectations whatsoever, with no future to look forward to.
Last but not least, I would like to share the most touching visit at the CereCare Wellness Centre For Children in Shanghai, directed by two outstanding ladies, Ms Lieu Sung Ling who has cerebral palsy, and her sister Iris Sung May Lieu, who have operated the first centre in China to adopt the Conductive Education model for some eight years. These two determined, energetic and target focused ladies provide their children the most sensitive Conductive Education upbringing in the full sense of the word, what Dr Mária Hári called ‘intelligent love’.
I am grateful to all who made my stay in China a landmark in my professional development; who took care of me and did all they could to make me feel at home away from home; To those who made sure that I eat (although I ate!) and shop (as I did not have time for this) and see some local attractions that have nothing to do with Conductive Education. To all professionals, who were and are open-minded and courageous to make a shift in service-provision that be considered a tectonic one.
Obstacles are a way to show how determined you are to achieve your goals. Partnerships and cooperation are the methods to overcome these obstacles; and as learning is a constant in one’s professional life, we can continue to learn from each other.
A special Thank You goes to Ms Cao Limin, Ms Iris Sung Lieu, Ms Juliana Lo, Mrs Edith Y.S. Cheng, Miss Huang Hui Jin, and Mr Ivan Su, who accompanied me along this journey, and looked after me with great attention and affection.
A very special Thank You goes to Dr Clare Cheng.
Ákos, K., Ákos, M.
Dina: a mother practises Conductive Education (Pető System), Birmingham, Foundation for Conductive Education, and Ulm, Alabanda Verlag
Some pages of this book are available free on line through Google books: