McCam Child Care & Development Centre

ADHD Prevalence Study in Jamaica

2010-05-04T09:43:00.000-07:00

Prevalence of Attention Deficit Hyperactivity Disorder (ADHD) in students, 4-15 years, attending rural and urban schools In Jamaica

(A study commissioned by the Mc Cam Child Development and Resource Centre)

One of the most frequently diagnosed mental health problems of children globally is Attention-Deficit Hyperactivity Disorder (ADHD), a major concern of child health specialists and educators because it typically undermines a child’s learning potential and impairs social skills and behaviour.

This study sought to determine the prevalence of ADHD in Jamaican students, using a purposive sample of 243 pre-school to secondary level students, 4 – 15 years, attending urban and rural schools in Jamaica. Standardised assessments of behaviours specific to ADHD completed by parents and teachers were used to identify ADHD along with in-depth interviews with parents.

The results indicate almost a quarter of the sample (19.6%) had significantly high symptoms of inattention or hyperactivity-impulsivity as reported by either parent or teacher, with a 3% prevalence rate of the disorder; a rate that is similar to that reported in the international literature. While ADHD symptoms were not found to be related to socio-economic differences, students in urban schools, particularly those in inner city communities, were more likely to be rated as having ADHD symptoms. Teachers were also more likely to rate boys as hyperactive and/or impulsive than girls. Exposure to violence was identified as a key contributing factor why students in inner city schools were more likely to have ADHD symptoms. Medical factors associated with symptom presentation were not strong, with only maternal stress during pregnancy being associated with ADHD symptoms. Of significant association also was a family history of attention problems and hyperactivity as well as family history of drug abuse. Children with ADHD symptoms were also more likely to be in families where there was excessive family conflict, aggressive outbursts among family members and to be physically or emotionally abused.

We also found these students to be more likely held back in class, suspended from school and their parents called in for special conferencing. While students with ADHD symptoms were no more likely than others to get adequate resource help in the classroom, they were however getting extra help in literacy.

These results indicate that students with ADHD symptoms who do not meet the diagnostic criteria of the disorder nonetheless need to be managed. Particular attention and resource help need to be paid to schools in inner city communities but in general, conflict-free and healthy family life habits beginning from pregnancy need to be promoted.

Dr Audrey M Pottinger, PhD

The University of the West Indies

Occupational Therapist - The Advocate Part II

2010-03-12T08:14:00.000-08:00

This blog is Part II of previously posted blog.

"The Role of Occupational Therapists as advocates for persons with disabilities (PWDs) – a report on promoting SRH for AWDs in Jamaica"

The following report is an example of the role that I was asked to play as an occupational therapist in making a difference in the delivery of health care to adolescents with disabilities. In advocating for this change, I had to engage providers at all levels, that is, from the community to the policy level and vice versa.

In 2003, the GOJ/EC/UNFPA agreed on an approach to poverty alleviation and a millennium goal which involved the introduction of contraceptives in family planning, the safe delivery of babies for both mother and baby and the control of STIs . The youths were targeted as a core group to be educated on issues related to their sexual and reproductive health and to advocate for the practice of safe sex. For the first time, this national programme also included adolescents with disabilities since persons within the disability sector continued to advocate strongly for inclusion. Afterall, AWDs also had the same challenges, and in some cases more so, to their sexual and reproductive health. Subsequent research conducted among adolescents with disabilities by the Jamaican Association on Mental Retardation revealed that –

Children with disabilities are at high risk for sexual molestation and abuse by care givers and family members (JAMR, 2005).

It was also discovered that the inclusive practices of some disability groups such as the deaf, made their members particularly susceptible to the spread of STIs. What did these adolescents know about their sexual and reproductive health and what were the obstacles to their accessing health care services?
Three agencies were given the responsibility to investigate these obstacles and to determine a way forward for AWDs which considers equality in accessing SRH services and the fulfillment of their expectations as citizens.

My agency’s mandate was –‘to build the capacity of providers of SRH services to deliver equitable, gender sensitive, high quality services to AWDs’.

It was widely speculated that in mainstream health care in Jamaica, providers of services were not inclined to consider the needs of persons with disabilities as they plan and execute their delivery of health care services for the ‘whole’ community. There was genuine ignoranceThe only effective approach that we could use to fuel our arguments was from a human rights perspective. - for nurses and doctors this was a perspective that could be readily understood since their oath of practice prepares them to act without prejudice when responding to the needs of patients. The members of the health team to be targeted included:
* Community Health Aides
* Registered Nurses
* Public Health Nurses
* Registered Midwife
* Enrolled Assistant Nurse
* Family Nurse Practitioner
* General Practitioner
* Contact Investigator
* Dental Nurses/Assistant
* Health Educator
* Other – the receptionist, the porter, the security guard in the clinics and hospitals
If we were to advocate effectively for improved SRH services for AWDs we had to hear from the stakeholders, that is, the AWDs as well as the providers of the SRH services. As Advocates, we must know the facts and not make assumptions. about the diverse needs of persons with disabilities, including their sexual and reproductive health needs. The planning of health care services for AWDs would have to transcend institutional, personal and environmental barriers.

The report from the qualitative research conducted among AWDs by the Jamaican Association on Mental Retardation (JAMR), indicated their dissatisfaction with the approach of members of the medical team. This approach is best described as the medical model of disability which believes that the medical practitioner is ‘the expert’ who fully understands the patients’ medical needs and how to ‘cure or fix it’. The medical practitioner is prepared to make decisions that significantly affect disabled persons lives without giving due consideration to their opinions or the circumstances of their lives. AWDs described the general attitude of practitioners are condescending while deaf persons spoke of the lack of privacy in discussing intimate matters as most doctors insisted on having a third party present ‘a communicator’ using sign language between doctor and patient.

As OTs we must be passionate in our defense of a model of intervention /practice that is client –centred.

The client’s mental and physical state is given primary consideration and not the super ego of the practitioner.

In addition, we must also use the facts to argue for change!

THE FACTS AS DESCRIBED BY AWDS
Research conducted among AWDs identified the following insights
* Most AWDs reported negative experiences in many SRH service delivery sites and with service providers.
* AWDs have a strong desire to be treated with respect and dignity and to have their rights respected.

THE FACTS AS SEEN BY PROVIDERS OF SERVICES
Simultaneous research conducted among the providers of services revealed the following.

Rights Issues

Should AWD 18+ yrs make own decisions about contraceptive use?
* 81-89% agreed that the deaf, blind and physically disabled adolescents should make decisions about contraceptive use.
* 40% disagreed or were undecided that the mild MR should make decisions about contraceptive use.
* 70% disagreed or was undecided that moderate MR should make decisions about contraceptive use
* 70-80% agreed parents should be involved in contraceptive decisions for mild and moderate MR

Attitudes – cultural biases

Comments were noted on 57 questionnaires indicating respondents feelings that sexual relationship should not be outside of marriage
* disability and age less of an issue

Can AWD make a contribution to society
* More than 80% of respondents said AWD can contribute to society
* Mild and moderate MR had the highest rating for not being able to make contribution to society (10% & 13%)

At the completion of the project 0ver 500 health care providers including nurses, doctors, community health workers, public health nurses, hospital administrators and regional health managers were sensitized about the health care needs of persons with disabilities and there was much discussion around the shaping of services.

However, as we reviewed the outcomes, one group of health care professionals seemed to have eluded the process. The findings of the research conducted among AWDs had identified

Advocacy is also about providing pertinent information to key persons and expecting such persons to act on that new knowledge in a manner that will effect positive change.

As an occupational therapist, I could immediately relate to the issues that were likely to be problematic for PWDs in a pharmacy. It is the right of PWDs to be able to enter (physical access) any pharmacy, fill their prescription and have their concerns addressed in a confidential manner by the pharmacist and/or their assistants. I had always wondered how persons in wheelchair or who were blind, navigated the floors of most pharmacies. We considered that PWDs could best be their own advocates if they were brought face to face with the pharmacists. As OTs we can empower our clients /patients to be their own advocates. A face to face encounter in a cordial atmosphere would facilitate frank open discussion. pharmacists as one discreet group with whom AWDs consistently had negative experiences. Pharmacists are not traditionally a health provider with whom occupational therapists have direct contact concerning clients’ health care which possibly explains this omission. However, we have to be prepared to cross the bridge over uncharted waters. We had made an assumption that pharmacists were unaware of their effect on this population of persons. This was another opportunity to impact positively on the delivery of health care to persons with disabilities.

A 2-day workshop was organized in a residential setting, involving pharmacists from the administration/policy level, the inspectorate (council), professional (hospital based) and retail (community based) pharmacies.
The focus of this workshop was 1. To sensitize pharmacists to the SRH care needs of the AWDs 2.To present the reality of being disabled. 3. To determine how the lack of access to this service can directly affect the quality of life for persons with disabilities?

The following strategies were employed -
* Pharmacists were brought together in a non threatening environment –the atmosphere was non-adversarial.
* The president of the Association of Pharmacists was involved in the planning of the workshop – determining key persons to be involved
* Pharmacists were exposed to experiential learning as they were encouraged to take on a particular disability and live this experience for most of day one.
* Persons with disabilities joined the group on day 2 after the pharmacists had been educated about issues related to different disability groups. They shared openly about their experiences.
* The current standards of the pharmacy council were reviewed with respect to the delivery of services for all persons

The outcome of this workshop was truly inspirational and an example of advocacy at its best –there was a willingness on the part of all parties to speak and to listen and to appropriate the issues in a context for professional grow and development. A historic moment was captured as a mature pharmacist, overwhelmed by the nature of the sharing, chose to apologize on behalf of her colleagues for the negative experiences of disabled persons – those present and the community of persons they represented.

It is not possible to present fully the recommendations from this workshop. However, I would like to share that four pharmacists committed to having their pharmacies reorganized as model client-friendly pharmacies –

Recommendations
At least one passage /walk way to the pharmacy would be cleared of obstacles, widened where possible and lead directly to the pharmacy window.

Pharmacy windows would be lowered to a level that allows for effective communication between pharmacist or assistant and some one in a wheelchair.

Pharmacists are to inform persons who are blind when other persons are too close to overhear their conversation and should take the person to a confidential corner which allows for private conversation.

At least one disabled parking spot should be immediately in front of all pharmacies

A communication kit is to be devised by members of the group to facilitate the sharing of information with clients who are deaf, blind, physically and intellectually disabled.

As OTs we must see the benefits of advocating for change at the policy level

A 1-day seminar was also organized with the Managers of Regional and Central Government in the Ministry of Health (MOH) with a focus on the reality of delivery of service from an organizational perspective….what policies would sufficiently address the weaknesses in the system when considering the needs of persons with disabilities?

The Ministry of Health’s response to issues raise was that they were actively engaged in creating a client-friendly environment which considers the needs of all clients, including those with disabilities. It was not clear if persons with disabilities were invited to be a part of this review team. The discussions at this seminar, clearly exposed the lack of resources and the capital which would be required to provide comprehensive services. Strong consideration was given a referral system which originates at the community level (in type 4 - 5 clinics) leaving the resources at the tertiary (hospital) level mainly for specialist care.

In summary, I must emphasize the fact that OTs are uniquely educated to understand the many issues which surround their clients’ lives. We assist clients in identifying these issues and in problem solving. However, we should go further to advocate for the services and support they need to live quality lives. We know how it works in the developed countries – how therapists are strategically placed in hospitals, clinics, social services and educational institutions. The resources that are made available to persons with different disabilities so that they can be functional and enjoy quality of life. It may not work in exactly the same here in Jamaica but we can build an awareness of disability issues among providers of services and the general public, influence legislation where possible and build the capacity of persons with disabilities to advocate on their own behalf. Perhaps, this is an approach that we should seriously consider in Jamaica, so that in the next 50 years we will present ourselves as professionals who are passionate about the right of all citizens to health care and education – we need to focus on the bigger picture.

ReferenceBartley M. (2007), Paper entitled Disability Rights presented at workshop for providers of health services, social workers and guidance counselors.Cohen, D., R. de la Vega , G. Watson. 2001. Advocacy for social justice. Bloomfield, CT: Kumarian Press Inc.Jones et. al. 1998. Sociology and Occupational Therapy, An Integrated Approach, Churchill Livingston.WHO International Classification of Functioning retrieved from http://www.who.int/classifications/icf/en/.

Occupational Therapist - The Advocate Part I

2010-02-04T11:40:00.000-08:00

This blog is a paper wirtten by the Programme Director of McCam Centre Mrs. Pauline Watson Campbell, OT MSc, for the 9th Biennual Conference on Occupational Therapy presented by the Assocation Of Caribbean Occupational Therapist (ACOT).

"The Role of Occupational Therapists as advocates for persons with disabilities (PWDs) – a report on promoting SRH for AWDs in Jamaica"

This paper is not based on a theoretical model or framework. It is a composite of my experience as an advocate for persons with disabilities in Jamaica. It is clear to me that as an occupational therapist in a situation where there are limited resources and ignorance surrounding the needs of persons with disabilities, one cannot avoid adopting an attitude of advocating for improvement in the situation surrounding people’s lives.

Advocacy is the pursuit of influencing outcomes — including public-policy and resource allocation decisions within political, economic, and social systems and institutions — that directly affect people’s current lives. (Cohen, 2001)

Therefore, advocacy can be seen as a deliberate process of speaking out on issues of concern in order to exert some influence on behalf of ideas or persons. Advocacy has many interpretations depending on the issue at stake ……

The World Health Organization has advanced a definition of disability which confirms that the approach of occupational therapy, which has always maintained a focus on removing barriers to functional living for persons with disabilities, is indeed the correct approach. Occupational Therapists are educated to appreciate the matrix of the physical, mental, psychosocial and spiritual factors that co-exists in any client’s experience of disability. It is never only about the client’s ability to be independent but also about removing social and environmental barriers that depreciate the quality of a person’s life, so enhancing the individual’s ability to take full control of his/her life, giving him/her the required support to pursue a chosen lifestyle.

Therefore the occupational therapist consistently advocates for the best possible situation for the client by making recommendations for change that will facilitate optimal, independent living and the continuance of roles and habits that are the essence of persons’ lives such as being a homemaker, socializing with friends or attending worship service. Let me mention here that as members of the OTAJ we have been making inroads in our individual churches as we advocate for an environment for worship that will accommodate ‘all who will’ to come and be ….. At a practical level this means that persons with disabilities should find that they can enter the sanctuary, access toilets, share in the service through sign language, braille or large print. The whole congregation must be sensitized to the diverse needs of persons with disabilities who may become members of their church. It is our intention to take our ideas to the Jamaica Council of Churches so as to expand our reach to a greater number of member churches.

The occupational therapist understands that creating a partnership with the client is important as together they explore the possibilities and the challenges of being disabled- the implications within the home, social settings, the place of work for the adult or school for the child. It is typical for the occupational therapist to ask ….how can this person live as complete a life as possible (complete being determined by the client)?…what are the obstacles that must be eliminated to allow this to happen? What does the client see as a goal to be achieved in the immediate and in the long term? How can I help this person to achieve that goal? The occupational therapist realizes that the motivation to be successful in any domain of human existence requires effort and drive and a willingness to overcome real and imagined obstacles. The challenges are likely to be multiplied for the disabled person.

Therefore, the client must be motivated to want to overcome the challenges. I suggest that this is where the occupational therapist often has to begin to advocate - To advocate at this personal level, the client must believe that that opportunities will eventually outstrip the barriers. This is particularly true as the individual goes through the stages of acceptance of his/her disability or parents, that of their child. I have sometimes had to argue on behalf of the child whose mother wants to give up because she perceives that she is alone in her struggles and she does not see a future for this child living with her. What of this child’s right to realize her potential in a loving, caring home? The situation of single mothers in Jamaica is of particular significance as we contemplate this reality. A large percentage of our families in Jamaica are headed by single parents, in particular, single mothers. The structure of families has changed and the extended family is no longer a certainly to give support and well needed respite at timely intervals. Single mothers who have migrated to the city face even greater challenges. The occupational therapist in directing this mother to the services that she needs for her disabled child, must seek to empower her to be positive in her thinking, to be determined in struggles and to achieve a balance in her life which ultimately affects the quality of her life and therefore that of her child.

My advice to all parents of children with disabilities is always to 1.‘fight for the right’ of your children to a life that is not less than but equal to that of their peers., 2.to bond with other parents so that they can support each other and 3.to be united in their appeal for services. Many parents do not know of the existence of services or are reluctant to go public with their situations. I have had many persuasive discussions with mothers who for instance refuse to go to the family court to see redress from fathers who have neglected their children ….although they struggle to make the cost of services and in some cases must deny their children therapeutic intervention, they are reluctant to exercise their right to support in court.

As a paediatric occupational therapist, I make the necessary links between the Government agencies in health, education and social services, voluntary organizations, service clubs and other agencies. The advantages of practicing in a fairly small country like Jamaica are that 1. We can work closely with persons who can influence change 2. We can network effectively since the circle is smaller and it is not difficult to get to the top of the ladder if we persist long enough.
For example, we have made a positive move towards a holistic approach to meeting the needs of our children in Jamaica through the establishment of a Early Childhood Commission to include the Ministry of Justice and Local Government in providing a more comprehensive offering of services. It will be sometime before we will have a cadre of OTs in health, education and social services, however, we can now advocate on behalf of a child for services at all levels, from the tertiary /institutional level to the community.

Here, I pause to acknowledge the work of the members of the OTAJ who have for the past 30 years, have been relentless in the struggle for an education programme in occupational therapy in Jamaica. We have written many proposals, spent days in dialogue with Government and institutions. We have been angry, but we have never given up the cause. Today, the reality of the years of advocating for this development seems to have born fruit. We hope to see a programme in occupational therapy within the next 2 years under the faculty of medical sciences at the UWI.

Jamaica is signatory to several international agreements or non-binding resolutions that reference the Human rights of persons with disabilities. These include:
* The Convention on the Rights of the Child (1991).
* The International Covenant on Civil and Political Rights (1976),
* The Universal Declaration on Human Rights and
* The Economic Social and Cultural Rights (1976).
* International Convention on the Rights of Persons with Disabilities (2006)

Our National Policy on Disability provides guidelines based on the requirements of the U.N. Standard Rules - reduces the risk of social exclusion although there are no legal sanctions.

A National Disability Act is being drafted by the Central Parliamentary Counsel (CPC). The Act will Provide for the protection of the rights of persons with disabilities and for matters incidental to or connected with disability.

The occupational therapist must know the details of the Act and be prepared to pass on this information to disabled persons and their families as they advocate for their right to services. They must learn how to exercise their rights as citizens. Advocacy is a new concept for many persons in this country.

To be cont'd

Reference
Bartley M. (2007), Paper entitled Disability Rights presented at workshop for providers of health services, social workers and guidance counselors.
Cohen, D., R. de la Vega , G. Watson. 2001. Advocacy for social justice. Bloomfield, CT: Kumarian Press Inc.
Jones et. al. 1998. Sociology and Occupational Therapy, An Integrated Approach, Churchill Livingston.
WHO International Classification of Functioning retrieved from http://www.who.int/classifications/icf/en/.

Our Prayer For You

2010-01-08T13:32:00.000-08:00

Children are unique, precious, beautiful beings who need love, understanding and protection, without which they will learn hate, prejudice and cruelty. That is why we live our motto “It is no small thing to influence a child so fresh from the hands of God.”

This past year of 2009 was simply HARD for many of us. We want to encourage you, our past & present parents, past students and supporters that the future will be what YOU will make it. Don’t give up your dreams & your dreams for your children.

Just Believe. Rejoice. Have Faith In The Almighty. Appreciate. Laugh. Share. Care. Love.