From integration to inclusion: the Tirat Carmel Center for Learning Disabilities as a lever for beneficial integration of children with special needs.

This article describes changes experienced by the multidisciplinary team of the Center for Learning Disabilities in Tirat Carmel, Israel, in the wake of the enactment of the country's Special Education Law. Over the course of several years, the team working at the Center was able to adapt to the changes, while preserving the professional level of their interdisciplinary treatment of children with special needs. The process of change comprised four stages: entry into the process, implementation of the process, assimilation of the process, and assessment of the results of the change. Over time, the team became the lever for the integration process, for multidisciplinary treatment of children with special needs, and for the empowerment of parents and teachers.

The Special Education Law, passed in Israel in 1988, introduced a change in the placement of children with special needs, giving priority to their integration within regular classes (Reiter, 1999; UNESCO, 1994). The law mandated the integration of children with special needs in regular classes, requiring the education system to confront the change without delay on both the organizational and pedagogical levels and in the ecological sphere with its social and physical aspects (Schanin, 1992). As the overarching aim, the law emphasized the commitment of the education system to draw up an individualized program for each child with an integration within the community. The amendment to the Special Education Law (Ministry of Education, 1998) made these children's right to integration a legal requirement, rather than a mere recommendation

In view of the ongoing changes in attitude toward disabilities in Israel and worldwide (Reiter, 1999, 2000; Reiter, Schanin, & Tirash, 1998; Schalock, Baker, & Croser, 2002), a paradigmatic change has occurred regarding special education in Israel, manifested in a shift from the medical model to the humanistic-educational approach and its application to the education and treatment of learners with special needs (Penn, 2006). A simplistic implementation of the principle of normalization, which calls for maximum integration of children with disabilities, frequently led to a reduction in services available to these children while disregarding their needs. Gradually, this principle was replaced by the holistic-personal model (Reiter, 2000), which emphasizes the needs of the child as the main factor to be considered and the child's right for his needs to be addressed in the most appropriate way.

The new model called for a focus on the development of the child's individual competencies in the following five areas: academic, social, emotional physical, and cognitive-linguistic. Research related to the enactment of the law (Avisar, Reiter, & Leyser, 2003; Leyser, Kepperman, & Keller, 1994; Schanin, 1992; Talmor, Reiter, & Feigin, 2005) pointed out that the education system had not sufficiently prepared for the integration of children with special needs, from the point of view of either the assimilation of the ideology underlying the law or the organizational and pedagogical changes involved.

The staff at the Tirat Carmel Center decided to take the lead in introducing the theoretical principles underlying inclusion into the local school system and also demonstrate their application in practice. Staff members at the Center began to work with school staff within the regular education system, encouraging the teachers to express their views on the challenges they face in implementing inclusion. We hope to have paved the way to mutual respect and cooperation, as the regular teachers receive advice and assistance from the Center's multidisciplinary team.

The Center for Learning Disabilities, Tirat Carmel

The Center for Learning Disabilities was established by the Ministry of Education in the Haifa District in 1977, prior to the passing of the Special Education Law, and has functioned ever since under the direction of Michal Schanin. The Center, the first of its kind in Israel, was established as a unique multidisciplinary model for the diagnosis and treatment of children with special needs. Its aim has always been to meet the needs of children and integrate them within the regular education system, while assisting and supporting all those involved in their education at home, in school, and in the community. The Ministry of Education's special placement committees, with a mandate to recommend special additional services according to each child's needs, refer students to the Center. The staff at the Center provides services on a great variety of learning disabilities, developmental impediments, sensory-motor disabilities, cognitive, linguistic and communication disorders, ADHD, and emotional and social disabilities.

Over time, the staff has successfully adapted its methods to the changes taking place in the education system, and has adjusted them to the humanistic-educational paradigm that emphasizes the child's and the family's quality of life. Since its establishment, the staff has been working in cooperation with academia in various areas. At the University of Haifa, students majoring in occupational therapy, communication disorders, social work, and various art therapies have received training in the field within the framework of the Center. The connection with this university has facilitated the expansion of therapeutic services, thereby helping children with special needs and their families at the Center, as well as in community preschools and schools. Cooperation between the Center and the university promotes research-based follow-up of the intervention programs, developed by the staff and university students.

Today, 250 children with special needs receive free services from the Center, either on-site or in their community schools. The Center provides services for five regular schools and 14 preschools, two of which provide special education services; 40 percent of all the children study in special education classes within regular schools and 60 percent are individually included in regular preschools and schools. In the past 30 years, 20 staff members at the Center have provided services for more than 5,000 children with special needs, according to their needs, on a full-time or part-time basis, either individually or in groups.

Tirat Carmel is a small town in the northern part of Israel, near the city of Haifa. Its population is composed mostly of low-middle-class and poor households. Over the past 10 years, waves of new immigrants settled there and now make up 40 percent of the population. For example, 25 percent of all children at the Center are new immigrants from the former Soviet Union and Ethiopia. In addition, a considerable proportion of these children's families belong to a low socioeconomic stratum. Since the Center's establishment, the staff has orga nized 40 supplementary courses and study days on topics related to children with special needs. More than 700 teachers, preschool teachers, social workers, educational and developmental psychologists, special education and preschool supervisors, school principals, and directors of other treatment centers have participated. Families receive help in the form of both group and private sessions. Since its inception, the Center has offered specialized training to 290 students from various universities and colleges related to learning disabilities and communication disorders, occupational therapy, social work, and art therapy.

Embarking on Change at the Center for Learning Disabilities

In Israel, the amendment to the special education law regarding inclusion called for education reform. Implementation of a fundamental change in education involves a change in educators' values, opinions, and beliefs. Like any reform, calling for the implementation of inclusion raised resistance by policymakers, parents of exceptional children, organizations, and associations.

According to the spiral model (Fullan, 1991), in every process of change we can identify four stages. These four stages are: entry into the process, implementation, assimilation, and assessment of the results of the change. When the process is instigated through external pressure, such as the demand for inclusion of students with developmental disabilities in regular schools, the initial response often is anxiety and resistance. Cuban (1996) defines this change as radical, intended to effect a transformation in the vision, ideology, aims, organizational structures, and functions.

The spiral model enables us to analyze the various stages of the changes experienced by the staff at the Center following the enactment of the Law. In the wake of the reform, the staff at the Center had to cope with completing unfamiliar tasks, including learning how to absorb children with special needs in the classroom even before the education system was prepared to receive them (Schanin, 1992; Shechtman, Reiter, & Schanin, 1993; Tirosh, Schanin, & Reiter, 1997). The homeroom teachers lacked appropriate training, and they were challenged by the children's learning and social integration.

Stages of Change

Stage 1: Entry Into the Change Process. The change was initiated by external agents, that is, by the Ministry of Education, and the staff therefore perceived it as being imposed on them from above, which gave rise to a certain amount of anxiety and resistance. The staff expressed their fear that they would not be able to preserve a high level of interdisciplinary work. In the wake of the integration, the authorities focused on transferring various treatments from the well-equipped rooms at the Center to the schools and preschools. Therefore, the entry into the change process was accompanied by staff meetings to deal with problems, signs of resistance, and anxiety. The staff gradually formulated a new ideological approach congruent with the policy of inclusion. These discussions eventually led to consensus about adapting to the new policy.

Stage 2: The Implementation of the Change Process. At this stage, the changes were carried out in four dependent spheres:

a) Organizational changes included changes in the assignment and definition of functions, and in the staff's working procedures within the schools and preschools. A new schedule provided treatment for children in special education classes at the Center as well as on-the-spot treatment for the children within the regular framework.

b) Physical changes included changes in the allocation of rooms for the treatment of children with special needs at the Center and in the various educational frameworks, and also concerning the various resources enabling the necessary adaptations.

c) Changes in the treatment included implementing changes into their treatment mode, and adapting the individual programs to the learning strategies prevalent in the regular framework within which the children were included. This change was manifested in a transition to a holistic-personal approach, which views the children in terms of all their characteristics, rather than with a focus on specific disabilities.

d) Ideological change included a gradual shift in the educational approach of the Center's staff and in their attitude to the policy and principles on which they based their work. The staff began to emphasize the need to view children with special needs simply as they would any other children who also need special services that enable their maximal integration in society (Reiter, 2000). The change in the staff's educational perspective aroused fundamental questions as to the short-term and long-term aims of their work with these children. Instead of narrowing their focus to clinical treatment, the staff members began perceiving the children in the wider context of their inclusion.

Stage 3. Assimilation of the Process of Change and Its Institutionalization. At this stage, four main manifestations of the change were identified in the functioning of the Center staff: change in the aims of the staff's tasks; expansion of the "basket of services" provided by the Center; transferring activities from one sphere to another; and focusing on new objectives, congruent with integration, as demanded by the Special Education Law.

One of the tasks undertaken by the staff was to meet the needs of the integrating teachers and help them cope with the difficulties they encountered. An examination of the main aspects related to integration affecting the teachers and the students in regular classes (Talmor, Reiter, & Feigin, 2005; Tirosh, Schanun, & Reiter, 1997) revealed six important issues now facing the staff:

* Providing prior information about the children with special needs

* Changing the attitude to deviation from the norm among students and teachers in regular classes

* Becoming acquainted with the teacher's fundamental approach to education

* Teaching the teachers to foster the children's ability to defend and direct themselves

* Creating a network of people the integrating teacher could turn to for assistance

* Providing prior knowledge about the process of integration in other educational frameworks.

The relations between the interdisciplinary team and the integrating teachers revolved around these issues. A representative of the Center was sent to each school and, according to the specific needs of the integrated child, invited various members of the staff of the Center to interdisciplinary meetings.

Stage 4: Assessment of the Results of the Change. The process of change was evaluated by the Center's interdisciplinary team, according to the criteria proposed by Hopkins, Ainscow, and West (1994), Fullan and Stiegelbauer (1991), and Marsh (1992). The data came from two sources: 1) a feedback questionnaire, which was filled out at the end of each program by parents, principals, teachers, preschool teachers and 2) information regarding each student, compiled by means of a special software that was developed specifically for the Center that represents the student's background information and his/her individual program plan. Based on this data, a few general trends could be detected, summarized as follows:

* The Center staff integrated change into their procedures and behavior; together with the integrating teachers, they came to appreciate the innovative aspects of the change.

* The change was modular, enabling the staff of the Center to experience it as a gradual and nonthreatening process, in the spirit of the Special Education Law.

* Relative congruence existed between the beliefs and the aims of the staff, and the change occurring triggered by the law.

* Demand for the Center's services is growing fast. We receive repeated requests from principals, teachers, and parents for additional services from the staff in the sphere of treatment for the children and adolescents, guidance for teachers and parents, and for participation in various projects in preschools and schools.

* Such requests come not only from Tirat Carmel, but also from schools in Haifa and its vicinity.

* The number of students treated at the Center has grown, as have the types of treatment.

* The staff has remained stable; there is no turnover.

* The staff has become adept at including children with special needs and providing assistance to people within the community and elsewhere.

* Collaboration has developed among various agencies in the community. Those in charge of welfare, health, and education ensure that the Center receives the necessary budget for the provision of assistance to the children and their parents.

* Various universities in the country have chosen the Center as the appropriate framework for their students' practicum and specialization in various spheres of special education, learning disabilities, social work, occupational therapy, physiotherapy, communication disorders, early childhood, and art therapy.

* A research-based dialogue has developed between the Center and Haifa University, with the establishment of study groups and refresher courses as well as monitored follow-up of intervention programs facilitating inclusion.

Summary

The transition from a paradigm of integration to that of inclusion above all entails a process of philosophical-educational change. This change has ideological, organizational, physical, and pedagogical aspects (Leyser, Kepperman, & Keller, 1994; Reiter, 2000; Retish & Reiter, 1999). Over the course of several years, the staff of the Center has succeeded in adjusting to the changes resulting from the enactment of the Special Education Law and the Inclusion Law. The Center's interdisciplinary team has acted as a lever for interdisciplinary treatment of children with special needs and their parents and for the professional empowerment of teachers and preschool teachers as they cope daily with the complex task of inclusion. In the future, the staff intends to expand its work in conjunction with the teams of teachers and preschool teachers and to develop distinctive programs for the included students, introduce new technological teaching-learning aids, expand the diagnostic competence of the staff and the relationship with academia, facilitate the assessment of specific intervention programs and academic follow-up of projects for integrated children, and increase the number of students involved in the work of the Center.

References

Avisar, G., Reiter, S., & Leyser, Y. (2003). Principals' views and practices regarding inclusion: The case of Israeli elementary school principals. European Journal of Special Needs Education, 18, 355-369.

Cuban, L. (1996). Myth about changing schools and the case of special education. Remedial and Special Education, 17(2), 75-82.

Fullan, M., & Stiegelbauer, S. (1991). The new meaning of educational change. New York: Teachers College Press, Columbia University.

Hopkins, D., Ainscow, M., & West, M. (1994). School improvement in an era of change. New York: Teachers College Press.

Leyser, Y., Kepperman, G., & Keller, R. (1994). Teacher attitudes toward s mainstreaming: A cross-cultural study in six nations. European Journal of Special Needs Education, 9, 1-15.

Marsh, C.J. (1992). Key concepts for understanding curriculum. London: The Falmer Press.

Ministry of Education. (1998). Special populations, implementation of the Special Education Law: Individual study program. Jerusalem: Author. (In Hebrew)

Penn, R. (2006, February). Changing the world through education. Paper presented at Spastic Society of Greece international symposium, Athens, Greece.

Reiter, S. (1999). Society and disability: An international perspective on social policy. Haifa, Israel: AHVA Publishers.

Reiter, S. (2000). Quality of life: A central theme of the new high-school curriculum guidelines for teachers of adolescents with developmental disabilities. A national project, Israel. International Journal of Adolescent Medicine and Health, 12, 19-32.

Reiter, S., Schanin, M., & Tirosh, E. (1998). Israeli elementary school students' and teachers' attitudes towards mainstreaming children with disabilities. Special Services in the Schools, 13, 33-46.

Retish, P., & Reiter, S. (1999). Adults with disabilities: International perspectives in the community. Mahwah, NJ: Lawrence Erlbaum Associates.

Schalock, L., Baker, C., & Croser, M. D. (2002). Preface. In R. L. Schalock, P. C. Baker, M. D. Croser (Eds.), Embarking on a new century (pp. 11-12). Washington, DC: American Association on Mental Retardation.

Schanin, M. (1992). Attitudes of elementary school pupils and their teachers towards disability: An inter-cultural study. Doctoral dissertation, Haifa University. (In Hebrew)

Shechtman, Z., Reiter, S., & Schanin, M. (1993). Intrinsic motivation of teachers and the challenge of mainstreaming: An empirical investigation. Special Services in the Schools, 7(1), 107-124.

Special Education Law. (1988). In Special Education Law in Israel, Ministry of Education, Division of Special Education. Jerusalem. (In Hebrew).

Talmor, R., Reiter, S., & Feigin, N. (2005). Factors relating to regular education teachers' burnout in inclusive education. European Journal of Special Needs Education, 20, 215-229.

Tirosh, E., Schanin, M., & Reiter, S. (1997). Children's attitude towards peers with disabilities: The Israeli perspective. Developmental Medicine & Child Neurology, 39, 811-814.

UNESCO. (1994). Salamanca declaration: Principles, policy, and practice in special education, and the framework of activities. New York: Author.

Michal Schanin and Shunit Reiter Michal Schanin is Adjunct Lecturer, Department of Education, Division for Special Education, University of Haifa, and Director of the Center for Learning Disabilities, Tirat Carmel, Israel. Shunit Reiter is Professor, Department of Education, Division for Special Education, University of Haifa, and Director of the Israeli University Center for Disabilities, Haifa University.