FILE ON THE INTEGRATION INTO DAY CARE OF A CHILD WITH A DISABILITY

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1 FILE ON THE INTEGRATION INTO DAY CARE OF A CHILD WITH A DISABILITY PROFESSIONNAL S REPORT Document to be kept by the childcare establishment

2 IDENTIFICATION OF THE CHILDCARE ESTABLISHMENT NAME ADDRESS POSTAL CODE TEL. The purpose of the professional s report is to identify and confirm the impairment of a child with a disability to help integrate him/her into a childcare establishment. It must also include recommendations on the use of specialized material or equipment. Any recommendation on equipment or material must take into account the child s specific needs and the safe use of such equipment at the childcare establishment. The report must be filled out by one of the following professionals recognized by the Ministère de la Famille et des Aînés : REGARDING MOTOR FUNCTION REGARDING VISUAL FUNCTION REGARDING AUDITORY FUNCTION REGARDING COMMUNICATION REGARDING INTELLECTUAL FUNCTION 0general practitioners 0medical specialists 0occupational therapists 0physiotherapists 0ophthalmologists 0optometrists 0audiologists 0 speech therapists 0psychologists 0psychiatrists REGARDING PSYCHOPATHOLOGY 0psychologists 0psychiatrists REGARDING ORGANIC FUNCTION 0general practitioners 0medical specialists It is important to fill out the present report and return it promptly to the above -mentioned childcare establishment. For more details on the nature of the information requested, please contact the childcare establishment, or the Ministère de la Famille et des Aînés at the following numbers: Québec City region: ; elsewhere in Québec: File on the Integration into Day Care of a Child with a Disability 1

3 INTEGRATION INTO DAY CARE OF A CHILD WITH A DISABILITY CHILDREN CONCERNED: Children who live with an impairment and with a significant and persistent disability and who have difficulty integrating into a childcare centre either a facility or home childcare or a day care centre. DEFINITION OF TERMS Child with a disability A child limited in the performance of normal activities who is suffering, significantly and persistently, from a physical or mental impairment, or who regularly uses a prosthesis or an orthopaedic device or any other means of palliating his handicap. Ref.: An Act to secure the handicapped in the exercise of their rights, R.S.Q., c. E-20.1, chapter 1, g. Impairment A loss, malformation or anomaly of an organ; a structure; or a mental, psychological or anatomical function. Functional limitation or disability A restriction or decrease in the ability to perform an activity considered usual for a child of the same age. Handicap A social disadvantage resulting from an impairment or disability that prevents a child from playing roles in his/her environment that are usually played by other children. Significant That prevents the child from performing an activity in the manner or within the limits considered usual for a child of the same age. Persistent That is lasting but whose effects may vary with time. Obstacles Causes or effects of the handicap (prejudice, attitudes, access to places, etc.). File on the Integration into Day Care of a Child with a Disability 2

4 PART A GENERAL INFORMATION 1. IDENTIFICATION OF CHILD Last name First name(s) Date of birth Year Month Day Address (no, street, apt.) City Province Postal code Telephone (home) Area code ( ) 2. IDENTIFICATION OF PARENTS OR TUTORS Name of mother Name of father Tutor(s) Person(s) to contact Tel. ( ) Tel. ( ) Tel. ( ) Tel. ( ) STATEMENT BY PARENT(S) PART B STATEMENT I authorize the childcare establishment to receive the attached Professional s Report. This information will be used for the sole purpose of determining my child s eligibility for the allowance for the integration of a child with a disability and will remain confidential. I declare that I am the recipient of a supplementary family allowance from the Régie des rentes du Québec.?? yes * no Signature of parent(s) * If yes, the professional shall fill out parts D and E of this report. File on the Integration into Day Care of a Child with a Disability 3

5 PART C IDENTIFICATION OF THE IMPAIRMENT MOTOR FUNCTION No difficulty? After correction: Is the motor impairment: significant? persistent? VISUAL FUNCTION No difficulty After correction: Is the visual impairment: significant? persistent? AUDITORY FUNCTION No difficulty After correction: Is the auditory impairment: significant? persistent? Is the resulting disability severe enough to represent a handicap when performing usual activities for a File on the Integration into Day Care of a Child with a Disability 4

6 COMMUNICATION No difficulty? Despite intervention, is the language impairment: significant? persistent? INTELLECTUAL FUNCTION No difficulty After correction, is the intellectual impairment: significant? persistent? PSYCHOPATHOLOGY No difficulty After correction, is the psychopathological impairment: significant? persistent? File on the Integration into Day Care of a Child with a Disability 5

7 ORGANIC FUNCTION No difficulty? Indicate the impairments you observed during the examination After correction: Is the organic impairment: significant persistent PART D RECOMMENDATIONS FOR SUPPLEMENTARY AIDS TO FACILITATE THE CHILD S INTEGRATION INTO A CHILDCARE ESTABLISHMENT Does the child present particular needs requiring particular measures for his/her integration: a) in a childcare centre, facility component? b) in a childcare centre, home childcare component? c) in a for-profit day care centre? If yes, the particular measures should involve:? Equipment? Adaptation of material used by children of the same age.? Purchase of specialized equipment.? Layout (for facilities in childcare centres or for-profit day care centres only). File on the Integration into Day Care of a Child with a Disability 6

8 ? Human resources? Small group of children.? Individual help for some activities.? Other? PART E THE PROFESSIONAL INFORMATION ABOUT THE PROFESSIONAL Name (in block letters) Address Postal code Profession Telephone ( )? I am interested in learning about the integration program drawn up by the childcare establishment and the parents.? I am interested in collaborating with the childcare establishment and the parents of this child.? Information? Consultations? Meeting with child at childcare establishment? I am available to provide additional information, if necessary. Date Signature of professional File on the Integration into Day Care of a Child with a Disability 7

FILE ON THE INTEGRATION INTO DAY CARE OF A CHILD WITH A DISABILITY

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