Professional Documents
Culture Documents
m b o d i a
Pro
j e ct
JUNE 2015
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Table of contents
Acknowledgements ............................................................................................................... 4
List of Acronyms ...................................................................................................................... 5
Overview ................................................................................................................................. 7
I. Introduction ......................................................................................................................... 12
II. Background, Context & Definitions ............................................................................... 14
2.1 Cambodia and the absence of speech therapy ........................................................ 14
2.2 A new baby ............................................................................................................ 16
2.3 Pilot training ........................................................................................................... 17
III. Scope & Methodology ..................................................................................................... 20
IV. Findings ............................................................................................................................ 22
4.1 Developing and applying knowledge ....................................................................... 22
4.2 Nurturing organisational relationships .................................................................. 26
4.3 Engaging families and the wider community .......................................................... 27
4.4 Initial outcomes ....................................................................................................... 30
V. Recommendations ........................................................................................................... 34
VI. Conclusion ........................................................................................................................ 41
References ................................................................................................................................ 42
Appendices ......................................................................................................................... 43
Acknowledgements
This research would not have been possible without the
support of Speech Pathology Australia. We thank them for
their generosity.
We would also like to acknowledge the support of Mr. Yeang
Bun Eang, the Executive Director of CABDICO as well as all
CABDICO staff who are always helpful, engaged and eager to
participate in programs of this nature.
We are indebted to all our volunteers who have contributed
time, effort and resources in such a generous and passionate
way.
Finally, we would like to thank the many children and their
families for welcoming us into their homes, talking to us
about their experiences and participating in this work so
enthusiastically.
Note: Permission to conduct this research was provided to Dr.
Chyrisse Heine by the National Ethics Committee for Health
Research, Cambodia (number 182 NECHR).
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List of Acronyms
CABDICO
CCAMH
CBR
CDO
CP
Cerebral Palsy
CRO
DW
Disability Worker
JCU
MSC
NGO
Non-Governmental Organisation
ODM
Orthophonistes du Monde
PC
Project Coordinator
ST
Speech Therapy
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Overview
Background, scope and methodology
This report assesses the outcomes of pilot training
in basic speech therapy skills for Cambodian
disability workers. Conducted over eight months
in 2014, this training program is the first pilot
program to be comprehensively evaluated in
Cambodia. While the impact cannot be fully
assessed due to the short time frame and lack
of a comparable program, pilot training proved
effective in increasing disability workers basic
speech therapy skills and knowledge, having a
community reach of approximately one hundred
children (who consult the disability workers for
ongoing management).
OIC: The Cambodia Project was established to
bring this pilot into fruition, partnering with
Capacity Building for Disability Cooperation
(CABDICO), a Cambodian non-governmental
organisation supporting the empowerment of
Cambodian people with disabilities.
The nature and prevalence of disabilities in
Cambodia is poorly understood, yet recent
research by Handicap International indicates
that approximately 10.06% of Cambodian
children have disabilities, and treatment needs
are near 100% for those with moderate or worse
disabilities. Pilot training aimed to broaden
disability workers skill set to address basic speech
therapy needs, complementing and supporting
existing community based rehabilitation efforts.
OIC facilitated three training programs led
by three different organisations willing to
volunteer training services. Topics ranged
from fundamentals of communication and
swallowing disabilities to socialisation and
language development techniques (see Table
1). All training sessions covered much needed
anatomical and theoretical knowledge, and the
third session encouraged trainees to apply their
learning through site visits, role play, and other
Findings
Developing and applying knowledge
Trainees highly valued the training they received,
particularly in:
Effective treatment of swallowing difficulties
Basic speech therapy principles
Communication disabilities
Pronunciation difficulties.
Trainees highlighted that pilot training increased
their knowledge, skills, and confidence in treating
speech therapy needs. All trainees expressed a
desire for further training, particularly requesting
further training in:
Developing and utilising games and
activities in their work
Pronunciation difficulties
Problem identification (diagnosis of speech
therapy difficulty).
Although trainees benefited from training, they
noted that training did not provide enough
opportunity to practice learnt skills with their
clientele on site or provide enough time with a
professional resource person afterward to consult.
Trainees did however feel confident in
implementing techniques through tools such as
games and phonetic sound tables. Trainees felt
less confident applying and transferring their
new knowledge to families through specific and
measurable goals, particularly for children with
severe cognitive disabilities. Without a training
guideline or an overarching framework, trainees
lacked confidence regarding their abilities which
lead to requests for additional training programs.
Nurturing organisational relationships
The pilot succeeded largely through the strong
established trust between OIC and CABDICO staff.
This trust mitigated the confusion and uncertainty
created by a lack of pilot framework. Nevertheless,
CABDICOs community based rehabilitation
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Initial outcomes
Outcomes observed four months after the third
training session only indicate short-term impacts
of the pilot project. While an assessment later on
will provide more insights, the projects first year
has generated several key changes for disability
workers and children with disabilities.
Outcomes for disability workers
All trainees reported that they gained crucial
knowledge, especially in communication
disabilities, pronunciation difficulties and
treating swallowing disabilities. CABDICO run
focus groups noted that training improved their
staffs relationships with families and built their
confidence to identify and treat communication
and swallowing issues. They also identified
significant improvements in their ability to
identify, diagnose and address speech therapy
needs.
Outcomes for families
Treatment documentation indicated that some
children have begun attending school or making
Recommendations
Create a clear training framework
A clear training framework will reassure disability
workers about their progress and encourage
confidence. It will also help disability workers
and their managers understand the demands,
expectations and opportunities training entails.
Consider a long series of short training sessions
Multiple training sessions are necessary to develop
and effectively apply sufficient knowledge and
skills. This evaluation recommends a hub and
spoke model, whereby a professional speech
therapy trainer/mentor (hub) delivers a long
series of short workshops and mentoring, dividing
their time across several different groups in
different areas (spokes). This will balance the
need for rigorous training and the constraints of
resources and time.
Use pilot feedback to create grounded curriculum
Trainees have specific knowledge of implementing
speech therapy training in culturally-appropriate
ways. Prior trainees should be involved in
developing future curriculum.
Develop the knowledge and attributes disability
workers need
Feedback from all trainees demonstrated that the
speech therapy topics disability workers need
instruction in the most are:
Communication targets
Swallowing techniques
Resource development
Pronunciation and voice techniques
Setting and monitoring goals
Transferring knowledge to families
Managing family expectations, and
Treating children with severe disabilities.
Patience
Flexibility
Gentleness
Motivation, and
Enjoyment of work.
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Maintain adaptability
OICs ability to adapt throughout pilot
implementation without constraining donor
requirements allowed it to make the most of its
limited resources. An expanded donor portfolio
would bring much needed financial support,
however, OIC should aim to maintain its flexibility.
This can be achieved through a donor that
understands the ever changing nature of piloting
new work and is open to evaluation methods that
go beyond the traditional rigidity of counting
numbers. An evaluation method that prioritises
and rewards learning would be far more beneficial.
1 Introduction
This evaluation was initiated in February 2015,
only 13 months after the pilot speech therapy
training started, and four months after the pilot
training concluded. In that time, 19 disability
workers and hospital staff have used the basic
speech therapy skills they learned to support
children with communication and swallowing
disabilities. Speech therapy is a long-term process.
Nevertheless, after only months of basic speech
therapy services, children who participated in the
pilot program are better able to communicate with
the world around them, developing new abilities
to express themselves to their families, enrol in
school or make friends for the first time.
OIC aims to build the capacity of Cambodian
disability workers to identify and treat
communication and swallowing disabilities. By
supporting Cambodian community based speech
therapy practices, children can communicate better
and communities can understand them better and
be awakened to the possibilities for children with
communication and swallowing disabilities to lead
fuller and happier lives.
These training and treatment aims are interlinked
yet are different processes. The speech therapy
pilot program aimed to build basic speech therapy
capacity for Cambodian disability workers.
Therefore, this evaluation focuses on training
processes and outcomes. The evaluation considers
the effects of this training for children with
disabilities, their families, and wider Cambodian
communities to the extent possible at this early
stage.
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2 Background,
context & definitions
2.1 Cambodia and the absence of speech therapy
The nature and prevalence of disabilities in
Cambodia is not well understood. Research about
Cambodians with disabilities is scant, and many
Cambodians are unaware or misinformed about
disabilities (Evans, et al, 2014). A study conducted
by Handicap International in 2012 identified the
prevalence of children with disabilities at 10.06% of
the population (ibid.). In stark contrast, households
in Cambodias 2008 census self-identified children
with disabilities at less than 1%. The most common
disabilities identified in the Handicap International
study were cognition and speech (ibid.). Several
physical and cognitive impairments can lead
to communication and swallowing disabilities,
including cerebral palsy and cleft lip and palate.
Broadly, speech therapy aims to evaluate and treat
communication and swallowing disabilities.
Early intervention for children with disabilities is
critical, as the earlier a child receives treatment,
the more effective treatment outcomes are (Paul
and Roth, 2011). As one-third of Cambodians are
under the age of 15 (Evans, et al, 2014), the effects
of late intervention or no intervention for children
with disabilities are likely to be far reaching and
substantial.
OIC: The Cambodia Project was established as part
of Capacity Building for Disability Cooperation
(CABDICO) in 2013 to develop a universally
available, locally-led speech therapy service
system in Cambodia. CABDICO is a Cambodian
non-governmental organisation (NGO) that
supports the empowerment of people with
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PROGRAM 1
JAN 2014
TOPICS COVERED
PARTICIPANTS
3 Grace House
disability workers
2 Sangkheum Centre
caregivers
6 CABDICO staff:
-- 3 child rehab officers
-- 2 community
development officers
-- 1 field supervisor
PROGRAM 3
JUN 2014
19 parents of children
with communication
and swallowing
disabilities
29 teachers
PROGRAM 4
OCT 2014
7 CABDICO staff:
-- 3 child rehab officers
-- 2 community
development officers
-- 1 field supervisor
-- 1 finance and admin
advisor
2 Grace House
disability workers
16 total
6 total
48 total
12 total
Overview of
communication,
feeding, and swallowing
disabilities
Acquisition of language
Biomedical
considerations
Cultural, social and
linguistic foundations
Principles of
intervention
Cognition
Multimodal
communication
Language facilitation
techniques
Vocabulary training
Language stimulation
techniques
Pre-training knowledge
questionnaires
Qualitative
questionnaires
post-training
Parent baseline
questionnaire
(pre-treatment and
pre-training) (January
2014)
Parent post-training
questionnaires (May
2014)
Teacher pre- and posttraining questionnaires
(June 2014)
ASSESSMENT
9 CABDICO staff:
-- 3 child rehab officers
-- 3 community
development officers
-- 1 field supervisor
-- 2 Kep staff
PROGRAM 2
FEB 2014
Swallowing: diagnosis,
foods, positioning for
eating and drinking,
advice
Communication:
modelling,
reinforcement
Socialisation: advice to
neighbours, teachers,
community
Referrals
Knowledge quiz
Post-training knowledge
questionnaires
Overview of speech
therapy
Hearing loss
Swallowing disabilities
Fluency disabilities
Techniques to promote
speech and language
development
Pre-training
questionnaires (n=12)
Mid-training
questionnaires (n= 7)
Post-training
questionnaires (n=11)
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3 Scope &
methodology
OIC identified the following objectives for this
evaluation:
1. Determine the impact of the speech therapy
training program in regards to:
Participants knowledge of speech therapy
Participants ability to provide speech
therapy interventions
The communication and swallowing
outcomes of children with disabilities
who are currently receiving services from
CABDICO
2. Identify any barriers faced by participants in
implementing speech therapy interventions
3. Determine the sustainability of the training
including cultural sensitivity, training
methodology and appropriateness of content
4. Provide recommendations that will guide the
content and format of future speech therapy
training programs.
Early discussions with OIC management
demonstrated interest in a learning and reflection
evaluation process, rather than attributing
responsibility for all successes or failures. Because
the project is focused on locally delivered services
and strong partnerships with local organisations,
this evaluation aimed to spark an evaluation
process among all OIC and CABDICO staff
who implemented the pilot. Through an active,
participatory process, the evaluation could develop
staffs own monitoring and evaluation practice.
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4 Findings
4.1 Developing and applying
knowledge
Training sessions
Disability workers overwhelmingly expressed
gratitude for their training. While they
understandably requested more training, they
nonetheless found everything they learned useful:
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NEVER
I understand 1 0
what my child
wants
LITTLE
OF TIME
SOME
TIMES
NEARLY ALWAYS
ALWAYS
RESULT
1 0
3 1
13 8
1 10
My child can
says what
she/he needs
3 1
2 1
8 2
6 10
0 5
My child can
eat, drink
and swallow
easily
0 0
5 0
5 5
4 8
4 6
I know how 1 0
to help my
child be a
better speaker
3 0
11 8
4 11
0 0
My child can 0 0
communicate
with members
of the family
6 0
9 3
4 10
0 6
My child can 0 0
communicate
with friends
8 1
7 6
4 9
0 3
My child
4 1
participates
in community
activities
in spite
of her/his
communication
problem
6 2
6 7
3 8
0 1
My child is 3 0
confident
with the way
she/he speaks
5 6
3 8
11 6
4 11
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5 Recommendations
Create a clear training framework
Trainees consistently reported that they needed
more training, and did not know whether or
when further training would be provided. A clear
training framework will reduce trainees anxiety
about their partial knowledge. A clear training
framework, presented from the first session, will
reassure disability workers about their progress.
It will also help disability workers and their
managers understand the demands, expectations
and opportunities training entails.
Consider a long series of short training sessions
OIC must balance the need for rigorous training
with the realities of trainees time constraints and
the limited availability of professional speech
therapy volunteers. Employing a hub and spoke
model of training would effectively meet these
needs and challenges. A hub professional speech
therapy trainer/mentor would deliver a long series
of short workshops and mentoring, dividing their
time across several different groups in different
areas (spokes), visiting each at regular intervals
for short training sessions and mentoring.
Orthophonistes du Monde (2014) highlighted
that many training topics are completely new
to disability workers, and should be revisited
multiple times to reinforce learning. One disability
worker reflected: I cannot remember all of [the
training I received] and I want to have the same
training as before, but I want [OIC] to look for
new methods to add on top of those. Feedback
from trainers, disability workers and technical
specialists suggests that multiple training sessions
are necessary in order to grasp a sufficient breadth
of knowledge, fully absorb new concepts, and
effectively apply this knowledge. Orthophonistes
du Monde also found that two weeks of training
barely scratched the surface, yet acknowledged
the high opportunity cost of removing disability
workers from their regular duties for two weeks
Communication targets
Swallowing techniques
Resource development
Pronunciation and voice techniques
Setting and monitoring goals
Transferring knowledge to families
Managing family expectations, and
Treating children with severe disabilities.
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Patience
Flexibility
Gentleness
Motivation, and
Enjoyment of work.
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6 Conclusion
Cambodian disability workers, like the one quoted
to the right, have worked with children with
communication and swallowing disabilities for
years without access to the skills they need to
address these disabilities. Many families are weary
after trying other treatments that did not work. The
demand for speech therapy is enormous. In 2014,
OIC effectively trialled a unique speech therapy
approach in Cambodia.
Through this approach, there have been significant
improvements in the lives of children with
disabilities despite resource constraints. Although
care needs to be taken in scaling up this approach,
this evaluation validates not only the need for
speech therapy, but also the model that can
address this need.
Significant challenges to successful implementation
remain, from the need to increase community
awareness of speech therapy to the lack of a
common Khmer speech therapy language. Pilot
expansion will require the coordinated efforts
of many sectors and organisations beyond
OIC and CABDICO to successfully address
the barriers currently preventing people with
communication and swallowing disabilities
from participating fully in society. However, this
coordinated approach will only work with the
support of funding bodies that recognise the value
of this service and the uncertainty that comes
with piloting a new program. Limited financial
resources are the key barriers restricting access to
speech therapy for the one in 25 Cambodians who
need it.
If OIC and its partners strengthen and nourish
their relationships, communicate well between
themselves, and document and analyse how
implementation really works in a Cambodian
context, then the projects capacity to address
Cambodias long overlooked communication and
swallowing needs will flourish.
References
Astbury, J. and Walji, F. (2013) Triple jeopardy:
Gender-based violence and human rights
violations experienced by women with disabilities
in Cambodia. AusAID Research Working Paper 1,
January 2013.
Evans, P., Shah, S., Huebner, A.,
Sivasubramaniam, S., Vuthy, C., Sambath, K.,
Haurisa, L., and Borun, Y. (2014) A Populationbased Study on the Prevalence of Impairment and
Disability Among Young Cambodian Children.
Disability, CBR and Inclusive Development, 25(2),
5-20.
Greenhalgh, T., Robert, G., Bate, P., Kyriakidou,
O., Macfarlane, F., and Peacock, R. (2004) How
to Spread Good Ideas: A systematic review of
the literature on diffusion, dissemination and
sustainability of innovations in health service
delivery and organisation. Report for National
Co-Ordinating Centre for NHS Service Delivery
and Organisation R&D. Retrieved from http://
www.cs.kent.ac.uk/people/staff/saf/share/greatmissenden/reference-papers/Overviews/NHS-litreview.pdf.
Mannan, H. and Turnbull, A.P. (2007) A Review
of Community Based Rehabilitation Evaluations:
Quality of Life as an Outcome Measure for Future
Evaluations. Asia Pacific Disability Rehabilitation
Journal, 29(18), 1-17.
Orthophonistes du Monde (ODM). (2014)
CABDICO-OdM Mission Report October 20th
31st October 2014.
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Appendices
Appendix A: Primary and secondary evaluation data
Appendix B: Family MSC stories
Appendix C: Follow-up book summaries
Appendix D: ODM training evaluations
Appendix E: Pre and post training staff questionnaires
SAMPLE SET
DATE
COLLECTED
DESCRIPTION
Disability Workers/Trainees
15 DWs from four organisations
20/1/14
??
??
30/5/14
6 CABDICO trainees
2/15
3 CABDICO CROs
2/15
1 CABDICO manager
2/15
28/1/14
Pre-training questionnaire
Post-training questionnaire
1 9 c a s e s t u d y c h i l d r e n w i t h 1/14
communication/ swallowing disorders
identified by CABDICO
1 3 c a s e s t u d y c h i l d r e n w i t h 2/15
communication/ swallowing disorders
??/5/14
Managing Director
2/15
3 SLT Specialists
2/15
1 Strategy Advisor
2/15
n/a
2/15
Parents/Families
19 Families of children with
communication/swallowing disorders
Teachers
29 Teachers
OIC Staff and Advisors
BIRTH YEAR
CP
CP
CP
CP
CP
CP
2002 M
2007 M
2008 M
2012 M
2008 M
2005 M
MI 27
GENDER
DIAGNOSIS
2009 M
FAMILY
MEMBER
INTERVIEWED
Mother
Mother
Older
aunt
Mother
Mother
Mother
Mother
At first child has started with a few words until he can speak out a sentence.
Although his communication is improved, his voices is not so clear. He stop
coughing or stucking when he eat food, but he gets coughing only he does not
drink water through tube. His memory is better. The mother said the most
significant change is communication because I am so happy when my child can
debate or talk to his friends.
He can eat several kinds of food and he is not so often coughing. He can
communicate with others by body language. Parents are happy when he is
getting healthy so they have more time for income generation.
He can swallow in better way, for instance, not so often cough and stuck in the
throat. His family members are very happy when they see he is healthy. Now
he can turn his body over and he also be able to tell his needs by body language.
Lastly, he can position his neck.
Family happiness is happening while the child can speak more words and clearer
than before. For instance, parents could understand the child's needs. More
specifically, the child can eat both soft and hard food. And he has more friends
and they understand his communication. Right now, he can be far from his
mother.
He can speak the words he heard. He stop coughing when eating food. The
significant change is he can play with other children, for instance, he can visit his
neighbours alone because those people understand his words. His mother hope
that one day he can go to school.
The significant change is he can speak in better way and other people around him
understand his words. So he has more new friends. Last but not least the family
get more income and be closer.
Change in speaking since he has received the speech therapy. Before he was
often sick while now he is better. So he has changed a lot in speaking because his
mouth is not sticky. Moreover, he is getter easier to speak, especially parents are
happy when their child can go to school. In short, parents are happy when their
child's swallowing and communicating disorders is being solved from time to
time.
STORY
Better
Swallowing
X
Clearer
Speaking
X
Body
Language
X
Better
General
Health
X
School
X
Friends
X
Happy
family
X
Parents
have more
time
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BIRTH YEAR
CP
2008 M
CP
Cleft
Palate
2013 M
MI27
2004 M
CP
2009
Cleft
Palate
GENDER
DIAGNOSIS
2010 M
FAMILY
MEMBER
INTERVIEWED
Mother
Cousin
Father
Mother
Mother
Mother
Better
Swallowing
9
Total prevalence of outcomes in stories
Clearer
Speaking
Body
Language
X
School
3
Friends
4
Happy
family
5
Parents
have more
time
The child can swallow better, not too often cough and stuck. His body position is
improved. He is healthy. But his communication is growing slowly so the family
members are getting more responsibilities for take care of child.
The child can sit by himself. The most significant change, he can swallow better,
not too often cough and stuck. He is healthy. He can dress by himself. He can tell
his needs by body sign. Family members have more time to do other tasks.
The child can speak clearer and better than before, for instance, he can speak a
word that has two or three consonants. The most significant change, the child can
swallow easier and he can much more food. He is not coughing. Now parents
have more time to do other tasks.
Mother said, his voices is clearer than before so that she does not need to verify.
In regarding with swallowing is good. In short the family members are very
happy when the child can speak better. But there is only thing that they do not
happy with, the child cannot walk.
Mother is so happy when her child can communicate in basic way, for example,
he can communicate via body sign and face language. Moreover, he can sit . by
himself. From this improvements mother has more time to do other tasks because
she does not to be with him all the time.
The most significant change for him is that he can go to school because his voices
is assumed that is clear enough, for example, only one of ten words that is not so
clear while before ten words, that he speaks, are not clear at all. As the result, he
can do something by himself and he can tell about his needs. The most interesting
he can sing, and his sound is understandable, mother said.
STORY
Case Study #4
Name: Kea Sochhy
Gender: M
DOB: 2005
Diagnosis: Mouth
Cleft
CRO: Chhien
Case Study #5
Name: Mao Morn
Gender: M
DOB: 2009
Diagnosis: CP
CRO: Simoun
Case Study #3
Name: Houn Neang
Gender: M
DOB: 2007
Diagnosis: CP
CRO: Chhien
SHORT
TERM GOAL
FOLLOW UP
PLANNING
Case Study #2
Name: Hor Sreydav
Gender: F
DOB: 2011
Diagnosis: CP
CRO: Chhien
Case Study #1
Name: Bu Somnang
Gender: F
DOB: 2012
Diagnosis: Mouth
Cleft
CRO: Simoun
CASE STUDY
ACTIVITIES
Starts 10/2/2010
Starts 21/1/14
Starts 20/7/2010
Starts 30/09/2012
Starts 18/3/2014
TIMEFRAME
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FOLLOW UP
In 2012 teaching child how to hold
pencil and model skills and nothing
state about communication. In 2014
discussion about childs study,
but it does not tell the child study
at school or just only at home.
Mentioning about language, but not
sure what language is. Providing
many technical aids and many
donor visits. It seems like she is not
really providing communication
therapy- doesnt have time.
CRO follows what set in the
short-term plan, but every activity
undertaken did not tell the result,
but based on the progress the child
can go to school.
PLANNING
CASE STUDY
Case Study #6
Name: Yon Socheat
Gender: M
DOB: 2005
Diagnosis: CP
CRO: Chhien
Case Study #7
Name: Theoun Thiv
Gender: F
DOB: 2004
Diagnosis: CP
CRO: Simoun
Case Study #8
Name: Ra Tai
Gender: F
DOB: 2009
Diagnosis: CP
CRO: ??
ACTIVITIES
In the period of
three months,
child start learning
how to write and
in another three
months the child
can go to school.
SHORT
TERM GOAL
Starts 1/9/2011
Starts 8/2/2011.
For the Activity
1 takes between
2-7-2011. Activity
2 takes between
9-12-2011
Starts 26/2/2009
TIMEFRAME
FOLLOW UP
Keep records of activities such
as child development (social,
cognition, hearing, vision)
evaluation, medication history
from Angkors Children Hospital
and services (exercise, discuss with
parents to make technical aids) by
CABDICO. Staff start using skills
from ST training to access the
swallowing ability of child
There is no clear connection
between an activity to another one
in 2011. But more clear connection
in 2014. DW focusing more the
goal the child goes to school and
achieved goal. It does not tell the
missing activity is done in another
period of time. Moreover, their
notes are not clear enough for other
people to read.
PLANNING
Case Study #9
Name: Chheoun
Reaksmey
Gender: M
DOB: 2002
Diagnosis: CP
CRO: Phearom
CASE STUDY
Gross motor, playing game and exercise
ACTIVITIES
His family
members will
understand the
core activities of
CABDICO. Child
will be able to
walk. He will
dress by himself.
He can speak out
a sentence. He
can position his
arm. Child can
write and be able
to draw a circle.
Child will have
strong confident
in study. Child
will know how to
tell his own needs.
SHORT
TERM GOAL
Starts 7/6/2009
Starts 29/1/2011
Starts 27/7/2013
TIMEFRAME
S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 4 9
positioning
for eating and
drinking
2 - suck
and swallow
for infant
(interesting for
hospital staff)
I want to learn
more about
speech therapy
4 - speech therapy
3 / definition
and using speech
therapy and those
who receive speech
therapy
3 - speech therapy
4 - Yes / yes
it will change
/ I think
there will be a
change / yes,
definitely!
CHANGE
WORK
exercise for
stimulate
suck and
swallow
XX
communication communication
swallowing
NEW
TOPIC
2 - pronunciation X X
(for teaching
children)
listening testing,
listening sound
3 - Pronunciation
(vowel and
consonant)
communication
swallowing
WOULD
LIKE MORE
4 - hearing (listening) 2 /
hearing loss / hearing devices
3 - communication
(good habit)
3 - swallowing (how
to treat issues)
TOPICS MOST
IMPORTANT
7 - swallowing / helping
children with speak and
swallowing difficulty / how
to effectively help a child with
swallowing trouble / helping
children with speak and
swallowing difficulty / how
to effectively help a child with
swallowing troubles / how to
speak and swallow
SKILLS LEARNED
for sucking
and
swallowing
next
training
Should be
more new
topics or
courses
regarding
speech
therapy
BARRIERS OTHER
Communication disorder
and unclear and misspelled
speaking
(Hosp) Communication
and swallowing disorders
can affect anyone with
neurological problems,
so taking part in "normal
society life" is very difficult
or not possible for them.
Difficulties eating and
understanding and making
oneself understood
difficulty in swallowing,
choking while eating and
food falling from mouth
/ communication and
swallowing disorders have
resulted from giving food
or fluid and timing are not
consistent with each other
YOUR
UNDERSTANDING
stuttering
2 - stuttering
assistive devices;
adapted devices
assistive devices
stimulation games
1 - testing
1 - stimulation game
Practical
implementation
with children
sound disorders,
how to identify
sound
visiting
children
teaching signs
voice
expression /
good speaking
habit
WOULD
LIKE MORE
2 - intensity, frequency
sign development
voice expression
2 - what is voice?
vocal system
TOPICS MOST
IMPORTANT
SKILLS LEARNED
Intervening for
children with
speaking and
swallowing
difficulties
NEW
TOPIC
It's easier to
understand
and to work
with children
having speech
therapy
Know better
on how to
express voice
CHANGE
WORK
high
workload /
many fields
of works
that we
need to be
responsible
would be
interesting
for staff of
the hospital
to maybe
join shorter
workshops
(about five
days) since
it's not easy
for them to
get off work
altogether.
BARRIERS OTHER
Communication and
swallowing disorders
are important issues in
Cambodia, particularly
they happened with
small children. I do hope
that CABDICO will keep
continue to provide more
training to professional
staff so that they could
be able to intervene
directly with children with
disabilities
communication and
swallowing disorders are
resulted from varieties of
disabilities
YOUR
UNDERSTANDING
S P E E C H T H E R A P Y P I LOT P R OJ E C T E VA LUAT I O N | 5 1
hearing loss
benefit of basic
experiment on
child's growth
hearing system
(ear)
WOULD
LIKE MORE
demonstration of
hearing impact,
particularly
demonstration of
level of volume
(voice) that can
affect the ears
TOPICS MOST
IMPORTANT
SKILLS LEARNED
how to play
with children;
definition
of effective
activities for
playing with
children
details of
impact of
hearing loudly
NEW
TOPIC
(know better)
develop game
for children
yes I do, as
it helps us
to be more
confident
in helping
children
as well as
ways to
communicate
with the
family more
effectively
CHANGE
WORK
No
did not
practice
with
children
lack of
expert/
professional
nearby
BARRIERS OTHER
(teacher) Communication:
difficult to make
connections in head if do
not know the vocabularymaking links between
things; there are specific
techniques you can use to
help children who have
trouble swallowing. It
is harder to get specific
nutrients
YOUR
UNDERSTANDING
SKILLS LEARNED
TOPICS MOST
IMPORTANT
2 - specifically
with autistic
children
WOULD
LIKE MORE
specific tactics
with specific
disabilities/
impairment
want more
trainings;
should have
more refresher
trainings /
wish to have
an in-depth
lesson on each
training
NEW
TOPIC
after training,
all topics
or courses
will be the
experiences at
community
I have a
change after
attending
ten-day
training; I
feel that, after
attending
this course, I
gained more
knowledge
than before
CHANGE
WORK
2 - lack of
confidence
4 - lack
of skills 2
/ I have
difficulty as
I don't have
clear skill to
work with
children /
still have
difficulty
as I don't
receive skill
quite well
(teacher)
not a lot of
professional
support,
not a lot of
guideline
4 - wish to
have more
training in
the future 2
/ need more
training in
the future
/ don't be
rush with
too many
topics
BARRIERS OTHER
should provide this
training for teachers in the
community
YOUR
UNDERSTANDING
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