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{"_buckets": {"deposit": "660f843a-e6f9-4fb8-bb7c-290ae7380864"}, "_deposit": {"created_by": 16, "id": "1257", "owners": [16], "pid": {"revision_id": 0, "type": "depid", "value": "1257"}, "status": "published"}, "_oai": {"id": "oai:phoenix.repo.nii.ac.jp:00001257", "sets": ["85"]}, "author_link": ["7610", "7608", "7609"], "item_10006_date_granted_11": {"attribute_name": "学位授与年月日", "attribute_value_mlt": [{"subitem_dategranted": "2017-03-19"}]}, "item_10006_degree_grantor_9": {"attribute_name": "学位授与機関", "attribute_value_mlt": [{"subitem_degreegrantor": [{"subitem_degreegrantor_name": "九州保健福祉大学"}]}]}, "item_10006_degree_name_8": {"attribute_name": "学位名", "attribute_value_mlt": [{"subitem_degreename": "博士(社会福祉学)"}]}, "item_10006_description_10": {"attribute_name": "学位授与年度", "attribute_value_mlt": [{"subitem_description": "平成28年度", "subitem_description_type": "Other"}]}, "item_10006_description_7": {"attribute_name": "抄録", "attribute_value_mlt": [{"subitem_description": "1.問題の所在,研究課題及び研究目的\n 幼稚園には,障害や疾患などの健康課題が明らかで治療や支援の体制が整っている幼児だけでなく,発達障害など早期の把握が困難で支援体制が整っていない幼児も在籍している.後者の場合,幼稚園生活での困難に加え,小学校等への就学時に適切な支援や配慮が受けらない危惧がある.2012年に文部科学省は,障害のある者と障害のない者が共に学ぶ仕組みとしてインクルーシブ教育を推進していくと公表しており,特別支援教育の対象と公に認識される子どもの人数は,平成5年度と平成24年度を比較すると約6倍に増加している.特別な支援や配慮の必要な幼児の早期発見と幼稚園での早期支援体制の整備が急務となっている.このような現状を踏まえ,本研究では,特別な支援や配慮の必要な幼児の早期発見と特別な支援や配慮が必要な幼児と家族のために,幼稚園の養護教諭はどのような支援ができるのかを主たる研究課題とする.\n 本研究の目的は,特別な支援や配慮を必要とする幼児とその家族への支援体制の確立のため,早期発見・早期支援システムと幼稚園の養護教諭が行う支援に焦点をあて検討を行い,そこに養護教諭がどのように関わっていくかを明らかにすることである.本研究では,医療,福祉,教育が連携して実施する5歳児健診についての先行研究のレビューを行うととともに,実際に5歳児健診を実施している自治体に質問紙調査を実施し,5歳児健診の在り方について検証を行う.さらに,その5歳児健診の結果を受け支援体制を行う際に健康面からサポートする養護教諭の役割について調査研究を行い,有効な早期発見・早期支援体制の構築について検討する.\n2.論文の構成と研究方法\n 本研究は,「第Ⅰ部 特別な支援が必要な幼児の早期発見」とし,早期発見システムについて注目し,現在,日本で実施されているシステムについて検討を行った.第1 章では,障害児(者)福祉と教育における障害児支援の動向についての文献研究を行い,障害児福祉と学校教育,幼稚園教育,学校保健,養護教諭の職務に関する関連について論考した.第2 章では,障害や疾患等により特別な支援や配慮が必要な子どもの保護者へのインタビューに基づいた先行研究及び保護者支援に関する先行研究について文献研究を行い,保護者の思いや今後の保護者支援について考察・検討した.第3 章では,現行の法律に基づき実施されている乳幼児健診や就学時健診及び法的な整備のなされていない5歳児を対象とする健診等に焦点を当て文献研究を行い,その効果と課題について検討した.第4 章では,5 歳健診を実施している自治体及び実施していたが終了した自治体に質問紙調査を実施した.一部の自治体には訪問調査も実施した.調査結果から行政サイドから見た5歳児健診の効果や課題について検討を行った.調査期間は,2013年10月~2013年11月である.第5章では,第4章の調査結果を踏まえ対象幼児1,000 人以上の自治体における5 歳児健診の持ち方と支援体制を提案した.\n 「第Ⅱ部 特別な支援や配慮が必要な幼児への養護教諭が行う支援」では,特別な支援や配慮が必要な幼児への支援における養護教諭の役割についに検討を実施した.早期発見システムを実施するだけではその効果は十分でなく,早期支援体制の充実が急務である.幼稚園の園長,教諭,養護教諭を対象とした特別な支援や配慮が必要な幼児への支援における養護教諭の役割についに質問紙調査を実施し,今後果たすべき役割について検討し,提案を行った.第6 章では,特別支援教育に転換して3 年が経過し,教育現場の体制が整い始めた2010 年に発達障害のある幼児への支援における養護教諭の役割について質問紙調査を実施し,今後期待される養護教諭の役割について検討した.調査期間は2010 年6 月~2010年9 月である.第7 章では,特別支援教育に転換して8 年,インクルーシブ教育が導入され3 年が経過した2015 年に幼稚園の特別支援教育に関する体制整備及び関係機関との連携の状況について園長を対象に質問紙調査を実施した.調査結果から関係機関との連携や幼稚園における支援体制の課題について検討した.調査期間は2015 年8 月~2015 年9 月である.第8 章では,特別支援教育に転換して8 年,インクルーシブ教育が導入され3 年が経過した2015 年に特別な支援や配慮が必要な幼児への支援における養護教諭の役割について質問紙調査を実施した.調査結果から今後果たすべき養護教諭の役割について検討した.調査期間は2015 年8 月~2015 年9 月である.第9 章では,第6 章(2010 年)と第8章(2015 年)で実施した質問紙調査の同一質問項目について比較検討を行い,5 年間での養護教諭の役割の変遷について考察した.第10 章では,第1 部と第6 章から第9 章までの調査結果及び検討結果を踏まえて,養護教諭が今後果たすべき役割について提案を行った.\n3.結果と考察\n 第1 部では,障害児福祉における変遷に伴う学校教育,幼稚園教育,学校保健及び養護教諭の役割の変遷と保護者支援についての文献研究と障害や疾患の早期発見体制についての文献研究及び質問紙調査を実施し,対象幼児の1,000 人以上の自治体での早期発見システムと早期支援の在り方について提案を行った.\n 第1 章では,障害児福祉における変遷に伴う学校教育,幼稚園教育,学校保健及び養護教諭の役割の変遷について検討を行った.戦後日本では,障害のある子どもは盲学校,聾学校,養護学校等で教育を受けるという考え方のもと就学支援が進められていた.1950 年代に北欧で誕生した「ノーマライゼーション」の理念は,世界の障害者運動の基本理念となり,日本の障害児(者)福祉や学校教育にも大きな影響を与え,2007 年に特殊教育から特別支援教育に転換し,2012 年にはインクルーシブ教育が導入された.障害児支援の変化とともに幼稚園,養護教諭が果たす役割も変化していっていた.しかし,特別支援学校の幼稚部の設置数は少なく,特別な支援や配慮が必要な幼児の初めての集団生活の場となる幼稚園の役割は重要であることが示唆された.第2 章では,保護者支援に関する文献研究を実施した.障害や疾患がある子どもの保護者は悩み苦しみながら子どもを育てており,教職員には子どもをもっと理解して欲しいと考えていた.教職員は,保護者を共に子どもを支援する者というだけでなく,保護者も支援される側にいるという2 つの視点を持つ必要がある.第3 章では,文献研究により,乳幼児健診と就学時健診の間の5 歳の頃に健診等を導入することで早期発見につながることが示唆された.第4 章では,5 歳児健診を実施している自治体への調査結果から,5 歳児健診には,「乳幼児健診では発見されにくい健康課題を早期発見できる」,「早期支援体制の確立やスムーズな就学に結びつく」,「関係機関の連携が強化される」,「子育て支援が充実する」などの効果があることが明らかになった.一方で「医師やスタッフの確保が困難」,「大規模な自治体では,全ての幼児を対象とした実施が困難」,「予算の確保が困難」などの課題も明らかになった.第5 章では,対象幼児1,000 人以上の大規模な自治体における5歳児健診の持ち方と支援体制について次のような提案を行った.①人的・予算的負担の軽減:幼稚園・保育所での実施:教職員が5 歳児健診診査表で絞り込み後,対象幼児を園医が5 歳児健診を実施する.②関係機関の連携強化:乳幼児健診からの途切れのない支援体制を作る.③支援体制の充実:支援体制に養護教諭・看護師や園医を加え,保健・医療面での支援体制の充実を図る.\n 第2部では,特別な支援や配慮が必要な幼児への支援における養護教諭の役割について幼稚園の園長,教諭,養護教諭を対象とした質問紙調査を実施し,その結果をもとに養護教諭に求められる役割について提案を行った.第6 章では,2010 年に実施した調査結果の検討を行った.質問項目別に見てみると,園長・教諭の養護教諭への「役割期待」と養護教諭の「役割認知」においては,「ケガや体調不良時の手当て」,「日々の健康観察による変化の把握」,「個別の保健指導」,「園医との連絡調整」,「研修会の参加」は,全ての職種が養護教諭の重要な役割として考え,養護教諭はその期待を認識していることが明らかになった.一方で「主治医との連絡調整」,「関係機関との連絡調整」,「他の幼児や保護者への理解や協力の要請」,「特別支援に関する園内研修の企画・実施」,「支援幼児の情報提供」,「個別の支援計画作成の助言」,「就学前の学校との連絡調整」,「就学前の学校の養護教諭との連絡調整」は園長・教諭の期待に養護教諭は応えていないことが明らかになった.第7 章では,2015 年に実施した幼稚園長への特別支援教育体制についての調査結果の検討を行った.発達支援センターや保健センターとの連携状況から,「途切れのない支援」が充分でない幼稚園が多いことが明らかになった.また,幼稚園では,統計上は,「特別支援教育コーディネーターの配置」,「個別の教育支援計画の作成」,「関係機関との連携」は進んでいるが,特別支援教育コーディネーターは充分にその役割を果たしておらず,園長や担任の負担が大きいことが明らかになった.教職員の少ない幼稚園で特別支援教育コーディネーターを専任で配置することは困難であり,各教職員がその職務の特性を生かした適切な役割を担い,支援体制の充実を図る必要があることが明らかになった.第8 章では,2015 年に実施した調査結果から,「ケガや体調不良時の手当て」,「日々の健康観察による変化の把握」,「健康診断等保健行事を受ける際の工夫」,「保健室や処置対応場所の環境整備」といった「保健管理」に係る役割に園長・教諭は期待し,その期待に養護教諭も応えていた.「個別の保健指導」,「園内支援委員会への参加」,「ケース会議への参加」は園長・教諭は期待し評価しているが,養護教諭は自覚していない役割であった.一方で,医療や保健といった養護教諭の職務と深く関わるコーディネーター的な役割には期待に応えていなかった.この役割を養護教諭が担うことで園長や担任に集中した支援の負担軽減にもつながる.「保健室経営計画に特別支援に関する内容を加味」は園長や教諭で「ズレ」が大きく,養護教諭は小さかった.特別な支援や配慮が必要な幼児がすごしやすい幼稚園は,他の幼児にとってもすごしやすい場所となることから,今後の課題である.第9 章では,2010 年と2015 年の調査の同一項目の比較検討を行った.「ケガや体調不良時の手当て」,「日々の健康観察による変化の把握」はどちらの調査でも園長と教諭の期待が高く,養護教諭も期待に応えていた.「別室での個別対応」,「園内での情報提供」は,2010 年の調査ではあまり期待されず評価も低かったが,2015 年には認められた.養護教諭が「保健管理」,「健康相談」といった幼児への直接的な支援の必要性を自覚し,その役割を担い得た期待と評価である.\n 第10 章では,総括として,これまでの1 章から9 章までの文献研究及び質問紙調査の結果から,幼稚園における支援体制を充実するのために次のような提案を行った.①園長のリーダーシップのもと,幼稚園における支援体制の整備を行う.②養護教諭は幼児への直接的支援だけでなく,専門性を生かしたコーディネーター的な役割を担う.③幼稚園での養護教諭の適正配置を行う.\n 特別な支援や配慮が必要な幼児への支援の変化に伴い,養護教諭の役割にも新たなものが加わってきた.今後も目の前の子どもの健康課題に合わせ,新しい役割に柔軟に対応していく必要がある.\n4.結論\n 本研究では,障害や疾病の早期発見に有効的なシステムの導入と早期支援における幼稚園の養護教諭の役割について検討を行った.\n 乳幼児健診と就学時健診の間に5 歳児健診等の健康診断を導入することで,途切れのないの支援につながることが明らかになり,併せて早期支援を充実させる必要性が見えてきた.特別な支援や配慮が必要な幼児にとって,初めての集団生活の場となる幼稚園の役割は大きいが,幼稚園では,少ない教職員が支援にあたっており,適正な役割分担により支援にあたる必要がある.養護教諭は,チーム幼稚園における子どもの健康を守る専門職として,「保健管理」や「健康相談」に係る支援に限らず,健康面でのコーディネーター的な役割を担う必要があることが明らかになった.\n 本研究では,具体的な合理的配慮を含む支援内容を明示するにはいたっていない.養護教諭による合理的配慮を含む支援,保護者支援についての養護教諭の役割や支援者の資質向上についての探求及び検証が今後の課題である.", "subitem_description_type": "Abstract"}, {"subitem_description": "1. Nature of the Issue, Research Tasks, and Research Objectives\nKindergarten children include not only ones with obvious health issues such as disabilities or illnesses, for which systems for treatment and support are in place, but also ones with issues such as developmental disorders that are difficult to identify at an early stage, and for which no such systems have been established. In the case of the latter, there is a risk that the child will not only experience difficulty with kindergarten life, but also fail to receive appropriate support and care at elementary school. In 2012, the Ministry of Education, Culture, Sports, Science and Technology announced that it would be promoting inclusive education, a system under which both children with disabilities and children without disabilities study together, and the number of children officially recognized as requiring special-needs education increased by approximately six times between and 1993 and 2012.\n The early identification of children requiring special care or support and the establishment of systems for providing support at an early stage at kindergartens has become an urgent task. Given this situation, the primary research task of this study will be to find out what methods are best for the early identification of children requiring special care or support, how best to establish systems of support for health education teachers at kindergartens, and to determine what sort of support health education teachers at kindergartens can provide to children requiring special support and their families.\n This study focuses on early-identification/support systems and the support provided by health education teachers at kindergartens, and its purpose is to shed light on the role that health education teachers will play in the establishment of support systems for children requiring special care or support. In this study, I will review previous research on the medical examinations of five-year-olds, which are administered jointly by personnel from the fields of medicine, welfare, and education. I will also investigate the nature of the medical examinations for five-year-olds through a questionnaire survey of local governments that actually perform them. Furthermore, I will explore the roles of health education teachers in providing support from the health side of things when support is provided to a child based on the results of the medical examination they underwent at five years old, and then consider how to establish an effective early identification/support system.\n2. Structure of the Paper and Methods of Research\nThis study is divided into two parts. Part I, Early Identification of Children Requiring Special Support, focuses on early-identification systems and looks at the system currently being implemented in Japan. In Chapter 1, I reviewed literature covering trends in support for children with disabilities in the fields of welfare and education for people with disabilities, and examined the relationships between welfare for children with disabilities and kindergarten education, school health education, and the duties of health education teachers. In Chapter 2, I investigated the feelings of parents/guardians and possible support for them in the future by carrying out research based on interviews with the parents/guardians of children who require special support or care due to disabilities, illnesses, etc., and also by reviewing previous research on support for parents/guardians. In Chapter 3, I turned my attention to medical examinations for babies and for children beginning elementary school, both of which are currently mandated by law, as well as those for five-year-olds, which are not. This took the form of a literature survey, and I examined the effects of these examinations and issues with them. In Chapter 4, I conducted a questionnaire survey of local governments that perform medical examinations of five-year-olds and local governments that performed them in the past but no longer do so. I also visited some of the local governments in person. I then used the survey findings to explore the effects of the medicals examinations for five-year-olds and issues with them. The survey period was October-November 2013. In Chapter 5, I made suggestions for how to handle medical examinations for five-year-olds at local governments that perform such examinations on 1,000 or more children each year. I also proposed a support system for them.\n In Part II, Support provided by the role of health education teachers for infants who need special support and consideration, I investigated the role of health education teachers in supporting children who require special support or care. Simply deploying an early-identification system has little effect, so improving early-support systems is an urgent task. I carried out a questionnaire survey to find out about the roles of kindergarten principals, kindergarten teachers, and health education teachers in providing support to children requiring special support or care. I also considered and made suggestions concerning the roles they should play in the future. In Chapter 6, I describe a questionnaire survey of the roles of health education teachers in supporting children requiring special support or care that I conducted in 2010, three years after the introduction of special—needs education, when systems on the frontline of education were beginning to take shape. I then explored the roles that health education teachers will be expected to play in the future. The survey period was June-September 2010. In Chapter 7, I discuss a questionnaire survey of kindergarten principals that I performed in 2015, eight years after the introduction of special-needs education and three years after the adoption of inclusive education. This survey, which examined the establishment of systems relating to special-needs education at kindergartens and the nature of cooperation between them and the other organizations involved. Based on the results of the survey, I considered issues relating to cooperation with other organizations and support systems at kindergartens. The survey period was August-September 2015. In Chapter 8, I describe another questionnaire survey I performed on the roles of health education teachers in providing support to children requiring special support or care. I carried out this survey in 2015, eight years after the introduction of special-needs education and three years after the adoption of inclusive education. In light of the survey findings, I then explored the roles that health education teachers should play in the future. The survey period was August-September 2015. In Chapter 9, I compared the responses to questions that were the same in the surveys described in Chapter 6 (2010) and Chapter 8 (2015) in order to examine how the roles of health education teachers had changed after five years. In Chapter 10, I made suggestions for the future roles of health education teachers based on the results of the surveys discussed in Part I and Chapters 6-9 as well as my own analysis.\n3. Results and Investigation\nIn Part I, I performed a literature review covering developments that have occurred in school education, kindergarten education, school health education, the roles of health education teachers, and support for parents/guardians in conjunction with changes in the nature of welfare for children with disabilities. I also conduct a literature review and surveys of systems for the early identification of disabilities and illnesses. I then made proposals for early-identification systems and early-stage support that could be employed by local governments that oversee 1,000 or more children.\n In Chapter 1, I studied changes that have occurred in school education, kindergarten education, school health education, and the roles of health education teachers in conjunction with changes in the nature of welfare for children with disabilities. In postwar Japan, the approach to helping children with disabilities to receive an education was to establish special schools for blind children, deaf children, and children with physical disabilities. The philosophy of “normalization” that emerged in North America in the 1950s became the basic principle for activism by people with disabilities throughout the world, and also had a big impact on welfare for children with disabilities and school education in Japan. In 2007, “special education” was replaced with “special needs education,” and in 2012 inclusive education was introduced. With these changes in the nature of support for children with disabilities, the roles played by kindergartens and health education teachers also changed. However, few special schools with preschool divisions were established, which suggested that kindergartens had a vital role to play as the first place that children requiring special support or care interact with others in a group.\n In Chapter 2, I reviewed the literature concerning support for parents/guardians. The parents/guardians of children with disabilities or illnesses face stresses and struggles as they bring up their children, and wanted teachers to better understand them. Teachers, who serve as support providers, need to maintain two perspectives, one that views parents/guardians as partners in supporting the children, and one that also views parents/guardians as recipients to their support, which indicates the importance of support for both the children and their parents/guardians.\n In Chapter 3, my literature review suggested that the introduction of medical examinations for five-year-olds, i.e. between the ones they receive as babies and just before they start school, has contributed to early identification. \n In Chapter 4, the results of my survey of local governments that conduct medical examinations for five-year-olds made it clear that these examinations have a number of benefits. For example, they enable health issues that are hard to detect during medical examinations of babies to be discovered at an early stage, lead to the establishment of early-support systems and the smooth advancement of children to school, strengthen cooperation with the other organizations involved, and expand support for childrearing. However, the survey results also highlighted difficulties such as difficulty in securing doctors and staff, difficulty of large local governments to examine every child, and difficulty in securing budgets.\n In Chapter 5, I made the following recommendations concerning the handling of medical examinations for five-year-olds and support systems by large local governments that oversee 1,000 or more children: (1) reduce the human and budgetary burden by having the teachers at kindergartens and nursery schools perform the examinations using a diagnostic form and then refer children that warrant additional investigation to a kindergarten doctor, (2) strengthen cooperation with the other organizations involved and create a seamless support system that begins with the medical examinations for babies, and (3) expand the health/medicine-related aspects of the support system by adding health education teachers, nurses, and kindergarten doctors to it.\n In Part II, I reviewed the literature on the roles of health education teachers in providing support to children who require special support or care. I also surveyed kindergarten principals, teachers, and health education teachers and made suggestions concerning the roles of kindergarten teachers.\n In Chapter 6, I analyzed the results of the survey I performed in 2010. Looking at the responses to each of the questions, I found that on the subject of the roles that health education teachers are expected to perform and they roles that they are perceived as performing, every type of professional, i.e. kindergarten principals and teachers, considered “treating children who have hurt themselves or are feeling unwell,” “identifying changes by observing the health of children on a day-to-day basis,” “providing personal health guidance,” “communicating and liaising with kindergarten doctors,” and “participating in study seminars” as important roles for health education teachers, and it was clear that, in these respects, health education teachers were living up to the expectations placed in them. On the other hand, it also became clear that health education teachers were failing to meet the expectations of kindergarten principals/teachers in terms of “communicating and liaising with family doctors,” “communicating and liaising with relevant organizations,” “asking for understanding and assistance from other children and parents/guardians,” “planning/running special-needs-related training sessions at the kindergarten,” “providing information about children in need of support,” “offering advice on the preparation of support plans for individual children,” “communicating and liaising with the elementary schools children are going to attend,” and “communicating and liaising with health education teachers at the elementary schools children are going to attend.”\n In Chapter 7, I analyzed the results of the survey of kindergarten principals I performed in 2015. The results made it clear that many kindergartens are failing to deliver “seamless support” to an adequate degree due to a lack of cooperation with child-development support centers and health centers. The results also showed that while kindergartens are making progress with “appointing special-needs education coordinators,” “preparing education support plans for individual children,” and “liaising with relevant organizations,” the special-needs education coordinators are not fulfilling their roles sufficiently, which is placing a heavy burden on kindergarten principals and class teachers. It became clear that it is difficult to appoint full-time special-needs education coordinators at kindergartens that have few teachers, so it is necessary to improve support systems to enable teachers to play appropriate roles that allow them to perform those duties.\n In Chapter 8, I learned from the results of the survey I conducted in 2015 that kindergarten principals/teachers expect health education teachers to perform “health management” by, for example,“treating children who have hurt themselves or are feeling unwell,” “identifying changes by observing the health of children on a day-to-day basis,” “coming up with ideas for administering medical examinations and other health-related events” and “making kindergarten infirmaries and treatment rooms comfortable places to spend time in.” I also found that health education teachers are meeting these expectations. Furthermore, while kindergarten principals/teachers expect health education teachers to “provide personal health guidance,” join the support committee at the kindergarten,” and “participate in meetings to study individual cases,” and feel that health education teachers are doing well in these areas, the health education teachers themselves were not aware that they have these roles. On the other hand, health education teachers were falling short of expectations concerning roles relating to coordination, an activity that is closely connected with their medicine- and health-related duties. By having health education teachers take on the bulk of coordination work, the burden of support borne by kindergarten principals and class teachers is reduced. There was a big gap between principals/teachers and health education teachers on the topic of “adding content concerning special needs to kindergarten infirmary management plans,” with few health education teachers mentioning it. Kindergartens that are pleasant for children who need special support or care to spend time in are also pleasant places for other children, so addressing this issue is a major task for the future.\n On Chapter 9, I compared responses to the same questions from the 2010 and 2015 surveys. In both surveys, kindergarten principals had high expectations with respect to both “treating children who have hurt themselves or are feeling unwell” and “identifying changes by observing the health of children on a day-to-day basis,” and health education teachers were meeting these expectations. In the 2010 survey, expectations concerning “responding to individual children in separate rooms” and “providing information within the kindergarten” were low, and the principals/teachers felt that health education teachers were not really fulfilling these roles, but their views had changed by the time of the 2015 survey, so health education teachers had become personally aware of the need to provide direct support to children through health management and health consultations, and they were credited with having lived up to expectations to perform these roles.\n In Chapter 10, I made the following proposals for enhancing support systems at kindergartens with reference to the literature reviews and survey results contained in Chapters 1-9: (1) improve support systems at kindergartens under the leadership of the kindergarten principal, (2) have health education teachers not only provide direct support to children but also utilize their expertise to play a role in coordination, and (3) assign health education teachers to kindergartens in an appropriate manner.\n In conjunction with changes in the nature of support for children requiring special support or care, the role of health education teachers has come to contain new elements, and it will continue to be necessary for them to adapt flexibly to their changing roles as they meet the needs of the children they serve.\n4. Conclusions\nFor this study, I investigated the deployment of effective systems for the early identification of disabilities and illnesses and the roles of health education teachers at kindergartens in providing early-stage support.\n This investigation made it clear that the introduction of medical examinations for five-year-olds, which are administered in between those for babies and those for children who are soon to enter elementary school, facilitates the provision of uninterrupted support. The investigation also highlighted the need to improve early-stage support. Kindergartens play an important role for children requiring special support or care as the first place in which they interact with others in a group, but such support has to be provided by the teachers, who are few in number. There is therefore a need for the provision of such support to be based on an appropriate allocation of roles. It also became clear that as professionals responsible for safeguarding the health of children at kindergartens as part of a team of staff, health education teachers need to also act as coordinators in the area of health. In the future it will therefore be necessary to study the specifics of the support that health education teachers ought to provide.\n The view that parents/guardians also require support has yet to gain much recognition among kindergarten teachers, so in addition to raising levels of knowledge and understanding with respect to support for parents/guardians, it will be necessary to involve health education teachers as support providers and to enhance the techniques used to provide support techniques.", "subitem_description_type": "Abstract"}]}, "item_10006_dissertation_number_12": {"attribute_name": "学位授与番号", "attribute_value_mlt": [{"subitem_dissertationnumber": "37604博甲第ツ053号"}]}, "item_10006_full_name_22": {"attribute_name": "著者(ヨミ)", "attribute_value_mlt": [{"nameIdentifiers": [{"nameIdentifier": "7609", "nameIdentifierScheme": "WEKO"}], "names": [{"name": "ウエダ, ユカリ"}]}]}, "item_10006_full_name_3": {"attribute_name": "著者別名", "attribute_value_mlt": [{"nameIdentifiers": [{"nameIdentifier": "7610", "nameIdentifierScheme": "WEKO"}], "names": [{"name": "うえだ, ゆかり"}]}]}, "item_10006_identifier_registration": {"attribute_name": "ID登録", "attribute_value_mlt": [{"subitem_identifier_reg_text": "10.15069/00001234", "subitem_identifier_reg_type": "JaLC"}]}, "item_creator": {"attribute_name": "著者", "attribute_type": "creator", "attribute_value_mlt": [{"creatorNames": [{"creatorName": "上田, ゆかり"}], "nameIdentifiers": [{"nameIdentifier": "7608", "nameIdentifierScheme": "WEKO"}]}]}, "item_files": {"attribute_name": "ファイル情報", "attribute_type": "file", "attribute_value_mlt": [{"accessrole": "open_date", "date": [{"dateType": "Available", "dateValue": "2017-04-20"}], "displaytype": "simple", "download_preview_message": "", "file_order": 0, "filename": "甲053 博士学位論文内容および審査の要旨2017.03(上田ゆかり).doc", "filesize": [{"value": "73.2 kB"}], "format": "application/msword", "future_date_message": "", "is_thumbnail": false, "licensetype": "license_11", "mimetype": "application/msword", "size": 73200.0, "url": {"label": "甲053 博士学位論文内容および審査の要旨", "url": "https://phoenix.repo.nii.ac.jp/record/1257/files/甲053 博士学位論文内容および審査の要旨2017.03(上田ゆかり).doc"}, "version_id": "498b5dc3-687c-4675-96d5-9c341eaf828d"}, {"accessrole": "open_date", "date": [{"dateType": "Available", "dateValue": "2017-04-20"}], "displaytype": "simple", "download_preview_message": "", "file_order": 1, "filename": "甲第ツ053号 D311201 上田ゆかり.pdf", "filesize": [{"value": "22.8 MB"}], "format": "application/pdf", "future_date_message": "", "is_thumbnail": false, "licensetype": "license_11", "mimetype": "application/pdf", "size": 22800000.0, "url": {"label": "博甲第053号 本文", "url": "https://phoenix.repo.nii.ac.jp/record/1257/files/甲第ツ053号 D311201 上田ゆかり.pdf"}, "version_id": "09cb5d2f-624c-4e7c-91fa-e9867b5ef4e3"}]}, "item_keyword": {"attribute_name": "キーワード", "attribute_value_mlt": [{"subitem_subject": "早期発見", "subitem_subject_scheme": "Other"}, {"subitem_subject": "早期支援", "subitem_subject_scheme": "Other"}, {"subitem_subject": "5 歳児健診", "subitem_subject_scheme": "Other"}, {"subitem_subject": "養護教諭", "subitem_subject_scheme": "Other"}, {"subitem_subject": "特別支援教育", "subitem_subject_scheme": "Other"}, {"subitem_subject": "early identification", "subitem_subject_language": "en", "subitem_subject_scheme": "Other"}, {"subitem_subject": "early support", "subitem_subject_language": "en", "subitem_subject_scheme": "Other"}, {"subitem_subject": "medical examinations for five-year-olds", "subitem_subject_language": "en", "subitem_subject_scheme": "Other"}, {"subitem_subject": "health education teachers", "subitem_subject_language": "en", "subitem_subject_scheme": "Other"}, {"subitem_subject": "special-needs education", "subitem_subject_language": "en", "subitem_subject_scheme": "Other"}]}, "item_language": {"attribute_name": "言語", "attribute_value_mlt": [{"subitem_language": "jpn"}]}, "item_resource_type": {"attribute_name": "資源タイプ", "attribute_value_mlt": [{"resourcetype": "thesis", "resourceuri": "http://purl.org/coar/resource_type/c_46ec"}]}, "item_title": "特別な支援が必要な幼児の早期発見・早期支援に関する研究 : 5歳児健診と養護教諭の役割の課題分析", "item_titles": {"attribute_name": "タイトル", "attribute_value_mlt": [{"subitem_title": "特別な支援が必要な幼児の早期発見・早期支援に関する研究 : 5歳児健診と養護教諭の役割の課題分析"}, {"subitem_title": "The study on early screening and support for children with needs of special support and care. : Task analysis of the 5-year-old health checkup and the role of health education teacher", "subitem_title_language": "en"}]}, "item_type_id": "10006", "owner": "16", "path": ["85"], "permalink_uri": "https://doi.org/10.15069/00001234", "pubdate": {"attribute_name": "公開日", "attribute_value": "2017-04-21"}, "publish_date": "2017-04-21", "publish_status": "0", "recid": "1257", "relation": {}, "relation_version_is_last": true, "title": ["特別な支援が必要な幼児の早期発見・早期支援に関する研究 : 5歳児健診と養護教諭の役割の課題分析"], "weko_shared_id": -1}
特別な支援が必要な幼児の早期発見・早期支援に関する研究 : 5歳児健診と養護教諭の役割の課題分析
https://doi.org/10.15069/00001234
https://doi.org/10.15069/00001234db7dc7a2-b402-4146-a5e6-0172ad8e488b
名前 / ファイル | ライセンス | アクション |
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甲053 博士学位論文内容および審査の要旨 (73.2 kB)
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博甲第053号 本文 (22.8 MB)
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Item type | 学位論文 / Thesis or Dissertation(1) | |||||
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公開日 | 2017-04-21 | |||||
タイトル | ||||||
タイトル | 特別な支援が必要な幼児の早期発見・早期支援に関する研究 : 5歳児健診と養護教諭の役割の課題分析 | |||||
タイトル | ||||||
言語 | en | |||||
タイトル | The study on early screening and support for children with needs of special support and care. : Task analysis of the 5-year-old health checkup and the role of health education teacher | |||||
言語 | ||||||
言語 | jpn | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | 早期発見 | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | 早期支援 | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | 5 歳児健診 | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | 養護教諭 | |||||
キーワード | ||||||
主題Scheme | Other | |||||
主題 | 特別支援教育 | |||||
キーワード | ||||||
言語 | en | |||||
主題Scheme | Other | |||||
主題 | early identification | |||||
キーワード | ||||||
言語 | en | |||||
主題Scheme | Other | |||||
主題 | early support | |||||
キーワード | ||||||
言語 | en | |||||
主題Scheme | Other | |||||
主題 | medical examinations for five-year-olds | |||||
キーワード | ||||||
言語 | en | |||||
主題Scheme | Other | |||||
主題 | health education teachers | |||||
キーワード | ||||||
言語 | en | |||||
主題Scheme | Other | |||||
主題 | special-needs education | |||||
資源タイプ | ||||||
資源タイプ識別子 | http://purl.org/coar/resource_type/c_46ec | |||||
資源タイプ | thesis | |||||
ID登録 | ||||||
ID登録 | 10.15069/00001234 | |||||
ID登録タイプ | JaLC | |||||
著者 |
上田, ゆかり
× 上田, ゆかり |
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著者(ヨミ) | ||||||
識別子Scheme | WEKO | |||||
識別子 | 7609 | |||||
姓名 | ウエダ, ユカリ | |||||
著者別名 | ||||||
識別子Scheme | WEKO | |||||
識別子 | 7610 | |||||
姓名 | うえだ, ゆかり | |||||
抄録 | ||||||
内容記述タイプ | Abstract | |||||
内容記述 | 1.問題の所在,研究課題及び研究目的 幼稚園には,障害や疾患などの健康課題が明らかで治療や支援の体制が整っている幼児だけでなく,発達障害など早期の把握が困難で支援体制が整っていない幼児も在籍している.後者の場合,幼稚園生活での困難に加え,小学校等への就学時に適切な支援や配慮が受けらない危惧がある.2012年に文部科学省は,障害のある者と障害のない者が共に学ぶ仕組みとしてインクルーシブ教育を推進していくと公表しており,特別支援教育の対象と公に認識される子どもの人数は,平成5年度と平成24年度を比較すると約6倍に増加している.特別な支援や配慮の必要な幼児の早期発見と幼稚園での早期支援体制の整備が急務となっている.このような現状を踏まえ,本研究では,特別な支援や配慮の必要な幼児の早期発見と特別な支援や配慮が必要な幼児と家族のために,幼稚園の養護教諭はどのような支援ができるのかを主たる研究課題とする. 本研究の目的は,特別な支援や配慮を必要とする幼児とその家族への支援体制の確立のため,早期発見・早期支援システムと幼稚園の養護教諭が行う支援に焦点をあて検討を行い,そこに養護教諭がどのように関わっていくかを明らかにすることである.本研究では,医療,福祉,教育が連携して実施する5歳児健診についての先行研究のレビューを行うととともに,実際に5歳児健診を実施している自治体に質問紙調査を実施し,5歳児健診の在り方について検証を行う.さらに,その5歳児健診の結果を受け支援体制を行う際に健康面からサポートする養護教諭の役割について調査研究を行い,有効な早期発見・早期支援体制の構築について検討する. 2.論文の構成と研究方法 本研究は,「第Ⅰ部 特別な支援が必要な幼児の早期発見」とし,早期発見システムについて注目し,現在,日本で実施されているシステムについて検討を行った.第1 章では,障害児(者)福祉と教育における障害児支援の動向についての文献研究を行い,障害児福祉と学校教育,幼稚園教育,学校保健,養護教諭の職務に関する関連について論考した.第2 章では,障害や疾患等により特別な支援や配慮が必要な子どもの保護者へのインタビューに基づいた先行研究及び保護者支援に関する先行研究について文献研究を行い,保護者の思いや今後の保護者支援について考察・検討した.第3 章では,現行の法律に基づき実施されている乳幼児健診や就学時健診及び法的な整備のなされていない5歳児を対象とする健診等に焦点を当て文献研究を行い,その効果と課題について検討した.第4 章では,5 歳健診を実施している自治体及び実施していたが終了した自治体に質問紙調査を実施した.一部の自治体には訪問調査も実施した.調査結果から行政サイドから見た5歳児健診の効果や課題について検討を行った.調査期間は,2013年10月~2013年11月である.第5章では,第4章の調査結果を踏まえ対象幼児1,000 人以上の自治体における5 歳児健診の持ち方と支援体制を提案した. 「第Ⅱ部 特別な支援や配慮が必要な幼児への養護教諭が行う支援」では,特別な支援や配慮が必要な幼児への支援における養護教諭の役割についに検討を実施した.早期発見システムを実施するだけではその効果は十分でなく,早期支援体制の充実が急務である.幼稚園の園長,教諭,養護教諭を対象とした特別な支援や配慮が必要な幼児への支援における養護教諭の役割についに質問紙調査を実施し,今後果たすべき役割について検討し,提案を行った.第6 章では,特別支援教育に転換して3 年が経過し,教育現場の体制が整い始めた2010 年に発達障害のある幼児への支援における養護教諭の役割について質問紙調査を実施し,今後期待される養護教諭の役割について検討した.調査期間は2010 年6 月~2010年9 月である.第7 章では,特別支援教育に転換して8 年,インクルーシブ教育が導入され3 年が経過した2015 年に幼稚園の特別支援教育に関する体制整備及び関係機関との連携の状況について園長を対象に質問紙調査を実施した.調査結果から関係機関との連携や幼稚園における支援体制の課題について検討した.調査期間は2015 年8 月~2015 年9 月である.第8 章では,特別支援教育に転換して8 年,インクルーシブ教育が導入され3 年が経過した2015 年に特別な支援や配慮が必要な幼児への支援における養護教諭の役割について質問紙調査を実施した.調査結果から今後果たすべき養護教諭の役割について検討した.調査期間は2015 年8 月~2015 年9 月である.第9 章では,第6 章(2010 年)と第8章(2015 年)で実施した質問紙調査の同一質問項目について比較検討を行い,5 年間での養護教諭の役割の変遷について考察した.第10 章では,第1 部と第6 章から第9 章までの調査結果及び検討結果を踏まえて,養護教諭が今後果たすべき役割について提案を行った. 3.結果と考察 第1 部では,障害児福祉における変遷に伴う学校教育,幼稚園教育,学校保健及び養護教諭の役割の変遷と保護者支援についての文献研究と障害や疾患の早期発見体制についての文献研究及び質問紙調査を実施し,対象幼児の1,000 人以上の自治体での早期発見システムと早期支援の在り方について提案を行った. 第1 章では,障害児福祉における変遷に伴う学校教育,幼稚園教育,学校保健及び養護教諭の役割の変遷について検討を行った.戦後日本では,障害のある子どもは盲学校,聾学校,養護学校等で教育を受けるという考え方のもと就学支援が進められていた.1950 年代に北欧で誕生した「ノーマライゼーション」の理念は,世界の障害者運動の基本理念となり,日本の障害児(者)福祉や学校教育にも大きな影響を与え,2007 年に特殊教育から特別支援教育に転換し,2012 年にはインクルーシブ教育が導入された.障害児支援の変化とともに幼稚園,養護教諭が果たす役割も変化していっていた.しかし,特別支援学校の幼稚部の設置数は少なく,特別な支援や配慮が必要な幼児の初めての集団生活の場となる幼稚園の役割は重要であることが示唆された.第2 章では,保護者支援に関する文献研究を実施した.障害や疾患がある子どもの保護者は悩み苦しみながら子どもを育てており,教職員には子どもをもっと理解して欲しいと考えていた.教職員は,保護者を共に子どもを支援する者というだけでなく,保護者も支援される側にいるという2 つの視点を持つ必要がある.第3 章では,文献研究により,乳幼児健診と就学時健診の間の5 歳の頃に健診等を導入することで早期発見につながることが示唆された.第4 章では,5 歳児健診を実施している自治体への調査結果から,5 歳児健診には,「乳幼児健診では発見されにくい健康課題を早期発見できる」,「早期支援体制の確立やスムーズな就学に結びつく」,「関係機関の連携が強化される」,「子育て支援が充実する」などの効果があることが明らかになった.一方で「医師やスタッフの確保が困難」,「大規模な自治体では,全ての幼児を対象とした実施が困難」,「予算の確保が困難」などの課題も明らかになった.第5 章では,対象幼児1,000 人以上の大規模な自治体における5歳児健診の持ち方と支援体制について次のような提案を行った.①人的・予算的負担の軽減:幼稚園・保育所での実施:教職員が5 歳児健診診査表で絞り込み後,対象幼児を園医が5 歳児健診を実施する.②関係機関の連携強化:乳幼児健診からの途切れのない支援体制を作る.③支援体制の充実:支援体制に養護教諭・看護師や園医を加え,保健・医療面での支援体制の充実を図る. 第2部では,特別な支援や配慮が必要な幼児への支援における養護教諭の役割について幼稚園の園長,教諭,養護教諭を対象とした質問紙調査を実施し,その結果をもとに養護教諭に求められる役割について提案を行った.第6 章では,2010 年に実施した調査結果の検討を行った.質問項目別に見てみると,園長・教諭の養護教諭への「役割期待」と養護教諭の「役割認知」においては,「ケガや体調不良時の手当て」,「日々の健康観察による変化の把握」,「個別の保健指導」,「園医との連絡調整」,「研修会の参加」は,全ての職種が養護教諭の重要な役割として考え,養護教諭はその期待を認識していることが明らかになった.一方で「主治医との連絡調整」,「関係機関との連絡調整」,「他の幼児や保護者への理解や協力の要請」,「特別支援に関する園内研修の企画・実施」,「支援幼児の情報提供」,「個別の支援計画作成の助言」,「就学前の学校との連絡調整」,「就学前の学校の養護教諭との連絡調整」は園長・教諭の期待に養護教諭は応えていないことが明らかになった.第7 章では,2015 年に実施した幼稚園長への特別支援教育体制についての調査結果の検討を行った.発達支援センターや保健センターとの連携状況から,「途切れのない支援」が充分でない幼稚園が多いことが明らかになった.また,幼稚園では,統計上は,「特別支援教育コーディネーターの配置」,「個別の教育支援計画の作成」,「関係機関との連携」は進んでいるが,特別支援教育コーディネーターは充分にその役割を果たしておらず,園長や担任の負担が大きいことが明らかになった.教職員の少ない幼稚園で特別支援教育コーディネーターを専任で配置することは困難であり,各教職員がその職務の特性を生かした適切な役割を担い,支援体制の充実を図る必要があることが明らかになった.第8 章では,2015 年に実施した調査結果から,「ケガや体調不良時の手当て」,「日々の健康観察による変化の把握」,「健康診断等保健行事を受ける際の工夫」,「保健室や処置対応場所の環境整備」といった「保健管理」に係る役割に園長・教諭は期待し,その期待に養護教諭も応えていた.「個別の保健指導」,「園内支援委員会への参加」,「ケース会議への参加」は園長・教諭は期待し評価しているが,養護教諭は自覚していない役割であった.一方で,医療や保健といった養護教諭の職務と深く関わるコーディネーター的な役割には期待に応えていなかった.この役割を養護教諭が担うことで園長や担任に集中した支援の負担軽減にもつながる.「保健室経営計画に特別支援に関する内容を加味」は園長や教諭で「ズレ」が大きく,養護教諭は小さかった.特別な支援や配慮が必要な幼児がすごしやすい幼稚園は,他の幼児にとってもすごしやすい場所となることから,今後の課題である.第9 章では,2010 年と2015 年の調査の同一項目の比較検討を行った.「ケガや体調不良時の手当て」,「日々の健康観察による変化の把握」はどちらの調査でも園長と教諭の期待が高く,養護教諭も期待に応えていた.「別室での個別対応」,「園内での情報提供」は,2010 年の調査ではあまり期待されず評価も低かったが,2015 年には認められた.養護教諭が「保健管理」,「健康相談」といった幼児への直接的な支援の必要性を自覚し,その役割を担い得た期待と評価である. 第10 章では,総括として,これまでの1 章から9 章までの文献研究及び質問紙調査の結果から,幼稚園における支援体制を充実するのために次のような提案を行った.①園長のリーダーシップのもと,幼稚園における支援体制の整備を行う.②養護教諭は幼児への直接的支援だけでなく,専門性を生かしたコーディネーター的な役割を担う.③幼稚園での養護教諭の適正配置を行う. 特別な支援や配慮が必要な幼児への支援の変化に伴い,養護教諭の役割にも新たなものが加わってきた.今後も目の前の子どもの健康課題に合わせ,新しい役割に柔軟に対応していく必要がある. 4.結論 本研究では,障害や疾病の早期発見に有効的なシステムの導入と早期支援における幼稚園の養護教諭の役割について検討を行った. 乳幼児健診と就学時健診の間に5 歳児健診等の健康診断を導入することで,途切れのないの支援につながることが明らかになり,併せて早期支援を充実させる必要性が見えてきた.特別な支援や配慮が必要な幼児にとって,初めての集団生活の場となる幼稚園の役割は大きいが,幼稚園では,少ない教職員が支援にあたっており,適正な役割分担により支援にあたる必要がある.養護教諭は,チーム幼稚園における子どもの健康を守る専門職として,「保健管理」や「健康相談」に係る支援に限らず,健康面でのコーディネーター的な役割を担う必要があることが明らかになった. 本研究では,具体的な合理的配慮を含む支援内容を明示するにはいたっていない.養護教諭による合理的配慮を含む支援,保護者支援についての養護教諭の役割や支援者の資質向上についての探求及び検証が今後の課題である. |
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内容記述タイプ | Abstract | |||||
内容記述 | 1. Nature of the Issue, Research Tasks, and Research Objectives Kindergarten children include not only ones with obvious health issues such as disabilities or illnesses, for which systems for treatment and support are in place, but also ones with issues such as developmental disorders that are difficult to identify at an early stage, and for which no such systems have been established. In the case of the latter, there is a risk that the child will not only experience difficulty with kindergarten life, but also fail to receive appropriate support and care at elementary school. In 2012, the Ministry of Education, Culture, Sports, Science and Technology announced that it would be promoting inclusive education, a system under which both children with disabilities and children without disabilities study together, and the number of children officially recognized as requiring special-needs education increased by approximately six times between and 1993 and 2012. The early identification of children requiring special care or support and the establishment of systems for providing support at an early stage at kindergartens has become an urgent task. Given this situation, the primary research task of this study will be to find out what methods are best for the early identification of children requiring special care or support, how best to establish systems of support for health education teachers at kindergartens, and to determine what sort of support health education teachers at kindergartens can provide to children requiring special support and their families. This study focuses on early-identification/support systems and the support provided by health education teachers at kindergartens, and its purpose is to shed light on the role that health education teachers will play in the establishment of support systems for children requiring special care or support. In this study, I will review previous research on the medical examinations of five-year-olds, which are administered jointly by personnel from the fields of medicine, welfare, and education. I will also investigate the nature of the medical examinations for five-year-olds through a questionnaire survey of local governments that actually perform them. Furthermore, I will explore the roles of health education teachers in providing support from the health side of things when support is provided to a child based on the results of the medical examination they underwent at five years old, and then consider how to establish an effective early identification/support system. 2. Structure of the Paper and Methods of Research This study is divided into two parts. Part I, Early Identification of Children Requiring Special Support, focuses on early-identification systems and looks at the system currently being implemented in Japan. In Chapter 1, I reviewed literature covering trends in support for children with disabilities in the fields of welfare and education for people with disabilities, and examined the relationships between welfare for children with disabilities and kindergarten education, school health education, and the duties of health education teachers. In Chapter 2, I investigated the feelings of parents/guardians and possible support for them in the future by carrying out research based on interviews with the parents/guardians of children who require special support or care due to disabilities, illnesses, etc., and also by reviewing previous research on support for parents/guardians. In Chapter 3, I turned my attention to medical examinations for babies and for children beginning elementary school, both of which are currently mandated by law, as well as those for five-year-olds, which are not. This took the form of a literature survey, and I examined the effects of these examinations and issues with them. In Chapter 4, I conducted a questionnaire survey of local governments that perform medical examinations of five-year-olds and local governments that performed them in the past but no longer do so. I also visited some of the local governments in person. I then used the survey findings to explore the effects of the medicals examinations for five-year-olds and issues with them. The survey period was October-November 2013. In Chapter 5, I made suggestions for how to handle medical examinations for five-year-olds at local governments that perform such examinations on 1,000 or more children each year. I also proposed a support system for them. In Part II, Support provided by the role of health education teachers for infants who need special support and consideration, I investigated the role of health education teachers in supporting children who require special support or care. Simply deploying an early-identification system has little effect, so improving early-support systems is an urgent task. I carried out a questionnaire survey to find out about the roles of kindergarten principals, kindergarten teachers, and health education teachers in providing support to children requiring special support or care. I also considered and made suggestions concerning the roles they should play in the future. In Chapter 6, I describe a questionnaire survey of the roles of health education teachers in supporting children requiring special support or care that I conducted in 2010, three years after the introduction of special—needs education, when systems on the frontline of education were beginning to take shape. I then explored the roles that health education teachers will be expected to play in the future. The survey period was June-September 2010. In Chapter 7, I discuss a questionnaire survey of kindergarten principals that I performed in 2015, eight years after the introduction of special-needs education and three years after the adoption of inclusive education. This survey, which examined the establishment of systems relating to special-needs education at kindergartens and the nature of cooperation between them and the other organizations involved. Based on the results of the survey, I considered issues relating to cooperation with other organizations and support systems at kindergartens. The survey period was August-September 2015. In Chapter 8, I describe another questionnaire survey I performed on the roles of health education teachers in providing support to children requiring special support or care. I carried out this survey in 2015, eight years after the introduction of special-needs education and three years after the adoption of inclusive education. In light of the survey findings, I then explored the roles that health education teachers should play in the future. The survey period was August-September 2015. In Chapter 9, I compared the responses to questions that were the same in the surveys described in Chapter 6 (2010) and Chapter 8 (2015) in order to examine how the roles of health education teachers had changed after five years. In Chapter 10, I made suggestions for the future roles of health education teachers based on the results of the surveys discussed in Part I and Chapters 6-9 as well as my own analysis. 3. Results and Investigation In Part I, I performed a literature review covering developments that have occurred in school education, kindergarten education, school health education, the roles of health education teachers, and support for parents/guardians in conjunction with changes in the nature of welfare for children with disabilities. I also conduct a literature review and surveys of systems for the early identification of disabilities and illnesses. I then made proposals for early-identification systems and early-stage support that could be employed by local governments that oversee 1,000 or more children. In Chapter 1, I studied changes that have occurred in school education, kindergarten education, school health education, and the roles of health education teachers in conjunction with changes in the nature of welfare for children with disabilities. In postwar Japan, the approach to helping children with disabilities to receive an education was to establish special schools for blind children, deaf children, and children with physical disabilities. The philosophy of “normalization” that emerged in North America in the 1950s became the basic principle for activism by people with disabilities throughout the world, and also had a big impact on welfare for children with disabilities and school education in Japan. In 2007, “special education” was replaced with “special needs education,” and in 2012 inclusive education was introduced. With these changes in the nature of support for children with disabilities, the roles played by kindergartens and health education teachers also changed. However, few special schools with preschool divisions were established, which suggested that kindergartens had a vital role to play as the first place that children requiring special support or care interact with others in a group. In Chapter 2, I reviewed the literature concerning support for parents/guardians. The parents/guardians of children with disabilities or illnesses face stresses and struggles as they bring up their children, and wanted teachers to better understand them. Teachers, who serve as support providers, need to maintain two perspectives, one that views parents/guardians as partners in supporting the children, and one that also views parents/guardians as recipients to their support, which indicates the importance of support for both the children and their parents/guardians. In Chapter 3, my literature review suggested that the introduction of medical examinations for five-year-olds, i.e. between the ones they receive as babies and just before they start school, has contributed to early identification. In Chapter 4, the results of my survey of local governments that conduct medical examinations for five-year-olds made it clear that these examinations have a number of benefits. For example, they enable health issues that are hard to detect during medical examinations of babies to be discovered at an early stage, lead to the establishment of early-support systems and the smooth advancement of children to school, strengthen cooperation with the other organizations involved, and expand support for childrearing. However, the survey results also highlighted difficulties such as difficulty in securing doctors and staff, difficulty of large local governments to examine every child, and difficulty in securing budgets. In Chapter 5, I made the following recommendations concerning the handling of medical examinations for five-year-olds and support systems by large local governments that oversee 1,000 or more children: (1) reduce the human and budgetary burden by having the teachers at kindergartens and nursery schools perform the examinations using a diagnostic form and then refer children that warrant additional investigation to a kindergarten doctor, (2) strengthen cooperation with the other organizations involved and create a seamless support system that begins with the medical examinations for babies, and (3) expand the health/medicine-related aspects of the support system by adding health education teachers, nurses, and kindergarten doctors to it. In Part II, I reviewed the literature on the roles of health education teachers in providing support to children who require special support or care. I also surveyed kindergarten principals, teachers, and health education teachers and made suggestions concerning the roles of kindergarten teachers. In Chapter 6, I analyzed the results of the survey I performed in 2010. Looking at the responses to each of the questions, I found that on the subject of the roles that health education teachers are expected to perform and they roles that they are perceived as performing, every type of professional, i.e. kindergarten principals and teachers, considered “treating children who have hurt themselves or are feeling unwell,” “identifying changes by observing the health of children on a day-to-day basis,” “providing personal health guidance,” “communicating and liaising with kindergarten doctors,” and “participating in study seminars” as important roles for health education teachers, and it was clear that, in these respects, health education teachers were living up to the expectations placed in them. On the other hand, it also became clear that health education teachers were failing to meet the expectations of kindergarten principals/teachers in terms of “communicating and liaising with family doctors,” “communicating and liaising with relevant organizations,” “asking for understanding and assistance from other children and parents/guardians,” “planning/running special-needs-related training sessions at the kindergarten,” “providing information about children in need of support,” “offering advice on the preparation of support plans for individual children,” “communicating and liaising with the elementary schools children are going to attend,” and “communicating and liaising with health education teachers at the elementary schools children are going to attend.” In Chapter 7, I analyzed the results of the survey of kindergarten principals I performed in 2015. The results made it clear that many kindergartens are failing to deliver “seamless support” to an adequate degree due to a lack of cooperation with child-development support centers and health centers. The results also showed that while kindergartens are making progress with “appointing special-needs education coordinators,” “preparing education support plans for individual children,” and “liaising with relevant organizations,” the special-needs education coordinators are not fulfilling their roles sufficiently, which is placing a heavy burden on kindergarten principals and class teachers. It became clear that it is difficult to appoint full-time special-needs education coordinators at kindergartens that have few teachers, so it is necessary to improve support systems to enable teachers to play appropriate roles that allow them to perform those duties. In Chapter 8, I learned from the results of the survey I conducted in 2015 that kindergarten principals/teachers expect health education teachers to perform “health management” by, for example,“treating children who have hurt themselves or are feeling unwell,” “identifying changes by observing the health of children on a day-to-day basis,” “coming up with ideas for administering medical examinations and other health-related events” and “making kindergarten infirmaries and treatment rooms comfortable places to spend time in.” I also found that health education teachers are meeting these expectations. Furthermore, while kindergarten principals/teachers expect health education teachers to “provide personal health guidance,” join the support committee at the kindergarten,” and “participate in meetings to study individual cases,” and feel that health education teachers are doing well in these areas, the health education teachers themselves were not aware that they have these roles. On the other hand, health education teachers were falling short of expectations concerning roles relating to coordination, an activity that is closely connected with their medicine- and health-related duties. By having health education teachers take on the bulk of coordination work, the burden of support borne by kindergarten principals and class teachers is reduced. There was a big gap between principals/teachers and health education teachers on the topic of “adding content concerning special needs to kindergarten infirmary management plans,” with few health education teachers mentioning it. Kindergartens that are pleasant for children who need special support or care to spend time in are also pleasant places for other children, so addressing this issue is a major task for the future. On Chapter 9, I compared responses to the same questions from the 2010 and 2015 surveys. In both surveys, kindergarten principals had high expectations with respect to both “treating children who have hurt themselves or are feeling unwell” and “identifying changes by observing the health of children on a day-to-day basis,” and health education teachers were meeting these expectations. In the 2010 survey, expectations concerning “responding to individual children in separate rooms” and “providing information within the kindergarten” were low, and the principals/teachers felt that health education teachers were not really fulfilling these roles, but their views had changed by the time of the 2015 survey, so health education teachers had become personally aware of the need to provide direct support to children through health management and health consultations, and they were credited with having lived up to expectations to perform these roles. In Chapter 10, I made the following proposals for enhancing support systems at kindergartens with reference to the literature reviews and survey results contained in Chapters 1-9: (1) improve support systems at kindergartens under the leadership of the kindergarten principal, (2) have health education teachers not only provide direct support to children but also utilize their expertise to play a role in coordination, and (3) assign health education teachers to kindergartens in an appropriate manner. In conjunction with changes in the nature of support for children requiring special support or care, the role of health education teachers has come to contain new elements, and it will continue to be necessary for them to adapt flexibly to their changing roles as they meet the needs of the children they serve. 4. Conclusions For this study, I investigated the deployment of effective systems for the early identification of disabilities and illnesses and the roles of health education teachers at kindergartens in providing early-stage support. This investigation made it clear that the introduction of medical examinations for five-year-olds, which are administered in between those for babies and those for children who are soon to enter elementary school, facilitates the provision of uninterrupted support. The investigation also highlighted the need to improve early-stage support. Kindergartens play an important role for children requiring special support or care as the first place in which they interact with others in a group, but such support has to be provided by the teachers, who are few in number. There is therefore a need for the provision of such support to be based on an appropriate allocation of roles. It also became clear that as professionals responsible for safeguarding the health of children at kindergartens as part of a team of staff, health education teachers need to also act as coordinators in the area of health. In the future it will therefore be necessary to study the specifics of the support that health education teachers ought to provide. The view that parents/guardians also require support has yet to gain much recognition among kindergarten teachers, so in addition to raising levels of knowledge and understanding with respect to support for parents/guardians, it will be necessary to involve health education teachers as support providers and to enhance the techniques used to provide support techniques. |
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学位名 | ||||||
学位名 | 博士(社会福祉学) | |||||
学位授与機関 | ||||||
学位授与機関名 | 九州保健福祉大学 | |||||
学位授与年度 | ||||||
内容記述タイプ | Other | |||||
内容記述 | 平成28年度 | |||||
学位授与年月日 | ||||||
学位授与年月日 | 2017-03-19 | |||||
学位授与番号 | ||||||
学位授与番号 | 37604博甲第ツ053号 |