Health and Social Care in the Community (2017) 25(2), 790–798 doi: 10.1111/hsc.

12375

Development and pilot testing of an educational intervention for parents,

caregivers and teachers of children with verbal communication disabilities
in Mexico
Irene Parada-Toro PhD
1

mez-Quiroz
, Rosa M. Go MPH
2
~ o-Siller
and Sandra Trevin PhD
1
1

n de Determinantes y Retos de los Sistemas de Salud, Centro de Investigaciones en Sistemas de Salud, Insti-
Direccio

blica, Cuernavaca, Me
tuto Nacional de Salud Pu
xico and 2Facultad de Comunicacio
n Humana, Universidad Auto
noma


del Estado de Morelos, Cuernavaca, Mexico

Accepted for publication 2 July 2016

Correspondence
Sandra Trevin ~o-Siller
Direccio
n de Determinantes y Retos
de los Sistemas de Salud
Centro de Investigaciones en
Sistemas de Salud
Instituto Nacional de Salud Pu
blica
Av. Universidad #655 Sta
Mar
ıa Ahuacatitlan Cuernavaca
Morelos CP 62100, Me
xico
E-mail: sandra.trevino@insp.mx
What is known about this topic
• Verbal communication disabilities
(VCDs) are barely studied and
supported due to their low
prevalence in comparison to other
health impairments.
• VCDs have consequences in
cognitive development, and in
social integration, undermine self-
esteem and are a cause for
bullying among young children.
• Early identification allows
rehabilitation.
What this paper adds
• Experiences of teachers and
parents in an inexpensive
intervention to identify VCDs at
early stage and to develop abilities.
• Proposal to work at schools and
homes with local resources and
social capital in order to support
young children with VCDs.
• VCDs are a social problem and
must be tackled in the community
involving stakeholders in
permanent actions.
Abstract
The purpose of this study was to implement and test an educational
intervention aimed at training parents/caregivers and teachers in
strategies to support children with verbal communication disabilities
(VCDs). We carried out a descriptive observational research conducted in
two phases during 2013–2014: a mixed-method diagnosis and
intervention development. We used convenience sampling to select the
parents/caregivers and teachers of first-to-third graders with VCDs
across four public elementary schools in a suburban community in
central Mexico. Diagnosis was based on questionnaires conducted with
parents/caregivers (n = 38) and teachers (n = 16). The instruments
focused not only on the respondents’ socioeconomic characteristics and
general knowledge about VCDs but also included open questions (24/42)
about their common practices and support for children with VCDs. The
intervention was built on data collected through the questionnaires, and
was designed according to the Integral Intervention Model framework
based on the ecosystemic approach. Participants were parents/caregivers
and teachers of children with VCDs. Main results showed that the
participants were trained in various support techniques, they gained
knowledge about VCDs and changed their perception of their own ability
to help children with language impairments. As an important upshot of
the intervention, communication and networking among parents/
caregivers and teachers increased. The main strengths of this research
reside in its solid theoretical foundation and the fact that intervention
design was based on the specific needs of the target group. In as much as
the public health problem of VCDs in Mexico has barely been studied
and has received minimal official support, it is essential to engage
additional social actors, stakeholders and decision-makers in the
implementation of permanent actions. Our study emphasises the
importance of recognising this form of health impairment as a social
responsibility and not as an individual family problem.
Keywords: children with communication impairments, communication,
community care and learning disabilities, disabilities, education and training

790 © 2016 John Wiley & Sons Ltd


Introduction
Speech disorders have been defined as difficulty pro-
ducing the sounds required to speak or problems
with voice quality. They may involve interruptions in
the flow or rhythm of language, as for example in the
case of stuttering or dysfluency. A language disorder
is an impairment in the ability to understand and/or
use words in context, both verbally and non-verbally.
Some characteristics of language disorders include
incorrect use of words and their meanings, failure to
express ideas, inappropriate grammatical patterns,
reduced vocabulary and inability to follow directions.
Children with language learning impairment or
developmental language delay may exhibit one or a
combination of these symptoms. Some may see or
hear a word but not be able to understand its mean-
ing. They may also experience problems attempting
to communicate with others (U.S. Department of
Education 2007, Schimd et al 2008).
Given their low prevalence with regard to other dis-
abilities, verbal communication disabilities (VCDs)
have scarcely been studied by public health institutions
in Mexico. They constitute a significant impediment,
however, to the cognitive development and interper-
sonal relations of the children affected, thus severely
undermining their self-esteem and social integration.
In addition, the consequences of VCDs are not
restricted to the individual realm of these children;
they extend to their families/caregivers and teachers,
who are forced to acquire special abilities not only to
support and care for the children themselves but also
to cope with the social stigma attached to this condi-
tion. With Mexico characterised by a poor disability
culture, local official institutions offer minimal support
to the families of children with disability and hardly
any training for the parents/caregivers and teachers
who deal with the situation on a daily basis, particu-
larly in the smaller communities. Recent research has
demonstrated that, overall, the VCD population in
Mexico is marked by a low educational level and mar-
ginal opportunities for entering the labour market.
These circumstances acquire even greater relevance
where the onset of disability occurs at an early age.
Furthermore, apart from the hardship of disability,
these children report having to endure discrimination.
In the light of the foregoing, this study was designed
and implemented in the form of an educational inter-
vention, with the purpose of empowering parents/
caregivers and teachers with strategies to support
children with VCDs.
According to the WHO Global Burden of Disease
Report, of the 95 million children aged 0–14 years in
the world, 5.1% suffer from some form of disability
© 2016 John Wiley & Sons Ltd
Educational intervention for VCDs
and 0.7% from severe disability (Organizaci
on Mun-
dial de la Salud Banco Mundial 2011).
The National Institute of Statistics and Geography
in Mexico (INEGI by its initials in Spanish) revealed
that, in 2010, also a 5.1% of the Mexican population
experienced some form of disability, with proportions
varying significantly by age: 10.09% fell into the 0–14
age group, and 10.8% into the 15–29 age group. The
figure jumped to 33.07% in the 30–59 age group and
rose slightly to 38.5% in the 60–84 age group. Those
aged 85 and above proved the least affected, totalling
only 7.3% of the population with disability. INEGI
also published the percentage distribution of disabili-
ties: 58.3% of individuals with impairment experi-
enced problems walking or moving, 27.2% with
vision, 12.1% with hearing, 8.5% with mental func-
tions, 8.3% with speaking or communication, and
4.4% with their intellectual capacity (understanding
information) (Instituto Nacional de Geograf
ıa e
Inform
atica 2012).
The INEGI National Census for 2010 indicated
that, of the slightly over 30,000 individuals who
reported some form of disability in Morelos, the state
where the intervention was held, 1447 suffered from
VCDs (adults and children). Specifically with regard
to the community where the workshops were organ-
ised, a local Census for 2010 reported a total popula-
tion of 4613. A total of 3.36% experienced disabilities:
5.1% related to language and 20% to hearing, people
could be classified in more than one area, having
hearing and language problems (Instituto Nacional
de Geograf
ıa e Inform
atica 2012). For the same com-
munity, in 2009, the municipal Basic Rehabilitation
Units indicated a total of 229 individuals with some
form of disability: 26.7% related to verbal communi-
cation (Unidad B
asica de Rehabilitaci

on 2009).
The present research was conceived as an educa-
tional intervention involving the participation and
interrelation of parents/caregivers and teachers of
children with VCDs, with the aim of developing the
language abilities of these children. This report pre-
sents the main findings of our work. The impact of
the intervention is described by means of quantitative
data regarding changes in the knowledge of partici-
pants on communication disorders and qualitative
data regarding their daily living experiences beside
children with VCDs.
Methods
From October 2012 to March 2013, we developed a
descriptive observational study based on diagnosis
and intervention (including evaluation). We adopted
a mixed-method design featuring qualitative and
791
I. Parada-Toro et al.
quantitative approaches (Cameron 2009, Teddlie and
Yu 2007) that would allow us, first, to explore and
understand the experience of those who share their
lives with verbally impaired children at the elemen-
tary school level, and second, to identify the set of
elements required for an educational intervention
with parents/caregivers and teachers to improve the
language abilities of children with VCDs (Fern
andez
& D
ıaz 2002). The intervention group included 38
families with first-to-third-grade students identified
with VCDs from a total of 295 students from four
public elementary schools in a suburban community
in central Mexico, as well as teachers.
Diagnosis methodology
Data collection
To detect children with language problems, we applied
the Revised Navarra Oral Language Test [PLON-R by
its initials in Spanish (Aguinaga-Auerra et al. 2005)], a
15-minute instrument specifically designed to classify
the levels of oral language development as ‘Normal’,
‘Needs to improve’ and ‘Delayed’. The PLON-R test
was administered to the 295 children individually by
the principal researcher, who had been previously
trained in VCDs. From these 295 children only 38 were
detected with VCDs. Educational intervention
involved those 38 families and 16 teachers.
Diagnosis data analysis
Based on the results of the PLON-R test, we estab-
lished the criteria to elaborate a General Oral Lan-
guage Development component and three Partial
Oral Language Development sub-components for the
intervention. The former was constructed by explor-
ing the following sub-component variables: (i) form –
production of simple and complex sounds, and
function – phonology, morphology and syntax;
(ii) content – codification/decodification of semantic
meanings in linguistic structures (third exclusive,
contraries, categories and word definition); and
(iii) use – knowledge and production of language to
communicate thinking (absurd content or form, com-
prehension of metaphor to order and relate, compre-
hension and adaptation, and planning) (P
erez-Pedraza
& Salmer
opez 2006, Garc
ıa-Sanchez 2002). The
on-L

sub-components were constructed by transforming the
direct test scores, first, into typical scores and, then,
into language development criteria. The responses of
the children aged 1–6 years were processed according
to a Baremo scale (a relevance scale which serves to
rank elements according to merit; a set of admission
standards based on partial scores and test results; an
index). In the case of children aged 7 and above, the
792
aforementioned PRON-R test was also used to contrast
their oral language patterns against the normal pat-
terns defined under the test. This made it possible to
determine which items should have – but had not –
been assimilated by the children with VCDs (P
erez-
Pedraza & Salmer
on-L

opez 2006).
Intervention design and content
The intervention was designed in accordance with
the results of the diagnosis phase which, in turn, was
based on the results of a pre-test questionnaire
applied to parents/caregivers and teachers on their
socioeconomic characteristics, general knowledge
about VCDs and language support practices at home
and school, including open questions in order to have
a better understanding of daily experiences living
and supporting children with VCDs.
Following the Integral Intervention Model frame-
works based on the ecosystemic approach, which
include the individual, family and community
spheres, we organised the educational intervention
into two types of workshops: one for parents/care-
givers; the other for teachers. The results of the pre-
test questionnaires served to tailor the intervention to
the specific needs of the target population, and to
select strategies, techniques and materials based on
both practical experience and sound theoretical
frameworks (Schmid et al. 2008).
Workshops were participative: those for parents/
caregivers covered a total of 12 hours divided into
four 3-hour sessions (two per week); those for teach-
ers a total of 10 hours divided into four 2.5-hour ses-
sions (two per week) (Figure 1).
During the workshops, we observed, evaluated
and noted in an ethnographic register the language
development levels and verbal communication abili-
ties of the students in class. After the workshops, we
applied a post-intervention questionnaire to measure
any changes in the knowledge of parents/caregivers
and teachers with regard to VCDs.
Intervention data analysis
To analyse the pre-post test data, we calculated sim-
ple frequencies by comparing the scores obtained in
the questionnaire items before and after the interven-
tion. Each parent/caregiver and teacher answered
one pre- and one post-intervention questionnaire with
42 questions each, 24 were open questions (Table 1).
Then, to analyse the qualitative data of the open
questions, we followed Martiniello’s (1999) Taxonomy
on the participation of parents/caregivers in educa-
tion (Table 2). Data were collected with the parents/
caregivers and the ethnographic descriptions
recorded during the workshop sessions.
© 2016 John Wiley & Sons Ltd
 Educational intervention for VCDs

Figure 1 Themes worked in workshop.

Table 1 Knowledge and actions related to verbal communication disability (VCD) (pre- and post-test)

Pre-intervention Post-intervention

Questionnaires Caregivers Teachers Caregivers Teachers

General knowledge about VCD and practices 13 questions 19 questions 13 questions 19 questions
Support in home/school in verbal communication: 29 questions 29 questions 29 questions 29 questions
including questions to define caregivers participation
categories in VCD

Martiniello (1999) defines child-rearing according
to five categories: the practices, behaviours, functions,
roles and interactions at school that parents/care-
givers develop to support or limit the development
and formal education of children.
We used similar categories to define the teachers’
participation in the education of the students with
VCDs.
Qualitative analysis of the open questions and
ethnographic registers was based on the phenomeno-
logical proposal. Thematic/content analysis was also
performed, with a focus on meaning and the life
experiences of both social actors: parents/caregivers
and teachers. All answers of the 24 open questions
were transcribed and codified, and comparative
matrices were constructed to identify recurrences and
variances (Coffey & Atkinson 1996).
Ethical considerations
The present study was approved by the Research,
Ethics and Biosecurity Commissions of the
National Institute of Public Health. Verbal consent
was obtained from all participants prior to the
intervention.
Findings
The pre-post test results indicated a significant
improvement in the knowledge and practices of par-
ticipants regarding children with VCDs (Table 3).
Description of participants
A total of 38 parents/caregivers attended workshop
sessions entitled Home Support Strategies to Assist
Students with VCDs: 74% of them were mothers,
10% fathers and 13% other caregivers including
grandparents, aunts and uncles. Their ages ranged
from 35 to 64 years, and only 15% had completed
secondary school education. In the majority of cases,
both parents lived at home. While women performed
household tasks and looked after the children, men
engaged in farming and occupied low-income jobs at
local enterprises.

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I. Parada-Toro et al.

Table 2 Operationalisation of analytic categories for caregivers Table 3 Percentage distribution of knowledge and practices in
and teachers in relation to verbal communication disability relation to children with verbal communication disability (VCD)
(VCD) in children (following Martiniello’s proposal) (pre- and post-test), parents/caregivers/caregivers and teachers
(2013)
Social Analytic categories/ Definition/
actors concepts conceptualisation Percentage
distribution
Parents/ Parents/carers as Parents/carers develop parents/ Percentage
carers responsibles of appropriate care and child- caregivers/ distribution
child-rearing rearing functions like caregivers teachers
(basic parent’s care-giving or protection
responsibility) and provide conditions Pre- Post- Pre- Post-
so children will attend test test test test
school Knowledge or action Yes Yes Yes Yes
Parents/carers as Parents/carers continue and
teachers of minors strengthen class knowledge Knowledge about 74.4 100 53.5 100
at home, they supervise and concept of VCD
help children to finish Assistance to any course, 7.7 100 12.5 100
homework and work in workshop or talk where
school projects VCD was one of the
Parents/carers as Contributions parents/carers main issues
support agents do in order to improve Knowledge of the different 0 80.6 0 93.8
at school schools conditions including stages of language
money, time work and development in children
materials Knowledge of some signs to 2.6 88.9 6.3 81.3
Parents/carers as Parents/carers play roles of detect VCD in children
agents with power decision-making that modify Knowledge of some materials 17.9 91.7 43.8 100
decision at school school policies in relation to useful to help children with
minors, includes parents VCD
participation in school Knowledge of some activities 23.1% 94.4% 62.5 100
boards and management useful to support the
advisory development of language in
Teachers Teachers as Functions of care and children with VCD
responsibles of behaviour of VCD students Development of some 53.8% 97.2% 75 100
children education and promotion of actions to activities in order to support
(basic teaching support children to attend the language development in
responsibilities) school children with VCD
Teachers as Process in class learning and
children carers extra school work with
students including
Knowledge and practices of parents/caregivers
supervision and help to
complete school tasks Although only 28% of the children had received spe-
and work in school
cialised treatment for their communication disorders,
projects
Teachers as support Teachers’ contribution to and a mere 8% of the parents/caregivers had attended
agents at school school in order to improve workshops or talks on the matter, 74% of the latter
services for students with claimed to understand the concept of VCDs. One of
VCD, including money, time, the main findings of the study was, however, that
work or materials
according to data from the pretest, none were aware of
Teachers as agents Roles of decision-making
with power at which modify school policies the different stages in the acquisition of verbal lan-
school and its operation in relation guage, and as many as 92% were unable to recognise
to VCD students includes the warning signs for an opportune detection of VCDs.
teacher’s participation in According to the parents/caregivers, the children’s
school boards and
language problems centred on the difficulty of pro-
management advisory
nouncing the phonemes /l/, /s/ (important in the
Spanish language) and /r/ (also essential to Spanish),
whether alone or as part of consonant groups such as
Most parents/caregivers remarked that they were
pr/, /pr/, /br/, /cr/ and /
r/(double r). They also cited
very interested in taking their children to therapy,
reading and writing problems:
but that their income was insufficient and the dis-
tance to the nearest language specialist was My son doesn’t speak well, and the problem is that he
considerable. writes just like he speaks. His teacher’s already told me that

794 © 2016 John Wiley & Sons Ltd


he’s going to have a tough time at school. . .. [Father, 30,
and son with VCD, 8]
A large percentage of parents/caregivers (92%)
reported not having attended VCD lectures or work-
shops of any kind, whether private or public.
Only 18% of parents/caregivers were familiar with
materials for verbal language development, and 23%
with special activities for children with VCDs; how-
ever, 54% dedicated considerable effort to helping the
children overcome their language difficulties.
Among other resources, they used balloons, pin-
wheels and story books, as well as exercises based on
word repetition, blowing, pronunciation-error correc-
tion and diction drills with a pencil under the tongue.
Some of the foregoing, recommended by teachers,
achieved less than satisfactory results:
We do the exercises every day, but he just can’t. Sometimes
we get desperate because he can’t, he can’t pronounce what
he wants to say. Then he cries and I get really desperate.
I’ve already told the teacher that he just can’t do it.
[Mother, 38, and son with VCD, 9]
Parents/caregivers: responsible for rearing children
with VCDs
As many as 77% of the parents/caregivers inter-
viewed were responsible for the education and rear-
ing of the children with VCDs: fathers were incharge
of their economic subsistence, basically in terms of
food, housing, clothing and protection. A few families
were monoparental, with a single mother acting as
head of the household, and received help from rela-
tives, especially from the children’s grandparents.
Owing to the gender roles of women as caregivers
and men as providers, the mothers were fully in
charge of the activities pertaining to the children’s
language problems.
Teachers: responsible for children’s education
Although the majority of teachers (62%) declared that
they performed only the basic teaching functions,
they mentioned being concerned whenever children
with VCDs missed class. They tried to investigate the
reason for their absence and to help by giving them
individual attention so they would not fall behind in
their studies. Teachers also mentioned trying to inte-
grate children with VCDs in all the social activities at
school, sometimes by using integration dynamics:
I get worried if my students are absent. I ask their relatives
or neighbours . . . sometimes they are sick, but other times
parents/caregivers don’t send them to school, and that
causes them to fall behind in their studies. It’s very
© 2016 John Wiley & Sons Ltd
Educational intervention for VCDs
important to send the children to school. We constantly tell
parents/caregivers, but some don’t care or live too far away
or have no money to send them. . .. [Female teacher, 42]
Teachers: additional support for children with
VCDs
Most (62%) of the teachers reported providing addi-
tional support to the children with VCDs: some
helped by clarifying doubts about their homework
and themes covered in class, while others offered
suggestions on how to complete their homework or
assigned extra exercises. They carried out these activi-
ties after school hours:
I try to help kids with problems. Sometimes they are
abused or teased. I also give them special exercises so they
can speak better. I try to help as much as I can. [Female
teacher, 42]
Teachers: agents of change at school with decision
power
Among the teachers, 62% reported contributing finan-
cially to improve their schools, and assisting in the
organisation of social activities such as festivals and
meetings with parents/caregivers. Some mentioned
either elaborating or contributing financially to pur-
chase teaching material.
Although the majority of teachers contributed to
school activities, only 37% took part in actual deci-
sion-making processes. They commented that school
boards were transient and support required from
teachers was only occasional and temporary. It was
specifically in the planning of recreational and social
activities that teachers had any power or participated
in decisions.
Discussion
The main findings of this study may be classified into
two dimensions: context, referring to government
support and family structure; and knowledge/train-
ing of parents/caregivers and teachers.
In Mexico, like in many other Latin American coun-
tries, official support for VCDs is poor. There are few
teachers trained in special education, and even less in
VCDs. As schools in small communities and rural
areas rarely receive support of any kind, children’s
progress in life depends on help from the family. Simi-
lar to many other social and health issues, VCDs are
viewed as an individual problem, not a social responsi-
bility; yet it is a teacher’s obligation to deal with the
problem. Teachers attempt to help according to their
795
I. Parada-Toro et al.
possibilities although very few are properly trained.
None of the teachers/caregivers in our study had
received training in language development.
Hence, specialised knowledge and training have
acquired a critical role in meeting the demands of
children with VCDs. Specifically in our study, the
teachers, and of course the parents/caregivers, dis-
played strong personal will and sincere interest in
supporting these children but were not educated in
the early detection of verbal communication impair-
ments or in ways of developing a child’s language
skills. They ended up simply doing the best they
could. There was clearly a need for an educational
intervention in this community, and workshop activi-
ties targeted specifically to this need succeeded in
developing the ability of parents/caregivers and
teachers to both detect VCD warning signs and carry
out relevant support activities.
One of our key findings was the fact that teach-
ers had a very limited possibility of partaking in
school decisions despite their request for special
help from the authorities in the Ministry of Educa-
tion due they have no direct access to demand spe-
cial support.
Comparability with other studies
The results of the PLON-R test prove that it is a reli-
able tool for the detection of linguistic development
levels in children. This is consistent with data
reported by Ygual-Fern
andez et al. (2011), which
revealed a significant correlation between the empiri-
cal observations of the teachers and the results of the
test.
Our own results in identifying children up to
10 years with VCDs were similar to those of
V
azquez-Brise~no et al. (2006), which indicated that
language disorders were not exclusive to children
under 6 or in first grade of elementary school.
Furthermore, our study showed that alliances
among different actors, such as parents/caregivers
and teachers, was a feasible strategy in schools for
facilitating solutions to common issues, agreement
over new ways of working and development of activ-
ities in general. Nevertheless, collaboration with and
between teachers is restricted by work shifts, changes
in staff, diverging opinions, and lack of communica-
tion and trust among companions (Jim
enez &
Jim
enez 2004).
With respect to early detection of language disor-
ders, this study found that teachers do detect signs of
VCDs in minors, and some parents do seek advice
from specialised language therapists or, more com-
monly, from their peers.
796
Although in general parents/caregivers and teach-
ers have little understanding of the concept of VCDs,
our findings indicated that the perceptions of those in
our study partially matched the theoretical definitions
in the international guidelines and classifications used
widely to detect VCDs opportunely and seek medical,
educational and therapeutic support. In line with
Tamis-LeMonda and Rodriguez (2010), we found a
direct relation between language development and
the acquisition of reading and writing abilities, as the
students identified with VCDs were also struggling
with pedagogical learning.
Ygual-Fern
andez et al. (2011) highlighted the role
that teachers of basic education play in the lives of
students with language disorders; however, in our
research, teachers lacked adequate tools and strate-
gies to provide correct orientation to either students
or parents/caregivers. This may be a common situa-
tion across many developing countries.
The teachers who participated in the intervention
considered that the knowledge, use of tests and speci-
fic guides they acquired were effective tools for diag-
nosing students with VCDs. We therefore agree with
Ygual-Fern
andez et al. (2011) in the imperative need
to use a guide for the diagnosis of VCDs in elemen-
tary schools.
Finally, in line with the observations of Ramos
(2011), on school settings, our research uncovered
low-tolerance and disrespectful attitudes, bullying
included, in the school environments we canvassed,
especially against children with disabilities.
Differences with other studies
The most salient difference with other studies on the
subject is that our research was rooted in a compre-
hensive community diagnosis based on the ecosys-
temic approach. This allowed us not only to identify
the student population with VCDs but also to design
and implement an educational intervention tailored
to the needs of the target group (Garc
ıa S
anchez
2002, Nelson 1997, Finnegan & Viswanath 1990).
On the issues of responsibility and participation in
a young child’s education, Martiniello (1999) sug-
gested that interactive participation involving interre-
lation among key social actors is the foundation for
offering children with VCDs an educational experi-
ence and enriching opportunities. These conditions
were not present in the study setting prior to the
intervention: actions were carried out most frequently
on an individual basis, and low or no interaction took
place between families and educators. In the light of
these observations, our workshops attached special
importance to interaction among actors as a
© 2016 John Wiley & Sons Ltd

determining factor in forging a solution to the
problem of VCDs.
Limitations
Main limitation in this study relied on convenience
sampling and the fact of not having a control group
for comparison; therefore, results cannot be gener-
alised. Additionally, the intervention was designed
according to the specific sociocultural context of the
target population (parents/caregivers and teachers of
children with VCDs in a suburban community in
Morelos).
Furthermore, an experienced and specialised facili-
tator implemented this intervention, so if study
wanted to be replicated, new facilitators must be sen-
sitised and trained, not only in the development of
project sessions and activities but also, and most
importantly, in what it means to live with a VCD.
Facilitators need to understand the development
issues endured by these children, as well as the prob-
lems faced by the families, teachers and the commu-
nities surrounding them.
Conclusions
Consistent with other studies, our research showed
that verbal disability is barely mentioned or consid-
ered in public policy-making in Mexico. Its low
prevalence in comparison to other disabilities may
explain the marginal and often inexistent support
available for both children living with this condition
as well as the families and educators interacting with
these children on a daily basis. Hence, families and
teachers do the best they can without any training or
specific skills. Language disability tends to be experi-
enced as an individual, isolated condition, without
the possibility of turning to a local organisation to
find information, support or simply a space for talk-
ing about the problem.
Our intervention fulfilled two important purposes:
it informed and developed skills among parents/care-
givers and teachers who interact with and support
children with VCD on a daily basis. Second, and it
must be emphasised, it developed a space for collec-
tive reflection where doubts could be expressed and
joint actions considered. This means that the interven-
tion was designed and implemented adequately; that
is, taking into account the characteristics of the envi-
ronment and population, as proposed under the
ecosystemic model. It is therefore recommended to
replicate the intervention in other contexts so as to
evaluate, compare and determine its effectiveness.
© 2016 John Wiley & Sons Ltd
Educational intervention for VCDs
One of the first question that comes to mind as
one initiates a study in this public health area con-
cerns the role of public institutions such as the Min-
istries of Health and Education, the National System
for Integral Family Development (DIF, by its Spanish
initials), and other government and civil society enti-
ties with programs or actions focused specifically on
child welfare. Very few organisations under The
National Directory of Non-Governmental Associa-
tions attend the problem of verbal disability, showing
once more the lack of support available for a perma-
nent condition that limits not only the speech but also
the ability to communicate and the social interaction
of those affected.
Recommendations
To achieve greater visibility and support for the prob-
lem of VCDs, additional efforts are required in terms
of diffusion through the mass media and strategic
alliances with agencies – pertaining to both the gov-
ernment and civil society – which include the issue
on their agendas.
Finally, considering the WHO Healthy School pro-
posal, and the fact that children grow and develop
socially at school throughout their early years, it is
important to disseminate information about VCDs
extensively in schools and provide training for par-
ents/caregivers and teachers, with the view of forg-
ing a culture of respect for individuals with language
disability. It is essential to encourage communities to
become involved in creating a solution for VCDs by
obtaining information on prevalence, needs and
forms of support.
Acknowledgements
We are grateful to Dr. Blair Grant for her comments
and final revision. We also thank all those who con-
tributed their time and effort to participate in the
intervention workshops.
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© 2016 John Wiley & Sons Ltd