APPENDIX 13
Supplementary Memorandum from Northern
Health and Social Services Board
SPECIAL EDUCATIONAL NEEDS
Supplementary Questions
INTRODUCTION
The letter dated 18 December 1998 from the Clerk
of the NI Affairs Committee outlined seven supplementary questions
regarding Special Educational Needs which the NI Affairs Committee
requested in addition to the Board's Memorandum and oral evidence.
The following document outlines the Board's
response to each of the seven questions in tabular form with explanatory
narrative.
1. How many children have been referred to the
Board for assessment for the purposes of SEN statements in each
of the last five years, in total and by type of professional assessment?
Throughout the Northern Health and Social Services
Board's (NHSSB) area, staff respond to requests for advice in
respect of statutory assessments of special educational needs
from two Education and Library Boards, namely, North Eastern (NEELB)
and Southern (SELB) Education and Library Boards.
The number of requests for initial advice, as
well as updated reports for statutory assessments, over the five
year period from 1994 to 1998 is as outlined in the following
table.
| | |
| | | |
| Area | 1994 | 1995
| 1996 | 1997 | 1998
| Total |
| | |
| | | |
| Homefirst Community HSS Trust (NEELB & SELB)
| 258 | 253 | 306
| 303 | 269 | 1,389
|
| Causeway HSS Trust (NEELB) | 60
| 102 | 92 | 102
| 86 | 442 |
| | |
| | | |
| Total | 318 | 355
| 398 | 405 | 355
| 1,831 |
| | |
| | | |
Notes:
The geographical area covered by Homefirst Community HSS Trust includes Antrim, Ballymena, Magherafelt. Cookstown, Larne, Carrickfergus and Newtownabbey Council areas. Causeway HSS Trust includes Ballymoney, Coleraine and Moyle Council areas.
A request for a report in respect of the statutory assessment is not a referral to the service.
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The flowchart in Annex 1 describes the report request and
return process adopted within the Board's area, together with
the required timescales. Within the NHSSB, the Designated Officer
will either be the Senior Community Medical Officer (SCMO) or
the Community Paediatrician.
All requests for initial advice reports are sent routinely
to the:
— Speech and Language Therapist;
— Occupational Therapist;
If the Designated Officer knows that other Health and Social
Services professionals are involved in the care of the child,
for example, Orthoptist, Dietitian or Podiatrist, then these staff
will also be asked for a report.
Irrespective of whether or not the profession knows of the
child, a return must be completed. If the child is not known to
the service, a nil return is completed.
The Medical Officer, as the Designated Officer, must complete
a report. The Designated Officer (see Annex 2) will have a clear
view regarding the appropriate level of involvement of the other
professions both with the children and subsequently the assessment
process.
Those professions mostly involved include:
— Speech and Language Therapy;
— Social Work (in keeping with the Disability NI
Order);
Currently, Homefirst Community Trust has drawn up and is
piloting a statementing screen for the Child Health System which
will capture all this information in due course.
2. What has been the average time lapse between referral and
actual assessment in each of the last five years, overall and
by type of professional assessment?
As stated previously, the Medical Officer is the only professional
who must see every child referred for the purpose of statutory
assessment.
In 99 per cent of cases, this is undertaken and the report
written well within the 4 weeks time-frame required (see Annex
1).
All other professions would not assess a child specifically
for this purpose. If the child is known to the service, then a
report is written. In order for the advice contained in the report
to be up to date, the professional may see the child specifically
if the last contact has not been within the previous 12 weeks.
3. What has been the total number of children with statements
of special needs to whom the Board has provided support in each
of the last five years, in total, and broken down by type of support?
There are, at this point in time, approximately 1,250 children
within special schools and units across the Board's area. Currently,
no child can be placed in such a special needs facility without
a statement. In addition, there are a number of children in mainstream
education with statements.
In contrast, there are 3,232 children on the Special Needs
Register (Module V) of the Child Health System for whom there
is health service input.
Children with statements of special education receive services
and support from a range of disciplines throughout the various
stages of the child's life, and in keeping with their changing
needs. These include:
Medical Officers/Designated Officer
Annex 2 details the role of the Designated Officer in respect
of his/her statutory role. In addition to this extensive role,
the Medical Officer undertakes the following in respect of statemented
children:
— complete an annual review and report of each statemented
child;
— undertake ad hoc reviews if there is a
specific medical issue;
— attend annual review meetings where there is a
specific medical problem/issue;
— provide advice to parents in respect of the process
and the reports;
— meet with educational psychology staff in relation
to selected children;
— request and collate additional information for
other medical consultants;
— respond to ad hoc requests from schools
in respect of medical updates/issues;
— assess and designate children as disabled for
the purposes of transition planning for transfer to Adult Services;
and,
— provide training to mainstream school staff in
respect of children transferring from special schools.
Speech and Language Therapy
There are currently 39.10 whole time equivalent (wte) speech
and language therapy staff working with children across the Board's
area. Of this number, 18.25 wte work exclusively within the special
school/unit setting (46.6 per cent).
Additionally, there are staff who work with pre-school children
with special needs (6.13 wte) and a percentage of community clinic-based
staff's time would be taken up with writing initial advice reports
and providing support to mainstream schools (approximately 0.92
wte). In total, 25.30 wte could be estimated to be working with
children in the context of assessing and meeting SENs, which represents
64.7 per cent of the total speech and language therapy service
provision to children in the Homefirst Trust area.
In addition to the models of therapy provision as described
in Annex 4, speech and language therapy staff across the Board
are involved in the writing of initial advice reports, annual
review reports and attendance at annual review meetings. Within
the special schools, the speech and language therapist would attend
all reviews for children with whom she has contact. For children
in mainstream schools, such attendance is rare due to resource
constraints.
In addition to this regular work associated with the statutory
assessment process and subsequent support, senior speech and language
therapy staff have been heavily involved with special education
staff and education psychology staff in the following areas:
— preparation for and time spent at Tribunals in
respect of special educational needs;
— training of education staff by speech and language
therapists;
— informal meetings with special education staff
in respect of a variety of issues around the statutory assessment
process and subsequent support;
— informal and formal meetings with educational
psychology staff in relation to the statutory assessment and ongoing
support;
— contact with parents in respect of the process
and support;
— discussion with other Trust staff in relation
to children placed in the two regional schools—Thornfield
and Jordanstown Schools (see Annex 5 for a breakdown of children
from each of the four Boards receiving speech and language therapy
in these two schools);
— responding to requests for mainstream schools
for support;
— production of staff guidelines for writing reports;
— provision of equipment for therapy use within
school;
— in exceptional circumstances, provision of computer
for communication purposes in school by individual children;
— preparation of resource materials and advice for
mainstream schools in respect of children with speech and language
therapy needs; and
— training of mainstream school staff in respect
of children transferring from special school.
Speech and language therapy provision to children with special
educational needs is not as a result of them having statements.
The provision is dictated by the needs of the children, irrespective
of them having a statement. Speech and language therapists work
to professional standards and a Code of Practice. It is, therefore,
essential that each child's needs are assessed and a suitable
therapy programme initiated. Whilst a statement of special educational
need may, in some cases, dictate in detail the speech and language
therapy provision, it is the professional responsibility of the
speech and language therapist to provide a relevant service. She
could be held professionally negligent and irresponsible if she
provided therapy according to the dictate of a statement which
was at odds with assessed need.
Occupational Therapy
In total, there are 12.21 wte paediatric occupational therapy
staff working within the Board's area.
In the Homefirst Trust area, 3.76 wte work within special
education. Additionally, approximately 0.34 wte staff time would
account for involvement in the writing of initial reports. In
total, this represents 38.7 per cent of total Paediatric Occupational
Therapy staffing within Homefirst.
Paediatric occupational therapy staff are involved in:
— writing initial advice reports;
— writing annual review reports;
— attending annual review meetings as appropriate;
— training of mainstream school staff in respect
of children transferring from special school;
— providing selected equipment for use in school;
and
— advising on equipment needs within school.
As with speech and language therapy, these children would
be receiving occupational therapy input irrespective of having
a statement of special education need.
Social Work
In 1992, within Homefirst Trust, two dedicated social work
teams for children with disability were created (one in the Larne/Carrickfergus/Newtownabbey
area and one in the Antrim/Ballymena/Magherafelt/Cookstown area).
There are currently 13.5 wte staff in post, 3.5 wte of which have
been more recent appointments.
Similarly, in 1998, a dedicated social work team comprising
6.0 wte and 1.0 wte Team Leader was created in the Causeway area.
These three teams work with appropriately 750 children and
their families across the Board's area, approximately 70-75 per
cent of whom would have statements. A range of support services
are available to all of these families although these services
will normally not be directly as a result of the statement of
special educational need.
In addition, there may be children with disabilities and
their families who may be in receipt of mainstream social services
where the reasons for contact with social work staff are other
than specifically related to disability.
The range of support services include:
— writing initial and annual review reports;
— attending selected annual review meetings in schools;
— providing assistance for attendance at playgroups
and nurseries;
— providing both family-based and residential respite
services;
— providing domiciliary support;
— providing classroom support (in exceptional cases);
— providing transport support (in exceptional cases);
— providing Summer Scheme support; and
— providing social work support to children and
young people and their carers, particularly at significant milestones
in their life, i.e., diagnosis, school commencement/leaving and
transition to adulthood.
Nursing
Health Visitors throughout the Board's area undertake developmental
assessments of children between the ages of 0 to five years often
during which potential or existing disabilities are identified.
Currently, within the Homefirst area, the children's nursing
service has 3.27 wte specialist Health Visitors for children with
physical disability. These staff, along with the family health
visitor, will be involved in writing initial advice reports and
annual review reports. They are also involved in training school
staff (mainstream and special school) in specific procedures with
individual pupils on a needs-led basis (e.g., catheterisation)
and advice on equipment. These staff would also be involved in
liaison with carers and support within the home of these children
on a needs-led basis.
Within the Causeway area, although there are no specialist
Health Visitors for children with a physical disability, there
are 2.0 wte nurses providing support for children with learning
difficulties.
4. What clinical psychology/psychiatric services does the Board
provide for children and young people of school age; what resources
are committed to this; to what extent are the services provided
separately from services to adults; and to how many persons have
such services been provided in each of the last five years?
The Board has deployed significant resources in securing
an area-wide child and adolescent mental health service, which
is delivered by two multidisciplinary specialist teams. These
existing teams operate from two bases in Antrim and Ballymoney
and are each led by a Consultant Child and Adolescent Psychiatrist.
The funded establishment is as follows:
2.0 wte Consultant Child and Adolescent Psychiatrists
1.0 wte Senior House Officer (attachment)
2.0 wte Consultant Psychologists
1.0 wte Assistant Psychologist
1.0 wte Specialist Nurse Therapist
1.0 wte Senior Social Worker/Family Therapist
The Ballymoney team provides an outreach service in the Cookstown
and Magherafelt areas two days per month. Both teams provide a
consultation service for other professional staff in contact with
children and young people.
The resources directly associated with the two teams amounts
to approximately £442,000 (at 1998-99 levels), however children
and young people with mental health problems may also access other
generic health and social services.
Referrals to Child and Adolescent Psychiatry Service
| Contacts with Child and Adolescent Psychiatry Services by Profession
| | | |
| | |
|
| | |
|
| 1995-96 | 1996-97
| 1997-98 |
| | |
|
| | |
|
| Consultant Psychiatrist | 1,006
| 1,246 | 1,516 |
| Psychologist | 1,695 | 1,477
| 1,124 |
| Nurse Specialist | 700 |
548 | 791 |
| Social Worker | 513 | 382
| 685 |
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|
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|
| Total | 3,914 | 3,653
| 4,116 |
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|
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|
Note:
Figures for 1993-94 and 1994-95 were not available at the time of writing.
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Children's inpatient services are provided in the Children's
Unit at Foster Green, Greenpark Health Care Trust. The Board commissions
687 resident days and during 1997-98 there were 13 inpatient episodes
during 651 resident days.
The Board commissions, on an ad hoc basis, places
for a small number of adolescents who require more intensive treatment
over a longer period, at the Young People's Centre in South and
East Belfast Health and Social Services Trust.
Younger teenagers are sometimes admitted to paediatric wards
within the Board's area where Child and adolescent mental health
Services provides support and advice to medical and nursing staff.
The Board has allocated resources to fund a psychologist
and family therapist post to provide dedicated specialist support
to young people in residential care in the Board's area.
Eight places are also commissioned from regional care centres
for young people with challenging behaviour, all of whom have
access to psychological assessment and support.
The Board will also have access to the regional service to
be provided by the family trauma centre where psychotherapy and
family therapy will be offered to children and families in need.
Each year, approximately 12 young people between 14 to 16
years of age are admitted to adult psychiatric wards as a last
resort and are cared for by professionals in the adult service.
Generally these young people are returned to the care of child
and adolescent mental health Services when they are discharged
from hospital. The Board acknowledges that this is an unacceptable
position and is currently investigating means of avoiding such
situations.
5. How many children in residential care in the Board's area
had SEN statements in each of the last five years, and what percentage
was this of the total such population?
| | |
| | |
| Year | 1994 | 1995
| 1996 | 1997 | 1998
|
| | |
| | |
| Total number in residential care | 42
| 42 | 42 | 42
| 42 |
| Number with Statement | 3 |
6 | 9 | 12 |
14 |
| Per cent of total in care with Statement |
7.14 | 14.30 | 21.40
| 28.57 | 33.33 |
The reasons for the increase in the percentage of children
in residential care with a statement are complex. Children with
severe disabilities and emotional difficulties are remaining longer
in residential care due to difficulties in supporting these children
and meeting their individual needs within family based settings.
6. What training has been given to social services staff (and
social workers in particular) regarding the requirements of the
Education Order and the SEN Code of Practice and what financial
and other resources have been devoted to this?
Although this question focuses on training for social services
staff, the Board and local Trusts have also recognised that the
Education Order and the Code of Practice have significant training
issues for the community medical, speech and language therapy,
occupational therapy and physiotherapy professions.
Training has been provided by NEELB for 17 social services
staff, including social workers for specialist teams for children
with disabilities, their team leaders and training staff.
In addition, training in relation to children with disabilities
has been provided as part of the Board's Children Order training
and included specific training on topics such as children with
mild-severe reading difficulties and children with difficult and
disturbing behaviour. Approximately £7,000 has been made
available for training in relation to children with disabilities.
No specific financial resources have been devoted directly
to Education Order and SEN Code of Practice training within the
last five years. However, the following training, all initiated
by Health and Social Services Board staff, has been provided:
— preparation for the writing of guidelines for
health and social services staff in respect of the statutory assessment
procedure for the identification of special educational needs;
— community medical staff training with special
education staff;
— social work staff training in both Causeway and
Homefirst Trusts, facilitated by the social work training unit,
with participation from special education staff.
— feedback from Homefirst Trust staff who had experienced
the first SEN Tribunal in Northern Ireland to selected speech
and language therapy staff from Trusts throughout Northern Ireland;
— speech and language therapy staff training in
March to Special Education Needs Co-ordinating Officers (SENCOs)
in mainstream schools on supporting children with communication
difficulties.
— Education and Library Board curriculum training
for speech and language therapy staff throughout the Board.
7. What has been the Board's actual expenditure related to
assessing and meeting special educational needs in each of the
last three financial years, and what is your projected spend in
1998-99, 1999-2000 and 2000-01?
Current accounting mechanisms within the Board preclude precise
expenditure profiles for the assessment and meeting of special
education needs. Budget profiles reflect the focus of care provision
that is holistically meeting the identified health and social
care needs of children irrespective of whether or not they have
a statement of special educational needs.
In the Homefirst Trust area, for example, the following funding
has been made available for children with special needs:
|
| |
| £ |
|
| |
| Respite care | 872,000 |
| Children's Occupational Therapy | 276,000
|
| Social Work Teams | 331,000
|
| Speech and Language Therapy | 657,000
|
| Specialist Health Visitors | 76,000
|
| Clinical Medical Officers | 286,000
|
|
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| Total | 2,498,000 |
Over the past three years, the Board has directed Children
Order funding specifically towards meeting the care needs of children
with disabilities as follows:
It is likely that the involvement of health and social services
staff with education staff will increase steadily over the next
few years. In particular, in relation to speech and language and
occupational therapy, there is a clearly identified increase in
the number of requests from mainstream schools for support and
in other activity associated with collaborating with education
staff in supporting children in schools.
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