APPENDIX 15
Supplementary Memorandum from Eastern
Health and Social Services Board
I attach further comments concerning the seven
supplementary questions, which you raised following your memorandum
of the 18 December 1998.
SPECIAL EDUCATIONAL NEEDS—SUPPLEMENTARY
QUESTIONS FEBRUARY 1999
INTRODUCTION
The letter dated 18 December 1998 from the Clerk
of the Northern Ireland Affairs Committee outlines seven supplementary
questions regarding special educational needs which the Northern
Ireland 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.
Q1. 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
Staff respond to requests for advice in respect
of statutory assessment of special educational needs from Belfast
Education and Library Board and South Eastern Education and Library
Board. The number of requests for initial advice, as well as updated
reports for statutory assessments, over the five years period
from 1994-99 is as outlined in the table below.
| | |
| | |
| Area | 1994 | 1995
| 1996 | 1997 | 1998
|
| | |
| | |
| North and West Belfast Trust (BELB) | 218
| 363 | 425 | 362
| 225 |
| South and East Belfast (BELB and SEELB) |
223 | 225 | 280
| 202 | 195 |
| Down Lisburn Trust (SEELB) | 350
| 298 | 312 | 286
| 209 |
| Ulster Community and Hospitals Trust (SEELB)
| 187 | 161 | 129
| 134 | 126 |
| | |
| | |
| Total | 978 | 1,047
| 1,146 | 984 | 755
|
The geographical areas covered by the Trusts are as follows:
| |
| Trust | Geographical area |
| |
| North and West Belfast Trust | North Belfast and West Belfast within the Belfast District Council area
|
| |
| South and East Belfast | South Belfast and East Belfast within the Belfast District Council area plus the Castlereagh District Council area
|
| |
| Down Lisburn Trust | Down Lisburn District Council areas
|
| |
| Ulster Community and Hospitals Trust | North Down and Ards District Council areas
|
Q2. What has been the average time lapse between referral and
actual assessment in each of the last five years, overall, and
by type of assessment
In general, formal medical advice for the purposes of the
statementing process has been largely provided to the Education
and Library Boards by Trusts within the six weeks period and up
to three months for other professional reports.
The Medical Officer is the only professional who must see
every child referred for the purpose of statutory assessment.
At present information in relation to date referral issued
and assessment returned is recorded on individual files held by
SEELB and BELB. It is not broken down into type of professional
assessment by the Trust staff.
SEELB have commenced recording and monitoring of the time
frame for the return of assessments from September 1998 onwards
but not previously.
Q3. What has been the total number of children with statements
of special educational needs to whom the Board has provided support
in each of the last five years in total and broken down by type
of support?
Children with statements of Special Educational Need receive
services and support from a variety of disciplines throughout
the various stages of the child's life and in keeping with their
changing needs.
The range of support services provided to these children
from Social Services includes specialist child minding, foster
care, shared care, summer schemes, befriending, Breakaway Schemes,
Crossroads Care Attendant Schemes, respite care, psychology and
treatment services which include child or adolescent psychiatry
for children with severe learning difficulties. A variety of mainstream
children's services are offered within Trusts through the Child
and Family Programme.
The table below indicates the number of children from the
EHSSB area who are receiving therapy at special schools.
We cannot quantify this information on a five year basis
although it may be possible for both Education and Library Boards
to do so.
| Occupational
Therapy
| Physiotherapy | Speech and
Language Therapy
|
| | |
|
| | |
|
| Killard House | 8 | 2
| 82 |
| Clifton | 51 | 45
| 56 |
| Glencraig | 0 | 0
| 0 |
| Rathmore PHU | 0 | 0
| N/K |
| Brookfield | 1 | 0
| 74 |
| Parkview (SLD) | 63 | 47
| 90 |
| Knockevin (SLD) | 57 | 30
| 60 |
| Knockmore Diag Unit | 2 |
2 | 5 |
| Knockmore S and L Unit | 0 |
0 | 23 |
| Downpatrick Unit (MLD) | 0 |
0 | 16 |
| St Colmcille's Unit | 0 |
0 | 9 |
| Castlewellan Unit (MLD) | 0
| 0 | 6 |
| St Malachy's Unit (MLD) | 0
| 0 | 5 |
| Fleming Fulton | 140 | 138
| 89 |
| Tor Bank | 98 | 49
| 85 |
| Greenwood | 22 | 1
| 37 |
| Longstone | 6 | 4
| 55 |
| Mitchell House | 63 | 49
| 42 |
| Harberton Primary | 4 | 3
| 63 |
| Cregagh Primary PHU | 0 |
0 | 13 |
| Orangefield PHU | 0 | 0
| 4 |
| Cedar Lodge | 24 | 25
| 37 |
| St Gerard's ERC | 0 | 2
| 52 |
| Glenveagh | 107 | 91
| 97 |
| Oakwood | 46 | 41
| 61 |
| St Francis de Sales | 0 |
0 | 13 |
| Ballygolan S and L Unit | 0
| 0 | 2 |
| Holy Trinity Unit | 0 | 0
| 5 |
| St Rose's Sec PHU | 0 | 0
| 1 |
| Corpus Christie PHU | 0 |
0 | 0 |
| | |
|
| | |
|
| Total | 692 | 529
| 1,082 |
| | |
|
| | |
|
| Whole Time Equivalent (WTE) Therapists |
19.05 | 21.09 | 23.63
|
| | |
|
| | |
|
The number of children, however, with statements in 1997-98
is as follows:
|
| | |
| Schools and Units | Number
|
|
| | |
| SEELB | Special Schools and Units
| 1,730 |
| Mainstream Schools | 692
|
| BELB | Special Schools and Units
| 963 |
| Mainstream Schools | 438
|
|
| | |
| Total | Special Schools |
2,693 |
| Mainstream Schools | 1,130
|
|
| | |
| Total | | 3,823
|
The number of children attending school in EHSSB area is
134,489 and the percentage of children statemented[8]
is 2.84 per cent.
Q4. What clinical psychology/psychiatry services does the EHSSB
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 for adults; and how many persons have
such services been provided in each of the last five years?
The above services are commissioned on the following basis:
(i) Child and adolescent mental health services.
(ii) Services for children with learning disabilities.
Child and Adolescent Mental Health Services
The Board currently invests £2.278 million in commissioning
a range of in-patient, day care and out-patient child and adolescent
mental health services. These services are provided separately
from adult provision. During 1996-97, the following levels of
service were provided:
|
| |
| Number |
|
| |
| In-patients | 6,869 beds |
| Day Care | 1,846 attendances
|
| Out-patients | 7,434 attendances
|
The service was provided by the following numbers of staff:
| |
| WTE |
|
| |
| Consultant Psychiatrist | 5.4
|
| Associate Specialist | 1.0 |
| Senior Registrar | 2.0 |
| Senior House Officer | 3.5 |
| Nurses | 35.13 |
| Clinical Psychologist | 4.525
|
| Senior Social Worker | 3.0 |
| Social Worker | 5.0 |
| Senior Care Assistants | 5.0
|
| Support | 8.0 |
During 1996-97, 170 children and young people were admitted
for in-patient care (54 of whom were admitted to adult accommodation)
with approximately a further 1,100 being seen on an out-patient
basis.
The EHSSB Community Trusts are unable to fully quantify the
number of referrals to child and adolescent psychiatry services
from 1993-1996. The Board will continue to work with Trusts to
identify this information.
The EHSSB has recently carried out a comprehensive review
of child and adolescent mental health services in its area and
has identified the following main strategic recommendations:
— Services should be community-based with "in-reach"
services to hospitals, e.g., in relation to deliberate self harm.
— Services should be integrated into child health
and care services at community level.
— A tiered model of care should be implemented as
recommended by the NHS Health Advisory Service and the House of
Commons Health Committee. This model includes the development
of the role of mental health workers with specialist skills to
work closely with GPs, health visitors, school nurses and others
to enhance the delivery of mental health services at primary care
level.
— Mental health promotion and the delivery of primary
level mental health care should be recognised as a key function
of health visitors and school nurses.
— Appropriate training and continuing professional
development as well as specialist support are essential to enable
primary care professionals to meet the mental health needs of
children and young people.
— Joint working across health, social services,
education, juvenile justice and the voluntary sector is essential
at all levels including the planning and delivery of services.
— Specialist tiers of services should include a
multi-disciplinary team at community level and specialised services
provided on a area-wide basis, including in-patient services and
substances misuse service.
— Age-appropriate in-patient facilities for children
and young people should be provided in close proximity, preferably
on the same site.
— Family support and prevention services should
continue to be developed as a priority.
Children with Learning Disabilities
The Board has undertaken an extensive review and analysis
of the needs of children with learning disabilities in order to
inform its commissioning and expenditure priorities. An action
plan is now in place to implement the strategy within available
resources between 1999 and 2002.
The needs of children with disabilities, have been given
further impetus by the Children Services Planning Sub-Group for
children with disabilities and the resulting plan for the Board's
area will address, on an inter-agency basis the prioritised needs
of this group.
Services to children with learning disabilities are largely
provided in conjunction with those for adults. Diagnosis and assessment
services are however largely geared towards children. Some Trusts
are now attempting to separate more closely services provided
to children and adults.
There are currently five WTE consultant psychiatrists employed
by North and West Belfast Trust who cover in-patient and community
services. In addition, increased community clinical psychology
and more recently behaviour nurse therapy services have become
available within Trusts which have assisted in reducing the number
of children referred to specialist hospitals for treatment and
behaviour management programmes.
The number of referrals to the service is not fully available
from the Trusts in the Board's area.
The following clinical psychology services provided for children
and young people of school age are, however detailed below,
— Behavioural assessment/treatment.
— Development assessments.
— Assessment of autism and other developmental disorders
in conjunction with medical professionals.
— Psychometric and attainment assessments especially
pertinent for decision-making regarding the extent of learning
disability.
— Specialist advisory services to children learning
disability team regarding issues of childrens personal development
needs—e.g., assessment of risk of sexual vulnerability of
clients/emotional well-being/training/regarding sexual awareness
etc.
— Non-medical mental health assessment and advice/treatment.
— Planning of services for children along with other
senior members of programme.
— Attendance and input to educational reviews and
statements as necessary.
— Development of support groups for parents of autistic
children.
— Attendance at referral meetings for the Learning
Disability Programme.
— Liaison with learning disability hospital as necessary.
— Management of Behavioural Support Team.
In one Trust area, a behavioural clinic is now being run
by a Community Medical Officer, Education Welfare Officer and
an educational psychologist on a weekly basis for primary age
children.
Q5. How many children in residential care in the Board's area
had an SEN statement in each of the last five years and what percentage
was this of the total population.
| Number of children statemented in residential care
| | | |
| |
| | |
| | |
| 1994 | 1995
| 1996 | 1997 | 1998
|
| | |
| | |
| North and West Belfast HSST1 |
n/a | n/a | n/a
| n/a | n/a |
South and East Belfast HSST
(as percentage)
| 3
(4.4) | 2
(2.6)
| 4
(7.2) | 3
(7.9)
| 2
(5.7) |
| Down Lisburn HSST | 3 | 2
| 6 | 1 | 2 |
Ulster Community and Hospitals Trust
(as percentage)
| 1
(3.4) | 2
(6.8)
| 2
(7.7) | 4
(19.0)
| 4
(21.1) |
| | |
| | |
1 Information was not provided by North and West Belfast Trust.
| | | |
| |
Q6. 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?
The ethos and principles of the Children (NI) Order 1995,
Education (NI) Order 1996 and Disabled Persons Act 1989 are included
in qualifying training within the Colleges of Further Education
and Universities in Northern Ireland. Under the post-qualifying
training arrangements, in order to obtain post-qualifying credits,
or awards, staff must demonstrate a knowledge of all relevant
legislation pertaining to children, including the above legislation
and how it applies in practice.
A completed portfolio of evidence is required which demonstrates
how staff have integrated theory and knowledge of legislation
and how it applies in practice.
The senior management who professionally supervise social
work staff in Trusts are responsible for identifying the training
needs of their staff which can be met either within the Trust
by the Trust's training team or by attending specific courses.
One of the values which underpins social work training is
inter-organisational and inter-sectoral working arrangements regarding
children with a disability.
EHSSB have produced a Children Services Training Plan 1997-2002
for the EHSSB area. This Plan identifies a need for joint education
and social services training.
Needs assessment training has been put in place across children
services, e.g., early years, family support, child protection,
family PLacement, leaving care and after care.
Cross reference to the Education Order and Code of Practice
will have been made in the Children Order training as the Children
Order identifies children with a disability as children in need.
The EHSSB are currently in the process of confirming training
plans for 1999-2000 and training in the requirements of the Education
Order and SEN Code of Practice will be included in this plan.
An agreed protocol will be drawn up between Trusts and Education
and Library Boards to operationalise this and will take account
of the service level agreements between Education and Library
Boards which are currently being finalised by the Regional Working
Group.
As in other areas such as the Children Order and Child Protection,
the EHSSB will be working collaboratively with Education and Library
Boards in respect of training.
The South Eastern Education and Library Board held a half-day
Awareness Session for Health and Personal Social Services staff
in the Ulster Community and Hospitals Trust covering the Education
(NI) Order 1996 and the Code of Practice to appraise Trust staff
of statutory responsibilities and to inform about the Boards policy
for pupils with SEN.
Q7. 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?
The Board is unable to provide information requested above
as financial information is gathered in line with Health and Social
Services Executive programme definitions (e.g., Maternal and Child
Health, Learning Disability, Physical Disability) and these cannot
be easily disaggregated and related to special educational 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. The Board would require
a very specific information technology programme to capture this
information pan-Trust and Board as it encapsulates a full range
of professions in a variety of settings.
The Board has however been able to estimate its investment
in therapy services to children who attend special schools and
units in its area as being approximately £1.291 million (see
Annex 2). It has not yet been possible to quantify medical, nursing
or dental input in this regard.
8
Information on Statemented Children was provided by Education
and Library Boards. Back
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