Memorandum from the Western Health and
Social Services Board
CHILDREN WITH SPECIAL EDUCATION NEEDS
With reference to your letters of 11 and 18
December 1998, I now enclose a memorandum outlining how the Board
contributes to helping the Education and Library Board meet the
needs of children with Special Educational Needs.
In the time available, we have only been able
to give you an overview of how we are approaching this issue.
Mr Dominic Burke, Director of Social Care, and Mr Martin Bradley,
Chief Nurse in the Board, will be speaking on our behalf at the
oral evidence session and can elaborate on aspects of the memorandum
With regard to the Supplementary Questions attached
to your letter of 18 December we are currently preparing a response
for the Committee. You will appreciate that some of the detailed
information you require is not currently held and we are discussing
with Trusts how we might best provide a realistic assessment of
Interagency Co-operation with reference to Special
Educational Needs (including Learning Disability Services)
Process involved in formal assessment SENs (Statementing)
A Regional Perspective
Provision of Services to Children with Special Educational
Needs in the West
Community Paediatrics (medical)
Speech and Language Therapy
Occupational Therapy Services
Pressures and unmet needs in PAMs
Social Work Services (Physical and
Child and Adolescent Mental Health
Children's Services Plan
Clinical Psychology Services
Annex 1 School Children and the Disabled
Persons (NI) Act 1989a guide for parents.
SPECIAL EDUCATIONAL NEEDS
The WHSSB believes strongly in the benefit of
interagency co-operation at both a strategic and operational level.
The Board initiated the setting up of a "Disabled
Persons Act" meeting a number of years ago to ensure the
implementation of the Act. Since then, the meeting has been extended
in membership and it now includes Consultant Community Paediatricians
and their staff, Appropriate Officers, the WELB's Special Education
Officer and his staff, representatives of health care practitioners,
social work staff and the relevant planners at the Board.
The meeting, which is held approximately three
times per year, has carried out the following tasks recently:
Revised the leaflet "A Guide
for Parents" which explains how the legislation works and
how it can bring benefit to the disabled young person and their
family by ensuring the necessary links between the WELB, Trust
staff and the family.
Conducted a thorough revision of
the WHSSB Disabled Persons Act Protocol to include reference to
the Education (NI) Order 1996. This document has been developed
to guide professional staff through the statutory responsibilities
of the Education and Library Board, the Health and Social Services
Board and the Trusts, the definitions of disability and the roles
of key personnel. The Protocol draws together the strands of both
the Code of Practice of the Education (NI) Order 1996 and the
Disabled Persons (NI) Act 1989 with particular emphasis on the
effective implementation of transition planning from the review
of statements at 14 years to pre-school leaving assessments.
Established a joint Training Sub-Group
to plan training for appropriate Health and Social Services staff
with reference specifically to:
the Statementing Process
the Disabled Persons Act
This initiative will be supported by the Social
Services Training Team and a programme is currently being worked
up to ensure that all Social Services staff, including Social
Workers, are conversant with all the aspects of the interface
between Health and Social Services and the Western Education and
Library Board/Schools. Resources have been allocated by the Social
Services Training Team to facilitate this initiative and staff
from the Community Paediatric Service and from the Western Education
and Library Board will contribute to the training.
This joint approach continues to:
facilitate the sharing of information
between the two Boards. It has been possible to facilitate earlier
transition planning for potential school leavers this year.
ensure the dissemination of information
to and from Head Teachers of Special Schools.
provide a forum for identifying problems
and for co-ordinating effort. The meeting is of the opinion that
the time and effort given to working on areas of joint interest
has paid off though much remains to be achieved.
The Health and Social Services Learning Disability
Services have traditionally had close links with Special Needs
Education (having at one stage been part of one agency!).
The following points explain the relationship:
The Learning Disability Teams, comprising
the social work, nursing and medical (psychiatric) profession,
"know" all the children on the Register. Most of these
children attend Special Schools (former "S" and "M"
Schools). The Teams in each Trust area deal with both children
and adults and are therefore involved at transition.
Liaison with the schools by social
workers and nurses is maintained via an "attached" staff
member or the child's key worker.
Health and Social Care staff attend
Reviews in schools; there are examples of Reviews being brought
forward this year to facilitate earlier assessment and planning.
Liaison with schools is vital as
respite care arrangements must take account of continuity in education
requiring logistical adjustment when children are away from home.
Examples can be cited of staff from
each Agency attending reviews etc., organised by the other, e.g.,
Educational Psychology input to multi professional meetings organised
by a Trust and Head Teachers attending case discussions organised
by Health and Social Services.
A recent example of good practice
where parents, school staff and Multidisciplinary Teams all met
(in Strabane) to develop a coherent utilisation of the TEACCH
methodology at home and at school in respect of a child with special
There is therefore some cause for encouragement
though the Community Teams are short of resources and the number
of children on the register increases every year. The demands
of the Children Order in relation to respite care have increased
work dramatically leaving relatively less time for direct work
The multi-disciplinary teams include 11.59 funded
posts for nurses (including a nurse based at Foyleview Special
School). The nursing staff focus their attention on children with
more complex and profound needs and are in regular contact with
the schools, advising staff and parents regarding care and treatment.
They also liaise closely with their professional colleagues. The
programme includes a funded post for a Clinical Psychologist and
19 Social Work staff at various grades, all of whom have responsibility
for adults as well as children.
Support for Children with Disabilities
1. Western Area Committee for Hearing Impaired:
Chaired by Chief Educational PsychologistMembership
includes Medical Consultants, Commissioner, Specialist Social
Workers, Speech and Language Therapists, Specialist Teachers,
Senior Education Officers.
Number of children reviewed annually;
Information booklet for parents produced;
Shortfall in services identified.
Overview of service provided to individual children.
This is done through case conference system which
is chaired by the Medical Consultant.
2. Western Area Committee for Visually Impaired:
Chaired by Medical ConsultantMembership
includes Chief Educational Psychologist, Specialist Senior Teachers,
Commissioner, Specialist Social Workers, Fiona North, Optometrist,
Claire McGartland, Orthoptist.
This mirrors the role of WACHI. An information
booklet is being prepared.
Specialist Social Workers work with individual
hearing and visually impaired children and link as appropriate
with schools and other professionals. Equipment is provided as
Children with Physical Disability
Assessment and review carried out at a special
clinic by Dr Hutton within the Foyle Trust area. There is a PAMs
services input to this clinic. Assessment and review are also
carried on a multi-disciplinary basis within the Sperrin Lakeland
Social work support is provided for individual
child and family as appropriate. Links are maintained with schools
and other professionals including after school-support. Some families
may be care managed.
Where statements are in place in respect of
children about to leave school, social work follow-up is provided
The provison of respite care for children necessitates
close liaison between the Teams and the schools in order to maintain
continuity and conisistency.
Initial notification of proposal to make statutory
assessment of Special Educational Needs received by Community
Paediatrician from Western Education and Library Board.
In May 1997 a Regional Group was established
to plan for the consequences of the introduction of the Code of
Practice for the Identification and Assessment of Special Educational
Needs. The group has representation from each of the Education
and Library Boards and each Health and Social Services Board.
As the first part of its work, the Group has
produced an Interagency Agreement for the Provision of Education,
Health and Social Services to Children with Special Educational
The Group has also completed work on guidance
for schools on meeting the medical needs of children in school
and that work is now with the Department of Education.
In 1998-99 the group plan to:
review the operation of the Interagency
carry out a review of the nursing
support to children with special educational needs;
facilitate and support training for
both education and health staff in the working of the Code of
The Agreement is between the Health and Social
Services Boards (HSSBs) and the Education and Library Boards (ELBs)
and sets out the respective responsibilities for the provision
of therapy, medical and nursing services to children with special
Under the Agreement, the ELB, in conjunction
with schools and Health and Social Services Trusts, will develop
local Service Level Agreements to facilitate the provision of
education and health and social services to children with special
educational needs based on the principles and within the spirit
set out in it.
The role and responsibilities of all parties
are set out to ensure the provision of a comprehensive, high quality,
effective and efficient level of service to children with special
All parties will work together within the available
resources to meet the needs of the child taking into account the
wishes of the child (where these can be ascertained) and those
with parental responsibility.
Nursing, Medical and Therapy Support
In relation to the provision of health care
support, the following principles have been developed:
When considering provision for a
child's nursing and/or medical needs and/or therapy needs, the
ELB, School and Trust should ensure that the needs are clearly
and accurately described and that the relevant responsible professionals
are consulted as necessary.
Schools are responsible for ensuring
that all relevant staff know about and are, if necessary, trained
by the most appropriate Trust Officer in procedures to provide
support required by pupils with nursing and/or medical and therapy
needs. This should be co-ordinated by the designated Trust Officer.
Trusts and schools shall work together,
in close partnership with parents, to ensure proper support in
schools for pupils with medical, nursing and therapy needs.
HSS Trust staff, in consultation
with education staff, will assess the needs for care and assistance
with the tasks of daily living for children, individually and
also collectively where this is appropriate. On the basis of that
assessment the Trust and ELB will arrange for the appropriately
trained staff to provide the service within a setting which should
reflect the policy of "normalisation".
Written information should be drawn
up (locally) for parents to advise them on the type of care services
which can be expected as part of the school day and to help them
appreciate the limitations of any reasonable level of care service
in the school.
Planned Service Development
The Agreement advocates that protocols must
be in place to facilitate discussion of any future service development
or proposed changes in service at the earliest opportunity, to
enable service planning by Trusts and, where required, funding
by commissioners of services. This needs to reflect the needs
of both agencies, for example ELBs need to know if the Health
and Social Services are planning changes including the withdrawal
or change of personnel or additional investment.
It is to be hoped that the Interagency Agreement
will facilitate a more planned and rational approach to meeting
the needs of these children and greater co-ordination between
Health and Social Services and Education.
PROVISION OF SERVICES TO CHILDREN WITH SPECIAL
EDUCATIONAL NEEDS IN THE WEST
Up to 20 per cent of the school population may
have special educational needs at some point in their school career.
A smaller number of pupils, estimated to be around two per cent
or less, will have more complex needs which will require a statement
of special educational needs. Within the Western Board two per
cent of pupils currently have statements of need. This is consistent
with the recent Government guidelines (Green Paper: "Excellence
for All" suggested target of overall statementing level 1.5
per cent to 2 per cent) and recognises the need to promote the
inclusion of children with special educational needs within mainstream
education wherever possible. Therefore, when considering the
contribution of health and social care professionals, it is important
to recognise that their services are offered to, and required
by, a much larger group of children than those who have been formally
The demand for these services is also likely
to grow as the mortality rates for premature babies and post-accident
trauma cases improves and there is a subsequent increase in the
number of profoundly or multiple disabled children. The increased
awareness and identification of children with specific learning
difficulties, speech and language difficulties, autism and emotional
behavioural difficulties will also lead to an increasing pressure
on these services.
A minority of children with special educational
needs require formal assessment (statementing). The remainder
are managed according to the stages set out in the Code of Practice.
The majority of these children are identified
to the School Health Service by:
Health visitors (pre-school entry);
Parents via the Health Appraisal
forms at school entry;
Once identified, they have vision and hearing
checks carried out by the School Nurse and are seen by the Staff
Grade doctor at the routine school medical. Each school is visited
once in the school year, and the School Nurse liaises with the
parents and school (usually via the SENCO, the school's Special
Educational Needs Co-ordinator). The SENCO frequently requests
information about medical problems which might affect the child
educationally and this can be given, with parental consent.
The school nursing service also provides information
and training for school staff on children with specific medical
problems in school, e.g., children at risk of anaphylaxis who
have adrenaline syringes for use in school, asthmatics who have
nebulisers in school, etc.
By far the majority of children seen for selective
medical examination in school are those with special educational
needs but without statements.
The School Nursing Service provides a care surveillance
developmental and immunisation programme to children with special
educational needs. The method of screening may vary according
to need but basically adheres to the following format:
(a) Sees all school age children who are for:
Initial assessment special education
needs: for height, weight hearing, vision checks, as requested
by Medical Officer
All statemented children have yearly hearing
checks done. The latter are carried out in special schools by
the School Nurse working with the Orthoptist. In addition, she
assists the Orthoptist and Staff Grade doctor at the Community
(b) Special Schools
Each school has a named School Nurse. Each child
is seen by the School Nurse as per the routine school health programme,
e.g., P1 Health Appraisal, height, weight, vision and hearing
checks, routine immunisations etc., but also as above. Each school
is visited yearly but the nurse can be contacted by phone at any
The School Nurse assists the Medical Officer
at selective medical examinations (children with medical problems
associated with their learning difficulties). She can give advice
and information regarding specific problems to the school (with
(c) Special Educational Needs in Mainstream Schools
The School Nurse is involved with children with
special educational needs in mainstream (statemented and non-statemented).
routine core school health programme;
yearly vision and hearing checks;
assists Medical Officer at school
gives advice to parents, e.g., referral
to other agencies, e.g., speech therapy, behaviour management
gives advice and information to the
school (with parental consent), e.g., soiling, diet, etc. In a
significant number of cases where children have serious medical
problems resulting in them having special educational needs, the
School Nurse has been involved in helping to provide information
and training to school staff, e.g., children with severe asthma
and epilepsy and children at risk of anaphylaxis.
Providing services for children with special
educational needs forms a major part of the work of community
The work involves:
(1) Identification for the WELB of those
pre-school children who, due to their health problems, are likely
to have special educational needs. This includes children with
congenital abnormalities, developmental delay and complex multiple
(2) Identification of those children who,
after an illness, disease or road traffic accident develop special
(3) Carrying out detailed medical and other
assessments of children with special educational needs for the
Education and Library Boards for the purpose of statementing.
(4) Co-ordinating the response to the Education
and Library Board regarding the assessment of children with special
educational needs for the purpose of statementing.
(5) Providing ongoing therapy and assessment
of children with special educational needs.
(6) Providing regular updates on the progress
of children with special educational needs to the educational
psychologists, schools, special education officers, specialist
palipatetic teachers and other appropriate Education and Library
(7) Attending and contributing to meetings
regarding children with SENs both locally at special schools and
centrally with Education and Library Board officers.
(8) During preparation of transition plans
for age 14+ children with statements, Medical Officers provide
reports and an Opinon as to whether the child is "disabled"
under the Disabled Persons Act 1989.
The assessment of children with SENs for the
purpose of statementing is given top priority by Community Paediatricians,
alongside the developmental assessment of children who may have
SENs and require a referral to educational psychology.
It is estimated that over 50 per cent of the
time of Community Paediatricians is spent on activities relating
to children with SENs, recognising the importance of helping Education
and Library Boards see that these children maximise their educational
Speech and Language Therapists interpret children
with SENs to be those children who fall into the following categories:
Specific Language Impairment (SLI)
These are estimated to be 655 children with
SENs involving Speech and Language Therapy input in Foyle Health
and Social Services Trust and 376 children with SENs involving
Speech and Language Therapy input in Sperrin Lakeland Trust.
The two Trusts in the Board that provide Speech
and Language Therapy Services have given information on input
to the various categories as follows:
Foyle HSS Trust
Hearing Impaired 1.5 Wte
Specific Language Impairment 4.8 Wte
Sperrin Lakeland Trust
In both Trusts, this equates to approximately
50 per cent of the funded establishment.
The Speech and Language Therapist often sees
children with special educational needs from a very young age
and provides input to educational psychology reports. This group
of children also receive speech and language therapy advice and
where appropriate, treatment as part of the statementing process.
Staff offer support and guidance on a regular
basis to outreach and support teachers, SENCOs in mainstream schools
and teachers in special units.
The WHSSB, the Trusts and the WELB are currently
looking closely at the possibility of appointing an Advisory Speech
and Language Therapist to mainstream schools and nurseries.
Children with SENs receive a high priority with
the therapy being delivered by specialist Speech and Language
The Occupational Therapy service contributes
to the Trusts' input to meeting identified SENs in the first instance
by submitting an assessment report for consideration within the
The Occupational Therapy (OT) assesses and provides
treatment and/or recommends appropriate equipment.
The OT devises a treatment programme to develop
skills and advises teaching staff how to maximise the child's
The OT advises on alternative approaches to
the task, adapting the equipment where necessary.
In addition, the OT will contribute to the general
care of the child within the school environment by offering advice
appropriate manual handling of the
specialist equipment required;
requirements in relation to daily
Currently there are eight Whole Time Equivalent
posts dedicated to paediatrics, the vast majority of which is
involved in dealing with children with special education needs.
Formal and informal links between the Trusts'
Occupational Therapists and staff in educational establishments
have been formed in order to maximise the potential of all children
referred to the service.
Physiotherapists have an input via the
Community Paediatrician at the assessment stage of the statementing
Follow-up treatment and reassessment is carried
out in both Trusts in the WHSSB. These activities are carried
out at schoolsboth special and mainstream, in the patient's
home and in clinic facilities.
The Foyle Trust have four whole time equivalents
physiotherapists assessing and treating the needs of children
with special educational needs while the Sperrin Lakeland Trust
Physiotherapists have developed formal and informal
links with staff in special schools, meeting them on a daily basis.
Local groups of Trust physiotherapy staff and Education and Library
Board staff meet on specific cases if and when required.
MEDICINE (PAMS) SERVICES
Other professions allied to medicine that are
involved in the assessment and treatment of children with SENs
are dieticians, podiatrists and orthoptists.
It is estimated that, in any one year, each
of the professions will have the following input to children with
special educational needs:
|Profession||Percentage of total contacts given to children with SENs|
Relevant staff meet at multidisciplinary meetings with the
Education and Library Board on specific cases.
IN PAMS SERVICES
The Education Order and the timescales within it have increased
pressures on PAMs staff.
Other pressures have arisen and will continue to increase
as more premature babies survive and those born with a disability
As the public and professionals become more aware of language
difficulties, speech and language therapists have increased demands
made on their services. It is now estimated that one in 5 children
require some therapy whereas previously the ratio was one in 12.
There are 18 social work staff working in the field of physical
disability in the WHSSB. In addition, the Trusts employ specialist
staff to work on a dedicated basis in the area of sensory impairment.
Staff are based in local offices and within Specialist Sensory
Support Centres in Londonderry and Enniskillen. There are 12 full-time
and one part-time staff of various grades undertaking work with
sensorily impaired people, both adults and children. Some are
employed directly by the Trusts, others are employed by voluntary
organisations which receive funding from the Trusts who, in turn,
contract with the Board.
Services to children and young people and their families
are delivered on an individual casework basis but input is made
with reference to education during and after the initial statementing,
the review of statements and at pre-school leaving assessments
in keeping with the Disabled Persons Act requirements.
This involves attendances at pre school-leaving conferences,
liaison with staff and the completion of reports in respect of
children with special educational needs.
Staff have been able to assist young people in preparing
for further and higher education by setting up packages of support,
including domiciliary care and advice regarding welfare and housing
Specific help is given in the Foyle Trust to young people
who have suffered from head injury, in relation to training, support
Close liaison is maintained with the Community Paediatric
The Board's Child and Adolescent Services began in 1992 with
the establishment of a Multi-Disciplinary Team comprising psychiatry,
psychology, nursing and social work. In 1995 a second team was
set up to cover the Sperrin Lakeland area. This allowed for a
base to be created in each Trust area, in Londonderry and Omagh.
The Teams take referrals from GPs, other health professionals
and the Educational Psychology Service. The target age group is
those under 16 years of age and a very wide range of disorders
present themselves to the Teams, including emotional, conduct,
hyperkinetic and development disorders. The Teams also deal with
children and young people with eating disorders, habit disorders,
post traumatic syndromes, somatic disorders and psychotic disorders.
There is significant contact where appropriate with schools
in relation to the children and young people. Many of the young
people may not be statemented but their wellbeing and, no doubt,
capacity to learn and achieve will be affected by their emotional
distress. The assistance of the Teams is vital in securing their
A recent Review of the Service indicates the need for other
elements of a Child and Adolescent Service and this is the subject
of ongoing planning.
A wide range of interventions is provided by highly skilled
and trained professional staff, including family therapy. The
current funded establishment comprises 1.9 Consultant Psychiatrists,
two Clinical Psychologists, two Senior Social Workers and four
Nurses. The total revenue budget for the Teams is £513,000.
In addition, the Western Board purchases residential treatment
services for young people and children at the Foster Green Hospital
and the Young People's Centre in Belfast at a cost of approximately
£180,000 per year. It has also been estimated that in-house
treatment and care costs amount to somewhere in the region of
£150,000 per year.
The Board is alive to the many challenges facing young people
and the necessity to develop further resources. The component
parts of the service envisaged for the West are included as recommendations
in the report"With the Young in Mind".
In accordance with the Children (NI) Order (1995) which became
law in November 1996, Part 4, Boards and Trusts have a responsibility
to provide services for children in need and to seek the collaboration
of other statutory agencies and voluntary agencies in achieving
A child is "in need" if:
he is unlikely to achieve or maintain or to have
the opportunity of achieving or maintaining a reasonable standard
of health or development without the provision for him of services
by the appropriate authority;
his health or development is likely to be significantly
impaired or further impaired, without the provision for him of
The Board has issued a draft Children's Services Plan for
consultation. The finalised document will provide the template
for planning and operationalising services for children and young
people into the next millennium, including "looked after
children",. "disabled children", and "children
with emotional, behavioural, psychiatric or psychological difficulties".
The draft document references the number of children subject
to Statements of Special Educational Needs in the Western Area
|Number of Children Subject of Statements of Special Educational Needs in Western Area, October 1998|
|Category||Number of Children|
|Specific Learning Difficulties||41|
|Speech and Language Difficulties||98|
|Number of Statements in process||248|
|Number of pre-school children with Statement||8|
The document fully acknowledges the implications of the Code
of Practice for the Identification and Assessment of Special Educational
Needs (DENI 1998).
Interagency co-operation is highlighted by the document as
per "All of the agencies and groups will work towards
agreement about the approaches and services needed to maximise
support for children and young people. Assessment of need will
be developed and discussed between agencies and opportunities
for collaboration in the planning and provision of services will
be pursued positively."
The Board plans to commission a major and specific Needs
Assessment project in respect of disabled children and young people
CLINICAL PSYCHOLOGY SERVICES
At the moment there is one full-time Grade B Clinical Psychologist
working in the Child and Adolescent Team in Sperrin Lakeland.
The Psychologist works with children between the ages of 0 and
16, all whom would be assessed as having special needs of an emotional
mental health nature.
There is one vacant Clinical Psychology post in Learning
Disability which has not yet been filled.
FOYLE HSS TRUST
Foyle Trust have had one full-time Grade B and 0.5 Grade
A Clinical Psychologists working in the Child and Adolescent Team
in the Trust's area for the past six months. The children in this
Team have also been assessed as having emotional/mental health
In addition, there is one vacant Clinical Psychologist post
in Learning Disability which has been advertised on a number of
6 January 1999
2 See also Appendix 14, p. 169. Back
3 Note by Witness: In special schools, vision testing is
done by the school nurse with the orthopist-this relates only
to Fermanagh. Back