Memorandum from the Southern Health and
Social Services Board
1. BACKGROUND
The Southern Health and Social Services Board
(SHSSB) is responsible for commissioning health and social care
on behalf of its resident population. In the Southern Board there
are 98,225 people under the age of 19 and 75,305 under the age
of 14.
There are four Health and Social Services Trusts
in the Southern Board responsible for the delivery of services
to children.
Special Education Needs
The term "Special Educational Needs"
(SEN) is defined as "a learning difficulty which calls for
special educational provision to be made". Learning difficulty
is used to describe (i) a child who has significantly greater
difficulty in learning than most children of the same age, and/or
(ii) has a disability which restricts the use of standard educational
facilities. Children with special educational needs may present
to health and social services either before or after school entry.
It has been estimated that approximately 20
per cent of the child population have special educational needs
and approximately 2 per cent have "statements" of their
special educational needs. In the Southern Board, around 2.1 per
cent of the school population have "statements" in relation
to their special education needs. The Southern Board has experienced
an increase in the number of "statemented" children
in the last few years similar to other parts of Northern Ireland.
2. PROVISION OF
SERVICES TO
ASSIST EDUCATION
AND LIBRARY
BOARDS MEET
IDENTIFIED SENS
The SHSSB commissions a range of medical and
social care services covering the areas of child health surveillance,
diagnosis and assessment, and ongoing care of children with SENs.
This includes the provision of information, advice and support
to educational staff regarding the likely impact of a child's
disability or medical condition on their education.
The objective of services is to ensure that
children with special educational needs are recognised at the
earliest stage possible to enable appropriate remedial/supportive
interventions to begin during the child's early formative years.
There is a regionally-agreed child health surveillance
programme in Northern Ireland. In the pre-school age group this
is carried out by members of the primary care team in the community.
When problems are detected, children are referred to community
child health services. In school age children, child health surveillance
is undertaken by the school health service doctors (under the
supervision of a Community Paediatrician/Senior Clinical Medical
Officer) and nurses.
The Child Development Clinic, located in Craigavon
Area Hospital, provides a specialist multidisciplinary developmental
paediatric service for children with complex disability. This
service is mainly for children in the pre-school age group who
require combinations of therapy, advice and treatment.
The "Statementing" process
The Community Paediatrician/Senior Clinical
Medical Officer in each of the Trusts in the SHSSB is the "designated
officer" who co-ordinates the health services' role and contributes
to the statementing process. The assessments undertaken depend
upon the nature of the disability—assessments are undertaken
on all children by community paediatric/clinical medical officers
who draw on information from other medical staff such as child
and adolescent psychiatrists, orthopaedic surgeons and clinical
psychologists, speech and language therapists, occupational therapists,
physiotherapists and social services when a child is known to
their services.
The services provided for a child vary reflecting
the diverse nature of the assessed needs of any child and the
wide range of conditions that lead to SEN. Care is provided across
a number of settings e.g., hospital, community, school and in
the child's home. While care can usually be provided within the
Southern Board, there are occasions where it is necessary to refer
the child outside the Southern Board, for example in the provision
of specialist treatment/intervention for children with sensory
impairment.
3. CO -ORDINATING
MECHANISMS BETWEEN
THE SOUTHERN HEALTH
AND SOCIAL SERVICES
BOARD AND
THE EDUCATION
AND LIBRARY BOARD
There is a long history of close working, at
both strategic and operational levels, between the Southern Health
and Social Services Board, local Health and Social Services Trusts,
and the Southern Education and Library Board. Health and social
care professionals from local Health and Social Services Trusts
meet regularly with colleagues in the SELB on issues relating
to Special Educational Needs. This includes regular scheduled
meetings between Trust staff and SELB officers and ad-hoc
meetings/contacts, on a day-to-day basis, between service professionals
to discuss management of individual children. In the school health
service, named medical and nursing staff work in schools and are
available to answer queries as they arise about pupils or health
matters, e.g., meningitis case in a pupil attending a school.
Specific examples of service co-ordination at strategic and operational
level with the SELB include the following:
Strategic
Development of Service Level Agreement between
Education and Health and Social Services Boards
A regional interagency working group has drafted
an interagency service level agreement between Health and Social
Services Boards and Education and Library Boards outlining the
roles and responsibilities of health and educational staff for
effective interagency working. The SHSSB expects to work closely
with the SELB in the future in relation to the implementation
and monitoring of this agreement.
Child Protection
SELB are represented on the Southern Area Child
Protection Committee (SACPC) and have actively co-operated with
SHSSB on a number of initiatives including the joint funding of
multi-disciplinary training posts, the introduction of the "Kidscape"
child protection programme in schools and the amendment of that
programme for use with children with disabilities.
Children Order
The SELB was represented on the SHSSB multi-disciplinary
planning group which was set up in 1995 to consider the implications
of the introduction of the Children (NI) Order 1995. Co-operation
has continued with a quarterly meeting of SHSSB, Trust, and SELB
representatives to address issues of joint interest in relation
to the working of the Order. SELB has also provided support to
individual schemes such as the "Adolescent Projects"
operating within each of the Trusts in the Southern Board.
Early Years
This is an area of close co-operation with the
SELB being an active member of the Early Years Committee Forum
and the SHSSB taking a full role in the SELB-led Pre-School Education
Advisory Group. This has included the joint funding of administrative
support to the Committee and the development of a geo-mapping
data base to support the allocation of European funding and the
more general strategic planning of early years services.
Children's Services Plan
The SELB Chief Executive is a member of the
Southern Board Children and Young Peoples Committee which has
established a strategic planning framework to take forward multi-agency
co-operation in planning services to vulnerable children. Eight
planning sub-groups have been formed with representatives from
the relevant agencies and disciplines. SELB officers are key members
of a number of these planning groups, in particular the groups
considering the following issues: children with school related
difficulties and young people in conflict with the law; Children
with disabilities (including children with SEN) family support
and child protection (SACPC), Early Years (SAEYC), children with
a mental health problem, and young carers.
Operational
Child Development Clinic
An educational psychologist attends the Child
Development Clinic in Craigavon on a weekly basis where an educational
assessment is commenced and the appropriate referral is made to
local education services.
Rathfriland Hill Pilot project
A jointly funded pilot project between the SHSSB
and SELB is under way in Rathfriland Hill school in Newry. This
is targeted at pre-school children with complex disability and
provides therapy and education. The pilot project started in 1997
and will be evaluated after the pilot phase is completed in 1999.
Attention Deficit Hyperactivity Disorder
A new clinic for children with this condition,
which is sometimes associated with SEN, will open on a pilot basis
in Kilkeel at the end of January 1999. The clinic will be run
by an educational psychologist and community paediatrician. The
effectiveness of the service will be evaluated after the pilot
phase.
Autistic Spectrum Disorder
Research has shown that this condition can affect
up to 1 per cent of the total population. These children require
special interventions and learning environments. Currently within
the Southern Board there is a working group consisting of health
and educational professionals agreeing procedures for streamlining
the assessment of children with this condition and the services
that will be required in the future.
DENI Code of Practice
Two Trusts within the Southern Board have developed
arrangements with SELB and agreed protocols for operationalisation
of this.
Health Promotion
There is a Youth Officer post for health promotion
in the Southern Area which is jointly funded by the SHSSB and
SELB.
4. PRIORITISATION
OF PROVISION
FOR SPECIAL
EDUCATIONAL NEEDS
WITHIN THE
SOUTHERN HEALTH
AND SOCIAL
SERVICES BOARD
Within the broad context of relatively fixed
resources, but increasing demand for health and social care provision,
the SHSSB has continued to develop services to meet the specific
health and social care needs of children with SENs.
An additional recurrent sum of £146,000
has been invested in therapy posts, i.e., speech and language
therapy, physiotherapy and occupational therapy in the Southern
Board since 1995 for the management of children with SENs. Prior
to this, the SHSSB funded a unique training initiative focusing
on developing the competencies and skills of therapists. Designated
staff rotated through the Child Development Clinic, special units,
schools and community settings for children with a disability
and, under supervision, gained experience and skills in managing
and supporting children with special needs.
Children Order funding has been used to develop
services for children with a disability. Since 1996 this has amounted
to £220,000 which is approximately 25 per cent of the money
available for the Children Order. It is anticipated that this
level of investment will continue for the next three to five years.
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