Memorandum submitted by the National Association
of Paediatric Occupational Therapists (NAPOT)
INTRODUCTION
1.1 A majority of children's occupational
therapists work in educational settings—mainstream and special
schools and pre-schools. Services are also beginning to support
the post-16 and higher education sectors.
1.2 NAPOT communicates regularly with its
members throughout the UK, providing regular policy updates and
inviting responses. Children's occupational therapists (OTs) are
based largely in the NHS but also in local authorities and the
independent sector.
1.3 NAPOT has a particular interest in multi-agency
approaches and the provision of comprehensive support for children
with special educational needs.
Occupational therapists work closely with children
and young people, parents and teachers to improve access to both
the learning and physical curricula.
1.4 NAPOT welcomes the chance to submit
written evidence to the Committee and would appreciate the opportunity
to submit oral evidence.
RESPONSE TO
POINTS RAISED:
2. Provision for SEN pupils in mainstream
schools : availability of resources and expertise; different models
of provision
2.1 Over the past two decades, SEN legislation
has resulted in a growing number of children with a wide range
of special needs being included in mainstream schools and parents'
expectations continue to increase. NAPOT welcomes greater choice
and opportunities for children to be educated in their local communities
and alongside their peers. However, mainstream schools have had
to accommodate this change with very limited support and training
from other agencies with regard to the specific needs of these
children.
Occupational therapy referral rates have continued
to rise in response to successive SEN legislation since the 1981
Education Act but with no specific increase in resources. Health
authorities have been obliged to provide only `within available
resources' with the result that many children are `included' in
mainstream schools but are not fully able to reach their potential
within such educational settings. The higher profile of special
needs in mainstream schools has been matched with teachers' growing
awareness of additional needs among existing pupils. This has
led to steadily increasing referral rates with children waiting
excessively long times for assessment and intervention—particularly
those with developmental coordination disorder, including dyspraxia.
(This condition can seriously affect many aspects of learning—from
PE to handwriting, organisational skills and social interaction,
with consequent effects on self-esteem). As Al Aynsley-Green,
(now Children's Commissioner), has said `to wait a year is an
outrage for a child: it devastates the child and child's family
and may seriously compromise the long-term outcome'. Yet children's
occupational therapy waits across England are typically two years.[52]
The importance of therapy services in supporting
early intervention is stated in the SEN Strategy, (Removing
Barriers to Achievement, DfES 2004). OT services have tended
to focus scarce resources on preventive approaches in early years.
Intervention for pupils at secondary school and in transition
planning for moving on to further education and employment is
rarely available.
Although some local examples of service level
agreements exist, local education authorities have tended to overlook
existing expertise where it resides in another agency and have
failed to explore opportunities for joint funding to support pupils
or negotiate effective partnership arrangements. Although further
devolvement of budgets may encourage schools to take earlier action
thus minimising later costs, this may make it even harder to negotiate
funding to provide equitable multi-agency support.
2.2 Many OT services already offer a largely
consultative approach following assessment—providing training
to parents, carers and school staff (and also exploring workforce
re-design to incorporate more junior and therapy assistant posts).
However, therapists already operate within a broad skill-mix context—training
and monitoring the work of many learning support assistants employed
by schools. There is a danger of specialist expertise being spread
too thinly to ensure effective outcomes for children.
Nevertheless, OTs would wish to continue exploring
the opportunities for extended schools to deliver more accessible
and responsive local services.
2.3 A more efficient, cost-effective system
to supply special equipment for school/home use (seating, self-care,
IT access etc.) has been specified in Integrated Community Equipment
Service (ICES) policies but progress across the country has been
variable with schools, families and therapists still dealing with
a complexity of funding and provision.
2.4 School staff have taken on a big, new
agenda in providing for special educational needs and NAPOT would
like to commend the high levels of commitment and motivation which
OTs working in schools often experience. However, teachers are
under considerable pressure. Training in the needs of children
with a wide range of developmental and medical conditions (including
pre-registration teacher training) is minimal and little time
is available to differentiate materials, attend review meetings
or work with the child and visiting professionals. NAPOT recommends
more involvement of health professionals in training and supporting
teachers and other school staff. Such good practice does exist
but it is patchy and inconsistent.
The learning support assistant may become the
local `expert' and while this may be appropriate with regard to
the child's self-care and day to day management, it can be less
so when devising programmes for accessing the academic curriculum.Visiting
professionals also need to be able to work with the teacher.
Behavioural needs pose additional challenges
in the classroom for which sufficient resources are often lacking
and more consistent multi-agency support would help deliver better
quality inclusion (a need recognised in the 2002 Ofsted report
Towards Inclusive Schools).
The 2002 Audit Commission report `Special Educational
Needs—a mainstream issue' recommended that SEN should be
given higher priority and clear expectations of inter-agency support
established. This is reinforced in the National Service Framework
for Children, Young People and Maternity Services, 2004 which
states that local therapy services should be reviewed to ensure
`timely supply'.
2.5 The most effective school SEN systems
are characterised by well-defined SENCo roles (with sufficient
allocated time), close links with visiting professionals and transparent
SEN budget arrangements which can be used flexibly to provide
timely support. In some schools, workforce re-modelling has reduced
allocation as SENCos have been re-deployed to manage classes.
2.6 A range of additional support services
is required to meet children's needs. There would be value in
a detailed review of levels of actual need and of the specific
contribution of specialist services to meet those needs. Understandably,
parents are particularly aware of and concerned, for example,
about speech and communication. What may be less obvious is the
need to develop underlying postural, sensory or perceptual abilities
as the foundation on which cognitive skills can develop more efficiently.
In such cases, joint therapy programmes can work effectively and
a balance of therapy provision is therefore important but rarely
planned from this perspective.
Protocols for joint working (therapy and schools)
do exist (eg in Hampshire) and could form the basis for more widely
available guidance.
2.6 Evidence of need is now available: the
Audit Commission report (2002) noted OT as the second most common
shortage area in health and social services provision for school
support.
2.7 Special schools often provide good opportunities
for developing `life skills and independence'—a vital part
of education for disabled pupils. Flexible ways of addressing
these needs within the mainstream curriculum(adjusted timetable,
after-school activities etc.) are required.
The current debate about mainstream and special schools
risks overlooking the fact that fair comparisons can only be made
where inclusion is properly resourced. Many children are `included'
in mainstream school but not able to fully participate in the
curriculum due to lack of specialist support.
3. Provision for SEN pupils in special schools
Special schools are a valuable resource where
high staff ratios, specialist expertise and small classes provide
suitable environments for children with complex special needs.
Special schools are now encouraged to become
an outreach resource; some retain high levels of expertise and
access to such specialist support can be very helpful. However,
current policy has contributed to a shift towards greater innovation
sometimes taking place in mainstream settings.
Special schools require as much recognition,
training and support as other settings. A range of provision (such
as units within mainstream schools) can help maximise inclusion
opportunities.
In the past, occupational therapists have often
been attached to special schools; services now need to be spread
across the full range of schools with the result that special
schools sometimes receive less support and only more urgent needs
(such as assessment for self-care and equipment) can be met.
4. Raising standards of achievement for SEN
pupils
The emphasis on individualised approaches in
current Government guidance (SEN Strategy; `Higher Standards,
Better Schools', 2005) is particularly helpful for children with
SEN. The degree to which the curriculum sometimes needs to be
differentiated while maintaining a child's sense of inclusion
and self-esteem remains a considerable challenge in mainstream
settings.
The recognition now given to `P' scales reflects
more positive, realistic assessment which can demonstrate different
rates of progress and it would help to include them in statutory
reporting. Ways of also recognising broader learning achievements
(self-care, social skills and independence) are also required.
Reviewing ways of incorporating therapy goals into IEPs would
be helpful.
5. The `statementing process'
Statementing has proved to be a fairly slow,
centralised process which focuses some resources on administrative
systems rather than direct support. Decisions on additional resource
allocation are made by those with little direct experience of
the child and there is rarely additional consultation with the
team who knows the child well. It is therefore hard for informed,
consistent and equitable decisions to be made.
There is a significant group of children with
additional needs which may severely affect their learning but
for whom it is difficult to obtain statements- and more importantly,
the amount of help needed—they can be seriously disadvantaged.
One benefit of a statement is the statutory
annual review; it is harder to sustain a regular multidisciplinary
review system for children without statements.
For those children who do qualify, the
current process does provide a ring-fenced resource. If there
were to be further devolvement to individual schools, a guarantee
of protection for the budget and some way of achieving better
team concensus in allocating resources would be essential.
In particular, some mechanism is required whereby
both health and local authorities are required to plan strategically
and jointly provide resources needed to support children with
special needs—essential to provide the `timely' response
specified in the NSF (Standard 8 Disabled Children and Young People
and those with Complex Health Needs).
6. The role of parents in decisions about
their child's education
NAPOT sees the active involvement of children
and young people as well as their parents in decisions about their
learning as essential.
Assumptions are easily made about particular
types of school and it is important that parents and children
are given every opportunity to make fully informed choices as
to what may best suit their needs. This may require detailed discussion
with the team of people who know the child well.
Therapists work with children at home as well
as school and need to ensure therapy continues to be delivered
in the most appropriate setting, helping parents support the child's
`full learning experience' (NSF). (This is particularly important
for children who may not be accessing formal education because
of eg school refusal or hospital stays).
7. How special educational needs are defined
As multi-agency working develops, a greater
range of specialist terms are being used more widely. While jargon
is to be avoided, specific terms do need to be used in order to
ensure accuracy and an updated classification would be useful
(together with translation of commonly used acronyms). This would
be helpful to parents as well as professionals.
However, while definitions of SEN should be
informed by factors such as medical diagnosis, they also need
to more accurately reflect the impact on the child's abilities
and learning. Such clarification could result in support being
more available to children whose needs have been previously overlooked.
8. Provision for different types and levels
of SEN, including emotional, behavioural and social difficulties
Children with disabilities are more vulnerable
to emotional pressures and lower self-esteem.
LEAs and schools are often unaware of the full
range of professional support on which they could draw. For example,
at registration, OTs are trained to work equally with mental health
and physical needs. While they could usefully join Behavioural
Support Teams, OTs may already be working in a school and could
support teachers (at Child and Adolescent Mental Health Service
Tiers 1/2). OTs specialising in more complex psychological conditions
could support teachers dealing with complex needs (but in spite
of additional funding, most teams still lack the OTs specified
in the NSF as part of a comprehensive CAMHS').
The needs of `looked after' children who may
have had disrupted social support systems are at particular risk
and NAPOT welcomes efforts to provide specific teaching liaison
and multi-agency support.
9. The legislative framework for SEN provision
and the effects of SENDA
The Act has been welcome in extending rights
to equal opportunities in educational settings; more clarity on
how specific services in agencies such as health can help deliver
better access to learning would be useful. This is a particularly
relevant to adapting the physical environment. (Unlike England,
Scottish guidance specifically recommends the involvement of occupational
therapists with this expertise). Good practice does exist—where
OTs are funded by LEAs work alongside architects and access officers
to adapt buildings, developing appropriate and cost-effective
solutions to suit children with a range of disabilities—but
this is rare. As schools are able employ architects and builders
directly (who may not have extensive experience of children's
needs), the requirement for access to the right specialist advice
becomes even more crucial.
November 2005
52 National Association of Paediatric Occupational
Therapists, College of Occupational Therapists (2003) Doubly Disadvantaged:
Report of a Survey on Waiting Lists and Waiting Times for Occupational
Therapy Services for Children with Developmental Coordination
Disorder. Back
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