Webinar on joint working and integration around SEND sharing the - - PowerPoint PPT Presentation

Webinar on joint working and integration around SEND – sharing the learning from CDC’s regional events

16th January 2019

• “Joint working for quality improvement and integration

around SEND: what we’ve learned” presented by the Council for Disabled Children

• "Doing it differently: The St Helens Neurodevelopmental

Pathway" presented by Garry Joyce, Julie Hoodless and Sara Dolan.

• "Therapies in School Projects, Bringing therapies into the

heart of schools" presented by Linnie Chapman and Sam Taylor. Agenda

Joint working for quality improvement and integration around SEND: what we’ve learned

• 9 events, 1 in each of the DfE Regions
• Focus on joint working and integration
• Updates from key partners – NNPCF, NHS England,

Transforming Care, Regional Networks

• 1-2 examples of new ways of working
• Discussion and action planning

CDC Regional workshops – what we did

• Engaging with reality – children and young people with SEND and

their families have complex lives; their needs cross traditional service boundaries

• CYP with SEND are also more likely to belong to other groups that need

support

• The policy context – the Children and Families Act and duties

around joint working

• The financial context – may seem to make joint working harder,

but integration has the potential to reduce pressures on families and professionals

Why we need a focus on joint working

A complex web of inter-relating and intersecting vulnerabilities

SEND 1,244,255 Young

• ffenders

sentenced 25,700 LAC 72,670

SEN support 45% 28% EHCPs

6% 52% * 57.3%

Learning disability 23-32% Dyslexia 43-57% Communi cation disorder 60-90% ADHD 12% ASD 15%

Young Offenders** 26%

Children needing support

SEND LAC CiN Poverty Alternative provision Young

• ffenders

Excluded Mental health needs Troubled families

Engaging with reality

Current figures for LAC, children with SEND and children in custody

• The number of pupils with special educational needs (SEN) was 1,244,255 in January 2017 (DfE, Special

Educational Needs in England, 2017)

• At 31 March 2017 there were 72,670 looked after Children (DfE, Children Looked After in England, 2017 )
• In 2016/17 25,700 children and young people received a sentence in court (Youth Justice Board/MoJ,

Youth Justice Statistics 2016/17) Intersection between vulnerabilities

• 57.3% of LAC have a SEN identified by the end of KS2 (DfE, Children Looked After in England, 2017)
• 52%* of young offenders asked for a 2014-15 study said they were or had been in care (Youth Justice

Board, Children in Custody 2014–15, 2015)

• 45% of young offenders sentenced in 2014 at the end of KS4 were recorded as having SEN without a

statement, and 28% as having SEN with a statement (DfE and MoJ, Understanding the educational background of young offenders, 2016)

• 26% of boys held in YOIs in 2014-15 who said they had been in local authority care also reported having a

disability (Youth Justice Board, Children in Custody 2014–15, 2015) *This is the percentage who said they were or had ever been in care. The official figures are much lower and

• nly represent children currently looked after.

**Prevalence rates of neurodevelopmental disorders among young people in custody (Howard League What is Justice? Working Papers 17/2015)

Context and sources

• Early intervention and the graduated approach
• Low intensity support, e.g. West Berks Emotional Health

Academy

• Starting in the early years, e.g. Northants Specialist SEND

Support Services

• Sharing resources and expertise locally
• Collaboration between specialist settings, e.g. Lincolnshire

Special Schools, to deliver support closer to home

• Building skills and knowledge in universal settings, e.g.

Therapies in Schools, Whole School SEND

What’s working well?

• Shared outcomes and strategy
• Hertfordshire Outcome Bees
• Bedford’s shared outcomes
• Meaningful co-production and participation
• Working with forums and families from the start e.g. St.

Helens ND pathway, Rotherham Charter

• Empowering young people’s groups e.g. Suffolk Young

Person’s Network

What’s working well?

Key challenges for 2019?

Links with youth justice system Inclusion (and exclusion) Identifying and supporting children and young people with autism only

The national picture: what’s coming up

• SEND Leadership Board
• NHS Long Term Plan
• Key worker role
• Expanded mental health services and support
• Information and training on LD and autism
• Integrated Care Provider Contract and ICS Accountability and

Performance Framework

• Changes to Ofsted framework and exclusions review
• SEND inspections and revisits ongoing
• Autism review and strategy to include children (Autumn 2019)

Opportunities for support

Support to local areas through the DBOT partnership

• Audit tool
• Regional events
• Local support
• DMO/DCO forum
• Children’s Commissioners Forum

Can you help us?

• Survey on joint commissioning arrangements:

https://www.surveymonkey.co.uk/r/27NWPXC

• Survey on autism pathways:

https://www.surveymonkey.co.uk/r/XW9HZMW

Visit our website: www.councilfordisabledchildren.org.uk Subscribe to our blog: councilfordisabledchildren.wordpress.com Find us on Facebook: www.facebook.com/councilfordisabledchildren Follow us on Twitter: @CDC_tweets

Contact details

St Helens Neurodevelopmental Pathway

Introductions

• Garry Joyce – Senior Integrated Children’s

Commissioning Manager

• Julie Hoodless - DCO
• Sara Dolan – Parent Carer Forum

SEND Inspection Letter Comments

Joint commissioning is a strength of the local area. The development of the neurodevelopmental pathway demonstrates the commitment of senior leaders and managers to work collaboratively. Arrangements for working together are strong, from senior managers through to frontline staff. Co-production with Listen4Change has been key to success in developing the neurodevelopmental

• pathways. The learning from this work is now

paying dividends with the development of the new local offer, occupational therapy (OT) services as well as improving EHC planning processes. The innovative neurodevelopmental pathway has transformed the accessibility, timeliness and coordination of specialist services for children, young people and their families. Parents and carers agree that referrals are dealt with efficiently and appropriately.

Families awaiting assessment as part of the neurodevelopmental pathway are able to access a range

• f training and support. This helps them better

understand their children’s conditions and associated

• behaviours. Parents told inspectors about the positive

impact of the range of training programmes offered. For example, some parents and carers reported that their child required no further support or help following the completion of these programmes. Children and young people who are looked after have their needs identified and assessed quickly. For example, those referred into the neurodevelopmental pathway are routinely prioritised for assessment by individual

• services. This means that they are assessed within six

weeks of referral so they receive the support and help they need quickly

The parent carer forum, ‘Listen4Change’, co-produced the neurodevelopmental pathway from its earliest consideration to its implementation.

Context

• Autism coordination established 2012/13
• Challenges from the beginning – long waits,

inconsistent service involvement, complaints

• Challenges from parents and local parent carer

forum

• Services re-designed 2014 – 2015 SLT and

Community Paediatrics

• Introduction of additional support services –

2015-16

• New NDP coordination function established 2017

Governance Arrangements

• Agreed establishment of

Multi-Agency stakeholder group was crucial

• Involvement of CAMHS

from start of pathway process for children with SEMH conditions

• Bi-monthly Meetings over 2

year period

• Within project plan, each

phase was approved by the stakeholder group

Multi –Agency Stakeholder Group

• Local Authority Assistant Director
• Education Psychology
• Specialist Teachers
• Behaviour Improvement Team
• SENCO
• Head Teacher
• Speech and Language Therapy
• Occupational therapy
• Community Paediatrics
• CAMHS
• Commissioners
• ADDvanced Solutions
• Parent Carer Forum
• Healthwatch

Parent Carer Forum View

• Background
• Identifying St Helens Issues
• Feedback to Parent Carer Forum

Members

• Now and the Future

Implementation Phase

• Coordination team delivered by North West

Boroughs NHS Foundation Trust established

• Coordination team consist of Clinical Lead,

Pathway Coordinator, Administrator

• Establishment of electronic database for Early

Years and School Age Pathways

• Focus on reducing backlog via additional

assessment panels and feedback sessions

• Investment in ADOS training, Hanen ‘More Than

Words’ training

• Documentation

Implementation Phase (cont)

• Transforming pathway from Autism to wider ND remit
• Introduction of weekly multi-agency triage sessions

involving pathway clinical lead, SLT, Specialist Nurse, OT and Consultant Psychiatrist (as required)

• Consideration of multiple potential diagnoses for Autism,

ADHD, General Development Delay, Attachment Difficulty, Developmental Language Disorder, Social Communication Disorder through a single, coordinated assessment process

• On-going Monthly panels for Early Years and School Age,

with increased capacity

• Feedback sessions to parents normally within a fortnight
• f the panel decision

How Does the Model Work

• Referral – triage
• Redirection to specific services eg. DLD
• Coordinated assessment
• Ongoing communication
• Ongoing support throughout pathway process
• Opportunity for ADOS, as required
• Annually planned monthly multi-agency panels

for Early Years and School Age

• Multiple diagnoses considered eg. Autism, ADHD,

GLD, DLD, Attachment, DCD etc.

• Prompt face-to-face feedback sessions

Pathway Oversight Group

• Smooth transition at launch from stakeholder

group to oversight group as per NICE guidance

• Ensure continual governance

Oversight Group Functions

• Current performance
• Issues arising and solutions
• Ongoing development of the pathway

What Have We Achieved

• Early identification of needs
• Early and ongoing access to support services
• A shorter journey for children with complex

needs from referral to diagnosis decision

• Current average waiting time from referral to

panel decision is 26 weeks

• Pathway discharge letters which confirm

diagnoses other that Autism eg. ADHD, General Development Delay, Attachment Disorder, Developmental Language Disorder, Social Communication Disorder.

Feedback from the latest Parent Carer Forum Meeting that was held on 1st November 2018

Therapies In Schools Project

BRINGING THERAPIES INTO THE HEART OF SCHOOLS

The TIS Story Why TIS……

• Losing Tribunals due to lack of therapeutic

input.

• Non maintained schools were able to sell

packages as all therapists in house. We need to compete in this world.

• Having to use private therapies to plug the

gaps.

• Private therapists did not have knowledge

about the school, its students or their

• parents. No continuity in care.
• NHS therapists felt like they were firefighting.

Lack the autonomy to choose and deliver a service they feel fits the child's needs.

• We were not meeting the needs of our

students or their families.

The TIS Family:

child

Parent or Carer SENCO Therapy Manager Champions Therapist/s NHS & TIS Teachers Supporting Staff

TIS Accredited Champion TIS Accredited Enhanced Employee TIS Mandatory Training for all staff within first 6 months of employmen t

Level 1 Level 1 Level 1 Level 2 Level 2 Level 3 Physical Support

Central and Peripharal Nervous System Biomechanics Use of orthotics Typical Development Atypical Development Respiratory System Application of Orthotics and Postural equipment Postural Management Referral for Interventions Observation

Sensory Processing

8 Sensory Systems Sensory Processing Regulation and Sensory Preferences Sensory Support Plans Sensory Friendly Environments Using Sensory Rooms Classroom Strategies and Regulation Programmes Making Sensory Support Plans Referral for Intervention Observation

Life Skills

Typical Development Occupational Performance and associated Skills Activity Analysis Strategies to Teach Life Skills Further Steps into Activity Analysis Goal Setting Further Strategies to Teach Life Skills Using Equipment to Aid Independence Referral for Intervetion Observation

TIS Modular Training

Accreditation Training For All

• All education staff across 3 schools have

Level 1 foundation training in all 3 streams during inset days. We have trained over 200 staff.

• Level 2 training will roll out on 23rd

November with 60 staff being trained.

• Is in the process of being granted

accreditation.

• All trainees are given a workbook to work

through throughout their training .

• All attendees were audited with evaluation

forms to assess how the training affected their confidence level.

Impact of training in schools

• Since the training staff have been observed

to be putting more strategies in place within the classrooms. E.g. sensory thermometers and life skill groups

• Decrease in the number of inappropriate

referrals to the NHS.

• Increase in class staff trouble shooting

independently and seeking their own solutions.

• An increase in understanding of the roles of

Occupational Therapists and Physiotherapists

• TIS therapists being able to spend time in

the classrooms and being part of staff team.

• Supported teaching staff to embed

therapeutic aims into the curriculum.

More TIS in Schools

• Water Skills Programme
• Posture passports for complex disability
• Sensory screening pilot
• TIS support the teachers to embed

therapeutic goals into the holistic curriculum

• Therapist led groups
• TIS surgeries
• Attendance at PATH, MDT, TAF and Annual

Review meetings

• Part of the school family – contribution to

newsletters and school social media

• Supporting schools with parents evenings and

parent tours

• Sensory circuits training.
• The Alert Programme.

Within Schools

Comments "Since the TIS project started the most significant thing for me personally has been having time to talk and work closely alongside the therapists, all of whom have been very approachable.....By sharing our school curriculum and way of working with the therapists we have been able to set targets together having a better understanding of where education and health approaches come from - passionate about our roles and being able to combine approaches will transform how we support our children moving forward." Teacher at Palatine

Supporting all carers and families

• Attendance at meetings (e.g. TAF, PATH, AR,

MDT)

• Available at coffee mornings and parent

evenings

• Home Visits (Non term time and home visits)
• Transition Document
• Collaborative goal setting with family
• Offer parents level 1 in all modules
• Assist in school to school transitions
• Flexible communication
• Linked in with the parent carer forum
• Supporting and liaising with external agencies
• Build confidence of parents in the schools

ability to competently meet their child's therapeutic needs.

Supporting all carers and families

Comments “I felt the training was extremely useful both as a parent and as a member of staff - it provided a huge insight into the types of difficulties the children can have from a physical and sensory point of view and how we can help them

• vercome some of their barriers. It has

been great putting some of it into practise with the children in the last few days! I would have loved the chance to learn about this a long time ago, especially with regard to physical development as it is so relevant to J. So I definitely think

• ther parents would benefit from the

training...” Parent at Palatine

TIS, NHS and schools working together

• TIS enables schools to prioritise

children for caseload

• If a child is on NHS caseload-TIS

compliment and support current plans

• Liaise directly with therapists for

unified outcomes

• TIS offers adhoc and flexible

support when we are available

• Capped but flexible caseload.
• Liaise and support social services

where needed.

Building the future with TIS

• Being able to deliver a service that is

flexible enough to meet the ever changing needs of the students.

• Parent confidence in local provision will

continue to build

• Supporting staff to continue to train and

TIS strategy becomes part of school culture

• Modular training becomes entrenched in

school mandatory training

• Unified working with NHS and external

agencies strengthens and develops

• Potential to roll out across the county
• Modular training could be ‘sold’ to

mainstream and other special schools so may become a source of revenue

• A long term goal of reduction in ‘out of

area’ placements and costly and lengthy tribunals may be negated.

Thank you for listening….

Questions ?

Thank you for joining this webinar !