Making EHC plans more effective for CYP with sensory impairments Lilias Reary, Andrea Scrivens 25 February (London) and 8 March (York) 2016 Outline for the Day 10.00-10.10: 10.10-10.50: Welcome and introduction The Analysis of 40 EHC plans Short Break 11.00-12.00: Sections A and B of the EHC plan Lunch 12.45-13.50: Health and Social Care input Short Break 14.00-15.00: Section E - Outcomes Break 15.10 -15.45: Section F – Provision 15.45-16.00: Plenary and Questions Learning Aims for the Day • Know the required sections of an EHC plan and any flexibilities permitted • Know the ‘information to include’ for each section in an EHC plan • Know how to improve those sections involving Health and Social Care • Feel more confident about producing and ensuring more effective EHC plans for children and young people with sensory impairments in order to improve their outcomes Session One The Analysis of 40 EHC plans Why? • To identify emerging trends (both positive and not so positive) from EHC plans for CYP with SI from across England • To use this information to support NatSIP in its objective to support professionals in writing ever more effective EHC plans by: - identifying training needs; - providing additional resources and tools - producing practical guidance Information on the EHC plan review The Sample • 40 EHC plans for CYP with SI from at least 32 different LAs across England • The CYP ranged in age from early years to 17 years Method • A tick sheet based on the information to be included in an EHC plan (SEND COP sect 9.62 ) was used for quantitative information. • Individual sections of each plan were then read to assess the qualitative information Task – ‘Room for improvement’ From your experience of EHC plans: Which aspects of the plans do you think might have shown ‘room for improvement’? What did we find? The positives Most LAs had made a conscious effort to: • Make the plan look more attractive and accessible • Access the views aspirations of children, young people and their parents / carers • Reduce the use of jargon in the plan itself • Describe the SEN and identify outcomes There were aspects in some plans that are worthy of sharing as ‘good practice.’ What did we find? • • • • • • ‘Room for Improvement’ Headlines The easy part – format of the plan - was not easy! The Health and Social Care sections seemed to cause the most difficulty Out of the 40 EHC plans, there were no examples of a personal budget being used in Education. SMART outcomes not easy to formulate Rigorous assessment not always reflected in the description of the CYP’s SEN Provision confused with classroom management strategies and outcomes What did we find? Format of a plan SEND COP para 9.62 states: The format of a plan will be agreed locally…….. However, as a statutory minimum (they) must include the following sections, which must be separately labelled…. using the letters A-K…’ The permitted ‘flexibilities’ SEN COP, para 9.62 continues: ….The sections do not have to be in the order below (alphabetical) and LAs may use an action plan in tabular format to include different sections….as long as sections are separately labelled.’ Format of the plan – the findings Almost 40% did not fully meet the required (‘statutory minimum’) specifications, due to: • Missing out complete sections • Using the letters required by COP, but ‘content to be included’ did not match up • Using own unique format, but still using the title – EHC plan • Putting several sections together, but not labelling the different elements • Using old terminology (Parts 1-5) and calling it an EHC plan Format of the plan – comment The above findings were totally unexpected, but easily corrected……………. Our suggestions 1. Do not delete any sections 2. Do a quick simple check using the ‘The first quick check’ followed by the ‘Statutory Minimum Checklist.’ ‘The first quick check’ 1. Are there 12 clearly defined sections? Y/N 2. Are the letters A –K used (including H1 and H2) to denote each section? (Note – do not need to be in alphabetical order) Y/N 3. Are some sections joined together and / or in tabular format? Y/N If yes, are the different sections within the section clearly labelled? Y/N 4. Does the letter of the section heading match the content title in para 9.62? Y/N (See ‘Statutory Minimum Checklist’ below) Task (Content of EHC plan) 1. Use the 2 checklists to evaluate your LA EHC plan (or the EHC plan provided) to ensure all the required sections are present. 2. Note any changes that need to be made to your LA’s EHC plan or, if you do not have a plan with you, make a note to check your plans when you get back ‘Statutory Minimum’ Checklist A B Views, interests and aspirations of the child and their parents, or of the young person CYP’s special educational needs C CYP’s health needs related to their SEN D CYP’s social care needs related to their SEN or to a disability Outcomes sought for the CYP E F Special educational provision required by CYP ‘Statutory Minimum’ Checklist cont’d G I Any health provision required by the learning difficulties or disabilities which result in CYP having SEN Social care provision to be made for CYP under 18, as a result of CSDPA (1970) Any other social care provision resulting from learning difficulties or disabilities Placement J Personal Budget K List of advice and information and appendices H1 H2 How the sections of an EHC plan are related H1 and H2 Social Care Provision J. Personal budget D. Social Care Needs F. SEN Provision G. Health Provision (Where the SEN provision will be made) C. Health Needs E. Outcomes B. SEN I. Placement A. Aspirations Underpinned by rigorous and detailed assessment Think about the ‘Golden Thread’ throughout (From DfE) There should be a golden thread directly from the aspirations to the provision - this is achieved by thinking about outcomes as steps on the journey towards the aspirations. Aspirations Needs Outcomes Provision A good Education Health and Care (EHC) plan… • Meets the requirements of the Act, regs and the Code. • Describes positively what children and YP can do • Clear, concise, understandable and accessible • Is co-produced • Sets good, relevant outcomes • Tells the child or young person’s story well/ coherently (From DfE) Session Two Closer examination of Section A and Section B Section A. Views, interests and aspirations of the CYP and his/ her Parents or the YP ‘Information to include’ (SEND COP, para 9.69) • Details about the child (and his /her parents) or young person’s aspirations and goals for the future • Details about play, health, schooling, independence, friendships, further education and future plans (inc. employment if practical) • Summary of how to communicate with CYP Section A. ‘Information to include’ cont’d • The CYP’s history • If written in the first person, plan should make it clear if the child is being quoted directly or if the views of parents / professionals are being represented. Section A. General Findings (Largely administrative) • Section A had more subsections (‘information to include’) missing than any other section • Very variable in length from one side of A4 to 6 pages • Very difficult to access the information as only a few plans had clearly marked subsections Section A. Specific Findings (Areas to check in your plans) • Missing out the child’s views etc. due to their young age or capacity to express them • Confusing aspirations with provision – ‘I want my child to go to a specific visual unit’ • Failing to include: - the CYP’s preferred method of communication - the CYP’s history and details about schooling, etc - when written in first person, whether views coming directly from CYP or an adult’s interpretation Suggestions for improving Section A • Write to the required content and use sub headings • Use bullet points so that information is presented in a succinct way • Use a single page summary to introduce the child / YP was used by several LAs and seemed a good way to introduce a child at the beginning of Section A (not required by SEN COP) • Include a short section on strengths and challenges (not required by SEND COP) Hello! My name is Kirsty Suggestions for improving Section A cont’d • Improve the quality of the parental input by: asking parents not just to focus on wants but also on aspirations asking them to think about these aspirations in the short, medium and long term requiring the different professionals to ask these questions in order to get more detail (Reference NatSIP document ‘Better Assessment..’) Suggestions for improving Section A cont’d • Improve further the quality of the CYP voice / input by considering: - the efficacy of the identification of these views through the use and reporting of questionnaires • Increase the number of children having their views recorded by: - ensuring there are no assumptions being made about children being too young - using a range of techniques to elicit views Task (Section A) • Look at the EHC plan from your LA and check if all the ‘information to be included’ in this section is present and note any omissions • Check the quality of the information and note any actions to be taken Section B – The CYP’s special educational needs. ‘Information to include…’ • All of the child or young person’s identified needs must be specified. • SEN may include needs for health and social care provision that are treated as special educational provision because they educate or train a young person (SEN COP, para 9.73) (Note paras 9.74 – 9.76. Decisions about where to include health and social care needs / provision: • must be made on an individual basis • should be agreed between LA and health and social care partners) Section B. The findings • 39 of the 40 plans (98%) appeared to identify a range of special needs but there was: - large variation in length of this section from half a page (or less!) to multiple pages - large variation in the amount of detail from use of very general phrases (‘issues with anger management,’ ‘sensory processing developmental difficulties’) to very detailed information citing assessments Section B. The findings cont’d • Only 10 plans (25%) made explicit reference to health and social care needs; however, the need for therapy (particularly speech and language) input seemed to be implicit in many more plans • Only 50% plans were consistent in quoting specific assessment results (although this is not asked for by the SEN COP) which then provided a clear baseline for future monitoring Suggestions for improving Section B • This is a crucial section as it should provide the information on which the rest of the plan is based • The information should be based on strong evidence / assessment and describe all the SEN needs in sufficient detail to ensure: - the formation of clear outcomes - the identification of required provision - effective monitoring and review • Need to drill down from the general need The importance of assessment ‘A focus on the quality of assessment will improve the quality of outcomes’. Ofsted 2010: A statement is not enough Remember this? Have you used it? Task (Section B) • Read Section B of the ‘Bad’ plan and identify ways in which it can be improved. • How does Section B of your LA EHC plan measure up? Session Three Health and Social Care (Closer examination of • Sections C and G • Sections D, H1 & H2) Section C. The child or young person’s health needs which relate to their SEN Information to include: • The plan must specify any health needs related to the child’s SEN • The Clinical Commissioning Group may also choose to specify other health care needs which are not related to the CYP’s SEN Section C. The Findings • Just under half the plans (48%) specified any health needs related to SEN • Often these ‘needs’ were recorded as provision (e.g. needs regular vision tests) • Input did not always give the impression it had been contributed directly by health professionals (e.g. ‘known information’) • Only 12 plans (30%) included health needs not related to SEN, but often only the condition given (e.g. diabetes) Section C. Suggestions for improvement • Check how health professionals are currently involved in the EHC plan assessment process in your LA • If you find that provision (as opposed to needs) is being recorded in this section, it is helpful to ask: - why is this provision necessary and what effect might this have on the child or young person’s education? The answer should indicate the needs • A similar exercise can be used if just a condition is given – what are the implications of this for the CYP in the educational setting? Section G. Health provision required by the learning difficulties / disability which result in the CYP having SEN The Findings • Only 15 plans (37%) had completed this section • Only 2 of these 15 plans met the requirements of being detailed, specific and quantified (but it is a ‘should’ rather than ‘must’) • Content was very general with phrases such as ‘therapy as normally commissioned’ and ‘as deemed by the health authority’ often used. • No plan related the provision to outcomes as requ’d Section G (Health provision). The Findings cont’d • Only 7 plans exercised the option to include specialist support and therapies, e.g. medical treatments, OT, physio, specialist equipment (wheelchairs, continence pads etc.) • 6 of the above plans included speech and language therapy and this seems questionable • Only 4 plans chose to specify health care not related to the learning difficulties/disabilities Section G. Suggestions for improvement • This is the section in which to record provision, but it should be specific, detailed, quantified and related to an outcome/s. • Should never state ‘as described in Section C’! • Could consider putting it into a table to show the outcome that is being supported Provision As Julie’s hearing levels are unstable, the audiology service will carry out a review (to include hearing tests, tests of middle ear function and hearing aid function using real ear measurement) every 3 months Outcome Outcome A. Section G. Suggestions for improvement cont’d. • Be aware of the relevant legislation around considering and agreeing health provision: - Joint commissioning arrangements must include arrangements for securing EHC needs assessment; securing EHC provision and agreeing personal budgets (Section 26 Children & Families Act 2014) - The EHC plan to include any ‘health care provision reasonably required by the learning difficulties or disabilities’ (Section 37 Children and Families Act 2014) Section G. Suggestions for improvement cont’d - Reg 12 of the SEND Regulations 2014 states that when preparing an EHC plan, a local authority must: set out ‘any health provision reasonably required…..’ while ‘the health care provision specified in the plan must be agreed by the responsible commissioning body.’ • The SEND COP 2014 (paras 9.70, 9.71,9.141): - each CCG will determine the services it will commission to meet the reasonable health needs of CYP with SEND - relevant local clinicians will participate in the CYP’s plan Section G (Health). SEND COP cont’d - CCG must ensure oversight to provide assurance that the needs of children with SEN are being met - health care provision specified in Section G of EHC plan must be agreed by the CCG - any health provision should be included in the draft EHC plan sent to child’s parents or young person - partners must have clear disagreement resolution procedures - CCG must ensure any specified health provision in EHC plan is delivered to CYP. Task (Sections C and G) • Check sections C and G in the EHC plan from your LA or in the ‘bad’ plan • Identify any improvements required Health and Social care Social Care Section D. The child or young person’s social care needs which relate to their SEN Information to include: • The EHC plan must specify any social care needs which relate to the child or young person’s SEN or which require provision for a CYP under 18 under section 2 of the CSDPA 1970 • The LA may also choose to specify other needs not linked to the SEN or disability (Must have consent of parents) Section D. The Findings • This section was sometimes removed completely from the plan; left blank or a response was given such as ‘not known to social care’ or ‘no details available’/ ‘no details given’ • Only 5 (12.5%) plans had completed this section • An additional 4 plans indicated that the CYP had been referred for / or was undergoing an assessment • One family had been asked to contact social care for advice Section D. The Findings cont’d • 5 plans seemed to confuse fairly basic social skills needs (met by the school) with needs requiring social care intervention • No plans included other social care needs not linked to SEND, e.g. from child in need assessment, early help assessment or child protection plan. Section D. Suggestions for improvement • Find out how your LA currently gets information from social care for EHC plan assessments • Consider the CYP’s potential social care needs in relation to: - developing independence - participating fully in family life and activities in the community - developing socially and emotionally Sections H1 and H2. Social care provision Why 2 sections? • H1 is for any social care provision which must be made for a child / young person under 18 resulting from section 2 of the Chronically Sick and Disabled Persons Act (CSDPA) 1970 • H2 is for provision not covered by the CSDPA for under eighteen year olds and…. for those who are 18 and over provided for under the Care Act 2014 Section H1. Social care provision Information to include: • Provision should be detailed, specific and normally quantified (type of support and provider), noting if a social care direct payment • Should be clear how the provision will help achieve the outcome • Must specify all services assessed as needed under S2 of the CSDPA Section H2. Social care provision. Information to include: • Social care provision identified through early help and children in need assessments and safeguarding assessments (must only include services not provided under section 2 of the CSDPA). Can include parent carers assessments. • Any adult social care provision required by those over 18 and set out in an adult care and support plan (Not applicable to any plan in the Review) • May include provision not linked to CYP’s SEND Sections H1 & H2. The Findings • Most plans left these sections blank/deleted them. • At least 3 CYP seemed to have need of social care provision (2 MSI and 1 registered blind) but none was specified in either H1 or H2. • One child had short breaks specified under needs (Section D) but not specified in provision sections. • Only 3 plans (out of 5) attempted to complete section H1 with information about provision but it given in very broad terms, e.g. ‘long term support from CDT;’ ‘short term breaks’ and ‘as agreed by the social care team.’ Sections H1 & H2. The Findings cont’d • No plan linked the provision to outcomes • Due to lack of detail, it was impossible to tell if all the services being provided were specified. • One plan stated ‘open case but no details given’ (this was written in both H1 and H2) • Only one plan completed H2 by correctly recording residential short breaks • 5 plans stated assessment underway or being requested – acceptable practice? • No plan included provision unrelated to CYP’s SEND Sections H1 & H2. Suggestions for improvement. • Know how social care professionals are involved in the EHC plan assessment process in your LA • Be aware of the range of services provided under CSDPA which the LA has a duty to provide if an assessment shows eligibility criteria are met. These services include: practical assistance in the home; adaptations in the home (alerting devices); assistance to attend recreational activities outside the home; telephone (including specialist equipment to use it) etc. Sections H1 & H2. Suggestions for improvement cont’d • Consider presenting the information to be included in tabular format: Provision Outcome/s Provider supported Long term loan of the Enables Jan Children’s following assistive to be more Social technology – TV loop independent. Care and flashing doorbell (Outcome 2) Training for their use. OT Sections H1 & H2. Suggestions for improvement cont’d • Be aware of the relevant legislation around social care and the EHC plan needs assessment: - SEND Regs 2014, sec 4(2) states that the LA, must notify ‘officers of the LA responsible for exercising the social care functions for children with SEND’ when considering an EHC assessment - SEND Regs 2014, sec 6(1)(e) states the LA must seek advice and information in relation to social care regarding any needs or provision for the CYP Sections H1 & H2. Suggestions for improvement cont’d - SEND Regs. Sec 8 ‘Duty to co-operate.’ Social care must comply with the request from the LA within 6 weeks • The SEND COP (paras. 9.46, 9.47,9.49,9.52,9.176) - LA must gather advice from relevant professionals about the CYP’s education, health and care needs, desired outcomes and any appropriate provision - LA should consider with the child’s parent or YP and those listed in para 9.49, the range of advice required Sections H1 & H2. Suggestions for improvement cont’d - In some cases, a CYP may already have a statutory child in need or child protection plan, or an adult social care plan and so the local authority can include the social care provision resulting from these assessments in the CYP’s EHC plan - Reviews: ‘……and a local authority social care representative must be invited.’ (SEND COP 9.76) Task (Section D, H1, and H2) Look at sections D, H1 and H2 in your EHC plans? Are there improvements you could make? or Evaluate and improve on those sections in the ‘bad’ EHC plan Session Four All about Outcomes and a bit more!! (A closer examination of Section E) Section E. The outcomes sought for the child or young person Information to include: • A range of outcomes over varying timescales covering education, health* and social care* • SMART outcomes with a clear distinction between outcomes and provision • Steps towards achieving outcomes • Arrangements for monitoring progress, including review and transition arrangements Section E. The outcomes sought for the child or young person Information to include cont’d • Arrangements for setting and monitoring shorter term targets by the early years provider, school, college or other education or training provider • Forward plans for key changes in CYP’s life • For CYP preparing for transition to adulthood, outcomes that will prepare them well for adulthood and clearly linked to the achievement of aspirations in Sec A. Section E. The outcomes sought for the child or young person. The Findings • Most plans came up with a range of outcomes (though some used different terminology such as goals) • 22 plans (55%) had varying timescales • Not one plan had consistent SMART outcomes 13 plans did not provide any timescales while others lacked specificity and / measurability • Most plans (78%) seemed to omit steps towards achieving outcomes Section E. The outcomes sought for the child or young person. The Findings cont’d • Arrangements for monitoring progress etc. were only recorded in this section in 10 plans (25%). Most frequently found in a separate section towards the end of the plan. • Arrangements for setting shorter term targets in the educational setting were overlooked by most (present in only 22%) • Forward plans for key changes were signposted in 7 plans – generally few details given. Section E. (Outcomes). Suggestions for improvement • The ‘quick wins’- ensure that the following are recorded in Section E: - arrangements for monitoring progress, reviews - forward plans for key changes in a CYP’s life • Outcomes are important….. ‘Outcomes underpin and inform the detail of EHC plans. (SEND COP, para 9.68) • The word ‘outcomes’ appears 249 times in the SEND COP (2015)!! ……and can / should be improved in many cases!! Section E. (Outcomes). Suggestions for improvement - focus on outcomes • Need SMART outcomes – many were very general, more like aspirations. The two are different, but there is a relationship between the two of them. • Aspiration: something which it is hoped will happen further into the future (longer term)e.g. employment or further study plans, or the degree of independence hoped for in adulthood…’ Recorded in Section A • Outcome: something which contributes towards the aspiration but can be measured and is expected to be achieved within the medium term, e.g. by the end of the key stage. Recorded in Section E. Section E. Suggestions for improvement cont’d. Focus on outcomes. • Writing ‘good’ outcomes: Know what is important to the CYP and what they want to achieve (Section A - Aspirations) + Know what parents and others think is important for CYP and what is in their best interests (Section A. Aspirations) + The results of assessments and professional information (indicating gaps/potential barriers). (Sections B,C,D. Needs) = OUTCOME Writing a ‘good’ outcome- example • Becky in Y1 is ‘a bit sad’ (her words) as she wants to have friends and be able to play with them. + • Becky’s parents want her to be happy and have friends and learn at school + • School staff note she is withdrawn and alone at breaks. SALT reports indicate expressive and receptive language at 5th and 10th percentile. Section E. (Outcomes). Suggestions for improvement cont’d. Focus on outcomes. A SMART outcome might be along the lines: By the end of Year 3, Becky’s speech language and communication skills will be at, or close to, the levels expected for a child of her age and ability so that she will be able to chat with other children and join in games with them. Section E. Suggestions for improvement cont’d. Focus on outcomes Checking for a ‘good’ outcome • Is it helping the CYP to achieve / move towards achieving an identified aspiration? • Is it person centred (i.e. not service centred)? • Is it challenging with high expectations? • Is it SMART? • Is it clear what benefit the difference or benefit will be for the pupil? Section E. Suggestions for improvement cont’d. Focus on outcomes The acid test for outcomes: How easily will you be able to tell if the outcome has been achieved? A possible outcome format: By (give a timescale, end of phase/stage/year), s/he will be (state achievement) so that he/she can (state what she / he will be able to do). Section E. Suggestions for Improvement cont’d. Focus on outcomes Beware the ‘woolly’ outcome!! • She will be more independent X • He will develop fine motor skills X • She will improve her literacy and numeracy skills X Task (Section E) Outcomes. 1. Look at the examples in the first list on the sheet and identify the ‘good’ outcomes 2. Add information to the second list of outcomes to make them SMART 3. How do the outcomes on your EHC plan measure up? Section E. Suggestions for Improvement cont’d. Also include in Section E: 1. Steps towards meeting the outcomes - these will be shorter term and possibly for around a year (e.g. By the end of Y2, Becky will be able to say clearly 60% of the speech sounds for her age group; her vocabulary will have increased by a year; she will use simple sentences) Section E. Suggestions for Improvement cont’d. Also include in Section E: 2. The arrangements for monitoring progress, including review and transition review arrangements and the arrangements for setting and monitoring shorter term targets by the early years provider, school, college or other education or training provider. Session Five A closer look at Section F (Special educational provision) Section F. The special educational provision required by the CYP. Information to include: • Provision must be detailed and specific and normally quantified • Provision must be specified for every need in Section B • Should be clear how provision supports achievement of outcomes • Health and social care provision must be in this section if it educates or trains Section F. The special educational provision required by the CYP cont’d. Information to include cont’d • The plan should specify any appropriate facilities, equipment, staffing and curriculum any modifications to the National Curriculum any exclusions from the NC or course in post 16 setting and the proposed substitute where residential accommodation is appropriate if there is a Personal Budget, the outcomes to which it is contributing. Section F. The special educational provision required by the CYP. The Findings • Surprised to find that over 80% of the plans still describing some, or all of the provision in woolly terms – ‘would benefit from…;’ ‘access to a teacher of VI;’ ‘speech and language as required/ as provided by health;’ ‘MSI provision to be specified by service.’ • Some plans included lists of classroom strategies (‘make sure you do not cover your face when speaking.’) Section F. The special educational provision required by the CYP. The Findings • Most plans (70%) made some attempt to show how the provision was supporting the achievement of particular outcomes • 19 (48%) plans specified some health provision in this section (usually speech and language therapy) • No plans listed social care provision • No plans allocated personal budgets for educational provision. Section F. The special educational provision. Suggestions for improvement • Make sure that the provision is detailed, specific and quantified: How long is a session? How often is it to be delivered? Which professional / qualifications required to deliver the session? Example. One Braille lesson (1 hour) per week from a qualified teacher of the Visually Impaired • Check that only provision and not classroom management strategies are included. Section F. The special educational provision. Suggestions for improvement cont’d • Linking provision to outcomes seemed to be most effective when in tabular format. We found the following helpful: A By the end of Y9, R’s speech, language and communication skills will be at a level expected for a pupil of his age and ability Section E Section F Steps towards meeting Special educational outcome provision Who will be responsible? A1 R’s spoken language Weekly 1:1 session (45 and voc. will show mins) SALT measurable year-year Daily prog of 20 mins CSW (level progress (’expected level’) 3BSL) Section F. The special educational provision. Suggestions for improvement cont’d • Although not required by the SEND COP, it can be helpful to summarise the educational provision required – again a table can be useful: Outcome Educational provision being funded Step A1, A2,C3 B1, B2 Qualified MSI teacher- weekly sessions of 2 hours Specialist Speech and Language Therapist – one session (45minutes) every two weeks, plus 1 x 2hour session every term for liaison with CT/CSW A3 Radio aid Remember this? Starting Assumption in 2014 An Education, Health and Care Plan should be as good as, if not better than, a statement. Making EHC plans more effective l Plenary Questions Reflections
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