Inclusive and Supportive Education Congress
International
Special Education Conference
Inclusion: Celebrating Diversity?
1st - 4th August 2005. Glasgow, Scotland
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Inclusive and Supportive Education Congress 1st - 4th August 2005. Glasgow, Scotland |
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Liz Flavell
North West Specialist Inclusive Learning Centre
Meanwood Site
Tongue Lane
Leeds LS6 4 QD
flavelde01@leedslearning.net
Grainger_J, and Flavell_L
Multi- Disciplinary Working Within An Inclusive System to Serve the Needs of the Individual
The work described within this paper, is that of two professionals who recognised that by combining expertise, they could optimise the very best practice when working with pupils with complex needs in an inclusive setting. As professionals we work in other schools and organisations within the city, but this paper is a focus on a small area of our work, both joint, individual and as team members, within the North West Specialist Inclusive Learning Centre (NWSILC)
The context in which we worked initially with a pupil called Leeann, whose story forms the central core of our study. It is very important in that it precedes but reflects the desired national picture since the Children Act came into being in 2004. It shows how good professional relationships, when working as part of a strong multi-agency team, can develop and be sustained that will then benefit all pupils including those with complex needs.
In January 2005, all the special schools in Leeds became wedge- based Specialist Inclusive Learning Centres (SILC’s), reflecting the shift in focus from full-time specialist provision to one which not only serves the needs of an ever decreasing number of pupils on specialist sites but also developing the new practices of serving those pupils with complex needs who access mainstream education. Leeds is divided into 5 wedges and 6 SILC’s. One generic area SILC also serves as a city- wide service for pupils with physical difficulties. Another serves the whole city and is for pupils who have behavioural, emotional and social difficulties.
The North West SILC, within which we work, comprises 3 sites that were special schools and is now one organisation. One of the sites is due for closure, another is out of town in a semi-rural setting and we have a central site. The SILC has its own issues with funding, an extending range of needs in the pupil group being served on its specialist sites and the need for staff to change their roles to accommodate the pupils on mainstream sites. These include turning teachers into trainers, co-teaching, team teaching and teacher as planner and manager with assistants as service deliverers. The range of challenges to be met and overcome is growing as the role of the SILC alters and evolves.
This SILC also has 3 partnership EarlyYears’ Centres (soon to become Children’s Centres), 5 partnership Primary schools (5-11 years) and 4 partnership High schools (11-16 years). Staff and pupils from the SILC work alongside their mainstream peers on the site of a partnership. A partnership school is one which has a contract with the SILC whereby pupils with complex needs on the roll of the SILC are educated full or part-time on the mainstream site alongside their peers. Staff from the SILC are also employed to work on partnership sites and share their expertise by working alongside subject and national curriculum specialists.
Base rooms in partnership settings provide an area for small group or individual working. These rooms also can be multi-functional where existing buildings are short of space, providing treatment space for all the therapists involved with the pupils with complex needs. Thus the co-operative ways of working are already built into the fabric of the partnership. However, rooms for therapists must be part of the initial planning in new or extending buildings. The benefits of the partnership school model mean that a small number of mainstream schools can be resourced for pupils who would previously have spent all their school life in a special school with little contact with mainstream peers. Similarly, the special school staff who have developed enormous amounts of expertise in providing for the pupils within their school can share that expertise with mainstream staff while also extending their own skills which will benefit all pupils by this shared way of working. Thus partnership working became a normal part of the work of some special school and mainstream staff.
Within the special school system partnerships were already formed between the staff who were employed by health and those in education, although these partnerships may be seen as location-led. Pupils, education staff with the expertise in working with them and health staff all in the same building provided a rich resource area for exploring ways in which committed professionals could serve a wider community together. As two dedicated and inclusion- driven workers in this sector, exploring attitudes to joint working was possible and other staff were very encouraging if from a distance at first.
When we started our journey towards a more joined- up way of working, it was on the basis that we perceived it to be the very best way we could find to serve our children. It relied on both professionals possessing the same ethos that maintains the child and family at the centre of our planning and then fitting our existing systems around it. This was not systems or directive led, but born from the desire to work together in a way that best served the needs of the child and family. Excellent communication between us enabled us to identify potential problems and update existing action planning instantly as required to maintain confidence. As we progressed, other strategies, personnel and opportunities came into being, reinforcing our beliefs that what we were doing could be replicated to benefit others in different settings.
The case study that follows is an individual one illustrating the way we worked together. Our work preceded the Children Bill with its ethos of co-operative working. The case is unique as are all cases in that we are working with a unique set of components including child, family, professionals, mindsets, previous experiences, resources, school services, health services. The work we did with Leeann will however, guide us through as we develop a sustainable and interwoven personalised service for all children, including those with complex needs. It identified that the respect we held for each other’s professionalism would override any of the previously perceived competitiveness or blame between services if things go wrong as Seamus Hegarty observed (2003). We were indeed finding a new way of working that not only suited us, but preceded the national picture.
Multi-agency working to meet the needs of any child with complex problems and include them in mainstream education is indeed a challenge for all professionals concerned. This challenge was embraced by a team of professionals and culminated in excellent examples of good working practice and is clearly illustrated by the following case study.
Leeann was a normal happy eleven year old on her way to her first day at high school (05/09/01). Little did she realise that this would be a day which would change her life and that of her family forever. Leeann was involved in a serious road traffic accident outside the school gates. She sustained severe brain injury, fractures and multiple injuries. Her condition was critical. Leeann spent several weeks in intensive care, followed by months in hospital.
Leeann started to attend, what was then, Penny Field Special School ten months after her accident. At this point, Leeann’s physical condition was poor. She presented with;
It was unclear what the future would hold, however it was very clear from the start that Leeann would require intensive multi-agency provision to maximise her potential and support her and her family through the difficult times ahead.
The special school environment allowed Leeann to have access to physiotherapy on a daily basis and to benefit from the expertise of the team of staff. Over the next few months Leeann improved in all areas and it was felt that to remain in such a specialist environment would now become a limiting factor to her progress.
The National Service Framework for Children, Young People and Maternity Services (NSF) (2004); sets out clear standards for promoting the health and well being of children and their families. In NSF Standard 8 it states, as its vision, that health, education and social care services should be organised around the needs of the child and that responsive, high quality, multi-agency interventions would maximise the child’s ability to reach their full potential.
In 2002 when Leeann started full time mainstream high school at City of Leeds High, we did not have the benefit of the vision from the NSF but devised our own methods of multi-agency work which have become a model of good practice and an established working example of what the new legislation describes.
If Leeann’s development physically, educationally and socially was to be continued then a diverse team of professionals would be required to meet her needs not only during transition but continued support during inclusion. The team consisted on parents, school representatives, teaching and non-teaching, physiotherapist, occupational therapist, speech and language therapists, individual case workers, educational psychologists and of course Leeann herself.
City of Leeds High School had no previous experience of children with such complex needs on their roll. However, they did offer a genuine ethos of inclusivity, a willingness to learn and a fully accessible building. Mackay and McQueen (1998) outlined an excellent model of shared professionalism where teachers and therapists must be prepared to become learners as well as specialists for the benefit of the child. This style of joint professional approach was used by our team. It allowed the education staff to fully appreciate the need for ongoing therapy for Leeann. The therapists were able to train and support the education staff whilst making their programmes flexible enough to fit around the curriculum.
Initial meetings took place, equipment was ordered, a phased transition in place. Then two key workers from the team, the physiotherapist and the inclusion manager, took on the job of training the school staff and monitoring Leeann as she settled in, as well as the school staff as they started to cope with their new roles. This was an enormous commitment for the foreseeable future, including their changes in roles, for the two professionals most closely involved.
Leeann has continued to make improvement over the last three years and has provided an ongoing challenge to her key workers to keep the training and programmes up to date in order to maximise her potential.
There was never any doubt that Leeann would benefit socially from her setting and she has made many new friends. Educationally, she has benefited from a well differentiated curriculum, which has enabled her to make good progress and even attend a course of linked college sessions with her peers. The biggest challenge of all was, could Leeann continue to receive the intensity of physiotherapy she needed in the mainstream setting?
Leeann has amazed her medical team from having poor control of her body and little functional use of her limbs she can now pull herself to standing with minimal help, is learning balance skills and it is hoped she may walk with appropriate aids. This progress has been due to her determination and intensive physiotherapy. There is no full time physiotherapist or specialist facilities at her new school, creative measures had to be devised to ensure that Leeann’s needs were fully met. Off site sessions of physiotherapy have allowed Leeann to benefit from hydrotherapy, rebound therapy and gait training on the SILC specialist site. She is accompanied by her non-teaching assistant who is able to see her progress, ask questions, get up to the minute advice and training from her physiotherapist on how best to assist Leeann in the school day and how therapy can be brought into the classroom e.g. in the form of good moving and handling and good positioning.
This model of best practice has been developed by a team of diverse and dedicated professionals, it is child centred and needs led. It had not only managed to successfully meet the challenges posed by including a child with complex needs into a mainstream setting, but has been able to respond to the many changes in those needs as Leeann has progressed thus maximising her potential.
As we developed closer working arrangements around Leeann, we came to value the input of others, including leaders, managers, therapists and teaching assistants. Carried by our belief that all children have the right to be educated together regardless of the complexity of their need, were the efforts of other workers who also became enthused both by our commitment and by their own observations on partnership school working. The goodwill in some cases was enormous, but it is amazing when trialling new ways of working, how many others come on board as they see the results of the joint labours on the children affected. This is not just limited to those directly within our immediate surroundings, but others who learn alongside and pick up on the attitudes from the positive adults. Thus the initial work of two people as key workers pulled in others affected by the inclusive work within their environment.
One of the greatest resources within the school environment is the teaching assistants. Fortunately, within workforce reforms, they now have a true career path and are an integral part of the team in future education for all pupils. In mainstream schools, assistants tend to work in a way that is complementary to teachers, on such initiatives as supplementary literacy work or by working directly with a pupil whose needs mean they require a supported approach to learning. Workforce reforms (2005) allowed more flexibility that meant the assistants could take part in continuing professional development and work with children in enhanced ways which were combining skills as directed by teachers or therapists while also trained to fulfil a number of roles that enable pupils with complex needs access mainstream educational settings.
Lack of training has often been highlighted as a stumbling block to the inclusion of children with complex needs (Grainger 2002). Who should be trained? What areas should the training focus on? Who should deliver the training? These were all questions that were addressed by a group of professionals in the NWSILC who to put together a multi-agency package of training. The professionals, all working within child health in East Leeds PCT, represented five different disciplines; physiotherapy, occupational therapy, speech and language therapy, nursing and dietetics. All had expertise in working with children with complex needs. They worked collaboratively with members of the leadership team of the NWSILC.
The training consisted of normal development; delayed and disordered development including cerebral palsy, physical movement, seating and positioning issues, eating, drinking and nutrition issues, problems and practical solutions in the classroom, hygiene and personal care and epilepsy. The team has already delivered the package to staff from Early Years Centres and partnership schools. On each occasion training was well received and the feedback was very positive. The aim was to explore a wide range of issues which staff may face whilst supporting children with complex needs and to give them an appreciation of the problems that these children and their families face on a daily basis. Giving staff the increased knowledge and skills will hopefully empower them to feel more confident to support a child within inclusion. More specific training and support needed for individual pupils to attend mainstream sites will be offered by the therapists and nurses who are familiar with the child and their needs.
Health professionals are no strangers to collaborative working and training support staff. However the development of multi-agency teams allows those partaking to benefit from the combined expertise from many different professions and promote the value of teamwork which is essential if inclusion is to succeed. Pickles (1998) recognised that mainstream staff would be reliant on therapists for training, advice and guidance for the effective inclusion of children with complex needs. Physiotherapists along with other professionals have seen their role change and training is now at the forefront of successful practice both as previously described and also in the educating of physiotherapy students which will give newly qualified therapists an appreciation of the complexity of working within an inclusive environment.
By training staff to deliver therapy, medical and educational services under the direction of the relevant professionals leads us to explore the possibility of a new category of school assistant, one who is acknowledged for their skills across the divide of different health and educational professionals. The new career structure suggested by ‘Remodelling The Workforce’ (2004) in the education system alongside the implementation of the Children Act with joined up services for children and families would give these workers a proper professional status to develop their skills and expertise.
Looking at the practice of distributed leadership would suggest that a system of training to different levels of skill and with teams of assistants working across the professional ‘divide’ would serve the needs of the children and families while also providing a key worker structure to support parents and carers in meetings and planning for future placements. Both professionals have worked with families as ‘key workers’ alongside our professional role, developing the close relationships involving trust and confidence. Whilst this way of working was successful in this instance for us, we recognise that change is needed to make it sustainable.
The future looks good for parents, carers and children if the continuing professional development opportunities are linked to the support assistants’ career structure. Some examples can show how far support assistant roles have already changed within the education system. For example, we have worked with assistants who have developed skills in ICT to work as a team of 3 and develop literacy programmes for pupils with complex needs. One of these assistants has developed a ‘difference awareness’ unit of work for pupils in Year 10/11 who are not entered for GCSE. She has worked alongside charity workers giving instruction, given them wheelchair experience, and used visual impairment aids, videos from Disability Rights Commission etc. This is to be developed further to train mainstream school assistants who will support special needs, including part of a unit for the Higher Level Teaching Assistants (HLTA’s) through higher education providers.
The future also includes the need for a good communication system (NSF 2004). Many believe this should be updated and held centrally with password secure access. Ideally, this would be a shared electronic register. Sue Nicklin, a physiotherapist working in the NWSILC who possesses the shared vision of the future, had an idea of a formalised checklist for equipment within inclusive settings. She proposed the idea as a joint project to a group of professionals. Although in its infancy, a joint working party is already piloting the scheme and if successful we hope it will be adopted as good working practice. By being accessible by all professionals concerned to the secure sites, it would join up the resources, training and input from all necessary providers to make mainstream schooling successful for all children including those with the most complex needs. It would enable us to ensure that equipment, resources and training are in place before a child moves into inclusion. Parents and carers would provide the ‘critical eye’ and monitor the quality of care and education given to their child by providing access to their child’s site. This will provide equity of provision on mainstream or specialist base, and give parents a real choice.
The resources and expertise on specialist sites that are presently only available to the few children with severe and complex needs whose parents choose a specialist setting can be opened for more pupils in mainstream provision who may benefit. There is action research that shows how much children with emotional and behavioural problems benefit when working alongside those with profound and multiple learning difficulties in a sensory room.(Flavell, Singleton and Ross, 2004) Using these and other specialist facilities such as Rebound therapy, Intensive interaction, and hydrotherapy to develop such skills as communication without speech as they learn to relax and explore massage, aromatherapy, tactile, visual and auditory stimuli in an unthreatening environment show a way forward for developing self esteem and empathy for others. Speech and language therapists suggest that up to 80% of pupils who have behavioural difficulties in mainstream schools also have language processing disorders. By using resources creatively and flexibly all children could benefit, especially those in danger of failing in the present system. The resources are there, it just needs creative and innovative thinking by professionals to optimise their use.
The Children Act 2004, Every Child Matters: Change for Children (2004) and the National Service Framework for Children, Young People and Maternity Services(2004) are all new legislation designed to improve the health and well- being of children and promote high quality services that meet their needs. It is clearly set out within the NSF that good collaborative arrangements between therapists and other professionals are required to meet the health needs of children whilst minimising disruption to their education. The described method of joint working that has been developed clearly meets the visions of the new legislations. The underpinning basis of legislation gives all involved the confidence that their ideals and working practice are in line with nationally identified themes to enhance the lives of children with complex needs.
Inclusion has meant new and exciting opportunities for all children. It has reduced discrimination, removed barriers and enabled children with even the most complex needs to have the opportunity to choose mainstream education. The necessary changes for this to be a success cannot happen without adequate training, resources and a willingness to embrace change. Physiotherapists as well as other professionals have seen their role evolve and change over the last few years and have a greater diversity as they take on a proactive role within inclusion. Their role not only involves the delivery of therapy but the developing and delivery of training and the ability to work flexibly in many different settings. They also have valuable contributions to make in the planning of new schools under the Building Schools for the Future initiatives. Their expertise along with that of other professionals would ensure that the child’s entire needs would be adequately catered for in a purpose built setting that serves the whole community.
Change is not without its problems and barriers but it has been shown that a small group of professionals with shared values can establish an effective good model of working practice that embraces the ethos of all the new legislation.
It is while developing these new ways of working that we will all make a success of ‘inclusion’ in its broadest sense and the beginning of this is a respect for the professionalism each possesses, and the ability to form good relationships where the well being and progress of the children and families is of paramount importance. We are looking at ways of formalising our work and extending it to others across the different professions. The work we have done is by no means unique or perfect, but it is a model that works for us. It may provide a structure for others to develop their own ways of joint working. That it fits so well into the Children Act shows that it must be a sustainable model with the flexibility to continue to be refined and improved as we all strive to do our best for and with children and families.
We are both privileged to work within strong professional teams, namely East Leeds PCT and Education Leeds, which promote continued professional development and innovative working. We would like to thank them and all the other committed professionals involved for their continued support. Change is only possible by teams working closely together. Whilst we are two individuals, we recognise and celebrate that it was by being part of a larger team that this work develops and breaks down barriers.
Special thanks to Leeann and all the Rhodes family whose invaluable assistance made this paper possible.
Paper Presented at ISEC 2005 by June Grainger MCSP Senior 1 Community Paediatric Physiotherapist, East Leeds PCT. and Liz Flavell, Leader of Partnerships North West Specialist Inclusive Learning Centre, Education Leeds.
References.
DfES (2004) Remodelling the Workforce London, DfES Publications
DfES (2004) Every Child Matters: Change for Children London, DfES Publications.
DHSS (2004) The Children Act. London HMSO.
DHSS (2004) The Children Bill. London HMSO.
DOH (2004) The National Service Framework for Children, Young People and Maternity Services London HMSO.
Flavell, Singleton and Ross (2004) Access to ICT London Fulton Publishers
Grainger J. (2002) ‘Inclusion’ For Individuals With Profound And Multiple Learning Disabilities; A Physiotherapists Perspective. University of Huddersfield
Hegarty, S- (2003) Inaugural Inclusion Conference, University of Hong Kong-
Mackey S. McQueen J. (1998) Exploring The Association Between Integrated Therapy And Inclusive Education . British Journal Of Special Education, Vol. 25 No.1 22-27
Pickles P.A.C. (1998) Managing The Curriculum For Children With Severe Motor Difficulties. London, David Fulton Publishers Ltd.
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