1 Norfolk Information for Evidence Writers May 2016. To be reviewed May 2017

Norfolk Information for Evidence Writers

Writing outcomes-focused advice

Principles and practical advice for

health professionals writing statutory

advice for Education, Health and Care

needs assessments

2 Norfolk Information for Evidence Writers May 2016. To be reviewed May 2017

CONTENTS

1.0 Introduction2.0 Context: key messages from2.1 Families

2.2 The SEND Code of Practice

2.3 Pathfinder local authorities

3.0 Three guiding principles3.1 Co-production

3.2 Person-centred planning

3.3 Outcomes-focused

4.0 Specifying Outcomes and separating them from Provision4.1 Defining outcomes, steps to outcomes & provision

4.2 Separating aspiration, outcomes and steps to outcomes

4.3 Separating Outcomes from Provision

5.0 Moving from Outcomes to Provision5.1 Examples of the progression from outcomes and their link with

specific provision

6.0 Appendices6.1 Contributors to these guidelines

6.2 The EHC needs assessment process in Norfolk

6.3 Developing Outcomes in Education, Health and Care Plans

6.4 The Council for Disabled Children’s Outcomes Pyramid

6.5 L i n k t o p a g e c o n t a i n i n g H e a l t h A d v i c e f o r m

1.0 INTRODUCTION

These guidelines have been written for professionals who will be providing statutory advice for

Education, Health and Care (EHC) Plan needs assessments.

The guidelines have been produced to provide a common framework and to support

professionals when they have been asked to provide this advice. The guidelines address

many questions that have been raised by advice writers. They also reflect best practice in a

wide range of teams, who have been proactive in developing new frameworks for providing

advice, which meets the needs of children and families as well as the standards required by

professional regulatory bodies. It is hoped that advice writers will find these guidelines useful

and relevant to their professional role. There has been a focus throughout on primary sources of

evidence and examples from practice. This document is based on the work done by the SEND

pathfinder areas and local policies.

Further resources about SEND for healthcare professionals can be found here

2.0 CONTEXT

2.1 Families say they want: To see that professionals have listened to their views and included those views in their

written advice;

To see that the assessment/planning/intervention process starts with what children,

young people and families want and need, not with what services typically do or deliver;

Reports that are written primarily for parents, carers and young people to read: jargon-

free, personal, as brief as possible, with unambiguous professional opinions, advice and

conclusions and specific recommendations regarding needs and provision.

2.2 The Special Educational Needs and Disability (SEND) Code of Practice

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SEND Code of PracticeSEND code of Practice for Health Professionals

The SEND Code of Practice states that children, young people and their families must

experience the assessment and planning process as a partnership leading to the co-production

of the EHC plan.

In particular‘The local authority must gather advice from relevant professionals about the child or young

person’s education, health and care needs, desired outcomes and special educational, health

and care provision that may be required to meet identified needs and achieve desired

outcomes.’ (paragraph:9:46 Code of Practice(COP))

‘The evidence and advice submitted by those providing it should be clear,

accessible and specific. They should provide advice about outcomes relevant for the child or

young person’s age and phase of education and strategies for their achievement. The local

authority may provide guidance about the structure and format of advice and information to be

provided. Professionals should limit their advice to areas in which they have expertise. They

may comment on the amount of provision they consider a child or young person requires and

local authorities should not have blanket policies which prevent them from doing so.’ (paragraph

9:51 COP)

2.3 FeedbackFeedback from national pathfinders indicates that the drafting of a good EHC plan depends on

the quality of advice received from professionals. Feedback shows that “a poor quality plan might be written based on good professional advice, but a good plan cannot be written based on poor professional advice”

Where professional advice is most helpful it is outcomes-focused. Professionals too-often

base their recommendations on descriptions of provision such as “Janette needs a social skills

programme,” instead of describing the outcomes that they believe the young person should

achieve such as “Janette will be able to play with a

group of friends of her own age”, and how those outcomes can be achieved.

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Where professional advice is most helpful it is clear that the professional understands the difference between submitting a report and providing advice. Professionals can become

fluent in providing reports that contain lots of description but relatively few conclusions and

recommendations. Families and local authorities seek out and appreciate the advice of professionals, not their reports.

The form to be used for writing new advice can be seen on the next few pages. Remember you only fill in the relevant parts for your area of expertise. Try to keep the “golden thread” linking OUTCOMES, NEEDS and PROVISION as you fill in the form.

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Request for statutory advice for an EHC needs assessment – HEALTH.

CONTEXTThe purpose of this form is to support Education Health and Care assessment by the Local Authority in accordance with the Children and Families Act 2014.

Child / Young Persons Details:

Full Name: DOB:

NHS Number:

Education Setting:

Advice Givers Details:

Name:

Title/role: Choose an item.

Qualifications:

Contact details:

Service: Choose an item.

Length of time involved:

This form completed by Choose an item.

Date of last contact:

Would you hope to attend the EHC person centred planning meeting? Choose an item.

Part 1: Relevant background information and aspirations

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Diagnosis (if known)

Summary of contact with the service (attach reports if appropriate)

Child’s or Young Person’s views and aspirations for health: (it may be different to parent’s perspective)

Parent’s views and aspirations for health: (it may be different to child’s perspective)

Part 2: Summary of child / young person’s strengths and needs

CommunicationSpeech and Language and Communication: (as appropriate to your profession)Strengths:

Needs:

Risks of harm or to child’s health and wellbeing if needs not met:

Attention and concentration: (as appropriate to your profession)

Strengths:

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Needs:

Risks of harm or to child’s health and wellbeing if needs not met:

Social Communication: (as appropriate to your profession)Strengths:

Needs:

Risks of harm or to child’s health and wellbeing if needs not met:

Cognition and Learning: (as appropriate to your profession)Strengths:

Needs:

Risks of harm or to child’s health and wellbeing if needs not met:

Social, emotional mental health: (as appropriate to your profession)Strengths:

Needs:

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Risks of harm or to child’s health and wellbeing if needs not met:

Physical disability (as appropriate to your profession)Strengths:

Needs:

Risks of harm or to child’s health and wellbeing if needs not met:

Sensory - Visual impairment (As appropriate to your profession)Strengths:

Needs:

Risks of harm or to child’s health and wellbeing if needs not met:

Sensory - Hearing impairment : (As appropriate to your profession)Strengths:

Needs:

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Risks of harm or to child’s health and wellbeing if needs not met:

Medical health: (As appropriate to your profession)Strengths:

Needs:

Risks of harm or to child’s health and wellbeing if needs not met:

Part 3: Outcomes and provision – outcomes identified should be linked specifically to the needs stated in Part 2 with the provision required to meet those needs and achieve the outcomes.

Communication and Interaction (As appropriate to your profession)Long term outcome(s)(end of key stage/Transition)Short term outcome(s)

Provision (who, what, how often, when)

Cognition and Learning (As appropriate to your profession)Long term outcome(s)((end of key stage/Transition)Short term outcome(s)

Provision (who, what, how often,

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when)

Social, emotional, mental health (As appropriate to your profession)Long term outcome(s)(end of key stage/Transition)Short term outcome(s)Provision (who, what, how often, when)

Sensory and / or physical (As appropriate to your profession)Long term outcome(s)(end of key stage/Transition)Short term outcome(s)

Provision (who, what, how often, when)

Please describe how will you / your service be involved in supporting these outcomes?

Name:

Date:

Please return this completed form along with any supporting documents securely by email to:

Send copy to Parents/Carers

NCHC staff childhealthteam@nchc.nhs.uk

All other professionals ehcp@norfolk.gcsx.gov.uk

Office use only:

UPN NO:

Date information received:11

On receipt please save information to child’s electronic file EHCP > Needs assessment and notify EHCP Coordinator

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3.0 THREE GUIDING PRINCIPLES FOR WRITING ADVICE Co-production

Person-centred planning

Outcomes-focused

3.1 Co-productionCo- production means that families and young people feel that they are partners in the drafting

and writing of plans, not passive recipients of them.

It is an important general principle, especially in relation to the development of the Norfolk Local

Offer and Joint Commissioning arrangements. Please note that there is no requirement that

individual professional advice has to be co-produced with young people and their families in

the same way required of the EHC plan. Professional advice must show clear evidence of

consultation with them and should refer to their wishes and aspirations in its recommendations.

In Norfolk there is a Multi-agency person centred planning meeting to which all

professionals involved in the assessment, or identified through the assessment as having a

role, should be invited. The Education, Health and Care Plan coordinator facilitates the

meeting, which occurs after all advice has been received, to support with the co-production of

the EHC plan. It is expected that parents will already know about and understand the advice

that has been submitted prior to the meeting.Co-production does not mean that professionals

have to give advice that always agrees with and supports young people and their families’

wishes and aspirations It is entirely credible and acceptable that professional advice will

disagree or diverge from what a young person wants, but where this happens the professional

should refer to this disagreement, explain how it has arisen and justify their own position and

how his will benefit the child or young person.

3.2 Person-centred planning• For professionals writing advice about an individual, assessments should be conducted in

a manner that takes account of the individual’s needs and wishes; enables them to

express their views; enables them to understand what is being done and proposed; and

describes the individual as far as possible in terms that they would choose to

describe themselves. Person centred planning should have the person’s aspirations and

outcomes at the heart of the process.

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However, please note that aspirations are different to outcomes: Aspirations are

“ambitions or hopes” whereas Outcomes are “the benefit or difference made to an

individual as a result of change”.

Prior to receiving a request for statutory advice, as part of an EHC needs assessment,

professionals may already have been asked for “existing advice” to help inform the decision as

to whether or not an EHCP assessment should be completed. This existing advice should be

current or recent reports, or a brief summary of the involvement of the professional with the

child , their needs and desired outcomes from professional input. If all professional reports are

written using a format that includes Outcomes, Needs and provision then this may prevent new

advice needing to be written further on in the process.

When writing new advice there should be a “golden thread” linking the outcomes, the needs

(the barriers to achieving the outcomes) and the provision (what is needed to help the child or

young person address their needs and achieve their outcomes).

The advice should help with the decision making with regards to the needs identified and the

provision required to meet the outcomes. It is important to remember that an EHC plan is only

required if special educational needs require specials educational provision that is over and

above that which would normally be available in the educational setting for all children and

young people. Many children will not need an EHC Plan as in Norfolk the majority of special

needs funding is allocated to schools or the school cluster for distribution directly.

SEN funding details for Norfolk can be found here

3.3 Outcomes-focusedProfessionals may feel that they already incorporate important elements of co- production and

person-centred planning in their work and in their advice. However, experience suggests

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that writing outcomes-focused advice is far less common than it should be, and it is the case that

professionals frequently recommend provision or processes in their reports instead of commenting on outcomes. An outcome as part of an EHC Plan is understood as the fulfilment

of something that the person is going to attain or achieve; it is not a goal set by a professional as

part of their service delivery, not a piece of provision or description of part of an intervention.

From the SEND Code of Practice:para 9.64 ‘EHC plans must specify the outcomes sought for the child or young person…. EHC

Plans should be focused on education and training, health and care outcomes that will enable

children and young people to progress in their learning and, as they get older, to be well

prepared for adulthood. EHC plans can also include wider outcomes such as positive social

relationships and emotional resilience and stability. Outcomes should always enable children

and young people to move towards the long-term aspirations of employment or higher

education, independent living and community participation.’

From the SEND Code of Practice:para 9.66 ‘An outcome can be defined as the benefit or difference made to an individual as a

result of an intervention. It should be personal and not expressed from a service perspective;

it should be something that those involved have control and influence over, and while it does not

always have to be formal or accredited, it should be Specific, Measurable, Achievable, Realistic

and Time bound (SMART). Outcomes are not a description of the service being provided. For

example, the provision of three hours of speech and language therapy is not an outcome. In this

case, the outcome is what it is intended that the speech and language therapy will help the

individual to do that they cannot do now and by when this will be achieved.”

From the SEND Code of Practice:

para 9.67 ‘When agreeing outcomes, it is important to consider both what is important to

the child or young person – what they themselves want to be able to achieve – and what is

important for them as judged by others with the child or young person’s best interests at heart.

In the case of speech and language needs, what is important to the child may be that they want

to be able to talk to their friends and join in their games at playtime. What is important for them

is that their difficult behaviour improves because they no longer get frustrated at not being

understood.’

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From the SEND Code of Practice:para 9.68 ‘Outcomes underpin and inform the detail of EHC plans. Outcomes will usually set out

what needs to be achieved by the end of a phase or stage of education in order to enable the

child or young person to progress successfully to the next phase or stage. An outcome for a

child of secondary school age might be, for example, to make adequate progress or achieve a

qualification to enable him or her to attend a specific course at college. Other outcomes in the

EHC plan may then describe what needs to be achieved by the end of each intervening year to

enable him or her to achieve the college place. From year 9 onwards, the nature of the

outcomes will reflect the need to ensure young people are preparing for adulthood. In all

cases, EHC plans must specify the special educational provision required to meet each of the

child or young person’s special educational needs. The provision should enable the outcomes to

be achieved.’

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4.0 SPECIFYING OUTCOMES AND SEPARATING THEM FROM PROVISION

4.1 Defining outcomes, steps to outcomes & provisionFor professionals writing statutory advice, the best approach to advising on outcomes will

be to start with an understanding of the achievable outcomes the individual is aiming for; then

consider what are likely to be the steps to outcomes; then to specify the provision that will be

needed to make this happen.

Outcomes:

will be broad and ambitious;

will relate to where the young person is currently up to and be realistic and

achievable;

will in most cases be things that the young person wants for themselves;

are an opportunity for professional advice to indicate a young person’s

potential;

give a sense of direction and purpose to the rest of the planning process;

should be worded in the future tense for Norfolk EHC plans to avoid confusion;

should be long term, and will usually span the next stage or phase of education.

Steps to outcomes: will describe what can realistically be achieved towards the outcome with the correct

provision and support in a shorter timescale, usually one year but could be less;

will allow the impact of the EHC Plan to be gauged during the Annual Review meeting;

will offer an opportunity for the quality of provision to be held to account.

Provision will typically describe the type of support a young person needs, including the frequency,

duration, the methods and the professionals who need to be involved in delivering

it;

should be specific about all of the above without naming a particular school, nursery or

other setting.

4.2 Separating aspirations, outcomes and steps to outcomes17

The Department for Education advises that ‘long term’ is best understood as a period of a few

years, perhaps the end of the current Key Stage in a child’s education or a transition point

between the current school and the next phase of education. At the same time professionals

must not lose sight of children’s and families’ realistic aspirations that go beyond this time

frame. Even for very young children, parentsoften express their ambitions in terms of adult

living and choices and they want education, health and care support to be informed by this, and

professional advice to have a view on it.

Appendices 5.2 and 5.3 of this document has some helpful clarification of this issue

The following are examples of possible outcome and steps to outcomes:

Outcomes: Steps to outcomes:

Simon will be a fluent reader so that he

can access the curriculum independently

Simon will be able to correctly read all

phonically regular words using synthetic

phonics knowledge

Simon will be able to socialise safely in the

community without adult supervision

Simon will be able to play in an age

appropriate way with at least one child

of his own age for the majority of break

times at school

Simon will be able to reliably communicate

the majority of his wishes and preferences

to others in his life

Simon will be able to indicate a

preference, either through gesture or

vocalising, from a choice of two options

presented as visual prompts

Simon will be able to walk independently

so that he can do the things he enjoys and

have fun with his family and friends

By the end of the year Simon will be

able to walk the 10 steps from the

classroom door to the playground

without falling over

By the time Simon is at the end of year 6

he will be able to follow instructions

containing 4 key words in a small group

situation

Simon will be able to constantly follow

instructions at a 2 word level by the end

of term

4.3 Separating Outcomes from Provision18

These are all statements of provision, NOT outcomes: Simon will receive 15 minutes of targeted individual word-level literacy support each

day

Simon will require a daily speech and language programme focussing on

comprehension of instructions containing three key items of information

Simon needs an individual daily visual timetable that is discussed with him at the

start of each day by a member of staff

Simon will remain under review by the community paediatrician

Simon should be assessed by the occupational therapist

Simon should have a Circle of Friends intervention set up and run by a

teaching assistant

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5.0 MOVING FROM OUTCOMES TO PROVISION

5.1 Examples of the progression from outcomes to steps to outcomes and their link with specific Provision

Outcome Steps to outcome Provision

Simon will be able to

describe, explain and

control his own

behaviour at age

appropriate levels so

that he can be educated

alongside his peers and

achieve age appropriate

learning achievements.

Simon will be able to

confidently identify and

label his feelings and

emotions

Simon should receive weekly small

group support led by a suitably

experienced TA focussed on

understanding thoughts, feelings

and behaviour. This work should

be supervised by a qualified

teacher and be linked to objectives

seeking to develop Simon’s social

interaction skills in the classroom

and during unstructured times at

school. The impact of this work will

need to be monitored on a daily

basis by key staff working with him.

Simon to develop age

appropriate spoken and

social interaction skills

enabling him to join in

play and work

cooperatively with

others

Simon will show the

ability to turn-take in

structured small group

discussions with peers,

with minimal or no

interruptions of others

and no purely self-

directed changes of topic.

activities that occur as part of the

differentiated class curriculum

across the year. Parents to be

aware of this target and supported

by school in drawing Simon’s

attention to it as appropriate at

home. All staff working with Simon

should be aware of this target and

should take all available

opportunities to raise Simon’s

awareness of his skills in this area

and provide him with specific

praise for his efforts to improve.

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I will be able to walk

independently so that

he can do the things he

enjoys and have fun

with his family and

friends.

By the end of the year I

will be able to walk the 10

steps from the classroom

door to the playground

without falling over.

A programme aimed at developing

mobility as recommended by the

physiotherapist and delivered by

the teacher and support staff for 30

minutes per day monitored by the

physiotherapist termly

By the time Simon is at

the end of year 6 he will

be able to follow

instructions containing 4

key words in a small

group situation to

enable him to become

independent in his

learning.

Simon will be able to

constantly follow

instructions at a 2 word

level by the end of term

Programme developed and

monitored by the speech and

language therapist termly.

Delivered by teaching staff 3 times

per week for 20 minutes. Breaking

down instructions into small parts,

asking them to repeat the

instruction, use of visual aids e.g.

objects, symbols and photos

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6.0 APPENDICES

6.1 Contributors to these guidelinesThe Portsmouth and Essex Guidance for Evidence Writers were used as the basis for this document.

Consultation, collaboration and feedback collection will be ongoing ready for the next review point .

6.2 THE NORFOLK EHC NEEDS ASSESSMENT PROCESS

6.3 DEVELOPING OUTCOMES IN EDUCATION, HEALTH AND CARE PLANS

6.4 RESOURCES TO USE AND REFER TO

6.5 COUNCIL FOR DISABLED CHILDREN OUTCOMES PYRAMID

Exit point: Feedback provided Exit point: Feedback provided

Week 0-6 (maximum) Week 7-16 (maximum) Week 17-20 (maximum)

Norfolk’s EHCP Process “At a glance”

Referral stageReferral

processed by SEN Centre of

Excellence

Existing information/

reports/ assessments

requested from agencies/

professionals in consultation with parent / young person

(including from health

professionals).

Evidence gathering phase

Consultation and information gathering with

family

Local Authority undertakes

initial information

gathering meeting /

consultation with

parent/young person. Their views, hopes,

aspirations gathered.

Decision making phase

Analysis of evidence and

decision for EHC needs

assessment

Local Authority considers and

moderates evidence base

for an EHC needs

assessment based on

Norfolk Criteria and SEN Code of

Practice

EHC needs assessment

phase

New professional

advice requested

Local Authority requests advice

from professionals in

full collaboration with parent / young person (professionals must respond

within 6 weeks): health advice

givers proformas on

Local Offer

Decision making phase

Analysis of evidence and decision for issue of an

EHCP

Local Authority considers and

moderates evidence base

for an EHC needs

assessment based on

professional advice, person

centred planning

meeting (where undertaken) compared to

Norfolk Criteria and SEN Code of

Practice

Draft EHCP Phase

Draft EHCP produced

Local Authority drafts the EHCP

based on/as part of person

centred planning meeting,

incorporating outcomes, needs and provision. Personal Budgets

prepared.

Health provide outcomes, needs and

provision for Section C and G as part of their advice giving.

Provision above core and personal

budgets agreed with CCG.

Consultation on Draft EHCP

Phase

Draft EHCP sent to parents /

young person

Local Authority produces draft

EHCP and sends to parent /

young person for 15 day

consultation. Parent / young

person has opportunity to

request a specific

educational establishment to be named in the Final Plan.

Local Authority meets with

parents / young person where needed and

consults with education

providers over placement

where needed

Final Plan issued

Final EHCP produced

Local Authority finalises EHCP and issues to:

Parent / young person

CCGPrincipal / Head

Teacher of educational

establishment

Parent issued with right of

appeal to SENDIST or dispute /

complaint to health services

EHCP must be reviewed within

12 months

Multi agency Person Centred Planning meeting with parents / young person / all professionals – chaired by EHCP Coordinator to consider needs, outcomes and provision across education, health and social care.

6.3 Developing Outcomes in Education, Health and Care Plans

6.4 Resources to use and refer to:

Resource Where to find it

SEND Code of Practice (in particular chapter 9) ww w . g o v . u k/ go v ern m en t/ p u bli c a t io n s / s en d - c od e -o f - pra c t i c e -0- t o-25

0 to 25 SEND code of practice: a guide for health professionals

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/502913/Health_Professional_Guide_to_the_Send_Code_of_Practice.pdf

Norfolk Local Offer www.norfolk.gov.uk/SEND

Council for Disabled Children SEND Resources http://www.councilfordisabledchildren.org.uk/what-we- do/supporting-the-send-reforms/resources

Council for Disabled Children - E-learning modules http://www.councilfordisabledchildren.org.uk/resources/health-support-in-universal-settings-and-continuing-care

Supporting Pupils at School with medical conditions – Statutory Guidance

school-with-medical-conditions--3

SEND Pathfinder Information Pack, 0-25 CoordinatedAssessment Process and EHC Plan Pack (Section 3)

ww w .s endpath f i n d e r . c o . u k / c oo r dina t e d -a s s e s s m e n t - pro c e s s

Implementing the 0 to 25 special needs system: LAs and partners

to-25-special-needs-system

:

6.4 COUNCIL FOR DISABLED CHILDREN OUTCOMES PYRAMID