Special Educational Needs and Disability (SEND)

Reforms: towards Integrated working

Nottinghamshire Pathfinder Project Team

January 2014

The presentation aims to cover

• Experience of the Nottinghamshire pathfinder

• Reflections and learning that may be useful to voluntary sector colleagues

Case study: Why change? A more integrated approach will benefit children and families

Worst month ever was Dec 2009 – 24

appointments in 17 days - etched on their

memory forever!

35 services are currently involved, with six

monthly reviews, some more often

Attending 6-12 appointments a month (each can be up to ½ a

day out of school)

Over 50 services have supported her since she

was born

11 year old girl and her

family

Nottinghamshire’s Education, Health & Care Plan Pathway

Pathway Step 1: The Local offer

Nottinghamshire are developing a multi media approach to information provision about services/ resources for use by families & services with:- •an integrated website is now in place building on family services directory for all services to input and to access information.•a mobile phone ‘app’ version is available•access to face to face support through key working/ family supporters.•Involvement of parents/ carers & other key stakeholders in development, updates and review.

Pathway Step 2: Referral Referrals are accepted from anyone…….•parents •young people •professionals involved with the child or young person

They are submitted to the Multi-agency/ integrated Hub

The referral process seeks information about:•parental responsibility •the child or young person’s needs•the reason for the request•which services/agencies are already involved•whether a CAF is already in place

Eligibility criteria for an Education, Health & Care plan in Nottinghamshire

An integrated assessment & plan may be needed for a child/ young person with SEN & disabilities aged 0 to 25 with needs over & above those met at universal/targeted level, such as:-•Severe/ complex long term needs affecting everyday life •requiring provision & resources not normally available •requiring intensive help & support from more than one agency•making limited or no progress despite high levels of support  •are above statutory school age with evidence of a graduated response (appropriate interventions, support & resources, available through the Local Offer, have already been put in place.)

TimelineStage 2Referral

Stage 4My Plan

20 weeks maximum

4 weeks max

6 weeks max

2 weeks max

2 weeks max

2 weeks max

4 weeks max

Stage 3My Story

SEND Hub

All About Me Multi-

Agency meeting

Education

All About Me

Multi-Agency meeting

Health

All About Me

Multi-Agency meeting

Children’s Social Care

All About MeMulti-

Agency meeting

AdultSocial Care

All About Me

Multi-Agency meetingVoluntary &

CommunitySector

Hub and spoke delivery model- linking services

Integrated Hub structure

An Integrated HubHub manager Hub Commissioners from •Education•Health•Children’s social care•Adult Social Care: •Post 16: Plan coordinators: 3 teams covering North, central and south (District placement assessment team plus relevant others TBC)

Parent/ family involvement

• Parent Partnership Hub• Parents working with central pathfinder team• Detailed person centred case studies used to

support training and illustrate need for change• Voluntary sector involvement in development

and implementation of pathway e.g. A Place To Call Our Own- APTCOO

Pathway Step 3- Gathering information for the plan: “My Story”

Each family will be allocated a worker in the hub and spoke. Both have a role in developing the plan

Hub: Plan coordinator to draw the plan together

Spoke: Family supporter, identified in agreement with the family from one of the services closely involved, fulfilling key working responsibilities. They will know the family well & will help gather person centred information ‘All about me’ to support EHC planning

Step 4: Gather information for ‘My plan’The ‘All about me’ information gathered by family supporter is shared at the multi agency meeting. This information includes:①Relationship circle②Working/ not working③Like and admire④One page profile.⑤What is important to maintain a child/ young person’s health, safety and wellbeing. Some children/ young people and families are also piloting a ‘Wiki’ which also holds this information

Making ‘My Story’ interactive

Background: Wiki

• Research with collaboration agreement in place with University of East London

• Easy-build web site platform (Klik In) being piloted to create personalised ‘wikis’with multi media technology to help tell a child/ young person’s story

• Multi perspective understanding quickly gained through photos, video, documents, text and web links

• Piloting ‘wikis’ with some children and young adults

• Evaluation will be undertaken across the control groups to inform our next steps

• Any services can access the ‘Wiki’ with family’s permission

Why a wiki supports integrated working ...• Reduce the times families explain their story

• Reflects a whole day and not just the part of it that most professionals are likely to see

• Shows simple techniques used to fit equipment or ways to help with activities or encourage independence e.g. positioning

• Shows all those supporting a child an insight into their life

Useful source of family held information for all services providing care or support

Hannah

Ruth (Mum)

Paul (Dad)

Lily (Twin Sister)

Carin4Families- short breaks at home & overnight (Continuing Care)Rachel Gregory- QMC 0115 9249924 ext. 62738

Judith West (Teaching assistant)Bleby School 01656 830203

Dr Marder PaediatricianCDC 0115 8831156

Kate Sutton- Speech & Language Therapist) Stapleford Health Centre 0115 8835187

Kath Beastall- KeyworkerChildren's Disability Services Meadow House 01623 433675

Dilys Whitehead-Occupational Therapist Meadow House 01623 433077

Granny Beth

Grandad Will

GP 0115 9664120

Mobility Services- outdoor chair/ buggy

Mr Marshall- ENTAudiology Ropewalk 0115 9485591

Miss Eastwood- OrthopaedicsGreat Ormond St. 0207 4059200

Mrs TambeOpthalmology CDC 0115 8831156

Dr Thomas- Respiratory services QMC 0115 9249924 ext. 62395

Ash lea school/ hydrotherapy0115 9892744

Orthotics/ physiotherapy

Downs Syndrome AssociationNotts Downs Syndrome Speech Group

New life (car seat)

Jo Farquarson 0115 8831110Physiotherapist-CDC

John & Rachel(Uncle/ Aunt)

Alicia, Richard George & MillieFamily friends:

Home adaptation

Home Oxygen company – Air Liquide 0808 143 9993

Continence supplies

Alex Holland 01623 433077Educational Psychologist

Fennel- Dog

Cardiology

Neurology

Motability- Car

HEALTH

EDUCATION SOCIAL CAREVOLUNTARY

Bleby School 01656 830203

SEN services- educational statement

Dentist 0115 9603572

Children & Adolescent Mental Health Services CAMHSSensory services

Chiropodist

Inclusion support services Visual Impairment Team – Sue Newman 0115 8546024

Occupational Therapist 0115 8831101PDSS

Contract care-Short breaks away from home-awaiting a family placement

Direct payments team

Claire Godmother

Karen, SteveAnna & PeterVillage friends

Kirsty- friend at school

Nana & Grandpa (Dad's parentsLive in London)

School for Parents 0115 9586641

OTHERS

RELATIONSHIP

CIRCLE

Children's Community Nurses (CCN'S) QMC

Shelagh & family- School friends

Hoist Company – Astor Bannerman 01242 820820

WORKING NOT WORKING BUGGY: Buggy is really great & helps us get out and about. Will soon outgrow current buggy & readjustment is needed.

BOOTS/ SPLINTS: Boots/ splints are fine. Understand ongoing arrangements for follow up/ ongoing support with Orthotics dept.

The toes on left foot are overlapping, middle toe nail is growing in a ‘V’shape and is sharp and difficult to cut.

MOVING AND HANDLING: Building work is underway on new downstairs extension (bedroom/ bathroom), which will help with moving and handling (no stairs to climb) and allow better facilities for short break support.

Builder has recently been changed & progress is now being made.

Extension work has been fraught with problems and delays.

Home hoist has been playing up. A sling assessment is required when the hoist is functional (OT aware)

Out family have never had moving and handling training. Transferring in & out of the car is becoming more challenging. This needs consideration when motability vehicle is changed, Car seat will soon need adjusting.

SHORT BREAK SUPPORT: Carin4Families overnight short breaks very helpful, the staff are really fantastic and allow Mum to catch up on some much needed sleep.

Assessment has been made for contract care (24 nights away from home a year) but no family yet identified

3 hour short breaks shifts don’t allow sufficient time to do anything really meaningful with sister, Lily.

Hannah’s is easily disturbed at night. She does not always settle back to sleep if disturbed. She is always best left to sleep and only disturbed when absolutely necessary i.e. when responding to alarm, coughing or settling Hannah if distressed.

Still waiting to find a family for ‘out of home’ short breaks on a regular basis, for the next few years.

ENT (Ear, nose and throat) Sleep apnoea continues. Date set for ENT review

WORKING NOT WORKING DENTAL SUPPORT: Hannah goes to the family dentist H hates having her teeth brushed. We need to find the best ways protect

her teeth?SUPPORT AT SCHOOL: Support at school is absolutely brilliant. Teaching Assistant Fabulous.

It is difficult for Mum to work, due to taking to school late on many mornings. There is no ‘back up plan’ in place for days off school due to ill health, other than grandparents, if they are free. A long term solution would be useful.

CLEANING: Cleaning help creates time for the family It would be great if short breaks service could help with small tasks in the home to support life at home e.g. ironing

LEISURE/ HOLIDAYS: Enjoy any opportunities to socialise as a family and love going away on holiday.

H loves being entertained. She enjoys going out in her buggy on dog walks, playing with stickle bricks and swinging on her swing

H has a keen sense of humour and fun.

We would like to have a holiday away with friends, but due to high support needs we have not found a way to make this possible.

‘Ad hoc’ babysitting for both girls together is difficult to organise. We rely heavily on grandparents. This will get more difficult in the future. This excludes us from some of the social activities we would like to join in with.

Finding leisure activities that we can take part in as a family can prove very challenging. There are probably leisure facilities that we do not know about. Any help / ideas would be welcomed.

Finding leisure activities for to help H develop, learn and keep her body and mind active is challenging, especially in the school holidays.

COMMUNICATION: H can communicate, if she spoken to clearly/ slowly, face to face and given time to process questions or instructions (see communication chart). The spoken word can be successfully backed up with the use of signing, pictures and Makaton symbols.

It would be useful to explore if there any further communication aids that could be used at home. H sometimes grabs and pulls and this can sometimes hurt those looking after her. How do we manage this safely and understand what Holly is trying to tell us?

It has been suggested there is a possible diagnosis of ‘Autistic Spectrum disorder’. This need to be considered further to ensure H is receiving the correct help and support to assist communication & learning

Pathway Step 5: An integrated budgetThere are a number of different options being tested, depending upon level of responsibility a family wishes to take. These include:

•Direct Payment•Individual Service Fund•Independent Third Party

There will be a phased introduction. This will be supported by the Plan Coordinators and may require some independent support from a brokerage service.  

Step 4 & 7: Multi-agency meetings/ Review

• Once ‘Like and admire’ & ‘what is working/ what could be improved’ are shared, outcomes are identified for the Education, Health and Care Plan. The actions required to achieve the outcomes are agreed, along with the budget.

• This is progressed at an initial facilitated Multi agency meeting, attended by key services involved

• Timescales for further reviews/ multi agency meetings are agreed as the EHC plan is put in place

• Many reviews have been run as person- centred meetings using a ‘working/ not working’ and other such approaches/ conversations.

Learning/ Reflections so far……..• Babies, children and young people with complex needs generally

have very complex arrangements in place to support them. Working in a more streamlined/ integrated way is a challenge for all involved!

• Integrated teams may well develop to support the EHC pathway and process. Voluntary sector services need to be linked in.

• Person centred tools/ conversations have worked well with services in many different settings, including voluntary sector.

• Case studies are a useful & powerful resource to help make the case for change, demonstrating unique input of each service & showing where support could be more integrated or ‘joined up.’

• Families/ young people who have tested the Wiki to date like to be empowered, holding and developing information themselves and choosing who they wish to share it with.

Thank you for your attention

The end