ASNTS_D_08_2009_01.09.09

 

 

ANONYMISED DECISION OF THE TRIBUNAL

 

 

 

Reference:              d/08/2009

 

Gender:                   Male

 

Age:                        6

 

Type of Reference: Contents of Co-ordinated Support Plan

 

 

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1. Reference:

 

The Appellant made the reference in respect of the contents of the child’s coordinated support plan dated 13^th March 2009 (under section 18(3)(d) of the 2004 Act).

 

 

2. Decision of the Tribunal:

 

To require the education authority to make the following amendments to the coordinated support plan by 30^th September 2009:        

Educational Objectives

• under each of the Educational Objectives, to specify to which of the numbered aims in the child’s current Individualised Education Programme (IEP) they consider it relates;

Additional Support Required

• in relation to the first Educational Objective (individualised education), to insert an additional paragraph at the end:

“Communication between school and parents:

• use of weekly diary in both directions, to reflect the focus of learning for the coming week and relevant information from home;
• individualised curriculum plan (adapted from present group planning format) to be provided to the parents as near to the start of each term as possible
• seek to establish agreed and efficient means of communication on other issues as they arise, with an emphasis on informal and oral communication.”

• in relation to the second Educational Objective (communication skills), to insert an additional paragraph at the end:

“Using a collaborative approach SALT, OT and Physiotherapists will design appropriate programmes which will last for approximately 12-13 weeks. Each programme will be based on observations from each therapist resulting in jointly set targets. Following the completion of each programme, targets will be reviewed and the process of observation repeated to inform the setting of new targets for the following 12-13 weeks. This statement applies to the implementation of this and all the following educational objectives.”

Persons providing the Additional Support

• in relation to the first Educational Objective (individualised education), insert opposite the new additional paragraph  “Education staff” and “parents”
• in relation to the second Educational Objective (communication skills), insert opposite the new additional text “Education staff”, “Speech & Language Therapist”, “Occupational Therapist” and “Physiotherapist”
• in relation to the sixth Educational Objective (self-help), add “Dietician” and “Continence Advisory Nurse”.

 

 

3. Issues Contained in the Reference

 

In his reference to the Tribunal, the Appellant stated he wished four further factors from which additional support needs arise, all relating to the child’s learning environment, to be included in the CSP:

• the curriculum, on the basis that he was not aware what curriculum his son was following or how his needs were being met;
• the refusal of the education authority to carry out a specific educational psychology assessment of the child;
• the learning environment itself, on the basis that the CSP made no mention of opportunities for his inclusion in a mainstream class;
• and what he described as the need for a more comprehensive dialogue with the child’s parents about his progress.

 

Further, he sought replacement of the educational objectives in the CSP with a far more specific and detailed set of objectives; several amendments to the additional support required; and addition of the dietician, the continence advisory nurse and the educational psychologist to the persons or agencies providing that support.

 

He also sought other detailed amendments, but accepted in the course of the hearing that these did not fall within the elements of the plan listed at section 9(2)(a) of the 2004 Act, and thus fell outwith the Tribunal’s jurisdiction as defined by sections 18(3)(d)(i) and 19(4).

 

 

4. Preliminary Matters:

 

The Appellant requested on 28^th June 2009 that the Tribunal serve a citation on NHS seeking production of all the child’s occupational therapy and physiotherapy records. On the basis of the information he provided, a direction to that effect was issued on 30^th June 2009, requiring production of these records by 13^th July. Records lodged in response to the citation were received shortly before the first day of the hearing on 17^th July.

 

The Convenor held a teleconference with parties on 14^th July 2009. It was agreed that the child and his mother would attend briefly at the start of the hearing, and that the Appellant’s witness Consultant Paediatrician would give evidence through a teleconference in the course of the hearing. 

 

 

5. Summary of Evidence:

 

The Tribunal received a very substantial bundle of documents lodged primarily by the Appellant. Each party provided a detailed case statement and written submissions; these were most helpful. Among the other papers, which ran to over 550 pages, we particularly noted:

• the CSP dated 13^th March 2009 and parental comment (T26-43 in the bundle)
• the independent centre assessment report (T45-85)
• the decision of a previous Tribunal in respect of the child’s first CSP (T118-123)
• IEP of February 2009 (T163-186)
• The Appellant’s version of the CSP (A3-14)
• The Appellant’s analysis of the Elaborated Curriculum Associated Steps (A15-18)
• EA’s letter to NHS requesting its assistance under section 32(1) of the 2004 Act (A96)
• the response from NHS (A98-101)
• The Appellant’s analysis of use by the School of the weekly planner (A125-128)
• correspondence between The Appellant’s and Head of Support for Learning, (A133-161)
• School planner sheets (R4-22)
• School weekly planner pages (R23-61)
• Letter to School from the Appellant advising of the embargo on health communications (R81-82)
• Reply from Education department (R84-85).

 

The Appellant gave evidence on his own behalf and also called Consultant Paediatrician. The education authority called Depute Head Teacher and the Education Authority Manager for Additional Support Needs. Neither party sought permission to call more than the two witnesses per party allowed for under the Tribunal Rules.

 

We were satisfied that we had more than sufficient information on which to base our decision.

 

 

6. Findings in Fact:

 

1. The child was born on 2002. He lives with his parents. He started at the enhanced provision in August 2008, and has just begun his second year there.
2. The child has additional support needs in that he has a diagnosis of autistic spectrum disorder, low muscle tone, developmental delay, eating problem and dietary issues.
3. The child’s school is a mainstream provision with an enhanced provision on site. The enhanced provision currently provides for 18 children, all of whom are on the autistic spectrum, in two classes of nine each. There are three classroom assistants in the child’s class, of whom one provides dedicated support to him. There is regular input from a speech and language therapist, including individual times spent with him, and advisory support for staff from an educational psychologist.
4. The enhanced provision uses the “TEACCH” approach, which uses clear structure and routine to support learning and to reduce anxiety for children on the autistic spectrum.
5. Staff members in the enhanced provision are trained and very experienced in working with children on the autistic spectrum. The provision has been accredited three times by the National Autistic Society. In the School’s last HMIe inspection, three years ago, it was noted that inclusion of children in the enhanced provision was a strength of the School.
6. The education authority issued a coordinated support plan (CSP) for the child in October 2007. Following its review, a further CSP was issued on 13^th March 2009.
7. The education authority has established an individualised educational programme (IEP) for the child. The current IEP is dated 29^th April 2009 and was issued to his parents on 12^th June 2009.
8. He benefits from an elaborated and individualised curriculum derived from the Three to Five Learning through Play Curriculum and the Elaborated Five to Fourteen Curriculum (Small Steps).The IEP details the aims of the curriculum for the child, and the strategies, support and resources to be deployed to achieve them.
9. The curriculum is appropriate to his needs and he is making good progress. School staff members have noted that he is showing significantly higher levels of skill in some areas, such as numbers, than in others.
10. For each child in the enhanced provision, the School assesses, on an individual and ongoing basis, the appropriate level of inclusion within mainstream groups or classes.
11. The child currently accesses a mainstream peer group once a week for 45-60 minutes, for play activities. These periods are carefully planned and closely supervised. He also attends school assemblies. He does not yet interact with other children, although he is becoming more aware of them.
12. The current level of inclusion is appropriate to his needs. Further inclusion into mainstream classes at this stage of his development would be confusing and distracting for him, and would serve no good educational purpose. Attempts to extend the scope of his inclusion have been made, but thus far without benefit to him. 
13. There has been a mismatch in communication styles between the School and the father in particular. The School generally prefer informal communication, whether one to one or through events for parents. The child’s parents have made limited use of these opportunities. The School also provides a school diary with notes on each day, although these tend to be quite limited. The diary offers space for parents to note activities or progress while at home, but his parents have made limited use of this. The Appellant tends to communicate in print and in great detail. The School provides formal feedback on progress annually in the child’s IEP and end of year reports; he would prefer detailed and structured feedback on a very regular basis.
14. The Appellant has engaged in extended communication, discussion and dispute with the education authority and with NHS over several aspects of their provision for the child. For instance, in October 2008 the Appellant sent an email to all the NHS staff then involved with his son in which he said “Until further notice I am now placing an embargo on any information, verbal or otherwise, being shared with specifically, education department and, in general, any other party”. He did so following the release of an NHS dietician’s report to the School. He had disputed the recommendation in the report and had sought and obtained assurances that it would not be passed on to the School.
15. The embargo caused considerable anxiety and practical difficulty for the School staff and the speech and language therapist in relation to working together in the school, and in relation to seeking advice or consultation with other therapists.
16. Because of his complex needs profile, he would benefit from periodic observation by an occupational therapist and a physiotherapist so that they can design appropriate programmes for the child and advise the School on how to deliver them.
17. The School continue to require advice and guidance from staff of NHS, namely the dietician and the continence advisory nurse, in relation to the child’s feeding and toileting. The support they provide requires to be coordinated with that provided by education authority staff and the speech and language therapist.

 

 

7. Reasons for Decision

 

The Tribunal has power to review the information contained in a CSP insofar as it comes within the scope of section 9(2)(a) of the 2004 Act, namely:

“(a) a statement of the education authority's conclusions as to-

(i) the factor or factors from which the additional support needs of the child or young person arise,

(ii) the educational objectives sought to be achieved taking account of that factor or those factors,

(iii) the additional support required by the child or young person to achieve those objectives, and

(iv) the persons by whom the support should be provided”.

 

The Appellant’s reference contained seven issues: four additional factors to be included (section 9(2)(a)(i)), and issues under each of the succeeding sub-paragraphs. As these seven issues are largely discrete, we shall discuss each in turn, outlining the evidence, the submissions and our decision. Finally, we consider the questions of timescale for amendment, and of future review of the now amended CSP.

 

7.1  Factor: The Curriculum

The Appellant’s evidence was that the curriculum the child was following was not appropriate to his needs. His evidence went into technical aspects of curriculum design, supported by his own research on the basis of which he had gone so far as to draw up his own version of the Elaborated Five to Fourteen Curriculum. He considered this offered scope to track the child’ progress against 77 strands, and had presented it to the School in the expectation that they would use it for that purpose. He considered the curriculum in use at the School was largely drawn from the Three to Five Learning through Play Curriculum, which had been appropriate at the nursery stage but was no longer appropriate.

 

The Head Teacher, who is a very experienced teacher of children on the autistic spectrum, said that the child’s curriculum is at present mostly delivered through play. It is tailor-made to match his skills and needs. The School had taken on board the Appellant’s version of the curriculum, which they felt closely matched their plans; but several of its strands would be irrelevant for the child, and others could not necessarily be worked through in a linear way. He was initially very passive within school but is now showing interest in his environment, and playing alongside other children. His vocabulary has extended and he is counting, sorting and matching. His progress is the best indicator of the appropriateness of the curriculum.

 

The Manager for Additional Support Needs, who was a long-serving support for learning teacher prior to moving into development and management posts, added that the curriculum is delivered in a holistic way, and in a highly visual, autism-friendly environment. The Appellant’s version would be heavily weighted to assessment and recording, which could detract from good teaching. The School already used an individualised curriculum plan and would now share that with the Appellant in an adapted format. Future curriculum development would need to take account of changes related to the forthcoming Curriculum for Excellence.

 

The Appellant stated in written submissions that curriculum could be a factor giving rise to additional support needs. There was no evidence of curricular tools being individualised at school. In oral submissions, he did acknowledge the force in the Head Teacher’s evidence, but nevertheless suggested there were holes in the current provision.

 

The Solicitor for the Education Authority accepted that curriculum could be a factor if significantly mismatched with a child’s needs, but said none of the evidence substantiated this in the child’s case.

 

We accept that the curriculum could in itself be a factor giving rise to additional support needs, as noted in the Code of Practice “Supporting Children’s Learning” at Chapter 4, para. 11. But we had no hesitation in preferring the education authority’s evidence on this issue. The Appellant has clearly spent considerable time in developing his version of the curriculum but, although he has detailed knowledge of his son at home and is committed to his development, he lacks the depth and breadth of knowledge about the curriculum, teaching and learning of children on the autistic spectrum of the Head Teacher and the Manager for Additional Support Needs. We were satisfied that they were committed to the child’s development and that the undisputed progress he has made during his first year at School is the clearest possible indication that his individualised curriculum has been appropriately designed and delivered to date.

 

We thus make no direction to amend the child’s CSP on this point.

 

7.2 Factor: Refused Assessment

This factor concerned a request for assessment of the child using a particular assessment tool, which was recommended by the Consultant Paediatrician and her colleagues when they assessed the child, at the request of his parents, in January 2009. The requested assessment was refused by the education authority, as was a request for independent adjudication of that refusal and the Appellant has now referred the matter to the Scottish Ministers under section 70 of the Education (Scotland) Act 1980.

 

The Appellant conceded that this issue did not fall within the compass of section 9(2)(a) of the 2004 Act. It appeared he included it in his reference partly to demonstrate what he considered the education authority’s unhelpful attitude to his requests, and partly in furtherance of his view that the assessment he sought was necessary in order to clarify the child’s factors giving rise to additional support needs.

 

We are clear that this is not a matter that falls within the scope of our jurisdiction in relation to the contents of the CSP. We thus make no direction to amend the CSP on this point.

 

7.3  Factor: Inclusion in Mainstream Provision

The Appellant said that at nursery, the child spent almost half his time in mainstream provision and really enjoyed it. The lack of opportunity to mix with his peer group now was not helping him with social inclusion and communication skills. He felt his son was sufficiently observant to benefit from greater inclusion. But if integration didn’t happen now, it was unlikely ever to happen. His one to one support would go with him into mainstream.

 

The Head Teacher said that each child’s inclusion was worked out individually. It was essential to think how it would be relevant and developmental for the child. Inclusion in a music-related activity had built on his interest, but was discontinued as the music specialist was on long-term sick leave. A busy mainstream class would be inappropriate for him at his current level of development and could not be compared to the less structured nursery environment. He did not yet have sufficient awareness of other children to play with them or learn from them, and mere physical inclusion with a classroom assistant would not be beneficial for the child. The School’s thrust was to have more inclusion for children from the enhanced provision, but it always had to be planned and supported individually to ensure their genuine participation and well-being.

 

The Manager for Additional Support Needs echoed the Head Teacher’s evidence and said the education authority regarded children as, first and foremost, mainstream pupils. Both the child and the class are carefully prepared whenever he goes into mainstream provision. He needs the specifically adapted environment of the enhanced provision. He does not yet have the awareness of others or the skills to play with other children.

 

The Appellant continued to submit that the relative lack of inclusion available for the child at school, when compared to his nursery experience, was not what he had envisaged. The EA’s Solicitor rested on the evidence of the Head Teacher and the Manager for Additional Support Needs.

 

We agree that inclusion could, if significantly mismatched to a child’s needs, amount to a “factor” in terms of section 2(1)(b) of the 2004 Act that could have a “significant adverse effect” (section 2(2)(a)) on the child’s education. But we accept the evidence of Head Teacher and the Manager for Additional Support Needs that there is no such significant mismatch here. The Appellant’s wish for his son to experience as much inclusion as possible is deeply felt and entirely understandable, particularly given the child’s experience at nursery school as he described it, but cannot displace the strength of the evidence pointing to the appropriateness of his son’s current learning environment, or the care with which the question of inclusion is addressed in the School. We thus make no direction to amend the CSP in this respect.

 

7.4  Factor: Dialogue

The Appellant said that regular communication from school to home was mostly through the weekly planner, which in practice provided only limited information. He had missed some scheduled meetings at the School. He had provided information, when the child started school, on how to manage his toileting and feeding, amongst other things, but this information had not been properly utilised. Further difficulties had arisen over a recommendation by a health service dietician with which he disagreed, but which had been passed to the School despite his having sought and received assurances that it would not be issued to anyone. That had resulted in his embargo on communication. He accepted that his highly detailed approach could appear overwhelming and to an extent de-skilling of professionals, but he had previously been brushed off when he had tried to ask simple questions about what people were doing for his son. Communication between himself and the education authority was now almost at an impasse, as exemplified by holding eight meetings to consider the child’s CSP in draft.

 

The Head Teacher said parents were encouraged to attend various meetings in school and to maintain dialogue. The Appellant was always very amenable when they met and it was disappointing things had come to this. The Appellant’s information had been helpful. The School tried to let parents know what they needed, but had to balance that with the time required and the needs of other parents. The School had worked closely with other parents using TEACCH. She had only limited ongoing information from his parents as to how the child was doing at home: more would be helpful. The School did have detailed records of planning and of achievement through the year, which would be shared through parents’ nights and open afternoons. The School worked very closely with speech and language therapists: the effect of the embargo on health communication was like having their right hand cut off.

 

The Manager for Additional Support Needs said that, taking account of the earlier evidence the School would now share their individualised curriculum planning material with the parents every term. The School would welcome more informal communication, and more information about the child’s activities and progress at home, as they could then build on that in school. Communications from the Appellant were highly specific and detailed. Staff found it relentless and felt their expertise was constantly being questioned. The time spent on the child’s CSP, and the level of her personal involvement, were both unique. The Appellant’s inputs had resulted in several positive changes for the child, but the overall impact was a level of pressure such that staff members were in danger of losing sight of their duty of care for the child. The embargo on health communication had caused great anxiety for school staff and the speech and language therapist, giving rise to questions about whether it was impacting negatively on their ability to work together for the child.

 

The Appellant submitted that parental involvement was a key concept of the 2004 Act. He wished his views to be taken into account for action, not merely noting, and considered this was in his son’s best interests. He accepted our suggestion that, if amendment of the CSP was required in this regard, it might be more appropriate to see this as a matter of the additional support required, rather than of a factor giving rise to additional support needs.

 

EA’s Solicitor confirmed the education authority now proposed an amendment to the CSP to include reference to communication with the parents by the School. In broader terms, however, nothing in the evidence demonstrated that communication issues were in themselves a factor giving rise to additional support needs. There had been exhaustive communication between the authority and the Appellant. What was now on offer was well in excess of that which the School made available to any other parent. But everything was being questioned and cross-checked, without any degree of trust, which was very wearing.

 

This aspect of the reference overshadowed much of the evidence, and gave us greater difficulty than any other. We have no doubt that there was a mismatch of expectations as to communication between the School and the Parents, at least in the early days. But the Appellant’s requirements are, on both the evidence and our experience as Tribunal members, at the high end of extreme – particularly as he seeks not just information but influence and even control. Several issues have become both enmeshed and entrenched. Yet it is puzzling and disappointing that it appears the flow of information from home to school has been much less than the School would prefer, and that communication is typically carried on through detailed written means rather than informally and orally.

 

We think EA’s Solicitor is correct in highlighting an underlying lack of trust, and in expressing concern as to its longer term implications. Despite the progress that the child is making, and the commitment and professionalism of staff, we also find ourselves most anxious at the prospect that the child longer-term progress may be impeded by staff feeling driven to an increasingly defensive stance. The practical implications of the embargo on health communications already point in that direction. It was most concerning that the Appellant gave no indication of acknowledging that these difficulties arose directly from his actions in furtherance of a dispute with the health service. His dispute concerned control over information flows; the results, on the evidence, directly affected service delivery to the child.

 

We consider that these communication issues do not, in terms of either the Act or the Code of Practice, amount to a factor giving rise to additional support needs. It would be straining common usage to suggest that this is, for instance, an issue arising from the learning environment or the family circumstances (Code of Practice, chapter 4 para. 11). Nor - at least yet - is it having a significant and ongoing adverse effect on the child’s school education.

 

There is, however, an undoubted need for improved home-school communication as an aspect of the additional support requiring coordination if the child’s needs are to be met properly. Moreover, this must be addressed in both directions if relations between the Parents and the education authority are to improve – which they must. We welcomed the amendment proposed by the education authority, which we consider offers a framework for very comprehensive communication from school to home. But that must, in our view, be further developed through ongoing communication from home to school and ongoing development of trust. Accordingly, we direct that the “Additional Support Required” as stated in the CSP be amended in the terms set out on page 2 above.

 

7.5  Educational Objectives

The Appellant referred in evidence to his proposed version of his son’s CSP. He considered the authority’s CSP contained too few objectives, and that they were expressed in vague terms such that success could not be judged. His version included objectives that were “SMART” that is specific, measurable, attainable, relevant and timed. He demurred somewhat from the suggestion in his original reference that the authority’s objectives had been “designed to avoid quantification entirely” (emphasis added), but said the difficulty in specifying whether the child was improving got in the way of dialogue. His version of the CSP picked up all the elements requiring integration from his curriculum plan. His child was entitled to a holistic education, and he had described what he thought his son could reasonably achieve in a year. 

 

The Consultant Paediatrician evidence touched on this issue in that she said he was a complex child with a variable skills profile. It would be difficult to plan up to a year in advance: in relation specifically to his motor impairment, all that could be said was that he was likely to require intervention at some point during the year from an occupational therapist and a physiotherapist in addition to the School and speech and language therapy staff already working with him. Professionals would need a flexible approach to assessing need and responding appropriately.

 

The Head teacher saw the CSP as the overarching document, whereas the IEP was the working document. CSP objectives did not require to be as measurable as those in the IEP. It was possible to review progress against the CSP objectives: the manager for Additional Support Needs had produced a detailed grid which was used successfully at a meeting in January 2009 to review the previous CSP.

 

She echoed the Head Teacher’s evidence about the relationship between the CSP and the IEP. She added that CSP objectives had to be written with a view to progress over a year, to show how the child was moving on and how inputs were being coordinated. It was much harder to predict where he might be in a year than it would be for many other children. She accepted that it would be helpful to show more explicitly how the CSP objectives linked to those in the IEP.

 

The Appellant submitted that his version of the CSP was more in keeping with the terms of the Code of Practice, particularly para. 54, than the education authority’s version was. EA’s Solicitor submitted that the purpose of a CSP was quite different from that of an IEP. The appropriateness of the broad brush approach taken to defining objectives in the authority’s CSP was supported by the Consultant Paediatrician’s evidence. The use of a highly detailed CSP would be cumbersome and impractical in the time available to staff.

 

We consider it helpful to start by comparing the references in the Code of Practice to the setting of objectives in an IEP and in a CSP. In relation to IEPs, the Code states at chapter 3, para. 75:

“An individualised educational programme describes in detail the nature of a child’s or young person’s additional support needs, the ways in which these are to be met, the learning outcomes to be achieved, and specifies what additional support is required, including that required from agencies outwith education.”

 

The issue of educational objectives in a CSP is addressed in chapter 4, para’s 51-54. The key statements appear to us to be these:

“Educational objectives should be set to ensure that the child or young person benefits from the school education provided or to be provided. They should be viewed in the widest sense as encompassing a holistic view of the child or young person. They should be specific to the child or young person and their additional support needs.” (para. 51)

 

“The starting point should be to establish what it is reasonable to expect the child or young person to achieve over the course of the next year, taking account of the assessment information available. The objectives should be described in terms that are specific enough to enable the education authority, and the other agencies involved in supporting the child or young person, to monitor and review progress over time. When setting an objective, a question that needs to be answered is ‘How will we know the objective has been achieved?’ Since each co-ordinated support plan has to be reviewed on, at least, an annual basis then the objectives should be those which can be achieved in a year approximately or for which progression milestones will be identifiable within the year.” (para. 54)

 

Taking these passages as a whole, our view is that the intention of the statutory scheme is to have a greater level of detail in an IEP than would normally appear in a CSP. The CSP is intended to cover a full year period and to take a broader view of the child’s potential and the support required. The question suggested for consideration when setting CSP objectives is a relatively broad one. Given that, and also the contrast with the terms of chapter 3 para. 75, we do not agree with the Appellant’s contention as to the degree of specificity required in CSP objectives. It appears to us that the level of detail he seeks is entirely appropriate for an IEP, but not for a CSP.

 

Further, we accept the evidence of the Head Teacher and the Manager for ASN that it was possible to review effectively the objectives set, at a similar level, in the child’s previous CSP, and to determine the progress he had made against them. Their evidence as to the onerous implications of adopting the Appellant’s curriculum is also pertinent here. We also accept the Consultant Paediatrician’s evidence that a degree of flexibility is required in planning for the child. That necessary flexibility seems much more in keeping with the form and number of objectives in the CSP as it stands than in the Appellant’s alternative version, which contains 18 educational objectives, of which 16 are further elaborated into multiple strands of assessment.

 

Nevertheless, as the child has both a CSP with 6 broadly-based objectives, and an IEP with many more detailed objectives, we can see merit in being clearer about the correlation between the objectives CSP objectives and those in the IEP. We thus direct the education authority to amend the educational objectives in the CSP to the extent of making these links explicit.

 

7.6  Support Required

The Appellant’s reference encompassed several points about the information in the CSP on the additional support the child required, namely:

• there should be direct input from a physiotherapist and an occupational therapist
• the speech and language therapy input should be updated
• the parents should be viewed as co-therapists in the TEACCH approach
• he also raised issues about the child’s support chair, his feeding and his toileting.

 

The Appellant said the Centre, to whom he and his wife had referred their son privately, had made recommendations about ongoing review by therapists. But local OT and physiotherapy services had now – improperly - discharged him, and had not offered to provide any further service even when the education authority requested them to do so. Local newspapers had reported serious concerns about health provision for autistic children in the area. The child’s diet and eating problems were still concerns for now, but these should reduce over the next year. To gain the maximum benefit for the child from the TEACCH programme it was necessary to view the parent as a co-therapist who would be fully involved in all aspects of his education. The child’s special chair should be used wherever he was working at a table – consideration had been given to whether he should use it in the dining room - and required OT input.

 

The Consultant Paediatrician spoke to the multi-disciplinary assessment carried out at the independent centre in January 2009 over a period of 2 days and to the resulting report. The assessment was informed by reports of previous assessments as supplied by the appellant, but (at his request) without direct contact with local services. The report recommended specific physiotherapy and OT input but, given the child’s variability, his motor difficulties and her lack of knowledge of how expert the School staff members were, it would be better to specify a regular reviewing input from therapists: both to guide the School’s interventions, and to allow for direct intervention as required. She recommended the use of the psycho-educational profile-3 tool to monitor the child’s development, and that a formalised cognitive assessment should be gathered by school staff over time and collated by the educational psychologist. The child showed large discrepancies between strengths and weaknesses, necessitating ongoing profiling.

 

The Head Teacher said a physiotherapist had seen him in school. The classroom assistants were very caring and well-trained, and had taken advice from the independent report and from the physiotherapist and occupational therapist. She accepted that therapists could sometimes see things that school staff missed. Further input would depend on the School contacting the therapist, unless it was part of the programme for the child, in which case it would need to be planned in. The School had followed the Appellant’s advice about managing the child’s eating and drinking. The School had worked closely with other parents using TEACCH. The child’s special chair was used mainly in his classroom, for table-based work. The current chair would not fit the dining room tables.

 

The Manager of ASN said the independent report contained lots of practical suggestions, which School staff had utilised. In practice, it was difficult to get NHS professionals involved in formal review processes: they would rather prioritise spending time with the children. Reflecting on the Consultant Paediatrician’s evidence, the authority would now ask for regular observation and planning inputs from physiotherapy and occupational therapy (taking the form of a more collaborative approach now being developed by the authority), and agreed the CSP should be amended accordingly. On TEACCH, visual symbols played an important part. The School had offered the parents to support the use of symbols at home. The Appellant had declined this, which was fine since like many autistic children the child may present differently in different environments. But it would also be helpful to have information coming into school about what he was doing at home, upon which staff could then build in developing their programmes for him.

 

The Appellant submitted that the CSP should provide for the full range of additional support recommended by the independent centre. The CSP should also include text requiring health therapists to adhere to professional standards in their involvement with his child, and to continue their involvement unless discharge criteria were met. As stated in the Code of Practice chapter 4, para. 55, the support to be provided should be clear and specific, as it was in his version of the CSP.

 

EA’s Solicitor submitted that the CSP should be amended as now proposed by the authority in the light of the Consultant Paediatrician’s evidence. The School would be happy to collaborate with the Appellant on TEACCH, but only on clearly understood parameters. The authority would liaise with OT on problems raised by the Appellant about the use of the child’s special chair.

 

The Code of Practice states at chapter 4, para. 55:

“The co-ordinated support plan must describe the additional support required to achieve the education objectives stated. This will cover teaching and other staffing arrangements, appropriate facilities and resources, including information and communications technology, and any particular approaches to learning and teaching. The statement of support to e provided should be clear and specific and, wherever possible, should be quantified. Everyone should understand and be clear about what is being provided and why it is being provided.”

 

In our view, there is already a reasonable degree of specification in the statement of additional support required in the child’s CSP. We accept the Consultant Paediatrician’s emphasis on the child’s variable profile, which must imply caution as to making over-specific statements that quickly become irrelevant. Nevertheless, her evidence did point to a clear need for coordinated advice and (where necessary) input from health therapists. We were pleased that the education authority recognised the force of that evidence, and endorse the amendment to the CSP which they proposed. In our view, this also sufficiently addresses the Appellant’s concern about updating the detail of the ongoing speech and language therapy input.

 

Beyond that, on the evidence before us we do not consider that any further amendment to this aspect of the CSP is required. We consider it would be highly inappropriate to include in the CSP directives drawn from professional standards. A reference on the contents of a CSP is not an appropriate vehicle for taking a position on the quality of service provision: as the Appellant is undoubtedly aware, there are other avenues open to him if he is dissatisfied with the availability or quality of service provision.

 

In relation to TEACCH, given the already difficult climate of communication between the Appellant and the services, we do not think it appropriate to direct even greater involvement than he already seeks to have. But we do accept the emphasis in the authority’s evidence on the need for two-way communication, and have reflected that in the communication-related text discussed earlier. On the support chair, the Appellant contended that the child should be able to use it in the dining room as well as in class-based activities. No evidence, however, was presented to indicate whether the child was experiencing actual difficulty in the dining room, in a way that would be addressed by using the specialised chair there. The other matters are, in our view, sufficiently addressed in the CSP.

 

We thus direct the education authority to make the amendment specified on page 2 above.

 

7.7  Persons Providing the Support

The Appellant said that the educational psychologist, the dietician and the continence advisory nurse had all been omitted from the list of persons providing support to the child. Any element requiring coordination should be in the CSP, even if not significant in itself. Use of the toilet was included in the CSP as part of the additional support required. Similarly, additional support was required on eating and drinking yet the dietician was not included. Whether or not the educational psychologist was covered by the generic descriptor “education staff”, there was no evidence in the CSP of what their actual input was. He had sought the involvement of educational psychology in undertaking an assessment of the child, but they had refused to provide it.

 

The Head teacher said the educational psychologist came into the school perhaps once a fortnight, primarily to advise the staff. The psychologist recognised the School staff as experts. They had not required her input regarding the child, but would certainly do so if needed.

 

The Manager for ASN said that all children have the right to access the educational psychology service, which in terms of the CSP was covered by the term “education staff”. Any direct input would need the parent’s consent and would be in response to a specific issue. But the expertise of school staff was recognised by other schools as well as by the psychologist. The continence advisory nurse would continue to review the child every 6 months. Although she had declined to attend the CSP review meeting, coordination would continue at school level anyway. There was no reference to the dietician as the Appellant had informed her that the previous dietician had been removed from working with the child, and had not provided details of her replacement. The CSP process would normally engage with a named therapist who had the child as an open case and was currently working with him or her.

 

The Appellant submitted that his proposed insertions were appropriate in terms of chapter 4, para. 56 of the Code of Practice. The evidence had demonstrated a need for continuing coordination on toileting, feeding and the child’s support chair. EA’s Solicitor submitted that the educational psychologist currently had no ongoing part to play; the continence advisory nurse does not provide significant additional support; and that the Appellant had not allowed the dietician to offer any service.

 

We consider that the Code of Practice offers little guidance on this aspect of the CSP. Chapter 4, para. 56 simply states that the statutory reference to “persons” providing support really means the agencies or professions who do so, rather than named individuals. Equally, however, we do not think it is helpful to seek to apply the “significant additional support” test to every individual element of support required in order to meet a child’s additional support needs. Nothing in the Act or the Code of Practice requires application of the test at that level of detail. Rather, we consider that a reasonably broad approach must be taken: when a child requires significant additional support to the extent that a CSP is appropriate, and the support required is set out in the CSP, then any service whose input must be coordinated with that of other services in order to provide that support should be listed against that support in the CSP.

 

On that basis, we agree with the Appellant that the dietician and the continence advisory nurse should be included in relation to the sixth objective, where the additional support required includes reference to drinking, eating and toileting. It is clear on the evidence that the input of these services will require to coordinate with the actions of the School staff. We also direct that the occupational therapist and the physiotherapist should be included in relation to the new text to be inserted into the second objective (which, as stated above, will also be relevant to all four subsequent objectives); and, against the text on communication to be inserted into the first objective, that education staff and the parents should be shown as the persons providing the additional support.

 

We do not, however, consider it necessary to direct that any specific reference to the educational psychologist be inserted. We think it reasonable to work on the basis, which is accepted by the authority, that they are included in the generic term “education staff”. Even the cognitive assessment proposed by the Consultant Paediatrician would, on her evidence, be carried out largely by school staff with the psychologist providing analytical support. Should it be accepted at any stage that there is a requirement for more direct intervention with the child, it may then become appropriate to include specific reference to educational psychology as a distinct service provider in a future review of the CSP.

 

We should add that evidence on this and the previous strand of the reference frequently strayed beyond questions of the CSP contents and into issues of service provision or delivery. It is a curious feature of the Tribunal’s jurisdiction that it is focused so exclusively on planning rather than delivery. It was necessary at several points to bring attention back to the question before us.

 

7.8  Timescale for Amendment

As we have specified all the amendments to be made to the CSP, we shall allow the education authority until 30^th September 2009 to incorporate them and to distribute the CSP as thus revised. 

 

7.9  Review of the Amended CSP

Both the Appellant and the education authority indicated that it would be helpful to have guidance from the Tribunal on the timescale within which the now amended CSP should be further reviewed. Again, this is an issue curiously overlooked in specification of the Tribunal’s jurisdiction over CSPs. It is not a matter on which we can make binding directions. Nevertheless, it may be helpful to offer a view.

 

The current CSP was issued in March 2009. Several aspects of its contents have been subject to exhaustive review in the course of this three day hearing. Against that, we have to bear in mind the Consultant Paediatrician’s evidence about the need for ongoing flexibility in planning for the child.

 

It seems to us it would be most appropriate to allow the now amended CSP to run through the current school year, with a review scheduled to be completed by the end of the summer term of 2010. That would allow planning for the child’s third year in school to build on a review of most of his second year.

 

It is, however, for parties to determine this themselves. We simply express the hope that they can do so quickly and without complication.

 

Date:  9^th September 2009