Webinar on joint working and integration around SEND – sharing the learning from CDC’s regional events

21st February 2019

• “Joint working for quality improvement and integration around SEND: what we’ve learned” presented by the Council for Disabled Children

• “The Emotional Health Academy”, presented by Sally Murray and Barry Stormont

• “Developing an Outcomes Framework for children and young people in Bedford”, presented by Mrunal Sisodia

Agenda

Joint working for quality improvement and integration around SEND: what we’ve learned

• 9 events, 1 in each of the DfE Regions

• Focus on joint working and integration

• Updates from key partners – NNPCF, NHS England, Transforming Care, Regional Networks

• 1-2 examples of new ways of working

• Discussion and action planning

CDC Regional workshops – what we did

• Engaging with reality – children and young people with SEND and their families have complex lives; their needs cross traditional service boundaries

• CYP with SEND are also more likely to belong to other groups that need support

• The policy context – the Children and Families Act and duties around joint working

• The financial context – may seem to make joint working harder, but integration has the potential to reduce pressures on families and professionals

Why we need a focus on joint working

A complex web of inter-relating and intersecting vulnerabilities

SEND 1,244,255

Young offenders

sentenced 25,700

LAC

72,670

SEN support 45%28% EHCPs

6%52%*

57.3%

Learning disability

23-32%

Dyslexia 43-57%

Communicationdisorder

60-90%

ADHD 12%

ASD 15%

Young Offenders**

26%

Children needing support

SEND

LAC

CiN

Poverty

Alternative provisionYoung

offenders

Excluded

Mental health needs

Troubled families

Engaging with reality

Current figures for LAC, children with SEND and children in custody

• The number of pupils with special educational needs (SEN) was 1,244,255 in January 2017 (DfE, Special Educational Needs in England, 2017)

• At 31 March 2017 there were 72,670 looked after Children (DfE, Children Looked After in England, 2017 )

• In 2016/17 25,700 children and young people received a sentence in court (Youth Justice Board/MoJ, Youth Justice Statistics 2016/17)

Intersection between vulnerabilities

• 57.3% of LAC have a SEN identified by the end of KS2 (DfE, Children Looked After in England, 2017)

• 52%* of young offenders asked for a 2014-15 study said they were or had been in care (Youth Justice Board, Children in Custody 2014–15, 2015)

• 45% of young offenders sentenced in 2014 at the end of KS4 were recorded as having SEN without a statement, and 28% as having SEN with a statement (DfE and MoJ, Understanding the educational background of young offenders, 2016)

• 26% of boys held in YOIs in 2014-15 who said they had been in local authority care also reported having a disability (Youth Justice Board, Children in Custody 2014–15, 2015)

*This is the percentage who said they were or had ever been in care. The official figures are much lower and only represent children currently looked after.

**Prevalence rates of neurodevelopmental disorders among young people in custody (Howard League What is Justice? Working Papers 17/2015)

Context and sources

• Early intervention and the graduated approach• Low intensity support, e.g. West Berks Emotional Health

Academy• Starting in the early years, e.g. Northants Specialist SEND

Support Services

• Sharing resources and expertise locally

• Collaboration between specialist settings, e.g. Lincolnshire Special Schools, to deliver support closer to home

• Building skills and knowledge in universal settings, e.g. Therapies in Schools, Whole School SEND

What’s working well?

• Shared outcomes and strategy

• Hertfordshire Outcome Bees

• Bedford’s shared outcomes

• Meaningful co-production and participation

• Working with forums and families from the start e.g. St. Helens ND pathway, Rotherham Charter

• Empowering young people’s groups e.g. Suffolk Young Person’s Network

What’s working well?

Key challenges for 2019?

Links with youth justice

system

Inclusion (and exclusion)

Identifying and supporting children and young people with

autism only

The national picture: what’s coming up

• SEND Leadership Board

• NHS Long Term Plan• Key worker role• Expanded mental health services and support • Information and training on LD and autism• Integrated Care Provider Contract and ICS Accountability and

Performance Framework

• Changes to Ofsted framework and exclusions review

• SEND inspections and revisits ongoing

• Autism review and strategy to include children (Autumn 2019)

Opportunities for support

Support to local areas through the DBOT partnership

• Audit tool

• Regional events

• Local support

• DMO/DCO forum

• Children’s Commissioners Forum

Can you help us?

• Survey on joint commissioning arrangements: https://www.surveymonkey.co.uk/r/27NWPXC

• Survey on autism pathways: https://www.surveymonkey.co.uk/r/XW9HZMW

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Contact details

The Emotional Health Academy

Sally Murray (DCO & Head of Children’s Commissioning, Berkshire West CCG

Barry Stormont (Manager, Emotional Health Academy)

Berkshire West West Berkshire

Catalysts, challenges and enablers

• 2014 independent whole system stakeholder engagement on CYP emotional and MH across Berkshire

• Wake up call! Relationships. Co- production.• 2015 Future In Mind published• Mandate to transform. • More co-production.• £ helped.• THRIVE approach- Anna Freud Centre• Outcomes, outcomes, outcomes.• More co-production

Enablers

Co- production

Who we are

• A network of professionals

• Early intervention

• Child and family centred

• Part of a wider partnership

How we are funded

• Mixed funding model• Local Authority

• Berkshire West CCG

• Public Health

• Children and Family Services

• Virtual School for Looked after Children

• Trading with schools, families and organisations

What do we do

• Provide advice and signposting

• Coordinate support for families

• Emotional health support for children and young people

• Targeted support for emerging mental health problems

• Training for schools

Our Core Offers

Emotional Health Triage

Emotional Health Outreach

Primary Mental Health Support

Emotional Health Triage

• Triage is the place to refer children and young people too who have mild or emerging difficulties.

• Triage sits operationally with the EHA but it is a partnership model.

• It has strong links with the Contact Advice and Assessment Service and BHFT CYPF Health Hub

• A panel of key professionals meets every week to discuss cases

Emotional Health Triage

• Anyone can refer in to Triage to make a referral to get help, or to seek advice.

• Our Triage Coordinator makes contact with the family.

• If the family cannot be immediately signposted the case is discussed at panel

• The family, referrer, and GP are notified of recommendations

• A review is carried out at 10 weeks.

Triage Panel

EHA

SAFE! Project

CAMHS

Time 2 Talk

CAAS

School Nurses

ANDY Research

Clinic

Emotional Health Triage

Emotional Health Triage

• We receive on average 132 referrals to triage each quarter.

• Most of our referrals come from GPs, Parents and Schools.

• Anxiety is a reason for referral in 55% of cases. Likewise for mood.

• 10% of referrals had a diagnosis of Autism.

• A further 10% were waiting for an Autism assessment.

Emotional Health Outreach

• We have four Emotional Health Workers

• Their time is bought back by schools, and more recently by parents.

• Deliver low intensity emotional health interventions.

• They offer classroom based interventions

• Run PPEPCare Training and Restorative Practice Interventions

Primary Mental Health Support

• We have four Primary Mental Health Workers (PMHWs).

• Provide targeted interventions for emerging mental health problems.

• They receive regular supervision from a CAMHS Practitioner.

• They line manage and supervise our Emotional Health Workers.

Primary Mental Health Support

• Two PMHW provide support for common difficulties such as anxiety, low mood, and self-harm

• Our PRU Mental Health Worker provides systemic support to our pupil referral units, as well as individual and group interventions.

• Our LAC Mental Health Worker provides assessment and treatment to children in care, and consultation to our LAC Service

Our Impact

• By enabling earlier access to briefer interventions we are able to see more children and young people. We close 85 direct interventions per quarter.

• We use Routine Outcome Measures to track improvements. 85% of children receiving our support report improvement in their wellbeing.

• 1 in 10 children who access our support are stepped up into additional CAMHS support.

• We see a further 250 on average per quarter in large group or classroom activities

Our Impact

• We are providing more support to children, young people and families than ever before.

• We have been selected as a trailblazer site for NHS England’s Mental Health Support Team pilot.

• However, demand is increasing nationally and we need to continue our focus on innovation and early intervention.

Thank you and questions

Barry Stormont (EHA Manager) –barry.Stormont@westberks.gov.uk

Outcomes Framework

Overview

Bedford Borough’s local area inspection

1

An outcomes framework

2

Workshops to understand what our priorities are and measure how we are doing

3

Findings and recommendations

4

What happens next?

5

Local Area Inspection

In February 2018, Bedford Borough had its local area SEND inspection. The

inspectors issued a Written Statement Of Action. They highlighted five areas:

There are no co-ordinated priorities, strategies or accountabilities between

the services to ensure that joint commissioning is undertaken

effectively.

BCCG has only very recently carried out its self evaluation to identify

progress and barriers to implementing the reforms. At the time of the

inspection, there was no robust plan in place to deliver the necessary

actions to ensure that outcomes for children improve.

Leaders have not ensured that the local offer provides clear,

comprehensive accessible and up to date information about the available

provision and how to access it…

Leaders have not ensured collectively that EHC plans identify the range of needs for children and young people beyond diagnosis or a multi-agency

approach to meeting needs effectively including subsequent signposting and guidance around personal budgets.

There are weaknesses in provision across the borough for young people who have emerging SEND including SEMH and more complex needs such as ASD to live successful lives where they participate positively in wider borough life and engage successfully in education, training and transition

to adulthood.

Outcomes

To create “co-ordinated priorities, strategies [and] accountabilities” we need a shared approach

We need to agree the outcomes that we must deliver.

We have adapted Hertfordshire’s work and grouped our outcomes into 5 different areas:

Be happy Be healthyBe

ambitious

Be independent

Be heard

What is an outcomes framework?

An outcomes framework describes the things that children and young people

with SEND and their families want for them.

The outcomes people want

What does this mean for children, young people and

families?

What support and services do we need to deliver

this?

How do we measure this?

Examples of the outcomes framework

Outcome What does this mean? What services and

support are needed?

How do we measure

this?

Be independent I can make choices about

my own life and I am

supported to plan what I

want to do

Flexible personal

budgets that enable

me to plan and do

what I want to

The number and

percentage of SEND

families eligible for a

personal budget /

direct payments who

have one

Be independent I can go where I want to,

when I want toSafe, quality assured

and risk assessed

transport services are

accessible and

transport training is

available where

required

The number and

percentage of CYP who

have been transport

trained.

The number of bus

drivers and taxi drivers

that have had

disability awareness

training.

Workshops:

What do

families want?

A survey to ask them how we are currently doing

against our outcomes

What is currently working well and what changes

to services would make a difference to families?

The outcomes people want

What does this mean for

children, young people and families?

What support and services do we need to deliver

this?

How do we measure this?

Survey - United Nations Convention on

the rights of the Child (UNCRC)

Our survey is based on the UN convention on the human rights of the child

We do not include all of the articles because not all of them are relevant for

children with SEND in the UK (for example child labour or child soldiers)

We believe that all children should have these rights and that children and

young people with SEND are no different

Outcomes survey

Do you think you are supported to provide a standard of living that meets your child's physical and social needs?

Do you think your child is protected from bad treatment, violence abuse or neglect?

Is your child enabled to have friends and participate in groups that they chose?

Do you think your child is able to play, relax and take part in leisure, cultural or physical and social needs?

Is your child’s supported to be as healthy as possible, including education about how to stay healthy?

Do you think your child is enabled to reach their full potential?

Does your child have access to education?

Is your child’s education developing them to their full potential – their personality, their talents and their abilities?

Do you think you child's privacy is protected?

Is your child able to freely learn about their culture, language and religion?

Do you think your child is supported to live an independently as possible and be active in their community?

Do you think as a parent you are respected to act in the best interests of your child, including them in decisions where appropriate?

Do you think your child's best interests are always the top priority in decisions about them?

Do you think your child is supported to express their views about anything that effects them (this could include your decisions as a parent)?

Do you and / or your child understand what rights they have?

Survey results

The average score was

3.04 out of 5

It tells us that the

needs of children and

young people with

SEND in Bedford

Borough are only

being partially met

Is this good enough?

Findings

Families like the local charities and the services they provide

Families like the SEND Advice service and want more of it

The special schools in Bedford are person centred and wrap around the family.

Families with personal budgets recommend them

Families do not feel included in the community

Families need more access to therapy services

The experience of children with SEND in mainstream schools is too varied and often poor

Families are waiting too long to get help

Parents want and need more information and support

Parents do not feel that they are heard

Recommendations

The report made 16 specific recommendations that were coproduced with the local authority and the CCG. These included measures to:

Support mainstream schools to be more inclusive

Jointly commission therapy services

Explore making more personal budgets available for therapy services

Hosting a local offer live event relaunch and publicise the new local offer

Creation and widespread adoption of the new co-production charter across all agencies

Next steps

The report is being shared with key decision making bodies in Bedford

Borough – SEND Implementation Board, Health and Wellbeing Board,

Children’s overview and scrutiny committee.

The recommendations have all been incorporated into the WSOA plan and

the local area SEND strategy

We will conduct the survey again in January 2020 to see what difference it

has made to the lives of children and young people with SEND.

Questions ?

Thank you for joining this webinar !