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CHAPTER FIVE: EDUCATION

Background

5.1. Education has a key role to play in our understanding of the needs of people with communication support needs. Children's first experience of society often comes through school and those with communication support needs may have distinct experiences of the school system which are outlined in greater detail below. However, education does not exclusively relate to school. Individuals with learning and other disabilities continue to have a wide range of opportunities in the further and higher education sectors.

5.2. Within the statutory education system it is now broadly accepted that children with special educational needs are, in the main, best provided for in mainstream schools within their community. UNESCO's 1994 Salamanca Statement triggered a major revision of the way in which services are offered to children with special educational needs leading to a series of policy initiatives across the UK ( DFES 2004) of which the most recent in Scotland has been The Education (Additional Support for Learning) (Scotland) Act (2004). The Act aims to ensure that all children and young people are provided with the necessary support to help them work towards their fullest potential, and that, where possible, they should be included in their local school. It is now understood that the system needs to address the individual child's needs in a flexible manner so that schools are able to respond to those needs appropriately at different points in the child's educational career. The Education ( ASL) Act also promotes a more integrated model of service delivery built around the child's needs and collaborative working among all those supporting children and young people and their families. Nonetheless, concerns have been raised about the "presumption of mainstreaming" for all children, especially those with autism and emotional and behavioural difficulties (Pirrie, Head and Brna 2005).

5.3. One of the key components of an adequate support system is integrated policy to identify and manage the needs of all children ( DFES 2003; Scottish Executive 2005). This is particularly relevant where different public agencies are involved - eg. education, health and social services. Allied health professionals, such as speech and language therapists and occupational therapists, feed into this process of support for individual children with additional learning support needs. Although, historically, such professional groups, with their close association with the health system, have tended to work with children outside the context of the school environment i.e. within clinics or hospitals, this has been changing both within the NHS (Scottish Executive 2002) and in terms of the interaction between other agencies. Indeed it is now common practice for speech and language therapists, and perhaps to a lesser extent occupational therapists, to offer the greater part of their services within the school, their practice embedded within the curriculum. There remain groups of children with complex health needs who require focused attention from an individual therapist but it is now assumed that, even for these children, best practice requires services to be delivered within the classroom (Carlin 2005) and the playground (Wooley, Armitage, Bishop et al. 2005). Inevitably such changes offer challenges to those concerned and this has led to the pressure to develop models of best practice that can be adopted for use within the educational context.

5.4. An area that has attracted considerable interest in recent years, especially for the professions covered by this review, is that of children's mental health. There is considerable pressure to integrate health, social care and educational systems delivering services to children experiencing difficulties in relation to their mental health ( PHIS 2003). While many activities are designed to be community based public health interventions involving nursery and teaching staff and more generic practitioners, occupational therapists and speech and language therapists are commonly involved in providing specialised services for the more severe complex or persistent mental health problems where assessment and treatment are the core function (Scottish Executive 2005). It is now also recognised that many of the children referred to specialist services such as Speech and Language Therapy are at risk of mental health problems.

5.5. Good models of practice are underpinned by systematic review and clinical guidelines ( RCSLT 2005; RCSLT 2006). There is now a range of such published guidelines, but these are usually derived from the literature and are thus sensitive to the nature of that literature. For example, gaps in the literature and low quality of available evidence will limit the strength of any recommendations and models of good practice that emerge from the existing evidence base. There are many gaps in the evidence base and as a result services commonly develop their own, more informal, guidelines reflecting custom and practice. A number of such guidelines related to the ASL legislation are available within the geographical area covered by the present project (Scottish Executive 2005; Midlothian Council 2004; City of Edinburgh Council 2004). There is also an increasing emphasis on the role that parents can play in the process of identifying and contributing to the support of children with additional support needs (Enquire 2005). Key variables in such guidelines include the range of children covered by a given service, the severity of the difficulties experienced by those needing intervention, the intensity and duration of the support provided, and the extent to which face to face contact is provided by the specific professional concerned or a non specialist professional, such as a teacher or an untrained assistant whether provided within the health system (ie. a speech and language therapy assistant) or within the education system (a teaching assistant). It is also important to recognise that good practice results from a combination of teacher and therapist input, parental involvement and an integrated management system designed to support practitioners (Law, Lindsay, Peacey et al. 2000).

5.6. There are a number of variables beyond current educational policy that affect the model of service delivery employed. Of these, one of the most persistent is the supply of therapy staff. While this is not necessarily true of the local context, it is often difficult to recruit and retain therapy staff and this can reduce the scope of service delivery, for example restricting coverage and having a negative effect on waiting lists within the service (Scottish Executive 2003a). This, in turn, can affect the skill mix of the service providers with pressure for less qualified but more readily available staff to fill gaps in services. One solution to the problem of availability of staff is to plan services that include specialists overseeing a larger group of relatively untrained practitioners, whether speech and language therapy assistants, occupational therapy technicians, or the teaching assistants found in most schools. While appealing both as a practical solution to the availability of therapists and in terms of the coverage needed to provide support to children within their local school the implementation of a "consultative model" is not always straight-forward (Law, Lindsay, Peacey et al. 2002). For example, there is concern that services that are addressed indirectly may lack the specificity focus and intensity of services provided by specialists.

5.7. Clearly different children have different needs and the system needs to be sufficiently responsive to this varying demand. It has been suggested that it may be useful to conceive of a number of different levels of need (Gascoigne 2006). The first of these might be termed the population level where provision is characterised as modifying curriculum delivery to improve the learning of all children. In this example good practice reflects what best meets the needs of children with additional support needs, but rather than working with the individual child, the decision is made to extend that practice out to all children. Examples here might be adapting strategies used with children with developmental co-ordination disorders or specific language impairment to help the organisational and listening skills of all children. The second level is aimed at targeting vulnerable children and is characterised by the use of specific intervention packages targeting the needs of individuals or groups of children with specific difficulties. This level would typically be carried out by learning support staff under the guidance of the therapist. The third level is aimed at providing specialised services to children with the most serious learning needs. At this level the child's needs are sufficiently complex to warrant individual attention from the therapist. There are various different versions of this model but the principle of a differentiated level of input relative to need is clearly a central tenet of the provision for children who have additional support needs. Although this approach was developed for England the same has been developed for Scotland at both a national (For Scotland's Children 2001) and local level (Mitchell, Smith and Stevens 2005).

Barriers

Statutory education

5.8. As indicated above, for many children with communication difficulties their first experience of services is through their health service, but with the increasing accessibility of nursery places for all and the extension of education services into nurseries it is commonly education services which have the central role in interacting with parents and children. A snapshot of the experiences of parents going through the process of having their child identified as being in need of support services was taken by the children's charity AFASIC (1993). As the name of this report, Alone and Anxious, suggests, for most parents their interaction with services, whether within the education or the health system, was considered to be negative. Although such tensions remain, the ground has shifted somewhat since then. Services in nursery and primary school have developed to a considerable extent and there is an increased awareness of the needs of children with developmental speech and language difficulties. There is also an acute awareness that there is very little provision to support transition across primary and secondary school and into employment, and there is almost no support for children when they are in mainstream secondary school. The barriers to effective provision in this area have been well described (Law, Lindsay Peacey et al. 2000) but tend to focus on problems at a system level such as the co-location of practitioners or the co-terminosity of authorities. There is relatively little in the literature about the attitudes of young people with CSN themselves to their difficulties, although there are clear moves to increase participation of children and young people in the educational process ( AFASIC 2002).

5.9. Although there is a great deal of literature about the tested performance of children in schools there is less information about the experience of school as far as children with CSN are concerned. One way of assessing this is to look at the way that children are treated in class, and specifically the extent to which they are bullied. The largest UK study of language impaired children examined the risk of bullying in this population and identified a three fold risk in language impaired children relative to children with normally developing language skills (Knox and Conti-Ramsden 2003). The rate for the latter group was 12% and for children with difficulties 36%.

This type of experience has often been reported in the deaf community where individuals have found it very difficult to integrate into mainstream schooling. The following is taken from a study of social alienation in the deaf community with a deaf adult looking back at his experience of education in a mainstream school:

" I did not know how to hang around with the hearing people. They constantly made fun of me, they tried many times to put up a fight with me. Several times I was involved in a …street fight. I really don't have much of a bitter (feeling) at it all now at what happened in the past. You know I just feel sorry for them, because they did not understand me as I didn't understand them…So I think that had a lot to do with what's happening to me as a person I am now…I've become shy. I learned to be shy as I was growing up. I learned to be quiet. Most of my friends today are complaining that I keep it to myself too much...many times I (would) like to talk out interpersonal relations, insights. Many times I can't. I don't trust them. I don't know, that's the way I am. I don't get close enough to anyone who is willing to listen or share with me."
Foster 1989 p.232.

5.10. One of the groups of children readily recognisable with CSN, are those who use alternative and augmentative communication systems ( AAC). Alternative and augmentative communication systems pose some very real challenges for the school system (Kent-Walsh and Light 2003, Hunt-Berg 2005). Not only do the children have major needs as far as communication is concerned but the equipment itself poses challenges, for example in distinguishing between the cost of the equipment and the "real cost" of installing and maintaining it, and ensuring that those around the child are able to use it (Parette and Marr 1997). The role of the family and their attitudes to the equipment and the services concerned are key to successful uptake in school (Parette, Brotherson and Blake-Huer 2000) and for use in leisure (Dattilo, Light, Peter et al. 1995). There are also likely to be culturally specific approaches to the introduction and use of such equipment (Parette, Blake-Huer and Brotherson 2001, Parette and Blake-Huer 2002). Parents views as to who is most and least helpful in meeting the needs of their children can make instructive reading. A survey of stressors and supports to families of children who use AAC found that mothers relied on their parents as a source of support within the family in meeting their child's needs. Fathers, on the other hand, relied on their spouses and their spouses' parents as sources of support. Professionals need to be aware of the family systems when advising parents of appropriate use of AAC technology and available support services. As parents rely on the wider family as a means of support then professionals may include extended family members in educating families on the implementation of AAC (Jones, Angelo and Kokoska 1998).

5.11. Adults who stammer also report experiences of being teased by peers, feeling alienated by teaching staff who lacked an understanding of their difficulties, and consequently being prevented from participating in extra-curricular events such as school plays. These early negative experiences led them to avoid stressful situations such as reading aloud or speaking in public (Hayhow, Cray and Enderby, 2002).

Higher and further education

5.12 Historically, little provision was made for people with disabilities going to further or higher education. This changed in Scotland with the Further and Higher Education (Scotland) Act 2005. The authors of this piece of legislation used the term "support needs" to refer to "support for the purposes of overcoming a difficulty of learning or a difficulty in participating in learning." Although this covers the full range of disabilities it is clear from the examples given in the consultation into the development of a needs led model of funding in this sector arising out of the legislation that young people with communication support needs come within its remit Scottish Funding Council (2006). Indeed one could argue that people with CSN are in many ways a focus of this legislation because the nature of the core business in the further and higher education sectors is completely dependent upon communication.

5.13 Yet it is clear from a recent report on the views of young people with disabilities on the accessibility of Further Education that there is still along way to go (Millar and Aitken 2005). A series of reasons were cited for not accessing or having difficulties accessing existing options:

• There is a severe lack of information, transparency and awareness of FE options, a particular obstacle faced by people who have severe difficulties accessing information
• Many college placements appear to be provision rather than needs led
• Those who provide services may find it difficult to communicate with and support the communication needs of students with specialised systems of communication
• There be no local additional specialist support for students with highly specialised additional needs
• Major funding problems arise for non-specialist areas particularly transport, escorts and helps for personal care
• Where services are identified and costs are involved there are often lengthy negotiations before agreements to fund are obtained. This results in delays in gaining access to both the college placement and to support services needed to access a given course

5.14 By contrast, people who stammer appear to experience fewer problems in further education, although concern was expressed that people with stammers do not pursue further education because of their earlier negative experiences of education (Klein and Hood 2004).

5.15 There is relatively little literature associated with the higher education sector. For some people with more severe CSN there may be funding available for assistants and other help in further education, a facility which is not generally available in higher education (Knight, Sked and Garrill 2003 p.18).The experiences of a visually impaired student training to become an occupational therapist suggested that attitudes remained a barrier even at this level, and within a professional group well versed in the expectations associated with disability (Sivanesan 2003).

Attitudes

5.16. In a relatively recent study of the impact of cochlear implantation, 181 school-aged deaf children were asked to report on their psycho-social adjustment, and their parents were asked to comment on how their children were managing in school. The children generally perceived themselves to be well adjusted in most aspects of daily life. Parents too were positive. Interestingly, parents' perception of their children's progress was significantly related to the child's speech and language development (Nicholas and Geers 2003). Parents' attitudes and expectations have also been seen as critical to the update of computer assisted devices for children with cerebral palsy.

5.17. Inclusion of children in school depends, at least in part, on the acceptance of peers. A child's experience is likely to be far more positive if their peers want to play with them. This is particularly true for people with communication disabilities, and within this group those who use alternative and augmentative communication ( AAC). Although there are a variety of ways of improving this (Beck, Thompson, Clay et al. 2001, Beck and Fritz-Verticchio 2003, Beck, Bock, Thompson et al. 2006), one of the main obstacles is probably that the children themselves commonly perceive AAC to be "uncool and boring" (Clarke, McConachie, Price et al. 2001). Indeed it could be argued that this very response is a classic example of the expectations of those in the child's immediate environment disabling the child.

Transitions

5.18. Transitions can be problematic for all children, but have the potential to be even more so for children with additional support needs, especially when they leave school. Guidance is now available to help young people manage this in Scotland. This became available when the new Additional Support for Learning legislation came into force on 14 ^th November 2005 (Contact a Family 2005).

5.19. The transition from primary school to secondary school can present a new set of challenges to adolescents who rely on AAC technology. Secondary school staff may have limited experience of non-speaking children. Furthermore, the structure of secondary education can put excessive demands on pupils with specific speech and language disorders. For example subjects are taught in separate classes by different teachers, who may have varied levels of experience of this group of children, thus different communication styles are likely to have a differential impact on the communication needs of the children concerned ( AAC 2000).

5.20. When young people leave the education system there are not always provisions in place to aid them with any ongoing problems they may have with their AAC device. For example if their equipment breaks or they require new updated technology - where do they turn for assistance? There may be organisations that provide assistance and support to this group after leaving school, however these services as yet may not be standard issue throughout the country (Larcher, 1995).

5.21. Transitions within education can be changing from primary to secondary, moving to a school in a different area or leaving school. In order to manage these transitions effectively the Additional Support for Learning (Scotland) Act recommends that local education authorities begin planning for these changes with other authorities such as health and social work at least 12 months in advance. Necessary information should be passed on to other schools and agencies at least 6 months before the transition occurs. For young children entering pre-school provisions planning should commence 6 months before the transition and the relevant information should be provided at least 3 months before the child starts. In the case of school leavers planning should begin at least 12 months before. Information should be passed on to the relevant agencies, such as the careers services of further education institutions, no later than 6 months before the young person leaves school (Contact A Family 2006).

Potential improvements

5.22. One of the key barriers to overcome in the education sector is that between the different professionals concerned. If these individuals are working to different goals it is probably unlikely that the child and family will have an altogether positive experience of the education system. Much has been written about this and the considerable implications for those delivering services as well as those training the practitioners concerned (Wright and Kersner 1998). Although this is true for all children with additional support needs, in schools it may be that children with CSN are especially vulnerable to misunderstanding because of the different professional backgrounds of the professional groups concerned. For example, there are clear differences in the way that speech and language therapists and teachers are trained to conceptualise disability.

5.23. A highly differentiated set of recommendations have been made as to how to include children in the decision making about their needs in school, for example in terms of eliciting the views of the young person, and conducting meetings to discuss the child's needs ( AFASIC 2002). These have much in common with the inclusion of children with a wide range of different needs. The nature of the communication difficulty experienced by the child means that there are likely to be specific issues for this group, but the principle of participation is now well established.

5.24. There has been an increasing emphasis on consulting children directly about their needs within the system and this process has been extended to people with learning difficulties, and by extension communication support needs (Lewis 2004, Lewis and Porter 2004). But there is relatively little literature on how this is done with children who find oral and written communication difficult.

5.25. One area which is starting to become potentially very promising is encouraging children to use new technologies to support their learning. By this we mean going beyond the idea that a relatively small group of children need access to alternative and augmentative communication towards a position where a much wider range of children use texting and e-mail as a way of communicating their needs and supporting their school work. This type of activity remains in its infancy at present and has to ensure that it can deal with the potential resistance from adults who might see this mode of communication as degraded (Plester and Wood 2006, Conti-Ramsden (forthcoming)). Apart from the obvious appeal of the technology, this approach may be able to enhance the children's ability in retaining instruction for assignment and develop their interactive skills.

5.26. Including people with communication and other disabilities into further education has become a focus of considerable interest in recent years. For example it has been shown that careful management of people in further education using AAC has considerable potential (Foley and Staples 2003).

5.27. The attitudes of the public as a whole are a key dimension of any policy of inclusion. Currently there is very little evidence available about attitudes to CSN, partly because the term is relatively new. An interesting recent development has shown that there may be a case for encouraging people to volunteer to work with children with disabilities (Fichten, Schipper and Cutler 2005). In this study adult volunteers working with children with physical disabilities and hearing impairment were assessed before and after starting to work as volunteers on scales of social distance and stereotyping. Not only does this appear to increase their understanding of the needs of the children concerned, but it also appears to have a beneficial effect on individuals' attitudes towards adults with disabilities.

EDUCATION - KEY POINTS

Problems identified

• Many children with CSN are subject to bullying. Adults report negative interactions with school peers and teaching staff which impact on their adult lives.
• Children who rely on AAC technology (artificial speech aids) often have negative attitudes towards this mode of communication. Their difficulties increase in secondary school and beyond, due to multiple teaching and communication styles.
• Although access to further education by people with CSN has improved, some barriers still remain and transitions to higher education are difficult.

Potential for improvement

• Full integration within the education system requires measures to promote awareness and understanding of CSN amongst staff, peers and the public.
• Managing the needs of children and their families can be improved through collaborative goal setting between professionals from different disciplines.
• Children should be included in decision making about their CSN; e.g, children using AAC may choose to adopt more accepted means of communication technology eg. text messages or email.
• All relevant staff should be familiarised with the child's communication needs and style of communication in order to adapt accordingly.
• AAC users need ongoing support as they move through the education system.

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