Guidance on partnership working between allied health professions and education

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3. PARTNERSHIP WORKING: IMPACT AND OUTCOMES FOR CHILDREN AND YOUNG PEOPLE

This guidance begins with the impact and outcomes of partnership working for children and young people. It is important to consider the Getting it right for every child6practice model and My world triangle which place the young person at the centre. This allows everyone involved to consider systematically:

  • How the child or young person is growing and developing
  • What the child or young person needs from the people who look after him or her
  • The impact of the child or young person's wider world of family, friends and community.

Getting it right for every child practice model

Getting it right for every child practice model

It is clear from Getting it right for every child principles, the practice model and My World triangle that placing the child at the centre is vital to successful partnership working. It is also clear that in addition to friends and family, a child or young person might be involved with a broad range of professionals. This guidance on partnership working does not want to diminish the key role of professionals from social work, other areas of health and the third sector who are all key partners in delivering Getting it right for every child. However, it is focused on the specific role that allied health professionals play in delivering additional support for learning in schools. 7 We recognise that the principles in this guidance will have wider relevance and apply to partnership working in other contexts.

My World Triangle

Collaborative Advantage8

The My World Triangle introduces a mental map that helps us all to understand a young person's whole world. The impact of what we do and the outcomes for the young person, captured by Getting it right for every child well-being indicators, relate to his or her whole world. It is important to acknowledge however, that identifying outcomes for young people which are the result of partnership working can be challenging. Difficult questions include, what is the result of maturation, independent of interventions? What is the result of the involvement of education alone or the involvement of allied health professionals independently? While acknowledging the difficulty, it is also important to avoid using false measures or settling for what can be measured and presuming that is the whole picture. If partnership working is valued and valid then there has to be an identifiable outcome for young people which is more than what would be gained by services being provided separately. This may be described as collaborative advantage. The concept of collaborative advantage has to be central to evaluating the impact and outcomes for young people which are the result of partnership working.

NHS Forth Valley with Falkirk Council have used progress in children's reading and writing skills and self-esteem as measures of working together to support communication needs. Joint evaluation, using baseline assessments and a control school, show that teachers and speech and language therapists working together can meet children's speech, language and learning needs within a school environment.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

NHS Fife and Fife Council work to build capacity in schools by determining the communication needs of each school. They then develop shared knowledge and understanding of communication, roles and responsibilities and curricular demands on speech and language. This process benefits children particularly at the early stages of staged intervention. Benefits include more systematic and appropriate support for individual children and for classrooms. This has a positive impact on learning, educational achievement, social development and mental health and wellbeing.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

Improving outcomes for children and young people

HMIE identify a number of sources of evidence in answer to the question "What key outcomes have we achieved?" Answering this question in relation to outcomes for young people may involve evidence which comes from different sources. This can include:

  • quantitative information such as progress identified through national assessments; specific assessment tools; achievement in jointly set targets.
  • qualitative information such as directly observing new skills applied in a different situation.

Establishing a baseline against which to measure progress is clearly helpful and facilitated by Getting it right for every child well-being indicators. Outcomes 9 from partnership working are best identified at the outset with individual roles and timescales agreed at the planning stage. This planning stage will include ensuring parents' and children and young people's views are taken into account.

Argyll and Bute Council with NHS Highland have developed local multi agency assessment teams. These include an educational psychologist, mental health nurse and speech and language therapist. The purpose is to reduce waiting times for assessment of autism spectrum disorder assessment. Trained initially by a specialist assessment team, comparisons have been made between both teams with a high diagnostic consensus achieved. Waiting times for assessment are significantly reduced as a result.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

Partnership working in Curriculum for Excellence and Getting it right for every child

For children and young people aged 3 to 18, the outcomes of partnership working between education and allied health professionals will normally be expressed in terms of progress in achieving the outcomes of Curriculum for Excellence. Curriculum for Excellence sets out every child's and young person's entitlement to a broad general education. A broad general education includes all of the experiences and outcomes across all curriculum areas up to and including what is called the third level, normally by the end of S3.

If we take the definition of literacy in Curriculum for Excellence as an example, it is possible to identify immediately ways in which education and speech and language therapists can work closely. Literacy is defined as "the set of skills which allow an individual to engage fully in society and in learning, through the different forms of language, and the range of texts, which society values and finds useful." 10 The literacy experiences and outcomes promote the development of skills in using language, particularly those that are used regularly by everyone in their everyday lives.

As part of an integrated approach to literacy, the City of Edinburgh Council has worked with NHS Lothian speech and language therapy service to identify joint approaches to developing key literacy skills. Central to this is the delivery of guidance and training to secondary schools to support the implementation of Curriculum for Excellence, especially literacy across learning.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

Partnership working is expected when delivering the experiences and outcomes, particularly those on health and wellbeing. Curriculum for Excellence states that "Effective learning through health and wellbeing which promotes confidence, independent thinking and positive attitudes and actions requires … partnership working which … draws upon specialist expertise [and] ensures, through careful planning and briefing, that all contributions come together in ways which ensure coherence and progression" ( Curriculum for Excellence, Health and Wellbeing Principles and Practice, p.5). 11

Education staff, allied health professionals and parents already work together to identify short and long term targets for children and young people. The same level of planning will continue to take place, only now it will be within the context of Curriculum for Excellence. When planning takes place in the context of Curriculum for Excellence, partners will focus on the outcomes identified in the curriculum areas. Partners will work together to identify the experiences required and steps a young person will make as he or she works towards achieving a particular outcome. The outcomes and the steps towards achieving the outcomes should be measurable in the same way that short and long term targets are measurable. In this way, partners should be able to identify the ways in which they are making a difference and helping young people achieve.

NHS Lothian and West Lothian Council have compiled a target bank aligned to Curriculum for Excellence. Targets are clear and easy to understand and help children and young people access the curriculum. Joint targets help everyone involved to work towards the same goals and see that therapy targets are relevant to Curriculum for Excellence. This enables effective therapy approaches to be woven into learning and teaching and throughout the school day.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

Fulfilment of Statutory Duties

Statutory duties do not apply to the partnership between allied health professions and education, but apply instead to the relevant education authority or health board. However, it is important that allied health professionals and education staff are aware of the relevant statutory duties as these relate to partnership working. Allied health professionals and education professionals are governed by different duties. Allied health professions' services are seldom statutory whereas education services are almost always statutory. In practice this means that allied health professionals' duty is to work with a child or young person for as long as they are able to make a difference to that child or young person. There is a wide range of legislation, guidance and codes of practice that are relevant to partnership working. These are summarised in appendix 4.

Central to partnership working is the Additional Support for Learning (Scotland) Act 2004 as amended by the 2009 Act along with the associated regulations and code of practice. These set out the framework for assessment, providing information and preparing co-ordinated support plans. Allied health professions working for NHS Boards, as an 'appropriate agency', have duties under the Act to help an education authority discharge their duties under the Act to identify and meet the additional support needs of children and young people. The involvement of the allied health professional is based on a clinically-determined decision regarding a child's needs and the potential impact the allied health professional may have on the child or those supporting the child. In the best practice, local authority staff and NHS staff work very closely in relation to meeting statutory requirements. The outcome of this partnership is that parents are involved and kept well informed and children have their needs met within the time-scales set out in legislation, associated regulations and the code of practice.

When partners are evaluating the quality of partnership working, part of this evaluation process includes evidence from self-evaluation, feedback and complaints. The additional support for learning legislation establishes clear procedures for mediation and dispute resolution. Information on the number of occasions when parents have requested mediation, dispute resolution or a reference to the Additional Support Needs Tribunals for Scotland is useful for partners. The information can help partners to understand how effectively the partnership is communicating with parents and meeting the needs of young people.

"What you said…"

We can see that the child's progress has been greater than we would have expected and that we have achieved more working on this programme together than if we had been going our own ways.

(Allied Health Professional and Teacher)

I find it really reassuring to know that my child's teacher regularly meets with his occupational therapist and that they talk about things that will help him.

(Parent)

Signposts for improvement. Allied health professions and education staff can improve outcomes for children and young people by:

1. Jointly agreeing the outcomes of partnership working, including indicators of progress.

2. Jointly identifying the steps a young person will make as he or she works towards achieving a particular outcome. Agreeing what evidence will be used to demonstrate progress towards a particular outcome, whether this is qualitative or quantitative.

3. Ensuring that allied health professionals and education staff are aware of and adhere to the relevant legislation, guidance and codes of practice within which each operates.

4. Ensuring that parents and children and young people are central to the collaborative process.

Issues to consider

1. How do partners identify which outcomes will be used to identify progress and therefore the outcome of partnership working?

2. Are allied health professionals sufficiently informed about Curriculum for Excellence to be able to contribute meaningfully to planning for children and young people to achieve the outcomes?

3. How can allied health professions record information on improved outcomes for children and young people and use the information in planning and resourcing services?

4. How can services use the evidence for collaborative advantage to inform school and service improvement plans?