Managing SEND, Part 6: Complex Needs - Shared experience

See the full series on managing SEND

Children with complex needs have a right to experience as ‘normal’ a childhood as possible. Innovations in medical equipment and professional support – along with a positive mindset – make this increasingly the norm. For early years providers, one of the biggest challenges is to ensure children participate in all aspects of nursery life.

Consultant and trainer Kay Mathieson believes that health professionals working ‘around the child’ are now attuned to the benefits of attending high-class early years provision to provide a common experience with their peer group and invaluable support for a family.

‘The more care plan discussions include sharing professional perspectives and training, the more inclusive the child’s experience is likely to be,’ she says. ‘We are not talking about early years practitioners becoming medical professionals but recognising how they can contribute to specific elements of the child’s plan.

‘Where individual professionals from health, social care and education are talking to each other, training and combining their energies around the child, inclusive practice becomes the norm rather than the exception.’

BRIDGING THE GAP

Even those nurseries which are proud of their inclusive provision may have to rely on parents initially for the required one-to-one support, however.

At LEYF’s Angel Community Nursery in Islington, this worked well for two-year-old Elisha, who has spina bifida, which is when the bones of the spine don’t form properly around part of the spinal cord.

Elisha has strong upper-body strength and is able to access all areas of the provision, as long as someone is there to ensure she doesn’t hurt herself. Her mother was able to stay with her in the mornings for her first two and a half months at the nursery until additional help had been secured. However, this was not easy as, though she did not have a job, she had other children to look after and English is not her first language.

Manager Christel Brown says, ‘Elisha came to us on the two-year-old entitlement, and our first step was to secure contingency funding from Westminster Council’s inclusion fund. This involved an advisory teacher coming into the nursery and spending time with Elisha, her mum, myself and staff to gather all the information needed.

‘In the end it took a couple of months for the funding to come through, but this now supports her for her full 15 hours a week.’

The setting is in the process of securing an Education, Health and Care plan. ‘When this is in place it will supersede the current funding and ensure she has support when she moves to school,’ Ms Brown adds.

ACCESS ALL AREAS

Securing funding for children with complex needs, who do not have special education needs, can be problematic, as Allexton Day Nursery in Leicester highlights.

With its strong track record in SEND, the nursery currently has 18 children with a range of additional needs, including autism, DiGeorge syndrome and hearing impairments. Deputy manager and SENDCo Barbara Betts explains that the nursery is still struggling to access funding for a little girl with cerebral palsy, whose body is paralysed on the right-hand side.

‘The little girl is dual-language and is bright, so there is no reason for us to contact our local specialist teaching service and they would not be able to offer us anything,’ says Ms Betts.

‘Her needs are purely physical and for this reason we are trying to bring occupational health and a physiotherapist on board, and having got the ball rolling we are now waiting for follow-up appointments.

‘But it is a slow process and there is a lot of paperwork involved. There is a language barrier for her Polish mother, who hasn’t been in the UK very long.’

She adds, ‘Our space is very flexible, and at the moment the little girl is moving around with one-to-one help from a member of our staff, but certain equipment will give her a lot more independence. We would like to get her a walker to begin with, but this kind of equipment can run into hundreds of pounds. At the moment we are not even receiving the Disability Access Fund of £615 a year, as mum is still trying to fill in the form.’

ACHIEVING INCLUSION

With the focus on securing one-to-one support for children with complex difficulties, particular attention should be given to ensuring this does not create a barrier to the child’s participation in all activities.

At charity Dingley’s Promise, which operates three specialist SEND centres in Berkshire and Surrey, director Catherine McLeod says she has observed how sometimes these children can become isolated, with little attention paid to the development of their social, communication and play skills.

‘Quite often one-to-one is used for health and safety purposes, to ensure children are not causing harm to themselves or others,’ she says.

‘While that is great, the actual learning and development for that child is not being catered for. These individuals may also be isolated from the nursery team and not have any contact with the family.’

HOLISTIC APPROACH

One aspect of SEND which commonly runs through many types of complex needs, is speech and language, and support for this can make a huge difference to a child’s ability to interact in the setting.

At the Pennine Care NHS Foundation Trust, which works with nurseries in Trafford, clinical lead for speech and language Joanne Jones says speech and language problems can be linked to physical issues, such as stiffness in limbs, lack of sleep or eating problems. Its early years team works with the parents to ‘see beyond the diagnosis’.

The Giving Voice project, delivered in partnership with the Trafford Early Years and Children’s Workforce Learning Team, is part of Trafford’s approach to identifying and supporting emerging need. It has so far delivered free speech and language training to 150 practitioners.

Meanwhile, the Trafford Early Development Service (TEDS) provides portage, with early assessment and interventions including speech and language therapy and occupational therapy.

Ms Jones believes these strategies are boosting practitioner confidence.

She explains, ‘We believe that training is absolutely key for early years settings because they cannot achieve goals for children without the skills to do so, and this is what we are prioritising with Giving Voice. We also ensure that parents are involved every step of the way.’

With this kind of support for a holistic approach, Ms Mathieson feels that parents now have more choice when it comes to providing an appropriate setting for their child with complex needs.

She says, ‘Whether it’s a Forest School approach, childminder, pre-school, school-based or day nursery context – or a combination of more than one setting – as long as the decision is informed by a regularly reviewed and realistic view of the child’s needs, their wishes and their parents’ aspirations, the experience should be a positive one.’

CASE STUDY: HAVING FUN AND BEING STIMULATED

Nicky Harper is a childminder working in north Somerset who has six children between the ages of two and three, attending at different times. Eighteen months ago she started looking after a three-year-old girl with reduced mobility due to a rare form of muscular dystrophy. She spends one day a week at her setting, during which time she enjoys the company of three other children in her age group.

‘The little girl came to me through the early years support advisor at North Somerset Council,’ says Ms Harper. ‘Although she is the first child with complex needs I have looked after, I do have prior experience of childminding a little boy with Down’s syndrome, and it was something I wanted to do.

‘From initially meeting up with the child and her parents, it took around six months before they were happy for her to start. She had been to stay-and-play sessions at local charity the Springboard Opportunity Group, and they helped to arrange top-up funding for one-to-one support while she attends my setting for four hours.

‘The aim is for her to have fun and be stimulated by the sessions with me. I offer messy play, small-world play, and lots of music and interaction.

‘She uses a motorised chair and also a special chair which allows her to get close to what she is playing with. I don’t have to make many adaptions to the environment to make it inclusive – it is just a case of making space and rolling the rugs up.

‘She will be with me until July and then she will be off to school. Her parents asked me if I would be interested in home-schooling her, but the other girls her age are moving on and it would require a level of knowledge I don’t have.

‘This is the next challenge that her parents have to deal with.’