1 SENATE EDUCATION AND EMPLOYMENT REFERENCES COMMITTEE INQUIRY INTO CURRENT LEVELS OF ACCESS AND ATTAINMENT FOR STUDENTS WITH DISABILITY IN THE SCHOOL SYSTEM, AND THE IMPACT ON STUDENTS AND FAMILIES ASSOCIATED WITH INADEQUATE LEVELS OF SUPPORT OCCUPATIONAL THERAPY AUSTRALIA (OTA) SUBMISSION AUGUST 2015 Occupational Therapy Australia Limited ABN ACN / 340 Gore St. Fitzroy VIC 3065 Ph Fax Website
2 P a g e 2 INTRODUCTION Occupational Therapy Australia welcomes the opportunity to submit to the Senate Education and Employment References Committee Inquiry into Current levels of access and attainment for students with disability in the school systems, and the impact on students and families associated with inadequate levels of support. Occupational Therapy Australia (OTA) is the professional association and peak representative body for occupational therapists in Australia. As of June 2015 there were over 17,000 registered Occupational Therapists (OTs) working in Australia. Occupational Therapists are health professionals whose role is to enable their clients to participate in meaningful and productive activities. Occupational Therapists provide health care, vocational rehabilitation, physical and mental health therapy, services to the disability sector, students and the education sectors and serve the community through a number of government funded health initiatives. This submission addresses a number of the inquiry s terms of references by looking at the current deficits in the structure and delivery of occupational therapy services to students with disability in local school settings. This submission also recommends ways that these services can be enhanced so students can achieve their education goals. Finally this submission looks at opportunities for better evidence based, cost effective services within the context of current and future policy reform such as the national implementation of the National Disability Insurance Scheme. SUMMARY RECOMMENDATIONS OTA recommends the Commonwealth and State Governments implement a number of practical and cost affective policies that would better support students with disability in mainstream schools to achieve their education goals. Revised, updated and better implemented national Disability Standards for Education and supplementary notes that support enactment of this legislation in local schools, Consistent access for occupational therapists to schools and classrooms, Multidisciplinary education teams that include occupational therapists, and, Policy and funding clarity around implementation of NDIS for eligible young Australians within educational settings. CONTEXT Occupational Therapists have a unique role in supporting students to achieve their learning and education goals. The purpose of occupational therapy in an education setting is to enhance or supports a student s educational goals, by facilitating access and participation in the educational process.
3 P a g e 3 Occupational therapists provide services to students with disabilities in schools to promote access to the curriculum and promote social inclusion within the school community. Occupational therapists are professionals who specifically seek to intervene to create enabling educational environments for students who cannot access education under standard conditions. They provide solutions that allow students with disabilities to experience equality with their peers; effective participation in classroom learning and school yard play and socialization; and access to educational opportunities that will allow students to flourish and reach their full potential. Occupational therapy is an evidence based health care profession that uses evidence to provide interventions that promote the participation of children with disabilities in all of the daily occupations that they want and need to engage in. Occupational therapists seek to help students learn skills, change, modify or enhance aspects of the occupation or environment to facilitate the best fit for the student and therefore the most successful outcome for the student. Within the school setting occupational therapists: work directly with students to develop new or improved skills (such as handwriting, turning a page independently, understanding social interactions with other students); work with the student and teacher to modify or tailor the occupation, or school activity to ensure that the student participates (switch access to an electronic book in prep rather than a paper reader if the child can t hold the book, or supportive seating at a desk); consult and modify the environment or instructional techniques so that universal access is achieved or specific assistive technology incorporated into the curriculum and the classroom environment. This submission highlights current problems preventing students receiving adequate occupational therapy supports in the classroom, and proposes recommendations to address each problem. PROBLEM 1: LACK OF CLASSROOM EXPERTISE IN SUPPORTING STUDENTS WITH DISABILITY Research shows state schools across Australia are not providing adequate occupational therapy supports to students with disabilities. This is due to a number of issues. Schools face many competing priorities in the disability space. Often those priorities go to servicing the largest number of students, rather than addressing individual student needs. Schools also face competing financial demands and there is often a lack of appropriate levels of funding to support students with disabilities to participate and be involved in classroom learning. There is also a lack of support funding and specialized training necessary for curriculum modifications; Example: Due to the lack of funding: Schools use the students funding to purchase aide time. Rarely is therapy purchased. Parents fund therapy privately, the majority of students then miss out on specialist knowledge and collaborative input.
4 P a g e 4 With the HCWA and BSI funding finishing at 7 years students have steady therapy support until 7, then it all stops. The NDIS will address this for some students, however this then creates further pressure on schools to accommodate more therapy support for students. Another problem students with disabilities encounter is the lack of awareness and understanding. Teachers similarly, have a lack of appropriate levels of support which impacts on their capacity to meet the needs of students with special needs Current teacher training does not offer sufficient, and in some cases offers only optional, education to trainee teachers resulting in the majority of school teachers and administrators lacking knowledge and experience in disability. Additionally, many teachers have a lack of understanding of allied health professionals and occupational therapists specifically, and the role of occupational therapists in supporting students and their contribution towards schools education teams. It is common for there to be different levels of understanding across different schools and even internally across different teaching staff which is reflected in different attitudes and openness to occupational therapists in classrooms, accessing resources and time with students. Furthermore, educational staff having limited experience with working with students with disabilities (especially in local schools) and limited experience working with allied health professionals such as occupational therapists. This is most commonly demonstrated in two ways limited teacher knowledge of developmental disabilities and strategies to enhance functioning within the mainstream environment and, limited collaboration with outside specialists, or team around the child This lack of knowledge and experience leads to: Viewing behaviour only through the lens of behaviour management with insufficient regard for individual difference or other issues which may be triggering challenging behaviour which may need attention (eg the environment in which the child is functioning, sensory and other needs, communication issues, learning needs) (inadequate explanation for occupational concerns) lack of understanding of how to address disability and reduce the impact of the disability for the student in the classroom / school yard. Lack of understanding about how the student s constitutional factors/vulnerabilities impact occupational performance (eg everyday functioning), and these may be attenuated Lack of specialist knowledge to ameliorate, accommodate, and compensate occupational concerns which impact on a student s learning and success at school as well as extra circular activities
5 P a g e 5 Limited knowledge and understanding from the parents and education system of the skills and contribution of an occupational therapist to collaborate with schools and assist young people to engage and participate in their education. Occupational Therapists cam work as members of the education team to consult with and provide resources to the school, staff, parents and the community. RECOMMENDATION: REVISE COMMONWEALTH DISABILITY STANDARDS FOR EDUCATION AND TRAIN TEACHERS IN THIS. The Commonwealth Disability Standards for Education were first published in They have been revised in 2010 and are set to be revised again. There is a need to regularly revise and update content to ensure standards align with best practice. It is essential the standards capture the latest evidence on working ecologically and intervening in the environment where the skills are required- ie the importance of doing educational therapy support at school not at home. It is important to ensure occupational therapists, teachers, disability and education experts and other allied health professionals are all involved in the regular review and revision of these standards. Both the content and the implementation of these standards needs regular review. State Governments must commit to training their education staff and disability workforce not just schools, principals, allied health professionals working in schools, but all those working with school aged children and young people. Furthermore, teachers need to be provided with regular CPD training opportunities to be updated on the latest evidence based practice in disability care. Annual refreshers. This will benefit teachers and prevent onset of mental health, distress, anxiety etc In addition to receiving the training that will better support classroom teachers and benefit students with disability, disability professionals with evidence based and best practice knowledge and skills, who can make positive contributions to a student s Education Team and who could contribute to a student achieving their education goals such as occupational therapists must have access to the student s classroom. PROBLEM 2: OCCUPATIONAL THERAPISTS HAVE IRREGULAR, INCONSISTENT ACCESS TO STUDENT S IN THE CLASSROOM The current Disability Standards for Education 2005 states that students with a disability have the right to specialised services needed to participate in the educational activities they are enrolled in. Ensure that students with disability are able to use general support services Ensure that students have access to specialised support services. Facilitate the provision of specialised support services.
6 P a g e 6 Occupational therapy is one of these crucial specialised support services. Therefore negotiated access for an occupational therapist into the school environment and or classroom is essential when supporting a student s educational goals. However, whether an occupational therapist is allowed on school site and in the classroom is different in every Australian state. Some states, such as Queensland, employ occupational therapists in the Department of Education. These therapists have regular access to classrooms and provide a service to designated state education facilities in Queensland. Other states like Victoria and New South Wales, do not employ occupational therapists. Some schools allow private occupational therapists to visit and contribute to student Education Teams at the discretion of the principal. The following is a summary overview of the current access occupational therapists have to classrooms in different states in Australia: Queensland The Queensland Government Department of Education and Training State Schooling, employs occupational therapists to work in state schools. There are around 68.3 FTE (2015) Occupational Therapists who provide a service to eligible students enrolled in state education facilities. The focus of the department s service is to enhance educational programs and outcomes for students with a verified disability i.e. intellectual disability, vision impairment, hearing impairment, speech-language impairment, autism spectrum disorder or multiple impairments. South Australia Example: Within south Australia we do not tend to have many OT s employed by the education sector, therefore most of the time therapists who go into schools or kindy settings are doing so at the request of a parent, with permission from the school. So if a school specifically wants occupational therapy to focus on education based input then this may be addressed and shaped within therapy. Australian Capital Territory Occupational Therapists are not employed by the Department of Education, however private practice occupational therapists are allowed on site in classrooms, at the discretion of the School Principal. Example: Schools have commented they do not like the disruption to class. School often is the best way to work with children from vulnerable families. School have also commented that it is becoming more difficult and frustrating in Canberra with the NDIS and many more services looking to come into their school. In ACT the service is currently completely integrated between home and school as there are no school based services. Therapy goals are designed around the individual child s needs and implemented within whichever environment the occupation occurs. A consultative model is used when the goal is in the school environment. In Canberra all school are individually run by the principal. There are overarching guidelines from the directorate, however all procedures are school dependent. Often the principal would have an allocated staff member to work with
7 P a g e 7 Therapy ACT therapists, if the principle was not directly involved. Frequent meetings were held with principals from schools with higher populations of children with disabilities. Victoria The Victorian Government Department of Education and Training employs speech pathologists for state schools in a similar way that the Queensland Department employs Occupational therapists. Speech Pathologists are employed in a region of Victoria and have oversight of a particular case load of children in a number of schools. In Victoria the Department of Education and training does not however, employee Occupational Therapists in the same role. At the discretion of the principal, some state schools in Victoria allow for private practice Occupational Therapists to work with children with a disability. However, in many instances Occupational Therapists have been refused entry to schools, even when families request this option. Example: Alex is a 6 year old boy referred by his teacher for social difficulties, handwriting and attention issues. His parents agreed to school based assessment and intervention. School were contacted to arrange the initial assessment, however advised us that there are no external providers allowed to work school grounds. They recommended he be taken out of school to attend therapy in a clinic or home environment. We had a long chat about the importance of working in the child s natural environment and collaborating with the teachers. The principle commented if we let you in we have to let all of the O.T s in. His parents were hesitant to push the issue as Alex is only in Prep, and they have a long relationship ahead of them at the school. They didn t want to make waves but were really worried about what would happen if he did not have therapy. Alex was becoming increasingly unhappy at school and starting to act out. Alex s parents work full time therefore taking him out of school for therapy wasn t an option. So it has been put on hold in the hope that one day the principle will change his mind New South Wales The Department of Education does not employee Occupational Therapists. Therapists working in private practice may work with school students on site at the discretion of the principal. There is no consistency regarding access it varies from school to school. Occupational therapists are employed in some non-government special and mainstream schools throughout the state. Example: One primary school won t let me in the door, another has engaged me as a consultant on their high level three year plan for special needs students. My experience suggests that every single school has its own organisational culture, they all operate quite differently. Some school welcome therapists with open arms others won t let you in the door. Equity issue based on Principals attitude.
8 P a g e 8 RECOMMENDATION: OCCUPATIONAL THERAPISTS MAKE IMPORTANT CONTRIBUTIONS TO EDUCATION TEAMS AND STUDENT GOALS AND MUST HAVE CONSISTENT ACCESS TO CLASSROOMS State governments must take responsibility for ensuring students have access to all their education support needs. Currently this is not happening in every state. Occupational therapists in every state should be able to negotiate access to the classroom to provide best practice, evidence based, cost effective services to the students with disability. Occupational therapists need to get in the classroom because that is what is best for the students. Occupational therapists have the skills to assess the student, the environment(s) and the occupations of the child and develop the child s skills, make adaptations to the environment or occupations and prescribe equipment to enable child to access the curriculum and achieve their educational goals Once school aged, children spend more awake time at school than in any other environment. The school environment ideally provides then with opportunities for whole of life academic, social, emotional and physical learning. Occupational Therapy works with the child, the tasks that they need to complete and in the environments in which it all needs to happen. Working in schools is critical. It is essential to therapy outcomes to observe and work with child in their natural environments. Without this there is limited opportunity to look at environmental impacts on functioning, as well as effectively collaborate with teachers to enhance the students functioning. Evidence Based practice supports this. Example: OTs don t just talk about a holistic approach because it sounds good. It is the only approach where we are able to be effective to our full potential. This is recognised not only by occupational therapy. In our multidisciplinary service as an NGO, we are able to see children at school (through Non-School Organisations funding, distributed by Education Queensland), at home, at hospital clinics, and in any other environment that is important to the child (funded through donations/philanthropic grants). Occupational Therapy is the only service involved with the student that is able to take a holistic approach to their therapy. Occupational therapists ensure priorities and interventions are consistent across all areas of the child s life, and through coordination of all the adults involved, goals are achieved. For example, assistance coordinating with medical specialists and the home environment is frequently requested by schools. Getting access to the classroom is extremely important, as an OT working in schools and private practice for many years I see the difficulties with transference of skills and communication across all of these environments. Having onsite access is also important for assessment - to see the student in natural environment where they complete their occupation, and it allows the occupational therapist to work with parents and educators.
9 For example in ACT: Therapists were also often invited to Individual learning plan meetings with families as well as SCAN meeting to assess to education funding. This ensured that goals were consistent across environments, and families were not overloaded. P a g e 9 Example: In Queensland OTs are involved in the classroom. They are part of the Student s Education Teams. The focus of their therapy is to enhance the students education programs and outcomes. In Queensland Occupational Therapists have proven to be key members of student Education Teams helping students to achieve their education goals. RECOMMENDATION: STUDENTS WITH DISABILITY NEED MULTI-DISCIPLINARY THERAPY TEAMS - OCCUPATIONAL THERAPISTS ARE IMPORTANT PART OF THIS. The Department of Education & Training in Queensland employs Occupational Therapists and physiotherapists as members of the education team, to provide a service to students enrolled in state education facilities. The focus of the department s service is to enhance educational programs and outcomes for students with a verified disability. Example: Our allied health team (occupational therapy, speech pathology, physiotherapy, social worker) must be working towards educational outcomes as determined by what the school have requested. These restrictions apply to other agencies with the same NSO funding. Social workers receive no funding under this government grant, however they are an integral part of our team. School-based therapists compared to external therapists, have a better understanding of student s educational needs, developing programs that integrate into the school curriculum and goals and understanding of teachers capacity and or time. Many students have complex learning needs, and see many different allied health providers as part of their Education Teams. Each of the allied health providers needs access to the student in the classroom environment and there needs to be a coordinated approach to all of these allied health services for students with disability. PROBLEM 3: CONSUMER CONFUSION AROUND FUNDING AND POLICY CLARITY WITH THE INTERSECTION OF EDUCATION AND THE NDIS The National Disability Insurance Scheme is currently being rolled out in launch sites across Australia. The NDIS will dramatically affect the way people with disability receive support from the government. Australian Capital Territory Example: However schools have commented they do not like the disruption to class. School often is the best way to work with children from vulnerable families. School have also commented that it is becoming more difficult and frustrating in Canberra with the NDIS and many more services looking to come into their school. Prior to NDIS, all schools only had to work with Therapy ACT (Govt services) South Australia Occupational therapists in South Australia, currently delivering to school aged children, note that NDIS suggest a therapeutic intervention or a specific goal is considered too education
10 focused then they may not fund it. NDIS would suggest that this is the business of the education department not the NDIS. P a g e 10 Example South Australia: A child s goal as identified either at the NDIS planning meeting, or by the parent/therapist in collaboration, may relate to improved fine motor skills, or improved ability to write etc. sometimes a therapist can work on these issues and it is never a problem with NDIS, other times an NDIS planner may decide that hand writing is a school skill not a life skill and therefore the therapy is not allowed to focus on handwriting. RECOMMENDATION: SUGGESTED PRINCIPLES TO GUIDE THE IMPLEMENTATION OF THE NDIS AND EDUCATION OTA advise the following principles should apply in navigating the intersection of education systems and NDIS: Children and their families operate across a wide range of life domains (for example educational, community social and civic, recreational and spiritual) Children need therapy supports and solutions which meet needs across life domains. Current evidence supports ecological practice that is, applying interventions within the life domain in which the child is occupationally engaged. Educational goals are best pursued in an educational context. Therapy supports (including behavioural strategies, environmental adaptations, and assistive technologies) will usually have application in other areas of life than the school. Therefore best practice suggests recommendations are made in relation to the whole child and family context. Educationally focused occupational therapy: That is, ethical practice for occupational therapists must include consideration of the child and their educational goals in light of whole-of-life domains. In implementing the above principles, OTA recommend a specialist taskforce to establish the following: How one consistent therapist can work across NDIS-specific and education-specific goals How one consistent therapist can be utilised if funds are jointly provided How assistive technologies can be provided if funds are jointly provided How to best realise choice and control for the child and family in both the education and broader NDIS setting.
11 P a g e 11 RECOMMENDATIONS OTA recommends the Commonwealth and State Governments implement a number of practical and cost affective policies that would better support students with disability in mainstream schools to achieve their education goals. Revised, updated and better implemented national Disability Standards for Education and supplementary notes that support enactment of this legislation in local schools. Consistent access for occupational therapists to schools and classrooms Multidisciplinary education teams that include occupational therapists Policy and funding clarity around implementation of NDIS for eligible young Australians within educational settings. Thank you for the opportunity to submit to the committee s inquiry. It is important to involve government, researchers, health professionals and the broader disability and community sector in the design and implementation of these services to ensure students with disabilities are supported to achieve their education goals. OTA would be more than happy to provide the committee with further information should this be required. Rachel Norris Chief Executive Officer Occupational Therapy Australia
APPA Senate Inquiry Submission: Current levels of access and attainment for students with disability in the school system, and the impact on students and families associated with inadequate levels of support
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