Guidance on partnership working between allied health professions and education

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1 Guidance on partnership working between allied health professions and education INCLUDED HEALTHY WORKING TOGETHER CONFIDENT

2 Guidance on partnership working between allied health professions and education Healthy Working together Confident Included The Scottish Government, Edinburgh 2010

3 Crown copyright 2010 ISBN: The Scottish Government St Andrew s House Edinburgh EH1 3DG Produced for the Scottish Government by RR Donnelley B /10 Published by the Scottish Government, May 2010 Further copies are available from Support for Learning Division Learning Directorate Victoria Quay Edinburgh EH6 6QQ Telephone number The text pages of this document are printed on recycled paper and are 100% recyclable HEALTHY CONFIDENT

4 GUIDANCE ON PARTNERSHIP WORKING BETWEEN ALLIED HEALTH PROFESSIONS AND EDUCATION III CONTENTS Joint Ministerial foreword 1 1. Summary of key messages 2 2. How to use this document 4 3. Partnership working: impact and outcomes for children and young people Features of good practice Different ways of supporting children and young people Parents 2 as partners Planning for better partnership working Planning and working together to support young people Joint continuing professional development and self-evaluation Leadership Conclusion 45 Appendix 1: List of all Allied Health Professions (AHPs) 46 Appendix 2: Summary of engagement process 47 Appendix 3: Tools for self-evaluation and improvement planning 50 Appendix 4: Legislative and policy summary 57 Appendix 5: Allied Health Professions Practice Matrix 61 Appendix 6: Membership of the project steering group ( ) 65 Additional resources and examples of current practice can be found at the website linked to this document at: partnershipworking 1 young people refers to children aged three to eighteen, or younger if they have additional support needs and are referred to a local education authority by an NHS Board. The term children is also used but applies to the same age range. 2 Wherever it is used, parents refers to parents, foster carers, carers who are relatives or friends and care staff in a residential setting (including secure provision). INCLUDED WORKING TOGETHER

5 CONFIDENT IV GUIDANCE ON PARTNERSHIP WORKING BETWEEN ALLIED HEALTH PROFESSIONS AND EDUCATION HEALTHY

6 GUIDANCE ON PARTNERSHIP WORKING BETWEEN ALLIED HEALTH PROFESSIONS AND EDUCATION 1 JOINT MINISTERIAL FOREWORD The Scottish Government wants all of Scotland s children to have the best start in life and to be ready to succeed. We are committed to ensuring that our young people are successful learners, confident individuals, effective contributors and responsible citizens. Achieving this vision requires strong and effective partnership working across agencies. The framework provided by Getting it right for every child supports working together to make things better for all children and young people. We know that without extra help some children will not benefit fully from school education. That is why in Scotland, there is legislation in place which aims to ensure that all children receive the additional support they require to meet their individual needs. That support does not only come from within the school. Along with parents, schools work with a range of agencies to support children. One of the partnerships working well to provide additional support is between allied health professions and education. In particular, schools have worked successfully with speech and language therapists, occupational therapists and physiotherapists over many years to make sure children and young people gain as much as possible from school education. People working in partnerships will require strong support and leadership from local authorities and NHS Boards to develop further this way of working. This guidance aims to build on the successful work which already takes place between allied health professions and education. It is the result of extensive discussions with parents, education staff and health staff across the whole of Scotland. It describes what you told us made partnership working more effective. We expect effective partnership working to help improve the life chances for children, young people and families at risk. Curriculum for Excellence gives us a great opportunity to raise achievement levels for all our children and young people. This guidance will contribute by encouraging all partners to work together and ensure that all children and young people reach their highest level of achievement, confidence and wellbeing. Adam Ingram MSP, Minister for Children and Early Years Shona Robison MSP, Minister for Public Health and Sport INCLUDED WORKING TOGETHER

7 2 GUIDANCE ON PARTNERSHIP WORKING BETWEEN ALLIED HEALTH PROFESSIONS AND EDUCATION 1. SUMMARY OF KEY MESSAGES How to use this document This document is intended as a way of helping allied health professions, education staff and parents to improve the quality of their partnership working. Achieving this will improve the experience of children and young people and the likelihood of success in reaching their potential. The guidance is written in accordance with the Getting it right for every child approach and the requirements of the additional support for learning legislation. You may wish to focus on specific sections depending on local circumstances. You may also wish to start with the reflective grids in Appendix 3 which are designed as a tool for self-evaluation. Partnership working: Impact and outcomes for young people: This section places the young person at the centre of partnership working. The purpose of partnership working is to improve outcomes for young people. Outcomes are set in the context of Getting it right for every child and Curriculum for Excellence. Partnership working: Features of good practice Different ways of supporting children and young people: The main focus here is on the variety of roles individuals have in supporting young people. A significant part of this section deals with the allied health professions practice matrix which is a summary of the different ways allied health professions support young people. Parents as partners: During engagement with parents, almost all expressed some level of concern at their lack of involvement. This section re-states the very good practice on involving parents which is contained in Supporting children s learning: The Code of Practice. Planning for better partnership working: Partnership working sits within the wider local context. This section focuses on the way that partnership working contributes to meeting local strategic objectives. Strategic planning needs to support effective partnership working. Equally, planning between allied health professions services and individual schools should support effective joint working through taking a Getting it right for every child approach. Planning and working together to support young people: This section looks at planning to meet the needs of individual children and young people. It starts with the Getting it right for every child practice model as the basis for all joint working. The section then goes on to explore joint interventions between health and education aimed at supporting young people. CONFIDENT HEALTHY

8 GUIDANCE ON PARTNERSHIP WORKING BETWEEN ALLIED HEALTH PROFESSIONS AND EDUCATION 3 Joint continuing professional development (CPD) and self-evaluation: Joint CPD is one of the most effective ways of improving partnership working. This section identifies ways this can be done. It then explores how allied health professions, education and parents can jointly evaluate their partnership working and agree ways they can get better. Leadership: This section sets out what is meant by leadership in the context of partnership working. It explores how everyone can exercise leadership as well as the importance of personal relationships within partnership working. INCLUDED WORKING TOGETHER

9 4 GUIDANCE ON PARTNERSHIP WORKING BETWEEN ALLIED HEALTH PROFESSIONS AND EDUCATION 2. HOW TO USE THIS DOCUMENT Who is this document for? Children and young people who will be supported in achieving their potential through successful partnerships. Parents of children and young people, including those who have additional support needs. Allied health professionals who work in or out of school with children and young people, including those who have additional support needs. Education staff at all levels who work with or influence work involving children and young people, including those with additional support needs. Background The overriding purpose of this guidance is to improve outcomes for children and young people. It has been written to improve support for children and young people by encouraging more effective partnership working between allied health professions, 3 education staff and parents. The guidance is needed because many parents and practitioners are saying that there is room for improvement in partnership working between allied health professions and education staff. This message is also clear in the HMIE report on the implementation of the Education (Additional Support for Learning) (Scotland) Act The guidance has been drawn from the experiences of parents 5 and practitioners across Scotland who are working in partnership to improve outcomes for children and young people, particularly those with additional support needs. The main allied health professions this guidance refers to are speech and language therapy, occupational therapy and physiotherapy. Arts therapists, orthoptists and dieticians also informed the development of this document and the relevant practice examples included on the website. A summary of the engagement process is included at Appendix 2. 3 For a full list of allied health professionals and a description of what they do, see appendix 1. 4 HMIE (2007) Report on the implementation of the Education (Additional support for learning) (Scotland) Act Children and young people were interviewed during the period of engagement. However it proved difficult to gather their views on partnership working. CONFIDENT HEALTHY

10 GUIDANCE ON PARTNERSHIP WORKING BETWEEN ALLIED HEALTH PROFESSIONS AND EDUCATION 5 A tool for self-evaluation This document is designed to help people think about, and improve, their practice together. Each section of the document contains: Features of good practice Issues to consider Signposts for improvement. The Issues to Consider and Signposts for Improvement have also been compiled in grids in Appendix 3. The purpose of these tools is to help joint reflection and self-evaluation for improvement. The areas chosen for reflection will depend upon local circumstances. For example, where relationships with parents are being targeted for improvement, parents and professionals may consider together the issues and signposts relating to parents as partners. Focusing on a particular area does not always mean there are concerns. It may be a way of getting even better. Services may wish to carry out an evaluation exercise alone and then join with partners to consider the results and produce an action plan for improvement. This may relate to a commitment to a process of continuous improvement. INCLUDED WORKING TOGETHER

11 CONFIDENT 6 GUIDANCE ON PARTNERSHIP WORKING BETWEEN ALLIED HEALTH PROFESSIONS AND EDUCATION 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 child 6 practice 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 6 Scottish Government (2008) GIRFEC overview. HEALTHY

12 GUIDANCE ON PARTNERSHIP WORKING BETWEEN ALLIED HEALTH PROFESSIONS AND EDUCATION 7 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. 7 Wherever it is used, school includes early education centres, residential and day special schools (including secure provision), and primary and secondary schools. INCLUDED WORKING TOGETHER

13 8 GUIDANCE ON PARTNERSHIP WORKING BETWEEN ALLIED HEALTH PROFESSIONS AND EDUCATION Collaborative Advantage 8 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: 8 Huxham,C. and Vangen,S. (2005) Managing to Collaborate: The Theory and Practice of Collaborative Advantage. Routledge, Oxon. CONFIDENT HEALTHY

14 GUIDANCE ON PARTNERSHIP WORKING BETWEEN ALLIED HEALTH PROFESSIONS AND EDUCATION 9 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: 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: 9 We recognise that AHPs gather data relating to HEAT targets (http://www.scotland.gov.uk/about/scotperforms/partnerstories/nhsscotlandperformance). The outcomes in this guidance however relate to the partnership AHP s have with education. INCLUDED WORKING TOGETHER

15 10 GUIDANCE ON PARTNERSHIP WORKING BETWEEN ALLIED HEALTH PROFESSIONS AND EDUCATION 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: 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) CONFIDENT HEALTHY

16 GUIDANCE ON PARTNERSHIP WORKING BETWEEN ALLIED HEALTH PROFESSIONS AND EDUCATION 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: 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. INCLUDED WORKING TOGETHER

17 CONFIDENT 12 GUIDANCE ON PARTNERSHIP WORKING BETWEEN ALLIED HEALTH PROFESSIONS AND EDUCATION 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) HEALTHY

18 GUIDANCE ON PARTNERSHIP WORKING BETWEEN ALLIED HEALTH PROFESSIONS AND EDUCATION 13 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? 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. INCLUDED WORKING TOGETHER

19 14 GUIDANCE ON PARTNERSHIP WORKING BETWEEN ALLIED HEALTH PROFESSIONS AND EDUCATION 4. FEATURES OF GOOD PRACTICE 4.1 DIFFERENT WAYS OF SUPPORTING CHILDREN AND YOUNG PEOPLE By working in partnership with professional colleagues, [AHPs] can help to overcome perceived boundaries between services and organisations, developing ways of working that will be of benefit to patients and people who use our services. Building on Success. Future Directions for AHPs 12 Effective partnership working is built upon a clear understanding of the different roles each person has in supporting the young person. Increasing clarity and agreement about roles and responsibilities improves understanding, and leads to mutually supportive relationships. Clear remits, lines of communication and accountability characterise successful approaches to partnership working. Understanding the universal, targeted, and specialist roles of allied health professionals The work allied health professions do with partners to support children and young people includes a range of options which are increasingly referred to as: universal, targeted and specialist support roles. This approach encourages allied health professions to redefine their practice beyond their input or tasks. Their focus is more on what they can reasonably achieve for children and young people as outcomes. The distinction between the universal, targeted and specialist roles also allows allied health professionals to anticipate and prevent difficulties early. The universal, targeted and specialist roles are outlined in more detail in Appendix 5 with examples of current practice on the website Scottish Executive (2002) Building on success. Future directions for the allied health professions in Scotland CONFIDENT HEALTHY

20 GUIDANCE ON PARTNERSHIP WORKING BETWEEN ALLIED HEALTH PROFESSIONS AND EDUCATION 15 NHS Lanarkshire, in collaboration with North and South Lanarkshire Councils, are carrying out and evaluating a motor skills development project. The project provides occupational therapy intervention at a preventative stage in line with health promotion principles. Training for education staff along with parents helps to ensure that children s motor skills are developing through effective support which is embedded in learning and teaching contexts. More information is available from: The universal, targeted and specialist way of understanding what allied health professions do can also help allied health professions to build capacity in services, and be clearer about who they should be targeting based on vulnerability and risk. The different roles all require specialist, professional knowledge and skills. The universal role enables allied health professions to benefit all children in a particular setting. An example of this universal role is where a speech and language therapist supports language development in the early years through a training course for nursery and early primary teachers. Staff development sessions can meet the health needs of a larger population of children. In addition other provision may be made within the universal role. For example, occupational therapists may advise education staff on health promotion programmes which can be used to improve co-ordination skills. Another example of the universal role is where allied health professionals and education staff work together to build the key skill of communication in line with Curriculum for Excellence. NHS Forth Valley through their Communication Help and Awareness Team (CHAT) target pre-school children in areas of socio-economic disadvantage. They do this by providing training for early years education staff and implementing whole nursery approaches to developing language and communication. CHAT also offer support and advice for parents through drop-in sessions and workshops. They also offer teenage mother and toddler groups and provide accessible information and advice for health and education colleagues. This has meant significant numbers of children have been able to enter primary school with improved levels of language and those who need more specific help are identified early. More information is available from: INCLUDED WORKING TOGETHER

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