NHS Sheffield

Comprehensive Health and Well-Being Needs Assessment for Children and Young People with LDD (Learning Disabilities and/or Difficulties

Report

June 2009

CONTENTS

1. Introduction...... 1 2. Key Findings...... 2 3. Definition of Population...... 6 4. External Research...... 20 5. Map Current Services...... 24 6. Health & Well-being Needs of Population ...... 29 7. Predict Future Needs...... 36 8. Stakeholder Analysis...... 58

Appendix 1: External Research Findings Appendix 2: Population Data Appendix 3: Sheffield Services for Children with LDD Appendix 4: Sheffield – Special Educational Needs Criteria

Prepared for Kate Laurance Children’s Services Specification Manager NHS Sheffield 722 Prince of Wales Road Sheffield S9 4EU 0114 3051172 Prepared by Colin Brookman Contract Number TCC2325 Version 1.1

DOCUMENT HISTORY

Version Date of Issue Comment 1.0 June 30th 2009 Final Report 1.1 August 20th 2009 Correction of formatting errors on diagrams & paragraph numbering

1. INTRODUCTION

1.1 This assessment has been commissioned by NHS Sheffield with the following objectives:

• To identify numbers of children and young people with LDD within Sheffield and predict future trends, based upon diagnostic profile and DDA criteria. • To identify both current and predicted future needs in order to inform appropriate planning and delivery of services. • To identify health and well-being need across health, social care, and education and housing spectrums. • To identify health and well-being need across the different groups of children and young people defined as LDD as defined within specification and by age range.

1.2 The assessment covers all children and young people who fall within the commissioning responsibilities of NHS Sheffield from age 0-19+ who are identified as having a learning disability and/or difficulty. The definition of LDD used is that defined in The Disability Discrimination Act (1995) as someone who has “a physical or mental impairment which has a substantial and long term adverse effect on his or her ability to carry out normal day to day activities”.

1.3 The approach adopted to the assessment has been to: • Research and identify appropriate datasets to capture the population and its characteristics. • Use these datasets to project future needs for the period 2009-12. • Identify and map services currently available to support the population. • Research information on services available in other local areas to identify approaches which could usefully be adopted in Sheffield. • Review specific services available within Sheffield to support Health and Well-being Needs for children with LDD.

1.4 The major findings and recommendation from this work are summarised in Section 2. The detailed findings from the above activities are discussed in the main body of the Report and its Appendices.

Page 1

2. KEY FINDINGS

DATA SET 2.1 The Dataset used for this work was the DCSF 2008 census data for Sheffield schools. This covered the main school population (Age 5-16 approximately). The age 17-19 population was estimated using projections of the DCSF data from previous years.

2.2 A comprehensive, accessible dataset for the pre-school population was not available. However, the DCSF 2008 census does include data on children in nursery schools. This is not a complete dataset for the age range in that it excludes the very youngest children and not all pre-school children are in a nursery setting. Despite this the data was felt to provide some insight into the characteristics of this part of the population and was therefore included in the review.

2.3 It became apparent during the assessment that there is no single, comprehensive database covering all children and young people who fall within the DDA definition of disability. Facilities such as the Sheffield Case Register and the Sheffield Disability Index contain excellent data. Indeed, the Case Register is recognised as one of the best of its kind nationally. However, they each have limitations in terms of:

• Coverage – they are voluntary facilities so not all disabled people will be recorded; in particular their coverage at the younger end of the age-scale is limited. • Scope – they tend to cover people with more complex disabilities. Hence, those with more moderate conditions are not covered.

2.4 It is recommended that Sheffield should consider the best approach to ensuring that it has a single, comprehensive and consistent dataset covering its population of children and young people with LDD.

POPULATION 2.5 The population of children with LDD in the Sheffield school system (defined to be those with statements or in school action plus) for age 5-16 is 8,976 of which 88 come from out of Sheffield. The projected number for age 17-19 is 1,699. The pre-school population identified through the DCSF census of nursery schools is 176.

2.6 For the school population the Service Districts with the largest population are Arbourthorne /Manor /Darnall (17.2%) and Shiregreen / Burngreave (19.4%). These are also the districts with the highest indices of social deprivation.

Page 2

2. KEY FINDINGS (CONTINUED) 2.7 The most common Primary Needs within the school population are:

• Moderate Learning Difficulties (MLD) (28.5%). • Behavioural, Emotional and Social Development Difficulties (BESD) (21.8%). • Speech, Language and Communication Needs (SLCN) (16.2%). • Special Learning Difficulties (SPLD) (e.g. Dyslexia) (13.7%).

2.8 21.5% of the school population with LDD come from the BME community

2.9 Children with LDD are more likely to be eligible for free school meals; 29.2% of children with LDD in the age range 5-16 take free school meals compared with 16.6% of the Sheffield school population as a whole. The difference is particularly marked for children with BESD (35.4%), Severe Learning Difficulties (SLD) (34.4%) and MLD (33.7%).

2.10 The 17-19 population has broadly similar characteristics to the 5-16 years age group.

2.11 The analysis of the available data for pre-school children indicates a very high percentage of children with SLCN (45.5%). For this population Shiregreen /Burngreave, again, has the highest representation (22.4%). The percentage of this population from a BME background is significantly higher than for the main school population at 36.9%.

POPULATION GROWTH 2.12 DCSF census data for school age children from 2005-8 was analysed to develop growth projections for the Sheffield population. These were compared to national growth rates over the same period.

2.13 The average annual growth rate for children with LDD needs in Sheffield over the period 2005-8 is 5.1%. This compares to a comparative national figure of 3.1%.

2.14 The rate of growth in Sheffield for all categories of Primary Need exceeds the national rate. The exceptions are BESD and Visual Impairment (VI).

2.15 The fastest growing areas of Primary Need in Sheffield are Autistic Spectrum Disorders (ASD) (16.8%), SLCN (13.5%) and SLD (9.5%). ASD (6.5%) and SLCN (10.5%) are also the fastest growing categories nationally.

2.16 For ASD and BESD the Sheffield growth rate for 2007-8 is radically different from those for 2005-7. This may reflect improvements in diagnosis capability during the early part of the period, the impact of which has now levelled out. These rates should therefore be revisited when 2009 data is available.

Page 3

2. KEY FINDINGS (CONTINUED) 2.17 The Service Districts with the highest growth rates for children with LDD (7%) are Shiregreen / Burngreave and Greenhill / Gleadless Valley. Arbourthorne /Manor/ Darnall, which currently has one of the largest populations of LDD children has an average growth rate which is quite significantly lower than the rest of the City.

2.18 The growth rate within the BME community (8.9%) exceeds that of the White British community (4.2%). The difference is particularly pronounced in ASD and Profound & Multiple Learning Difficulties (PMLD).

POPULATION PROJECTIONS 2.19 The children with LDD population was projected using rates of growth from 2005-8 for the White British and BME populations.

2.20 The projections indicate a growth in the total children with LDD population which averages at about 6.3% per annum over the period 2009-2012. On this basis the percentage of children from BME communities will increase from 21.5% to 25.5%.

2.21 The greatest increases will be experienced in the numbers of children with ASD, SLCN and PMLD. It is the services supporting children with these conditions which will experience the greatest increases in demand.

SERVICE NEEDS 2.22 All services are experiencing demand which equates to, or exceeds, their nominal capacity. There is particular pressure on therapist resources (SLT, Physio, and OT) and on assessment clinics (Multi-disciplinary Assessments and Social & Communication Disorders Clinics).

2.23 The Dual Diagnosis service for children with LDD and mental health problems is also failing to meet outcome measures as a result of capacity constraints. Opportunities to supplement CAMHS services through closer working with therapists (e.g. SLT) are also being missed as a result of shortfalls in capacity.

2.24 Specialist community nurse capabilities in areas such as ASD, mental health, Downs & Neurofibromatosis would improve accessibility and quality of service particularly in the development of self-care and social skills (washing, dressing, feeding etc.). It would also, potentially, reduce demands on therapists, in particular OTs.

Page 4

2. KEY FINDINGS (CONTINUED) 2.25 Extension of the Helena Specialist Nursing team would improve Short Breaks provision for children with complex medical and nursing support needs. It would also allow additional continuing care packages to be offered and reduced reliance on agency staff.

2.26 There is a need for better management and control of specialist equipment other than wheelchairs, specialist seating and orthotics (provided by the Mobility and Specialised Rehabilitation Service at the Northern General Hospital) which is felt to be operating well.

2.27 Opportunities exist to extend the availability of the intrathecal baclofen (ITB) treatment to younger children thus reducing possible needs for surgical intervention in later life.

2.28 It is understood that plans are being considered to allow cochlea implants to be carried out within Sheffield rather than in Bradford or Nottingham as at present. This will improve the capability to support children with Hearing Impairments but needs to be supported by appropriate therapist input.

2.29 Consideration should be given to the development of a community paediatric dietician capability.

2.30 The availability and nature of services for young people in the 17-19 age group needs to be reviewed particularly with respect to children with ASD conditions and mental health issues. Availability of services for children with less severe needs should also be considered.

2.31 Practical issues such as cost and availability of transport and parking issues can act as an inhibitor to families and children accessing services.

ENGAGEMENT NEEDS 2.32 Sheffield’s practices with respect to engaging families and children in the development of strategy and the shaping of services are “embryonic”. Progress is being made through the Interim Carers Forum and the recent LDD Strategy Consultation forum.

2.33 A cohesive strategy to engage third sector partners to enhance services and improve the capability to meet needs is required. Again, it is understood that this process is under way.

2.34 Better structured and managed processes for eliciting and acting upon service user feedback would assist in ensuring that needs are met.

Page 5

3. DEFINITION OF POPULATION

DATASETS 3.1 The requirement for this review was to identify the health and well-being needs for the population of children and young people who fall within the commissioning responsibilities of NHS Sheffield from age 0-19+ who are identified as having a learning disability and/or difficulty. (LDD).

3.2 There is no currently agreed national or local definition of LDD. For the purposes of this review the population was defined to be children and young people who meet the description of disability defined in The Disability Discrimination Act (1995) as someone who has “a physical or mental impairment which has a substantial and long term adverse effect on his or her ability to carry out normal day to day activities”.

3.3 A number of potential datasets for the review were considered and discounted. These included:

• The Sheffield Case Register which, whilst nationally recognised as a source of excellent data, is focussed on people at the more complex end of the spectrum. • The Sheffield Disability Index which is also focussed on children at the more complex end of the spectrum. • Data from the Office of National Statistics, which does not provide sufficient detail on the population of Sheffield. • Various data held by service providers in Sheffield which are mainly case- based and would need significant effort to develop into a viable dataset.

3.4 Having considered all options it was decided that the most comprehensive and consistent dataset was that relating to children with Special Educational Needs (SEN) held in the Department of Children, Schools and Families (DCSF) census. The most recently produced data from this source is that for Spring 2008.

3.5 The DCSF census SEN data is most accurate in terms of children in school years 0-11 (i.e. approximately 5-16 years of age). Whilst it incorporates data on some children outside this age range, the data for these children is incomplete.

3.6 The DCSF census includes data on children aged approximately 3-4 through the nursery school returns. These are not a full representation of the younger age group since the very youngest children (typically aged 0-2) and the 3-4 year olds who do not attend nursery school are excluded.

3.7 For children aged 16+ only those who stay in mainstream education (typically a low proportion of children with LDD) are included.

Page 6

3. DEFINITION OF POPULATION (CONTINUED)

3.8 It was therefore decided to use the 2008 census data for years 0-11 as the main part of the dataset and assume that it is a reasonable approximation to the children in the age range 5-16. In terms of the population of children with SEN those with Statements of Special Education Needs and those within the School Action Plus programme were defined to be in scope. It was felt that these children fulfilled the definition of “substantial and long term adverse effect”.

3.9 For children and young people in the age range 17-19 it was decided that the most accurate approach would be to use the latest complete data on this population i.e. data for School Year 11 from 2005, 2006 and 2007. Whilst effects such as mortality, migration and acquired conditions will have impacted this population in the interim period it was felt to be sufficiently accurate for estimating purposes.

3.10 A complete and consolidated dataset for pre-school children is not available. It was hoped that the Sheffield Index, which is the Child Disability Index for Sheffield as required by the Children’s Act of 1989, would provide the required data but inspection of the records for children under five from this source showed that the records were significantly incomplete.

3.11 The pre-school analysis is therefore based upon the DCSF SEN data which is available, recognising that it is neither complete nor accurate as a representation of the population. The data does, however, provide some interesting indications of the characteristics of this population and its future impact on the overall population of children with LDD.

3.12 The lack of a single consolidated dataset covering all children with LDD in the city is one that Sheffield needs to address.

CLASSIFICATIONS

3.13 The DCSF census data incorporates information on the Primary Condition driving the special educational need. In some cases it also provides information on a Secondary Conditions.

Page 7

3. DEFINITION OF POPULATION (CONTINUED)

3.14 The Condition categories used are as follows:

Key: ASD Autistic Spectrum Disorder BESD Behavioural Emotional and Social Difficulties HI Hearing Impairment MLD Moderate Learning Difficulty MSI Multi-sensory Impairment PD Physical Disability PMLD Profound & Multiple Learning Difficulties Speech, Learning or Communications SLCN Difficulties SLD Severe Learning Difficulties Specific Learning Difficulties (including SPLD Dyslexia) VI Visual Impairment OTH Other

3.15 A paper detailing how these categories are specified is provided as Appendix 4.

AGE 5-16 DATA

3.16 This is the age group for which the most accurate data exists. The 2008 DCSF SEN shows a total of 8,976 children and young people in the population. Summary data is provided in this Section with more detailed analyses included at Appendix 2. Where data from this Appendix is quoted below the relevant figures are referenced (in the form Figure A2.XX).

Page 8

3. DEFINITION OF POPULATION (CONTINUED)

3.17 The breakdown by gender and Primary Condition is shown in Figure 3.1.

PRIMARY NEED Total F M F% M% Autistic Spectrum Disorder 677 95 582 14.0% 86.0% Behavioural Emotional and 1956 394 1562 20.1% 79.9% Social Difficulties Hearing Impairment 210 103 107 49.0% 51.0% Moderate Learning Difficulty 2554 984 1570 38.5% 61.5% Multi-sensory Impairment 4 1 3 25.0% 75.0% Physical Disability 209 87 122 41.6% 58.4% Profound & Multiple Learning 88 44 44 50.0% 50.0% Difficulties Speech, Learning or 1456 454 1002 31.2% 68.8% Communications Difficulties Severe Learning Difficulties 285 87 198 30.5% 69.5% Special Learning Difficulties 1227 379 848 30.9% 69.1% (Dyslexia) Visual Impairment 80 25 55 31.3% 68.8% Other 230 99 131 43.0% 57.0% Total 8976 2752 6224 30.7% 69.3% Figure 3.1 Analysis of 5-16 population by Primary Need

3.18 There is a significant majority of males for virtually all needs with the bias particularly pronounced in ASD and BESD. Only in HI and PMLD is there an approximate balance between the genders.

3.19 Figure 3.2 illustrates the breakdown of children with LDD by Primary Need.

Figure 3.2

Page 9

3. DEFINITION OF POPULATION (CONTINUED)

3.20 Of the 8,976 children within this population, the breakdown between the Sheffield Service Districts is shown in Figure 3.3.

Figure 3.3

Page 10

3. DEFINITION OF POPULATION (CONTINUED)

3.21 The eastern Service Districts of Arbourthorne /Manor /Darnall and Shiregreen / Burngreave include the largest proportion of children with LDD. There are, however, differences, relating to particular needs. (See Figures A2.3 & 4).

3.22 These are also the most socio-economically deprived districts in the city with the highest Index of Multiple Deprivation (IMD) ratings overall and for health and education and the highest percentages of the population on Income Support and Housing Benefit. Figure 3.4 refers.

IMD 2004 IMD 2004 IMD 2004 Income Housing overall Education Health Support Benefit score Score Score % 2005 % 2005 Arbourthorne / Manor 51.52 65.16 1.10 30.2% 41.7% / Darnall Greenhill / Gleadless 25.28 24.66 0.35 17.2% 26.0% Valley Hillsborough / Upper 20.52 21.19 0.26 14.0% 21.1% Don Mosborough / 25.97 37.45 0.32 15.7% 24.7% Handsworth Parson Cross / 29.76 44.08 0.58 18.8% 27.8% Ecclesfield Rivelin to Sheaf 15.14 6.83 -0.56 9.2% 13.1% Shiregreen / 47.74 57.20 1.08 29.3% 39.8% Burngreave Figure 3.4 Service District Socio-Economic Data 2004/5

3.23 Using eligibility for free school meals as an indicator for families with lower income, Figure 3.5 (overleaf) shows that 29.2% of children with LDD have free school meals. This figure compares with a figure of 16.6% for the total school population of Sheffield. This would indicate that children with LDD are more likely to come from lower income families than the general school population.

3.24 All categories of Primary Need show a higher percentage of children who have free school meals than the population as a whole. This trend is particularly marked for BESD, MLD and SLD where over 30% of children have free school meals.

Page 11

3. DEFINITION OF POPULATION (CONTINUED)

PRIMARY No NEED Total fsm fsm No fsm % fsm % ASD 677 544 133 80.4% 19.6% BESD 1956 1263 693 64.6% 35.4% HI 210 172 38 81.9% 18.1% MLD 2554 1693 861 66.3% 33.7% MSI 4 4 100.0% 0.0% OTH 230 175 55 76.1% 23.9% PD 209 166 43 79.4% 20.6% PMLD 88 66 22 75.0% 25.0% SLCN 1456 1066 390 73.2% 26.8% SLD 285 187 98 65.6% 34.4% SPLD 1227 959 268 78.2% 21.8% VI 80 64 16 80.0% 20.0% Total 8976 6359 2617 % 70.8% 29.2% Figure 3.5 Eligibility of Children with LDD for free school meals (5-16)

3.25 Together with Rivelin to Sheaf these are also the districts with the highest distribution of children from the BME community. Figure 3.6 below refers.

Total White % of % of British BME BME % WB BME Arbourthorne / 1116 412 27.0% 15.8% 21.3% Manor / Darnall Greenhill / 831 134 13.9% 11.8% 6.9% Gleadless Valley Hillsborough / 931 147 13.6% 13.2% 7.6% Upper Don Mosborough / 1246 89 6.7% 17.7% 4.6% Handsworth Parson Cross / 1127 63 5.3% 16.0% 3.3% Ecclesfield Rivelin to Sheaf 656 415 38.7% 9.3% 21.5% Shiregreen / Burngreave 1057 664 38.6% 15.0% 34.4% Out of Sheffield 79 9 10.2% 1.1% 0.5% Total 7043 1933 21.5% Figure 3.6 Analysis of Service District by Ethnicity (5-16)

Page 12

3. DEFINITION OF POPULATION (CONTINUED)

3.26 The numbers of children in Arbourthorne /Manor /Darnall and Shiregreen / Burngreave with ASD needs is relatively low; the larger proportions with ASD are centred in Rivelin to Sheaf (19.2%) and Mosborough /Handsworth (18.3%).

3.27 The relatively high incidence of children in Arbourthorne /Manor /Darnall and Shiregreen / Burngreave is particularly pronounced for BESD. Rivelin to Sheaf (9.0%) and Greenhill / Gleadless Valley (9.3%) have relatively low incidences for this need.

3.28 The districts of Arbourthorne /Manor /Darnall and Shiregreen / Burngreave also show relatively high incidences of Learning Difficulties and Sensory Impairment although the incidence of PMLD in Shiregreen / Burngreave (13.6%) is relatively low. This may, however, be a reflection of the relatively low incidence of this need (88 in all across the City). There is also a comparatively low incidence of SPLD in Arbourthorne /Manor /Darnall (13.7%).

3.29 A more detailed breakdown of the population by ethnicity is shown in figure 3.7.

Ethnic Origin Total % White British 7043 78.5% Asian/Asian British - Pakistani 619 6.9% Mixed/Dual Background - White & 276 3.1% Black Caribbean Black/Black British -Somali 160 1.8% Yemeni 113 1.3% Black/Black British - Caribbean 104 1.2% Other 661 7.4% Total 8976 Figure 3.7 Analysis of Population by Ethnic Origin (5-16)

3.30 The proportion of children from ethnic minorities at 21.5% is slightly lower than the total percentage of children from ethnic minorities in Sheffield schools which is 22.6%.

3.31 Further analyses of primary needs by ethnicity are provided in Figures A2.5 & 6.

Page 13

3. DEFINITION OF POPULATION (CONTINUED)

3.32 The Asian/Asian British Pakistani population represents a higher proportion of the total LDD population in the areas of Learning Difficulties and Sensory Impairment. Therefore, for example, the percentage of children with HI, VI, PMLD and SD from a Pakistani background are 17.1%, 13.8%, 14.8% and 14.4% respectively whilst the equivalent percentages for ASD, BESD and SPLD are 2.5%, 3.1% and 3.4%.

3.33 The Caribbean (2.0%) and White/Caribbean (4.7%) communities show relatively higher percentages of children with BESD than the overall LDD population. The Somali and Yemeni populations show comparatively high percentages in the Learning Disabilities categories with a particularly high representation of Yemeni children in the PMLD population (3.4%).

3.34 There is no evidence that the gender distribution for differing categories of need varies between the White British and BME communities (Figures A2.7 & 8 refer).

AGE 17-19 3.35 The data for this population is derived from historic data for Year 11 for 2005, 2006, and 2007. Detailed analyses for this population are provided at Appendix 2.

3.36 The estimated population is 1,699 with a split by gender similar to that for the 5-16 population.

PRIMARY NEED Total F M F% M% Autistic Spectrum Disorder 84 11 73 13.1% 86.9% Behavioural Emotional and 723 178 545 24.6% 75.4% Social Difficulties Hearing Impairment 62 31 31 50.0% 50.0% Moderate Learning Difficulty 378 145 233 38.4% 61.6% Multi-sensory Impairment 0 0 0 N/A N/A Physical Disability 39 16 23 41.0% 59.0% Profound & Multiple Learning 1 1 100.0% 0.0% Difficulties Speech, Learning or 94 23 71 24.5% 75.5% Communications Difficulties Severe Learning Difficulties 60 23 37 38.3% 61.7% Special Learning Difficulties 197 63 134 32.0% 68.0% (Dyslexia) Visual Impairment 16 10 6 62.5% 37.5% Other 45 25 20 55.6% 44.4% Total 1699 526 1173 31.0% 69.0% Figure 3.8 Analysis of estimated population by Primary Need (17-19)

Page 14

3. DEFINITION OF POPULATION (CONTINUED)

3.37 Figure 3.9 illustrates the breakdown of the children with LDD for this age group by Primary Need.

Figure 3.9

3.38 The break down by Service District is shown in Figure 3.10

Figure 3.10

Page 15

3. DEFINITION OF POPULATION (CONTINUED)

3.39 Figures A211-14 provide a detailed breakdown of this population by Primary Need.

3.40 As for the 5-16 population, the largest percentage of children with LDD is found in Arbourthorne /Manor /Darnall and Shiregreen / Burngreave. The overall pattern for this population is similar to the 5-16 group in that the relative incidence of ASD in these districts is very low. Hillsborough / Upper Don has the highest level of young people with ASD at 29.3%; Rivelin to Sheaf is again relatively high with 17.1% of the overall number.

3.41 For this population, Arbourthorne /Manor /Darnall and Shiregreen / Burngreave show relatively high numbers of young people with BESD, 24.4% and 21.2% respectively. Shiregreen / Burngreave also has a very high percentage of young people with sensory impairments and learning difficulties.

3.42 The ethnic breakdown for this population is shown in Figure 3.11.

Ethnic Origin Total % White British 1392 81.9% Asian/Asian British - Pakistani 100 5.9% Mixed/Dual Background - White 47 2.8% & Black Caribbean Black/Black British - Caribbean 25 1.5% Yemeni 23 1.4% Black/Black British -Somali 11 0.6% Other 101 5.9% Total 1699 Figure 3.11: Analysis of estimated 17-19 Population by Ethnic Origin

3.43 This analysis, when compared to the 5-16 data is, perhaps, indicative of trends in the ethnic mix of the population for children with LDD. It shows that the percentage of children from White British, Black Caribbean and Yemeni communities is lower in the younger age range whilst the percentage of children from the Pakistani, Mixed White/Black Caribbean and Somali communities is growing.

3.44 The overall pattern of needs within the various communities for this population is similar to that for the 5-16 age group.

Page 16

3. DEFINITION OF POPULATION (CONTINUED)

PRE-SCHOOL 3.45 As noted before this part of the analysis is based upon the DCSF census returns from nursery schools.

3.46 The population totals 176 with a breakdown in terms of primary need and gender as shown in Figure 3.12.

PRIMARY NEED Total F M F% M% Autistic Spectrum Disorder 15 2 13 13.3% 86.7% Behavioural Emotional and 20 2 18 10.0% 90.0% Social Difficulties Hearing Impairment 8 6 2 75.0% 25.0% Moderate Learning Difficulty 16 7 9 43.8% 56.3% Multi-sensory Impairment 0 0 0 N/A N/A Physical Disability 11 4 7 50.0% 50.0% Profound & Multiple Learning 9 4 5 36.4% 63.6% Difficulties Speech, Learning or 80 24 56 44.4% 55.6% Communications Difficulties Severe Learning Difficulties 5 5 30.0% 70.0% Special Learning Difficulties 3 2 1 0.0% 100.0% (Dyslexia) Visual Impairment 1 1 0 66.7% 33.3% Other 8 4 4 100.0% 0.0% Total 176 56 120 31.8% 68.2% Figure 3.12 Analysis of sample population by Primary Need (Pre-school)

Page 17

3. DEFINITION OF POPULATION (CONTINUED)

3.47 The gender mix is very similar to that for the older school population. However, as shown in Figure 3.13, the distribution of primary needs is quite different with a very large percentage of children (45.5%) with SLCN.

Figure 3.13

3.48 Figures 3.14 and 3.15 provide breakdowns of this population in terms of Service District and Ethnicity.

Figure 3.14

Page 18

3. DEFINITION OF POPULATION (CONTINUED)

Ethnic Origin Total % White British 111 63.1% Asian/Asian British - 20 11.4% Pakistani Other 45 25.6% Total 176 Total BME 65 36.9% Figure 3.15 Analysis of sample 17-19 Population by Ethnic Origin

3.49 The largest population of pre-school children with LDD is in Shiregreen / Burngreave which also has the highest proportion of the 5-16 age group. Arbourthorne /Manor /Darnall which also has a high proportion of the 5-16 age group has a rather lower representation in this population.

3.50 Given that the pre-school population will, to a large degree, drive the future growth of the children with LDD population as a whole, these findings would appear to support the projections developed in Section 7 which indicate that Shiregreen /Burngreave will have the highest growth rate in the city whilst growth in Arbourthorne /Manor /Darnall will be much slower.

3.51 The BME element of this population is larger in percentage terms than for the school age population. This would again, appear to support the projections in Section 7 which indicate that a growing percentage of the children with LDD population over the period 2009-12 will come from the BME community.

Page 19

4. EXTERNAL RESEARCH

4.1 The review of population trends and specific needs within Sheffield was supplemented by a review of information available on approaches taken in other areas to addressing the needs of children with LDD. The outputs from this research are presented in Appendix 1.

4.2 The key findings relevant to the Sheffield context are summarised below.

CHANGING DELIVERY MODELS 4.3 Children’s and Families’ Services Resource Guide 14: Having a break: good practice in short breaks for families with children who have complex health needs and disabilities (SCI 2008) states that “Parents of disabled children want practical, flexible help and a break from the physical and emotional demands of caring for their child. They often wish that their relationship with their disabled child could be more ‘ordinary’ and they did not always have to perform caring or nursing roles.”

4.4 A variety of approaches have been taken to meeting this requirement and these are outlined in the Appendix. In this context services such as the Ryegate House Centre and the Helena Specialist Nursing team, which provide a short breaks capability for parents/carers of children with long term conditions requiring extensive medical and nursing intervention, is an important element of the portfolio.

PARTICIPATION AND ENGAGEMENT 4.5 This is a key requirement of the “Aiming High for Disabled Children” Core Offer and covers engagement with Parent/Carers and Service Users themselves. In this way services can be configured to meet the needs of families and children.

4.6 A number of examples are provided in the Appendix ranging in form from consultation through involvement in training and Steering Committees to active involvement in management of services and recruitment of key personnel.

4.7 This is a need in which Sheffield is showing progress but must still be regarded as “embryonic”. It is discussed further in Section 6.

MARKET SHAPING/DEVELOPMENT 4.8 The introduction of new service models brings with it the requirement to work with local and national suppliers, including the third sector, to develop new capabilities and offers. Areas such as Sutton, Dorset and Cornwall, highlighted in the Appendix, have engaged with their partners and suppliers to develop local plans for service delivery to good effect.

Page 20

4. EXTERNAL RESEARCH (CONTINUED)

4.9 Strategic engagement of partners, in particular, the third sector will significantly enhance the ability of Sheffield to meet the needs of a growing population.

INFORMATION MANAGEMENT 4.10 A key to success is the ability to access and disseminate information regarding the availability of new and existing services. The Halton case study refers to the development of a “joined up” database incorporating service users, services and suppliers to facilitate the management of the Aiming High programme. Such a facility would be of great value to Sheffield and would support the needs assessment process.

FACILITATION/ENABLEMENT 4.11 There is a need to go beyond simply setting services up and letting people use them. Other factors come into play – transport, specialist care support, special equipment. It is also necessary to ensure that personal circumstances e.g. poverty do not impact participation.

4.12 Areas such as Sunderland have set up discretionary funds to allow issues such as this to be overcome where appropriate and feasible. On a practical level, Plymouth has established a programme to train disabled children to use public transport independently thus enabling greater access to facilities and services and preparing for transition.

“HARD TO REACH” COMMUNITIES 4.13 Special measures are required to ensure that particular communities (e.g. ethnic groups) are not deprived of participation. Areas such as Brighton & Hove and Nottinghamshire have identified the need for proactive steps to ensure that these communities are engaged.

ASD AND CHALLENGING BEHAVIOUR 4.14 This is a rapidly growing area of need within Sheffield and, hence, one that requires particular focus. . In their paper “Family-Based Short Breaks (Respite) for Disabled Children: Results from the Fourth National Survey”, (British Journal of Social work, 2008) Cramer and Carlin report that, “The most common profile of children waiting the longest for a service is still teenage boys with autism or ‘challenging behaviour”.

Page 21

4. EXTERNAL RESEARCH (CONTINUED)

4.15 Researchers at the Norah Fry Research Centre at the University of Bristol, (Better for the Break? Support for children and teenagers with autistic spectrum disorders and their families, 2007) suggest that service providers need to understand the condition and recognise the importance of:

• “Acceptance of the child/teenager. • Matching with appropriate supporters who have similar interests. • Preparing children for their short break. • Appropriate introductions which take as long as necessary. • Thorough planning, which reduces anxiety but allows for carefully introduced new experiences. • Suitably sized environments in which children are safe and secure. • Consistency in provision by ensuring the same supporter is available and services are provided at consistent times. • Partnerships with parents and other agencies to ensure the child’s individual needs are met and their behaviour managed consistently. • High staffing levels so that children can have 1:1 support. • High levels of training and support for staff.

4.16 Supporters working with children with ASD should receive training in ASD as well as gaining a detailed understanding of the child through working in partnership with their parents, school and any other agencies.”

4.17 Case Studies for Wokingham and Greater Manchester deal specifically with services for these children and illustrate how specific partnership working between agencies and the third sector can improve the quality and focus of services.

4.18 The Northamptonshire example also provides organisational and practice pointers regarding the key transition activities for children with this type of condition.

TRANSITION

4.19 Successful transition services for disabled children into adult services are key activities. A number of good practice examples are given indicating how best to organise multi-agency teams and processes to achieve this successfully.

PALLIATIVE CARE

4.20 The Government’s future direction for children’s palliative care services is laid out in the document, “Better Care: Better Lives” published in February 2008.

Page 22

4. EXTERNAL RESEARCH (CONTINUED)

4.21 This document states the vision that, “Every child and young person with a life- limiting or life-threatening condition will have equitable access to high-quality, family-centred, sustainable care and support, with services provided in a setting of choice, according to the child and family’s wishes.”

4.22 It goes on to create a vision for services that have the following attributes:

• An early, inclusive, joint (health and social care) assessment of need; • An identified key worker/lead professional with responsibility and authority for negotiating and co-ordinating packages of care; • Care that is planned and delivered in full consultation and partnership between the child and family, and service providers; • Clear, comprehensive information and support regarding the child’s condition, including sources of further support; • Practical assistance and timely provision of equipment and adaptations; • Universal provision of emotional, psychological, spiritual and bereavement support for the family (including siblings), carers and wider community; • Education and learning appropriate to the age and stage of development of the child or young person; • Play and recreational opportunities; • Specialist short breaks with appropriate healthcare, nursing and medical input; • Access to responsive care and support from staff skilled in children’s palliative care management; and • Better advanced and emergency care planning to enable the child to die in their preferred place of care.

Page 23

5. MAP CURRENT SERVICES

5.1 A search of the Health and Social Care Services available to children with LDD in Sheffield was undertaken. The full listing of the services identified is provided at Appendix 3.

5.2 The services identified are primarily those delivered from within the public sector i.e. NHS and CYPD plus some third sector providers of support for parent/carers and families. However, no source of over-arching information covering the engagement of third and private sector organisations in service provision for children with LDD has been identified.

5.3 As noted in the Best Practice Review described in Section 4, effective, coordinated engagement of, in particular, the third sector can significantly enhance the quality of services available to children with LDD. It is recommended that Sheffield should consider how best to engage with, and deploy, services from other sectors as part of the overall portfolio for the city.

5.4 Figures 5.1 to 5.3 show mappings of the identified services to the categories of primary need based upon age ranges.

5.5 There is a wide range of services and, at a gross level, it appears that the needs of children and young people in each age group and with each primary condition have services to cater for their needs. The capability of the Health and Well-being services are discussed in more detail, particularly in terms of stakeholder feedback in Section 8.

5.6 The service map for the 16-19 age group is less well populated and there is a concern that children moving from the school system see a reduction in services available to them. For Sheffield, the growing population of children and young people with ASD conditions brings this issue into focus. Cramer and Carlin report that, “the most common profile of children waiting the longest for a service is still teenage boys with autism or ‘challenging behaviour” in their paper “Family-Based Short Breaks (Respite) for Disabled Children: Results from the Fourth National Survey”, (British Journal of Social work, 2008). Particular attention needs to be taken to ensure that there are adequate services to support this sector.

Page 24

5. MAP CURRENT SERVICES (CONTINUED)

Provider ASD BESD HI MLD MSI PD PMLD SLCN SLD SPLD VI Multi- disciplinary Early Years Early Years Early Years Early Years Early Years Early Years Early Years Early Years Early Years Early Years Early Years Service Service Service Service Service Service Service Service Service Service Service Sibling Support Group Sibling Support Sibling Support Sibling Support Sibling Support Care Pathways Sibling Support Care Pathways Sibling Support Sibling Support Sibling Support Working Better Together Group Group Group Group Project Group Project Group Group Group Project Working Better Working Better Working Better Working Better Sibling Support Working Better Sibling Support Working Better Working Better Working Better Together Project Together Project Together Project Together Project Group Together Project Group Together Project Together Project Together Project Working Better Working Better Together Project Together Project Ryegate CDC ADHD Service ADHD Service Multi-disciplinary ADHD Service Multi-disciplinary Multi-disciplinary ADHD Service ADHD Service ADHD Service Multi-disciplinary Multi-disciplinary Combined Clinic Multi-disciplinary Assessment Multi-disciplinary Assessment Assessment Multi-disciplinary Combined Clinic Multi-disciplinary Assessment Assessment Multi-disciplinary Assessment Sheffield INDEX Assessment Sheffield INDEX Sheffield INDEX Assessment Multi-disciplinary Assessment Sheffield INDEX Sheffield INDEX Assessment Social & Comms Neurofibromatosis Sheffield INDEX Neurofibromatosis GAIT Analysis Sheffield INDEX Assessment Sheffield INDEX Neurofibromatosis Neurofibromatosis Social & Comms Disorders Clinic Neurofibromatosis Service GAIT Analysis Social & Comms Neurofibromatosis Disorders Clinic Sheffield INDEX ITB Service Service Disorders Clinic Sheffield INDEX Dual Diagnosis Neurofibromatosis ITB Service Sheffield INDEX Neurofibromatosis Service Paediatric Physio Neurofibromatosis Neurofibromatosis Neurofibromatosis & OT Service Paediatric Physio Paediatric Physio & OT Service & OT Service Other Health Community Child & Family Audiology Clinic Community Audiology Clinic Community Community Community Community Community Community Paediatricians Therapy Teams Community Paediatricians Community Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatric Speech Child Mental Paediatricians Paediatricians Paediatric Speech Paediatric Speech Paediatric Speech Paediatric Speech Orthoptics Service & Language Health Team Orthoptics Service & Language & Language & Language & Language Therapy Service ADHD Liaison Therapy Service Therapy Service Therapy Service Therapy Service Nurses Helena Specialist Community Nurses Paediatricians Ryegate Respite Centre CYPD Portage Portage Portage Portage Portage Portage Portage Portage Portage Portage Portage Assessment, Assessment, Assessment, Assessment, Assessment, Assessment, Assessment, Assessment, Assessment, Assessment, Assessment, Support & Support & Support & Support & Support & Support & Support & Support & Support & Support & Support & Provision Service Provision Service Provision Service Provision Service Provision Service Provision Service Provision Service Provision Service Provision Service Provision Service Provision Service Participation & Inclusion Participation & Participation & Participation & Participation & Participation & Participation & Participation & Participation & Participation & Participation & Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Visual Impairment Early Years Early Years Early Years Early Years Visual Impairment Early Years Early Years Early Years Early Years Early Years Support Team Inclusion Team Inclusion Team Inclusion Team Inclusion Team Support Team Inclusion Team Inclusion Team Inclusion Team Inclusion Team Inclusion Team Early Years Inclusion Specialist Autism Educational Service for Educational Early Years Educational Educational Educational Educational Educational Team Team Psychology Children with a Psychology Inclusion Team Psychology Psychology Psychology Psychology Psychology Service for Children with Educational Service Hearing Service Service for Service Service Service Service Service a Visual Impairment Psychology SNIPS Impairment SNIPS Children with a SNIPS SNIPS SNIPS SNIPS SNIPS Educational Psychology Service Family Placement Educational Family Placement Hearing Family Placement Family Placement Family Placement Family Placement Family Placement Service SNIPS Team Psychology Team Impairment Team Team Team Team Team SNIPS Family Placement Short Breaks Service Short Breaks Service for Short Breaks Short Breaks Short Breaks Short Breaks Short Breaks Family Placement Team Team Service SNIPS Service Children with a Service Service Service Service Service Short Breaks Service Short Breaks Family Placement Visual Impairment Service Team Educational Short Breaks Psychology Service Service SNIPS Family Placement Team Short Breaks Service Schools Third sector SIGN SIGN SIGN SIGN SIGN SIGN SIGN ICAN Language SIGN SIGN SIGN MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP Centre MILAAP MILAAP MILAAP Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers SIGN Sheffield Carers Sheffield Carers Sheffield Carers Centre Centre Centre Centre Centre Centre Centre Centre MILAAP Centre Centre Home-Start Sheffield Mencap Sheffield Mencap Home-Start Sheffield Mencap Home-Start Home-Start Sheffield Mencap Sheffield Carers Sheffield Mencap Sheffield Mencap Within Reach & Gateway & Gateway Within Reach & Gateway Within Reach Within Reach & Gateway Centre & Gateway & Gateway Crossroads ACCT Home-Start Crossroads Home-Start Crossroads Crossroads Home-Start Sheffield Mencap Home-Start Home-Start Home-Start Within Reach Within Reach Within Reach & Gateway Within Reach Within Reach Within Reach Crossroads Crossroads Crossroads Home-Start Crossroads Crossroads Crossroads Within Reach Crossroads

Page 25

5. MAP CURRENT SERVICES (CONTINUED)

Figure 5.1 Age 0-4 Service Mapping

Provider ASD BESD HI MLD MSI PD PMLD SLCN SLD SPLD VI Multi- disciplinary Sibling Support Sibling Support Sibling Support Sibling Support Sibling Support Sibling Support Sibling Support Sibling Support Sibling Support Sibling Support Sibling Support Group Group Group Group Group Group Group Group Group Group Group Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Transition Group Transition Group Transition Group Transition Group Transition Group Transition Group Transition Group Transition Group Transition Group Transition Group Transition Group Ryegate CDC ADHD Service ADHD Service Multi-disciplinary ADHD Service Multi-disciplinary Dyspraxia/ Dev Co- ADHD Service ADHD Service ADHD Service Multi-disciplinary Multi-disciplinary Multi-disciplinary Multi-disciplinary Assessment Multi-disciplinary Assessment ord Disorders Multi-disciplinary Multi-disciplinary Multi-disciplinary Assessment Assessment Assessment Assessment Sheffield INDEX Assessment Sheffield INDEX Multi-disciplinary Assessment Assessment Assessment Sheffield INDEX Sheffield INDEX Social & Comms Social & Comms Neurofibromatosis Sheffield INDEX Neurofibromatosis Assessment Sheffield INDEX Social & Comms Sheffield INDEX Neurofibromatosis Neurofibromatosis Disorders Clinic Disorders Clinic Neurofibromatosis Sheffield INDEX GAIT Analysis Disorders Clinic Neurofibromatosis Sheffield INDEX Sheffield INDEX GAIT Analysis Service Sheffield INDEX Neurofibromatosis Dual Diagnosis Service ITB Service Neurofibromatosis Service ITB Service Neurofibromatosis Paediatric Physio Neurofibromatosis Neurofibromatosis Paediatric Physio & OT Service Paediatric Physio & OT Service & OT Service Other Health Continence Child & Family Audiology Clinic Continence Audiology Clinic Continence Continence Community Continence Community Community Advisory Service Therapy Teams Community Advisory Service Community Advisory Service Advisory Service Paediatricians Advisory Service Paediatricians Paediatricians Community Child Mental Paediatricians Community Paediatricians Community Community Paediatric Speech Community Orthoptics Service Paediatricians Health Team Paediatricians Orthoptics Service Paediatricians Paediatricians & Language Paediatricians Paediatric Speech Young People’s Paediatric Speech Paediatric Speech Therapy Service Paediatric Speech & Language Mental Health & Language & Language & Language Therapy Service Team Therapy Service Therapy Service Therapy Service ADHD Liaison Nurses Community Paediatricians CYPD Progression & Progression & Progression & Progression & Progression & Progression & Progression & Progression & Progression & Progression & Progression & Transition Service Transition Service Transition Service Transition Service Transition Service Transition Service Transition Service Transition Service Transition Service Transition Service Transition Service Assessment, Assessment, Assessment, Assessment, Assessment, Assessment, Assessment, Assessment, Assessment, Assessment, Assessment, Support & Support & Support & Support & Support & Support & Support & Support & Support & Support & Support & Provision Service Provision Service Provision Service Provision Service Provision Service Provision Service Provision Service Provision Service Provision Service Provision Service Provision Service Participation & Participation & Participation & Participation & Participation & Participation & Participation & Participation & Participation & Participation & Participation & Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Connexions LDD Connexions LDD Connexions LDD Connexions LDD Connexions LDD Connexions LDD Connexions LDD Connexions LDD Connexions LDD Connexions LDD Connexions LDD Team Team Team Team Team Team Team Team Team Team Team Specialist Autism Educational Service for Educational Service for Educational Educational Educational Educational Educational Service for Team Psychology Children with a Psychology Children with a Psychology Psychology Psychology Psychology Psychology Children with a Educational Service Hearing Service Hearing Service Service Service Service Service Visual Impairment Psychology Parent Partnership Impairment Parent Partnership Impairment Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Educational Service Service Educational Service Service for Service Service Service Service Service Psychology Parent Partnership SNIPS Psychology SNIPS Children with a SNIPS SNIPS SNIPS SNIPS SNIPS Service Service Family Placement Service Family Placement Visual Impairment Family Placement Family Placement Family Placement Family Placement Family Placement Parent Partnership SNIPS Team Parent Partnership Team Educational Team Team Team Team Team Service Family Placement Short Breaks Service Short Breaks Psychology Short Breaks Helena Specialist Short Breaks Short Breaks Short Breaks SNIPS Team Service SNIPS Service Service Service Nurses Service Service Service Family Placement Short Breaks Family Placement Parent Partnership Ryegate Respite Team Service Team Service Centre Short Breaks Short Breaks SNIPS Short Breaks Service Service Family Placement Service Team Short Breaks Service Figure 5.2 Age 5-16 Service Mapping

Page 26

5. MAP CURRENT SERVICES (CONTINUED)

Provider ASD BESD HI MLD MSI PD PMLD SLCN SLD SPLD VI Schools Bents Green Aldine House Angram Park Mossbrook Angram Park All Saints Catholic Norfolk Park Bents Green Mossbrook Nook Lane Junior Bents Green Secondary Heritage Park Primary (IR) Primary Primary (IR) High (IR) Primary Secondary Primary (IR Secondary Norfolk Park Holgate Meadows Ecclesfield (IR) Oakwood School Ecclesfield (IR) Notre Dame Rowan Primary Rowan Primary Norfolk Park Arbourthorne Primary Oakwood School Greystones Nook Lane Junior Greystones Catholic High (IR) Seven Hills Birley Community Primary Community Oakwood School Shirle Hill Hospital Primary (IR) (IR) Primary (IR) St Thomas of Talbot Specialist College (IR) Oakwood School Primary (IR) Rowan Primary High Storrs (IR) Arbourthorne High Storrs (IR) Canterbury School King Ecgbert (IR) Rowan Primary Fox Hill Primary Talbot Specialist Lower Meadow Community Lower Meadow Catholic Primary Wooley Wood Myers Grove (IR) Seven Hills (IR) School Primary (IR) Primary (IR) Primary (IR) (IR) Primary Birley Spa Primary Talbot Specialist Hartley Brook Birley Spa Primary Silverdale (IR) Fox Hill Primary Silverdale (IR) Nook Lane Junior (IR) School Primary (IR) (IR) (IR) (IR) Wooley Wood Nether Green Hartley Brook Arbourthorne Primary Junior (IR) Primary (IR) Community Nook Lane Junior Sharrow Primary Nether Green Primary (IR) (IR) (IR) Junior (IR) Fox Hill Primary Arbourthorne Stradbrooke Sharrow Primary (IR) Community Primary (IR) (IR) Hartley Brook Primary (IR) Wharncliffe Side Stradbrooke Primary (IR) Fox Hill Primary Primary (IR) Primary (IR) Nether Green (IR) Wharncliffe Side Junior (IR) Hartley Brook Primary (IR) Sharrow Primary Primary (IR) (IR) Nether Green Stradbrooke Junior (IR) Primary (IR) Sharrow Primary Wharncliffe Side (IR) Primary (IR) Stradbrooke Abbeydale Grange Primary (IR) (IR) Wharncliffe Side Primary (IR) Abbeydale Grange (IR) Third sector SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Centre Centre Centre Centre Centre Centre Centre Centre Centre Centre Centre Sheffield Mencap & Sheffield Mencap & Within Reach Sheffield Mencap & Within Reach Within Reach Sheffield Mencap & Sheffield Mencap & Sheffield Mencap & Sheffield Mencap & Within Reach Gateway Gateway Crossroads Gateway Crossroads Crossroads Gateway Gateway Gateway Gateway Crossroads ACCT Within Reach Within Reach Within Reach Within Reach Within Reach Within Reach Within Reach Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Figure 5.2 Age 5-16 Service Mapping (contd.) (IR = School Integrated Resource)

Page 27

5. MAP CURRENT SERVICES (CONTINUED)

Provider ASD BESD HI MLD MSI PD PMLD SLCN SLD SPLD VI Multi- disciplinary Sibling Support Sibling Support Sibling Support Sibling Support Sibling Support Sibling Support Sibling Support Sibling Support Sibling Support Sibling Support Sibling Support Group Group Group Group Group Group Group Group Group Group Group Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Transition Group Transition Group Transition Group Transition Group Transition Group Transition Group Transition Group Transition Group Transition Group Transition Group Transition Group Ryegate CDC Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Other Health Continence Young People’s Audiology Clinic Continence Audiology Clinic Continence Continence Continence Orthoptics Service Advisory Service Mental Health Advisory Service Orthoptics Service Advisory Service Advisory Service Advisory Service Team Helena Specialist ADHD Liaison Nurses Nurses Ryegate Respite Centre CYPD Progression & Progression & Progression & Progression & Progression & Progression & Progression & Progression & Progression & Progression & Progression & Transition Service Transition Service Transition Service Transition Service Transition Service Transition Service Transition Service Transition Service Transition Service Transition Service Transition Service Assessment, Assessment, Assessment, Assessment, Assessment, Assessment, Assessment, Assessment, Assessment, Assessment, Assessment, Support & Support & Support & Support & Support & Support & Support & Support & Support & Support & Support & Provision Service Provision Service Provision Service Provision Service Provision Service Provision Service Provision Service Provision Service Provision Service Provision Service Provision Service Participation & Participation & Participation & Participation & Participation & Participation & Participation & Participation & Participation & Participation & Participation & Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Inclusion Service Connexions LDD Connexions LDD Connexions LDD Connexions LDD Connexions LDD Connexions LDD Connexions LDD Connexions LDD Connexions LDD Connexions LDD Connexions LDD Team Team Team Team Team Team Team Team Team Team Team Specialist Autism Educational Service for Educational Service for Educational Educational Educational Educational Educational Service for Team Psychology Children with a Psychology Children with a Psychology Psychology Psychology Psychology Psychology Children with a Educational Service Hearing Service Hearing Service Service Service Service Service Visual Impairment Psychology Parent Partnership Impairment Parent Partnership Impairment Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Educational Service Service Educational Service Service for Service Service Service Service Service Psychology Parent Partnership SNIPS Psychology SNIPS Children with a SNIPS SNIPS SNIPS SNIPS SNIPS Service Service Family Placement Service Family Placement Visual Impairment Family Placement Family Placement Family Placement Family Placement Family Placement Parent Partnership SNIPS Team Parent Partnership Team Educational Team Team Team Team Team Service Family Placement Short Breaks Service Short Breaks Psychology Short Breaks Short Breaks Short Breaks Short Breaks Short Breaks SNIPS Team Service SNIPS Service Service Service Service Service Service Service Family Placement Short Breaks Family Placement Parent Partnership Team Service Team Service Short Breaks Short Breaks SNIPS Service Service Family Placement Team Short Breaks Service Schools Talbot Specialist Aldine House Talbot Specialist Talbot Specialist School School School Third sector SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Sheffield Carers Centre Centre Centre Centre Centre Centre Centre Centre Centre Centre Centre Sheffield Mencap & Sheffield Mencap & Within Reach Sheffield Mencap & Within Reach Within Reach Sheffield Mencap & Sheffield Mencap & Sheffield Mencap & Sheffield Mencap & Within Reach Gateway Gateway Crossroads Gateway Crossroads Crossroads Gateway Gateway Gateway Gateway Crossroads ACCT Within Reach Within Reach Within Reach Within Reach Within Reach Within Reach Within Reach Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Figure 5.3 Age 17-19 Service Mapping

Page 28

6. HEALTH & WELL BEING NEEDS OF POPULATION

6.1 At a national and local level there is a significant body of legislation, policy and guidance relating to the needs of children with LDD. Nationally this includes:

• Standard 8, National Service Framework for Children, Young People & Maternity Services – “Children and young people who are disabled or who have complex needs receive co-ordinated, high quality child and family- centred services which are based on assessed needs, which promote social inclusion, and where possible, which enable them and their families to live ordinary lives”.

• Every Child Matters Disabled Child Matters Local Authority Charter – which Sheffield is signed up to.

• Aiming High for Disabled Children – the Government’s transformation programme for disabled children, which aims to deliver improved access and empowerment; responsive services and timely support; and improved service quality and capacity. The Aiming High programme described the Core Offer for disabled children & young people.

• The NHS Operating Framework and the national Children’s Plan which identify disabled children as a priority. The National Indicator (NI 54) for disabled children is a key part of performance management arrangements aimed at improving the quality of services for disabled children.

6.2 Locally, meeting the needs of disabled children and young people is also identified as a key strategic priority. This is demonstrated in:

• Achieving Balanced Health – Sheffield PCT’s 5 year strategy

• Sheffield Children & Young People’s Plan

6.3 These requirements have been distilled into a framework of needs for Sheffield against which services are mapped. This framework is identified in Figure 6.1 overleaf.

Page 29

6. HEALTH & WELL BEING NEEDS OF POPULATION (CONTINUED)

Requirement Detail Access to Services (General) • Services available to all relevant sectors of the community • Actions in place to ensure access for children from minority communities–cultural sensitivity, language etc. • Service providers fulfil their responsibilities under the Disability Discrimination Act 1995 to remove barriers and improve access to services • Assistance for children/families to access services in case of poverty • Proactive action to allow “hard to reach” communities to access services Access to Services (Specific) • Services in place which: o Have sufficient capacity for current and planned needs o Deliver required service quality standards (e.g. waiting times) o Are flexible in terms of location (centre, home, school) o Are configured to meet needs of children with LDD and their families o Have staff with specific paediatric capabilities • Services to be considered o Hospital/Primary Care Services o Child & Adolescent Mental Health Services o Rehabilitation & Therapy Services o Social Services o Equipment Services o Housing Services o Education o Transport & Leisure Intra-service processes • Early identification & intervention • Integrated Diagnosis and Assessment • Co-ordination of services – multi- agency/discipline • Key Worker engagement • Transition arrangements • Monitoring and evaluation of child and family experience of services Figure 6.1 Sheffield Children with LDD Needs Framework

Page 30

6. HEALTH & WELL BEING NEEDS OF POPULATION (CONTINUED)

Requirement Detail Parent/Carer/Family Support • Respite arrangements – short breaks and other models • Emotional & psychological support to families (in particular siblings) • Care & Support • All family support sensitive to family routines and schedules Information for Parents and • Timely, accessible & accurate information on Children services • Format & language support Engagement of children & • Consultative arrangements families • Advocacy arrangements • Involvement in (i) specifying/commissioning services (ii) person-centred plans Specific areas of concern • Effective arrangements for o ASD/Challenging Behaviour (particularly for teenage boys) o Palliative Care Figure 6.1 Sheffield Children with LDD Needs Framework (Contd.)

6.4 This framework has been mapped against the services identified in Section 5 to identify how it is currently fulfilled. The mapping is shown in figures 6.2 to 6.3.

Page 31

6. HEALTH & WELL BEING NEEDS OF POPULATION (CONTINUED) Age 0-4 ASD BESD HI MLD MSI PD PMLD SLCN SLD SPLD VI Access to Services Portage Portage Portage Portage Portage Portage Portage Portage Portage Portage Portage (General) MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP Early Years Inclusion Early Years Inclusion Early Years Inclusion Early Years Inclusion Early Years Inclusion Early Years Inclusion Early Years Inclusion Early Years Inclusion Early Years Inclusion Early Years Inclusion Early Years Inclusion Team Team Team Team Team Team Team Team Team Team Team Specialist Autism Team CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Community Community Community Community Community Community Community Community Community Community Community Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Community OT Community OT Community OT Community OT Community OT Community OT Community OT Community OT Community OT Community OT Community OT Community S< Community S< Community S< Community Physio Community Physio Community S< Community S< Community S< Community S< Community S< Helena Specialist Nurses Access to Services Combined Clinic ADHD Service (3-16) Neurofibromatosis Neurofibromatosis Social & Neurofibromatosis Social & Combined Clinic Social & Social & Neurofibromatosis (Specific) Social & Combined Clinic Assessment, Support & Assessment, Support & Communication Clinic GAIT Analysis Communication Clinic Assessment, Support Communication Clinic Communication Clinic Assessment, Support Communication Clinic Social & Provision Service Provision Service Neurofibromatosis Service Neurofibromatosis & Provision Service Neurofibromatosis Neurofibromatosis & Provision Service Assessment, Support Communication Clinic Portage Portage Assessment, Support ITB Service Assessment, Support Portage Assessment, Support Assessment, Support Portage & Provision Service Assessment, Support Service for Children Sheffield Mencap & & Provision Service Assessment, Support & Provision Service ICAN Language Centre & Provision Service & Provision Service Sheffield Mencap & Portage & Provision Service with a Hearing Gateway Portage & Provision Service Portage Educational Portage Portage Gateway Sheffield Mencap & Portage Impairment Educational Visual Impairment Portage Sheffield Mencap & Psychology Team Sheffield Mencap & Educational Visual Impairment Gateway Educational Educational Psychology Team Support Service (0-3) Educational Gateway CAMHS: Child & Gateway Psychology Team Support Service (0-3) Specialist Autism Team Psychology Team Psychology Team CAMHS: Child & Service for Children Psychology Team Educational Family Therapy Teams Educational CAMHS: Child & Service for Children Educational CAMHS: Child & CAMHS: Child & Family Therapy Teams with a Visual CAMHS: Child & Psychology Team OT Service Psychology Team Family Therapy Teams with a Visual Psychology Team Family Therapy Teams Family Therapy Teams Continence Advisory Impairment Family Therapy Teams CAMHS: Child & S< Service CAMHS: Child & OT Service Impairment CAMHS: Child & CAMHS Mental Health Audiology Clinic Service Service for Children Continence Advisory Family Therapy Teams Family Therapy Teams Educational Family Therapy Teams Team OT Service OT Service with a Hearing Service Continence Advisory Continence Advisory Psychology Team OT Service ADHD Liaison Nurses S< Service S< Service Impairment OT Service Service Service CAMHS: Child & S< Service OT Service Educational Physio Service Audiology Clinic OT Service Family Therapy Teams Psychology Team S< Service OT Service S< Service OT Service CAMHS: Child & Sheffield Community Orthoptics Service Orthoptics Service Family Therapy Teams Equipment Loan Physio Service OT Service Service S< Service S< Service Sheffield Community Equipment Loan Service

Intra-service LDD: Early Years LDD: Early Years LDD: Early Years LDD: Early Years LDD: Early Years LDD: Early Years LDD: Early Years LDD: Early Years LDD: Early Years LDD: Early Years LDD: Early Years processes Service Service Service Service Service Service Service Service Service Service Service Multi-disciplinary Multi-disciplinary Multi-disciplinary Multi-disciplinary Multi-disciplinary Multi-disciplinary Multi-disciplinary Multi-disciplinary Multi-disciplinary Multi-disciplinary Multi-disciplinary Assessment Assessment Assessment Assessment Assessment Assessment Assessment Assessment Assessment Assessment Assessment Care Pathways Project Care Pathways Project Care Pathways Project Care Pathways Project Care Pathways Project Care Pathways Project Care Pathways Project Care Pathways Project Care Pathways Project Care Pathways Project Care Pathways Project Working Better Working Better Working Better Working Better Working Better Working Better Working Better Working Better Working Better Working Better Working Better Together Project Together Project Together Project Together Project Together Project Together Project Together Project Together Project Together Project Together Project Together Project

Parent/Carer/ Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Family Support Home-start Home-start Home-start Home-start Home-start Home-start Home-start Home-start Home-start Home-start Home-start MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group ACCT Family Placement Family Placement Family Placement Family Placement Family Placement Family Placement Family Placement Family Placement Family Placement Family Placement Family Placement Team Team Team Team Team Team Team Team Team Team Team Ryegate Respite Centre Helena Specialist Nurses Information for Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Parents and SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN Children Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Service Service Service Service Service Service Service Service Service Service Service Engagement of Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum children & families

Figure 6.2 Services to Needs Framework Mapping (Age 0-4)

Page 32

6. HEALTH & WELL BEING NEEDS OF POPULATION (CONTINUED)

Age 5-16 ASD BESD HI MLD MSI PD PMLD SLCN SLD SPLD VI Access to Services MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP (General) Specialist Autism Team CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Community Community Community Community Community Community Community Community Community Community Community Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Community OT Community OT Community OT Community OT Community OT Community OT Community OT Community OT Community OT Community OT Community OT Community S< Community S< Community S< Community Physio Community Physio Community S< Community S< Community S< Community S< Community S< Helena Specialist Nurses Access to Services Social & ADHD Service Social & Neurofibromatosis Social & CD& N: Dyspraxia & Social & Social & Social & Social & Social & (Specific) Communication Clinic Social & Communication Clinic Assessment, Support Communication Clinic Dev Communication Clinic Communication Clinic Communication Clinic Communication Clinic Communication Clinic Neurofibromatosis Communication Clinic Neurofibromatosis & Provision Service Neurofibromatosis Social & Neurofibromatosis Neurofibromatosis Neurofibromatosis Neurofibromatosis Neurofibromatosis Assessment, Support Neurofibromatosis Assessment, Support Sheffield Mencap & Assessment, Support Communication Clinic Assessment, Support Assessment, Support Assessment, Support Assessment, Support Assessment, Support & Provision Service Assessment, Support & Provision Service Gateway & Provision Service GAIT Analysis Service & Provision Service & Provision Service & Provision Service & Provision Service & Provision Service Sheffield Mencap & & Provision Service Service for Children Educational Service for Children ITB Service Sheffield Mencap & Educational Sheffield Mencap & Educational Service for Children Gateway Educational with a Hearing Psychology Team with a Visual Neurofibromatosis Gateway Psychology Team Gateway Psychology Team with a Visual Specialist Autism Team Psychology Team Impairment CAMHS: Child & Impairment Assessment, Support Educational CAMHS: Child & Educational CAMHS: Child & Impairment Educational CAMHS: Child & Educational Family Therapy Teams Service for Children & Provision Service Psychology Team Family Therapy Teams Psychology Team Family Therapy Teams Educational Psychology Team Family Therapy Teams Psychology Team Continence Advisory with a Hearing Educational CAMHS: Child & OT Service CAMHS: Child & OT Service Psychology Team CAMHS: Child & CAMHS Mental Health CAMHS: Child & Service Impairment Psychology Team Family Therapy Teams S< Service Family Therapy Teams SNIPS CAMHS: Child & Family Therapy Teams Team Family Therapy Teams OT Service Educational CAMHS: Child & Continence Advisory SNIPS Continence Advisory Within Reach Family Therapy Teams OT Service ADHD Liaison Nurses Audiology Clinic S< Service Psychology Team Family Therapy Teams Service Within Reach Service OT Service S< Service OT Service OT Service SNIPS CAMHS: Child & Continence Advisory Audiology Clinic OT Service Orthoptics Service SNIPS SNIPS S< Service Within Reach Family Therapy Teams Service OT Service S< Service SNIPS Within Reach Within Reach SNIPS OT Service OT Service Orthoptics Service SNIPS Within Reach Within Reach S< Service Physio Service Physio Service Within Reach SNIPS S< Service S< Service Within Reach Sheffield Community Sheffield Community Equipment Loan Equipment Loan Service Service SNIPS SNIPS Within Reach Within Reach

Intra-service Multi-disciplinary Multi-disciplinary Multi-disciplinary Multi-disciplinary Multi-disciplinary Multi-disciplinary Multi-disciplinary Multi-disciplinary Multi-disciplinary Multi-disciplinary processes Assessment Assessment Assessment Assessment Assessment Assessment Assessment Assessment Assessment Assessment Parent/Carer/Family Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Support MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group ACCT SNIPS SNIPS SNIPS SNIPS SNIPS SNIPS SNIPS SNIPS SNIPS SNIPS SNIPS Family Placement Family Placement Family Placement Family Placement Family Placement Family Placement Family Placement Family Placement Family Placement Family Placement Family Placement Team Team Team Team Team Team Team Team Team Team Team Ryegate Respite Centre Helena Specialist Nurses Information for Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Parents and SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN Children Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Service Service Service Service Service Service Service Service Service Service Service Engagement of Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum children & families

Figure 6.3 Services to Needs Framework Mapping (Age 5-16)

Page 33

6. HEALTH & WELL BEING NEEDS OF POPULATION (CONTINUED)

Age 17-19 ASD BESD HI MLD MSI PD PMLD SLCN SLD SPLD VI Access to Services MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP (General) Specialist Autism Team CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & CAMHS: Child & Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Family Therapy Teams Community Community Community Community Community Community Community Community Community Community Community Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Paediatricians Community OT Community OT Community OT Community OT Community OT Community OT Community OT Community OT Community OT Community OT Community OT Community S< Community S< Community S< Community Physio Community Physio Community S< Community S< Community S< Community S< Community S< Helena Specialist Nurses Access to Services Neurofibromatosis Neurofibromatosis Neurofibromatosis Neurofibromatosis Neurofibromatosis GAIT Analysis Service Neurofibromatosis Neurofibromatosis CDC CDC Neurofibromatosis (Specific) Progression & Progression & Progression & Progression & Progression & ITB Service Progression & Progression & Neurofibromatosis Neurofibromatosis Progression & Transition Service Transition Service Transition Service Transition Service Transition Service Neurofibromatosis Transition Service Transition Service Progression & Progression & Transition Service Assessment, Support Assessment, Support Assessment, Support Assessment, Support Assessment, Support Progression & Assessment, Support Assessment, Support Transition Service Transition Service Assessment, Support & Provision Service & Provision Service & Provision Service & Provision Service & Provision Service Transition Service & Provision Service & Provision Service Assessment, Support Assessment, Support & Provision Service Sheffield Mencap & Connexions LDD Team Connexions LDD Team Sheffield Mencap & Connexions LDD Team Assessment, Support Sheffield Mencap & Connexions LDD Team & Provision Service & Provision Service Connexions LDD Team Gateway Educational Service for Children Gateway Service for Children & Provision Service Gateway Educational Sheffield Mencap & Connexions LDD Team Service for Children Connexions LDD Team Psychology Team with a Hearing Connexions LDD Team with a Visual Connexions LDD Team Connexions LDD Team Psychology Team Gateway Educational with a Visual Specialist Autism Team CAMHS: Child & Impairment Educational Impairment Educational Educational CAMHS: Child & Connexions LDD Team Psychology Team Impairment Educational Family Therapy Teams Educational Psychology Team Service for Children Psychology Team Psychology Team Family Therapy Teams Educational CAMHS: Child & Educational Psychology Team Young People’s Mental Psychology Team CAMHS: Child & with a Hearing CAMHS: Child & CAMHS: Child & S< Service Psychology Team Family Therapy Teams Psychology Team CAMHS: Child & Health Team CAMHS: Child & Family Therapy Teams Impairment Family Therapy Teams Family Therapy Teams SNIPS CAMHS: Child & SNIPS CAMHS: Child & Family Therapy Teams ADHD Liaison Nurses Family Therapy Teams Continence Advisory Educational Continence Advisory Continence Advisory Within Reach Family Therapy Teams Within Reach Family Therapy Teams S< Service SNIPS Audiology Clinic Service Psychology Team Service Service Continence Advisory Orthoptics Service SNIPS Within Reach S< Service S< Service CAMHS: Child & Physio Service Audiology Clinic Service SNIPS Within Reach SNIPS SNIPS Family Therapy Teams S< Service Orthoptics Service S< Service Within Reach Within Reach Within Reach S< Service Sheffield Community Physio Service SNIPS SNIPS Equipment Loan S< Service Within Reach Within Reach Service Sheffield Community SNIPS Equipment Loan Within Reach Service SNIPS Within Reach

Intra-service Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs Complex Needs processes Transition Group Transition Group Transition Group Transition Group Transition Group Transition Group Transition Group Transition Group Transition Group Transition Group Transition Group Parent/Carer/Family Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Crossroads Support MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP MILAAP Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group Sibling Support Group ACCT Young People’s Mental SNIPS SNIPS SNIPS SNIPS SNIPS SNIPS SNIPS SNIPS SNIPS SNIPS Health Team Ryegate Respite Centre SNIPS Helena Specialist Nurses

Information for Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Sheffield INDEX Parents and SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN SIGN Children Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Sheffield Carers Centre Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Parent Partnership Service Service Service Service Service Service Service Service Service Service Service Engagement of Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum Interim Carers Forum children & families

Figure 6.4 Services to Needs Framework Mapping (Age 17-19)

Page 34

6. HEALTH & WELL BEING NEEDS OF POPULATION (CONTINUED)

6.5 Sheffield has a good mix of services and has services to address most elements of the Needs Framework. As noted previously this could be enhanced by a more strategic engagement with the third sector to enhance services and, potentially, cover gaps.

6.6 Parent/Carer/Family Support is generally good; SIGN, the Disability Index and publications such as “What’s Going On” provide a good flow of information to families and service users. However, the level of engagement is still developing. Initiatives such as the Interim Parent/Carer Forum and the recent LDD Strategy Consultation are steps in the right direction but time, effort and mutual confidence building are required to develop this aspect of the Needs Framework to where it needs to be.

6.7 It is noted that although there is progress on engaging parents/carers in strategy development and implementation there are currently no vehicles for the children themselves to provide their own input. Consideration should be given to models such as the City Equals initiative at Sunderland.

Page 35

7. PREDICT FUTURE NEEDS

7.1 In predicting the volume and characteristics of future needs used, the DCSF survey data for children in years 0-11 (i.e. approximate age 5-16) has been used. This represents the most reliable and comprehensive dataset against which to assess trends. The availability of equivalent national data also provides the capability to compare local and national trends.

7.2 Appendix 2 provides detailed trend analyses covering: • Analysis of local Sheffield data from 2005-8. • Comparative analysis of national Primary Need data with local Sheffield data from 2005-8 (National Primary Need data is not available from pre- 2005).

7.3 Figures 7.1 and 7.2 (overleaf) provide a comparison of national trend data for each category of Primary Need with local Sheffield data.

7.4 The number of children with identified LDD needs in Sheffield has grown by 16.1% between 2005 and 2006 representing an equivalent Annual Growth Rate of approximately 5.1%. This compares with a national annual growth rate over the same period of 3.1%.

7.5 Figures A2.16-30 provide a more detailed view of growth trends.

7.6 For most categories of Primary Need the rate of growth in Sheffield exceeds the national rate. The exceptions are BESD and VI. The VI difference is relatively small. However, the difference between the annual growth rate for BESD in Sheffield (1.8%) and nationally (5.2%) is, perhaps, surprising.

7.7 The fastest growing areas of Primary Need in Sheffield are ASD (16.8% AGR), SLCN (13.5%) and SLD (9.5%). ASD (6.5%) and SLCN (10.5%) are also the fastest growing categories nationally.

7.8 Having noted this, the ASD growth rate in Sheffield is much higher than the national rate of 6.5%. This may reflect the fact that, as the understanding and the ability to diagnose ASD conditions has increased, so has the number of children recorded with this category of need. Taken with the relatively lower growth rate for BESD (Sheffield 1.8%, national 5.2%) this may indicate that a growing number of Sheffield children who hitherto would have been categorised as having a primary need of BESD are now being diagnosed with ASD.

7.9 This issue should be kept under review since the relative growth rates in Sheffield are driven by 2005-7 growth to a large degree. The 2007-8 growth rates for ASD and BESD are 8.5% and 6.7% respectively (see Figure A2.16) and therefore closer to average national growth. Appropriate projected growth rates should be reviewed once 2009 data is available.

7.10 Sheffield runs counter to the national trend in the area of SLD, which is growing significantly in Sheffield but is actually reducing nationally.

Page 36

7. PREDICT FUTURE NEEDS (CONTINUED)

Sheffield Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI 2005‐8 Growth 16.1% 59.3% 5.5% 16.0% 6.5% 100.0% 15.0% 5.6% 35.4% 46.0% 31.3% 10.1% 6.7% Equivalent Annual Growth 5.1% 16.8% 1.8% 3.7% 2.1% 0.0% 4.8% 1.8% 6.0% 13.5% 9.5% 3.3% 2.2% Rate National Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI 2005‐8 Growth 9.6% 35.5% 16.3% 7.6% 0.9% 3.3% 11.5% 2.3% 12.5% 33.3% ‐6.0% ‐6.7% 8.3% Equivalent Annual Growth 3.1% 6.5% 5.2% 2.5% 0.0% 1.1% 3.7% 0.8% 4.0% 10.5% ‐2.0% ‐2.2% 2.7% Rate Figure 7.1 National vs. Sheffield Primary Need Trends 2005-8

Page 37

7. PREDICT FUTURE NEEDS (CONTINUED)

Figure 7.2

Page 38

7. PREDICT FUTURE NEEDS (CONTINUED)

SERVICE DISTRICTS

7.11 Growth rates by Service District are shown in Figure 7.3.

Figure 7.3

7.12 Arbourthorne /Manor/ Darnall, which currently has one of the largest populations of LDD children has an average growth rate which is quite significantly lower than the rest of the City. This is driven largely by an overall drop in children with BESD as their primary need over the period in question (approx 3.4% per annum). Growth in other categories such as ASD and SLD is relatively high and is ahead of the average across Sheffield.

7.13 Greenhill / Gleadless Valley has the lowest population of children with LDD in the City. The growth rate between 2005 and 2008 has been variable with extremely high growth in 2005-6, a small drop in 2006-7 and an above average increase in 2007-8 (9.4%).

7.14 Shiregreen / Burngreave has the largest population of children with LDD in Sheffield and the joint highest growth. The level of growth for most categories in this district is relatively high in this district. However, PD and VI show a reduction although in both cases the overall numbers are low so individual changes of status have a relatively high statistical impact. This Service District reflects the city-wide trend with respect to BESD; the number of children with this primary need is virtually the same in 2008 as it was in 2005.

Page 39

7. PREDICT FUTURE NEEDS (CONTINUED)

ETHNICITY 7.15 Growth rates for the various ethnicity categories are shown in Figure 7.4

Figure 7.4

7.16 The annual growth rate for children from the BME community with LDD is just over double that for the White British community. This has driven an increase in the proportion of children with LDD who come from this community from 19.4% in 2005 to 21.5% in 2008.

7.17 The population of children with LDD from a Pakistani ethnic background is the second largest in the city representing 6.9% of the total. This population is growing faster than the average for the city. Growth within this population is particularly high (albeit on relatively low totals) for ASD (34.5% AGR), PMLD (17.5%), SLD (16.4%) and SLCN (11.2%).

7.18 The growth amongst other ethnic groups is higher than average albeit on relatively small populations. Within these groups individual changes of condition can have a relatively significant impact on overall percentages.

Page 40

7. PREDICT FUTURE NEEDS (CONTINUED)

7.19 There is high growth across all ethnic groups for SLCN. Other areas with particularly high growth include:

• Mixed White/Black Caribbean – ASD (53% AGR), PD (18.5%), MLD (16.5%) • Somali – SLD (20.5%), BESD (20.5%) • Yemeni – PMLD (44.5%) • Other – ASD (29.0%)

7.20 Although relatively small in overall terms, the Eastern European population of children with LDD has grown significantly over the period 2006-8 reflecting the probable impact of migration over that period. In 2008 the total number for this population was 21 spread relatively evenly across a number of categories including 6 children with a primary need of SLCN.

PRIMARY NEEDS

AUTISTIC SPECTRUM DISORDER

ASD 2008 Total (Age 5-16) 677 2008 Total (Age 17-19 est.) 84 Sheffield 2005-8 AGR 16.8% National 2005-8 AGR 6.5%

Ethnicity ASD AGR White British 573 14.9% Asian or Asian British - Pakistani 17 34.5% Mixed/Dual Background - White & Black Caribbean 18 53.0% Black or Black British - Somali 2 N/A Yemeni 1 N/A Black or Black British - Caribbean 10 12.6% Other Ethnicity 56 29.0% Figure 7.5

Page 41

7. PREDICT FUTURE NEEDS (CONTINUED)

Figure 7.6

Figure 7.7

7.21 This is the fastest growing area of need within Sheffield and one of the fastest growing nationally. Growth rates in all Service Districts are above the national average although the areas with the highest numbers of children with these needs have the lowest growth rates.

7.22 Growth for all ethnic groups is ahead of the national average.

Page 42

7. PREDICT FUTURE NEEDS (CONTINUED)

7.23 The growth rates for this condition are startling. However, it should be noted that the growth in ASD in 2007-8 at 8.5% was substantially lower than those for the previous two years and is closer to national levels. This may indicate a degree of “levelling out” which will need to be reviewed when 2009 data is available.

BEHAVIOURAL EMOTIONAL AND SOCIAL DISORDERS

No 2008 Total (Age 5-15) 1956 2008 Total (Age 17-19 est.) 723 Sheffield 2005-8 AGR 1.8% National 2005-8 AGR 5.2%

Ethnicity No AGR White British 1583 1.8% Asian or Asian British - Pakistani 61 -4.5% Mixed/Dual Background - White & Black Caribbean 92 3.1% Black or Black British - Somali 35 20.5% Yemeni 20 7.7% Black or Black British - Caribbean 40 -5.3% Other Ethnicity 125 2.8% Figure 7.8

Page 43

7. PREDICT FUTURE NEEDS (CONTINUED)

Figure 7.9

Figure 7.10

7.24 Growth rates are substantially below the national level with some service areas and ethnic groups showing reductions over the past three years. The growth rate for children from a Somali background is very high.

Page 44

7. PREDICT FUTURE NEEDS (CONTINUED)

SENSORY IMPAIRMENT

HI MSI VI 2008 Total (Age 5-15) 210 4 80 2008 Total (Age 17-19 est.) 62 0 16 Sheffield 2005-8 AGR 3.7% 0.0% 2.2% National 2005-8 AGR 2.5% 1.1% 2.7%

Ethnicity No AGR No AGR No AGR White British 151 4.0% 2 N/A 54 0.0% Asian or Asian British - Pakistani 36 8.8% 1 N/A 11 6.9% Mixed/Dual Background - N/A White & Black Caribbean 0 N/A 0 N/A 1 Black or Black British - N/A N/A Somali 1 0 N/A 1 Yemeni 3 N/A 0 N/A 0 -21.5% Black or Black British - Caribbean 3 15.7% 0 N/A 0 -21.5% Other Ethnicity 16 7.2% 1 N/A 13 17.5% Figure 7.11

Figure 7.12

Page 45

7. PREDICT FUTURE NEEDS (CONTINUED)

Figure 7.13

Figure 7.14

7.25 Growth rates for sensory impairment are similar to those in the national population with HI slightly higher and VI slightly lower. The low instances for most of the Service Districts and Ethnic Groups mean that the impact of individuals on the total numbers is increased.

Page 46

7. PREDICT FUTURE NEEDS (CONTINUED)

LEARNING DISABILITIES

MLD PMLD SLD SPLD 2008 Total (Age 5- 15) 2554 88 285 1227 2008 Total (Age 17-19 est.) 378 1 60 197 Sheffield 2005-8 AGR 2.1% 6.0% 9.5% 3.3% National 2005-8 AGR 0.0% 4.0% -2.0% -2.2%

Ethnicity No AGR No AGR No AGR No AGR White British 1978 1.3% 56 6.8% 201 7.2% 1038 2.9% Asian or Asian British - Pakistani 207 2.0% 13 17.5% 41 16.4% 42 2.5% Mixed/Dual Background - White & Black Caribbean 79 16.5% 3 N/A 6 N/A 38 10.7% Black or Black British - Somali 58 5.1% 1 N/A 7 20.5% 15 4.9% Yemeni 48 15.7% 3 N/A 7 0.0% 8 -6.3% Black or Black British - Caribbean 16 7.2% 1 N/A 3 0.0% 12 0.0% Other Ethnicity 168 3.2% 11 22.5% 20 12.6% 74 8.5% Figure 7.15

Figure 7.16

Page 47

7. PREDICT FUTURE NEEDS (CONTINUED)

Figure 7.17

Figure 7.18

Page 48

7. PREDICT FUTURE NEEDS (CONTINUED)

Figure 7.19

Figure 7.20

7.26 Growth rates for all categories of Learning Disability exceed national rates. Nationally, instances of SLD and SPLD are shown to be falling but this is not the case in Sheffield.

Page 49

7. PREDICT FUTURE NEEDS (CONTINUED)

7.27 From a Health and Well-being perspective the relatively high rates of growth for PMLD and SLD in particular are important as these are the categories most likely to need health intervention. There is a reasonably even spread for these categories of need across Service Districts.

7.28 The data on ethnic minority groups in general has too few instances to make growth analysis particularly meaningful. However, it does indicate relatively high rates of growth in the Pakistani community for PMLD and SLD. This is consistent with research (Estimating Future Numbers of Adults with Profound Multiple Learning Difficulties in England, Emerson, CeDR, Lancaster University Research Report 2009:1) which indicates that these types of condition are more prevalent within this community.

Page 50

7. PREDICT FUTURE NEEDS (CONTINUED)

PHYSICAL DISABILITIES

PD 2008 Total (Age 5-15) 209 2008 Total (Age 17-19 est.) 39 Sheffield 2005-8 AGR 1.8% National 2005-8 AGR 0.8%

Ethnicity No AGR White British 156 1.1%

Asian or Asian British - Pakistani 27 7.1%

Mixed/Dual Background - White & Black Caribbean 5 N/A Black or Black British - Somali 3 N/A Yemeni 2 N/A

Black or Black British - Caribbean 0 N/A Other Ethnicity 16 7.2% Figure 7.21

Figure 7.22

Page 51

7. PREDICT FUTURE NEEDS (CONTINUED)

Figure 7.23

7.29 Instances for Physical Disability are relatively low and growth rates both nationally and within Sheffield are also low. Sheffield’s rate is, however, higher than nationally.

7.30 Again, there is a relatively even split between Service Districts. The discrepancies in growth rates probably reflect the relatively low numbers in each case and the effect of individual changes.

Page 52

7. PREDICT FUTURE NEEDS (CONTINUED)

SPEECH, LANGUAGE OR COMMUNICATIONS DIFFICULTIES

SLCN 2008 Total (Age 5-15) 1456 2008 Total (Age 17-19 est.) 94 Sheffield 2005-8 AGR 13.5% National 2005-8 AGR 10.5%

Ethnicity No AGR White British 1080 11.9%

Asian or Asian British - Pakistani 140 11.2%

Mixed/Dual Background - White & Black Caribbean 31 41.0% Black or Black British - Somali 34 21.5% Yemeni 20 26.0%

Black or Black British - Caribbean 18 11.5% Other Ethnicity 133 24.0% Figure 7.24

Figure 7.25

Page 53

7. PREDICT FUTURE NEEDS (CONTINUED)

Figure 7.26

7.31 This is the fastest growing area of need nationally and the second fastest within Sheffield. Again, the rate of growth within Sheffield exceeds that nationally.

7.32 All Service Districts are experiencing a large increase in cases with Shiregreen / Burngreave, Greenhill/ Gleadless Valley and Hillsborough /Upper Don particularly prominent. The rate of growth in Arbourthorne /Manor /Darnall, which has the highest number of instances is comparatively low.

7.33 All ethnic communities are demonstrating growth rates above the national average for this area of need with particular emphasis on the Mixed White/Caribbean, Somali, Yemeni and Other Ethnic groups.

POPULATION PROJECTIONS

7.34 Using the 2008 actual data for the Age 5-16 population and applying the average Annual Growth Rates for the period 2005-8 it is possible to develop a model for the projected children with LDD over the period 2009-10. This is shown in Figure 7.27 and 7.28 overleaf.

7.35 The model has been developed using the growth rates by Primary Need for the White British and BME populations. This, it was felt, would provide a reasonable approximation of growth based upon experience over the past 3 years. As noted previously it is recommended that the ASD and BESD figures, in particular are re-visited once 2009 data is available to check that the 2005-7 growth rates are not having a disproportionate effect.

Page 54

7. PREDICT FUTURE NEEDS (CONTINUED)

7.36 The projections indicate a growth of 27.7% in the children with LDD population over the period 2008-2012, an average annual growth rate of 6.3%. Growth within the BME population exceeds that for the White British population and, by 2012, will have risen from 21.5% of the population to 25.5%.

7.37 ASD, PMLD, SLD and SLCN represent the fastest growing areas within the children with LDD community. Services which support these needs will see the greatest increase in demand on their capabilities; MDA and SCD assessment, SLT, OT and Physiotherapy services and clinical resources associated with ASD conditions fall into this category. Specialist Respite provision will also be an increasing requirement.

7.38 For the age 17-19 population, each year’s population is projected by removing the oldest children and replacing them with the appropriate school year from the 2008 data i.e. Year 11 for 2009, Year 10 for 2010, Year 9 for 2011 and Year 8 for 2012. Whilst this is necessarily an approximation and does not take into account factors such as mortality, acquired conditions etc. it is viewed as a reasonable approximation. These projections are provided in Figure 7.29. The detailed calculations can be found in Figure A2.30.

7.39 The growth figures for the age 17-19 population are also significant. Overall, the children with LDD population is projected to increase by 37.7% from 1,699 to 2,339. If children with MLD needs are excluded from the numbers the growth is similar to that for the 5-16 population at 27.3%.

Page 55

7. PREDICT FUTURE NEEDS (CONTINUED)

Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI 2008 (Current) White British 7043 573 1583 151 1978 2 171 156 56 1080 201 1038 54 BME 1933 104 373 59 576 2 59 53 32 376 84 189 26 Total 8976 677 1956 210 2554 4 230 209 88 1456 285 1227 80 2009 White British 7366 658 1611 157 2003 2 172 158 60 1208 215 1068 54 BME 2125 136 380 63 607 2 73 55 38 446 97 200 28 Total 9491 794 1991 220 2610 4 245 213 98 1654 313 1267 82 2010 White British 7720 756 1641 163 2028 2 172 159 64 1351 231 1098 54 BME 2349 177 387 68 640 2 91 57 45 529 113 211 30 Total 10069 933 2027 231 2668 4 263 217 109 1880 344 1309 84 2011 White British 8109 869 1670 170 2053 2 173 161 68 1511 248 1129 54 BME 2612 230 394 72 674 2 112 60 54 627 131 223 32 Total 10721 1099 2064 242 2728 4 286 221 122 2138 378 1352 86 2012 White British 8537 999 1700 177 2079 2 174 163 73 1690 265 1161 54 BME 2923 300 401 78 711 2 139 62 64 744 152 236 35 Total 11460 1298 2101 254 2790 4 313 225 137 2434 417 1397 89 Figure 7.27 Age 5-16 Projected Population 2009-12

Page 56

7. PREDICT FUTURE NEEDS (CONTINUED)

Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI White British % 21.2% 74.3% 7.4% 17.0% 5.1% 0.0% 1.6% 4.5% 30.1% 56.5% 32.1% 11.9% 0.0% growth BME % growth 51.2% 188.3% 7.4% 31.6% 23.4% 0.0% 136.4% 17.4% 100.5% 97.9% 80.4% 24.8% 33.1% Total % growth 27.7% 91.8% 7.4% 21.1% 9.2% 0.0% 36.2% 7.8% 55.7% 67.2% 46.3% 13.9% 10.7%

2008 % BME 21.5% 15.4% 19.1% 28.1% 22.6% 50.0% 25.7% 25.4% 36.4% 25.8% 29.5% 15.4% 32.5% 2012 % BME 25.5% 23.1% 19.1% 30.5% 25.5% 50.0% 44.5% 27.6% 46.8% 30.6% 36.3% 16.9% 39.0% Figure 7.28 Comparison of 2012 projections vs. 2008 actuals

Year Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI 2008 1699 84 723 62 378 0 45 39 1 94 60 197 16 2009 1814 92 737 58 443 1 43 37 8 94 71 214 16 2010 2003 108 808 49 507 1 50 47 12 97 69 238 17 2011 2150 120 818 55 561 2 46 50 20 126 62 274 16 2012 2339 157 767 68 657 1 50 55 21 143 66 340 14 Figure 7.29 Age 17-19 Projections

Page 57

8. STAKEHOLDER ANALYSIS 8.1 Structured Interviews were conducted with representatives of the key services designed to meet the Health and Well-being needs of children with LDD.

8.2 The services that were reviewed are shown in figure 8.1

Location Service Beighton Community Hospital Dual diagnosis service (CAMHS) Children's Hospital Audiology Clinic Children's Hospital Orthoptics Service Children's Hospital Physiotherapy & OT Service Ryegate CDC ADHD Liaison Nurses Ryegate CDC Child Development and Neurodisability: ADHD Service Ryegate CDC Child Development and Neurodisability: Dyspraxia / Development Co-ordination Disorders Ryegate CDC Child Development and Neurodisability: Multidisciplinary Assessments (MDAs) & Social and Communication Disorders Assessment Clinics (SCDs)

Ryegate CDC Intrathecal Baclofen (ITB) Service Ryegate CDC Neurofibromatosis Ryegate CDC Ryegate Respite Centre/Helena Specialist Nursing Team Ryegate CDC Speech & Language Therapy Service Ryegate CDC SPQ Gait Analysis Service Figure 8.1 Health & Well-being Services reviewed

8.3 In addition parent/carer representatives were canvassed for their opinions on the extent to which needs are currently being met.

8.4 Key findings from this activity are detailed in the following paragraphs.

CAPACITY ISSUES

8.5 The demand on all services is such that they are operating to their capacity or are required to make adjustments to service levels. This issue is particularly acute in areas such as the assessment clinics and the provision of ongoing therapy services (Physio, OT and SLT).

Page 58

8. STAKEHOLDER ANALYSIS (CONTINUED) 8.6 This capacity issue for initial assessment is being overcome through a number of devices:

• Triage processes designed to allow prioritisation and signposting of cases are adopted by the therapy units. However, once these processes are complete the waiting time for follow up appointments can be long (e.g. 6- 10 months for a follow up Physio appointment). • Modified referral processes which introduce a doctor’s consultation in advance of a Multi-disciplinary assessment. The effort in this consultation is very often wasted as the assessment “proper” really commences when the multi-disciplinary team is assembled.

8.7 Estimates of the extent of the capacity shortfall at this phase vary. However, it is suggested that the capacity in terms of medical and therapist staff for assessments needs to be increased by approximately a third.

8.8 Capacity of therapists to support children in schools settings is an issue. Given the level and growth rate for children with ASD and SLCN needs pressure on SLT resources will be particularly acute. This service is estimated to be operating at 25% of required capacity within the mainstream schools environment.

8.9 The Dual Diagnosis service for children with LDD and mental health problems is also failing to meet outcome targets as a result of capacity constraints. Opportunities to supplement CAMHS services through closer working with therapists (e.g. SLT) are also being missed as a result of shortfalls in capacity.

SPECIALIST NURSING SUPPORT

8.10 The specialist nursing provision for children with ADHD and chronic neurological conditions (the Helena team) is a success. However, specialist nursing support for other conditions (e.g. ASD, mental health, Downs & Neurofibromatosis) would improve quality of service. Provision of these services in a community setting (in-home and/or in-school) to support children in developing self-care and social skills (washing, dressing, feeding etc.) would improve the life-style of parents/carers and the children would reduce demands on therapists, in particular OTs.

Page 59

8. STAKEHOLDER ANALYSIS (CONTINUED) 8.11 The Helena Specialist Nursing team provides a valuable service both in terms of palliative care and respite care in the home. However, demand is met through a combination of over-time working by the core team and the use of agency nurses for the 24 hour continuing care requirements (typically 2-3 at any one time). Regularisation of this situation through an increase in permanent staffing would allow the team to extend the service to more families in line with projected increased numbers. The reduction in reliance on agency staff would improve cost efficiency and, potentially, allow more continuing care packages to be supported, thus reducing demand for comparatively expensive hospital-based resource. It is understood that a business case for an additional eight nurses for this team is currently under consideration.

SPECIALIST EQUIPMENT 8.12 Access to and ongoing support of specialist equipment other than wheelchairs, specialist seating and orthotics (provided by the Mobility and Specialised Rehabilitation Service at the Northern General Hospital) lacks focus and co-ordination. Equipment is procured via a variety of budgets: Equipment Service, Physio/OT, schools, social service etc. and there is a lack of clarity over ownership. Issues such as procurement processes and authorities, warranty/maintenance responsibilities and reuse are also unclear. Training of staff and, in turn, parents/carers is also an area of potential vulnerability and liability.

SERVICE MIX

8.13 Sheffield is one of a small number of centres nationally that provide intrathecal baclofen (ITB) treatment for children with spasticity or dystonia and takes cases from a wide geographical area. The treatment is relatively expensive and is currently provided for older children with relatively advanced conditions. There is a case for reviewing the feasibility of earlier treatment which may help to reduce care requirements and the potential need for surgical intervention in later life.

8.14 Plans are being considered to allow cochlea implants to be carried out within Sheffield rather than in Bradford or Nottingham as at present. This will improve the capability to support children with HI needs but needs to be supported by appropriate therapist input.

8.15 There is currently no specialist paediatric dietician service and no community- based dieticians. Children with LDD frequently have associated dietary issues: allergies, intolerances etc. Consideration should be given to the development of a community paediatric dietician capability.

Page 60

8. STAKEHOLDER ANALYSIS (CONTINUED)

TRANSITION 8.16 Transition to adult services is an area of concern. For the majority of services young people who leave the school system at 16 will also leave paediatric services. In many cases, unless they have acute conditions or are on defined pathways, their access to Health & Well-being services may well diminish significantly. In many cases of children with ASD and mental health issues this change can be disruptive and upsetting. For some children, e.g. those with less severe needs (e.g. MLD) access may cease completely. Options for ongoing support, if appropriate, for the 17-19 years age group should be reviewed.

PRACTICAL ISSUES

8.17 On a logistical level, a number of services identified transportation issues as an inhibitor to patients wishing to access services. Parking, including for Blue Badge holders, is an issue at the Children’s Hospital whilst transport to and from the Ryegate Centre can be an issue for families with reduced means. Consideration of funds to support such families and/or better health based transport services should be a considered. 8.18 A number of services reported difficulties in getting user feedback to assist them in ensuring that needs are being addressed appropriately.

Page 61

APPENDIX 1: EXTERNAL RESEARCH FINDINGS

Page 62

This Appendix provides background to the requirement placed on local partnerships in the context of Aiming High for Disabled Children – ref: http://www.everychildmatters.gov.uk/socialcare/ahdc/ and provides examples of good practice which has been implemented around the country to meet this challenge.

BACKGROUND

Aiming High for Disabled Children (AHDC) was launched in May 2007, and is the Government’s transformation programme for disabled children's services. The documentation states that:

“The Government wants all children to have the best start in life and the ongoing support that they and their families need to fulfil their potential. Disabled children are less likely to achieve as much in a range of areas as their non-disabled peers. Improving their outcomes, allowing them to benefit from equality of opportunity, and increasing their involvement and inclusion in society will help them to achieve more as individuals. It will also reduce social inequality, and allow communities to benefit from the contribution that disabled children and their families can make, harnessing their talent and fostering tolerance and understanding of diversity.”

Supported by substantial new funding and measures designed to make the system work better, the Government is assisting professionals, managers and children's services commissioners to deliver the programme. A range of resources are available under each of the following five work streams:

• Short Breaks • Childcare • Transition Support • Palliative Care • Core Offer and National Indicator

The Core offer for AHDC was published in May 2008 and places the following requirements:

1. Information and Transparency Information on services for disabled children and young people and their families should be accessible, available, accurate, joined up and user focussed. Also, the availability of services and decisions on how services are commissioned should be transparent and fair.

2. Assessment In order to deliver services for disabled children and young people, assessments should be holistic, multi-agency and co-ordinated. Best practice evidence shows that integrated assessments are more likely to meet needs effectively and increase family satisfaction with services.

3. Participation and Feedback Parents and young people should be able to participate effectively in decisions about the services they receive, and practitioners should both seek and act upon feedback. If disabled children and young people and their parents are consulted about services available in their local areas, better services should result, and their satisfaction levels are likely to increase. Page 63

Core offer implementation materials to help LAs and PCTs develop their local core offer were also published in May 2008

Best Practice Review

A review of the approaches being taken to meeting these requirements by other areas was undertaken. Details of this review are provided below

The primary sources for this review were:

Aiming High for Disabled Children - http://www.everychildmatters.gov.uk/socialcare/ahdc/

Together for Disabled Children - the joint venture between Serco and Contact a Family, that was contracted to deliver support to LAs and PCTs in June 2008 www.togetherfdc.org

Plus the web-sites of Local Authorities, in particular those appointed to receive Short Breaks Pathfinder funding in March 2008:

• Bradford, Bolton, Bournemouth-Dorset-Poole (joint pathfinder), Brighton, Dudley, Derbyshire, Enfield, Gloucestershire, Gateshead, Halton, Kent, North Yorkshire, North Tyneside, Nottinghamshire, Norfolk, Suffolk, Sutton, Sunderland, Telford & Wrekin.

The main themes to emerge from this review were as follows:

Changing Delivery Models

Children’s and Families’ Services Resource Guide 14: Having a break: good practice in short breaks for families with children who have complex health needs and disabilities (SCI 2008) states that “Parents of disabled children want practical, flexible help and a break from the physical and emotional demands of caring for their child. They often wish that their relationship with their disabled child could be more ‘ordinary’ and they did not always have to perform caring or nursing roles.”

It goes on to suggest that there is a move away from total reliance on the traditional model of residential respite care for the disabled child. Newer, more flexible, models are being developed which provide various benefits:

• They are flexible and responsive to the whole family’s needs. • They can be based at home or in the community. • They ensure continuity of care. • They offer stimulating and educational activities. • They are family-centred. • They support parents. • They are distinct from healthcare services.”

Page 64

This is reflected in the case studies reviewed which demonstrated a range of alternative offerings including:

• Home based care arrangements. • Holiday play schemes. • Family outings and holidays. • Befriending schemes both for service users and their carers. • The use of foster carers or link families. • The use of Leisure facilities (e.g. football and theatre based activities).

Examples of these schemes are highlighted in the Review detail.

User Participation

A number of areas are engaging the service users to help in shaping the services to be delivered. This provides a sense of “ownership” and ensures the services are stimulating and challenging. Examples of this include the Disability Partnership Board Commissioning Group at Sutton and City Equals at Sunderland.

Parent/Carer Participation

This is a key requirement for the Core Offer and is a feature which is well developed in a number of areas. Contact a Family are very active in this respect and provide advice and support to Parent/Carer groups either in their own right or through Together for Disabled Children.

Parent Participation can take a number of forms from consultation through involvement in training and Steering Committees to active involvement in management of services and recruitment of key personnel.

Examples of active partner groups include:

• The Amaze Parent Group in Brighton & Hove • The Parent Carer Councils in Sunderland and Cornwall

Further examples are provided in the detailed descriptions

Organisational Factors

Successful implementation of the requirements of Aiming High for Disabled Children requires a strong and effective organisational structure to support it. Together for Disabled Children identifies a number of key factors to be considered in ensuring that there is appropriate management capacity for implementation and ongoing management of the requirement:

1. “Local areas should acknowledgement that the Aiming High Programme cannot be developed on top of the ‘day jobs’ of their staff and additional staff must be appointed. 2. There should be one person nominated to coordinate/ manage the actual project management – to ensure that the programme plan is adhered to and that all project documentation is kept up to date etc. 3. One person nominated to be the ‘Lead’ in terms of heading up the strategy – and being senior enough to be taken seriously/ have authority.

Page 65

4. The appointment of additional staff should be proportional to the size of authority. 5. Additional staff should cover the main tasks required by the programme (workforce development, data collection etc.). 6. There should be clear governance arrangements for reporting upwards and communicating outwards.”

The Case Studies on Nottinghamshire and Sunderland indicate how they have gone about organisation and management capacity issues.

Market Shaping/Development

The introduction of new service models may well bring with it the requirement to work with local and national suppliers, including the third sector, to develop new capabilities and offers. Areas such as Sutton, Dorset and Cornwall have engaged with their partners and suppliers to develop local plans for service delivery

Information Management

A key to success is the ability to access and disseminate information regarding the availability of new and existing services. The Halton case study refers to the development of a “joined up” database incorporating service users, services and suppliers to facilitate the management of the programme. A number of areas use newsletters and other information methods to engage directly with service users and keep them informed.

Facilitation/enablement

There is a need to go beyond simply setting services up and letting people use them. Other factors come into play – transport, specialist care support, special equipment. It is also necessary to ensure that personal circumstances e.g. poverty do not impact participation. Areas such as Sunderland have set up discretionary funds to allow issues such as this to be overcome where appropriate and feasible. On a practical level, Plymouth has established a programme to train disabled children to use public transport independently thus enabling greater access to facilities and services and preparing for transition.

“Hard to Reach” Communities

Special measures are required to ensure that particular communities (e.g. ethnic groups) are not deprived of participation. Areas such as Brighton & Hove and Nottinghamshire have identified the need for proactive steps to ensure that these communities are engaged.

ASD and Challenging Behaviour

Children with these conditions present particular challenges; In their paper “Family- Based Short Breaks (Respite) for Disabled Children: Results from the Fourth National Survey”, (British Journal of Social work, 2008) Cramer and Carlin report that, “The most common profile of children waiting the longest for a service is still teenage boys with autism or ‘challenging behaviour”.

Page 66

Researchers at the Norah Fry Research Centre at the University of Bristol, (Better for the Break? Support for children and teenagers with autistic spectrum disorders and their families, 2007) suggested that service providers need to understand the condition and recognise the importance of:

• “Acceptance of the child/teenager. • Matching with appropriate supporters who have similar interests. • Preparing children for their short break. • Appropriate introductions which take as long as necessary. • Thorough planning, which reduces anxiety but allows for carefully introduced new experiences. • Suitably sized environments in which children are safe and secure. • Consistency in provision by ensuring the same supporter is available and services are provided at consistent times. • Partnerships with parents and other agencies to ensure the child’s individual needs are met and their behaviour managed consistently. • High staffing levels so that children can have 1:1 support. • High levels of training and support for staff.

Supporters working with children with ASD should receive training in ASD as well as gaining a detailed understanding of the child through working in partnership with their parents, school and any other agencies.”

Case Studies for Wokingham and Greater Manchester deal specifically with services for these children and illustrate how specific partnership working between agencies and the third sector can improve the quality and focus of services.

The Northamptonshire example also provides organisational and practice pointers regarding the key transition activities for children with this type of condition.

Transition

Successful transition services for disabled children into adult services are key activities. A number of good practice examples are given indicating how best to organise multi-agency teams and processes to achieve this successfully.

Palliative Care

The Government’s future direction for children’s palliative care services is laid out in the document, “Better Care: Better Lives” published in February 2008.

This document states the vision that, “Every child and young person with a life- limiting or life-threatening condition will have equitable access to high-quality, family- centred, sustainable care and support, with services provided in a setting of choice, according to the child and family’s wishes.”

Page 67

It goes on to create a vision for services that have the following attributes:

• An early, inclusive, joint (health and social care) assessment of need; • An identified key worker/lead professional with responsibility and authority for negotiating and co-ordinating packages of care; • Care that is planned and delivered in full consultation and partnership between the child and family, and service providers; • Clear, comprehensive information and support regarding the child’s condition, including sources of further support; • Practical assistance and timely provision of equipment and adaptations; • Universal provision of emotional, psychological, spiritual and bereavement support for the family (including siblings), carers and wider community; • Education and learning appropriate to the age and stage of development of the child or young person; • Play and recreational opportunities; • Specialist short breaks with appropriate healthcare, nursing and medical input; • Access to responsive care and support from staff skilled in children’s palliative care management; and • Better advanced and emergency care planning to enable the child to die in their preferred place of care.

Better Care:Better Lives is based upon a review undertaken for the Secretary of State for Health by Professor Sir Alan Craft and Sue Killen: “Palliative Care Services for Children and Young People in England”. This report stressed the need for partnership working both on a multi-agency and geographical basis:

“SHAs and GOs should take the lead in planning services at regional level, ensuring there is an established, functioning and effective Paediatric Palliative Care Network and that PCTs and Local Authorities form sub-regional groups covering the right population size and geography for effective commissioning of sustainable services. Commissioning some elements of the specialist provision will involve Specialised Commissioning Groups.

The voluntary sector providers should be seen as key partners at every level of planning and delivery. Given their vital role in developing palliative care, the two main bodies representing the voluntary sector, the Association for Children’s Palliative Care (ACT) and the Association of Children’s Hospices (ACH) should consider the scope for providing an even stronger national voice for children and young people with palliative care needs.”

The recommendation regarding the establishment of Children’s Palliative Care Networks in the Craft/Killen report is underlined in Better Care:Better Lives which states that “In order to improve and enhance the understanding and awareness of the needs of children with life-limiting and life-threatening conditions, local networks, jointly developed with local authorities and children’s trusts, can be an effective model of service provision. Regional networks are needed at strategic health authority/ Government Office level, in order to be operationally relevant and efficient.” Page 68

It identifies the following benefits for a network-based approach:

• “Better integrated and more effective commissioning models can be developed and shared. • Statutory and voluntary agencies will work together to provide an agreed and comprehensive range of services. • Local needs can be assessed, through mapping of affected children and young people and available services (this would be via children’s trust arrangements). • Skills, knowledge and expertise can be exchanged. • Local service users can be involved and included in service development.

• Care pathways can be implemented. • More equitable services can be developed. • Training and development opportunities for staff can be developed at a more strategic level across all agencies; and • Development of a recruitment and retention strategy can be pursued.”

ACT recommends that these networks “should draw on the full range of local children's palliative care champions from across the whole sector of statutory and voluntary organisations, these may include:

• Commissioners of Children’s Services. • Heads of Services. • Paediatric Consultants with special interest in palliative care. • Children Community Nurse team representatives. • Children’s Disabilities Team representatives. • Representation from local hospices and other voluntary organisations. • Education representative. • Parent representative.

The Good Practice material highlights a number of areas where a regional networking approach has been taken to palliative care including London, North East England and South West England.

The following material summarises the findings of the Best Practice Review. A summary of how this material maps on to the identified framework of needs is provided in Figure A1.1 below.

Page 69

Kingston-upon-Thames Kingston-upon-Thames Northamptonshire LCPCN (London) St Oswald's (NE) Greater Manchester Greater Manchester SWCPCN (SW) Stoke-on-Trent Nottinghamshire Nottinghamshire Brighton & Hove & Brighton Hove Northumberland Birmingham Plymouth Plymouth Wokingham Wokingham Leicester Sunderland Sunderland Gateshead Gateshead Sandwell Sandwell Bradford Bradford Cornwall Enfield Sutton Sutton Dorset Halton Halton

Access to Services (General) Facilitation/Enablement x x x x x

"Hard to Reach" Communities x x Access to Services (Specific) ASD x x x x x x Palliative Care x x x x x x Leisure/Social x x x x x Intra-service processes x x x x x x x x x x x x Parent/Carer/Family Support Short Breaks x x x x x x x x x x x x x Emotional/practical support x x x x x x x Information for Parents/Children x x x x x x Engagement of Children/Families x x x x x x x x x Figure A1.1 Mapping of Best Practice Examples to Needs Framework

Page 70

Sutton (Short Breaks Pathfinder)

• Approach to short breaks is defined by the overall strategy for disabled children consisting of six core themes: social inclusion, prevention/early intervention, independence and choice, participation, integration and financial sustainability. • Working with parents, children and young people, professionals providers to produce a comprehensive “Market Development and Purchasing Plan” – plans use of resources and commissioning/decommissioning strategies. • The Disability Partnership Board Commissioning Group, which includes service user representatives, agreed a spending plan by which a substantial proportion of the 2008- 09 grant was used to strengthen commissioning infrastructure, workforce development and support for participation.

Enfield (Short Breaks Pathfinder):

• Range of short breaks designed to respond to the changing phases and needs of family life. • 24/7delivery model of short break options comprising specialist and inclusive holiday play schemes, specialist and inclusive after school clubs, specialist and inclusive youth clubs, home care, home sitting, overnight breaks, weekend leisure activities and family supported outings. • Plan to increase and extend mix, providing more short breaks to more families and to increase choice including more direct payments and a range of more overnight short breaks including family supported holidays. • Plan to extend inclusive opportunities thus building capacity and sustainability in mainstream providers; support settings which provide training and ‘link workers’ to promote and aid positive inclusive practice children and young people with ASD and/or complex health needs. • Engagement with a wide range of community partners via Disability Forum to increase and extend short break options. • Use of Disability Sports Coordinator, Inclusion Outreach Worker and Tottenham Hotspurs Inclusion Officer for Disabled People to promote sporting opportunities including at a competitive level for our disabled young people. • Further development of links with Enfield Town FC and Enfield FC to enable greater participation both as spectators and participators. • Development of opportunities for access to the arts through partnership with Enfield Arts and Events Team and local theatre groups including Facefront.

Dorset (Short Breaks Pathfinder):

• Joint sub-regional approach already in place to establish consistency in service provision for short terms breaks. • Frequency of use for overnight residential services has been declining overall, leading to poor economies of scale and the need for service re-commissioning. • An expansion of existing services may need to be considered if appropriate. Key to this is the additional training needed for providers to encourage additional places for children who are disabled. • Transport issues are a key factor in Dorset and require more consideration than linking provision to specialist services. • Joint approaches to continue in relation to direct payments, holiday schemes and leisure opportunities, family based short break provision inclusive of befriending and contracted carers, general market development, eligibility and thresholds, domiciliary care and palliative care development and workforce planning. Page 71

Brighton & Hove (Short Breaks Pathfinder)

• Children with Disabilities and Complex Needs Strategic Partnership Board with robust parental representation and terms of reference that outline the process of engagement and consultation and a mechanism for conflict resolution. • Explicit support mechanisms in place from the independent sector for parents who are involved and a system of payment for parents and carers to attend meetings. • Partnership board is jointly chaired by the director of Amaze, the independent voluntary parent support organisation. • Open process with shared influence re agreeing spending priorities and in formulating the tendering process. • Open process for agreeing some of the initial infrastructure needed to support Aiming High e.g. an Aiming High project manager; parents and voluntary sector partners to be fully involved in the recruitment process. • Plan to look in more detail at how to engage in an ongoing way with young people and will use the school councils as the starting point. • Have undertaken a consultation exercise with young people which informed commissioning strategy but recognises that ongoing consultation with children and young people is an area which needs strengthening. • Setting up a parent council which will address consultation and engagement across the whole agenda i.e. health, social care and education; working to ensure that representation is as broad as possible but recognise that further work on the area of BME and families from more deprived wards within the city is required. • Has made a clear commitment to ensure that all stakeholders including parents and young people have a fully participative role in deciding spending plans for Aiming High.

Nottinghamshire (Short Breaks Pathfinder)

• Alison Shield, leader of the Nottinghamshire Council pathfinder, says there have been wide disparities in the quality of provision, with some families in the county receiving a "gold standard" service, while others were getting little support. • Review of services undertaken to reconfigure them, increase their range and ensure the involvement of leisure, play and sports services so disabled children have "an enriching experience". • As a result of the review, the authority can provide more community-based resources, such as sitter services, across a wider geographical area as well as high-cost residential places for children who need them. • Increasing use of foster homes; the council has successfully developed a contract care scheme where salaried foster carers provide overnight stays for children with profound disabilities or challenging behaviour. • NoRSACA (Nottingham Regional Society for Adults and Children with Autism) provides regular planned 'breaks' and outreach services for carers of people with autism. • Residential short break units are funded jointly by both the local authority and PCTs – for example the unit for children with multiple impairments and complex health needs is managed by the local authority but staff from health work within the unit in an integrated way. There is a nurse and occupational therapist employed within the family based short break team to assist in facilitating the assessment, training and safe placements of disabled children. • In preparing for the Aiming High programme, Nottinghamshire appointed a Lead Officer for Service Development and have since added two additional posts – a Project Manager from the PCTs and a Lead Officer – Systems / Resources.

Page 72

• Each of these posts is responsible for specific work strands within the Aiming High programme. Part of this role is to chair task groups that meet around that area of work. Parents are represented on these task groups. These task groups can debate, discuss and plan the transformation of services in their particular areas – concentrating on detail – which allows more senior managers to take a more strategic view. • In addition, the overall Project Manager who holds responsibility for a number of services within the authority arranged to take 3 months away from ‘her day job’ in order to progress some particular strategic issues – for example the development of a sufficient and flexible workforce.

Bradford (Short Breaks Pathfinder):

• Nursing and health care staff based within the residential respite services and working closely alongside social care staff. • The joint funded provision at Behaviour Evaluation Support Team (BEST) which provides short break whilst working to modify a child’s behaviour. • The partnerships with Housing Providers to enable adapted housing within the family short break scheme. • Multi-agency behaviour management training.

Sunderland (Short Breaks Pathfinder):

• Establishment of a “Participation Fund” to enable disabled children to participate in activities where something is stopping them from joining in e.g. lack of transport, equipment, extra support workers to support the child, specific training for staff. • The Aiming High Project Board established to involve all stakeholders in deciding how money should be spent: Sunderland Parent Carer Council, Children’s Services, Sunderland Teaching PCT, City Hospitals NHS Trust, Sunderland Carers’ Centre, Health, Housing and Adult Services. • Aiming High Newsletter to keep stakeholders abreast of developments. • Aiming High Project Team established: o Programme Manager – to work with disabled children and young people, their families and colleagues to ensure the Aiming High programme is implemented successfully. o Information Officer to provide disabled children and young people and their families with the information that they need, in a range of formats so that it is available to everyone o Information Analyst to collect and analyse information about the number of children accessing different types of short breaks, to help us understand if disabled children’s needs are being met. o Business Support Assistant to provide administrative and financial support to the Project Board and Project Team.

Page 73

• City Equals: o Run by nine young people aged between 13 and 25 who coordinate a group with varying disabilities working towards representing young people with disabilities across the City. The Group has been running since April 2003. o Has been involved in a wide range of national and local consultations, including work on the Youth Matters Green Paper, the local Strategic Partnership review of transition services, Sunderland's anti-bullying charter and the State of the City Debate. o Work by the group with local hospitals has convinced health professionals to change their practice by talking straight to disabled young people instead of consulting through parents and carers.

Gateshead (Short Breaks Pathfinder):

• Home from Home Short Break Fostering Scheme arranges for disabled children to have regular stays with another family. The length of the stay depends on the needs of the child and the availability of the carer. Some may visit their link family for one weekend a month, others may spend as much time with them as they do with their own family.

Cornwall:

• The Parents Carer Council in Cornwall, in conjunction with the local voluntary befriending organisation, Face2Face, works closely with all local agencies to help plan and deliver services to families. • Parental representation on all strategic groups, often in a chairing or co-chairing role. • Direct involvement has led to a number of changes in provision, from the retention of threatened services to the development of new ones. The use of direct payments is encouraged and other creative solutions to ensure families receive the most efficient packages of care, including inclusive childcare and flexible short breaks. • Parents involved in Face2Face help shape services through designing and delivering training to childcare settings in providing for disabled children and their families. The dual benefits of transferring skills to the universal workforce, and allowing parents a platform to share their expertise and regain their confidence, is proving hugely beneficial to promoting inclusive childcare settings, breaking down attitudinal barriers and improving the trust in universal settings for parents of disabled children.

Halton (Short Breaks Pathfinder):

• Halton uses a single data set, which includes all health, social services and education data available on their vulnerable children population to improve communication, eligibility assessment and commissioning of services. The work of the Halton Children and Young People Strategic Partnership is firmly based on the operation of this database. • The Local Authority maintains pupil-centred data relating to pupil service, early years, grants and benefits (Free School Meals), e-Common Assessment Framework, Special Educational Needs and Admissions. It also utilises information from a very wide range of organisations and information sources which affect the lives of children, including Youth Offending Teams, Colleges, Looked-After Children, the Traveller Service, exclusions, PCT 0-3 year olds, Connexions (including children not in education, employment or training), non-Halton schools, academic performance etc..

Page 74

Wokingham:

• Wokingham Autism Partnership established to consider the needs of children and young people with Autism in Wokingham. The Partnership has representatives from statutory agencies, voluntary organisations (including the National Autistic Society (NAS), Berkshire Autistic Society, Autistic Spectrum Disorder (ASD) Family Help and Mencap) and parent groups. It meets six times a year and there are five sub-groups covering Information, Communication and Consultation, Diagnosis and Assessment, Services, Training, ASD Family Help (parent group). • There is a multi-agency team presenting the National Autistic Society EarlyBird and EarlyBird Plus programmes. • Identified areas for action include: o A plan to deliver a variety of training and workshops for parents and those who work with children on the spectrum. o More specialist provision for secondary age pupils. o A clearer pathway through diagnosis and assessment. o Access to appropriate therapies. o Inclusion, awareness and support from mainstream leisure providers. o Access to short-break provision for children with high functioning Autism and Aspergers Syndrome. o Autism-specific leisure activities and social groups.

Greater Manchester:

• The Greater Manchester Autism Consortium is formed by the 10 Social Services Departments in Greater Manchester (Bolton, Bury, Manchester, Oldham, Rochdale, Salford, Stockport, Tameside, Trafford and Wigan). It funds and steers The National Autistic Society’s (NAS) Family Services Development Project which supports the strategic development of local services for people with autism. • There are Autism Services Development Groups in each of the local areas which are comprised of parents of people with autism and key staff in local statutory services in Social Services, Health and Education. The groups work together to develop and improve local services. They also link with each other across the region through the consortium. The Chairs of the groups are also members of the Consortium Steering Group, together with the NAS Family Services Development Project. • As well as providing telephone advice and individualised Information Packs parents & carers can be put in touch with other support groups and receive a parent-to-parent telephone link via the Greater Manchester Parent Resource Network. • The project supports the development of statutory services within each of the 10 Local Authorities through the Autism Services Development Groups. These multi-agency groups, which include parent representatives, look at ways of developing better services for all people with autism. • The project has developed a website and a quarterly newsletter (AutismGM) for the region to ensure better access to information about autism within the Greater Manchester region and to disseminate policy development and good practice. • Examples of support services operated in the area include: o ASD youth groups in Manchester, Bolton, Bury, Oldham, Rochdale and Salford o Befriending schemes in Bury and Oldham. o Trampolining groups in Stockport and Salford. o Bury, Manchester and Trafford have trained some foster carers to work with children with ASD so they can offer breaks to those children. o Short Break services for people with learning disabilities undergoing Autism Accreditation with the NAS.

Page 75

o Leisure for Autism (a Manchester-based charity) play-schemes running in Manchester, Stockport, Salford, Trafford and Wigan. o Meridian, a short break service run by Together Trust has expanded its service to include an outreach service.

Kingston-upon-Thames

• The Carers' Support Scheme recruits and approves individual befrienders for disabled teenagers aged 12 to 19 years. A befriender will help the disabled teenager to take part in a range of leisure activities in the community or in their own homes, so they can have fun and develop their independence. • Befrienders are recruited from young people aged 16 to 25 years who live in or near Kingston; they may be at Sixth Form College, university or working in the local community. They are approved, trained and matched to individual disabled teenagers according to their interests, age and experience. • Parent/carers get a short break from their caring role in the knowledge of their son or daughter is involved in social activities appropriate to their age. A befriender whom the parent/carer has come to know and trust provides short breaks. • Share the care provides short breaks for parents/carers of disabled children and gives the children the chance to make new friends and develop their independence in a family environment. Each child is matched to a link carer/s who offer short periods of care on a flexible basis. Care is usually provided in the link carer's home or out in the community. • Link Carers may be married, single, male or female and are checked approved and trained in a similar way to foster carers. Links may last for a number of years and provide friendships and support for the child and family.

Sandwell

• The children’s trust has developed a co-located multi-agency service whose role is to plan and facilitate services for disabled children and young people from birth to 25 years. None of the staff are employed directly by the children’s trust. The team includes:

• Learning disability nurses and psychologists from the CAMHS. • A youth coordinator from the Youth Service. • Connexions personal advisers (PAs). • Children’s and adult social workers. • Sensory support teachers. • Preschool education and child development centre staff.

• The service’s base hosts a range of direct provision, including outpatients’ clinics. • For transition, Personal Advisors identify young people from Year 9 reviews onwards who need a coordinated multi-agency response, then liaise with other staff in the team to ensure that respective responsibilities are agreed prior to a young person’s 18th birthday. • The PAs work with schools to plan joint working with ‘getting ready sheets’ in school. These sheets can be used as a basis for individual discussions with pupils around their PSHE and future plans.

Page 76

Sandwell Palliative Care and Continuing Care Team

• Provides 24 hour respite home care at weekends, nights and bank holidays for children and their families. • The services provided include: o Support for children in the terminal phase of their condition. o Close working with primary care team to enable them to support the child and the wider family. o Advice on symptom management and direct management of complex or difficult symptoms when requested. o Care for children and young people in their home. o Extended hours of practical nursing support. o Psychological support. o Advice on the impact of illness on emotional well-being of child and family. o Work with child and family to facilitate adjustment to change in the child’s illness and offer support in coping with the condition. o Coordination of care package and joint working with other service providers, including specialist services and the voluntary sector. o Seeking of support for families through statutory and voluntary bodies. o Work with siblings. • Staff work in partnership with teams from acute and community health services and also other agencies. Close links with other speciality services and the voluntary sector include Birmingham Children’s Hospital (Paediatric Macmillan Service and other clinical specialties); Acorns Children’s Hospice (in house team, community team and bereavement service); Early Years Integrated Support Services; Crystal House and Sandwell Multi-care.

Northumberland

• Following consultation with young disabled people, Northumberland Children’s Fund and Northumberland Sport have implemented “Max” cards • These are available to all disabled children and their families and offer free or • reduced admission to historical and cultural places of interest. • Leisure service providers and district councils have agreed Max card holders will also be entitled to reduced-cost activities in leisure centres. • Northumberland Care Trust, Northumberland County Council’s Fair Access to Care implementation team and Connexions Northumberland are piloting a system for data sharing at transition to ensure that adult care services know who is likely to need support in future. • At the Year 9 review, a set of seven simple and brief questions is posed (focusing on levels of ability). If the answers imply that the young person may need adult services in the future, their details will be added to the database. Adult services will then contact the young person and their existing care managers and work with them to plan for the future.

Leicester

• The LSC funds a Policy & Planning Officer – Transition. This is a resource for all partner agencies to encourage collaboration and inter-agency working to support transition activities. • Post is hosted in Children and Young People’s Services and reports to the Transitions Working Group, a subgroup of the Learning Disability Partnership Board (LDPB), and the CYPSPB.

Page 77

• The transitions action plan is closely aligned with other strategic and working plans, including the CYPP, Adult Learning Disabilities Plan, the LSC’s priorities for disabled learners and the Connexions Service Business Plan. • Activities underway include: o A transitions pathway plan, person-centred review programme and introducing person-centred thinking skills to schools o A CD-Rom ‘Going to college’, based on what young people say is important to them to meet their information needs o Best practice activities – information transfer, linked to the person-centred review activities o A DVD for parents/carers focusing on their engagement in the transition process and the changes from children’s to adult services.

Northamptonshire

• The Transition and Liaison Team (TLT) was established in November 2003 after it was noted that there was no service provision for young people with Attention Deficit Hyperactivity Disorder, Asperger’s syndrome or Tourette’s syndrome after they left school. • It is a county-wide service which provides detailed assessments, diagnoses and short- term focused interventions for young people aged 16+ with these disorders: • The team also supports young people with the above disorders who are due to leave school and transfer into adult services and young people with a learning disability and mental health problems. • The TLT works with a range of services and agencies, including specialist forensic, learning disability, mental health (including inpatient), accommodation and commissioning, social care and health, employment, Connexions and further education services.

Page 78

Plymouth

• The City Council has set up a scheme to provide independent travel training to young people with special educational needs aged 14–19 in full time education. • Travel trainers work on a one-to-one basis with students, helping them to develop independent travel skills and problem solving skills, as well as providing general support. • This scheme opens opportunities both for learning and job prospects, increases independence and use of own initiative, provides greater freedom and raises self confidence and social skills. • The trainee is taken through three stages: Accompanied, Supervised and Independent travel • There is then a final assessment where the student will be assessed while travelling independently on a relevant journey. The trainer is then available for ongoing support • On completion the student receives a certificate and as a free bus pass valid for one year which can be used for their independent school journey and at weekends.

Page 79

North East England – St Oswald’s Children’s Partnership

• Provides specialist short breaks for children who have a shortened life expectancy in the North East. The service is provided by a regional charity that works to a tried and tested partnership model with seven local authority and PCT areas (six Tyne & Wear plus Northumberland). • Service is commissioned by the LAs and the contract reflects joint assessment and referral model agreed with the six PCTs, St Oswald’s and social services. The contract is the same for each area. • Fees are based upon a joint (and equal) contribution from the LA and PCT from the area the individual child comes from. This contribution is the same throughout the seven areas. St Oswald’s meets the remaining costs for each child accessing the service. The “contractual funding” level is 20.1% as of April 2007 • Annual meeting with commissioners from the LAs and PCTs and contracting officers with St Oswald’s is built in as a part of the process. This meeting sets the fee for the following year (and standardises it across each of the areas). It also allows review of the service and future service developments • St Oswald’s worked with health and social care to co-design and develop the pathways that are underpinned by the same principles in all seven areas to ensure equal opportunities for access; entry points are identified in each local area for all enquiries and social care and health work together to ensure a holistic assessment of the needs of the child and family, building on existing statutory sector assessment processes. • Pathway coordinators in each area provide leadership and a knowledge base about the service working closely with St Oswald’s. They also develop an understanding of the likely demand for the service in their area to assists with the business planning processes for all the partners.

London Children’s Palliative Care Network (LCPCN)

• A multi-agency working group designed to ensure that palliative care for children and young people and their families is delivered in a seamless and integrated way across the City of London (i.e. the area served by the Strategic Health Authority – NHS London). • Working group representatives include: o Parent representatives. o Children’s Community Nursing team representatives. o Commissioners of Children’s Services for PCTs and Las. o Education representatives. o Head of Service Improvement for Children and Young People (PCTs). o Paediatric Consultants with special interest in palliative care. o Children’s Complex Needs representatives (PCTs). o LA Children with Disabilities Team representatives. o Representation from local Children’s Hospice services. o Representation from other voluntary organisations. o Cancer Network representative. o Other professionals as appropriate. • The function of the group is to: o Ensure that the responsibility of individual agencies are identified and met o Develop an integrated multi-agency care pathway for the provision and delivery of palliative care for children and young people and ensure there is a shared accountability for it across agencies. o Receive information and feedback from families about the level of service they require.

Page 80

o Agree work streams and sub groups which will report to the Children and Young Peoples Partnership Board. o Ensure that palliative care provision fits into the wider pan-London agenda of the CYPP. o Share progress and plans with other networks, ACT, ACH.

South West England Children’s Palliative Care Network (SWCPCN)

• The Children’s Palliative Care Network for the South West evolved in response to Better Care: Better Lives and from a desire to bring together the various agencies and individuals within the region providing support to children, young people and families living with life-challenging illness. • Membership of the network is open to all those engaged within or interested in the delivery of children and young people’s palliative care within the South West. There is multidisciplinary membership, with representation from both statutory and voluntary sectors and health, social and education services. • The Network structure is as follows: o Strategic Regional Palliative Care Network Group to undertake strategic planning, oversight of zonal groups regarding local services, consideration of over-arching regional themes via subgroups (Transitional care, Service Mapping, Care Pathways, Standards, Workforce Planning, Training), and collection of information and service mapping. o Geographically based zonal networks (e.g. Somerset, Devon/Cornwall) to co- ordinate at PCT/ LA level commissioning of general and core palliative care services e.g. CCN teams, OT & Physio services, bereavement services, respite care, psychological support etc.. These groups include commissioners, service improvement leads, users, providers from voluntary and statutory sectors, from local authority and health. o Disease-specific networks e.g. cancer, neonates, intensive care etc. These are often clinically-driven, with input from service users, managers, commissioners etc. They feed into the regional strategic network group, and also into regional and national structures re disease-related service improvement, in response to NICE guidance etc. • The stated objectives of the network are: o To share and disseminate best practice. o To develop the evidence base for children and young people’s palliative care through supporting research and disseminating research outcomes. o To promote effective communication and collaboration between the agencies and professionals providing children and young people’s palliative care in all settings. o To advocate on behalf of children and young people requiring palliative care and their families, ensuring user’s views are listened to. o To raise awareness of children and young people’s palliative care, strategically and politically, at all levels. o To develop supportive networks amongst colleagues working within children and young people’s palliative care services. o To support providers of children and young people’s palliative care to deliver recommended models of care and to minimise disparity across the region. o To quantify the level of need for palliative care for children and young people across the South West.

Page 81

Birmingham Footprints (Palliative Care)

• Available to all children registered with a Birmingham GP, Footprints provides nursing care, as well as practical, emotional and spiritual support for life-limited children aged 0- 18 and their families. • The service aims to reduce hospital stays for nursing procedures such as passing NG tubes, IV antibiotics or medication via syringe driver, thereby reducing disruption and upset to the family. • Service provided o A Consultant Paediatrician, palliative nurses, respite carers, a community parent and input from psychology services are available from 9.00am-7.30pm, 7 days per week. o Each family is allocated a Key Worker to co-ordinate services but families can contact any team member. Families can contact staff on duty directly, which means they are able to speak to someone who knows them and their child - this is particularly helpful for parents whose English is limited. o Respite carers can offer support during family crisis such as parental illness. o Staff work in partnership with teams from acute and community health services and also other agencies. o 24 hour care for children during the terminal phase, allowing the family to stay at home and be supported by a team that is available any time they are needed. o Support and advice before and after death on necessary legal procedures.

• Footprints is part of the Pan Birmingham Palliative Care Network. Other agencies involved include: o Community Children’s Nursing Teams (see Sandwell Palliative Care and Continuing Care Team) o West Midlands Paediatric Macmillan Team o Sandwell Asian Family Support Service (SAFSS) and Sandwell Foundation of Asian Aurat (SFAA) providing specific services to the Asian community o ACT and ACH

Stoke-on-Trent

• Stoke Speaks Out is a partnership approach to tackling the causes of language delay in the City. Partners from Education, Health and Voluntary Sector joined forces to create a long-term vision of "a city that communicates - where children and young people are able to take full advantage of health, education and employment opportunities." • The multi-agency Stoke Speaks Out team includes professionals from Speech and Language Therapy, Clinical Psychology, Midwifery, Children and Young Peoples Services and the Pre-School Learning Alliance. Each agency contributes its expertise to help resolve the underlying issues causing language delay, and to promote secure parent-child attachment, positive parenting, early opportunity for development through play, quality language - promoting environments and quality support. • The partnership runs an extensive web-site with information for children, parent/carers and professionals to provide information on facilities, resources and good practice.

Page 82

APPENDIX 2: POPULATION DATA

Page 83

This Appendix provides detailed analyses of the population datasets.

The datasets used are:

• For age 5-16 – 2008 DCSF census data.

• For ages 17-19 extrapolated data for year 11 from the 2005, 2006 and 2007 DCSF census.

Page 84

AGE 5-16 ANALYSES

Figure A2.1 Analysis of Primary Need by School Year (Age 5-16)

School Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI Year 0 363 38 51 13 17 11 20 6 168 25 9 5 1 548 50 71 13 69 13 13 9 273 11 23 3 2 709 64 102 22 159 1 23 19 9 228 31 44 7 3 829 61 117 14 264 22 12 10 183 27 109 10 4 892 75 111 15 308 1 33 15 6 144 28 145 11 5 922 66 139 9 319 22 29 8 127 22 173 8 6 934 68 170 14 334 19 17 12 103 19 171 7 7 764 72 144 23 252 21 17 59 31 139 6 8 865 63 233 32 271 20 17 8 45 29 140 7 9 716 50 233 22 193 1 11 20 8 55 17 103 3 10 758 44 301 14 193 19 18 5 43 20 97 4 11 676 26 284 19 175 1 16 12 7 28 25 74 9 Total 8976 677 1956 210 2554 4 230 209 88 1456 285 1227 80

Page 85

Figure A2.2 Percentages by Primary Need by School Year (Age 5-16)

School Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI Year 0 4.0% 5.6% 2.6% 6.2% 0.7% 0.0% 4.8% 9.6% 6.8% 11.5% 8.8% 0.7% 6.3% 1 6.1% 7.4% 3.6% 6.2% 2.7% 0.0% 5.7% 6.2% 10.2% 18.8% 3.9% 1.9% 3.8% 2 7.9% 9.5% 5.2% 10.5% 6.2% 25.0% 10.0% 9.1% 10.2% 15.7% 10.9% 3.6% 8.8% 3 9.2% 9.0% 6.0% 6.7% 10.3% 0.0% 9.6% 5.7% 11.4% 12.6% 9.5% 8.9% 12.5% 4 9.9% 11.1% 5.7% 7.1% 12.1% 25.0% 14.3% 7.2% 6.8% 9.9% 9.8% 11.8% 13.8% 5 10.3% 9.7% 7.1% 4.3% 12.5% 0.0% 9.6% 13.9% 9.1% 8.7% 7.7% 14.1% 10.0% 6 10.4% 10.0% 8.7% 6.7% 13.1% 0.0% 8.3% 8.1% 13.6% 7.1% 6.7% 13.9% 8.8% 7 8.5% 10.6% 7.4% 11.0% 9.9% 0.0% 9.1% 8.1% 0.0% 4.1% 10.9% 11.3% 7.5% 8 9.6% 9.3% 11.9% 15.2% 10.6% 0.0% 8.7% 8.1% 9.1% 3.1% 10.2% 11.4% 8.8% 9 8.0% 7.4% 11.9% 10.5% 7.6% 25.0% 4.8% 9.6% 9.1% 3.8% 6.0% 8.4% 3.8% 10 8.4% 6.5% 15.4% 6.7% 7.6% 0.0% 8.3% 8.6% 5.7% 3.0% 7.0% 7.9% 5.0% 11 7.5% 3.8% 14.5% 9.0% 6.9% 25.0% 7.0% 5.7% 8.0% 1.9% 8.8% 6.0% 11.3%

Page 86

Figure A2.3 Analysis of Primary Need by Service Area (Age 5-16)

SERVICE DISTRICT NAME Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI Arbourthorne / Manor / 1528 77 355 35 475 2 26 38 17 278 59 153 13 Darnall Greenhill / Gleadless Valley 965 93 180 21 276 25 28 11 158 24 141 8 Hillsborough / Upper Don 1078 96 228 26 252 37 23 13 169 31 191 12 Mosborough / Handsworth 1335 122 309 26 357 14 31 10 252 42 162 10 Parson Cross / Ecclesfield 1190 71 286 28 429 1 18 27 9 155 30 131 5 Rivelin to Sheaf 1071 128 174 33 226 50 31 16 155 43 204 11 Shiregreen / Burngreave 1721 80 406 37 516 1 57 28 12 277 55 233 19 Out of Sheffield 88 10 18 4 23 3 3 12 1 12 2 Total 8976 677 1956 210 2554 4 230 209 88 1456 285 1227 80 % by Primary Need 7.5% 21.8% 2.3% 28.5% 0.0% 2.6% 2.3% 1.0% 16.2% 3.2% 13.7% 0.9%

Figure A2.4 Percentage by Primary Need in each service area (Age 5-16 excl Out of Sheffield)

SERVICE DISTRICT NAME Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI Arbourthorne / Manor / 17.2% 11.5% 18.3% 17.0% 18.8% 50.0% 11.5% 18.4% 19.3% 19.3% 20.8% 12.6% 16.7% Darnall Greenhill / Gleadless Valley 10.9% 13.9% 9.3% 10.2% 10.9% 0.0% 11.0% 13.6% 12.5% 10.9% 8.5% 11.6% 10.3% Hillsborough / Upper Don 12.1% 14.4% 11.8% 12.6% 10.0% 0.0% 16.3% 11.2% 14.8% 11.7% 10.9% 15.7% 15.4% Mosborough / Handsworth 15.0% 18.3% 15.9% 12.6% 14.1% 0.0% 6.2% 15.0% 11.4% 17.5% 14.8% 13.3% 12.8% Parson Cross / Ecclesfield 13.4% 10.6% 14.8% 13.6% 16.9% 25.0% 7.9% 13.1% 10.2% 10.7% 10.6% 10.8% 6.4% Rivelin to Sheaf 12.0% 19.2% 9.0% 16.0% 8.9% 0.0% 22.0% 15.0% 18.2% 10.7% 15.1% 16.8% 14.1% Shiregreen / Burngreave 19.4% 12.0% 20.9% 18.0% 20.4% 25.0% 25.1% 13.6% 13.6% 19.2% 19.4% 19.2% 24.4%

Page 87

Figure A2.5 Analysis of Primary Need by Ethnic Origin (Age 5-16)

Ethnic Origin Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI Bangladeshi 54 4 7 16 2 17 6 2 Indian 24 5 1 8 1 1 5 3 Pakistani 619 17 61 36 207 1 23 27 13 140 41 42 11 Other Asian Background 51 2 1 2 16 1 3 5 15 1 5 Caribbean 104 10 40 3 16 1 1 18 3 12 Somali 160 2 35 1 58 3 3 1 34 7 15 1 Other Black African 69 4 15 1 19 1 1 14 4 8 2 Other Black Background 41 3 12 10 1 1 7 1 5 1 Chinese 15 1 3 1 2 1 7 White & Any Other Asian 54 6 13 1 11 2 2 9 2 7 1 Background White & Pakistani 33 3 13 3 1 5 1 5 1 1 White and Black African 24 3 8 1 1 8 3 White & Black Caribbean 276 18 92 79 3 5 3 31 6 38 1 Any Other Mixed 89 9 24 2 21 4 1 1 13 2 10 2 Background White British 7043 573 1583 151 1978 2 171 156 56 1080 201 1038 54 Eastern European 21 1 1 2 4 3 6 2 2 Irish 14 1 3 2 1 1 2 4 Traveller of Irish Heritage 11 3 5 1 1 1 Other White 46 7 11 1 7 1 3 6 2 8 Gypsy/ Roma 9 1 6 1 1 Any Other Ethnic Group 51 7 6 3 14 3 3 1 8 2 4 Yemeni 113 1 20 3 48 1 2 3 20 7 8 Info not yet obtained 37 2 8 12 4 1 7 3 Refused 18 1 1 7 6 2 1 Total 8976 677 1956 210 2554 4 230 209 88 1456 285 1227 80 Figure A2.6 Percentages by Ethnic Origin by Primary Need (Age 5-16) Page 88

Ethnic Origin Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI Bangladeshi 0.6% 0.6% 0.4% 0.0% 0.6% 0.0% 0.9% 0.0% 0.0% 1.2% 0.0% 0.5% 2.5% Indian 0.3% 0.7% 0.1% 0.0% 0.3% 0.0% 0.4% 0.0% 1.1% 0.3% 1.1% 0.0% 0.0% Pakistani 6.9% 2.5% 3.1% 17.1% 8.1% 25.0% 10.0% 12.9% 14.8% 9.6% 14.4% 3.4% 13.8% Other Asian Background 0.6% 0.3% 0.1% 1.0% 0.6% 0.0% 0.4% 1.4% 5.7% 1.0% 0.4% 0.4% 0.0% Caribbean 1.2% 1.5% 2.0% 1.4% 0.6% 0.0% 0.4% 0.0% 1.1% 1.2% 1.1% 1.0% 0.0% Somali 1.8% 0.3% 1.8% 0.5% 2.3% 0.0% 1.3% 1.4% 1.1% 2.3% 2.5% 1.2% 1.3% Other Black African 0.8% 0.6% 0.8% 0.5% 0.7% 0.0% 0.0% 0.5% 1.1% 1.0% 1.4% 0.7% 2.5% Other Black Background 0.5% 0.4% 0.6% 0.0% 0.4% 0.0% 0.0% 0.5% 1.1% 0.5% 0.4% 0.4% 1.3% Chinese 0.2% 0.1% 0.2% 0.0% 0.0% 0.0% 0.0% 1.0% 1.1% 0.5% 0.0% 0.0% 0.0% White & Any Other Asian 0.6% 0.9% 0.7% 0.5% 0.4% 0.0% 0.9% 1.0% 0.0% 0.6% 0.7% 0.6% 1.3% Background White & Pakistani 0.4% 0.4% 0.7% 1.4% 0.0% 0.0% 2.2% 0.5% 0.0% 0.3% 0.0% 0.1% 1.3% White and Black African 0.3% 0.0% 0.2% 0.0% 0.3% 0.0% 0.4% 0.5% 0.0% 0.5% 0.0% 0.2% 0.0% White & Black Caribbean 3.1% 2.7% 4.7% 0.0% 3.1% 0.0% 1.3% 2.4% 3.4% 2.1% 2.1% 3.1% 1.3% Any Other Mixed Background 1.0% 1.3% 1.2% 1.0% 0.8% 0.0% 1.7% 0.5% 1.1% 0.9% 0.7% 0.8% 2.5% White British 78.5% 84.6% 80.9% 71.9% 77.4% 50.0% 74.3% 74.6% 63.6% 74.2% 70.5% 84.6% 67.5% Eastern European 0.2% 0.1% 0.1% 1.0% 0.2% 0.0% 1.3% 0.0% 0.0% 0.4% 0.7% 0.2% 0.0% Irish 0.2% 0.1% 0.2% 0.0% 0.1% 0.0% 0.4% 0.5% 0.0% 0.1% 0.0% 0.3% 0.0% Traveller of Irish Heritage 0.1% 0.0% 0.2% 0.0% 0.2% 0.0% 0.4% 0.0% 0.0% 0.1% 0.0% 0.1% 0.0% Other White 0.5% 1.0% 0.6% 0.5% 0.3% 25.0% 1.3% 0.0% 0.0% 0.4% 0.7% 0.7% 0.0% Gypsy/ Roma 0.1% 0.0% 0.0% 0.5% 0.2% 0.0% 0.4% 0.0% 0.0% 0.0% 0.0% 0.1% 0.0% Any Other Ethnic Group 0.6% 1.0% 0.3% 1.4% 0.5% 0.0% 1.3% 1.4% 1.1% 0.5% 0.7% 0.3% 0.0% Yemeni 1.3% 0.1% 1.0% 1.4% 1.9% 0.0% 0.4% 1.0% 3.4% 1.4% 2.5% 0.7% 0.0% Info not yet obtained 0.4% 0.3% 0.4% 0.0% 0.5% 0.0% 0.0% 0.0% 0.0% 0.3% 0.4% 0.6% 3.8% Refused 0.2% 0.1% 0.1% 0.0% 0.3% 0.0% 0.0% 0.0% 0.0% 0.4% 0.0% 0.2% 1.3%

Page 89

Figure A2.7 Analysis of Primary Need White British/BME by gender (Age 5-16)

Tota BES PML Ethnicity Gender ASD HI MLD MSI OTH PD SLCN SLD SPLD VI l D D White British Female 2145 78 314 75 763 0 71 68 29 343 68 317 19 White British Male 4898 495 1269 76 1215 2 100 88 27 737 133 721 35 BME Female 607 17 80 28 221 1 28 19 15 111 19 62 6 BME Male 1326 87 293 31 355 1 31 34 17 265 65 127 20 Total Female 2752 95 394 103 984 1 99 87 44 454 87 379 25 Total Male 6224 582 1562 107 1570 3 131 122 44 1002 198 848 55

Figure A2.8 Percentages by Primary Need White British/BME by gender (Age 5-16)

Ethnicity Gender Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI White British Female 30.5% 13.6% 19.8% 49.7% 38.6% 0.0% 41.5% 43.6% 51.8% 31.8% 33.8% 30.5% 35.2% White British Male 69.5% 86.4% 80.2% 50.3% 61.4% 100.0% 58.5% 56.4% 48.2% 68.2% 66.2% 69.5% 64.8% BME Female 31.4% 16.3% 21.4% 47.5% 38.4% 50.0% 47.5% 35.8% 46.9% 29.5% 22.6% 32.8% 23.1% BME Male 68.6% 83.7% 78.6% 52.5% 61.6% 50.0% 52.5% 64.2% 53.1% 70.5% 77.4% 67.2% 76.9% Total Female 30.7% 14.0% 20.1% 49.0% 38.5% 25.0% 43.0% 41.6% 50.0% 31.2% 30.5% 30.9% 31.3% Total Male 69.3% 86.0% 79.9% 51.0% 61.5% 75.0% 57.0% 58.4% 50.0% 68.8% 69.5% 69.1% 68.8%

Page 90

AGE 17-19 ANALYSES

Figure A2.9 Analysis of Primary Need by (Nominal) School Year (Age 17-19)

School Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI Year 12 569 38 223 16 139 15 17 26 24 67 4 13 569 28 230 23 129 12 8 1 40 22 73 3 14 561 18 270 23 110 18 14 28 14 57 9 Total 1699 84 723 62 378 0 45 39 1 94 60 197 16

Figure A2.10 Percentages by Primary Need by (Nominal) School Year (Age 17-19)

School Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI Year 12 33.5% 45.2% 30.8% 25.8% 36.8% N/A 33.3% 43.6% 0.0% 27.7% 40.0% 34.0% 25.0% 13 33.5% 33.3% 31.8% 37.1% 34.1% N/A 26.7% 20.5% 100.0% 42.6% 36.7% 37.1% 18.8% 14 33.0% 21.4% 37.3% 37.1% 29.1% N/A 40.0% 35.9% 0.0% 29.8% 23.3% 28.9% 56.3%

Page 91

Figure A2.11 Analysis of Primary Condition by Service Area (Age 17-19)

SERVICE DISTRICT NAME Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI Arbourthorne / Manor / 298 4 175 13 48 10 1 18 10 17 2 Darnall Greenhill / Gleadless Valley 161 11 61 5 25 6 6 1 10 8 28 Hillsborough / Upper Don 212 24 86 8 38 4 5 9 3 32 3 Mosborough / Handsworth 213 11 88 5 39 8 13 9 39 1 Parson Cross / Ecclesfield 263 13 104 5 98 6 1 15 7 13 1 Rivelin to Sheaf 168 14 52 8 29 11 4 10 10 28 2 Shiregreen / Burngreave 365 5 152 17 98 8 13 18 13 36 5 Out of Sheffield 19 2 5 1 3 1 1 4 2 Total 1699 84 723 62 378 0 45 39 1 94 60 197 16 % by Primary Condition 4.9% 42.6% 3.6% 22.2% 0.0% 2.6% 2.3% 0.1% 5.5% 3.5% 11.6% 0.9%

Figure A2.12 Percentage by Primary Condition in each service area (Age 17-19 excl Out of Sheffield)

SERVICE DISTRICT NAME Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI Arbourthorne / Manor / 17.7% 4.9% 24.4% 21.3% 12.8% N/A 22.2% 2.6% 0.0% 19.4% 16.7% 8.8% 14.3% Darnall Greenhill / Gleadless Valley 9.6% 13.4% 8.5% 8.2% 6.7% N/A 13.3% 15.8% 100.0% 10.8% 13.3% 14.5% 0.0% Hillsborough / Upper Don 12.6% 29.3% 12.0% 13.1% 10.1% N/A 8.9% 13.2% 0.0% 9.7% 5.0% 16.6% 21.4% Mosborough / Handsworth 12.7% 13.4% 12.3% 8.2% 10.4% N/A 0.0% 21.1% 0.0% 14.0% 15.0% 20.2% 7.1% Parson Cross / Ecclesfield 15.7% 15.9% 14.5% 8.2% 26.1% N/A 13.3% 2.6% 0.0% 16.1% 11.7% 6.7% 7.1% Rivelin to Sheaf 10.0% 17.1% 7.2% 13.1% 7.7% N/A 24.4% 10.5% 0.0% 10.8% 16.7% 14.5% 14.3% Shiregreen / Burngreave 21.7% 6.1% 21.2% 27.9% 26.1% N/A 17.8% 34.2% 0.0% 19.4% 21.7% 18.7% 35.7%

Page 92

Figure A2.13 Analysis of Primary Need by Ethnic Origin (Age 17-19)

Ethnic Origin Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI Bangladeshi 14 3 6 2 2 1 Indian Pakistani 100 26 12 33 1 6 5 6 10 1 Other Asian Background 6 1 1 1 2 1 Caribbean 25 2 17 1 3 1 1 Somali 11 2 1 4 1 1 2 Other Black African 4 2 1 1 Other Black Background 7 6 1 Chinese 2 1 1 White & Any Other Asian 9 1 4 2 1 1 Background White & Pakistani 2 1 1 White and Black African 3 2 1 White & Black Caribbean 47 32 9 1 5 Any Other Mixed 20 9 3 2 2 3 1 Background White British 1392 77 599 45 301 40 25 1 80 46 165 13 Eastern European Irish 6 1 3 2 Traveller of Irish Heritage 1 1 Other White 13 1 3 1 1 1 1 3 2 Gypsy/ Roma Any Other Ethnic Group 6 1 1 1 1 1 1 Yemeni 23 5 2 10 2 1 1 2 Info not yet obtained 6 4 1 1 Refused 2 2 Total 1699 84 723 62 378 0 45 39 1 94 60 197 16

Page 93

Figure A2.14 Percentages by Ethnic Origin by Primary Need (Age 17-19)

Ethnic Origin Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI Bangladeshi 0.8% 0.0% 0.4% 0.0% 1.6% N/A 4.4% 0.0% 0.0% 0.0% 3.3% 0.5% 0.0% Indian 0.0% 0.0% 0.0% 0.0% 0.0% N/A 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Pakistani 5.9% 0.0% 3.6% 19.4% 8.7% N/A 2.2% 15.4% 0.0% 5.3% 10.0% 5.1% 6.3% Other Asian Background 0.4% 0.0% 0.1% 0.0% 0.3% N/A 2.2% 5.1% 0.0% 1.1% 0.0% 0.0% 0.0% Caribbean 1.5% 2.4% 2.4% 1.6% 0.8% N/A 0.0% 0.0% 0.0% 0.0% 0.0% 0.5% 6.3% Somali 0.6% 0.0% 0.3% 1.6% 1.1% N/A 0.0% 2.6% 0.0% 1.1% 0.0% 1.0% 0.0% Other Black African 0.2% 0.0% 0.3% 0.0% 0.3% N/A 0.0% 0.0% 0.0% 1.1% 0.0% 0.0% 0.0% Other Black Background 0.4% 0.0% 0.8% 0.0% 0.0% N/A 0.0% 0.0% 0.0% 0.0% 1.7% 0.0% 0.0% Chinese 0.1% 1.2% 0.0% 0.0% 0.3% N/A 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% White & Any Other Asian 0.5% 1.2% 0.6% 0.0% 0.5% N/A 0.0% 0.0% 0.0% 0.0% 1.7% 0.5% 0.0% Background White & Pakistani 0.1% 0.0% 0.1% 0.0% 0.3% N/A 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% White and Black African 0.2% 0.0% 0.3% 0.0% 0.0% N/A 0.0% 0.0% 0.0% 0.0% 0.0% 0.5% 0.0% White & Black Caribbean 2.8% 0.0% 4.4% 0.0% 2.4% N/A 0.0% 0.0% 0.0% 1.1% 0.0% 2.5% 0.0% Any Other Mixed 1.2% 0.0% 1.2% 0.0% 0.8% N/A 0.0% 5.1% 0.0% 2.1% 0.0% 1.5% 6.3% Background White British 81.9% 91.7% 82.8% 72.6% 79.6% N/A 88.9% 64.1% 100.0% 85.1% 76.7% 83.8% 81.3% Eastern European 0.0% 0.0% 0.0% 0.0% 0.0% N/A 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Irish 0.4% 1.2% 0.4% 0.0% 0.0% N/A 0.0% 0.0% 0.0% 0.0% 0.0% 1.0% 0.0% Traveller of Irish Heritage 0.1% 0.0% 0.1% 0.0% 0.0% N/A 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Other White 0.8% 1.2% 0.4% 1.6% 0.3% N/A 2.2% 0.0% 0.0% 1.1% 5.0% 1.0% 0.0% Gypsy/ Roma 0.0% 0.0% 0.0% 0.0% 0.0% N/A 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% Any Other Ethnic Group 0.4% 1.2% 0.1% 0.0% 0.3% N/A 0.0% 2.6% 0.0% 1.1% 0.0% 0.5% 0.0% Yemeni 1.4% 0.0% 0.7% 3.2% 2.6% N/A 0.0% 5.1% 0.0% 1.1% 1.7% 1.0% 0.0% Info not yet obtained 0.4% 0.0% 0.6% 0.0% 0.3% N/A 0.0% 0.0% 0.0% 0.0% 0.0% 0.5% 0.0% Refused 0.1% 0.0% 0.3% 0.0% 0.0% N/A 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

Page 94

Figure A2.15 Primary Need by Gender (Age 17-19)

PRIMARY NEED Total F M F% M% Autistic Spectrum Disorder 84 11 73 13.1% 86.9% Behavioural Emotional and Social Difficulties 723 178 545 24.6% 75.4% Hearing Impairment 62 31 31 50.0% 50.0% Moderate Learning Difficulty 378 145 233 38.4% 61.6% Multi‐sensory Impairment 0 0 0 N/A N/A Physical Disability 39 16 23 41.0% 59.0% Profound & Multiple Learning Difficulties 1 1 100.0% 0.0% Speech, Learning or Communications 94 23 71 24.5% 75.5% Difficulties Severe Learning Difficulties 60 23 37 38.3% 61.7% Special Learning Difficulties (Dyslexia) 197 63 134 32.0% 68.0% Visual Impairment 16 10 6 62.5% 37.5% Other 45 25 20 55.6% 44.4% Total 1699 526 1173 31.0% 69.0%

Page 95

2005-8 TREND ANALYSIS DATA (BASED ON 5-16 YEAR OLD POPULATION)

Figure A2.16 Total Sheffield LDD Population 2005-2008

Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI 2005 7728 425 1854 181 2398 2 200 198 65 997 217 1114 75 2006 8133 520 1744 201 2544 3 165 205 67 1199 234 1175 76 2007 8500 624 1833 179 2457 3 205 212 63 1306 287 1250 81 2008 8976 677 1956 210 2554 4 230 209 88 1456 285 1227 80 Percentage Changes 2005‐6 5.2% 22.4% ‐5.9% 11.0% 6.1% 50.0% ‐17.5% 3.5% 3.1% 20.3% 7.8% 5.5% 1.3% 2006‐7 4.5% 20.0% 5.1% ‐10.9% ‐3.4% 0.0% 24.2% 3.4% ‐6.0% 8.9% 22.6% 6.4% 6.6% 2007‐8 5.6% 8.5% 6.7% 17.3% 3.9% 33.3% 12.2% ‐1.4% 39.7% 11.5% ‐0.7% ‐1.8% ‐1.2% 2005‐8 16.1% 59.3% 5.5% 16.0% 6.5% 100.0% 15.0% 5.6% 35.4% 46.0% 31.3% 10.1% 6.7%

Figure A2.17 National LDD Population 2005-2008

Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI 2005 597,780 34,920 128,130 13,250 170,360 920 24,230 24,850 8,050 71,980 30,990 82,650 7,450 2006 614,770 39140 134800 13590 171740 940 23810 25010 8330 81770 30460 77420 7760 2007 627,390 43130 139310 13850 169420 920 24230 25050 8670 88870 30080 75880 7980 2008 655,200 47300 149040 14260 171960 950 27010 25420 9060 95920 29130 77080 8070 Percentage Changes 2005‐6 2.8% 12.1% 5.2% 2.6% 0.8% 2.2% ‐1.7% 0.6% 3.5% 13.6% ‐1.7% ‐6.3% 4.2% 2006‐7 2.1% 10.2% 3.3% 1.9% ‐1.4% ‐2.1% 1.8% 0.2% 4.1% 8.7% ‐1.2% ‐2.0% 2.8% 2007‐8 4.4% 9.7% 7.0% 3.0% 1.5% 3.3% 11.5% 1.5% 4.5% 7.9% ‐3.2% 1.6% 1.1% 2005‐8 9.6% 35.5% 16.3% 7.6% 0.9% 3.3% 11.5% 2.3% 12.5% 33.3% ‐6.0% ‐6.7% 8.3%

Page 96

Ethnicity Trends

Figure A2.18 White British

Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI 2004 6005 334 1578 137 1878 3 148 161 37 660 188 833 48 2005 6229 378 1500 133 1906 1 169 151 46 772 163 954 54 2006 6419 448 1381 140 1974 2 127 154 45 921 161 1014 52 2007 6710 533 1483 126 1896 2 156 156 41 997 198 1066 56 2008 7043 573 1583 151 1978 2 171 156 56 1080 201 1038 54 Percentage Changes 2005‐5 3.7% 13.2% ‐4.9% ‐2.9% 1.5% ‐66.7% 14.2% ‐6.2% 24.3% 17.0% ‐13.3% 14.5% 12.5% 2005‐6 3.1% 18.5% ‐7.9% 5.3% 3.6% 100.0% ‐24.9% 2.0% ‐2.2% 19.3% ‐1.2% 6.3% ‐3.7% 2006‐7 4.5% 19.0% 7.4% ‐10.0% ‐4.0% 0.0% 22.8% 1.3% ‐8.9% 8.3% 23.0% 5.1% 7.7% 2007‐8 5.0% 7.5% 6.7% 19.8% 4.3% 0.0% 9.6% 0.0% 36.6% 8.3% 1.5% ‐2.6% ‐3.6% 2004‐8 17.3% 71.6% 0.3% 10.2% 5.3% ‐33.3% 15.5% ‐3.1% 51.4% 63.6% 6.9% 24.6% 12.5% Percentage of Total Population 2004 81.8% 89.3% 82.0% 74.9% 80.2% 75.0% 87.1% 77.4% 67.3% 80.6% 77.4% 87.1% 77.4% 2005 80.6% 88.9% 80.9% 73.5% 79.5% 50.0% 84.5% 76.3% 70.8% 77.4% 75.1% 85.6% 72.0% 2006 78.9% 86.2% 79.2% 69.7% 77.6% 66.7% 77.0% 75.1% 67.2% 76.8% 68.8% 86.3% 68.4% 2007 78.9% 85.4% 80.9% 70.4% 77.2% 66.7% 76.1% 73.6% 65.1% 76.3% 69.0% 85.3% 69.1% 2008 78.5% 84.6% 80.9% 71.9% 77.4% 50.0% 74.3% 74.6% 63.6% 74.2% 70.5% 84.6% 67.5%

Page 97

Figure A2.19 Asian or Asian British - Pakistani

Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI 2004 439 7 58 29 185 1 5 21 9 66 16 35 7 2005 514 7 71 28 195 1 6 22 8 102 26 39 9 2006 574 13 71 35 215 1 15 25 10 113 31 36 9 2007 579 14 58 32 205 1 25 26 10 114 38 46 10 2008 619 17 61 36 207 1 23 27 13 140 41 42 11 Percentage Changes 2004‐5 17.1% 0.0% 22.4% ‐3.4% 5.4% 0.0% 20.0% 4.8% ‐11.1% 54.5% 62.5% 11.4% 28.6% 2005‐6 11.7% 85.7% 0.0% 25.0% 10.3% 0.0% 150.0% 13.6% 25.0% 10.8% 19.2% ‐7.7% 0.0% 2006‐7 0.9% 7.7% ‐18.3% ‐8.6% ‐4.7% 0.0% 66.7% 4.0% 0.0% 0.9% 22.6% 27.8% 11.1% 2007‐8 6.9% 21.4% 5.2% 12.5% 1.0% 0.0% ‐8.0% 3.8% 30.0% 22.8% 7.9% ‐8.7% 10.0% 2004‐8 41.0% 142.9% 5.2% 24.1% 11.9% 0.0% 360.0% 28.6% 44.4% 112.1% 156.3% 20.0% 57.1% Percentage of Total Population 2004 6.0% 1.9% 3.0% 15.8% 7.9% 25.0% 2.9% 10.1% 16.4% 8.1% 6.6% 3.7% 11.3% 2005 6.7% 1.6% 3.8% 15.5% 8.1% 50.0% 3.0% 11.1% 12.3% 10.2% 12.0% 3.5% 12.0% 2006 7.1% 2.5% 4.1% 17.4% 8.5% 33.3% 9.1% 12.2% 14.9% 9.4% 13.2% 3.1% 11.8% 2007 6.8% 2.2% 3.2% 17.9% 8.3% 33.3% 12.2% 12.3% 15.9% 8.7% 13.2% 3.7% 12.3% 2008 6.9% 2.5% 3.1% 17.1% 8.1% 25.0% 10.0% 12.9% 14.8% 9.6% 14.4% 3.4% 13.8%

Page 98

Figure A2.20 Mixed/Dual Background - White & Black Caribbean

Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI 2004 185 5 93 0 46 0 4 4 3 8 0 22 0 2005 189 5 84 0 50 0 4 3 3 11 0 28 1 2006 218 9 80 0 65 0 2 5 2 17 3 34 1 2007 269 14 101 0 78 0 3 5 2 23 3 39 1 2008 276 18 92 0 79 0 3 5 3 31 6 38 1 Percentage Changes 2004‐5 2.2% 0.0% ‐9.7% N/A 8.7% N/A 0.0% ‐25.0% 0.0% 37.5% N/A 27.3% N/A 2005‐6 15.3% 80.0% ‐4.8% N/A 30.0% N/A ‐50.0% 66.7% ‐33.3% 54.5% N/A 21.4% 0.0% 2006‐7 23.4% 55.6% 26.3% N/A 20.0% N/A 50.0% 0.0% 0.0% 35.3% 0.0% 14.7% 0.0% 2007‐8 2.6% 28.6% ‐8.9% N/A 1.3% N/A 0.0% 0.0% 50.0% 34.8% 100.0% ‐2.6% 0.0% 2004‐8 49.2% 260.0% ‐1.1% N/A 71.7% N/A ‐25.0% 25.0% 0.0% 287.5% N/A 72.7% N/A Percentage of Total Population 2004 2.5% 1.3% 4.8% 0.0% 2.0% 0.0% 2.4% 1.9% 5.5% 1.0% 0.0% 2.3% 0.0% 2005 2.4% 1.2% 4.5% 0.0% 2.1% 0.0% 2.0% 1.5% 4.6% 1.1% 0.0% 2.5% 1.3% 2006 2.7% 1.7% 4.6% 0.0% 2.6% 0.0% 1.2% 2.4% 3.0% 1.4% 1.3% 2.9% 1.3% 2007 3.2% 2.2% 5.5% 0.0% 3.2% 0.0% 1.5% 2.4% 3.2% 1.8% 1.0% 3.1% 1.2% 2008 3.1% 2.7% 4.7% 0.0% 3.1% 0.0% 1.3% 2.4% 3.4% 2.1% 2.1% 3.1% 1.3%

Page 99

Figure A2.21 Black or Black British - Somali

Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI 2004 95 0 19 4 40 0 1 5 0 13 5 8 0 2005 117 2 20 1 50 0 2 4 1 19 4 13 1 2006 141 2 29 1 54 0 3 2 1 30 5 13 1 2007 146 2 24 1 56 0 3 3 0 35 8 12 2 2008 160 2 35 1 58 0 3 3 1 34 7 15 1 Percentage Changes 2004‐5 23.2% N/A 5.3% ‐75.0% 25.0% N/A 100.0% ‐20.0% N/A 46.2% ‐20.0% 62.5% N/A 2005‐6 20.5% 0.0% 45.0% 0.0% 8.0% N/A 50.0% ‐50.0% 0.0% 57.9% 25.0% 0.0% 0.0% ‐ 2006‐7 3.5% 0.0% ‐17.2% 0.0% 3.7% N/A 0.0% 50.0% 100.0% 16.7% 60.0% ‐7.7% 100.0% 2007‐8 9.6% 0.0% 45.8% 0.0% 3.6% N/A 0.0% 0.0% N/A ‐2.9% ‐12.5% 25.0% ‐50.0% 2004‐8 68.4% N/A 84.2% ‐75.0% 45.0% N/A 200.0% ‐40.0% N/A 161.5% 40.0% 87.5% N/A Percentage of Total Population 2004 1.3% 0.0% 1.0% 2.2% 1.7% 0.0% 0.6% 2.4% 0.0% 1.6% 2.1% 0.8% 0.0% 2005 1.5% 0.5% 1.1% 0.6% 2.1% 0.0% 1.0% 2.0% 1.5% 1.9% 1.8% 1.2% 1.3% 2006 1.7% 0.4% 1.7% 0.5% 2.1% 0.0% 1.8% 1.0% 1.5% 2.5% 2.1% 1.1% 1.3% 2007 1.7% 0.3% 1.3% 0.6% 2.3% 0.0% 1.5% 1.4% 0.0% 2.7% 2.8% 1.0% 2.5% 2008 1.8% 0.3% 1.8% 0.5% 2.3% 0.0% 1.3% 1.4% 1.1% 2.3% 2.5% 1.2% 1.3%

Page 100

Figure A2.22 Yemeni

Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI 2004 69 0 16 2 28 0 1 4 1 4 6 7 0 2005 85 0 16 4 31 0 1 4 1 10 7 10 1 2006 92 0 13 5 41 0 0 4 2 12 7 8 0 2007 100 1 17 3 44 0 0 3 3 11 8 10 0 2008 113 1 20 3 48 0 1 2 3 20 7 8 0 Percentage Changes 2004‐5 23.2% N/A 0.0% 100.0% 10.7% N/A 0.0% 0.0% 0.0% 150.0% 16.7% 42.9% N/A ‐ 8.2% N/A ‐18.8% 25.0% 32.3% N/A 100.0% 0.0% 100.0% 20.0% 0.0% ‐20.0% 2005‐6 100.0% 2006‐7 8.7% N/A 30.8% ‐40.0% 7.3% N/A N/A ‐25.0% 50.0% ‐8.3% 14.3% 25.0% N/A 2007‐8 13.0% 0.0% 17.6% 0.0% 9.1% N/A N/A ‐33.3% 0.0% 81.8% ‐12.5% ‐20.0% N/A 2004‐8 63.8% N/A 25.0% 50.0% 71.4% N/A 0.0% ‐50.0% 200.0% 400.0% 16.7% 14.3% N/A Percentage of Total Population 2004 0.9% 0.0% 0.8% 1.1% 1.2% 0.0% 0.6% 1.9% 1.8% 0.5% 2.5% 0.7% 0.0% 2005 1.1% 0.0% 0.9% 2.2% 1.3% 0.0% 0.5% 2.0% 1.5% 1.0% 3.2% 0.9% 1.3% 2006 1.1% 0.0% 0.7% 2.5% 1.6% 0.0% 0.0% 2.0% 3.0% 1.0% 3.0% 0.7% 0.0% 2007 1.2% 0.2% 0.9% 1.7% 1.8% 0.0% 0.0% 1.4% 4.8% 0.8% 2.8% 0.8% 0.0% 2008 1.3% 0.1% 1.0% 1.4% 1.9% 0.0% 0.4% 1.0% 3.4% 1.4% 2.5% 0.7% 0.0%

Page 101

Figure A2.23 Black or Black British - Caribbean

Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI 2004 104 5 47 2 25 0 2 0 0 14 4 5 0 2005 101 7 48 2 13 0 1 1 0 13 3 12 1 2006 96 7 40 3 20 0 1 1 0 14 2 8 0 2007 86 8 40 2 16 0 0 0 0 10 3 7 0 2008 104 10 40 3 16 0 1 0 1 18 3 12 0 Percentage Changes 2004‐5 ‐2.9% 40.0% 2.1% 0.0% ‐48.0% N/A ‐50.0% N/A N/A ‐7.1% ‐25.0% 140.0% N/A 2005‐6 ‐5.0% 0.0% ‐16.7% 50.0% 53.8% N/A 0.0% 0.0% N/A 7.7% ‐33.3% ‐33.3% 100.0% 2006‐7 ‐10.4% 14.3% 0.0% ‐33.3% ‐20.0% N/A 100.0% 100.0% N/A ‐28.6% 50.0% ‐12.5% N/A 2007‐8 20.9% 25.0% 0.0% 50.0% 0.0% N/A N/A N/A N/A 80.0% 0.0% 71.4% N/A 2004‐8 0.0% 100.0% ‐14.9% 50.0% ‐36.0% N/A ‐50.0% N/A N/A 28.6% ‐25.0% 140.0% N/A Percentage of Total Population 2004 1.4% 1.3% 2.4% 1.1% 1.1% 0.0% 1.2% 0.0% 0.0% 1.7% 1.6% 0.5% 0.0% 2005 1.3% 1.6% 2.6% 1.1% 0.5% 0.0% 0.5% 0.5% 0.0% 1.3% 1.4% 1.1% 1.3% 2006 1.2% 1.3% 2.3% 1.5% 0.8% 0.0% 0.6% 0.5% 0.0% 1.2% 0.9% 0.7% 0.0% 2007 1.0% 1.3% 2.2% 1.1% 0.7% 0.0% 0.0% 0.0% 0.0% 0.8% 1.0% 0.6% 0.0% 2008 1.2% 1.5% 2.0% 1.4% 0.6% 0.0% 0.4% 0.0% 1.1% 1.2% 1.1% 1.0% 0.0%

Page 102

Service Area Trends

Figure A2.24 Arbourthorne /Manor /Darnall

Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI 2004 1265 25 401 32 422 1 26 24 6 151 40 123 14 2005 1427 41 397 36 443 1 59 26 13 215 38 144 13 2006 1452 58 361 41 472 1 27 29 12 233 53 154 11 2007 1445 72 344 34 455 1 32 34 12 252 54 145 10 2008 1528 77 355 35 475 2 26 38 17 278 59 153 13 Percentage Changes 2004‐5 12.8% 64.0% ‐1.0% 12.5% 5.0% 0.0% 126.9% 8.3% 116.7% 42.4% ‐5.0% 17.1% ‐7.1% 2005‐6 1.8% 41.5% ‐9.1% 13.9% 6.5% 0.0% ‐54.2% 11.5% ‐7.7% 8.4% 39.5% 6.9% ‐15.4% 2006‐7 ‐0.5% 24.1% ‐4.7% ‐17.1% ‐3.6% 0.0% 18.5% 17.2% 0.0% 8.2% 1.9% ‐5.8% ‐9.1% 2007‐8 5.7% 6.9% 3.2% 2.9% 4.4% 100.0% ‐18.8% 11.8% 41.7% 10.3% 9.3% 5.5% 30.0% 2004‐8 20.8% 208.0% ‐11.5% 9.4% 12.6% 100.0% 0.0% 58.3% 183.3% 84.1% 47.5% 24.4% ‐7.1%

Page 103

Figure A2.25 Greenhill / Gleadless Valley

Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI 2004 727 47 188 16 184 0 12 23 6 87 36 122 6 2005 787 60 167 17 239 0 11 25 5 100 27 130 6 2006 994 81 198 21 293 0 20 30 11 119 19 194 8 2007 882 82 168 17 251 0 24 24 9 135 23 139 10 2008 965 93 180 21 276 0 25 28 11 158 24 141 8 Percentage Changes 2004‐5 8.3% 27.7% ‐11.2% 6.3% 29.9% N/A ‐8.3% 8.7% ‐16.7% 14.9% ‐25.0% 6.6% 0.0% 2005‐6 26.3% 35.0% 18.6% 23.5% 22.6% N/A 81.8% 20.0% 120.0% 19.0% ‐29.6% 49.2% 33.3% 2006‐7 ‐11.3% 1.2% ‐15.2% ‐19.0% ‐14.3% N/A 20.0% ‐20.0% ‐18.2% 13.4% 21.1% ‐28.4% 25.0% 2007‐8 9.4% 13.4% 7.1% 23.5% 10.0% N/A 4.2% 16.7% 22.2% 17.0% 4.3% 1.4% ‐20.0% 2004‐8 32.7% 97.9% ‐4.3% 31.3% 50.0% N/A 108.3% 21.7% 83.3% 81.6% ‐33.3% 15.6% 33.3%

Page 104

Figure A2.26 Hillsborough / Upper Don

Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI 2004 915 67 237 28 239 0 30 28 7 99 29 144 7 2005 951 77 213 27 242 0 24 29 9 107 21 193 9 2006 994 81 198 21 293 0 20 30 11 119 19 194 8 2007 1049 102 229 22 252 0 28 28 12 146 29 189 12 2008 1078 96 228 26 252 0 37 23 13 169 31 191 12 Percentage Changes 2004‐5 3.9% 14.9% ‐10.1% ‐3.6% 1.3% N/A ‐20.0% 3.6% 28.6% 8.1% ‐27.6% 34.0% 28.6% 2005‐6 4.5% 5.2% ‐7.0% ‐22.2% 21.1% N/A ‐16.7% 3.4% 22.2% 11.2% ‐9.5% 0.5% ‐11.1% 2006‐7 5.5% 25.9% 15.7% 4.8% ‐14.0% N/A 40.0% ‐6.7% 9.1% 22.7% 52.6% ‐2.6% 50.0% 2007‐8 2.8% ‐5.9% ‐0.4% 18.2% 0.0% N/A 32.1% ‐17.9% 8.3% 15.8% 6.9% 1.1% 0.0% 2004‐8 17.8% 43.3% ‐3.8% ‐7.1% 5.4% N/A 23.3% ‐17.9% 85.7% 70.7% 6.9% 32.6% 71.4%

Page 105

Figure A2.27 Parson Cross / Ecclesfield

Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI 2004 1089 36 297 21 473 1 24 20 7 89 28 84 9 2005 1031 36 241 19 438 0 26 19 10 108 23 103 8 2006 1095 47 237 21 443 1 24 23 9 147 26 106 11 2007 1167 67 276 20 430 1 17 24 7 138 29 148 10 2008 1190 71 286 28 429 1 18 27 9 155 30 131 5 Percentage Changes 2004‐5 ‐5.3% 0.0% ‐18.9% ‐9.5% ‐7.4% ‐100.0% 8.3% ‐5.0% 42.9% 21.3% ‐17.9% 22.6% ‐11.1% 2005‐6 6.2% 30.6% ‐1.7% 10.5% 1.1% N/A ‐7.7% 21.1% ‐10.0% 36.1% 13.0% 2.9% 37.5% 2006‐7 6.6% 42.6% 16.5% ‐4.8% ‐2.9% 0.0% ‐29.2% 4.3% ‐22.2% ‐6.1% 11.5% 39.6% ‐9.1% 2007‐8 2.0% 6.0% 3.6% 40.0% ‐0.2% 0.0% 5.9% 12.5% 28.6% 12.3% 3.4% ‐11.5% ‐50.0% 2004‐8 9.3% 97.2% ‐3.7% 33.3% ‐9.3% 0.0% ‐25.0% 35.0% 28.6% 74.2% 7.1% 56.0% ‐44.4%

Page 106

Figure A2.28 Rivelin to Sheaf

Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI 2004 908 77 164 36 268 0 14 33 5 93 40 170 8 2005 940 85 157 31 264 0 21 27 7 109 35 193 11 2006 1020 103 157 38 273 0 29 33 9 144 33 191 10 2007 1020 111 162 35 229 0 42 33 10 154 49 184 11 2008 1071 128 174 33 226 0 50 31 16 155 43 204 11 Percentage Changes 2004‐5 3.5% 10.4% ‐4.3% ‐13.9% ‐1.5% N/A 50.0% ‐18.2% 40.0% 17.2% ‐12.5% 13.5% 37.5% 2005‐6 8.5% 21.2% 0.0% 22.6% 3.4% N/A 38.1% 22.2% 28.6% 32.1% ‐5.7% ‐1.0% ‐9.1% 2006‐7 0.0% 7.8% 3.2% ‐7.9% ‐16.1% N/A 44.8% 0.0% 11.1% 6.9% 48.5% ‐3.7% 10.0% 2007‐8 5.0% 15.3% 7.4% ‐5.7% ‐1.3% N/A 19.0% ‐6.1% 60.0% 0.6% ‐12.2% 10.9% 0.0% 2004‐8 18.0% 66.2% 6.1% ‐8.3% ‐15.7% N/A 257.1% ‐6.1% 220.0% 66.7% 7.5% 20.0% 37.5%

Page 107

Figure A2.29 Shiregreen / Burngreave

Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI 2004 1339 54 402 29 422 2 38 46 12 126 37 157 14 2005 1406 43 403 29 449 1 25 42 8 163 43 179 20 2006 1525 65 381 37 524 1 31 37 8 199 40 183 19 2007 1640 72 371 29 523 1 45 37 7 240 61 234 20 2008 1721 80 406 37 516 1 57 28 12 277 55 233 19 Percentage Changes 2004‐5 5.0% ‐20.4% 0.2% 0.0% 6.4% ‐50.0% ‐34.2% ‐8.7% ‐33.3% 29.4% 16.2% 14.0% 42.9% 2005‐6 8.5% 51.2% ‐5.5% 27.6% 16.7% 0.0% 24.0% ‐11.9% 0.0% 22.1% ‐7.0% 2.2% ‐5.0% 2006‐7 7.5% 10.8% ‐2.6% ‐21.6% ‐0.2% 0.0% 45.2% 0.0% ‐12.5% 20.6% 52.5% 27.9% 5.3% 2007‐8 4.9% 11.1% 9.4% 27.6% ‐1.3% 0.0% 26.7% ‐24.3% 71.4% 15.4% ‐9.8% ‐0.4% ‐5.0% 2004‐8 28.5% 48.1% 1.0% 27.6% 22.3% ‐50.0% 50.0% ‐39.1% 0.0% 119.8% 48.6% 48.4% 35.7%

Page 108

Figure A2.30 Age 17-19 Projections year on year

2008 Estimate School Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI Year 12 569 38 223 16 139 0 15 17 0 26 24 67 4 13 569 28 230 23 129 0 12 8 1 40 22 73 3 14 561 18 270 23 110 0 18 14 0 28 14 57 9 Total 1699 84 723 62 378 0 45 39 1 94 60 197 16 2009 Projection School Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI Year 12 676 26 284 19 175 1 16 12 7 28 25 74 9 13 569 38 223 16 139 0 15 17 0 26 24 67 4 14 569 28 230 23 129 0 12 8 1 40 22 73 3 Total 1814 92 737 58 443 1 43 37 8 94 71 214 16 2010 Projection School Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI Year 12 758 44 301 14 193 0 19 18 5 43 20 97 4 13 676 26 284 19 175 1 16 12 7 28 25 74 9 14 569 38 223 16 139 0 15 17 0 26 24 67 4 Total 2003 108 808 49 507 1 50 47 12 97 69 238 17 2011 Projection School Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI Year 12 716 50 233 22 193 1 11 20 8 55 17 103 3 13 758 44 301 14 193 0 19 18 5 43 20 97 4 14 676 26 284 19 175 1 16 12 7 28 25 74 9 Total 2150 120 818 55 561 2 46 50 20 126 62 274 16 2012 Projection School Total ASD BESD HI MLD MSI OTH PD PMLD SLCN SLD SPLD VI Year 12 865 63 233 32 271 0 20 17 8 45 29 140 7 13 716 50 233 22 193 1 11 20 8 55 17 103 3 14 758 44 301 14 193 0 19 18 5 43 20 97 4

Total 2339 157 767 68 657 1 50 55 21 143 66 340 14

Page 109

APPENDIX 3: SHEFFIELD SERVICES FOR CHILDREN WITH LDD

Page 110

Sector Service Target Population Role (IR = Integrated School Resource) Child & Adolescent Mental Child & Family Children up to age 16 There are four community teams, each providing a Health Services (CAMHS) Therapy Teams specialist child, family assessment and treatment teams service for mental health. The community teams also offer a consultation service to primary care staff, providing advice, support and training. Referrals for children and young people up to 16 are via GP’s, psychologists, hospital and community doctors. Child & Adolescent Mental Child Mental An in – patient service Education is provided by the hospital school, which Health Services (CAMHS) Health Team (Monday – Friday) for is designated by the local education authority as a teams children up to 12 years old, special school for children with emotional and from Sheffield, Barnsley, behavioural difficulties. Most referrals come from Rotherham and North community mental health teams, but other Derbyshire. It also provides professionals may also refer. day – patient services.

Child & Adolescent Mental Young People’s Services for adolescents Services include specialist consultation, Health Services (CAMHS) Mental Health aged 12 – 16 years. assessment and treatment services. The centre teams Team provides in – patient, day – patient and residential help, including a special school for children with adjustment difficulties. Family meetings, multi – family groups and family therapy are offered to help parents/carers. Psychotherapy and an out – patient service for teenagers and families in Sheffield are also available.

Page 111

Sector Service Target Population Role CYPD Progression & Children age 5-19 Planning & implementing the Transition of children Transition Service through children's services and into adult's services CYPD Assessment, Children age 0-19 Assessment of children's support needs and Support & commissioning of appropriate services to meet the Provision Service need CYPD Short Breaks Families of children aged The Short Breaks Scheme is a service offered to Scheme 0-18 families to provide additional support, friendship and care for children with disabilities including: Extra social opportunities for the child; New friends for the child; Learning opportunities for the child; A break for the parents and child; Time for parents to spend with other children

CYPD Connexions LDD LDD children aged 13-19 Comprises youth workers, connexions workers, & Team as a priority but will also admin support workers work with children up to the age of 25 CYPD Visual Impairment Children 0-3 with visual Information, advice, support, activities & Support Team impairment experiences, liaison with other professionals

Page 112

Sector Service Target Population Role CYPD The Early Years Pre-school children Includes teachers and inclusion assistants covering Inclusion Team different areas of Sheffield. They work with young children with special educational needs at home and support nurseries, playgroups and primary school reception classes to include children with SEN and disabilities. They give support and advice on children’s play and development and work closely with health professionals to provide coordinated programmes. The Early Years Inclusion team works in collaboration with Pre- School learning Alliance who provide a number of Inclusion Assistants. CYPD The Specialist Children age 0-19 A city-wide service working with children who are Autism Team on the Autistic Spectrum and have complex communication difficulties, at both pre-school and school age. The team includes teachers who work in the home, in the specialist playgroup at Ryegate, and in mainstream nurseries, playgroups and schools. CYPD The Service for Children age 0-19 The Service for Children with a Hearing Impairment Children with a is a city-wide service. The service works closely Hearing with the Centre for Speech and Hearing at Sheffield Impairment Children’s Hospital and offers support to families from the time diagnosis to understand the impact of their child’s hearing loss and help them to develop strategies to encourage communication skills. The service works with other agencies to support of pre- schools, nurseries and schools to manage the learning of hearing impaired children.

Page 113

Sector Service Target Population Role CYPD The Service for Children age 0-19 The Service for Children with a Visual Impairment Children with a is a city-wide service which offers support to Visual Impairment parents to help them understand their child’s visual difficulties and introduce activities and experiences to help play and learning. They also offer training and support to staff in pre-schools, nurseries and schools to include children with visual impairment. Anyone can refer children with visual impairment to the service. CYPD The Educational Children age 0-19 The Educational Psychology Service is based at Psychology the Bannerdale Centre. The team works with Service children of all ages supporting learning, behaviour and emotional well being. The team offers advice to parents, pre-schools, nurseries, mainstream schools and special schools. CYPD Parent Partnership Children age 0-19 The Parent Partnership Service is a specialist Service service offering impartial information advice and support to parents and carers of children with special educational needs. Parent Partnership can help parents understand and prepare for the SEN process and help them communicate with schools and the local authority.

Page 114

Sector Service Target Population Role CYPD SNIPS - Special Children age 5-17 The Special Needs Inclusion Playcare Scheme Needs Inclusion (SNIPS) has a team of staff who can support Playcare Scheme children in accessing out of school activities such as holiday playschemes, after school clubs, youth clubs and leisure activities. The service provides the opportunity for parents/carers to take short breaks from caring whilst knowing that their child will be cared for in safe good quality play environment. Families can refer directly to the service. Families who have a social worker can ask for a referral to be made on their behalf. The service can provide a range of support to groups delivering out of school services. This includes advice and support for individual children to ensure staff working in clubs can meet any support needs they may have. Groups can receive funding towards additional staffing support if this is necessary for the child to attend. Parents and carers can receive assistance to pay clubs session charges through the services subsidised places scheme. The service also works with children on an individual or group basis to support them access to the recreational and leisure activities of their choice. CYPD Family Placement Children age 3-17 Can be a few hours day care or overnight stays Team CYPD Aldine House Age 0-19 Secure school - BESD CYPD Bents Green Age 11-16 ASD, SLCN, VI Secondary

Page 115

Sector Service Target Population Role CYPD Heritage Park Age 7-16 BESD Community School

CYPD Holgate Meadows Age 7-16 BESD Community School CYPD Mossbrook Age 4-11 MLD, SLD Primary CYPD Norfolk Park Age 4-11 SLD, PMLD, ASD Primary CYPD Oakwood School Age 11-16 BESD, SLD, MLD, ASD CYPD Rowan Primary Age 4-11 SLD, PMLD, ASD, SLCN CYPD Seven Hills Age 11-16 PMLD, SLD Special School CYPD Shirle Hill Hospital Age 5-12 BESD School CYPD Talbot Specialist Age 14-19 PMLD, SLD, ASD School CYPD Woolley Wood Age 4-11 PMLD, SLD Primary CYPD (based @ Ryegate) Sibling Support Siblings of a child with a Meetings, playgroups, information library Group Service disability

CYPD (IR) Birley Community Age 11-19 Communication Difficulties College CYPD (IR) King Ecgbert Age 11-19 Communication Difficulties CYPD (IR) Myers Grove Age 11-16 Communication Difficulties CYPD (IR) Angram Park Age 4-11 HI Primary

Page 116

Sector Service Target Population Role CYPD (IR) Ecclesfield Age 11-16 HI CYPD (IR) Greystones Age 4-11 HI Primary CYPD (IR) High Storrs Age 11-19 HI CYPD (IR) Lower Meadow Age 4-11 HI Primary CYPD (IR) Silverdale Age 11-19 HI CYPD (IR) Birley Spa Primary Age 4-11 Language Communication Interaction & ASD CYPD (IR) Nook Lane Junior Age 7-11 LD & Complex Needs CYPD (IR) Arbourthorne Age 4-11 LD & Complex Needs Community Primary CYPD (IR) Fox Hill Primary Age 4-11 LD & Complex Needs CYPD (IR) Hartley Brook Age 4-11 LD & Complex Needs Primary CYPD (IR) Nether Green Age 7-11 LD & Complex Needs Junior School CYPD (IR) Abbeydale Grange Age 11-19 Significant LD & Complex Needs CYPD (IR) Sharrow Primary Age 4-11 LD & Complex Needs CYPD (IR) Stradbrooke Age 4-11 LD & Complex Needs Primary CYPD (IR) Wharncliffe Side Age 4-11 LD & Complex Needs Primary CYPD (IR) All Saints Catholic Age 11-19 PD High CYPD (IR) Notre Dame Age 11-19 PD Catholic High CYPD (IR) St Thomas of Age 11-19 PD Canterbury Catholic High

Page 117

Sector Service Target Population Role CYPD Portage Pre-school children Teaching to develop core skills e.g. feeding, Toileting, language, reaching, holding, playing etc. Health ADHD Liaison Children age 0-19 The ADHD Liaison nurses provide education and Nurses support to children and their families, schools and anybody involved in the children’s lives. They work in conjunction with a number of professionals to help provide a seamless service. They can offer schools visits, anger management sessions, attention training sessions and behaviour management sessions. Health Continence For children over three with A qualified nurse or health visitor will normally do Advisory Service severe disabilities the assessment, or it can be done at a continence clinic. Health Audiology Clinic Children with Hearing Service: hearing service and referrals service for Impairment age 0-16 children aged 3 months to 16 years. Referrals are accepted from parents, GPs, health visitors and other professionals, through doctor-led clinics. There is an initial baseline test and, if the outcome is unsatisfactory, there is a referral to a GP-led clinic, and ultimately to a consultant-led clinic or ENT (ear, nose and throat). For newborns and school-age entries, failed cases are managed on an ongoing basis. For those with permanent hearing loss a hearing aid and long-term care are provided. Health Community Children age 0-16 Community Paediatricians provide assessment and Paediatricians support in schools and local clinics for children with developmental problems and special needs. They also provide advice on education, health related needs in schools and health promotion; immunisation, looked after children etc.

Page 118

Sector Service Target Population Role Health Occupational Children age 0-16 The occupational therapist works to help each child Therapy Service develop their maximum potential in function and independence. The occupational therapist will discuss the carer’s needs in daily management and any difficulties the child may have in daily living activities, such as dressing, feeding, bathing and toileting, positioning and seating. The therapist works with the child and carer on issues such as assessment, equipment provision, splinting and scar management therapy, therapy advice, individual and group work. Health Orthoptics Service Orthoptics services are provided at The Sheffield Children’s Hospital NHS Trust with a service for children with special needs at The Ryegate Children’s Centre. The Royal Hallamshire Hospital also provides an orthoptic service. The orthoptists assess the child’s ability to see and use their eyes together correctly. If there is a problem with the vision in one or both eyes, or there is a squint or eye muscle problem, a referral to the Consultant Ophthalmologist will be made. Health Physiotherapy Children age 0-16 Physiotherapists will see children in a variety of Service locations, - hospitals, Ryegate Centre, nursery, school, or at home. Children with a variety of conditions are usually referred by doctors, health staff and school teachers. The physiotherapist will assess the child’s physical condition and abilities to decide if treatment is needed, and then work with parents and carers to plan and implement treatment and to enable the child to be as independent as possible.

Page 119

Sector Service Target Population Role Health Speech & Children age 0-16 Speech and Language therapy services are Language Therapy provided in clinics and health centres throughout Service Sheffield. Specialist advice is available in the areas of dysfluency (stammering), communication aids, hearing impairment, learning difficulties, autism, eating and drinking difficulties, cleft palate and specific speech and language disorders. Families can be offered advice on the best strategies to help their child communicate. Speech and language therapists also work with mainstream and special schools in Sheffield Health Sheffield Administered by the Sheffield Care Trust. Provides Community a range of equipment for short and long term Equipment Loan including urinals, bed pans, walking aids, nursing Service beds, lifting poles, patient hoists and slings. Also short term loan of wheelchairs. Ryegate CDC ADHD Service Age 3 to 16 with ADHD Provision of diagnostic assessment and ongoing and Developmental support / management for children / young people Comorbidities with possible ADHD and Developmental Comorbidities (see Appendix 4) Ryegate CDC Combined Clinic Age 0-4 years who present Early assessment and intervention for children with with significant Autism and other significant communication communication difficulties; disorders; To provide information towards query - Autism diagnoses of Autism Spectrum Disorders and the identification of other disorders including ADHD and Receptive Language Disorder and Learning Difficulties. To work with parents towards developing an understanding of their child’s developmental strengths and weaknesses. (see Appendix 4)

Page 120

Sector Service Target Population Role Ryegate CDC Dyspraxia / Children between 5 and 16 The comprehensive assessment and treatment of Development Co- years with poor motor children referred with a Motor Coordination ordination coordination Difficulties which may be due to dyspraxia and Disorders developmental coordination disorders. Assessment for other developmental comorbidities and onward referral as needed. (see Appendix 4)

Ryegate CDC Early Years Children age 0-4 who Health professionals together with an education Service receive input from two or worker and a social worker meet regularly with more therapists (Speech parents to plan, coordinate and evaluate and Language Therapy, therapeutic interventions and family support. A Physiotherapy, service plan is produced at 3 to 6 monthly intervals Occupational Therapy). It according to child and families needs and will include children with preferences. The final meeting will be jointly with complex sensory motor health and education staff working in nurseries to and learning difficulties. arrange a transfer of therapy and care.

Ryegate CDC Multidisciplinary Children (0-16) with severe Purpose is to provide a comprehensive Assessment and complex assessment of children referred with complex neurodevelopmental neurodevelopmental difficulties; Diagnosis of disorders, cerebral palsy neurodevelopmental disorders; Description of and/or two or more areas developmental strengths and weaknesses; of developmental disability Planning and coordination of therapeutic services; (language delay/disorder, Liaison with and referral to other agencies. sensory & motor difficulties, social communication difficulties, learning difficulties)

Page 121

Sector Service Target Population Role Ryegate CDC Social and The service is for children Purpose is to provide a comprehensive Communication up to 16 resident in assessment of children referred with complex Disorders Sheffield where there are neurodevelopmental difficulties; Diagnosis and Assessment Clinic concerns about social description of developmental strengths and communication difficulties weaknesses; Planning of therapeutic interventions affecting functioning or and contribution to the planning of educational wellbeing; Children can be provision seen with queries as to autism, asperger's syndrome, autism spectrum disorder, pervasive developmental disorder, non verbal learning difficulties or DAMP. Ryegate CDC Sheffield INDEX of Aged 0 to 19, who live in Child disability register for Sheffield. Parents of Children and Sheffield and with any children who are registered receive a registration Young People with disability, or life altering letter, regular priority copies of the “What’s Going Disabilities medical condition. On” newsletter plus a personalised letter detailing all the disability services they and their child can access across Sheffield. Ryegate CDC Dual diagnosis The Dual Diagnosis Team The team operates a goal directed approach in service offers assessment, order to facilitate change in the clients' identified diagnosis and various behavioural problems, both directly and by interventions for children supporting the client's main carers through the with moderate/severe implementation of an agreed plan of care. learning disability and/or complex developmental problems, including Autism, mental health problems, and challenging behaviour.

Page 122

Sector Service Target Population Role Ryegate CDC Gait Analysis Children with a range of The gait analysis service provides an accurate Service conditions including measure of walking problems in children with cerebral palsy, spina bifida, complex walking patterns. A range of equipment is brain injuries, severe foot used to collect walking information and from this a deformities (e.g. talipes / comprehensive report is produced. This report is clubfoot), legs of different used to help plan treatments aimed at improving lengths and conditions that walking ability. Treatment options include orthotics cause children to walk on (splints), medication, physiotherapy and surgery. their toes. (see Appendix 4)

Ryegate CDC Intrathecal Children with severe Children are assessed by a team of Paediatric Baclofen (ITB) spasticity and / or dystonia Neurologists, Paediatric Neurosurgeon, Clinical Service which may impede or mask Specialist Nurse (neurology) and Senior existing motor control. Neurophysiotherapist. If the team considers that Children who develop the child would benefit from ITB therapy, a test unacceptable side-effects dose of ITB would be given following an elective to anti-spasticity admission and child would be assessed by the medications. Children team. The team would then discuss the results of whose positioning and the test dose with the child / parents and the ease of care could be expectations of the outcome to be achieved by the improved and contractures ITB pump insertion. If parents agree for ITB pump, especially in lower limbs then explanation given about surgery, may be prevented complications and follow up. Ryegate CDC Neurofibromatosis All children with type 1 NF New patient referrals from GP’s or tertiary from Sheffield. Help with quaternary referrals. Annual surveillance for complex patients from complications of NF1 and active intervention in other areas (though complex NF1 (Behavioural, educational, endocrine, subsequent follow-up hypertension, ophthalmic etc). Quarterly multi- arranged locally). Rarely disciplinary clinics held at Ryegate Children’s children in families with centre. NF2.

Page 123

Sector Service Target Population Role Third sector Crossroads Families of children aged Respite care in the home 0-18 Third sector MILAAP Asian women who are Group sessions for mutual support & development parents of disabled of new skills; increased understanding of children disabilities. Third sector Sheffield Carers Includes carers for Advice, information and support for parents/carers Centre disabled children & children: Helpline, Mailing List Third sector Sheffield Mencap Families and people with Support and services for children and adults with & Gateway learning difficulties learning difficulties, their families and carers. Third sector ACCT (Asperger's Parents/carers of Children Monthly meetings, social events, book & video Children & Carers with Aspergers Syndrome library, weekly drop in sessions (term time only), Together) in Sheffield and South monthly children's club (ACCTivate), siblings club Yorkshire. Third Sector Working Better Children age 0-19 This service is designed to coordinate support to Together Project parents of children under three with complex developmental needs, who will be seen by a number of professionals. The aim is to help coordinate the team of people working with the child to work to a single plan with the parent and child’s needs at the centre. Also to identify a key worker to coordinate support to the family. Referral can be made by anyone working with the family with the family in consultation with the family.

Page 124

Sector Service Target Population Role Third sector Within Reach WITHIN REACH was formed in 1989 following the commitment given by various organisations and individuals to the successful ‘Our Year Too’ programme of sports events and activities for disabled people, which ran as part of the World Student Games in 1991. Some of these people have continued their involvement in disability sport and have become an integral part of WITHIN REACH. With support from Sheffield City Council, Sheffield City Trust and many other organisations we have continued to champion the development of sport and opportunities for disabled people here in Sheffield. Our activities have enabled many participants and volunteers to become involved in events, clubs and training, leading to social and competitive experience and in some cases vocational opportunities.

Third sector Home-Start Families of children aged Support to parents/carers in the home 0-5 Third sector ICAN Language Pre-school children ICAN Language Centre offers specialist provision Centre for one term to children with an identified speech and language disorder. Third sector (based @ Ryegate) SIGN (Sheffield Families & children 0-18 Information service for disabled children and young Information Giving people and their families, and the professionals Network) who support them.

Page 125

APPENDIX 4: SHEFFIELD – SPECIAL EDUCATIONAL NEEDS CRITERIA

Page 126

SHEFFIELD

THE SPECIAL EDUCATIONAL NEEDS CRITERIA

Page 127

Contents

1. Forward

2. Introduction

3. General Criteria

(a) To initiate a Statutory Assessment (b) For use within the annual SEN audit

4. Specific Criteria:

4.1 (a) Academic Curriculum: General Learning Difficulties / MLD

4.1 (b) Academic Curriculum: Specific learning Difficulties (including dyslexia)

4.2 Social Curriculum: Emotional and Behavioural Difficulties

4.3 Physical Impairment

4.4 Medical Conditions

4.5 Severe Communication Difficulties: Specific Language Impairment

4.6 Severe Communication Difficulties: Autistic spectrum disorders

4.7 Visual Impairment

4.8 Hearing Impairment

5. Criteria for provision of a statement

6. Criteria for ceasing to maintain a statement

7. The SEN Panel & SEN Appeals Panel Not included?

8. Additional Guidance Not included?

Page 128

1. Forward

1.1 The government have, and are continuing to, work at improving the way in which we address special educational needs (SEN). The green paper "Excellence for All" and the "SEN Action Programme" propose that statements should continue to be used for those children with the severest of needs but that the costly bureaucracy of the "statementing" process should be reduced by:

• Enabling schools to meet the needs of children who are experiencing SEN wherever possible. • Simplifying the code of practice. • Shifting the emphasis 'for support services from "assessment" to working with teachers and children.

1.2 The SEN criteria presented here evidence the concordance between local LEA strategy and the national action programme. The criteria are the outcome of a successful two year pilot and are, as far as is possible, objective. They have operated as planned and have been tested at SEN Tribunal. The criteria have stabilised the proportion of the population for which the City maintains a Statement of SEN.

1.3 The pilot criteria were introduced in October 1997 following wide consultation. Nationally and locally concern had been expressed about the need for explicit criteria to initiate Statutory Assessments and issue Statements. In Sheffield the lack of 'such explicit criteria had led to concerns that:

• the allocation of Statements may have been inconsistent or inequitable across the Authority; and that, • the inexorable rise in the number of Statements would inevitably:

o Have a direct effect upon the Aggregated Schools Budget (ASS) (now relevant to the Individual Schools' Budget. ISB); o Spread resources more and more thinly reducing the support for those most in need, and; o Direct resources towards expensive statutory assessment processes and away from support.

1.4 There was, therefore a consensus about the need for:

• Clear, specific criteria; • Ensuring that decision making within the formal assessment process was open, equitable, and focused upon identified needs rather than categories of children's difficulties.

1.5 The SEN Criteria presented here were designed to address these very factors and do so effectively, They are also effective in supporting an annual SEN audit which enables the devolvement of funds to schools. The criteria cannot be seen in isolation from the varied funding streams supporting mainstream schools to make provision for the wide range of pupil needs. These funding streams are outlined within the introduction. Page 129

2. Introduction

2.1 National surveys of Special Educational Needs (SEN) processes identified inconsistencies both between and within LEAs with regard to which children are assessed and how provision is allocated. They confirmed the need for clear criteria and decision making. Parents in particular have often been unclear about what support they can expect from the school and/or the LEA given their child's level of difficulty in accessing the curriculum. In order to minimise such inconsistencies the DfEE 'Code of Practice on the Identification and Assessment of Special Educational Needs' offers guidance to LEAs on the development of criteria for assessment and for the issuing of a statement. In drawing up the SEN criteria outlined in this document, Sheffield LEA has taken careful account of:

2.1.1 the guidance contained in the DfEE Code of Practice and SEN Action Programme.

2.1.2 National surveys of LEA practices

2.1.3 The views of individuals and groups affected by the process

2.1.4 The arrangements for funding special educational needs in Sheffield which include:

• A nominal amount of the Age Weighted Pupil Unit for each school, as part of its basic funding, is meant to enable curriculum differentiation to meet special educational needs at all Stages of the Code of Practice.

• Additional funding for non-statemented pupils, delegated differentially to schools according to needs identified through the Special Educational Needs and Positive Action elements of the Formula for Funding Schools.

• Funding from the LEA to supplement school resources to meet some or all of an individual pupil's special educational needs. This funding is given to schools through the following mechanisms:

(a) Secondary schools receive funding for identified individuals with general, specific or behavioural difficulties through the annual SEN audit which obviates the need for statements in accordance with the SEN Action Programme. (the LEA intends to consult about possible methods of devolving further SEN funding to primary schools)

(b) All schools are eligible to receive funding for identified individuals through a formal Statement of SEN at Stage 5 of the Code of Practice;

Page 130

2.2 The benefits of our approach include:

• Ensuring that the needs of pupils with the severest of needs continue to be identified and met; • Maximising the resources available to schools to enable them to meet the needs of children; • Schools being able to plan and utilise their resources more effectively and efficiently; • No delays in getting financial resources into school budgets; • Less paper work and bureaucracy.

2.3 The aims of the criteria are as follows:

2.3.1 To enable the LEA to identify consistently and objectively those children with the greatest level of need who may require a Statutory Assessment and a Statement of Special Educational Needs.

2.3.2 To provide clear guidelines for parents, schools, voluntary organisations and other professionals concerning the level of special educational needs likely to be considered by the LEA to be sufficiently severe or complex to require a Statement.

2.3.3 The criteria are intended to be consistent with the detailed guidance contained in the SEN Code of Practice (Particularly Chapter 3, sections 46 to 94; and Chapter 4, sections 1 to 12). This document should therefore be used alongside the Cod-e when· detailed consideration is given to an individual pupil's needs. (A revised Code is expected to be published by the DfEE in the near future.)

2.3.4 To enable the LEA and schools to identify consistently and objectively those children with the greatest level of need within an annual SEN audit.

2.4 Clearly not all pupils who undergo statutory assessment will have a Statement drawn up:

• A statutory assessment may not confirm that a child's needs are significant or of a sufficient degree of severity for the LEA to issue a Statement. • A statutory assessment may confirm that a child's needs are of a sufficient degree of severity but that the necessary resources have been devolved to the school. • It is recognised that a statutory assessment might help clarify a child's special educational needs. It is nevertheless essential to minimise the number made for children who do not have severe or complex needs. The process of statutory assessment is very costly in terms of administration and professional time and diverts resources away from support and preventative work.

Page 131

2.5 The DfEE SEN Code of Practice recognises that, nationally, about 20% of children may have some form of special educational needs at some time in their school career. For the vast majority of children such needs will be met by their school at Stages One to Three of the Code, drawing upon the school's own basic funds and/or from the additional funding allocated to the school by the LEA for non- statemented special educational needs. Only in a very small minority of cases will a child have special educational needs of a severity or complexity which requires the LEA to determine and arrange the special educational provision for the child by means of a Statement of Special Educational Needs. The Code of Practice suggests a national figure of 2%. Sheffield currently maintains statements for approximately 3%.

2.6 The criteria levels presented in this document have been tested over a two year pilot. They operate as they were planned to do and that is stabilise the percentage of the population receiving a Statement. The year on year rise in the number of statements is being constrained.

2.7 It is likely that the current process of devolving funds to secondary schools through an annual SEN audit will reduce over time the necessity for maintaining the current level of statements and better enable early intervention with identified pupils.

2.8 Criteria for pre-school children are presented in a separate document.

2.9 The extent of a pupil's special educational needs is determined by the unique interaction between the individuality of the pupil and his or her educational environment. Whilst it would be impossible to define criteria that reflect fully the complexity of this interaction it is nevertheless necessary to formulate a range of objective criteria which can be applied as consistently as possible across the City.

2.10 It is not possible or even relevant to provide hard ability or attainment criteria for all types of difficulties. For some types of difficulty I notably behavioural, 'process' criteria are necessary. Where this is the case clear evidence of the processes undertaken will be required if judgements based on the criteria are to be sound. This relates to decisions about whether to provide or issue a Statement and to the moderation of decisions within the SEN audit.

2.11 Decisions whether or not to proceed with statutory assessment and whether to issue a Statement will of course need to be informed by a careful consideration of the pupil's individual circumstances and in some cases the cumulative effect on educational progress of a combination of special needs. In some exceptional circumstances therefore a combination of less significant special needs may be regarded as constituting significant special educational needs and justify statutory assessment.

Page 132

3. GENERAL CRITERIA

Page 133

3. General Criteria for Statutory Assessment

Request for Statutory

Assessment submitted to the

LEA by School or Parent

Does the evidence support all three of the following criteria: a) that the pupil's special educational needs have persisted despite the school having taken relevant and purposeful action to meet the pupil's needs (including the formulation, implementation, monitoring and reviewing of Individual Education Plans and consultation with appropriate external specialists)?

b) That the pupil may have: - Significant learning difficulties and / or - Significant impairment(s) and / or - Significant emotional or behavioural difficulties?

c) That the pupil's special educational needs are likely to require special provision that is not normally available in the mainstream school?

If necessary, more evidence is sought by LEA from school / parent / or other involved agency

NO

Is there evidence of YES exceptional circumstances to support 'Fast Track NO Assessment'? YES

LEA initiates Statutory LEA does not initiate Assessment Statutory Assessment

Page 134

3.1 General Criteria to initiate a Statutory Assessment

3.1.1 There are three general criteria for initiating Statutory Assessment

A) That the pupil's special educational needs have persisted despite the school having taken relevant and purposeful action to meet the pupil's needs, including the formulation, implementation, monitoring and reviewing of Individual Education Plans and consultation with appropriate external specialists. (NB. Fast-track in extreme circumstances)

B) That the pupil appears to have significant special educational needs; i.e.

• Significant learning difficulties; and/or • Significant impairment(s); and/or • Significant emotional/behavioural difficulties.

C) That the pupil's special educational needs may call for special educational provision which cannot reasonably be provided within the resources normally available to mainstream schools in Sheffield.

3.1.2 "That the pupil's special educational needs have persisted despite the school having taken relevant and purposeful action to meet the pupil's needs (including the formulation, implementation, monitoring and reviewing of Individual Education Plans and consultation with appropriate external specialists)."

• In submitting a request for Statutory Assessment the school should draw upon the following evidence base, although it is recognised that it may not be possible in all cases to cover all areas. • Information and action taken at Stage 1 Code of Practice. • At least two reviews of Individual Education Plan implemented at Stage 2 Code of Practice. • At least two reviews of Individual Education Plan implemented at Stage 3 of Code of Practice (including appropriate documentation relating to Stage 3 consultation with external specialists such as educational psychologist and support teachers). • Additional specialist reports submitted by parents' or school. • Records of regular attempts to consult with and actively involve parents. Records of the pupil's views. • Annotated samples of work submitted by school. • Where a pupil has transferred from another school, baseline information including details of earlier Code of Practice Stages and individual education programmes.

Page 135

3.1.3 “That the pupil appears to have significant special educational needs.”

Learning difficulties will be taken to exist if the pupil’s profile demonstrates:

• That attainments in English, Maths or Science are significantly below those normally found in pupils of the same age, (see specific criteria), or • In the case of specific learning difficulties, that there is a significant mismatch between attainments in particular skill areas of the curriculum and the level of attainment expected generally of the pupil. There will be a significant difference in National Curriculum levels between subjects or between attainment targets within core subjects (see specific criteria)

• Significant impairment will be assessed according to the degree to which the pupil's Impairment does or could impede access to the school curriculum.

• Significant emotional behavioural difficulties will be assessed according to the nature and degree of the pupil's behaviour in the school context. In most cases the pupil's emotional and behavioural difficulties will or could impede significantly his or her access to the school curriculum (see specific criteria).

3.1.4 "That the pupil's special educational needs may call for special educational provision which cannot reasonably be provided within the resources normally available to mainstream schools in Sheffield."

• Schools receive resources for special educational needs through:

¾ The Age-Weighted pupil Unit. ¾ Additional allocation in respect of non-statemented special educational needs via the specific positive action and special educational needs elements of the formula. ¾ Secondary schools receive funding for identified individual pupils through the annual SEN audit.

• In addition schools receive advice at Stage 3 of the Code of Practice from LEA specialists:

¾ Educational Psychologists ¾ Specialist Teachers ¾ Advisory Teachers

Page 136

3.1.5 Notes:

• The 1993 Education Act states that a pupil must not be regarded as having a learning difficulty solely because the language of his / her home differs from the language used to teacher the pupil in school. It is important that where a bilingual pupil from a minority ethnic group does have additional learning difficulties that these difficulties are properly identified and appropriate support provided. Care should be taken to consider the pupil within the context of his or her home, language, culture and community and that advice and help is secured from the relevant support services.

• In exceptional circumstances where it is clear that a pupil has significant special needs and where the school may not have been able to progress through the earlier stages of the Code of Practice then a 'fast track' through to Statutory Assessment is possible. It is impossible to foresee all circumstances where this might be necessary but some examples might be:

¾ Socially or medically traumatic events such as a road accident, severe illness or abuse which are likely to produce lasting learning difficulties and reduce access to the curriculum.

¾ Extreme emotional or behaviour difficulties arising for example immediately after entry to the school which prove unmodifiable in a short period.

¾ A child with obvious severe difficulties who has entered the school from outside the LEA and who needs an Assessment to determine provisional placement.

¾ Where a child is looked after by Social Services and a Statutory Assessment is needed urgently in order to secure appropriate educational provision.

3.1.6 Sheffield LEA will always wish to see evidence of the pupil's academic attainment including information about progress in core subjects of the National Curriculum. It is nevertheless acknowledged that National Curriculum Levels are not sufficiently precise or graded in small steps to stand alone as evidence of progress for pupils with special educational needs. National curriculum evidence will therefore need to be considered alongside other forms of assessment including standardised test results, teacher observations, advice from external specialists, parental information and, when possible, the views of the pupil him or herself.

Page 137

3.1.7 The LEA will also need to consider non-academic factors which may be affecting a pupil's performance and progress. These factors will include:

• Problems with the pupil's health which may have led to recurrent or significant absences from school or difficulty in concentrating or particularly in the full range of curriculum activity while at school. • Sensory impairment, e.g. visual loss • Speech and language difficulties • Poor school attendance • Problems in the pupil’s home circumstances • Any emotional or behavioural difficulties

3.2 General Criteria for use within the annual SEN Audit

3.2.1 The LEA will complete an annual audit of SEN across the city.

3.2.2 The aims of the audit are to:

(a) provide an overview of the nature and incidence of SEN across schools at differing stages of the SEN Code of Practice;

(b) enable the devolvement of resources to secondary schools based on the identification of individual pupils with severe levels of needs in relation to:

• General learning difficulties • Specific learning difficulties • Emotional and / or behavioural difficulties (EBD)

3.2.3 The general criteria for use within the audit for the identification of individual pupils with severe levels of general or specific learning difficulties or EBO are:

A) There is evidence that the pupil has significant 'common' or 'high' incidence special educational needs; i.e.

• Significant general or specific learning difficulties; and/or • Significant emotional / behavioural difficulties.

B) That the pupil's special educational needs persist despite the school taking relevant and purposeful action to meet the pupil's needs, including the formulation, implementation, monitoring and reviewing of Individual Education' Plans and consultation with appropriate external specialists.

‘The school’ can refer to the feeder school where appropriate.

Page 138

4. SPECIFIC CRITERIA

Please note:

To initiate a statutory assessment evidence should be provided that:

• The specific criteria including, where appropriate, those relating to cognitive abilities are met (see paragraphs B for each category). • The school has attempted appropriate strategies (see paragraphs C for each category).

For the purposes of the annual SEN audit specific criteria relating to cognitive abilities do not apply

Page 139

4.1 (a) Academic Curriculum: General Learning Difficulties / MLD

General indicators (i.e. not criteria)

• The majority of pupils who have significant learning difficulties relating to the academic curriculum will be identified early in their school careers. Their general level of academic attainment will be significantly below that of their peers. In most cases they will have difficulty acquiring basic numeracy and literacy skills and many will have significant speech and language difficulties.

• A pupil experiencing such difficulties may be considered for Statutory Assessment or for identification within the audit if his or her rate of learning or degree of retention of knowledge and educational skills in any of the National Curriculum core subjects is significantly lower than that expected for children of the same age.

(i) Specific Criteria

A: Attainment Age Approx Attainment levels indicative of significant learning of NCY Yr difficulties. Children functioning above these levels pupil Group without other difficulties would not be considered for Statutory Assessment

Early 4 or below 2.25 yrs. In two or more Developmental developmental areas (see Years pre-school criteria) 5 R at or below 2.5 yrs 6 Y1 at or below 3.5 yrs

National 7 Y2 at or below 4.5 yrs. Working towards level 1 in Curriculum core subjects

8 Y3 at or below 5 yrs 9 Y4 at or below 5.5 yrs Working at or towards level 10 Y5 at or below 5.75 yrs. 1 in core subjects

11 Y6 at or below 6.5 yrs. At or below level 2 in core 12 Y7 at or below 6.75 yrs subjects 13 Y8 at or below 7 yrs.

14 Y9 at or below 7.5 yrs 15 Y10 at or below 7.75 yrs 16 Y11 at or below 8.0 yrs B: Cognitive • The pupil's overall performance on standardised tests of abilities(does cognitive abilities will give a quotient of 65 or below. not apply to • The child's attainments in either literacy or numeracy are at or SEN Audit) below the 1st centile or at or below the 2nd centile in both.

Page 140

(ii) Evidence - The school has:

• Drawn up, implemented, monitored and regularly reviewed Individual Education Plans at Stages 2 and 3 of the Code of Practice over a period of at least 6 months. • Sought and acted upon advice from appropriate external specialists (e.g. educational psychologists) • Sought the views of and involved the pupil and his/her parents or carers at each stage. The parent(s) should have had full opportunity to be actively involved in supporting the school staff in the implementation and evaluation of any intervention programme. • Taken action to make the appropriate curriculum accessible to the pupil through differentiation, homework, resources, teaching and pastoral support. • Considered and taken steps to meet the pastoral needs of the pupil and, if necessary sought appropriate advice or expertise to meet any social, emotional or behavioural needs. • Explored the benefits of, and where practicable secured access for the pupil to appropriate information technology.

Code of Practice

• The Code of Practice sections 3:57 to 3:59 provide further information.

4.1 (b) Academic Curriculum: Specific learning Difficulties (Including dyslexia)

General indicators (i.e. not criteria)

• Some pupils may have significant difficulties in reading, writing, spelling or number which are not typical of their cognitive ability. They may gain some skills quickly and demonstrate a higher level of ability orally which does not correspond to the difficulty they experience in gaining literacy and / or numeracy skills. • These difficulties may sometimes be associated with significant difficulties .of sequencing; visual and auditory perception; developmental co-ordination difficulties: short-term memory; verbal recall or significant delays in language functioning (e.g. word retrieval difficulties). • Pupils with specific learning difficulties' may become severely frustrated and may also develop low self-esteem. • Pupils experiencing mild specific learning difficulties should have their needs identified and met within the resources normally available to schools.

Page 141

(i) Specific Criteria

A: Attainment Age Approx Attainment levels indicative of specific of NCY Yr learning difficulties. There will be pupil Group significant discrepancies particularly between a pupil’s verbal expressive skills and / or comprehension and skills in reading or written recording. Attainments 7 Y2 at or below 5 yrs. Generally, there are and National 8 Y3 at or below 5.5 yrs. extreme Curriculum 9 Y4 at or below 6 yrs. discrepancies 10 Y5 at or below 6.25 yrs. between attainment 11 Y6 at or below 6.5 yrs in different core 12 Y7 at or below 6.75 yrs. subjects or within 13 Y8 at or below 7.25 yrs one core subject, 14 Y9 at or below 7.75 yrs particularly English. 15 Y10 at or below 8.0 yrs These 16 Y11 at or below 8.25 yrs discrepancies are in the order of three National Curriculum levels. B: Cognitive • Assessment by an educational psychologist reveals a abilities difference at or below the 2nd percentile between the (does not pupil's actual attainment in reading and that expected on apply to SEN the basis of the pupil's intellectual ability. Audit)

(ii) Evidence - The school has:

• Drawn up, implemented, monitored and regularly reviewed Individual

Education Plans at Stages 2 and 3 of the Code of Practice over a period of

at least 6 months.

• Sought and acted upon advice from appropriate external specialists (e.g. educational psychologists) • Sought the views of and involved the pupil and his/her parents or carers at each stage. The parent(s) should have had full opportunity to be actively involved in supporting the school staff in the implementation and evaluation of any intervention programme. • Taken action to make the appropriate curriculum accessible to the pupil through differentiation, homework, resources, teaching and pastoral support. • Considered and taken steps to meet the pastoral needs of the pupil and, if necessary sought appropriate advice or expertise to meet any social, emotional or behavioural needs. • Explored the benefits of, and where practicable secured access for the pupil to appropriate information technology.

Page 142

Code of Practice

4.2• Social The CodeCurriculum: of Practice Emoti sectionsonal and 3:62 Behavioural to 3:63 provide Difficulties further information

General Indicators (i.e. not criteria)

• Emotional and behavioural difficulties' describes a continuum of behaviour from minor social maladaption to serious personality or mental disorder, Whilst the needs of most pupils with emotional and behavioural difficulties are being met within the resources generally available to mainstream schools, a very small number who have significant difficulties will require additional or special provision. • Pupils presenting with emotional and behavioural difficulties may react unpredictably, unusually or in an extreme fashion to a variety of social, personal or physical circumstances. • Emotional and behavioural difficulties may arise from a number of causes (including physical or sensory impairment; a learning difficulty; inappropriate teaching/curriculum or through family or school-based problems) and may manifest themselves in many different forms, degrees of severity and vary in duration. Severely withdrawn or passive behaviour may be as significant an indicator as aggressive or bizarre behaviour. • The pupil may show evidence of underachievement that can be related to emotional or bel1avioural difficulties and may display an uneven pattern of progress and attainments in the core subjects of the National Curriculum.

Page 143

(i) Specific Indicators / Criteria

Specific behaviours

The pupil will display a range of behaviours at a significant level and which may include the following:

At a personal level: Destroying own work; pre-empting failure in tasks; constant anxiety; depression/severely withdrawn; extreme resentment/vindictiveness or continual defiance. Bizarre, self-injurious, or obsessive behaviour. Significant difficulties establishing friendships with peers or adults in a range of different educational settings. Manipulative behaviours including lying and fantasising. Extreme attention-seeking behaviours: Acute anxiety and fear about attending school. Inappropriate sexual behaviour.

At a verbal level: persistent refusal to speak; extreme threats, continual interruption; persistent argumentativeness or extreme abusiveness.

At a non-verbal level: school refusal: continual failure to observe rules; extreme disruptiveness, destructiveness, aggression or violence.

At a work-skills level: inability or unwillingness to work without direct supervision, to concentrate, to complete tasks or to follow instructions.

The significance of these behaviours for any pupil will need to be judged against:

1. The degree of inappropriateness (particularly with regard to the age of the pupil and to the context in which the behaviour occurs) 2. Frequency of the behaviour 3. Its intensity 4. Its duration 5. Persistence over time, despite clear evidence of active strategies applied over a period of at least 6 months to modify the pupil's behaviours 6. A clear analysis of the pupil's cognitive functioning.

Page 144

Context

• The pupil's emotional and behavioural difficulties should be apparent in the

school environment.

• Where the pupil's emotional and behavioural difficulties cause management problems then these problems will occur in many situations and will usually be common to the majority of staff who have contact with the pupil.

• Since context can play a significant part in determining the extent of a pupil's (ii)behavioural Evidence difficulties – The school then where has a pupil has recently moved to another school or class he or she should be given the opportunity to settle before statutory Assessment is initiated. However, evidence from previous class/school would be relevant to a current assessment as part of a cumulative record.

• Drawn up, implemented, monitored and regularly reviewed Individual Education Plans at Stages 2 and 3 of the Code of Practice over a period of at least 6 months or has implemented, monitored and regularly reviewed Pastoral Support Plans.

• Sought and acted upon advice from appropriate external specialists (e.g. educational psychologist).

• Sought the views of and involved the pupil and his/her parents or carers at each stage. The parent(s) should have had the full opportunity to be actively involved in supporting the school staff in the implementation and evaluation off any intervention programme.

• Taken action to make the appropriate curriculum accessible to the pupil through differentiation

• Homework, resources, teaching and pastoral support.

• Systematically implemented, monitored and recorded a programme devised specifically to modify the behaviour-of the pupil concerned. Notes • Explored the benefits of, and where practicable secured access tor the pupil, to appropriate information technology.

Page 145

I. That the pupil's behaviour may have a detrimental effect on the education or welfare of other pupils may not itself define a special educational need. However it should be taken into account when decisions are made concerning appropriate provision.

II. In this context ‘permanent exclusion from school' may not constitute evidence of an intervention. Exclusion does not of itself indicate that a child requires Statutory assessment for special educational needs but may be taken into account The reasons tor exclusion should be explored rather than the fact of the exclusion.

Code of Practice

• The Code of Practice sections 3:68 to 3:70 provide further information

Page 146

4.3 Physical Impairment

General Indicators (i.e. not criteria)

• Children with severe physical disabilities are normally identified at the pre-school stage. Exceptions to this would be children experiencing severe trauma, perhaps the result of-an accident or serious illness, leading to a long term disability or could be the result of a degenerative medical condition.

• Some children will require significant changes to buildings, furniture or equipment to permit access to classrooms. Some will need specialist teaching strategies and equipment (e.g. adapted computers) to provide access to the curriculum and some will need help for quite specific medical problems. Some will be dependent upon adult support to deal with matters such as catheterisation or feeding as part of a planned programme to develop self-help skills. Adult support may also be needed in practical lessons, manipulating basic equipment, and moving around the school.

(i) Specific Criteria

There must be clear recorded evidence that the pupils physical disability does or could significantly impair his/her access to the curriculum, ability to take part in particular classroom activities or participation in aspects of school life. In addition, there is clear evidence of one or more of the following:

• Intensive, frequent and specialised nursing or other medical or paramedical care

• Significant problems regarding safety, including the need for a sheltered

environment, and protection against injury

• Evidence of a marked discrepancy between the pupil's attainments in core

subjects of the National Curriculum and the attainments of the majority of

pupils of the same age.

A marked discrepancy between the pupil's attainments in core subjects of • the National Curriculum and the expectations of the pupil as assessed by

his/her teachers, parents and external specialists who have closely observed

the pupil.

• Clear and substantial evidence based on specific examples, that the pupil's physical disability has given rise to significant emotional or behavioural difficulties.

Page 147

(ii) Evidence - The school has

• Drawn up, implemented, monitored and regularly reviewed Individual Education Plans at Stages 2 and 3 of the Code of Practice. • Sought and acted upon advice from appropriate external specialists (e.g. specialist advisory teacher, educational psychologist, physiotherapist, occupational therapist) • Sought the views of and involved the pupil and his/her parents or carers at each stage. The parent(s) should have had the full opportunity to be actively involved in supporting the school staff in the implementation and evaluation of any intervention programme. • Taken action to make the appropriate curriculum accessible to the pupil through differentiation, homework, resources, teaching and pastoral support. . • Explored the benefits of, and where practicable secured access for the pupil, to appropriate information technology. • Taken steps to meet the personal/self-help requirements of the pupil within existing resources. • Considered the nature and extent of the pupil's physical impairment and taken appropriate steps, within the resources of the school, to safeguard his/her health and safety. • Considered and taken steps to meet the pastoral needs of the pupil and, if necessary, sought appropriate advice/expertise to meet any social, emotional or behavioural needs.

Code of Practice

• The Code of Practice sections 3:72 to 3:74 provide further information

4.4 Medical Conditions

General Indicators (i.e. not criteria)

• Some medical conditions may, if appropriate action is not taken, have a significant impact on the pupil's academic attainment and/or may give rise to emotional and behavioural difficulties.

• Some pupils will require changes to buildings, furniture or equipment to permit access to classrooms. Some will need specialist teaching strategies and equipment (e.g. adapted computers) to provide access to the curriculum and some will need help for quite specific medical problems.

Page 148

(i) Specific criteria:

There must be clear recorded evidence that the pupil's medical condition does or could significantly impair his/her access to the curriculum, ability to take part in particular classroom activities or participation in aspects of school life. In addition, clear evidence of one or more of the following:

• A marked discrepancy between pupils’ attainments in core subjects of the National Curriculum and the attainments of the majority of pupils of the same age. • A marked discrepancy between the pupil's attainments in core subjects of the National Curriculum and the expectations of the pupil as assessed by his/her teachers, parents and external specialists who have observed the pupil. • Clear and substantial evidence based on specific examples, that the pupil's medical condition has given rise to significant emotional or behavioural difficulties.

• Significant and recurrent absences from school associated with the pupil's

medical condition.

(iii) Evidence· The school has:

• Drawn up, implemented, monitored and regularly reviewed individual Education Plans at Stage 2 and 3 of the Code of Practice. • Sought and acted upon advice from appropriate external specialists (e.g. specialist advisory teacher, educational psychologist, doctor). • Clarified whether an Independent health care Plan has been considered or implemented.

• Sought the views of and involved the pupil and his/her parents or carers at

each stage. The parent(s) should have had the full opportunity to be actively

involved in supporting the school staff in the implementation and evaluation

of any intervention programme.

• Taken action to make the appropriate curriculum accessible to the pupil

through differentiation, homework, resources, teaching and pastoral support.

• Explored the benefits of, and where practical secured access for the pupil, to appropriate information technology. • Taken steps to consider and meet the personal/self help requirements of the pupil within existing resources. • Considered the nature and extent of the pupil's medical condition and taken appropriate steps, within the resources of the school, to safeguard his/her health and safety. • Sought, with parental permission, the assistance and advice of the school doctor or other appropriate medical specialist. • Considered and taken steps to meet the pastoral needs of the pupil and, if necessary, sought appropriate advice/expertise to meet any social, emotional or behavioural needs.

Page 149

Code of Practice

• The Code of Practice sections 3:89 to 3:94 provide further information

4.5 Severe Communication Difficulties: Specific Language Impairment

General indicators (i.e. not criteria)

• Young children may exhibit a range of difficulties with speech and language, some of which will be long lasting and require specialist intervention at school age.

• Some children may have impaired utterance of speech sounds which render most of their speech unintelligible.

• Some children may have expressive language abilities that are so limited in grammar, word order, vocabulary and output as to prevent effective, coherent spoken communication at a level expected for their age group.

• Some children's comprehension of spoken language may be so limited that they frequently fail to understand requests, instructions and explanations that are easily understood by the great majority in their age group, although in other respects they appear to be of normal cognitive ability.

• Some children have major difficulties using language for successful communication and learning although the vocabulary and grammar of their language appears to be age appropriate. Their responses to verbal and non- verbal communication are often inappropriate.

• In some cases problems in communication may lead to emotional and social difficulties which might become more prominent, masking the special needs in communication skills.

Page 150

(i) Specific criteria:

There must be clear recorded evidence that the pupil's speech or language impairment does or could significantly Impair his/her progress in the curriculum, ability to take part in particular classroom activities or participation in aspects in school life. In addition one or more of the following:

• Expressive Language Disorders Scores from standardised assessments of expressive language are significantly below those obtained from non-verbal cognitive assessment and receptive language abilities

• Receptive-Expressive Language Disorders Receptive and expressive language abilities as assessed by appropriate standardised tests are significantly below those of non-verbal cognitive abilities.

• Phonological Disorders Failure to use developmentally expected speech sounds that are appropriate for age, including errors in sound production, use, representation and organisation.

• Clear substantial evidence based on specific examples, that the pupil's speech or language difficulties have given rise to significant social, emotional or behavioural difficulties.

(ii) Possible Additional Features

Higher order language difficulties may include severe word-finding problems, comprehension difficulties, inadequate discourse skills and possibly significant difficulties in the use and meaning of verbal and non-verbal communication.

Page 151

4.6 Severe Communication Difficulties: Autistic spectrum disorders

General indicators (i.e. not criteria)

• Children diagnosed as having an autistic spectrum disorder will usually show delay or impairment in the development of social relationships and social understanding; delay or impairment of language and social communication and have restricted imagination and symbolic play.

• Impairment in social relationships may involve impairments and inappropriate use of non-verbal communication e.g. eye gaze, lack of ability to share interests and activities with others, lack of interest or inability to develop peer relationships and general lack of emotional or social reciprocity.

• Impairment in communication may manifest as a delay in or lack of development of spoken language (without attempts to communicate using other methods of communication e.g. gesture), inability to initiate or sustain conversation with others or stereotyped and repetitive use of language.

• Lack of imagination and spontaneous make-believe or socially imitative play, appropriate to the child's developmental level.

• Restricted and repetitive patterns of thinking, behaviour, interests and activities which may include inflexible adherence to non-functional routines, stereotyped and repetitive mannerisms and persistent preoccupation with Objects or activities.

There is however a wide range of ability and functioning of children on the Autistic spectrum which affects ability to access the curriculum and need for specialist help and arrangements. A diagnosis of autism spectrum difficulties does not in itself mean that additional support is indicated.

Page 152

(i) Specific criteria for statutory assessment

• A diagnosis of autism using DSM IV criteria and where there is clear evidence that the impairments indicated are significantly restricting independent access to the school curriculum.

• A score on Child Autism Rating Scale of over 30 where there is also clear evidence that the difficulties highlighted are restricting progress and access to the school curriculum.

• Presence of at least four items from Section A of the DSM IV criteria and a score of 24- 30 on the Child Autism Rating Scale with one or more of the following additional features:

(a) Clear substantial evidence based 0n specific examples that the pupil’s autistic features have given rise to significant social, emotional or behavioural difficulties.

(b) A language delay of 12-18 months in children below Key Stage 1.

(c) Expressive and receptive language below 5th percentile.

(d) Marked impairment in the ability to sustain a conversation with others and to understand and process information in group teaching situations.

(e) Limited interest in play and learning activities except in repetitive way or child restricts him/herself to a very narrow range of activities.

(f) Inability to initiate or sustain play or learning activities independently.

(g) A significant discrepancy as to be found in only 5% of the population between language abilities and other cognitive abilities,

(h) A significant discrepancy as to be found in only 5% of the population between cognitive abilities and attainments in literacy and numeracy

In all cases there must be clear, recorded evidence that pupil's learning and communication Impairments do or could significantly impair his or her progress in the curriculum and ability to take part in particular classroom or school activities.

Page 153

(iii) Evidence – The school has:

• Drawn up, implemented, monitored and regularly reviewed Individual Plans at Stage 2 and 3 of the Code of Practice

• Sought and acted upon advice from appropriate external specialists (e.g. educational psychologist, specialist advisory teacher and speech and language therapist).

• Sought the views of and involved the pupil and his/her parents or carers at each stage. The parent(s) should have had the full opportunity to be actively involved in supporting the school staff in the implementation and evaluation of any intervention programme.

• Taken action to make the appropriate curriculum accessible to the pupil

through differentiation, homework, resources, teaching and pastoral support

• Explore the benefits of, and where practicable secured access for the pupil,

to appropriate information technology to encourage communication and self-

expression.

• Considered and taken steps to meet the pastoral needs of the pupil and, if necessary, sought appropriate advice/expertise to meet any social, emotional or behavioural needs.

Code of Practice

• The Code of Practice sections 3:86 to 3:88 provide further information.

Page 154

4.7 Visual Impairment

General indicators (i.e. not criteria)

• Visual difficulties take many forms with widely differing implications for a child's education. They range from relatively minor and remediable conditions to total blindness. Some children are born blind; others lose their sight, partially or completely, as a result of accident or illness. In some cases visual impairment is one aspect of multiple disabilities. Whatever the cause of the pupil's visual impairment, the major issue in identifying and assessing the pupil's special educational needs will relate to the degree and nature of functional vision, partial sight or blindness, and the pupil's ability to adapt socially and psychologically as well as to progress in an educational context. Pupils with significant visual impairment may have a range of specific needs including:

• Regular support and in some case daily teaching from a specialist teacher of the visually impaired in order to access the curriculum. • Safety supervision, particularly in practical lessons. • A significant modification and adaptation of normal print and other teaching materials. • A tactile modification of materials for the educational blind and Braille user. • Regular mobility training in order to be move independently and safely In their environment.

(i) Specific criteria:

There must be clear recorded evidence that the pupil's visual impairment does or could significantly impair his/her access to the curriculum, mobility, emotional or social development, ability to take part in particular classroom activities or participation in aspects of school life. In addition, there is clear evidence of one or more of the following:

• The child is registered blind/partially sighted. • The child needs to learn Braille. • The child needs modified layer print in all areas of the curriculum. • The child requires high levels of supervision to gain safe and effective access to the curriculum. • The child requires intensive mobility training. • A marked discrepancy between the pupil's attainments in core subjects of the National Curriculum and the attainments of the majority of pupils of the same age. • A marked discrepancy between the pupil's attainment in core subjects of the National Curriculum the expectations of the pupil as assessed by his/her teachers, parents and external specialists who have closely observed the pupil.

• Clear and substantial evidence based on specific examples, that the

pupil's visual impairment places the pupil under stress, with associated (iii) Evidence – The school has: withdrawn or frustrated behaviour.

Page 155

• Drawn up, implemented, monitored and regularly reviewed Individual Education Plan at Stages 2 and 3 of the Code of Practice. • Sought and acted upon advice from appropriate external specialists (e.g., Specialist advisory teacher, educational psychologist). • Sought the views of and involved the pupil and his/her parents or carers at each stage, The parent(s) should have had the full opportunity to be actively involved in supporting the school staff in the implementation and evaluation of any intervention programme,

• Taken action to make the appropriate curriculum accessible to the pupil

through differentiation, homework, resources, teaching and pastoral support.

• Explored the benefits of, and where practicable secured access for the pupil,

to appropriate information technology to aid the pupil's communication.

• Considered the nature of the pupil's visual impairment and taken steps, within the resources of the school, to safeguard his/her health and safety. • Considered and taken steps to meet the pastoral needs of the pupil and, if necessary, sought appropriate advice/expertise to meet any social, emotional or behavioural needs.

Code of Practice

• The code of Practice sections 3:82 to 3:84 provide further information

Page 156

4.8 Hearing Impairment

General indicators (i.e. not criteria)

• Intermittent and temporary hearing losses are usually caused by 'glue ear' and occur mostly in the early years. Such hearing losses fluctuate and are generally mild or moderate in degree although the effects may be exacerbated in poor acoustic environments.

• Permanent losses are usually sensori-neural and vary from mild through moderate to severe or profound. Children with severe or profound hearing loss may have sever or complex communication difficulties. An additional intermittent conductive loss can be present at any level of permanent sensori-neural loss.

• Whatever the cause of the pupil's hearing impairment, the major issue in identifying and assessing the pupil's Special Educational Need will relate to the degree and nature of functional hearing loss and the pupil's ability to adapt socially, psychologically and linguistically as well as to progress in the educational context.

• Early recognition, diagnosis, treatment, and specialist support for pupils with significant hearing difficulties are essential to prevent delays in the pupil's language acquisition, academic achievement, social and emotional development.

• Pupils with significant hearing impairment may have a range of specific needs which may include:

¾ Regular support and in some cases daily teaching from a teacher of the deaf to sustain the linguistic, communication and educational skills needed to access the curriculum. ¾ Specialist equipment to improve the acoustic environment. ¾ Speech and language therapy.

Page 157

(i) Specific Criteria

There must be clear recorded evidence that the pupil's hearing impairment does or could significantly impair his/her access to the curriculum, emotional or social development, ability to take part in particular classroom activities or participation in aspects of school life. In addition there is clear evidence of several of the following:

• The child has a history of functional severe or profound hearing loss. The child requires the support of signed communication methods. • A marked discrepancy between the pupil's attainments in core subjects of the National Curriculum and the attainments of the majority of pupils of the same age. • A marked discrepancy between the pupil's attainment in core subjects of the National Curriculum and the expectations of the pupil is assessed by his/her teacher, parents and external specialists who have closely observed the pupil. • A very large discrepancy in age level or scaled/standard deviation scores between language abilities (particularly expressive language skills) and other cognitive abilities. • Clear and substantial evidence based on specific examples, that the pupil's hearing Impairment places the pupil under stress, with associated withdrawn or frustrated behaviour.

(ii) Evidence – The school has:

• Drawn up, implemented, monitored and regularly reviewed Individual Educational Plans at Stages 2 and 3 of the Code of Practice. • Sought and acted upon advice from appropriate external specialists (e.g. specialist advisory teacher of the deaf, educational audiologist, educational psychologist). • Sought the view of and involved the pupil and his/her parents or carers at each stage. The parent(s) should have had the full opportunity to be actively involved in supporting the school and specialist staff in the Implementation and evaluation of any intervention programme.

• Taken action to make the appropriate curriculum accessible to the pupil

through differentiation, homework, resources, teaching and pastoral support.

• Explored the benefits of, and where practicable secured access for the pupil,

to appropriate information and audiological technology to aid the pupil's

communication.

• Considered the nature and extent of the pupil's hearing impairment and taken appropriate steps, within the resource of the school, to safeguard his/her health and safety. • Considered and taken steps to meet the pastoral needs of the pupil and, if necessary, sought appropriate advice/expertise to meet and social, emotional or behavioural needs.

Page 158

Code of Practice

• The Code of Practice sections 3:78 to 3:80 provide further information.

Page 159

5. Criteria for Issuing a Statement

Statutory Assessment

Has the Statutory Assessment confirmed that the pupil has significant greater difficulty in learning than the majority of children of his or her age?

YES NO

Is the school able, from the resources LEA issues Note in Lieu normally available to it, to make all of the of Statement special educational provision necessary to meet the pupil's social educational needs?

NO YES

LEA issues LEA issues

Statement of Special 'Monitoring

Educational Needs Statement of Special

(Additional LEA Educational Needs

resources allocated (No additional LEA

based upon SEN resources allocated)

Matrix of Provision)

Page 160

5.1 There are two main criteria for issuing a Statement of Special Educational Needs and Provision:

5.1.1 That the Statutory Assessment has confirmed that the pupil has significantly greater difficulties in learning than the majority of pupils of his/her age. There will .be clear evidence that the pupil has special educational needs arising from any one or a combination of the following areas:

• Significant learning difficulties • Significant impairment • Significant emotional or behavioural difficulty

5.1.2 That all of the special educational provision required to meet the pupil's special educational needs cannot reasonably be made from resources normally available to mainstream schools in the area, or;

The LEA needs to have oversight of the provision made to meet the pupil's needs.

5.1.3 The following examples incorporate guidance contained in the Code of Practice for LEAs in considering whether or not to issue a Statement.

Examples of provision which the LEA is likely to conclude that the school could reasonably be expected to make from within its own resources:

• Occasional advice to the school from external specialists. • Occasional support with personal care from a non-teaching assistant. • Access to a particular piece of equipment such as a portable word-processing device, an electronic keyboard or tape recorder, or • Minor building alterations such as widening a doorway or improving the acoustic environment.

Examples of provision needed for pupils with significant learning difficulties that would suggest that the LEA should consider identifying formally in a Statement:

• Regular direct teaching by a specialist teacher. • A significant piece of equipment such as a closed circuit television. • A major building adaptation such as the installation of a lift. • The regular involvement of non-educational agencies placement in a special school or special unit.

Page 161

6. Criteria for Ceasing to Maintain a Statement

3.4.1 A statement will remain in force until the LEA ceases to maintain it or until the child is no longer the responsibility of the LEA, for example if he or she moves into the further or higher education sector or to Social Services provision.

3.4.2 The decision to cease to maintain a Statement will only be made following careful consideration of all the circumstances and after close consultation with the parents.

3.4.3 The key criteria will be that:

• The pupil's future needs can be met within the resources available to the school without the need for continuing LEA oversight. An example would be where resources are devolved to the school to meet the needs of the identified pupil through the annual SEN audit.

• Recent reviews of the pupil's progress have demonstrated that the objectives of the Statement have been achieved.

• Recent reviews have demonstrated that the child's attainments have risen above the LEA's specific criteria for initiating a formal assessment.

• There is no evidence to indicate that the pupil's further progress will be halted or reversed if the special educational provision specified in the Statement were not continued.

Page 162

Criteria for statutory assessment of children under compulsory school age and over two

4:41 In deciding whether a statutory assessment is necessary for a child over two but under compulsory school age, where the child is attending an early education setting, the LEA should ask the following questions:

a) What difficulties have been identified by the setting? Have the practitioners provided individualised strategies through Early Years Action Plus to assist the child?

b) Has outside advice been sought, regarding the child’s:

• Physical health and functioning • Communication skills • Perception and motor skills • Self-help skills • Social skills • Emotional and behavioural development • Responses to learning experiences • Have parental views been considered?

4:42 Where a child is not attending an early education setting the LEA should try to collect as much information as possible before deciding whether to assess.

4:43 The LEA will then assess the evidence and decide whether the child's difficulties or developmental delays are likely to be addressed only through a statement of special educational needs. Where a child's educational needs appear to be sufficiently severe or complex as to require attention for much of the child's school life, or that the evidence points to the need for specialist early intervention that cannot be provided in the current setting, the LEA is likely to conclude that an assessment is necessary.

Page 163

LDD Needs analysis: Addendum to the report by NHS Sheffield November 2009

Introduction

1. The Consultancy Company were asked to complete an independent report providing a need analysis for children with Learning Difficulties and Disabilities (LDD). This was duly delivered in July 2009.

2. Following receipt and discussion with key stakeholders and partner organisations, NHS Sheffield wanted to take the opportunity to explore and question some aspects of the report. This should not be taken as a criticism of the report in any way. The sole purpose was to ensure that the maximum value was extracted from the excellent work done.

3. This addendum provides a written statement of that further questioning with the Consultancy Company. These are noted below in the form of key points.

Key points

4. Throughout the report there are a number of statements which fall into one of three categories:

 Recommendations  Conclusions  Observations

5. Sheffield wanted to be clear about these and explore the basis of the relevant statements. A tabulation was prepared highlighting these points in the report with agreement from the Consultancy Company so that they can be considered in more detail by NHS Sheffield (and partners) in the future for follow up and action. The results are shown in Appendix 1 to this addendum.

6. One question is the degree to which Sheffield is comparable to other localities with similar demographics. In particular, it was noted that the growth rate for ASD in Sheffield was much higher than the national average, although there is some suggestion that the rate of growth is now slowing somewhat. There may also be other factors influencing these statistics such as the approaches to the diagnosing and recording of LDD which may also have an impact on Sheffield’s prevalence rates.

7. There is census based data on LDD broken down by local authority area. It was agreed that the Consultancy Company would provide relevant sources of information for Sheffield to explore benchmarking with other localities in more detail should it choose to do so.

8. It was noted within the report by the Consultancy Company that the prevalence of LDD was higher amongst males than females in Sheffield. The Consultancy Company has since provided references to sources of national statistics showing that it was generally true that males had a higher incidence of LDD issues. The causes of this imbalance need further investigation before an inequality can be identified.

9. The report highlights a link between deprivation and the prevalence of LDD conditions and this therefore highlights another possible area for further research in efforts to reduce inequalities.

10. The report made use of Service Districts as a way of defining geographical areas. Until very recently, these were used by the Council to provide a basis for planning services and analysing need. It should be noted that this was accurate and correct at the writing of the report but that a new structure of Community Assemblies is now in place. Appendix 2 of this addendum shows how the boundaries of the Service Districts and the new Community Assemblies are broadly similar. This is important to note, and therefore inequalities highlighted in the Needs Analysis relating to the distribution of LDD across Service Districts is still applicable to the new Community Assembly boundaries to a large degree.

11. It was noted that there are more up to date IMD ratings than 2004 and IS/HB statistics than 2005. However, the basis of these statistics was different from previous years and therefore made mapping changes impossible. It is for this reason that earlier years statistics were used to draw conclusions.

12. The report notes the preparation of a business case for additional permanent Helena nurses (Page 60 paragraph 8.11). It should be noted that this proposal was not made by NHS Sheffield, but from a provider organisation.

13. The report suggests that there ought to be closer integration with the third sector in Sheffield’s strategy for meeting LDD needs. It was agreed that this will now be taken as a clear recommendation arising from the report.

14. Linked to this last point was the view that whilst the report highlighted a number of issues relating to individual services e.g. capacity, by and large these were the views of providers and parent/carers. Sheffield has limited information by which to judge whether these views are correct or appropriate. A logical conclusion must be to strengthen the monitoring and review processes to assess the performance of service providers in its broadest sense.

Conclusion

15. Overall, the report was judged to be a good piece of work that gives good insight into the LDD needs of children and young people in Sheffield. Any report of this nature will inevitably raise further questions and issues to be explored and it is now for Sheffield partner organizations and structures to decide how best to address these

Further information

For further information about the LDD Needs Analysis or this addendum please contact:

NHS Sheffield 722 Prince of Wale Road Darnall Sheffield S9 4EU

Tel. 01143051000 Appendix 1 – Analysis of key points arising from the report

Definition of population

Paragraph Statement Observation, Comment Recommendation or conclusion Page 7 The lack of a single consolidated dataset covering all Recommendation Current datasets found to paragraph children with LDD in the city is one that Sheffield needs to be inadequate particularly 3.10 address for years 0-5 and 16+ Page 9 The districts with the highest index of multiple deprivations Observation Based on district derived paragraph and for health, education, and percentages on income data 3.17 support and housing benefit also had the highest incidence of children with LDD. Page Districts with the highest distribution of children from the Observation Based on district derived 9paragraph BME community had the highest incidence of children with data 3.18 LDD

External research

Paragraph Statement Observation, Comment Recommendation or conclusion Page 20 Services such as the Ryegate House Centre and the Helena Observation Derived from referenced paragraph 4.4 specialist nursing team make an important contribution to document and observation of providing “practical, flexible help and a break from the service provided physical and emotional demands of caring for their child.” Page 20 Sheffield has shown progress in engaging with parent/carers Observation Although evidence based paragraph 4.7 and service users but this must be regarded as “embryonic”. (see section 6) there is no recommendation as to how this should be done Paragraph Statement Observation, Comment Recommendation or conclusion Page 21 Strategic engagement of partners, in particular, the third Observation A reasonable deduction given paragraph 4.9 sector will significantly enhance the ability of Sheffield to the contribution of the third meet the needs of a growing population sector to service provision and increasing demands for LDD related support. However, there is no indication as to how this should be done. Page 21 There is a need to go beyond simply setting services up and Observation Reasonable deduction from paragraph letting people use them. Other factors come into play – feedback 4.11 transport, specialist care support, special equipment Page 21 Special measures are needed for particular communities Observation Given the higher incidence of paragraph and there is a need for a proactive approach required to LDD amongst certain 4.13 ensure that they are engaged. communities and other barriers to engagement then this is a reasonable deduction Page 22 Supporters working with children with ASD should receive Observation Reasonable deduction paragraph training in ASD as well as gaining a detailed understanding 4.16 of the child through working in partnership with their parents, school and other agencies. Page 22 A number of good practice examples of how to organize Observation Good practice examples need paragraph multi-agency teams are given in the appendix to ensure to be examined to establish 4.19 successful transition from child to adult services what approach is suitable for Sheffield Page 23 The Governments vision for children’s palliative care is set Observation The fact that the vision exists paragraph out in a document called “Better Care: Better Lives”. is recorded but there is no 4.22 recommendation to carry out an assessment of current services against this vision.

Map current services

Paragraph Statement Observation, Comment Recommendation or conclusion Page 24 It is recommended that Sheffield should consider how best Recommendation How this is to be achieved paragraph 5.3 to engage with, and deploy, services from other sectors as is not stated but the part of the overall portfolio for the City (with particular implication is that Sheffield reference to the third sector). should adopt this principle and find its own path to achieving it. Page 24 The service map for 16-19 age group is less well populated Conclusion If there are fewer services paragraph 5.6 and there is a concern that children moving from the school available for this age system see a reduction in services available to them. group, and presumably the Particular attention needs to taken to ensure that there are numbers of children in this adequate services to support this sector. age group has not fallen greatly through mortality, then this is a reasonable conclusion to arrive at. Page 34 Parent/Carer/Family information support is generally good Observation Result of service mapping Paragraph 6.6 but the level of engagement is still developing Page 35 para The level of engagement with parents/carers is still Conclusion Result of service mapping, 6.6 developing. Time, effort and mutual confidence building are stakeholder feedback and required to develop this aspect of the Needs Framework to external research where it needs to be. Page 35 para There are currently no vehicles for the children themselves to Recommendation Result of service mapping, 6.7 provide their own input. Consideration should be given to stakeholder feedback and models such as the City Equals initiative at Sunderland. external research

Predict future needs

Paragraph Statement Observation, Comment Recommendation or conclusion Page 36 The difference between the annual growth rate for BESD in Observation Self evident and raises an paragraph 7.6 Sheffield (1.8%) and nationally (5.2%) could be considered issue for further inquiry. – 7.9 to be surprising. At the same time, the growth rate for ASD is much higher than the national average of 6.5%. It may be that improved diagnosis for ASD means that some children previously categorized as having BESD are now categorized as ASD instead. Page 36 Sheffield runs counter to the national trend in the area of Observation Evidenced in the statistics paragraph SLD which is growing significantly in Sheffield but falling and may require further 7.10 nationally. analysis.

Service Districts - All observations

Ethnicity – All observations

Primary Needs

Paragraph Statement Observation, Comment Recommendation or conclusion ASD Growth rates have been higher than the national average Recommendation Statistical anomaly needs but are now leveling off. This should be reviewed after the to be investigated further 2009 statistics are available BESD Growth rate is substantially lower than the national average Observation Supported by statistical for most groups except for children from a Somali observation background. Sensory Growth rates for sensory impairment are similar to those in Observation Supported by statistical impairment the national population with HI slightly higher and VI slightly observation. lower. Learning Growth rates exceed national rates. There are relatively Observation Supported by statistical difficulties high growth rates for PMLD and SLD in the Pakistani observation. community Physical Instances and growth rates are low nationally and in Observation Supported by statistical disabilities Sheffield. However, Sheffield’s rate is higher than national observation. rates. Relatively low numbers suggest that differences between service districts are not significant. Speech, Fastest growth nationally and in Sheffield. Sheffield higher Observation Supported by statistical language or than the growth rate. Growth rates higher for some ethnic observation. communications groups (mixed white Caribbean , Somali, Yemini and other difficulties ethnic groups).

Population projections

Paragraph Statement Observation, Comment Recommendation or conclusion Page 54 Between 2008-2012, the average annual growth rate of Observation Supported by statistical paragraph 7.32 6.3% can be expected. Rates for the BME population observation exceeding that of the White British population. Page 54 Between 2008-2012, for children between 17-19 the LDD Observation Supported by statistical paragraph 7.35 population is expected to increase by 37.7%. observation

Stakeholder analysis – Capacity issues

Paragraph Statement Observation, Comment Recommendation or conclusion Page 58 All services are operating at capacity and this is particularly Observation From feedback interviews paragraph 8.5 acute for assessment clinics and ongoing therapy services Page 59 Estimates of the capacity shortfall vary. It is suggested that Recommendation From feedback interviews paragraph 8.7 capacity in terms of medical and therapy staff needs to increase by a third. Page Given the growth rate for children with ASD and SLCN the Observation From feedback interviews 59paragraph pressure on already overstretched SLT resources will be with no empirical evidence 8.8 particularly acute. provided. Page 59 The Dual Diagnosis service for children with LDD and Observation From feedback interviews paragraph 8.8 mental health problems is also failing to meet outcome with no empirical evidence targets as a result of capacity constraints provided

Specialist Nursing Support

Paragraph Statement Observation, Comment Recommendation or conclusion Page 59 Specialist nursing support in a community setting would Recommendation Empirical evidence not paragraph 8.10 improve the quality of service, the life style of parents. provided but conclusion Carers and demands on therapists particularly OTs. derived from feedback interviews Page 60 The Helena specialist nursing team provides a valuable Observation Not clear who is preparing paragraph 8.11 service. Increasing the number of permanent staff would the business case which reduce reliance on overtime and agency nurses as well as would provide support to a reduction in hospital based care. A business case for 8 the observation. additional nurses is under consideration.

Specialist equipment

Paragraph Statement Observation, Comment Recommendation or conclusion Page 60 Access to and ongoing support of specialist equipment Conclusion Derived from observation Paragraph 8.12 other than wheelchairs, specialist seating & orthotics lacks that responsibility and focus and coordination. control over procurement is not located in one place or with one team. Page 60 The training of staff and , in turn, parents/carers is also an Observation No evidence is presented Paragraph 8.12 area of vulnerability and liability. other than that gained from interviews.

Service mix

Paragraph Statement Observation, Comment Recommendation or conclusion Page 60 There is a case for reviewing the earlier use of intrathecal Recommendation Empirical evidence not paragraph 8.13 baclofen treatment for children with spasicity or dystonia. provided but conclusion This would reducte care requirements and potential need derived from feedback for surgical intervention later in life. interviews Page 60 Plans are being considered to allow cochlea implants to be Observation Not clear who is doing the paragraph 8.14 carried out in Sheffield rather than elsewhere as at present. consideration. Page 60 Consideration should be given to the development of a Recommendation If children with LDD often paragraph 8.15 community paediatric dietician capability. have dietary issues then this is a logical recommendation.

Transition

Paragraph Statement Observation, Comment Recommendation or conclusion Page 61 Options for ongoing support, if appropriate, for the 17-19 Recommendation Recommendation for paragraph 8.16 years age group should be reviewed. further work based on observation although no empirical evidence provided.

Practical issues

Paragraph Statement Observation, Comment Recommendation or conclusion Page 61 Transportation and parking issues are an inhibitor to Recommendation Based on observation paragraph 8.17 patients wishing to access services. Consideration should reported through be given of funds to support families with reduced means. stakeholder interviews. Page 61 A number of services reported difficulties in getting user Observation No evidence is presented paragraph 8.18 feedback to assist them in ensuring that needs are being other than that gained addressed appropriately. from interviews.

Appendix 2 – Service District and Community Assembly Boundaries