MAGAZINE February 2003

ISSN 1366-0799

Multi-agencyMulti-agency workingworking

availableavailable toto membersmembers onlyonly From your editor This was going to be the most efficiently prepared Magazine as I planned to have a real break at Christmas. Well I didn't get the break as everything seemed to slow down during December and ground to a halt just before the Christmas holiday. Some articles and items just were not available to 'drop' into the publishing programme until the very last minute ie in January. The knock-on effect of the delays has been to miss all sorts of deadlines added to which, at the proofing stage of the magazine, my laptop and the proof of this magazine were stolen from my car - so Sharon Pointeer’s article on her ICT Newspage is particularly apt. So if your Magazine is a little later than usual - I am sorry. Maybe changing the publication dates was not such a good idea after all! Certainly this will be reviewed for the coming year.

There are exciting plans afoot to publish the Audiology Updates as a pack; produce a CD ROM of the Magazines 2000-2002 so that you will be able to print off pages (in colour) to laminate and use as resources; and the new Language of Examinations booklet has reached the publication stage. With a fair wind it is possible that the new items will be available by early during the summer term. The Magazine CD (£25.00) should be available by the AGM in Edinburgh…. Ann Magazine editor CONTENTS ADPS - achievements of deaf pupils in Scotland ...... 27 Articles Multi-xxxx - What do we mean? ...... 2 : www.BATOD.org.uk Multi-agency working ...... 4 web site The Early Support Pilot Programme...... 6 Our e-mail addresses are easy to remember. Vibrations ...... 7 They all end @BATOD.org.uk So the Magazine will be: Multi-agency work in the residential special school ...... 8 Working collaboratively in Scotland ...... 10 [email protected] SEN regional partnerships - where are they now?...... 12 (check your spelling so you don’t fall into the black hole!) SEN regional partnerships: contact details ...... 14

Phoning 01964 544243 Anything to learn from a cochlear implant team? ...... 15 BATOD Magazine, Publications & Advertising? Synchronise the singing and dancing ...... 18 ....PLEASE SPEAK Regular items (don’t sigh and hang up!) DCCAP - what equipment? ...... 24 if no-one makes it to the phone to respond Noticeboard ...... 31 LEAVE A MESSAGE ICT Newspage - watch out there is a thief about! ...... 32 or send a fax Let’s Sign - resource review ...... 35 or even e-mail Abbreviations in this issue ...... 36 [email protected] Visit our web pages www.BATOD.org.uk BBC resources for deaf children ...... 37 This and That ...... 50 Need to contact BATOD? talk to General information BATOD Secretary Paul Simpson Audit of services for HI children in Wales ...... 21 e-mail: [email protected] Time for standards - reforming the school workforce ...... 23 answerphone/fax 01494 464190 Red Nose Day ...... 52

NEC committees working for you Upper pay spine ...... 36 Association Business: BATOD CPD log evaluation ...... 38 Minutes of NEC Meeting 21 September 2002 centre pages Committee work ...... 39 Presidential View from the front ...... 1 Professional training issues ...... 40 What went on at NEC 7 December 2002 ...... 2 FEAPDA - council report ...... 42 Representing you ...... 20 Data collection by the DfES ...... 43 Election Nominees ...... 22 ToD - e-mail list ...... 43 BATOD UK ...... 48 NCPA report ...... 44 BATOD Wales report ...... 21 NDCS Hearing Services Working Group ...... 44 Subscription rates 2002-3 ...... 55 NHSP Executive meeting ...... 46 I’ve moved... notification form ...... 55 NHSP Education Meeting ...... 47 Advertising rates ...... 53 Calendar - Meetings to know about ...... 56 Obituary Just to remind you - the term ‘deaf’ is used throughout this Professor Orin Cornett ...... 53 Magazine to cover the full range of hearing loss. Tom McClaren MBE ...... 54

Cover picture BATOD UK BATOD works with many agencies throughout the UK representing all Teachers of the Deaf. The map shows the approximate areas covered by the committees although members may elect to which area they belong. The outline of the map is from EnchantedLearning.com but the region outlines and colour changes are editorial. View from the front.... A couple of years ago sidelined as difficult, expensive or some other BATOD celebrated its excuse will be used. The challenge which now silver jubilee. We marked faces us is how to retain our specialism, credibility the event by looking back and identity as a profession, whilst adapting some of at changes that had taken the aspects of our traditional role, to respond to the place in 25 years and new demands being made of us. those changes have continued into the 21st Having set ourselves the goal of 'Excellence in Deaf century. The landscape of Education' BATOD, as an association, must also deaf education is now face the challenge of change. With the help of very different and the Trevor Harrison, a consultant in financial planning profession is evolving to reflect changing needs. In we are being encouraged to examine both what we many ways we have been pioneers of an education do and the way we do it. Trevor has highlighted the system that is only now fully endorsing the notion of fact that BATOD works almost exclusively for the inclusion. For deaf children the advancement of good of the public as a whole and there is little or no hearing aids, the introduction of FM systems, our material benefit to members individually (despite the improved understanding of language development huge amount of 'professional' advice to our and the advent of cochlear implants have all membership!!). One possible outcome therefore, increased our expectations of educational and maybe an application for charitable status which lifestyle outcomes. This has been supported and could have a number of important implications for encouraged by Teachers of the Deaf who have us. It could extend our funding routes and thereby moved as a consequence to develop methods of allow us to better capitalise on volunteers' time, working which have promoted these outcomes. experience and enthusiasm and so allow us to be more creative in the pursuit of our goal. Now we are finding that the goalposts are moving again. Identification of deafness at or near birth, Change brings with it both threats and opportunities digital hearing aids and early cochlear implantation and I believe that BATOD can indeed evolve through will all combine in the inclusion climate to foster a metamorphosis towards being a relevant butterfly generation of deaf children who are seamlessly rather than disappearing slowly as a redundant integrated into their families and local communities. dinosaur. Utopia? Well maybe but for many children this is already a reality and the support they need from specialist teachers and support assistants is being David questioned and we may well be faced with increasingly having to defend our role. a growing European organisation for Teachers of the Deaf I am the first to argue that the body of knowledge and combined wealth of experience is essential to BATOD’s rôle:  biggest member of the federation ensure that deaf children and their families continue  BATOD Secretary Paul Simpson now Vice to access the education system in an optimal way. President We must, however, be clear that it is unlikely that we  BATOD to host 2003 Congress - prestige for will be able to continue exactly as we have in the BATOD and UK  all members of BATOD may attend past. The drive to include all children in the mainstream process will eventually mean that Will you be at FEAPDA Congress 2003? schools will be expected to embrace a whole range 30 October: delegates arrive 31 Oct - 1 Nov: congress of specialist teachers all needing to peddle their 02 November: cultural activities particular wares. If we appear too intransigent to change we will be viewed as 'precious' and be

©BATOD Magazine February 03 1 What went on at NEC on 07 December 2002 report by Alison Weaver David opened the meeting by welcoming Moira One criterion for approval for charitable status is that Philip the new representative from Scotland and an organisation should exist for general benefit. As Chris Payton, representing the North Region. membership of BATOD provides no material benefit to teachers and the work of the association is also Paul Simpson had recently received a letter from the of benefit to children and families, BATOD should be Head of Service for Lincolnshire, expressing his able to demonstrate eligibility. One important benefit concern that the minutes of the NEC meeting of of charitable status is that this would give the March 2002 published in the October magazine had organisation access to additional funding streams given the incorrect impression that Lincolnshire was that we are not currently able to apply for. now a fully delegated service. Paul has written to If discussions between advisors and NEC support apologise for this error and an apology will appear in the suggestion to pursue charitable status, this the magazine. proposal will be put to members at an AGM.

BATOD was again represented at the latest meeting Paul Simpson, Ted Moore and Carole Torrance met convened by the BSA, to pursue the discussions re recently with Ann Gross at the DfES, to look the forming of an umbrella organisation, which could specifically at training issues for Teachers of the represent the interests of all the key organisations in Deaf. The DfES were receptive to the concerns the field of audiology. The main outcome of this raised and suggested that BATOD take a number of latest meeting was the agreement of a statement of further actions before returning to the DfES to intent and that an executive officer should be continue the discussions. (A report of the meeting appointed to oversee the day to day running of the may be found on page 30) organisation, supported by a steering group and council. BATOD again raised the issue of the extension of the mandatory requirement for the additional An ambitious timeline has been proposed in that it is qualification for Teachers of the Deaf. At present hoped to address all the issues pertinent to setting the qualification is mandatory for teachers working up the organisation in time for an EGM in April. in schools and units but not for teachers in support One of the main issues is funding. It has been services. Currently, the legal advice to the DfES is suggested that treasurers of each organisation that the mandatory requirement cannot be extended involved meet to consider a way forward. NEC to services because the regulations only apply to agreed that BATOD could not afford to put a schools. However, the DfES will write a letter to substantial amount of funding into an umbrella heads of services to stress that they encourage the organisation. appointment of qualified Teachers of the Deaf to these posts. The new BATOD survey will go to schools and services in England, Wales and Northern Ireland in VIEW, the organisation for teachers of the Visually January. Responses to the survey will be collated Impaired, is keen to develop links with BATOD. and analysed, so that trends and important items Members of both BATOD and VIEW face many are identified and fed back to members. Carole similar issues and there are strong arguments for Torrance has established a link with Eirlys Lamb, the associations to work together over areas of who is compiling a survey on provision for deaf common concern. It is hoped that Rory Cobb, the children on behalf of the Welsh assembly to see chair of VIEW, will meet with members of the how we may work together in the future. steering group in the new year to consider in which ways the two organisations can work together. Trevor Harrison, financial consultant, continues to advise NEC on how the association may be run on a From feedback from members in England and more secure financial basis. He has suggested that Wales, it became clear that there is considerable BATOD enquires about becoming a registered variation from LEA to LEA in the way that schools charity. In order to pursue this proposal further, and services are addressing the payment of the Trevor and Brian Archbold have been invited to second point on the upper pay spine. A number of attend the next steering group meeting. As the chief teachers have already received additional payments, executive of the Ear Foundation, Brian can advise while others are still awaiting the outcome of LEA the group on the implications for the association of deliberations. Updated information about teachers charitable status. pay and conditions and threshold payments may be found on the BATOD website.

2 ©BATOD Magazine February 03 Those teachers becoming eligible to apply for the The groups discussed a range of issues, including: first threshold payment should be aware that the  representation application process is now much more rigorous.  format of NEC meetings, Teachers are advised to build up a comprehensive  role and organisation of the committees portfolio of evidence to demonstrate that they have  fundraising met the criteria. Outcomes of the discussions, recorded in each group, will be collated and taken to steering group Paul Simpson will gather information from schools for further consideration. and services (including through the use of the The next meeting of the NEC will take place in Heads of service e-mail forum) about how Teachers Edinburgh, following the National Conference and of the Deaf have fared in the process and feed back AGM, on Sunday 16 March 2003. outcomes. There will be more information in the April magazine. An Apology

Paul Simpson and Peter Annear attended the six The National Executive Council would like to monthly meeting of the Council of FEAPDA. At the apologise for any distress caused to the Lincolnshire meeting, Paul was elected President designate of Sensory Impaired Service. An error occurred in the the organisation. He will take up this post following minutes decision recorded in item 8Aiiia of the NEC the Congress in Cardiff in November 2003. BATOD Meeting 17 March 2002. The County involved members are encouraged to attend this congress, should have been Lancashire. Thanks to Asoka Moodley for drawing this to NEC's attention. which will look at issues of challenging behaviour bullet point of 8Aiiia from deaf children and young people.  Lancashire, where all money for SEN has been In September Paul wrote to the DfES expressing devolved to schools even if there are no deaf pupils on role. This has resulted in the loss of BATOD's concerns about arrangements for pupils four ToD and three VI posts and left insufficient with special educational needs at City Academies. Teachers of the Deaf to provide for early years. Paul has received a reply from the DfES, (Early years and post-16 support are threatened acknowledging the concerns and describing their wherever funding is devolved or delegated); expectations for SEN provision within these schools. Decision: Secretary to ask Northamptonshire A copy of the letter may be found on the BATOD and Lincolnshire Lancashire what the website and his further reply. long-term effects of delegation have been and how support is provided for The afternoon session was devoted to discussions early years and post-16. in groups re the current format and constitution of NEC. Multi-agency, multi-disciplinary, multi-professional, inter-disciplinary, inter-professional What does each imply? Which term is most readily understood and which best describes teamwork? Team working may be defined in different ways:  individuals working separately, often on differing sites, sharing written reports and meetings;  individuals working alongside one another, with informal meetings;  individuals delivering shared care to children and their families, with an integrated approach, shared reports and integrated planning and decision making. The aim of team working is to provide:  seamless care for children and their families;  consistent care and planning;  shared decision-making informed by different perspectives to ensure that the child and family have been considered in a holistic way.

Extract from 'The experience of multi-agency working in a cochlear implant team', by Sue Archbold, M Phil, Co-ordinator, Nottingham Paediatric Cochlear Implant Programme, published on the Deafness at Birth website.

Articles in this issue examine various aspects of teamwork in deaf education. There exists a huge resource of articles at the www.deafnessatbirth.org.uk website that extend the field of this Magazine and which you will find valuable if you wish to extend your reading.

©BATOD Magazine February 03 3 Multi-agency working Alex Kirwan SEN Division Department for Education and Skills

Following the publication of the Audit Commission standards and interventions which they are report ‘SEN: A Mainstream Issue’, DfES Minister for producing recognise the particular needs of SEN Baroness Cathy Ashton recently announced disabled children. that the Government would be putting together a The EWG has set up seven task groups to address new programme of action, for publication in the specific issues identified as central to services for Spring or Summer of 2003, setting out the vision disabled children and their families: and objectives for Government policies on SEN,  early diagnosis and intervention; supported by practical action on delivery.  family support, equipment and housing; One of the key themes of this programme will be  therapy services; multi-agency working. This article attempts briefly to  transition services; describe some of the key developments around that  participation; and theme.  children with complex health care needs.

National Service Framework for Children Overarching themes that have emerged to date are: One of the most important elements of the a inclusion: disabled children should be supported Government's increasing focus on multi-agency to participate in mainstream and community working in this area is the Department of Health-led services so that they have the same National Service Framework (NSF) for Children. opportunities and experiences as their non- NSFs are designed to: disabled peers;  set national standards and define service b partnership and participation: disabled children models for a defined service or care group; and their families should be actively involved in  put in place strategies to support and consulted about both their own individual implementation; care and the planning and development of  establish performance milestones against which services that affect them; progress within an agreed time-scale will be c co-ordinated multi-agency services: families measured; and should receive support through co-ordinated  form one of a range of measures to raise quality multi-agency services; and decrease variations in service. d early identification, diagnosis and assessment: multi-agency and multi-disciplinary assessment The rolling programme of NSFs was launched in processes should provide early identification of April 1998 and has so far covered areas such as impairments and any additional needs; mental health, coronary heart disease, cancer and e early intervention: families of disabled children older people. The Children's NSF is due to be should receive effective early intervention, published at the end of 2003. including timely therapy services and the The Children's NSF has a number of strands, provision of suitable equipment; and including one on disabled children. The Disabled f transition services: high quality transition services Children's External Working Group (EWG) is chaired should be delivered in a multi-agency context. by Francine Bates, Chief Executive of Contact a Further details of the work of the disabled children's Family. Its members include parents, managers and EWG can be found on the website front line staff from the health, social care and www.doh.gov.uk/nsf/children/externalwgdisabled.htm education sectors, key voluntary organisations and researchers. Children's Trusts and Green Paper on Children at Risk Another key element in the Government's strategy The EWG has set as its overall aim and objective for developing multi-agency support for children with recommending standards and interventions that will: SEN and disabilities is the development of ‘ensure that disabled children enjoy the highest Children's Trusts (CT). Children's Trusts pilots were quality of life possible, that they gain maximum life announced in the Summer, following the chance benefits from educational opportunities, Government's cross cutting review of children at health care and social care and that their and their risk, which recommended a three-pronged approach families' needs are promptly and sensitively to helping 'at risk' children and their families: addressed and their choices respected’.  strengthening existing local partnerships and The EWG is also working with the other EWGs piloting new ‘children's trust’ models for looking at specific services to ensure that the integrated services;

4 ©BATOD Magazine February 03  a better focus for mainstream services for outcomes for children and young people at risk of children and young people, to ensure they social exclusion. It should underpin improved co- respond better to those most in need; and ordination of services and an increased focus on  early identification of need to ensure prevention. This is a cross cutting agenda and it will preventative services are available before be important for education, health and social care children and their families hit crisis. agencies to be fully involved in the process of agreeing and implementing a local preventative Children's Trusts are a proposed new organisational strategy. model within a local authority framework, intended to integrate children's services better. They will be The interim guidance sets out principles for piloted from March 2003 and will include at least developing a local preventative strategy, areas in some of social care, health and education services - which early progress is likely to be important and to ensure better outcomes for children. Children's links with other service developments. It has been Trusts are a voluntary opportunity to enable local developed in consultation with a group of local partners to use existing legislation (section 31 of the stakeholders. The Government is keen to continue Health Act 1999) to plan, commission, finance and this dialogue and invites comments on the interim (where appropriate) deliver services jointly. The guidance. Government wants to test various approaches to The interim guidance, together with a covering letter combining services. from John Denham, is on the Children and Young The coverage of Children's Trusts and the focus of People's Unit website: www.cypu.gov.uk their work will be determined locally, although they The Regional SEN Partnerships must include as a minimum some of each of the The final element of the Government's strategy for following: education, social care and health services. multi-agency working on SEN and disability issues is Children's Trusts may wish to focus on a specific the network of eleven Regional SEN Partnerships. cohort of children such as disabled children and Lindsey Rousseau's article on the Partnerships in those with special educational needs; child and relation to hearing impairment in this edition of adolescent mental health services; early years; or BATOD magazine offers a good example of how other areas where the three statutory services need they can link up agencies in order to deliver better to work together. The Government would like at services for children and parents. least one of the pilots to involve a Connexions partnership and expects others to involve It is clear from the recent evaluation of the federations or other groups of schools. Some areas Partnerships by Manchester University that they are will use this as an opportunity to build on characterised by genuine collaboration between partnership working that is already well-developed. colleagues from LEAs, SSDs, health and the Others may be starting from a lower base. voluntary and independent sectors. As well as collaboration, they are about maximising resources The Government's forthcoming Green Paper on and skills, about working and thinking in new and Children at Risk will also look into multi-agency different ways and about inclusion. Piloted in 1999 working and its role in meeting the needs of children and established nationally since 2000, there are now at risk both now and in the future. eleven regions in England at the cutting edge of Local Preventative Strategies developments in SEN and inclusion. In September, John Denham, the Minister for Children and Young People, announced that the SEN Update Government was asking Chief Executives of all Finally, a brief word about SEN Update. This is a upper tier and unitary local authorities to take the termly newsletter which reports on key lead, on behalf of their councils, in ensuring all developments in special educational needs. those responsible for planning, commissioning and Readers should be aware that the newsletter is no delivering services to children and young people longer sent automatically to schools. However, it is come together to agree a co-ordinated local available on subscription (free). To receive a regular preventative strategy from April 2003. electronic copy, please subscribe to: www.dfes.gov.uk/sen. Alternatively, to receive a Interim guidance has now been issued to assist termly paper copy, please subscribe by writing to: local agencies in their development of a local DfES SEN Subscription, PO Box 99, Sudbury, preventative strategy. The development of such a Suffolk, CO10 2SN, or strategy will provide an important new mechanism e-mail: [email protected]. The next edition for agencies to work together to achieve better (SEN Update 11) will be available in March.

©BATOD Magazine February 03 5 The Early Support Pilot Programme - co-ordinating multi-agency support Jane Frew Education Action Team Officer RNID

The Early Support Pilot Programme (ESPP) is a and cost effectively as possible. To find this national initiative funded by the DfES to identify and information, go to www.deafnessatbirth.org.uk and develop good service provision for disabled children click on the 'Government initiatives' button. under two and their families. The programme was Progress reports will be posted up when they announced in May 2002 and is linked to the issue of become available. There is also a section called guidance by the DfES and the Department of Health 'Good stories to tell' which contains brief reports of to support service development for this population. emerging good practice and models of working These are: which may interest practitioners.  together from the start: practical guidance for professionals working with disabled children All the ESPP funded activity will provide the material to develop some practical tools for agencies (birth to two) and their families throughout the country including:  early intervention/support services for deaf  a toolkit to support professionals developing children and their families (published in multi-agency, family-focused services to families conjunction with RNID).  a complementary parents’ toolkit to inform and ESPP is working closely with the Newborn Hearing support families (the National Deaf Children's Screening Programme (NHSP) and is using the Society are project managing the first phase to emphasis on very early identification of deafness as develop a resource for the families of deaf a launch pad to explore how education services, children) working in partnership with other agencies, can build  an audit tool to enable services to check the on existing good practice for deaf and other standard of their provision disability populations. The aim is to improve the  a national monitoring protocol to measure the services for families with very young disabled children ensuring they receive well co-ordinated, very early development of deaf children. multi-agency and family focused services. The website also contains a news and events Co-ordinating multi-agency support, therefore, is one section. Keep an eye on this if you want to know of the areas of service development activity and more about the future of the programme - exciting there are several projects which have been funded news is expected in the New Year. including:  development of better multi-agency co- ordination and support for families by developing deafness@birthto2 a protocol for sharing information  sharing information  keyworker systems  protocols and structures One at a time  family support plans BATOD has no group membership  family held records but there are Special Interest Groups  centre-based multi-agency support and to keep you in touch with colleagues information. working in the same areas. JOIN BATOD Information and news about ESPP-funded activity is being hosted on the ‘deafnessatbirth’ web site to JOIN A SIG make on-line support for ESPP available as quickly

6 ©BATOD Magazine February 03 VIBRATIONS Pauline Cobbold, Advisory Teacher for Hearing Impaired Children

A Swindon Support Group for pre-school deaf and provided by the representative from Social Services hearing children, their parents and carers was on the Sub-Inclusive Group. established in the summer of 2002 in response to the needs of a small group of families on my Six months on we have met some of our targets. A caseload, all of whom had profoundly deaf children. wonderful worker from Social Services joins us for One of the mothers had contacts with a local church each session and plays with the children, leaving the that agreed to let us use their church hall at a very parents free to discuss experiences and exchange reasonable rate. This was centrally located in the ideas. The specialist speech and language therapist old part of the town. The hall had kitchen facilities for deaf children usually manages to pop in for part and there was also the offer of the use of the toys of the two-hour session. from the church playgroup. Another parent A deaf lady with a cochlear implant comes when suggested the name for the group. she can - three of the children have now had The three families who were most likely to use the cochlear implants. One of the highlights was when group agreed about the timing and venue. It was a newly implanted three year old girl pointed to her decided to have it once a month throughout the year, own implant, pointed to the one on a little boy and apart from December, on a Wednesday afternoon. then pointed to the deaf adult's implant and then There were ten families in total in the area with pre- signed ‘the same’. The teacher is involved in each school children who might attend. Swindon was also session providing information, advice and tea as one of the first wave pilot sites for the Newborn necessary; the other two advisory teachers come Hearing Screening Programme. This meant that the when they can or to bring a new parent along. At screening programme was likely to find 3 - 4 the next session, the parent partnership co-ordinator children locally with significant permanent hearing is attending at the parents' request. losses per year. Parents' comments include,”It's nice to have a chat The first two trial sessions were generously funded and socialise with other parents who are going by the Swindon and North Wiltshire Deaf Children's through the same thing.”; “It's good to see how all Society; it was soon clear that there was a need for the children are progressing”; “Once a month is the group to continue with some regular staff. One of fine, particularly now that X is at playgroup in the the aims was to involve health, education and social morning”. A new parent attending commented how services together with deaf role models. Our friendly she found it and how she liked the service was not in a position to employ any staff so smallness of the group. creative thinking was required. The matter was Four families attend regularly; one child comes with discussed with the Early Years Development either with his mother or his childminder depending Partnership SENCo for whom our Service had done on who is available. There is still room for some training. She suggested that a funding bid be development. The strength of the group is in its size submitted to the Sub-Inclusive Group. but it is agreed that there is a need for a few more This group consisted of a multi-disciplinary group of families. Links have been made with the health professionals including a representative from social visitors who were told about the group in their team services. They were very happy with the rationale meeting. They will encourage families to attend and for the group, which included parents inviting a some health visitors intend to pop in and see what hearing friend and his/her children and also deaf we do. parents with hearing children. The sub-inclusive A strength of being able to have a multi-professional group provided a generous sum of money to fund involvement in the group is being situated in a the rental of the building; the purchase of more toys unitary authority with close links, both professional and the funding of a sessional play worker from and personal. The group has only been running for Social Services up till April 2003. Funds for the eight months but is already providing a useful focus sessional worker went directly to the Family for families in the area. Resource Unit in Social Services; the link being

©BATOD Magazine February 03 7 Multi-agency work in the residential special school for the deaf Chris Owen Headteacher Royal School for Deaf Children Margate Following a lecture given by Ray Shostak, Director The first point is that I no longer go to Multi-Agency of 'Children, Schools and Families' Chris Owen Child Protection Team Meetings held in our school wrote about his realisation that the reason that multi- Conference Room. I delegate. I respect and admire agency working wasn't ringing entirely true as the work of our local police and, particularly, our revolutionary thinking was because, in residential very over-stretched Social Services. However, I special schools, this is the way they work all the don't attend. I know that issues and consciousness time. They have a multi-agency approach. You may are both being raised. I know that good practice wish to refer to the April 2002 Association Magazine guidelines are being discussed and protocols (page 8) - Focus on schools for the deaf. written. I know that keeping lines of communication open and well oiled is important. I know putting I have written about this before in this magazine and names to faces is invaluable. I really like the Chair. I recommend, if you caught that article, because I She's funny and forceful. I admire the drive and have nothing new to say really, that you pass on to energy of the facilitator. However, I don't go. I don't something more interesting. go because this is not a Strategy Meeting about a Previously I listed all the professionals who work at particular child. It's about principles and strategies. our school. I also listed all the professionals who It is not about a child. come to school on a regular or consultancy basis. I do go to ad hoc meetings about the most My theme was that this was The Next Big Idea, appropriate educational placement for a child. I talked about at every conference and that think the two most recent ones have been the most ‘Successful Multi-Agency Working’ was the new efficient and effective meetings I have attended in mantra and yet we were already doing it all the time. 2002. All the good practice in the previous By the way, cynics said it had been tried before, like paragraph was in place: all the more so because we planned regional provision and that if you waited had a real child to serve and a real problem to solve. long enough it would go away to be replaced by Professional respect was taken as read and there ‘The Next Big Idea But One’ but it would come back, was real pace and purpose. We ‘won’ one and ‘lost’ like planned regional provision. Cynics said. one of these meetings, in terms of placement in our school but that didn't affect my view of their Cynicism aside, perhaps now I should indicate how effectiveness. The process for the second one was we all work together for the good of the children - also much quicker because of the trust established how we try to be effective in our multi-agency at the first. working. Focus on the child I could now list all the meetings and case The second point I have to make is not mine at all conferences that take place in school: Looked-After really. It was offered to me as a criticism of multi- Children Reviews; Annual Reviews of Special agency teamwork by a colleague who alerted me to Educational Need; Assessment Meetings; Risk the danger of over-familiarity, of losing your own Assessment Meetings; Post-Admission Reviews; professional sharpness, of watering down your Individual Behaviour Management Plan Reviews; particular contribution. She felt that because you Multi-Agency Child Protection Team Meetings and are a Teacher of the Deaf, for instance, working ad hoc conferences to decide on the most regularly with Child Psychiatrists, nurses in mental appropriate educational placement - but I won't. I health placements and other professionals, you won't subject you to death by 'Listeria', as Graham become able to anticipate what the other Norton calls our current obsession with the list of professional will say, what line they will take. You the greatest in any and every obscure category, by begin, in fact, to think you can do their job, you know outlining the Death by Meetings that can lie in wait what they know. The effect is that the meeting loses for the enthusiastic multi-agency worker. I will, sharpness and subsequent reports are woolly. however, try to make a few observations about good (Maybe the cure is to have fewer meetings?) practice as I see it.

8 ©BATOD Magazine February 03 Keep your distinct professional vision I hope they will tell us when they don't. One multi-agency meeting in school I always try to One group we have at our disposal that is not attend is the Post-Admission Review. A group of available to all multi-agency workers is children. We professionals meet to discuss the first six to eight have lots of them in school, thankfully. They form weeks of a new child's educational placement with classes, houses, residences, year and peer groups - us. Teachers are there. Residential Social Workers the ones who enjoy deaf club; the school football attend. Educational Assistants have much to team; the summer cyclists; the ones who help staff contribute. There is a panoply of specialists. We and the ones who definitely don't. We have children might review the fee being charged. We will share to draw comparisons with. We have children to act and question the information gained from as buddies and mentors and to be friends. We have psychometric tests, speech and language therapy the nosey ones who badger the new kid, having a and specialist sessions in audiology and vision. We first look round and who take the poor frightened lad will share successful strategies. We will talk about or lass out to play football after lunch or for some the whole child. The focus will be sharp and the quiet time. And they tell us as much about children outcome practical. as all our psychometric tests and distinctive Focus on the child and keep your distinct professional vision and voice because they focus on professional vision the child. I am aware of two groups that we have to work really hard to include in our multi-agency working - LEAs and parents. Both have to be treated really sensitively and thoughtfully. Margate is a long way from almost anywhere. Organisation has to be efficient and the details taken care of. People have to feel welcome. Their time must not be wasted. I hope they both feel visits to RSDCM are worthwhile.

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In writing this piece I can only give an outline of the to the emerging Services and others got more way the Service in Edinburgh developed. Readers accustomed to the idea, the pros of being a larger will have their own knowledge and experiences of Service began to outweigh the cons. the wide variety of provision that exists in the UK. Staff realised that they could easily tap into an It is interesting, however, that the assumption is incredible diversity of expertise and that talking to often made that single Support Services are others was actually productive and could inform their synonymous with generic Services and that these in own practice. All staff are highly skilled and are turn are often managed by generic learning support wholly committed to continuous professional staff or often actually have no clear line development. However, the opportunities for such management. This cannot be further from the truth development increased and widened and teachers with regard to the Service in Edinburgh. do like to attend courses! So to start at the beginning…… As a direct result of these additional opportunities The Visiting Teaching and Support Service (VTSS) and the ongoing development of expertise, the was established in 1998 following the break up of Service staff are increasingly in demand to deliver the former Lothian Region into four unitary training. This has enabled staff to develop their authorities. presentation skills and some staff have really grown into this aspect of their work, although in some Lothian region operated well-established, highly cases initial reluctance was shown. The specialist staffed, clearly managed and accountable Visiting nursery nurses, in particular, have developed Services for deaf children and for blind children. excellent presentation skills and clearly demonstrate There were also Services such as the pre-school the added value they bring to the Service. home visiting teachers (PSHVT) that were well established but had less clearly defined line All staff have additional qualifications in their field, management, staff development and less robust yet recognise that children do not necessarily neatly quality assurance strategies. In addition to these, fit into one category or another. This is where a there were emerging Services, such as for children Service of this type is most successful. There are with communication impairments, that had no clear numerous areas of overlap. line management, work base or defined remit. For example: When the break up of the large Lothian Region  Traditionally the Sensory Services had their own occurred, the original idea was to combine the PSHVT teams. This is still the case, however, all Sensory Services. However, when the 'powers that teachers working with babies and young children be' started to examine this, it was quickly decided to have access to a wide range of resources and form a Service consisting of the Sensory Services many of the strategies used for one group of and these other 'emerging Services'. Thus the children equally apply to others. For example VTSS was established and 'growed’ like Topsy. the use of TEACCH, or PECs (picture exchange communication system). It was agreed right from the beginning that there  Video analysis, long used with deaf babies has was no question of this being a generic Service. been introduced to the PSHVT team as a whole. The line management of the Service was clearly They have found this particularly effective when established and commitment was given to analysing the very small steps taken by some of maintaining specialist provision. the most disabled children. A joint developmental checklist has also been devised. There are thus seven discrete departments, namely,  Advice can easily be sought for children with a the PSHVT Service for deaf children; Service for constellation of difficulties and parents may be children with a visual impairment; Service for saved a plethora of visits by different agencies children with a communication impairment; Service by the simple expedient of working together to for children with special needs and challenging deliver services, with the most appropriate behaviour; early intervention Service for children person visiting depending on need. This is a with Autistic Spectrum Disorder (ASD); and Service strategy much talked about but is so much for children with specific learning difficulties easier to deliver if most of the relevant people (dyslexia). are based in one place.  Strategies that are utilised with children with Inevitably there was some initial dissent and it took a ASD can be used for those with communication while even to get the staff all under one roof. difficulties. The visual environment has helped However, as new members of staff were appointed

10 ©BATOD Magazine February 03 deaf children as well as those with ASD or Some examples of current work communication problems. Again PECs has Groups many uses. Several parent/carer toddler groups operate; one for  It is encouraging to those involved to move away deaf children, others for babies and toddlers with from the idea that there is always a predominant complex needs. disability to the clearer understanding that it is all Social use of language groups for children with elements that contribute to a child's learning. Aspergers syndrome run in collaboration with Deaf children may also be dyslexic, or have speech and language therapists. pervasive speech and language disorders. There is an 'after school' club for deaf children  This harmonisation of working has allowed the There are various 'interest' groups for mainstream Service to promote good practice in schools. staff eg ASD, dyslexia. Although we receive separate referrals for individual need and there may be several Collaborative work members of the Service visiting the same Service staff members are involved in diagnostic school, it means that we can try to introduce clinics such as those for paediatric hearing whole school strategies that will benefit all the assessment and visual function assessment, also children. with the communication clinic that assesses the  We have developed staff support groups so that needs of children with ASD. These are all with Service staff can share difficulties encountered colleagues from health services. and seek joint solutions. This is particularly  PEP-r assessments are conducted jointly with effective where more than one staff member educational psychologists. visit a school and they are all encountering  The Service contributes to teacher training similar problems, maybe with the overall ethos of courses. the school or with particular staff members. We  CALM training (moving and handling) is can devise an agreed course of action to try to delivered jointly with social work colleagues. rectify the situation or at least start a meaningful dialogue that addresses the issues. The school The Service contributes significantly to the overall cannot simply play one Service off against policy and practice of the City of Edinburgh and is another. involved in developing guidelines for good practice. It is recognised as a centre of excellence and as There are issues for the Service to do with equity previously mentioned, is in great demand for training. and the ability to deliver to families and children on a sustainable basis. Not all departments have the These are just a few examples of the work same number of staff and so some intervention can undertaken by Service staff. Of course, many only be short term. This can cause tension when Services carry out similar work and there is nothing other departments can offer intensive long-term unique in what we try to do. However I'm sure that if support. However these issues are being addressed the Services in Edinburgh had remained small over time, I'm not sure there will ever be sufficient individually operated units then the breadth of work staff to meet all the needs however. would not have been achieved and some of the units may have been stretched beyond capacity. Some staff may feel they do not have enough opportunity for developing their own specialism as I think it is clear that there are benefits being a multi- in-service must now address much wider issues. disciplinary support Service but it has to be worked The very generous in-service funding that is at. A clear identity may be harder to achieve and available compensates this for. I see it as a positive tensions do exist. Generally all users do note that benefit that colleagues have to consider a much benefits accrue to them too. Crucially however, the wider range of issues than perhaps was the case in impact to parents is significant. No longer are they the past. forced onto the trail (and trial) of finding the right professional, or of accommodating a myriad of The VTSS operates best when working in people. This can all be co-ordinated from the centre collaboration with others not just internally but and the most appropriate person/people visit at the externally too. We therefore have excellent links most appropriate time. with Health, Social Services, the voluntary sector and other Educational Services. Not only does the I have only given a very brief overview of the Service promote inter departmental work but many Service but hope I've given a flavour of the work of the initiatives carried forward are done on an undertaken and the achievements made. If anyone inter-agency basis. fancies a visit, Edinburgh is a beautiful city, otherwise I'm happy to answer questions via e-mail. The VTSS is crucial to support and challenge within schools, helping to find individual solutions for [email protected] pupils, promoting a positive ethos and assisting in the development of achievements for children.

©BATOD Magazine February 03 11 The SEN Regional Partnerships - where are they now? Lindsey Rousseau, Facilitator, South East SEN Regional Partnerships

Background As many of you will be aware the formation of the place in the development of SEN policies and eleven SEN regional partnerships was as a result of practice across the country. Of course, as the the 1998 programme of action on SEN. facilitator of the South East partnership I would say that, wouldn't I? Following the five ‘phase one’ projects in early 1999 when one focus was on ‘low incidence disability’ I hope that this article will help address some of the there was great interest in the concept of disappointment I have sensed from members of the ‘regionalisation’ within the deaf world. There may SI professions in the SEN Partnerships and will give even have been some misunderstanding as to the you some information about our activities. intentions of the government with regard to the purpose of the regional projects. One or two of the As a ToD I would also say that the needs of deaf early projects concentrated on sensory impairment children have not been neglected in the or autism as their major focus of work although with developments of the SEN partnerships. The shift the intention of looking at regional co-ordination and away from the spotlight on low incidence disability dissemination of good practice rather than can be used to the advantage of our profession. establishing new regional provision. We have the possibility to influence developments from within a government agenda and focus on SEN When the six further (phase two) projects were where the opportunities to support change and established by April 2000 all LEAs in England were acknowledge good practice are there as never linked into the projects and the shift of direction was before. Deaf education has always been at the away from single focus projects to more strategic forefront of educational thinking and I agree with regional co-ordination within SEN. many of the excellent leaders we are fortunate to have in the deaf world who are asking us to move We were funded for two years to promote forward with the times now. partnerships to help establish more effective regional co-ordination of SEN provision and The regional SEN partnerships have continued to services. The LEAs determined the focus of the work with low incidence disabilities within their projects in their region and independent evaluation strategic remits. The DfES website www.dfes.gov.uk was commissioned from the University of links to all the partnership websites where details of Manchester. their activities can be found.

Developments Briefly, to mention just some of the work with HI In 2001, following an interim report from the services and schools, I can tell you that: Manchester University evaluation team, the DfES South West partnership started with a focus on made some significant changes and introduced sensory impairment (SI) and working with SI greater clarity in the co-ordination of the projects. providers voluntary organisations including NDCS, We became SEN regional partnerships, which RNID, BATOD, RNIB, NBCS and other agencies. supported the shift of emphasis to a more strategic They established: focus, we were assured of funding for three more  audits years until 2004 and the DfES defined 60% of our  training initiatives throughout the region core activities. The appointment of a National  transition planning materials additionally Adviser for the partnerships to the DfES was resourced through the Small Programmes Fund recommended to help co-ordinate our work at the  an annual benchmarking exercise involving all SI centre and to improve the inter-agency work locally, services in the region regionally and nationally. East Midlands partnership has a regional ToD Sensory Impairment has not been forgotten! group which meets termly and is seeking to audit Slowly these changes within the regional provision and services across the region. They have partnerships have taken effect and, in my opinion, also run an MSI conference and have been the SEN partnerships are beginning to have a valid researching monitoring of SEN services

12 ©BATOD Magazine February 03 North East partnership (FINE) produced TransPlan The ministerial working party looking at the future (transition planning CD rom) with input from role of the special school has representation from Northern Counties School and the media launch the specialist schools and services for the deaf and was at the school. The CD is user friendly for the the SEN Partnerships on its main membership and deaf community and is available nationally in focus groups. The report from that group in early 2003 and the consultation following should be Merseyside partnership carried out important influential in the future planning for specialist developmental work with HI as a phase one project services. It should provide further opportunity for and has since completed research on provision and the SEN partnerships to work with SI providers in support for young people who are deaf (14-19 regional co-ordination. years). They have a steering group including NDCS, Merseyside Society for Deaf People, Birkdale FE The DfES SEN Small Programmes Fund has College already been mentioned in the examples of SEN partnership work above. I am aware that the 2003- East region partnership is publishing (summer 2004 fund has attracted at least 15 Sensory 2003) an Inclusion Toolkit: Deaf Children in Impairment bids through the SEN Partnerships. If mainstream Schools - practical guidance for successful we should be able to produce some more teachers and governors. excellent examples of partnership working, training and research initiatives in the SI field. This is resourced through the SEN Small Programmes Fund and involves the East region and The next steps for the SEN Regional Stockport LEA in partnership with the NDCS Partnerships 2003 - 2006 The DfES announced in October 2002 that Ministers South East partnership (working with South have agreed to extend the funding arrangements for Central and some SE London LEAs) has a the eleven SEN Regional Partnerships. The Sensory Impaired Provider task group. decision followed the positive independent  Our objective is to address regional variations evaluation from the University of Manchester. and acknowledge good practice.  We have an interactive website for professional Each partnership will be required to produce a development and contact www.sersen.uk.net three-year strategic plan covering their work as well  We are aiming to deliver a clear message for as the regular annual work plans. parents and carers about the region’s shared view of the inclusion process and how it will The partnerships welcome this opportunity to be affect their child. involved in some longer term planning and the three-  We will be publishing quality standards and year plans are to link in with the objectives for the principles with regional models of benchmarking, SEN division of the DfES. There may yet be some eligibility criteria and joint working between the effective co-ordination! LEAs and non-maintained sector.  We have a pilot partnership between an LEA I speak personally but I believe that I represent the and a voluntary organisation with a non- views of my fellow facilitators, when I say that I look maintained special school for co-ordinated forward to continuing to work with BATOD and the HI delivery of services for children and young and deaf communities and professions. people with Visual Impairment. There is potential for our work together, within the I represent the SEN Partnerships at the National SI objectives of the regional partnerships, to have great Voluntary Reference Group which meets at the impact on deaf children and young people and their RNID termly. We meet with representatives from the families. DfES SEN division, RNIB, RNID, NDCS, BATOD, NASS, SENSE, Guide Dogs, LASER, OPSIS, etc. This is an effective mechanism for keeping the voluntary sector and professionals involved and up to date with SEN developments in the Partnerships and the DfES.

©BATOD Magazine February 03 13 SEN Regional Partnerships - contact details:

National Adviser, SEN Regional Partnerships: South Central Claire Lazarus Member LEAs: Hampshire (Lead), Bracknell Forest, ¤ 0208 340 1981; Mobile 07880 787190; Buckinghamshire, Isle of Wight, Milton Keynes, e-mail [email protected] Oxfordshire, Portsmouth, Reading, Slough, Southampton, West Berkshire, Windsor and Eastern: Maidenhead, Wokingham Member LEAs: Hertfordshire, Bedfordshire, Essex Website: www.scrip.uk.net (lead), Suffolk, Cambridgeshire, Luton, Norfolk, Facilitator: Hugh Clench Southend, Peterborough, Thurrock. e-mail: [email protected] Website: www.hertsdirect.org/senregionalproject ¤ 01273 230718; fax 01273 278108; Facilitator: Jackie Jackson-Smith Mobile 07980 897052 e-mail: [email protected] ¤ 01245 436320 South East: Member LEAs: Kent (lead), Brighton and Hove, East East Midlands: Sussex, Medway, Surrey and West Sussex Member LEAs: Northamptonshire (Lead), Derby Website: www.sersen.uk.net City, Derbyshire, Leicester City, Leicestershire, Facilitator: Lindsey Rousseau Lincolnshire, Nottingham City, Nottinghamshire, e-mail: [email protected] Rutland. ¤ 0208 541 9048; fax 0208 541 9570; Website: www.emleas.org.uk Mobile: 07711 030711 Facilitator: Pat Bullen e-mail: [email protected] South West: ¤ 01283 762430 (Tues, Weds, Thurs only) Member LEAs: Devon (lead), Cornwall, North Somerset, Bristol, South Gloucester, Plymouth, London: Torbay, Somerset, Bath and NE Somerset, Member LEAs: All 33 London boroughs Gloucestershire, Swindon, Wiltshire, Bournemouth, Westminster (lead) Dorset, Poole, Isles of Scilly Website: www.londonregionsenproject.org.uk Website: www.sw-special.co.uk Facilitator: Mary Kuhn Facilitators: Dorothy Hadleigh & Nick Knapman e-mail: [email protected] c/o Lucy Donnelly ¤ 01823 335491 ¤ 0207 217 3231 e-mail: [email protected] Dorothy Hadleigh ¤ 01398 361334 Greater Merseyside: e-mail: [email protected] Member LEAs: St Helens, Halton, Liverpool (lead), Nick Knapman ¤ 07970 967593 Knowsley, Sefton and Wirral e-mail: [email protected] Website: www.merseysen.org.uk Facilitator: Andy Simpkins West Midland: e-mail: [email protected] Member LEAs: Coventry (lead), Dudley, Sandwell, ¤ 0151 233 8261 Solihull, Wolverhampton, Warwickshire, Walsall, Telford & Wrekin, Birmingham, Staffordshire, Stoke North East: on Trent, Worcestershire, Shropshire, Herefordshire Member LEAs: Redcar and Cleveland (Lead) Website: www.westmidlandsrcp.org.uk/ Durham, Northumberland, Newcastle-upon-Tyne, Facilitators: North Tyneside, South Tyneside, Gateshead, Annette English ¤ 0121 445 0108 Sunderland, Darlington, Hartlepool, Stockton, e-mail: [email protected] Middlesbrough Bridget Jones ¤ 01432 820159 Website: www.inclusion-ne.org.uk e-mail: [email protected] Facilitator: John Kirton e-mail: [email protected] Yorkshire and the Humber: ¤0191 202 3587; Mobile 07909 906455 Member LEAs: Kirklees, Barnsley, Bradford, Calderdale, Doncaster, East Ridings of Yorkshire, North West: Hull, Leeds, North East Lincolnshire, North Member LEAs: Lancashire (Lead), Blackpool, Lincolnshire, North Yorkshire (Lead) Rotherham, Blackburn, Wigan, Bolton, Bury, Rochdale, Oldham, Sheffield, Wakefield, York Tameside, Stockport, Manchester, Trafford, Salford, Website: www.yhsen.org.uk Warrington and Cheshire, Cumbria Facilitator: Bill Hitchcock Website: www.sen-northwest.org.uk e-mail: [email protected] Facilitator: Diane Whalley ¤/fax 01423 705763; Mobile 07736 669660 e-mail: [email protected] ¤01457 855380; Mobile 07769 673163

14 ©BATOD Magazine February 03 Multi-agency working - anything to learn from a cochlear implant team? Sue Archbold, Co-ordinator, Nottingham Paediatric Cochlear Implant Programme "I never knew what multi-agency working was until I worked here." A new colleague on our implant programme recently sometimes express the same things differently! We remarked - "I never knew what multi-agency working may also put different priorities on different was until I worked here." We leave it to your outcomes. imagination to judge as to whether this was the voice of satisfaction or frustration! Are a surgeon There are tremendous challenges in bringing and a Teacher of the Deaf the right people to talk together such a range of professionals within one about teamwork? Surgeons are used to management structure but tremendous benefits too questionless obedience as the nurse and not only for parents, who, hopefully, are hands over the correct instrument on receiving a programme of care which provides a demand - and after all who wants to be range of professional input - seamlessly. As under the knife of someone having a long professional members of a multi-professional team, debate about the pros and cons of what the learning involved in having ones' view to do next? Teachers of the Deaf are challenged by others with a different perspective is naturally at ease in the more familiar demanding but rewarding. In training together we setting of the classroom but are likely to feel learn together, asking questions and moving on our vulnerable and somewhat intimidated in the less shared and individual thinking, benefiting from the hospitable environment of a hospital clinic. What wider perspective. happens when these disparate professionals find However, if communication is to be effective and themselves working together as decisions to be made, the multi-professional team part of a multi-disciplinary team? demands effective co-ordination. This demands Certainly not peace and quiet! listening to a range of views and bringing together a A paediatric cochlear implant consensus - which all can live with! Co-ordinating team, within one management such a team can seem like herding cats - all pointing structure, brings together surgeons, scientists, in different directions. radiologists, medical staff, teachers, speech and Real teamwork is reliant on mutual trust, on time language therapists, psychologists and many others, and on communication - in order to provide a working together over a long term. Perhaps some of complete package of care for a child and family, the lessons we have learnt - and continue to learn - rather than only looking at the audiological, medical can be helpful. Cochlear implantation inevitably or educational perspective in isolation. brings together the medical and educational worlds in a close relationship - making important decisions "A team of brilliant individuals can often be less with parents on behalf of their child, providing long- effective than a brilliant team of individuals." term and complex management. The success of (Margerison C, McCann R, 1995, Team Management) cochlear implantation lies not in the work of one person - the implant must be surgically safely Visit the deafnessatbirth.org.uk website. placed, programmed individually for each child and www.deafnessatbirth.org.uk click the content button only then can parents, teachers and therapists and then choose professional become involved in the long-term development of practice. Effective multi- the use of the system, so as to exploit the newly agency working has its restored sense of hearing. Each member of the own section. team is reliant on the others - and must trust and value each others' expertise and judgement - this takes time to understand and to realise that we

©BATOD Magazine February 03 15

Synchronise the Singing and Dancing: thoughts on developing listening with deafblind/MSI children Patricia Gibbons Advisory Teacher for Deafblind/MSI children This is a summary of a workshop presentation given However, behavioural testing techniques for hearing at a recent BATOD Midland conference. are referenced against typical, integrated sensory development and depend on removing extraneous Vision, touch and the other senses have a vital role sensory clues to concentrate on a purely auditory to play in supporting the process of learning to response. For the deafblind/MSI child this paring listen. From twenty weeks' gestation the foetus is down renders the experience even more piecemeal aware of the mother's voice and the auditory and possibly frightening. Such a child will probably components of the mother's body rhythm, as well as emerge from a clinic assessment with inconclusive of sounds coming from the outside environment. results. The child may only respond at ‘interest’ Pre-natal conditioning, enabling vibro-tactile and levels, well above the threshold for hearing. Pure kinaesthetic experiences to be associated with tones and warbles, less meaningful than complex auditory ones, ensures that the baby will continue to sounds and very fleeting, may be ignored. Often develop awareness of cause and effect after birth. children with severe visual impairment may register Sounds made in the course of the usual care-giving a sound once but then not respond again. In fact will become linked with the tactual and kinaesthetic this one response may not be a fluke. It could experiences and also with visual experiences as mean, "I know it is there but I can't do anything vision develops. about it so there is no point in reacting again."

Satisfaction of bodily needs is the early catalyst for Teaching is more effective than testing if we wish to developing sensory awareness. We are likely to see understand the child's hearing and it should be the first evidence of anticipation around care-giving planned to promote sensory awareness and sensory behaviours such as feeding and cuddling. The baby integration. Our knowledge of child development alerts to the sensory clues - mother's voice, reminds us of the importance of developing footsteps, sight of mother - in advance of being fed, cognitive processes of exploration and learning to for example. As bodily contr