Business Case: Warwickshire’s Provision for Speech, Language and Communication Needs for Children, Young People and Families Date: 12/11/2015 Version: 1.ii Authors: Ross Caws (NHS Arden & GEM CSU) Georgina Atkinson (NHS Arden & GEM CSU) Louise Cunningham (Warwickshire County Council) Jonathan Wilding (Warwickshire County Council)
3. Re-designate DSLP settings as Communication & Interaction (C&I) Resource Bases Complements the IDS intention of developing a more coordinated and integrated C&I service offering. Allows flexible use of resources to meet a range of needs. Maximises the benefits of established SEN provision Allows resource to support a wider range of needs – which are more prevalent Moves away from label-led approach to SEN towards a more personalised response to needs SLI needs may be marginalised by other needs (ASD) in settings Current staff might require training (or moving staff within C&I team) 4. Move away from separate Key Stage 1 & 2 Provision - create primary settings Generally agreed by all stakeholders this should be done in any event Minimise disruption for vulnerable learners who may have to move settings Make the most of the opportunity from school expansion Space constraints – in some settings this makes providing a service more challenging? 5. Transfer the management of DSLP settings to schools Potentially contentious and delicate proposal – some risks identified by current staff but would be welcomed by schools. Parents in the main seemed unconcerned either way. Facilitate and sharpen school’s focus on SEND – discourage sense of SEN as a LA issue Supports LA to fulfil role as an effective commissioner and champion rather than a service provider Shifts resource closer to the front line May lessen focus on continuing professional development? May mean resources are less focused on targeted need (i.e. subject to other pressures)
Non-financial appraisal A non-financial options appraisal was carried out on 21 October with representatives from Speech & Language therapy and the Specific Language Disorder Team. The scoring for each option is shown below: Criteria Weighting DSLPs Option 1 Score x weighting DSLPs Option 2 Score x weighting DSLPs Option 3 Score x weighting DSLPs Option 4 Score x weighting DSLPs Option 5 Score x weighting Improve outcomes for children and young people with C&I 20 1 20 2 40 2 40 3 60 1 20 Provides an equitable service across the County 20 0 0 2 40 2 40 3 60 1 20 Will lead to the delivery of improved outcomes for children and young people with SLI 20 1 20 0 0 0 0 3 60 1 20 Improves utilisation of resources (including workforce) 20 1 20 0 0 2 40 3 60 1 20 Flexibility of model to respond to further changes 20 0 0 3 60 2 40 3 60 2 40 Total 100 3 60 7 140 8 160 15 300 6 120
Non-financial appraisal A non-financial options appraisal was carried out on 21 October with representatives from Speech & Language therapy and the Specific Language Disorder Team. The scoring for each option is shown below: Criteria Weighting Outreach Option 1 Score x weighting Outreach Option 2 Score x weighting Outreach Option 3 Score x weighting Outreach Option 4 Score x weighting Improving outcomes for children and young people with C&I 20 1 20 1 20 3 60 1 20 Provides an equitable service across the County 20 1 20 2 40 3 60 1 20 Will lead to the delivery of improved outcomes for children and young people with SLI 20 1 20 1 20 0 0 1 20 Improves utilisation of resources (including workforce) 20 1 20 2 40 2 40 0 0 Flexibility of model to respond to further changes 20 0 0 3 60 3 60 0 0 Total 100 4 80 9 180 11 220 3 60
Option Advantages Disadvantages Option 1 - Continue with existing contribution from DSG funds (Do nothing) LA meets its statutory responsibilities Minimises disruption to children, young people and professionals Retain required support for vulnerable learners Continued joint working between education and health Cost effective No contribution to addressing current DSG overspend Question of equitability - whether LA should be funding cyp whose level of need would not ordinarily entitle them to this SLT support. Option 2 – LA to make the case to transfer responsibility and costs to Health May support LA in addressing part of the DSG overspend Would damage partnership working and trust CCG’s are also under pressure to make savings – likely to simply lead to funding reductions rather than cost transfer. Increases pressure on service to trade services to increase income LA statutory responsibility and case law Option 3 – Reduce or remove DSG funding contribution to SLT Would support LA in addressing DSG overspend Does not meet LA’s statutory responsibilities Loss of Statutory support to vulnerable learners with statements/EHC plans Highly likely to lead to dispute/mediation/tribunal Spot purchase of SALT will be at increased cost Non-financial appraisal A non-financial options appraisal was carried out on 21 October with representatives from Speech & Language therapy and the Specific Language Disorder Team. The scoring for each option is shown below:
Option Advantages Disadvantages Option 1 - Continue with existing arrangements (Do nothing) •Equitable service offer across the County •Current system is known by stakeholders •Level of support being delivered for high needs is dependent on school; current take up of support is variable •No action taken to test whether increased SLT provision may reduce levels of challenging behaviour •No assurance for CCG & LA that SLT provided to pupils is subject to clinical governance procedures (except SWFT traded offer) Option 2 – Year 7 transition term (pilot) •Equitable service offer across the County. •Children supported during unsettling transitional term; thereby being supported to achieve the best outcomes. •Demonstration to schools of the value of SLT Allows evaluation to test whether increased SLT provision may reduce levels of challenging behaviour •Delays rather than removes issue of variable secondary age support to the Spring term of Year 7 •Level of support being delivered for high needs is dependent on school; current take up of support is variable •No assurance for CCG & LA that SLT provided to pupils is subject to clinical governance procedures from Year 7 (second term) onwards •Additional resources required. Option 3 – Year 7 transition year (pilot) •Equitable service offer across the County. •Reduced levels of variable support at secondary age (up to Year 8) •Equitable delivery and service to all children with SCLN up to Year 8. •Assurance for CCG & LA that SLT provided to pupils is subject to clinical governance procedures in Year 7. •Children supported during unsettling transitional year; thereby being supported to achieve the best outcomes. •Demonstration to schools of the value of SLT Allows evaluation to test whether increased SLT provision may reduce levels of challenging behaviour •Delays rather than removes issue of variable secondary age support to Year 8 •No assurance for CCG & LA that SLT provided to pupils is subject to clinical governance procedures from Year 8 onwards •Additional resources required. Option 4 – Full secondary age service •Equitable service offer across the County. •Consistency in support delivered during secondary age. •Assurance that the SLT provided to pupils is subject to clinical governance procedures. •Children supported throughout secondary age to achieve the best outcomes. •Allows evaluation to test whether increased SLT provision may reduce levels of challenging behaviour •Significant additional resources required. •Evidence shows that interventions become less and less effective during secondary age
Non-financial appraisal A non-financial options appraisal was carried out on 21 October with representatives from Speech & Language therapy and the Specific Language Disorder Team. The scoring for each option is shown below: CRITERIA WEIGHTING Secondary Option 1 Score x weighting Secondary Option 2 Score x weighting Secondary Option 3 Score x weighting Secondary Option 4 Score x weighting Improves outcomes children and young people with SLCN 20 1 20 2 40 3 60 4 80 Provides an equitable service across the County 20 1 20 3 60 3 60 3 60 Will lead to the delivery of improved outcomes for children and young people with SLI 20 1 20 2 40 3 60 4 80 Improves utilisation of resources (including workforce) 20 1 20 3 60 3 60 3 60 Flexibility of model to respond to further changes 20 1 20 2 40 2 40 2 40 Total 100 5 100 12 240 14 280 16 320 Option 4 was identified as the ideal option. Options 2 and 3 also scored highly. Financial appraisal The financial appraisal below is based upon implementing each option without any change to working practice. The cost of each option is as follows: Option Cost 1 £0
Little Talkers ?? Children for whom a delay in communication has been identified by SLT - may include amber children or anxious parents Children's Centre and local clinics Monthly in Each geographical area 2 x S&LT Parents have increased confidence to support children with speech and language delay Parents have Increased knowledge and skills to support children with speech and language delay SALT/NHS venue may be different Individual clinic appointment Children for whom a delay in communication has been identified by SLT Health Centre Daily ? S&LT Improved language and communication for some children Formal assessment for those identified as needing further SLT involvement SALT/NHS SCHOOL AGE S&LT Language / Social communication group Children on SLT caseload or children identified by school School 8 group sessions S&LT: first three & last session SLT leads first three sessions and final session with TA or teacher. SLT provides resources Other sessions lead by TA or teacher Children improve confidence/communication skills TA or teacher develops skills to run groups and support carryover School have resources for future use NHS/SLT core service or schools buy in
Assessment of speech and language skills Children identified by parents or school Health clinic within 13 weeks of referral S&LT Parents and school gain information about the child's needs and strengths in relation to speech, language and communication. Specific advice is provided and recommendations about further therapy/support required NHS / SLT core funding PRE-SCHOOL SLT Supporting CFE in special schools Pupils who require a communication friendly environment in special schools Special schools CFE Training 1x a year. Ongoing support S&LT Improved communication environment and increased opportunities for communication NHS / SLT core funding PRE-SCHOOL SLT Reports and programmes for all pupils with Statements / EHC Plans for SALT All pupils in special schools with Statements / EHC Plans for SALT Special schools Annual S&LT NHS / SLT core funding Language groups Special schools Weekly or 6 week blocks S&LT NHS / SLT core funding / LA WCC SPECIALIST TEACHING Yr R screening process (transition) Children IDS have identified as having a potential language difficulty In schools Minimum of 5 sessions in the autumn term Specialist teachers and teaching assistants Identify children who have a high level need who will require on-going support. Free to school
SPECIALIST PROVISION TEAM SERVICE USER GROUP LOCATION TIME / BY OUTCOMES FUNDED BY PRE- SCHOOL SLT Little Discoverers parents and children who have attended Little Talkers but have made limited progress children's centre clinic as required S&LT improved development of SLC NHS / SLT core funding venue may be different 1-1 Therapy children with identified speech & language difficulties i.e. Dyspraxia, SLI clinic nursery as required S&LT improved speech and language skills NHS / SLT core funding Michael Palin PCIT therapy for dysfluency Children with stammer for whom Lidcombe is not deemed appropriate clinic as required S&LT improved understanding of stammering by parents and child reduced stammer NHS / SLT core funding AAC support inc PECS Children with communication needs inc ASD home &/or nursery as required S&LT improved communication via alternative means NHS / SLT core funding Lidcombe therapy children 4-6 identified with confirmed stammer of longer than 6 months health centre Weekly - median 11 weeks Monthly review for a year S&LT or specialist S&LT improved understanding of stammering by parents and child Fluency established and maintained NHS / SLT core funding
PRE-SCHOOL SLT Little Ears - parent and child group for deaf children Parents and children of deaf preschool children Children's Centre 2x month S&LT, SLTA and Teacher of the Deaf and specialist TA Parents build relationships with parents of other deaf children Deaf children have opportunity to play with other deaf children Access to professionals who work as a team to support children and deaf families Access to audiology services e.g. ear moulds Access to NDCS in non threatening environment NHS / SLT core funding venue may be different Phonology Group & sound awareness groups Children 5 and under who have been identified with a speech sound difficulty clinic block of 6 sessions Frequency as required S&LT and SLTA improved speech intelligibility NHS / SLT core funding language groups inc Narrative Preschool children identified with receptive/expressive language difficulty Clinic / children's centre rolling block of 4 sessions S&LT and SLTA improved SLC for individual children NHS / SLT core funding
PRE-SCHOOL SLT Little stars preschool children identified as social communication difficulties clinic rolling block S&LT improved social communication for children NHS / SLT core funding Baby sign children under 2 with complex needs Deaf children clinic as required specialist S&LT Develop parent and baby signing skills using MAKATON or BSL Improved communication skills NHS / SLT core funding SCHOOL AGE SLT Direct speech Therapy School aged child with speech sound disorder impacting on communication Mainstream Primary* School or health clinic Weekly for 6 weeks or ongoing for children in Primary DSLP S&LT with TA or parent in to carry out practice between sessions Child acquires/refines speech sound production and improves speech clarity NHS / SLT core funding School fund TA * LEA funds on case basis where need part of Statement for Secondary child Direct language therapy Children with severe specific language disorder Primary Designated Speech & Language Provision (DSLP) Weekly through school year S&LT Child improves language and communication skills Increased access to the curriculum NHS / SLT core funding
SCHOOL AGE SLT Speech therapy programme Children with speech difficulties impacting on communication on SLT caseload Mainstream school or Health clinic 3 weekly visit with SLT Daily practice S&LT and provides resources with key adult/s delivering (TA &/or parent) Child improves speech clarity NHS / SLT core funding SCHOOL AGE SLT Adult / Child interaction Therapy (ACIT) Child with complex need in mainstream school with regular support from a TA Mainstream Primary School Weekly for 6 weeks S&LT trains TA using video TA into daily TA adopts strategies to develop child's language/interaction Child shows improved attention/interaction/language NHS / SLT core funding
Direct therapy for stammering therapy Child with moderate/severe stammer Health clinic Weekly for 6 to 16 weeks (depending on progress) S&LT with parent in to carry out practice between sessions Child improves fluency and/or reports improved well-being in relation to communication NHS / SLT core funding SCHOOL AGE SLT Alternative & Support (PECS, picture based system, device) Child with significant communication needs / limited verbal language Primary school & home Initially weekly Later sustained by monthly visits S&LT with support from Specialist SLT in AAC Child has increased means and opportunity to communicate needs & participate in social & learning activity NHS / SLT core funding
Voice Child with voice problems referred by ENT consultant Health clinic & school Weekly for 6 weeks S&LT with parent in to carry out practice between sessions Voice quality improves NHS / SLT core funding SCHOOL AGE SLT Language for children in mainstream primary schools Children with identified medium/high language need on SLT caseload Mainstream Primary school* half termly visit from SLT x3 a week delivery by TA Reviewed termly TA with support from S&LT Child acquires and uses new language and communication skills. Child's access to curriculum and social participation improves NHS / SLT core funding with contribution from WCC *LEA funds on case basis (DSG) where need part of Statement or EHC Plan for Secondary child SPECIAL NEEDS SLT 1:1 therapy sessions Pupils with SLC needs who are high priority Special schools weekly or 6 weeks blocks of therapy 2x a year S&LT Improved speech, language or communication NHS / SLT core funding with contribution from WCC
SPECIAL NEEDS SLT SLT Young people 19-25 with Severe Learning Difficulties Awaiting information Awaiting S&LT from C&V Trust (Learning Coventry & Warwickshire Partnership Trust WCC SPECIALIST TEACHING Specialist intervention for children with identified SLI 5 -16 yrs in their local school SLA negotiated with school - regularly reviewed at least termly specialist teachers and teaching assistants pupils make good progress against identified IEP targets Dedicated Schools Grant (DSG) (free to school) and traded depending on level of need Specialist intervention for children with SLI Statements / EHC Plans 5 -16 yrs in their local school agreed at Annual Review - see our draft criteria specialist teachers and teaching assistants pupils make good progress against identified IEP targets Dedicated Schools Grant (DSG) Free to school
WCC SPECIALIST TEACHING Designated provisions for SLI children (max 80 places) 5 -16 yrs currently 6 primary schools county wide full time specialist teachers and teaching assistants pupils make good progress against identified IEP targets Dedicated Schools Grant (DSG) Assessment as requested by SENDAR 5 -16 yrs in local school as requested specialist teacher Updated language assessment Traded Transition groups 5 -16 yrs in local school 6 week block usually in the summer term specialist teacher or teaching assistants smooth transition to a new school Dedicated Schools Grant (DSG) ((free to school) and traded depending on level of need