Education, Health And Care Plans Research Articles

The inequity of education, health and care plan provision for children and young people with intellectual and developmental disabilities.

Children and young people (CYP) with intellectual and developmental disabilities (IDDs) have significant additional educational needs compared with the general population. In England, the government has established a system of education, health and care plans (EHCPs) to support children with special educational needs and disabilities, but disparities exist between the degree of need and the availability of support. We conducted a prospective UK national cohort study (IMAGINE) of children with rare pathogenic genomic variants, all of which are associated with IDD, to investigate associated neuropsychiatric risk. Subsequently, we obtained information from the UK's National Pupil Database on their educational progress through the state school system. We aimed to identify whether they had received EHCP provision and whether that support was associated with their family's socioeconomic status, region of domicile, ethnicity, sex, primary special educational needs (SEN) type, academic performance and mental health well-being. We recruited 2738 CYP from England into the IMAGINE study between 2014 and 2019. The educational histories of the participants (6-28years old, mean±standard deviation= 14±4years, 56% male) were obtained from the Department for Education's National Pupil Database in 2021. Educational data included attainment scores from the Early Year Foundation Stage (<5years) to key stage 4 (15-16years). Each family was assigned an index of multiple deprivation (IMD) score based on their home address postcode. Parents or carers rated their child's emotional and behavioural adjustment on the Strengths and Difficulties Questionnaire (SDQ). The association between receiving an EHCP and the child's IMD score, eligibility for free school meals, English region of domicile, ethnicity, sex, primary SEN type, academic attainment and SDQ score was investigated. In this cohort, 78% of participants had received an EHCP. CYP living in the most deprived IMD deciles were substantially less likely to receive EHCP support than those in the least deprived decile, irrespective of their degree of intellectual developmental disability, academic performance or associated mental health problems. There were no sex differences. Children of Asian heritage were more likely to have been granted an EHCP than White children from equivalent IMD deciles. There were striking regional disparities. Participants living in London were significantly more likely to have been awarded an EHCP than participants living anywhere else in England, regardless of their IMD decile; those in the least deprived decile had almost 100% EHCP provision. This study found evidence for nationwide regional inconsistencies in the awarding of EHCP to CYP with significant intellectual impairments of known genetic aetiology. Disparities in funds available to education authorities could be a contributory factor. EHCP support was potentially influenced by how strongly a parent advocates for their child.

Barriers faced when eliciting the voice of children and young people with special educational needs and disabilities for their Education, Health and Care Plans and Annual Reviews

Eliciting the views, wishes and feelings of children and young people with special educational needs and disabilities (SEND) has been a primary element of the Children and Families Act 2014. Despite professional rhetoric that aims to ensure the voice of children and young people remains at the centre of assessments, SEND professionals often experience difficulties in ensuring meaningful participation during assessments for Education, Health and Care Plans (EHCPs) and subsequent Annual Reviews. In this study, 36 SEND professionals from local authorities and 16 SEND professionals from specialist schools within England were asked their views on eliciting pupil voice through an online‐based questionnaire, with a particular focus on the barriers they experience. This was then followed up with six in‐depth semi‐structured interviews. The findings identify two distinct categories of barriers; the barriers relating to children and young people that inhibit their ability to express their views meaningfully, and the barriers relating to professionals that impede on their ability to elicit views meaningfully within their role. The implications of the analysis for a person‐centred approach during EHCP assessments and Annual Reviews are discussed.

The Coproduction illusion: considering the relative success rates and efficiency rates of securing an Education, Health and Care plan when requested by families or education professionals

This comparative study examines success and efficiency rates for Education, Health and Care (EHC) needs assessments in England when requested by families or education professionals. England is the only nation in the UK with EHC needs assessments. These are requested from the Local Authority (LA) if the school’s ordinarily‐available provision is insufficient for individuals to make expected progress. Policy states that needs assessments should include parents, pupils and professionals in all decision making (coproduction). After a needs assessment, the LA may issue an EHC plan. This study considers whether the outcome of a needs assessment (issuing an EHC plan) is independent of the source of the request. Statistical analysis compared outcomes of needs assessments requested by families and education professionals. Analysis of publicly‐available datasets and policy provided further context. Findings included: (i) a need for further research to explore inconsistencies in outcomes of needs assessments across England; (ii) LAs efficient at issuing EHC plans were consistently efficient for requests from education professionals and families; (iii) a potential discrepancy between families’ perceived level of involvement and the reality: a ‘coproduction illusion’. It is proposed that policy and guidance in England requires revision to ensure consistent use of language, roles, and responsibilities.

Points from the SENCo‐Forum

Points from the SENCo‐Forum

Education, health and care plans: What do we know so far?

The Children and Families Act, 2014 and the new Special Educational Needs and Disability SEND Code of Practice (DfE and DoH, 2014) has led to reforms in how children and young people with special educational needs and disabilities are supported in England. Now, five years on, research has begun to emerge exploring the implementation of the new statutory assessment process, the Education, Health and Care (EHC) plans and the outcomes of the process in England. This article seeks to review current research about the introduction of EHC needs assessment process and plans. It highlights three key themes: experiences of the process, reflections on the EHC plans and the outcomes of the process. Whilst parental involvement has improved, and there is some evidence of multiagency work, the views of children and young people continue to be marginalised, and EHC Plans are highly variable in quality, indicating that person‐centred approaches are not yet fully implemented. This indicates a need for further research on how to effectively involve CYP with SEND in statutory processes and support.

The Underreporting of Vision Problems in Statutory Documents of Children with Williams Syndrome and Down Syndrome.

Vision problems can lead to negative developmental outcomes. Children with Williams syndrome and Down syndrome are at higher risk of vision problems, and these are less likely to be detected due to diagnostic overshadowing and difficulty accessing eye-care. Education, Health and Care (EHC) plans are statutory documents, introduced by the Children and Families Act 2014 in England, with the intention of integrating provision across these domains. Vision issues should be reported in these plans, and recommendations made about appropriate adjustments for them. We analysed the EHC plans from 53 children with Down or Williams syndrome. Our results showed significant underreporting, especially for children with Williams syndrome, and little explanation of what adjustments should be made. We also report pockets of good practice.

Education, health and care plans and tribunals in England: A statistical tale from 2019

Education, health and care (EHC) plans were introduced in England in 2014, as a replacement for statements of special educational needs. Unexpectedly, the number of children and young people in receipt of an EHC plan rose by 49% during the 5 years up to 2019. Whilst most of the increase has been due to the extension of the age range up to age 25, there has still been a notable rise of 20% in the 0–15‐year range. This study explores the trends and variations in EHC plans and tribunals within English local authorities (LAs) for children and young people with special educational needs and disability (SEND) by interrogating the latest full set of data from 2013 to 2018. Two quintile groups (n = 30) are used for comparing LAs with high and low levels of EHC plans and LA case studies are also presented for further inspection of the data. Wide variations across LAs still exist for EHC plans (5.2% to 1.0%) and tribunal appeals (43 to 0 per 10,000). LAs with low EHC plans have more appealable decisions at tribunals and are financed at significantly lower levels than LAs with high EHC plans, largely due to an historic spend factor of 50% in the national funding formula. There are also clear differences between the English regions for both EHC plans and tribunals, with high increases for both in the South East. The implications of the findings are discussed within the framework of LA critical self‐reviews, benchmarking, fiscal constraints and inclusion.

Plans that work: improving employment outcomes for young people with learning disabilities

This article offers a critical reflection on the function of education, health and care plans (EHCPs) in pathways to employment for disabled young people. We consider ‘the education plan’ as an artefact of special educational needs systems. We problematise the often taken‐for‐granted assumption that such plans are always and only a ‘good’ thing in the lives of disabled young people seeking pathways to employment. At the same time, we consider the rise in demand for plans that are understood by many as a crucial mechanism for achieving support. Following the recent policy reforms in England, we describe a context in which the funding of education is shrinking and in which the promise of employment for disabled young people has yet to be delivered. We conclude by proposing some changes to policy and practice to enhance employment opportunities for disabled young people.

Statutory Assessment for Special Educational Needs and the Warnock Report; the First 40 Years

The Warnock report ‘Special Educational Needs’ (Warnock 1978) provided the catalyst for an enduring framework of individual statutory assessment in England for children and young people (CYP) with Special Educational Needs (SEN). . Through its implementation in the Education Act 1981, consolidated in the Education Act 1966, the report established the overall SEN framework in England for last 40 years; laying the foundation for statements of SEN and more recently Education Health and Care Plans (EHCPs). The underlying legal structure created by Warnock has been reinforced rather than changed with the introduction of the Children and Families Act 2014. However by establishing rights to specified levels of resources, at the level of individual provision, the Warnock framework has risked undermining adequate provision and parental confidence in Special Educational Needs and Disability (SEND) provision overall-a central paradox of the SEND framework. This paper considers the consequences of an over reliance on statutory assessment to secure provision, the extent to which it skews resources within the system to one group of children and is therefore in danger of undermining the overall objectives of the current SEND reforms. However it is difficult to reform the statutory system without creating greater parental confidence in the non-statutory offer. While additional legislation to strengthen the SEND framework is desirable the Government could address the overreliance on statutory assessment by a more rigorous implementation of current legislation linked to reforms in funding, accountability and a renewed focus on the Equality Act 2010 provisions on SEND. This would entail the Government being willing to support a more rights based and less market led approach in schools and other settings and introduce strategies to reduce the reliance on statutory assessment in favor of ensuring the education system could routinely meet more CYPs needs. The conclusions are focused on the English system of SEND but the solutions are of relevance for other SEND assessment and funding models which are also considered.

The Role of Educational Psychologists in Fuelling the Narrative of the “Velcro TA”

The notion of ‘Statementing’ borne out of the recommendations of the Warnock Report (1978) set in motion unprecedented reforms in the use and allocation of resources, including the use of Teaching Assistants (TAs), in supporting children with Special Educational Needs and Disabilities (SEND). There has been a move however to question the efficacy of TAs, which has led to a number of studies into their effectiveness. Concern remains around the idea of what has colloquially become known as the ‘Velcro TA’, and how support can provide scaffolded and independent learning. Central to the assessment process of Statements of Special Educational Needs, and current Education Health and Care Plans (EHCP), educational psychologists (EPs) have a prominent role to play in providing advice around provision and the effective use of resources. Consideration therefore needs to be made as to how EPs may contribute to the construct of the ‘Velcro TA’. This paper explores the role of EPs in contributing to this through a consideration of how EPs discuss support through written psychological advice for Statements of SEN/EHCPs and by exploring the perspectives of school staff of how support is delivered in practice. The historical Psychological Advice of ten pupils were analysed using Thematic Analysis. Of these ten pupils, interviews with members of current school staff for five of the pupils were transcribed and the data analysed using Thematic Analysis. These interviews included five SENCOs, five Teachers and five TAs. The results from the Thematic Analysis of the psychological advice identified that EP advice does not seem to have contributed to a notion of a Velcro TA and the theme of Independence was prominent throughout. However, analysis from both the psychological advice and the school staff interviews identified an overarching theme of Ambiguity which underpinned many of the themes, including themes of Classroom Practice and Role of Others. The analysis from the psychological advice identified that there was often a sense of ‘what to do’ but not necessarily ‘how to do it’ and it appears that this Ambiguity is reflected into school staff practice.

‘I'm ready for a new chapter’: The voices of young people with autism spectrum disorder in transition to post‐16 education and employment

This study explores the views and experiences of 12 young people with autism spectrum disorder (ASD) in transition to post‐16 education and employment, in light of the changes introduced by the new special educational needs and disability (SEND) legislation in England. The extension of provision until the age of 25, and the introduction of person‐centred education, health and care (EHC) plans, have given a significant place to the views of young people with SEND and their families. The views, wishes and aspirations of young people must be captured in the newly developed plans, reflecting the statutory requirement for local authorities to systematically record these in a biopsychosocial way, focusing on participation and well‐being. Twelve semi‐structured interviews were conducted with young people with ASD attending specialist settings or receiving specialist support under the new EHC plans. These were analysed inductively, through thematic analysis. The findings suggest that at the time of transition, young people with ASD want to become increasingly more independent, present ambivalent feelings about their future and acknowledge the relevance of support systems in their lives. Implications for practice and future research are discussed, in light of the new English policy context.

Developing an Individualised Assessment for KS1 &amp; 2 pupils with profound and multiple learning difficulties

This article charts one school's journey in securing an assessment regime aligned with its vision for its learners with profound and multiple difficulties (PMLD). Previous iterations, based on commercially‐based systems, as well as lessons learned from reflecting on the school's own assessment practices, were used as catalysts for the development of a whole‐school, whole‐curriculum approach which reflects both the short‐ and long‐term targets incorporated in education, health and care plans (EHCPs). The article, contributed by a member of the school's senior leadership, adopts a narrative style in reporting the success of a bespoke assessment scheme, which makes an innovative contribution to individualised learning. [ABSTRACT FROM AUTHOR]

Capturing the Voices of Children in the Education Health and Care Plans: Are We There Yet?

The need for a focus on the voice of children with special educational needs and disabilities (SEND) has received increased recognition internationally both in policy and research. In England, this was emphasized in the new special educational needs framework introduced in 2014. As part of this new policy, children with disabilities and/or additional needs can receive an Education Health and Care (EHC) plan. The EHC plan is a single document that should describe the children’s strengths and needs in a multi-disciplinary and holistic way. Section A of the EHC plan must include the child’s own perspective. In this context there is much need for evidence on the quality of these new plans and in particular on the quality of the depictions of children’s voices. The aim of this study was to address this knowledge gap by analysing the depictions of children’s voices and the process by which these were gathered in 184 EHC plans of children with SEND attending mainstream and special schools in the Greater London area. The content analysis of the section concerning the children’s voices was conducted using the categories of a multi-dimensional classification system, which includes aspects relating to the child herself, but also to her environment and relationships – the International Classification of Functioning, Disability and Health (ICF). The findings revealed high levels of variability in the way the voices of children were captured, including the methods used to ascertain their views. Additionally, the type of school that the child was attending seemed to play a significant role on how his/ her voice was captured, favouring mainstream schools. The findings of the present study provide the first set of evidence-based data concerning the quality of the content of the newly introduced EHC plans and are discussed in light of the implications they have for policy, practice and further research in the area.

‘Forget the Health and Care and just call them Education Plans’: SENCOs' perspectives on Education, Health and Care plans

In England, Education, Health and Care (EHC) plans are used to identify children's educational, health and social needs, and describe the additional support required to meet those needs. Replacing statements of special educational needs (SEN), the intent was to improve the process of accessing SEN provision through the greater participation of families in decision‐making processes, and increased collaboration between education, health and care sectors. Special educational needs co‐ordinators (SENCOs) play a pivotal role in the implementation of education reforms, and are often responsible for the application of EHC plans. As such, gaining insight into their experiences of initiating applications and transferring statements of SEN into EHC plans can help identify whether these documents are meeting their objectives as person‐led, wraparound care plans. This qualitative study used semi‐structured interviews to explore 16 SENCOs’ perspectives on the effectiveness of the process of applying for and transferring EHC plans. Thematic analysis of responses elicited three key themes: the perceived role of the SENCO in the EHC plan process; procedural challenges and changes – an evolving process; and difficulties in accessing an EHC plan for children with social, emotional and mental health needs.

Statements of special educational needs and tribunal appeals in England and Wales 2003–2013 – in numbers

The study presents a statistical analysis of statements of special educational needs and Special Educational Needs and Disability (SEND) tribunal appeal rates in England and Wales. It is set against the backcloth of the 2014 Children and Families Act which replaces statements with Education, Health and Care (EHC) plans. The numerical overview provides a research baseline for future Local Authorities’ (LAs’) benchmarking of EHC plans by comparisons with statements and SEND tribunal rates. There have been wide variations across LAs since 2003. The percentage change in statements ranges from +49% to −60% whilst there are even larger differences in the rate of tribunal appeals, both by type and location of Authority. The discussion refers to the use of mediation to resolve disputes between LAs and parents and for regular LA self-reviews, to avoid a potential inflationary and inequitable growth in EHC plans and to avert resource drift.

Care provision for children with special needs to be overhauled

Although many schools have support services in place to aid the learning of vulnerable students, it is becoming increasingly important for schools to also offer social and behavioural support to make sure nothing stands in the way of students achieving their full potential. Last month, the government published draft legislation on the reform of provision for children and young people with special educational needs (SEN), setting out the framework for a new system to support those currently identified with SEN and disabilities (Department for Education (DfE), 2012a). The Children and Families Bill will offer the biggest reform in 30 years, building on the reforms to the health service and drawing on recommendations of the Children and Young People’s Health Outcomes Forum. Key measures for SEN include the move to a single assessment process (0 to 25) which is streamlined, better involves children and families and is completed quickly. Also, Education Health and Care Plans (EHCP) will replace the statement, aiming to bring services together and improve outcomes. The requirement for local authorities and health services to jointly plan and commission services that children and their families need means that the local authority’s role will still be key in delivering and facilitating education services. Meanwhile, the requirement for the local authority to publish a local offer indicating the support available to those with SEN and disabilities and their families will no