Monday, 8 June 2015

EHCPs: how to make them work to address the core difficulties in autism



Several people have asked me recently if I could share my take on what - from a developmental perspective - should go in an Education, Health and Care Plan (EHCP) for a young person with autism.

First off, I would say that the developmental gaps or core difficulties of autism are best addressed under the sections on ‘communication and interaction' and ‘social, emotional and mental health’.

Exact needs will depend on the autism profile of the individual young person of course, but since the difficulties at the heart of autism are usually more or less the same (otherwise the young person wouldn't have a diagnosis of autism), the needs (Section B of the Plan) are likely to look something like this:

Needs: Communication and interaction

Number
Need
1
Student has difficulty making and maintaining friends
2
Student is often rigid in his thinking and behaviour and has great difficulty managing uncertainty and change
3
Student is unable to take on board the different perspectives of others in order to help  to decide what to do in situations of uncertainty and/or to problem-solve challenges
4
Student does not read the non-verbal communication of others or use trusted adults as a point of reference
5
Student does not have the social competence to take part in reciprocal social interaction

Needs: Social, emotional and mental health

Number
Need
6
Student has severe difficulties with emotional regulation
7
Student has difficulty staying within limits and accepting boundaries of adults
8
Student can become easily distressed and agitated
9
Student is unable to keep himself safe
10
Student has great difficulty sleeping and is often awake in the middle of the night

So if those are the needs, then the outcomes (section E) might look something like:

Outcomes: Communication and interaction

Number
Outcome
1
Student will make progress towards mastery of the developmental milestones that lead to competence in relationships
2
Student will start to be able to manage gradually more complex challenges/uncertainties, becoming more flexible and adaptive
3
Student will work towards mastery of simple perspective-taking
4
Student will make progress towards mastery of both reading and using the 5 channels on non-verbal communication as well as mastery of social referencing
5
Student will learn how to co-regulate (interact reciprocally) during social interactions

Outcomes: Social, emotional and mental health

Number
Outcome
6
Student will start to be able to take part in increasingly more complex cycles of regulation-challenge-regulation
7
Student will be more able to accept limits and boundaries from trusted adults
8
Student will be able to employ strategies that enable him to better handle his periods of distress and agitation
9
Student will be better able to understand the intentions of other people in order to keep himself safe
10
Student will be better able to settle himself if he wakes up in the night

……and then the provision (section F) to meet the need (and lead to the outcomes) might look something like:


Support needed
Who delivers
Frequency
Review
Assessment of student’s complex autism and anxiety
xxx specialist service
Within 1 month of funding being agreed
Quarterly against agreed outcomes
An integrated programme of:
 a) Psychodynamic therapy
xxx specialist service in conjunction with local CAMHS
Weekly
Quarterly against agreed outcomes
 b) Relationship
Development Intervention (RDI) in the educational setting
Teacher/TA on a 1-1 basis, supervised by external RDI Consultant
Daily for 1 hour
Quarterly against developmental objectives assigned
 c) An RDI programme in the home
Parents, supervised by external RDI Consultant
Twice weekly each parent for 30 mins
Quarterly against developmental objectives assigned

Bear in mind this is not the whole EHC Plan.  I have not addressed anything to do with young person’s views and strengths or their cognition and learning.  The sections on health and social care are not addressed here either as I am simply focusing on the developmental aspects but I would add that some of the mental health related needs could also be flagged up in the ‘health’ section and some of the needs around developing friendship competence, mastering perspective-taking, emotional regulation and staying within limits could also arguably appear in the ‘social care’ section as these would all be essential for the young person to be able to access appropriate leisure opportunities in the community setting.

So what I have done here is to make addressing social communication gaps (the ‘needs’ described in numbers 1-9 inclusive above) crucial to the young person’s ability to access the curriculum and then to show that RDI is the provision required to meet needs 1-9 inclusive.

I feel like I’ve come full circle here.  Regular readers of my blog might remember this post from back in 2011 when I wrote:

‘In the education sector, even the most up to date inclusion tools funded by government advocate compensating for or working around the difficulties that pupils on the autism spectrum present with. There is no mention of helping pupils develop flexible, adaptive thinking to help them better access both the academic curriculum and the hidden social curriculum.’

What I have described in the EHCP above in the ‘needs’, ‘outcomes’ and ‘provision’ will help pupils to develop flexible, adaptive thinking and better access both the academic and hidden social curriculum. 

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