Saturday, 13 August 2016

Updated example EHC Plan for a social communication programme in the home

Well here we are finally – at a stage where I can share my example EHC Plan.  When I said to participants at the Big Lottery funded ‘Social Communication and EHC Plans’ workshop last July that I was working on the example plan that ‘lined up the ducks’ for a home programme of social communication and would share it asap, I didn’t for a moment think it would take this long :(

For anyone who is new to the blog, what is meant by a ‘social communication programme’ is a way of interacting with a young person with autism that uses the relationship and interaction between the adult and the young person to give the young person another chance to master missed developmental milestones.  These missed milestones are what lead to difficulties in adaptive functioning – the ability to ‘read’ social situations; to understand and infer what other people are thinking; to use the perspectives of others to inform our thinking and decision-making; to build emotional regulation and resilience.

The example EHC Plan that I am sharing is based on a real life EHC Plan, N’s Plan (permission from parents and N himself given – for which we are extremely grateful).  Our goal with this Plan is to word it in such a way that it lends itself to requiring that a home programme of social communication is identified as the only way to meet some of the needs outlined in the Plan.  N, the pupil to whom this Plan belongs is already receiving a social communication programme in the school setting, because he is placed at Bright Futures School.

There have been protracted negotiations over the wording, with local authority representatives keen to ensure that any statements that were made about needs in the EHC Plan were backed up by evidence.  What has been key in terms of evidence has been the Educational Psychologist’s report and the social communication report completed by the external RDI Consultant who works with our school.

The order in which those reports were written and shared has also been crucial……we made sure the social communication report was done first so that it could be shared with the EP before she wrote her report (tactical manoeuvre).

Bright Futures School has a very good working relationship with the local authority EP who inputs into the annual reviews of our students.  She understands what we are trying to achieve with our school social communication programme and has seen the progress our students have made.  Her report, although it makes no comment on the need for a home/community-based social communication programme, was very supportive of the case for social communication input generally.

The social communication report from our external RDI Consultant was also pivotal, as you can imagine.  It provides very robust evidence for need and provision.  In particular, the RDI Consultant emphasises how many of the competencies that N has developed and the challenges that he has faced have occurred in the protected environment of Bright Futures School where staff are specifically trained to support him.   

The report highlights that he also needs to be able to employ adaptive strategies, use the perspectives of others to inform his thinking and remain on an even keel emotion-wise in the less protected and more challenging environment of the family home and the wider community.  This will require extensive practice including role plays, reviews and previews of different scenarios and varied potential responses.  It will also require a skilled supporter to be present with N so that when challenges happen, he can be supported appropriately to ‘Stop and Think’ in the moment in order to try to inhibit a potentially unhelpful reaction/response.

Funding from social care?

This is what opens the door to potential funding from social care.  Just to be clear – N already has a social care support plan in place but his Mum has been canny in the way she has approached this.  Initially she applied for support from social care to enable N to lead an ‘ordinary life’ i.e. to take part in enjoyable leisure activities in the same way as his typical peers.  At that stage, nothing about the need for N to practice key adaptive functioning competencies in the community was mentioned.  

Neither was mention made of a home programme of social communication being required as the provision to meet these needs.  This was done deliberately as it was anticipated that mention of these needs or of a home programme as provision to meet these needs would prove controversial and potentially delay and/or undermine the funding being agreed for the ‘ordinary life’ leisure activities.  Now that the EHC Plan has reached this stage, Mum has gone back to the social care panel with a request for additional funding to meet the needs relating to practicing adaptive functioning competencies in community and home settings.  The needs for adaptive functioning have already been agreed in the social care assessment but are not yet provided for in the social care support plan. Ahem, *cough, cough* not that we set that up at all…………..

Funding from health?

We placed quite a lot of detail about N’s difficulties with anxiety, stress and emotional regulation in the Plan in the ‘social, emotional and mental health’ part of Section B. These are (mental) health needs that relate to N’s education and as such, they are intended to pave the way for the potential for health funding for a home programme of relationship-based social communication to support work to be done in home and community-based settings on these issues.

Any readers who have been following my previous attempts to get health funding for N will know that an application for funding from the CCG under the Children’s Continuing Care Framework went all the way to the Health Service Ombudsman.  At the time, being eligible for Children’s Continuing Care funding was the only way to get funding from the CCG in an EHC Plan.  Rules have since changed and this resulted in the Ombudsman (who was a woman – that non gender-neutral language always annoys me!) ruling that funding must first be sought via ‘universal and specialist services’ before applying for Children’s Continuing Care funding.  EHC Plans are ‘universal and specialist services.’  

So, Mum has now written to the person at the CCG who is responsible for EHC health funding, pointing out that N has needs that cut across health, education and social care and asking what the arrangements are for joint funding/commissioning to be considered given these circumstances.

We have been told that a joint meeting between school, parents, education, health and social care commissioners/financial decision-makers will be arranged to discuss this further before September.

The EHC Plan

The example Plan can be found here.  What we have done is firstly to ensure that social communication (SC) needs are clearly identified in Section B.  These SC needs are highlighted in red, for ease of reference.  There is also some blue text, which reflects needs and provision relating to sensory/reflex integration……..that is another very long story, which I won’t go into here.

Similar information to that appearing in Section B, ‘Needs’, about mental health needs is repeated in Section C ‘Health needs which relate to SEN’.  Information about social care needs that is written into Section B is repeated in Section D ‘Social care needs which relate to SEN’ in order to cover all bases.  

Please note that only needs that appear in Section B and provision that is outlined in Section F can be appealed to SEN tribunal unless you are lucky enough to live in one of the 17 local authority areas that is trialing joint appeals for health and social care as well as education.  More info on pilot areas can be found here.

In Section F, ‘Provision’ you can see that a relationship-based social communication (RBSC) programme (that meets the NICE autism guidelines) is recommended at different points across both home/community and school settings.  In reality, all of the competencies delivered by an RBSC programme are needed in all areas life – to enable learning, to make and maintain friendships, to live independently and to secure meaningful employment as well as to have good mental/emotional wellbeing.  

So…..that’s where we’ve got to.  We have done our best to line up our ducks and we now await the joint meeting with reps of health and social care as well as education.  If we are not able to finalise the draft EHC Plan at that point, parents will, with my support, be appealing to SEN tribunal on the education matters and using the appropriate complaints systems to take up any matters relating to health or social care.  Poor parents…….what a performance…..potentially three separate appeals.  Good job they are resilient, resourceful and determined.

In summary

The EHC Plan example is not perfect, it’s still a work in progress and I am sharing it as a guide rather than a ‘bible’.  Additionally, each young person is different and their autism-related difficulties will express themselves in different ways, requiring different provision. 

However, we do know what the difficulties at the heart of autism are and we do know that in many cases, these difficulties result in huge challenges to a young person’s ability to have a good quality of life: to make and maintain friendships and relationships, to live independently, to secure meaningful employment and to have good emotional wellbeing.

We also know (and the National Institute for Clinical Excellence in Health and Social Care has endorsed this in this NICE guideline) that it is possible to work on, and to ameliorate some of these core difficulties.  NICE has even given us criteria for social communication interventions that work on the difficulties at the heart of autism.

NICE recommends that providers of services consider a specific social communication intervention for the core features of autism in children and young people that includes play based strategies with parents, carers and teachers to increase joint attention, joint engagement and reciprocal communication in the child or young person. NICE recommends that programmes should:

  • Be adjusted to the child or young person's developmental level
  • Aim to increase the parents', carers', teachers' or peers' understanding of, and sensitivity    and responsiveness to, the child or young person's patterns of communication and interaction
  • Include techniques of therapist modelling and video interaction feedback
  • Include techniques to expand the child or young person's communication, interactive play and social routines.

NICE recommends that this intervention should be delivered by a trained professional.  

RDI is one intervention that meets the above criteria.  If you are seeking to get social communication provision (at home or at school, or both) included in your child’s EHC Plan, I strongly recommend that you commission a social communication assessment and report from an RDI Consultant who will also be able to help you think through the wording for your EHC Plan.  

 A list of RDI Consultants can be found here.

I hope that is helpful.  Please do give me feedback.  I would be particularly interested in hearing from anyone who successfully uses any of my shared information.

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