“Keeping it local” – the challenges faced by a small

AAC team in a huge, densely populated county

Vicky Healy Specialist Speech and Language Therapist for AAC Surrey CAT victoria.healy@surreycc.gov.uk

SURREY

•  1.17 million people in Surrey (2017) •  642 square miles •  11 districts •  Borders / crossover of funding /

neighbours!

SURREY…….

SURREY – the wealthy county? •  In the UK, a disproportionate number of children and

young people are in or at risk of poverty or social exclusion compared to adults

•  This pattern is replicated in Surrey

•  We know that this can be detrimental to educational, health and social outcomes in later life.

•  There are an estimated 28,000 children and young people (0-19 years) living in poverty in Surrey.

•  Surrey is also the 4th largest Gypsy, Traveller and Roma community in the UK

SURREY – A diverse population? •  People describing themselves as “white British”

accounted for 83% of the population of Surrey in the 2011 census (slightly higher than the UK average)

•  However, Surrey has become more ethnically diverse with rising numbers of people identifying with minority ethnic groups since 2013

•  Looked after children

•  Military families

•  A parent set like no other….

Surrey’s challenges “We face significant challenges in achieving our ambitions for our children and young people. Not only are we facing a protracted period of fiscal restraint, we are also anticipating a significant growth in the number of children living in Surrey”

Helyn Clack, Cabinet Member for Health and Wellbeing, Surrey County Council

SURREY CAT • Naming issues…… Historical ties…. •  Janet Larcher and Ruth McMorran are a

hard act to follow!! (and a lot of their cohorts are still there……)

•  Surrey SEN / VI / ICT •  SCAT (oops!) •  SCAATT •  Surrey CAT

THE TEAM and where we are •  Based in Leatherhead – as part of the

Physical and Sensory Support Service Specialist teachers – HI / VI / PD / Post 16

•  Technical and financial officer •  Admin support for reports / school liaison •  Advisory teacher for Assistive Technology • Courier (Sight for Surrey) • Day to day running from base – equipment

– loan bank and spares

SPEECH AND LANGUAGE THERAPY SERVICE - links

•  April 2017 – SLT school service came to SCC from Virgin Care (NHS)

•  Promises made to about improvement of mainstream provision

•  Smooth transition!? •  A positive step for Surrey CAT in terms of better relations / training •  Lots still to do for joined up working

Referrals

•  Anyone can refer to our service •  SLTs, teachers and specialist teachers

(PSS),SENCOs, parents, nursery staff • Detailed form but not overwhelming! •  Ask for videos and reports to support

Caseload •  239 active students on caseload •  (15 in 2006 when Ruth started and around

200 when she left in 2014) •  40 new referrals this academic year (SLTs) •  200 attend schools / nurseries in Surrey •  16 are at home / home schooled •  23 are in special schools out of Surrey •  Additional AT caseload is extra (200) • Only 5 or 6 of caseload would meet criteria

for Specialised Services

SURREY CAT – OUR REMIT •  To assess, monitor and review the AAC needs of students in

Surrey education 0-19 years (19-25 is extra!)

•  Referrer should be present

•  Provision of information, support and advice to teachers, teaching assistants and other professionals in educational settings. Signposting…..

•  Monitoring the progress of those pupils provided with AAC equipment including trials and longer term (TOMS)

•  Supporting the management of pupils who have been provided with equipment including liaison with families

•  Planning and coordinating training courses and workshops.

SCHOOLS AND EDUCATION •  Overall, Surrey has high standards of educational

achievement

•  88% of schools were rated as good or above by OFSTED (2015).

•  Surrey’s results in Key Stage 2 and GCSE’s in 2013 / 2014 surpassed England and the South East.

•  74% of young people are supported through provision maintained by SCC

•  3.4% of Surrey’s CYP have SEND

•  Approx. 800 children in Surrey are home schooled

•  In 2014, 5,383 children and young people aged 0-19 in Surrey had Statements of SEN (now EHCP) though not all have transferred.

•  Since 2009, the number of children needing an education, health and care plan has increased by 7.5%

•  Our team has significant involvement with EHCP statements and review process BUT lack of clarity and consistency

•  45% supported in a mainstream setting •  45% special school •  8% in a specialist unit in a mainstream school •  2% spread between parental provision, nurseries, further

education and other provision

MAINSTREAM PROVISION •  Classes of 30(+) students •  Physical access around school •  Access to high and low tech resources (who

funds / who produces?) •  Trying to adopt a whole class approach •  Joint planning and target setting at the

beginning of the academic year •  INSET training •  Keeping parents informed and onside

SPECIALIST PROVISION •  The proportion of CYP with SLD in Surrey is

double what it is nationally – 13% compared to 6% (8 SLD schools & 7 LD schools + units attached to schools)

•  Training for staff is more focused on SEND •  Easier to work with the SLT / therapy teams

who are often on site more often • Higher turnover of support staff •  Focused day / half day dedicated to AAC

and communication built into school targets

SURREY’S commitment to SEND

•  SEND 2020 is a programme in Surrey to transform the way that services for children with special educational needs and disabilities are delivered, including early identification and intervention within the antenatal period.

•  “In line with SEND 2020, we should continue to develop a partnership approach to supporting children with SEND, including early identification of need and intervention”

1: Transform the customer experience

2: Re-build the system around the customer

3: Reshape the SEND local offer

4: Develop inclusive practice

OUT OF COUNTY PLACEMENTS •  PD provision is lacking for secondary

education in Surrey (1 school) • Historically been an over-reliance on out-of-

county independent provision. • Despite best efforts, children in mainstream

with PD / AAC needs often end up in out of county placements (secondary)

• Comes at a price and a parental battle TRIBUNALS!!!!!

•  A rethink of provision is needed…..

JOINED UP WORKING • Advice – phone / email / in settings • Variety of settings and staff groups • Communication across teams –

teachers, SLTs, Social services, health • Second pair of eyes • A back up to good practise already in

place •  “I always feel so much better after

you’ve been…”

BESPOKE TRAINING •  A necessary shift in how we deliver training • General AAC training – for school teams, SLT

teams •  Around a child and their device •  Parent training on software •  INSET training • Hardware / software day training – often with

AAC company

PARENTAL CHALLENGES •  Therapy input – delivery / time / how often

•  EHCP process is frustrating and time consuming

•  Social media / bad press / other families

•  Previous bad experience with services

•  Involvement of independent professionals

•  Preparation for the future – expectations

A POSITIVE SHIFT IN AAC OPINION

•  Better training / awareness and understanding of AAC

•  Increased knowledge from social media / mainstream tv etc

•  AAC less thought of as the last resort or as something to be feared

•  SALT targets • More joined up working

WHAT HAPPENS AT 19 YEARS?

• Current provision….. • Depends on placement or age of equipment •  Funding complicated…. •  Adult SLT team •  Specialised services • Colleges – continue support and can

usually hold onto equipment but chargeable visits

KNOWLEDGE BASE OF AN AAC “EXPERT”

•  Someone from one of the big AT suppliers said to me the other day “I could never do your job….”

•  Keep up to date with technology, latest thinking in AAC / AT……

• CPD for HPC including mandatory training •  Passionate about job……..Bigger picture

can be frustrating…

THE FUTURE? •  The overall population of young people aged

5-24 in Surrey is forecast to increase by 13% in the next 20 years

•  This projects an increase of 10% (or just over 1,000) in the number of young people aged 4-25 with SEND between 2013 and 2033

• How will services cope?

•  Funding – education / social services / CCGs?

•  Additional staff – OT / Technical instructor / SLTA

•  Already services are stretched to capacity – particularly OT / SLT

• More joined up working with other professionals – less battles!

LOCAL SERVICES – the challenges

•  Still a lack of consistency across country •  Funding – how sustainable? • How to make a good business case? •  Are we seen as a “second rate service”? •  Are parents scared of statutory services if

they have previous frustrations with other services eg wheelchair provision?

•  Better network of local services (this is happening – bear with us!)

Case study •  TB •  RTA – spinal, cervical and brain injury •  Children’s Trust, Tadworth •  Home •  Special school •  Home •  Huge MDT, many independent professionals,

ongoing difficulties with equipment, overlap of roles but works really well,

•  Complete trust and support from parents

A Day in the life of……