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Recommendation for Placement Report

Name: Matthew Ball

Date of Birth: 11.03.1998

Address: 21 Cleves Avenue, Epsom, Surrey

Authority: Surrey

Current School/College: Linden Lodge, Wimbledon, London

Assessment Dates: 18 & 19 November 2015

CONTENTS

1. Introduction2. Personal Profile3. Outline of Visual Status4. Summary of proposed provision5. Recommendations6. Appendices 1-9

THIS REPORT IS INTENDED FOR INTERNAL SCHOOL/COLLEGE USEONLY TO BE USED WITH PERMISSION AND AS A COMPLETE DOCUMENT

Rec for Placement Report Matthew Ball 2015 of 32

IntroductionMatthew currently attends Linden Lodge School, a specialist school for children with visual impairment in Wandsworth, London. WESC has a close working relationship with Linden Lodge School and each year a number of young people move on to WESC for a specialist residential college placement. Mr and Mrs Ball have been in contact with WESC since March 2013 and Mr Ball attended a WESC open day in October 2015. Matthew is being considered for a termly residential placement for his post 19 education from September 2017. It should be noted that it has been requested that Matthew has a termly boarding place, including staying at WESC for half term breaks. Matthew attended this two day assessment with his mother and father. This report has been compiled for the purpose of determining whether a placement at WESC Foundation would be appropriate for Matthew. It is based on information gathered from documentation and reports provided by his parents, previous school and various health professionals. It also draws on the observations and conversations that took place during this assessment visit.

Personal profileMatthew lives at home in Epsom with his Mum, Lynda and Dad, Graham. He has an older brother, James who has recently returned home following University. Matthew attends Linden Lodge and has 1 night/week residential respite. It is understood this is soon to increase to two nights a week. Matthew is on the IMPACTS pathway at school. The following p levels were reported for his last summer report 2015:

Curriculum area NC Subjects Current NC/P Levels

CommunicationLanguageLiteracy

ReadingP3ii.4Writing

SpeakingListening

Cognitive & Creative

Number

P3ii.6

Shape, space etc.

Use & applicationHumanities

CookingRE

MusicArt

Personal, social, emotional, well being

PSHCEE P3i.8

Environmental control technology

ICTScience

P3i.8

Physical PE, Fitness, Yoga,

movement, swimming

P7.4



It is reported that Matthew tends to be adult- centred in his social interactions. His school, reports that Matthew is becoming more sociable with his peers but that he still struggles to participate in some aspects of group activities. He is reported to appear to be enjoying and feeling secure in his class. He enjoys being outside and likes to go out and about in the community. He does struggle with changes to staff and needs a consistent 1:1 presence to ensure his confidence and progress. It is understood that he is currently funded for 30 hours of learning support during the day.

Matthew’s parents report that Matthew particularly enjoys being outside and listening to the sounds that he hears outside. However due to his sensory processing challenges and reduced vision he doesn’t enjoy busy places such as supermarkets or busy shopping centres. Matthew will tolerate some noisy environments but will put his hand up to his ears if things are becoming too noisy.

Parents report that Matthew has enough vocabulary to express his wants and needs and this is mostly through single words. They are trying to develop his language skills and develop the length of his phrases. Parents use sentence starters to cue Matthew in to what he wants to say. Matthew requires scaffolding questions to help him support his answer.

Matthew has Pervasive Developmental Disorder, ASD and Learning difficulties with behavioural problems. He is also cerebrally visually impaired. He is myopic, has nystagmus and a slight right convergent squint. Matthew is registered partially sighted.

Matthew can demonstrate challenging behaviour. It is reported that he has mood swings that can include temper tantrums, which can be linked to frustration and/or not getting his own way. Matthew may hit out, scratch, kick and make loud noises or head butt. These behaviours are rarely directed at a person, more likely towards the objects around him. Matthew takes Risperidone daily. Sometimes there are triggers to his behaviour but on occasions they seem to be unrelated to anything around him.

He also has an unsettled sleeping pattern. He tends to go to bed late. He goes off to sleep well but wakes numerous times throughout the night and at home is quite disruptive for the family.

Matthew has boarded for one night a week since 2011. It is understood that a second night has been requested to enable increased access to the waking day curriculum.

Outline of visual statusMatthew has a visual diagnosis of Nystagmus, myopia and is recorded as having elements of Cortical visual impairment.

It is reported that Matthew wears his glasses for specific sessions in school. At times he will independently remember that he needs to collect his glasses and will prompt his teaching assistant. He has no binocular vision and therefore finds judging distance and depth perception difficult.



Matthew has CVI (Cerebral or Cortical visual impairment). The level of impact that this has on functional vision is very individual and can vary depending on environmental conditions and indeed the individual person’s physical and emotional status. Matthew demonstrates a number of the characteristics that are typical of a young person with CVI, these include; being distracted from visual attention by background sounds/noises, ‘switching off’ vision if listening and tires from visual activity, giving up when his visual threshold is reached. Further time would be required for a more comprehensive assessment of Matthew’s CVI and an individual visual profile would need to be developed identifying which of the CVI characteristics Matthew demonstrates and to what extent these are impacting on his learning and living. An individually tailored programme of interventions would then be incorporated into his weekly timetable with the aim of trying to resolve some of the effects of his CVI.

Proposed WESC provision

Summary of overall outcomes:

To develop a comprehensive understanding of Matthew’s functional vision and implement a framework of interventions to support Matthew in using his vision as effectively as possible in learning and living.

To develop a range of independent living skills appropriate for a young person with little sight. These should include practical skills such as personal care skills and independent mobility skills taught by a qualified children and young people’s habilitation specialist.

To have a sensory diet developed which is effective in helping Matthew to process environmental stimuli and contribute to an effective behaviour management plan.

To provide Matthew with an environment in which he is challenged and stretched academically and in terms of his independence, within a supportive and structured framework, overseen and monitored by staff who understand visual impairment and the learning processes associated with it.

To provide a curriculum model which is flexible enough to provide Matthew with regular breaks to help himself regulate when he is over-stimulated.

To support and encourage the development of social interaction skills in a learning environment that has an appropriate social peer group who use verbal language.

To have a speech and language therapy programme based on a comprehensive assessment of speech, language and communication needs and implemented and overseen by a qualified speech and language therapist.

To have access to ICT and access technology equipment and training specifically designed for visually impaired young people.



Educational needs WESC provision

Matthew requires post 19 educational provision that is suited to his complex range of learning needs.He has been identified as having a severe learning difficulty.Educational provision needs to be able to meet his visual, behavioural, and sensory processing needs in a holistic way through a collaborative and consistent multi professional approach to supporting his learning.

At WESC, education and other specialist staff work collaboratively as part of a multi-disciplinary team. In many cases specialists work in the classroom as part of the timetabled day as well as supporting evening activities.

Multi-disciplinary case reviews can be called at short notice in addition to regular learner centred multi professional meetings.

His end of year report indicates that Matthew is generally working in the lower P levels, around P3.

At Post 16 a range of accredited vocational qualifications are offered to meet the young person’s aspirations & interests. The qualifications develop skills in independence and skills required for adulthood, these include Life & Living, Occupational studies-offering a range of units suitable to individual needs and Personal, Social, Development qualification. Alongside the vocational studies the young person will study Functional Skills (Maths & English), and ICT qualifications suitable to their level of ability.

Independent Living Skills(ILS) :Matthew has had some experience of ILS but this is a significant area for development and should involve taking responsibility for personal care, daily living and practical home care skills.

Skills for Independent People (SKIP). A significant percentage of the college timetable is dedicated to aspects of ILS, as determined on an individual basis.Food preparation, household tasks and personal care skills are delivered by QTVI’s in conjunction with members of the therapy team.

Work / employability skills:Matthew needs to develop appropriate social interaction skills.

This is achieved for all learners through community placements including; WESC charity shops, Dartmoor Heritage Pony Trust, Dawlish Garden Trust.

Social interaction - Matthew’s parents report this is a real area of weakness for Matthew, he does not initiate peer interaction and is more likely to seek attention from adults. When asked

Relationships and sexual health education is delivered by a specialist practitioner in small groups or individually as required.



who his best friend was Matthew named his enabler. Mum also reported that Matthew did not know how to respond when a peer began talking to him.

Matthew is a physical young man who enjoys swimming, cycling and using the gym. He needs to be supported to engage in regular exercise as part of learning to develop and maintain a healthy lifestyle.

Matthew would benefit from the wide range of physical activities available at the college which are suitably adapted for young people with little or no sight. Swimming is available on campus in a 25m pool accessed during the college day and during evening activities.A fitness suite is available for personal and small group fitness sessionsMatthew could participate in cycling; the college has a range of cycles, tandems and trikes, including hand operated trikes for on campus and off campus use.

Specialist needs WESC provision

Matthew has a complex profile of support needs and consequently requires input and monitoring from a range of specialist staff.

Specialist therapy, mobility and healthcare staff are employed by WESC and are an integral part of the multi professional staff team. Staff at the school and college have developed a valuable knowledge and experience base, having worked with a wide range of VI young people over a number of years. WESC staff are experienced in working with VI learners with a range of additional difficulties.

Visual needs:Matthew has high myopia and wears prescription glasses for specific tasks. He also has nystagmus and a slight right, divergent squint.

He also has elements of a Cortical visual impairment and the impact of this neurological impairment should be investigated further.

A full functional low vision assessment would be conducted including consideration of any neurological implications to Matthew’s sight loss. WESC staff are qualified and experienced in supporting young people with a visual impairment.

All of the staff, including catering, domestic and admin staff are made aware of VI issues and play an important role in monitoring learners’ progress and promoting their independence.

ICT/Access technology:Matthew is not particularly motivated A comprehensive assessment of Matthew’s



by ICT. He does engage in the operation of switches to activate visual patterns and sounds on the computer.

ICT support needs would be conducted by a specialist member of the staff team.It would be helpful to explore the availability of appropriate technology that links with Matthew’s interests or supports activities that he likes to engage in.

Behaviour support:Matthew can display challenging behaviours when he is anxious and will need a behaviour support plan. His behaviour may include mood swings, kicking, biting, head butting and screaming if anxious/frustrated. He has occasionally been known to smear faeces. He needs consistent 1:1 support.Parents are in the process of having him referred to the Adult Learning Disability Psychiatry team.

The college adheres to the NAPPI ethos of training and intervention. Staff are trained in the BILD accredited NAPPI behaviour management course. A behaviour management plan can be put in place if required to help avoid any incidents of difficult behaviour escalating.

NB: There is a helpful behaviour management plan ‘how to help me’ from Linden Lodge School which would be a good place to start understanding how to manage Matthew’s behaviour.

Mobility:Matthew moves around known environments without the use of a mobility aid. He needs supervision to ensure his safety and in an unfamiliar environment he would rely on physical or verbal assistance to make him aware of directional travel and obstacles in his path.

At WESC Matthew would have regular mobility sessions from trained and qualified Habilitation specialists. A programme of mobility would include:

Mobility Baseline Assessment Pre-cane skills – guiding techniques,

trailing, orientation techniques Familiarisation of campus layout Location and identification of

landmarks and base points Learning of routes around the

campus Continuation of Cane skills Programme of basic road safety

awarenessPhysiotherapy:Matthew is fully ambulant and is independent with all his transfers.He enjoys a range of physical activities including; trampolining, horse riding, cycle riding and the gym.On assessment it was noted that both feet were quite significantly pronated.

Matthew would benefit from a varied programme of physical activities for cardiovascular fitness and general well-being.

It is recommended that he is assessed by an orthotist for his foot posture.

He does not require any specific physiotherapy input.

Occupational therapy:THIS REPORT IS INTENDED FOR INTERNAL SCHOOL/COLLEGE USE

ONLY TO BE USED WITH PERMISSION AND AS A COMPLETE DOCUMENTRec for Placement Report Matthew Ball 2015 of 32

Matthew is physically quite able and his dexterity is good. However he needs support and supervision with all aspects of daily living and personal care. This includes dressing and undressing, using the toilet, bathing and feeding.Matthew also demonstrates sensory processing difficulties and these can impact negatively on his behaviour.

Matthew would benefit from a Sensory Assessment to establish his sensory processing difficulties and set up a sensory diet. This should form part of his behavioural management plan.

He would also have a SKIP (Skills and Knowledge for Independent People) Baseline assessment of current independent living skills. A programme aimed at maximising his independence skills would then be implemented.

A review of adaptive (VI) kit available to promote physical wellbeing.

Speech and language:Parents report that Matthew has enough vocabulary to express his wants and needs and this is mostly through single words. Matthew requires scaffolding questions to help him support his answer.

It is understood that at school the SALT has introduced the use of a language master device to increase the length of his expressive utterance. He has also been using a multi memo recorder, a portable device to support his expressive language.

Matthew also uses objects of reference to support choice making and communication.

Further assessment of Matthew’s speech, language and communication needs.

Ongoing support from Speech and language therapy to enable Matthew to continue to develop his listening and attention, receptive and expressive language skills and social communication skills.

Music therapy:Although not assessed specifically as part of this assessment it is reported in his last annual review that Matthew ‘thoroughly enjoys music therapy sessions, however struggles to participate in class group music sessions.’

Matthew should have access to individual music therapy sessions as part of his timetable if it is possible.

Healthcare:Matthew has Pervasive Developmental Disorder, ASD and Learning difficulties with behavioural problems. Matthew is registered

Monitoring of general health and well-being

Contribution to multi-professional meetings and report writing



partially sighted.

Matthew is described by parents as being generally very healthy although he has a poor sleeping pattern. Parents have tried Melatonin in the past with little effect.

It is understood Matthew takes liquid Risperidone - Twice a day.

Liaison with WESC staff, other professionals, and Parents/Guardians

Access to a weekly GP clinic held onsite

In addition if required access to various specialist clinics including Consultant Ophthalmologist. Audiology and Optometrist appointments, which are all offered annually

Management of medications alongside support from WESC medication trained Enablers

Learning environment needs WESC provision

Tutor group: Matthew would be part of a small tutor group who meet together each morning. The group gather each morning for registration and briefing before spending an hour together on a ‘Functional Skills’ programme (Literacy, Numeracy and ICT) which individuals follow at an appropriate level.

Teaching group: Groups are typically 1 teacher to 6 learners with 2 support staff. Individual learners also have additional support from LSW’s as identified. Matthew would need a high level of individual support to ensure he is enabled to access the curriculum and to manage inappropriate behaviour.

Teaching staff: Teaching staff are experienced in working with VI learners with a range of additional needs. All teaching staff have the MQVI mandatory qualification for teachers of the VI, are currently on the course or as in one case waiting to go on the next available course. All staff have participated in the WESC two day induction and have on-going CPD through twilight sessions and regular in house training sessions.

Support staff: Learning Support Workers working in education or in the residential care setting receive training in VI awareness and related issues by means of; a two day induction programme, extended induction and twilight training sessions related to VI. A CPD



framework is available to staff covering a range of aspects in relation to care and education of VI offered at levels 2 and 3.

Physical environment: The 14 acre campus provides a peaceful and safe environment which is a VI sympathetic environment encouraging independent mobility in a monitored setting.

Extended curriculum needs WESC provision

Residential provision:Matthew has one or two nights boarding at Linden Lodge each week.Matthew has an unpredictable and often disturbed sleep pattern. He will go to bed late (sometimes 12:30). Once the lights are off he will settle quite well, but will often wake at 3-4 am. Once awake he does not tend to go back to sleep. He will move bedrooms between his room and his parents’, he will say “Mummy get out” to which she will move rooms and Matthew will get into her bed. Although he will be awake and will vocalise he knows he must not put the lights on or be disruptive. However, he can sleep through the night and parents report that last night in the hotel he slept right through.

Residential accommodation is arranged in a number of flats and houses, both on and off campus staffing levels are arranged in accordance with individual learners identified support needs.

Matthew would be a termly boarder. Parents have requested that his boarding provision includes exeat weekends and half term breaks, this will need to be factored in to his residential fee calculation.

Key worker: Matthew would have a key worker allocated to him. The key worker is an important link with the family and regular communication arrangements are agreed and established once a placement has commenced.Key workers also have an important role in working with learners to identify and address areas of personal development.

Care and supervision: Residential boarding at WESC is provided in flats of between 6-8 learners. Staff ratios are high and there is waking night staff supervision through the night.



Independent Living Skills: The Independent Living Skills programme extends into the evenings and weekends. Living skills are supported in the residential flats and houses by the residential care staff. Therapy and mobility staff oversee and direct care staff in relation to their specific areas of expertise.

Leisure:Matthew is an enthusiastic participant in certain activities, particularly swimming and trikes & bikes. He is also interested and motivated by music.

Learners are encouraged to participate in a wide range of activities on and off campus. Learners are encouraged to contribute to the planning of the activities programme and can access activities either individually or as a group. Staff supervise learners and activities are risk assessed appropriately.

Recommendations

Cost of placement to be determined by individual fee calculation.

Date submitted to admission team – 16.12.15

Outcome of submission – To defer decision about placement until end of Spring term 2016. Concerns raised for further exploration:

Behaviour – with current learner profile at WESC would another young person with significant challenging behavior be realistically manageable to ensure safety of Matthew and other learners. Further liaison with Linden Lodge and other professionals recommended.

Residential – Termly boarding seems a big step for someone who has difficult sleeping patterns. Proposed increase in respite provision to be monitored to determine whether residential provision could meet Matthew’s needs.

______________________________________ Date: Richard EllisHead of VI Specialist Services



Appendices

1. Education2. Mobility3. Physiotherapy4. Occupational Therapy5. Residential6. Healthcare7. Speech and Language 8. Visual Assessment



Recommendation for Placement Report : Appendix 1

Subject: Education Name & Designation:Nick Ware – Teacher/Tutor

Name of Learner:Matthew Ball

Date of Assessment:19 November 2015

Assessed current level of functioning based on:

Previous documentation Y

Observation at assessment Y

Discussion with parent/carer Y

Discussion with learner Y

Current level of functioning:It was lovely to meet and work with Matthew on the second morning of the assessment. Matthew said “Hello” and, with prompting, was prepared to shake my hand, though he withdrew somewhat while I talked to his parents. However, he was happy to leave them and engage in the assessment. Over the morning, I observed the following.

CommunicationMatthew is quite verbal and constantly maintains something of an internal dialogue, though much consists of phrases heard in the company of others and inhibits direct conversation. Even so, with appropriate questioning and quiet persistence, he was encouraged to respond to my enquiries. It helped to pose questions and model incomplete answers that Matthew was able to finish (e.g. “Matthew likes to go to…” – “…the park.”) His responses tended to be delivered between recurring phrases that bore little relationship to the intended context and it was difficult to determine how aware Matthew was of my conversation against this background. Longer would certainly be needed to secure an efficient understanding of Matthew’s ability to attend and this might need to be the first focus during the initial stages of any College-based programme. However, it was evident during the morning that he does internalise information that he receives via external sources and that he has learning potential worth continuing development.

ICTIn discussion with his parents, I gained the impression that Matthew was not that motivated by ICT, but he did engage with me in the operation of switches to activate patterns and sounds on the computer. Matthew evidently understood cause and effect in this context and enjoyed the patterns on the screen with his face very near the glass. It would, I think, be helpful to explore the availability of appropriate technology that links with Matthew’s interests or supports activities that he likes to engage in.



LiteracyDuring the assessment, I was most interested in Matthew’s verbal communication, but his parents told me that he has an awareness of phonics and will often volunteer an item that begins with a particular letter when asked. There might therefore be an interest in patterns that merits exploration and might contribute to the eventual use of some symbolic communication, if only at a basic level.

NumeracyWhile exploring various natural objects, I encouraged Matthew to count shells when I passed them to him. He was able to keep to the correct sequence of numbers without difficulty. We also examined various boxes and talked about their shapes. Matthew was obviously aware of some of the terminology but not specific when encouraged to relate it to individual boxes. His internal distractions were quite pronounced at the time and I suspect that Matthew understands considerably more than emerges immediately in these circumstances.

Tactile skills (environments/materials/objects)As Matthew seemed more comfortable there, I sat with him on the floor to explore different items. Matthew investigated them, using various methods, including feeling and tapping. I questioned him regarding some everyday items and, in the case of an empty milk bottle, he was able to state what it once contained. When prompted, he removed the cap of the bottle and then replaced it, using effective fine motor skills. Matthew is evidently capable of manipulating objects and, while he needs the opportunity to engage in sensory exploration, may increasingly be able to learn to use them conventionally and with purpose.

Interests/MotivationsMatthew likes his food and would, I think, gain from the opportunity to regularly prepare his lunch. With a whole morning to achieve this, he would have time to explore the ingredients and engage for short bursts in appropriate elements of preparation and cooking. Domestic work like this could model the adulthood that Matthew will need to prepare for during the Post-19 phase of education and the informal setting would accommodate his tendency to distraction with plenty of time to return to focus. Matthew is an ambulant young man with plenty of energy and I would also strongly recommend plenty of physical exercise (cycling, Rebound Therapy, swimming, walking) and weekly ventures into the community to develop his confidence in the adult world.

Recommended programme or course of intervention offered by WESC:Programmes offered via the Dart Stream in College include the following elements:-

i) Embedded ICT/Literacy/Numeracy

What might this look like with Matthew?

Use of ICT to entertain, inform and support environmental control; development/ enhancement of existing communication skills in different contexts; use of skills with number, measure, shape and space to increase independence.



ii) Employability


Concept development (helpfulness, responsibility towards others, work ethic); engagement in on- and off-site work experiences; experience in different vocational areas; identification of therapeutic vocational interests.

iii) Independence and Life Skills


Community access (including travel); engagement in domestic routine (food preparation, laundry); management of environments, materials and objects.

All of the above could be accredited via the OCR Life and Living scheme which includes Milestones 1-8 and Entry Levels 1-3 or other programmes operating at Entry Level. Matthew currently operates on the middle Milestones (3-6) and could complete the OCR Award in Life and Living Skills (Entry 1) in his initial year at College, the Extended Award in his second year and the Certificate in his third. He would achieve this by completing units in several of the following: Arts and Crafts, Communication, Environment and Community, Home Management, Horticulture, ICT, Manufacturing, Media, Numeracy, Office Practice, Performing Arts, Personal Skills, World of Work. Matthew’s interests and aspirations would inform the selection of appropriate units. Stepping Stones qualifications are available and would also be completed if, on assessment, Matthew was deemed capable of achieving accreditation in one or more of the Functional Skills at Entry 1 or above.

Matthew will, I suspect, work most effectively on an individual timetable alongside and overlapping with others. In terms of grouping, he would be best placed with peers requiring this sort of programme themselves. They might spend the majority of their time engaging individually but with an awareness of those around them and opportunities to interact on their initiative.

Learner/Family aspirations/hopes for future:Not discussed.

Level of support required:Matthew would need 1:1 support to engage effectively in the individual timetable he would need.

Equipment requirements:Computers with switch and touch screen technology; adaptive kitchen equipment; talking microwave and scales




Subject: Mobility and Orientation Name & Designation:Jane Beveridge -Mobility and Orientation Specialist






Discussion with parent Y

Discussion with learner N

Current level of functioning:Matthew has previously had an assessment by a mobility specialist at his current school. It is understood he travels independently (supervised) around his school campus, as he knows the environment so well. He apparently does not use a cane around school but orientates himself and is aware of surface changes with the aid of verbal instructions.

Matthew was able to walk independently on flat surfaces, being closely monitored from behind. Due to his nystagmus and lack of depth perception he found difficulty with steps, stairs and kerbs. He needs verbal information to be precise in order to maintain his confidence with independent walking.

He does not use specific body protection techniques but will put his hands out in front of him and dramatically reduce his speed of walking when requested. Matthew is receptive to verbal information and requests. He will put on his coat but needs assistance with doing up the zip, which he liked to be right up to the top.

At times Matthew would put out his hand to be guided, and used an adapted method of guiding, linking his arm through mine. He did not appear to have a preference as to whether it was his right or left side. Matthew seemed to initially respond to directional language, but as the session progressed he became less reliable with the direction he would take after it had been requested. However, a light shoulder prompt was all that was needed for him to correct himself.

Matthew walks with a wide, flat gait – testing surfaces and entrances to doorways at times to ascertain the floor surface or to check if there was a step. On a couple of occasions he would land his foot forcibly down on the floor in certain areas, I believe to determine the size of the room through echolocation. His curiosity to check each room and see what was in there was very good as this helps with mental mapping and landmark recognition.



On stairs Matthew was able to ascend and descend whilst holding the hand rail on both sides. He tended to be right foot dominant but would put his left foot down first when requested, but would then return to his right foot. He would briefly look down at the step and then look up before stepping.

Matthew appeared to enjoy his walk, bouncing up and down at times, and vocalising. I tried to encourage him to listen to environmental noises e.g. the birds, traffic at the end of the driveway and he would momentarily stop, listen and then continue on again.

When we reached the tactile paving at the entrance to the car park I encouraged Matthew to stop at the tactile paving and to listen. He was being guided at this point. After prompting he would turn his head in both directions and repeated that the road was safe to cross. It was a dull rainy day, so I was unable to assess the effect of glare or bright sunshine on Matthew’s decision making.

When entering indoors from outside, Matthew would step cautiously over the threshold, ensuring there was no step or kerb. He enjoyed looking for the room that his mum and dad were in on his return.

Recommended programme or course of intervention offered by WESC:Matthew would benefit from regular mobility and orientation sessions with a qualified mobility and orientation specialist.These sessions should include:

Mobility Baseline Assessment Pre-cane skills – guiding techniques, trailing, orientation techniques Familiarisation of campus layout Location and identification of landmarks and base points Learning of routes around the campus Body Protection techniques Continuation of Cane skills Programme of basic road safety awareness

Level of support required:Commencing with a 30 minute session on a weekly basis to be delivered by a mobility and orientation specialist which is then supported and implemented by enablers on a daily basis.

Equipment requirements:Long cane with small roller ball after the teaching of pre-cane skills.




Subject:Physiotherapy

Name & Designation:John Annan








Current level of functioning:For our assessment hour, I first met Matthew in the new Assessment Centre with his mother and father. His parents were invaluable for providing background information into Matthew’s presentation. His mother explained that Matthew was born only three weeks prematurely but had had a non-specific hypoxic perinatal event. He was walking at 17 months but showed other signs of generalised developmental delay. He has no neuromotor impairment and no musculoskeletal impairment that his parents are aware of. Matthew is fully ambulant (with sighted guide where necessary), and is independent with all his transfers without the use of any aids.

I noticed quite quickly that Matthew is strongly influenced by the spectrum of sensory stimulus around him at any given time: he feels and smells objects to identify them and he seemed to enjoy listening to ambient sounds. In particular he picked out the 50 Hz hum of the fluorescent lighting in the Assessment Centre. He also seems to thoroughly enjoy physical movement and his mum tells me that the trampoline is used as a reward.

He enjoys riding a side-by-side bicycle and absolutely loves riding for the disabled. He just about tolerates wearing a helmet but he doesn’t like hats generally. Matthew goes to the gym weekly. He enjoys using the treadmill and the static bicycles. Matthew enjoys swimming. In the water he will jump, kick his legs and kick-off from the sides. He can float but he particularly enjoys being under the water.

On examination, Matthew presents as having full power and full range of movement of all parts of his body. He was able to jump, hop, high-kneel, bridge, and one-leg bridge and balance with little difficulty. He was unable to sustain a one-leg stand without slight tactile support.

I did notice that although Mathew’s calcanei were in a neutral position both mid-feet were quite significantly pronated. I feel that this would benefit from an assessment by an orthotist who may well prescribe orthotic insoles that would help support Matthew’s walking pattern which would make him feel more grounded and stable.



Recommended programme or course of intervention offered by WESC:As with any young man, Matthew would benefit from a varied programme of physical activities for cardiovascular fitness and general well-being. He does not require any specific physiotherapy input, however I would recommend that he is assessed by an orthotist for his foot posture. It would be highly beneficial to get a clearer understanding of Mathew’s sensory profile as this would help him to modulate his level of arousal and help him focus/attend to the learning tasks at hand.

Level of support required:No physiotherapy, sensory profiling

Equipment requirements:No equipment requirements



Recommendation for Placement Report: Appendix 4

Subject:Occupational Therapy

Name & Designation:Liz Couzens - Occupational Therapist








Introduction:I met Matthew with his parents in the Assessment Centre. As I walked in the room Mum prompted Matthew, “remember who’s coming to see you?” to which he replied “Liz, Hello Liz”. Matthew lives at home with Mum and Dad and currently his older brother James is back from University and living at home. Matthew attends Linden Lodge and has 1 night/week residential respite. The following information was gathered from conversation with parents, observation of Matthew during our session and some guided activities.

Current level of functioning:Seating / wheelchair:No specific needs identified, Matthew is not a wheelchair user.

TransfersIndependent with chair, bed, toilet transfers. Supervision with getting in/out of the bath. Would benefit from bath rail/stair rail for stability due to visual impairment.

MobilityFully ambulant, sighted guide, links arms, is not a cane user. He has poor safety awareness but understands not to wander off by himself.

Car travelTravels with standard 3 point seat belt.

24 hour postural needsN/A

Fine Motor skills:Hand dominanceMatthew demonstrated a right handed dominance in tasks and when holding cutlery, pouring drinks, manipulating items and playing games.



Upper limb range of movementFull active range of movement observed but not formally assessed.GripUsing a fine pincer grip Matthew was able to put pegs on a washing line. He was able to manipulate the peg and after investigating it was able to pinch and release effectively.

Dexterity (pen grip, scissors and small fastenings)When given a large disc to thread onto a lace he struggled to get the end of the lace through the hole (approx. 1cm diameter hole). With assistance to hold the lace firm he was then able to lace it on. He was able to pick up Connect 4 counters with precision and place them accurately into the slots. Mum states Matthew can undo buttons but can’t do them up, he can do a zip up once the two sides are attached. Due to Matthew’s visual impairment he does not use a pen.

Activities of Daily Living: PersonalMealtimes:Ability to self-feed & drinkMatthew can feed himself using a spork. He requires a plate guard or lipped bowl on a dycem mat. He doesn’t like chewy meats like beef or pork but otherwise has a good appetite and will eat most meals. He can drink from a standard cup or glass however his unpredictable behaviour means that a plastic beaker may be more suitable to prevent damage if he throws it. He was able to demonstrate drinking squash from an open glass during the assessment but did need verbal prompting from Mum to slow down as he takes large gulps and can spill it. Mum has been using a sports bottle which he likes.

Level of supportMatthew needs help to have his food cut up for him and to locate the last scoop of food on the plate. He needs reminding to keep his fingers out of his food and to drink slowly.

Dietary needsNone identified.

Toilet:ContinenceFully continent since the age of 4, can ask to go to the toilet.

Level of supportRequires assistance to cleanse after having his bowels open, and prompting to wash his hands.

Dressing & Undressing:DressingMatthew needs assistance to select the appropriate clothing but if his clothes are handed to him in the correct orientation then Matthew can dress himself, he may need assistance to straighten up his shirt.



UndressingCan undress independently.

ShoesMatthew requires assistance with getting his shoes on and doing up laces. Mum reports he has very narrow feet so velcro shoes are not supportive enough. We discussed alternatives such as curly laces and toggle laces to possibly increase his independence levels.

Ablutions:Bathing/showering & dryingAt home Matthew has a bath, Dad runs the bath and sets the correct temperature, Matthew gets in holding onto the sides. He will attempt to wash himself but not very thoroughly so requires assistance to ensure he has had a thorough wash. Matthew will rub shampoo into his hair, but requires assistance to rinse. Parents state he is very cooperative and doesn’t mind water in his face.

Teeth cleaningMatthew has an electric toothbrush but requires hand over hand assistance as he doesn’t apply enough pressure to ensure his teeth are cleaned effectively. Mum reports food can collect around his upper back gums so is keen on ensuring his dental hygiene is flagged as an area of concern if he were to come to residential placement. He sees the dentist on a regular basis.

ShavingMatthew has an electric shaver and has full assistance from Dad.

Sleep:Matthew has an unpredictable and often disturbed sleep pattern. He will go to bed late (sometimes 12:30). Once the lights are off he will settle quite well, but will often wake at 3-4 am. Once awake he does not tend to go back to sleep. He will move bedrooms between his room and his parents’, he will say “Mummy get out” to which she will move rooms and Matthew will get into her bed. Although he will be awake and will vocalise he knows he must not put the lights on or be disruptive. However, he can sleep through the night and parents report that last night in the hotel he slept right through.

Activities of Daily Living: DomesticPreparation of snacks / meals / drinksDuring the assessment I asked Matthew if he would like to make a sandwich to which he eagerly replied “yes”. I set up a piece of bread on a spreading board with a dycem mat under, a large handled knife and a small, individually wrapped pat of margarine. I showed him the set up and explained what I wanted him to do. Initially he put his fingers straight into the butter and into his mouth, I prompted him “not in your mouth’ to which he took his fingers out and picked the knife up in his right hand. With hand over hand I assisted him to get the appropriate amount of butter onto the knife. Again with hand over hand we started spreading. He required assistance to cover the bread fully. When I indicated that we had finished he went to put the knife in his mouth, again I prompted him “not in your mouth, it could be sharp”, to which he



brought the knife down. With minimal prompting he began to cut the bread in half and although he achieved a good sawing action he required some assistance to complete the task effectively.

I asked if Matthew would like to pour a drink to which he consented. I half-filled a plastic jug with water and set up a glass with liquid level indicator. I let Matthew explore the LLI and explained when it made a ‘beep’ sound he needs to stop pouring. He picked up the jug with hand over hand and started to pour, he needed prompting to continue until the beep but as soon as he heard it he stopped and put the jug down independently.

At home Mum states Matthew might help with some small tasks in the kitchen like stirring the pan when she is preparing a meal but doesn’t prepare his own snacks.

HouseworkMatthew has a set task at home of loading the dishwasher. He will do this every evening and sets it off independently. He can push the hoover around but as expected with his visual impairment does not complete the task.

General observations:BehaviourMatthew appeared happy and was compliant during our hour long session. He needed to get up and keep moving whilst constantly vocalizing to himself but was happy to follow direction upon my instruction. When given time on the keyboard he soon found the volume control and turned it up so we decided to give him “2 more minutes” and when asked to come off the keyboard he did with no complaint.

Mum states Matthew’s behaviour has been very problematic especially when he reached puberty. She feels it is getting better but the main problem she finds at home is his repetitive banging on walls, radiators, doors and windows and he jumps loudly on floorboards. When asked to stop he can sometimes do it more, or will go to hit the radiator and turn to mum and say “Mum?...” as he knows it will draw attention. He displays this behaviour at any time, not because he is annoyed or unhappy. We discussed the sensory seeking side of this behaviour which would be fully assessed if he were to come here.

Matthew currently takes medication to moderate his behaviour.

Emotional wellbeingParents feel Matthew is relatively happy. He needs his own ‘time out’ if things are getting too much or his arousal levels are getting too high. He enjoys a walk outside to calm down.

CognitionMatthew has learning difficulties with severe visual impairment, autistic spectrum disorder and limited communication. He is able to express his basic needs. He knew I was coming in for the assessment and with prompting was able to welcome me by saying “Hello, Liz”. The next day I saw him in the playground and said “Hello Matthew” and he replied “Hello Liz” demonstrating a good memory. He was able to



follow a 2 stage command “take the peg and place it on the line”. He demonstrated reasonable problem solving skills working out how to work the peg and get it on the line. He was able to follow direction albeit on his terms, if he did not want to participate he would say “no” or with prompting “no, thank you”. His concentration span was limited to short tasks.

Sensory issuesMatthew has some very clear sensory processing difficulties. During the assessment he demonstrated some sensory seeking behaviours such as flicking and rocking. He would vocalize, sometimes loudly, and direct the sound from his mouth to his ear, occasionally flicking by his ear or putting his fingers in his ears. He adopted a crouched position putting deep pressure through his hips and joints. When given a novel item Matthew will explore it my touch, smell and mouthing. Mum states he enjoys vibrations and likes to turn the volume up on the keyboard, to the extent they decided to remove it from his room because it was causing more problems by increasing his arousal levels. He does not like the sound of the washing machine and will close the kitchen door, the same with the extractor fan noise in the toilet. Mum says he enjoys lying on his bean bag or trampette and listens to the birds.

CommunicationMatthew is able to express his basic needs and speaks in one or two word phrases. Through the assessment he would say repetitively “find car”, or “go MacDonalds” but I did not observe during our assessment more complex sentence structure. He is working on speaking in fuller sentences and mum states he can say “Matthew’s sitting with Mum” for example.Recommended programme or course of intervention offered by WESC:Matthew would benefit from a Sensory Assessment to establish his sensory processing difficulties and set up a sensory diet.

SKIP (Skills and Knowledge for Independent People) Baseline assessment of current independent living skills. We could then set up a personalised graded programme to maximise his independence skills, including looking at self-occupation. A review of adaptive (VI) kit available.Learner/Family aspirations/hopes for future:Parents want Matthew to be happy. They are trying to get him to be more independent at home and want the skills he learns at school/college translated to his home life. They want him to learn to self-occupy and be able to entertain himself. They have not thought too far in the future and have not considered plans beyond college life yet.Level of support required:Matthew would require 1-1 assistance to access education, leisure activity and personal care.

Equipment requirements:Mealtime kit – dycem mat, high sided plate/plate guard, caring cutlery spork, Liquid Level Indicator (approx. £25).Possibly a weighted blanket following sensory assessment.




Subject: Residential Name & Designation:David Liley - Support Services Manager


Date of assessment:24 November 2015




Discussion with Mother and Father Y

Observation of learner Y

Current level of functioning:I met with Matthew, his mother and father in the Family Assessment Centre. Matthew shook my hand and was happy for me to give him sighted guide throughout our tour of the residential areas. We had a brief visit of the St David’s area then concentrated on Naylor where eight young men currently reside and Nell Arran where there are both young men and young ladies, although they are in different corridors . Matthew was attentive to begin with but gradually became less interested as it was at the end of the assessment.Recommended programme or course of intervention offered by WESC:SKIP programme along with education syllabus supported through education and support services.

Learner/Family aspirations/hopes for future:Matthew and his parents are looking at appropriate residential settings, possibly Sept 2017. Preferably where he can stay during exeats and half term holidays. Provision for this would need to be taken into account.Level of support required:Matthew’s health is generally good, however, he does take regular medication. Initially he will require 1:1 support in all aspects of personal health and social care needs. He will require close supervision to become accustomed to his surroundings and support to fully participate in activities and living skills and 1:1 off campus.

Matthew does not sleep well, his usual bedtime is 22.30. He seemed to respond well to verbal prompts once I had his attention. Although he has a little understanding of the concept of time i.e. wait there for five minutes, he doesn’t tell the time.

AccessMatthew will require a great deal of reassurance to overcome any anxieties and Mum asked if we encounter much homesickness and how do we overcome it. I explained that this was managed through regular contact with home and possibly through Skype and TLC.



Each residential area has waking and sleeping night staff and an RGN on site most of the day during term time.

Matthew seemed very friendly, however he finds it difficult to socialize although he is quite tolerant towards others. He has a tendency to start becoming volatile and has been known to lash out at staff (Linden Lodge Care Report). There are response options to this behaviour such as finding little jobs for him i.e. collecting and assisting in sorting out laundry.

Matthew has a good appetite and enjoys a variety of food, he will require support to have his food cut up and verbal prompting for him to use his manners.

The make-up of the residences can vary to enable a suitable peer group, however, there is one area in particular that I feel would suit him. This is Naylor House along with other young men of a similar age, this would give Matthew scope to increase his confidence where the support of staff can be geared to his needs.

He would also have the encouragement and opportunity to develop his social skills with an appropriate peer group.

Learners also have the opportunity to give their views and concerns in weekly house meetings and each learner has an appointed keyworker whom will be their main liaison and point of contact with home, tutors and outside agencies.

Naylor Flat has an open plan kitchen diner and lounge. There is a large communal lounge close by where learners meet regularly to socialise and visit the coffee shop. He will also be able to partake in organised off site activities to local attractions and access the countryside and beaches for exercise.

Matthew is a very interesting young man and given time and the appropriate level of support I am sure that he would soon adapt and enjoy life at WESC Foundation.




Subject: Healthcare Name & Designation:Cheryl Wolkers - Senior Nurse






Discussion with parent Y

Discussion with learner N

Communication:Mathew communicates verbally with prompting and uses Moon.

Medication:Risperidone Liquid - twice a day

PRNParacetamol

Allergies:None Known

Summary of health:Matthew has Pervasive Developmental Disorder, ASD and learning difficulties with behavioural problems.He is also cerebrally visually impaired. He is myopic, has nystagmus and a slight right convergent squint. Matthew is registered partially sighted.

Matthew is described by parents as being generally very healthy.

The main concern is his poor sleeping pattern. He will often be awake for the majority of the night. Parents have tried Melatonin in the past with little effect.

Matthew is independently mobile. He is continent. Matthew needs support with daily living skills.

Matthew can display challenging behaviours when he is anxious and will need a behaviour support plan. His behaviour may include mood swings, kicking, biting, head butting and screaming if anxious/frustrated. He has occasionally been known to smear faeces. He needs consistent 1:1 support.



Parents are in the process of having him referred to the Adult Learning Disability Psychiatry team.

Recommended programme or course of intervention offered by WESC: Monitoring of general health and well-being Contribution to multi-professional meetings and report writing. Liaison with WESC staff, other professionals, and Parents/Guardians Access to a weekly GP clinic held onsite In addition if required access to various specialist clinics including Consultant

Ophthalmologist, Audiology and Optometrist appointments, which are all offered annually

Management of medications alongside support from WESC medication trained Enablers

Level of support required:3 hrs per week




Subject:Speech and Language Therapy

Name & Designation:Alice Pearn -Speech and Language Therapist







Discussion with learner Y (with parent support)

Current level of functioning:I met with Matthew and his mother and father during their assessment day. Matthew was happy to communicate with SALT (Speech & Language Therapist) and was supported by his parents to do so. Matthew was able to engage in all the activities for a short period of time.

Communication Environment:Matthew’s parents report that Matthew particularly enjoys being outside and listening to the sounds that he hears outside.

Due to Matthew’s reduced vision he doesn’t enjoy busy places such as supermarkets. Matthew will tolerate some noisy environments but will put his hand up to his ears if things are becoming too noisy.

Matthew likes the sound of fireworks. He enjoys swimming, horse riding, and going to the gym.

Matthew has an older brother who he has a typical brotherly relationship with.

Understanding:There are no concerns with Matthew’s hearing at this point. During the session Matthew was observed repeating key words that had parents had said. Matthew did this on several occasions even when it appeared that he wasn’t listening.

Matthew’s mother reports that she doesn’t have any concerns with Matthew’s understanding, he is able to follow simple tasks or questions. She reports that if language used is complex he will be unable to understand. Matthew is reported to follow and understand routines. During today’s assessment Matthew was observed following simple questions such as ‘what is your favourite dinner?’ At times Matthew took a while to respond and needed prompting to give an answer.

During the session Matthew’s attention was fleeting, he would attend an activity for a



short amount of time and then would take himself off the chair and lie down or just say no. His parent’s report that at home Matthew needs encouragement to join in activities and his attention is often fleeting. They are yet to find one activity that really motivates Matthew to hold his attention.

Expression:During the assessment Matthew was observed using single words and short phrases. Examples are ‘go find car mum’, ‘no windy’, ‘no raining mum’. Matthew used lots of echolalia throughout the session and mum reports he often repeats phrases that he has heard a teacher at school using.

Parents report that Matthew has enough vocabulary to express his wants and needs and this is mostly through single words. They are trying to develop his language skills and develop the length of his phrases. Parents use sentence starters to cue Matthew in to what he wants to say. Matthew requires scaffolding questions to help him support his answer.

Parents report that Matthew is able to say ‘no’ when he doesn’t want to do something. He will at times bang the furniture which indicates that he is getting stressed.

Social communication and interaction:Matthew’s parents report this is a real area of weakness for Matthew, he does not initiate peer interaction and is more likely to seek attention from adults. When asked who his best friend was Matthew named his enabler. Mum also reported that Matthew did not know how to respond when a peer began talking to him. During the assessment Matthew was observed asking his parents for a response, but only initiated interaction with SALT when spoken to and then this was very limited.

Augmentative and Alternative Communication (AAC):Matthew’s parents report that Matthew doesn’t use any AAC at home, they are unsure of anything that he may use at school. Matthew’s vision means he is unable to see any 2D objects so he doesn’t access any resources visually. During the session he was introduced to an iPad which he engaged with for a short time, but then wanted to find the buttons on the outside.

During the session switch activities were also used with Matthew, he showed some awareness of switches and appeared to enjoy activating it. He did mostly ‘fly swat’ and was unable to activate the switch at the right time.

Dysphagia:There are no concerns with Matthews’s eating and drinking. He prefers things that aren’t too chewy.

Recommended programme or course of intervention offered by WESC:

Further assessment of Matthew’s speech, language and communication needs.

Ongoing support from Speech and language therapy to enable Matthew to



continue to develop his listening and attention, receptive and expressive language skills and social communication skills.

Total communication environment. Joint planning with tutors and enablers. Contribution to multi-professional meetings and report writing.

Level of support required:1:1 support to enable maximum communication of wants and needs.

Equipment requirements: Will need further assessment for any further tactile support to be put in place Assistive technologies (assorted software to develop switch skills) Switches




Subject:Visual Assessment

Name & Designation:Alison Wakeham - Orthoptist


Date of assessment:18 November 2015

Diagnosis Significantly myopicDivergent squintNystagmusCortical Visual Impairment

Visual Acuity Distance: No interest in Cardiff or Keeler tests Definitely saw 1’’ stripes card at .5 meter with BEO

Near:Without glasses (won’t tolerate – very short-sighted)

Fixation Central fixationFixation held okayFairly swift fixation.

Squint Slight moderate alternate divergent squint with some vertical element.

Ocular Movements

Grossly full

Convergence Nil

Binocular Vision Nil

Nystagmus Intermittent horizontal nystagmus as well as lots of generalized roving eye movements.

Visual fields Confrontation (BEO) – No obvious defect.

Other - Good eye contact – albeit brief- Distracted by sound/noises (a little)- Switches off vision when listening (a little)- Responses – fairly swift- Looks away when reaching/grabbing for an object (a little)- Gives up easily when visual threshold reached.

Summary Some excellent responses especially to stripes and lights. Will visually explore but more tactile and mouthing. Alternating divergent squint, intermittent horizontal nystagmus. No obvious problems with peripheral vision.



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