Experiences of Engagement Improving Integration and Coordination of care

1. Experiences of EngagementImproving Integration and Coordination of care Neil Wilson Executive Headteacher South Manchester Inclusive Learning Enterprise Foundation Trust nwilson615@btinternet.com

2. What is a multi discipline approach? • In my view, the collective intelligence and collaboration between different disciplines and which leads to new insights and greater understanding. Consequently better actions. • ….with the goal that, we can make the whole greater than the sum of the parts. We are thinking about the long-term future of the individual and the family. • By collaboration it means sharing without restraint with a goal to improving provision for the young person and the family. • Our approach is aimed toward ultimately improving curriculum grades, attendance, behaviour (now attitude to learning), and progress. All linked to emotional health and well being. • If you feel good about yourself- most likely you will have a good day.

3. The Federation and Trust • Members of the hard federation • Baguley Hall Primary School; Benchill Primary School; Newall Green High School; Newall Green 6th Form. • Approximately 2000 young people in 600 families • Soft federation • Newall Green Primary School • Members of the TRUST • Manchester International Airport PLC; University Hospital of South Manchester NHS Foundation Trust ; Barnardos; Parkway Green Housing Trust. • Federation since September 2009. Trust status since September 2010 • High School BSF Build including 6th Form £22m (2008)

4. CAMHS C0-Ordinator School Nurse Social Worker Family Support Worker Base Corridors with Display

5. Context • Benchill PS 82% FSM. Baguley Hall PS 44% FSM. NGHS 64% FSM (Year 11 2012). • 94% poor white. • Resourced provision for SLD, MLD, Autism, Physical Disabilities • Entry by children into the federation shows very depressed SLC standards • 105 children aged 3 - 4 were tested (Pre school language scales, Pearson Assessment) • National average score is 100. Any score below 85 is outside the normal range. • Average score for the two primary schools was 82.1. 50% fell below 85 and 26% fell below 70 ( national is 2.5%) • 29 children in the 70-85 score which is also below the range • Only 3 children achieved above 115 which is 2.9% ( 16% national. KS 2 results and KS 4 results are …. • ” not only very impressive they are miraculous

6. How the federation functions • One governing body. Each school has its own headteacher. Each school has its own budget but funds joint endeavours such as speech therapist. • One executive headteacher. • Federation Action plan with a proposed 16 year programme • Governing body committees; Strategic management; Finance; Buildings health and safety; Pastoral; Curriculum; Pay and Staffing. • Multi-Agency Team consists of Deputy Headteacher Pastoral Care and Safeguarding;Health Worker 2 day secondment from health and three days as CAMHS co-ordinator. High School is a CAMHS hub for Manchester (and training base); School based Social Worker, no statutory powers but supervision from Children’s services; Community Police Officer. Pay 1/3 of salary get him for 2.5 days per week; 10 family support workers who operate across the federation ( five in the high school, five across the federation); School Nurse. • MAT meetings weekly in each primary school and secondary school • Formal process of referral (via heads of year/senior staff). Allocation of case worker. CAF completion. Review programme. Sign off or move up

7. Health in Schools. Our Provision (brief outline) • School Nurse (Barbara Austin) • Emotional Health Adviser (Lindsey Shaffer) • Emotional health in Schools Service. (CAMHS programme) • Speech Language and Communication programme • Emotional Health and Well being programme • PSE Programme supported by health in terms of advice and delivery • UK Resilience programme now developing as Manchester Resilience programme • Parenting Classes • Family residentials for families in crisis, need or respite. The provision is supported by the Hamlyn Trust • Speech therapist • Multi Agency weekly meetings • Safeguarding advice and co-ordinated approach

8. The value of Multi Agency support • Health and CAMHS link to G.P.’s. CAMHS co-ordinator can short circuit referral and speed up the process • Child Protection. “We have massive information sharing and are seen as the hub of the community.” School based social worker. Our provision is highly rated and trusted by Children’s services • Police officer “Macca” (in post for 4 years) • He keeps young people out of the custodial system. He shares well at the multi agency meetings and on many other informal occasions. Gives us a sharpness to child protection and sexual exploitation of young people safeguarding procedures. • He receives text messages and phone calls at weekends from parents and students. • Has the power of entry and “protection”. Gets more Christmas cards than me!! • MAT and safeguarding • Serious case reviews show a lack of effective MAT involvement. Characterised by lack of sharing and failure to make a decision. • We have a very swift process of referral and action. Can access police action very quickly. • A direct referral from us to children’s services through our social worker, CAMHS, or Deputy head teacher invokes a good response • “I would be surprised if my MAT team were surprised”

9. The value of Multi Agency support • Family Support Workers. Get the students in to school, Work with the families to support the learning. Share intelligence within the multi agency team. Get economies of scale when dealing with the family and sharing within the federation. • Training and supervision essential and supported by CAMHS. Only work at level 1 and 2. MAT meetings help with scaling and further support. Identification skills are important but mostly it is observation and discussion. Awareness raising is continuous. • They need to understand how they fit into the system and how their work is actioned further. • Living in the community can have benefits and drawbacks. FSW’s can withdraw from a family if it compromises them. But FSW’s can pick up local intelligence that can be put into the system very quickly. • Early Intervention is essential. Through our programmes we can get immediate responses. Little fragmentation compared to lots of staff from different agencies focused on the child/family. Can call a meeting in minutes and share information on a need to know basis, there is no need to call a second appointment for “another” agency to be involved. “Coming into the school is seen as ok.” Sometimes going into social services is not OK! Family pride.

10. The value of Multi Agency support • Family residential programme. Sponsored by the Hamlyn Trust. Long leasehold on a property in the Peak District. (Tues/Wed/Thurs). Take families who need respite or extra support. First two residentials involve the children. Follow a programme of routines, cooking, hygiene (the family that plays together stays together). The third residential involves parents and the children together. Children become the mentors! Significant impact. First groups of families are now “advocates”. Follow up work in school through the FSW. National Award for Learning Outside the Classroom. 2001/11 • CAF. Part of the paper trail • What happens if the professional does not do as they have agreed to ? If the family doesn’t it is moved up a level! Who ensures accountability? • “CAF is the way if it is done correctly by all the agencies involved.” • Implementation is not always consistent. • If the CAF is completed correctly by all agencies it is highly unlikely there will be a serious case review. However there is always the unforeseen outcome.

11. Multi Agency • Why is this so important? • Communication between professionals and informed decision making process is crucial • Knowledge of the holistic issues around the young person and the family gives a more coherent and cohesive action plan. • Essential that information is shared in a transparent and sensitive way. This is not a forum for professional preciousness and it is essential that the right decisions are made. • Gives everyone the opportunity to understand the differing professional roles and responsibilities. It also helps families to understand the process and have one conversation rather than several! • It improves the confidence level in the parents and carers and the young people. • It helps all professionals to improve their practice as they understand and appreciate the language and protocols of each other • Staying until the job is done is crucial! Commitment to ensuring the child and family are put first. • Emotional Health and Well being is massively important.

12. School Nurse Provision • Instrumental in whole school training on Asthma, Allergic reaction, Diabetes, Epilepsy • Extended role ( pregnancy testing, STD’s and contraception) • Attends safe guarding meetings as the health representative • Co-ordinates the immunisation programme • Works closely with the community paediatrician • Liaises with other health professionals in the community e.g dentists, audiologists • Receives information about young people who have attended the hospital and share this information with appropriate school based staff. • Receive information from the police about domestic violence which can inform support work with young people and the family. • Can address the public health agenda such as anti smoking workshops • Fits perfectly into the multi agency method of working .

13. Some impact data • 2010/2011 • 100/900 young people referred to MAT in secondary school for a variety of reasons • 27 yr 7 (7), 15 yr 8 (10), 20 yr 9 (4), 26 yr 10 (11), 12 yr 11 (6).( case closed) • Average time of involvement 12 weeks • 38 (case closed). • 2009/2010 year 11 • 18/180 referred. Of this 18 12 passed 5 A*-C. 4 including E and M

14. Emotional Health (Source: South Manchester Area Health Authority) In a typical high school of 1000 pupils (at any one time) 50 are seriously depressed 100 suffer significant distress 5-10 girls have an eating disorder 10-20 pupils have obsessive compulsive disorder Who are they? What are we doing about it? If we are not doing anything about it we should!

16. How has the Health service impacted on the high school? • Grade 1 Ofsted for Care Guidance and Support (twice) • Improved pastoral care and a wider understanding by all staff of the importance of health in its relationship with prescribed education outcomes ( attendance, attainment, progress, optimism) • Recruitment and retention of staff who want to work within our context (very positive) • Young people who made it to the end of year 11 against all the odds • Sophisticated looked after children provision as a result of informed discussion with different agencies. • Parenting programmes that have impact • Swift and appropriate access to other health professionals • Opportunity to address the issues as they arise. Solution focused activity in real time. • Reduced teenage pregnancy. Boys seeking STD’s support and contraception advice. Increased boys engagement with health services • Since our BSF programme, dedicated spaces for health professionals and integrated MA work, a huge rise in positive outputs for young people.

17. Why has the service been so effective? • Outstanding relationships between the professionals who operate within the school and federation • Complete trust in the integrity of each other • A willingness to think and work outside the box and share without professional preciousness • Staying until the job is done • An understanding by senior managers (in the school) that physical and emotional health influences and is related to, educational output. ( attainment, progress, attendance and behaviour) • Relationships between the health staff and the young people and their families is crucial and fundamental. The service has enhanced positive relationships and gives parents/carers/young people a sense of optimism. • Everyone having high standards and high expectations of themselves and the service they provide

18. How health can work in schools • Specific providers: CAMHS, School Nurse, Speech and language therapist • Access to community Paediatrician, Physiotherapist for disabled young people, Clinical Psychologist, • Dental screening • Healthy Schools team • Voluntary health Sector e.g Brook advisory service (PSHCE), 42nd street, MIND • Very strong relationships with GP’s • Other agencies • Complex families, families first, family intervention team, home start, connections • Assistant head teacher “Director of Children and Families Inclusion Service for the federation”

19. Cracking Communication in practiceThe Holy Grail to breaking the cycles of disaffection, disengagement and underachievement • Upwardly mobile people have good speech language and communication skills • Those that don’t are not upwardly mobile • If we are to break the cycles of underperformance, deprivation, disaffection and poverty we need to address SLC • We know that poor behaviour is linked to SLC needs • Up to 50% of children in poor communities will have some form of communication delay • Language underpins all learning and is crucial to the development of socialisation • Poor employment prospects, poor emotional health and well being (mental health), are characterised by SLCN • Over 60% of young people in the criminal justice system have SLCN

20. Talk Of The Town • TOTT has 4 key aims:1. Early identification of children and young people with speech, language and communication needs (SLCN)2. Joint working between parents and practitioners across health and education3. Positive outcomes for children and young people with improved speech, language and communication skills4. A sustainable approach, so that policy and practice continues to support positive outcomes

21. Recent SLCN DataCelf 4UK Assessment Results

22. What it demonstrates • Recalling Sentences: a students ability to listen, ability to access the curriculum language, ability to relate to subject content • Formulated sentences: To communicate effectively, to understand and apply curriculum objectives, ability for story telling, written narrative and text. • Word Classes: Students ability to analyse, ability to know and use words generically, ability to acquire new words and understanding • Concepts and following directions: ability to follow instructions of increasing length and complexity, remembering homework, project work, following teacher instructions, comprehension.

23. Speech Language and Communication Improvement DataEach school is showing improvement for their children The charts show how the distribution of scores compare in each school for 2011 and 2012 compared to the UK Standard Sample. There are three charts for each school. Each one shows a separate component of the PLS4 assessment; Auditory Comprehension, Expressive Communication and the Total Language score.

24. Outputs • Both PS’s at national for KS2 in English and mathematics • Attendance for all three school’s at approx. 95% • Both PS’s historically have been in a category or labelled satisfactory for some time. Now both are graded Good. • High school below national but closing in. As better cohorts come through standards will improve even more. • NEET’s have been reduced from 17% in 2010 to less than 2% in 2012. • 24 students have moved on to university in the last 12 months (vocational 6th form) Many others into good jobs or training. • Crime rate is substantially down in the community. Good community policing. • Waiting list for the high school. Expansion of both primary schools.

25. My Staff. Christmas 2007 and every year since!