CIE0159

Written evidence submitted by Action Cerebral Palsy

Written evidence submitted on behalf of Action Cerebral Palsy

The impact of COVID-19 on education and children’s services

  1. I am providing evidence on behalf of Action Cerebral Palsy, a campaigning organisation which seeks to raise awareness of the challenges faced by children with cerebral palsy and their families. I am responding specifically on the following point of the terms of reference:

The effect on disadvantaged groups, including the Department’s approach to free school meals and the long-term impact on the most vulnerable groups (such as pupils with special educational needs and disabilities and children in need)

  1. Children with cerebral palsy have a range of physical, cognitive, sensory and health needs as a result of damage to their brain before, during or after birth. The impact of this damage may vary from mild to extremely severe and complex and may affect every aspect of their development. As a result, even in “normal” times, most children with cerebral palsy will have a higher level of special educational needs than their peers, but the unprecedented challenges presented by Covid-19 and lockdown on children with cerebral palsy and their families are significant.
  2. Children with cerebral palsy may attend mainstream, generic special, specialist day and independent special schools, day and residential schools.
  3. From conversations with parents and professionals about the impact of Covid-19 on the lives of children with cerebral palsy, I have been told that the following challenges and difficulties have been experienced:

4.1 Overall, parents of children with cerebral palsy have experienced heightened anxiety, stress and fatigue as a result of having to be sole carers, educators, therapists and health practitioners for their child with cerebral palsy during lockdown. Parents may also have other children and family members to care for and home educate during this very difficult time.

4.2 The vulnerability of their child with cerebral palsy and the potential serious consequences of contracting Covid-19 has caused, in some cases, extreme anxiety.

4.3 This anxiety is exacerbated by the cessation of all day to day services that parents were able to rely on; school, therapy, healthcare support, respite care and the face to face support from practitioners and professionals who provided these services.

4.4 NHS appointments for physiotherapy, occupational therapy, speech and language therapy, wheelchair services, orthotics and paediatric monitoring have stopped.

4.5 Many parents are doing their best to provide what physiotherapy exercises they can at home for their child with cerebral palsy for whom this is an essential part of their physical well-being and without which the child can become stiff, immobile and suffer pain. However, this can prove very difficult in the family home under lockdown in which other children are requiring parental care and attention.

4.6 Other examples of difficulty are with communication strategies and “high tech” devices on which a non-verbal child with cerebral palsy may depend in order to communicate. When these go wrong at home, without an expert to quickly repair or re-calibrate the device, the child is left without “a voice” to communicate – a risk to mental wellbeing and safeguarding.

4.7 Similarly, a wheelchair which develops a fault renders the child immobile or uncomfortable and may cause longer term postural problems.

  1. Children with complex cerebral palsy may require very specialist education, differentiation and adaptations to their learning environment. This is very difficult to emulate in the family home under lock down. Some schools have strived to support parents as much as possible to help their child access learning activities, but inevitably this is a major challenge for parents for whom simply caring for their child with complex health and educational needs on an all-day/every day basis is an exhausting task.
  2. Assessments for Education, Health and Care Plans have stopped and this will delay access to essential provision and intervention for children with cerebral palsy which will have long term consequences to their development and well-being. Once these assessments and the EHCP process begin again, there will inevitably be a back-log and delays, which were, prior to Covid-19, often too long, but will now be even worse. Also, many assessments which had been carried out prior to lockdown will need to be re-done to take account of the impact of lockdown on the physical and cognitive state of the child. Local Authorities’ Childrens’ Services will need to plan and act urgently to meet these heightened demands and use all resources available to them from across sectors to meet the needs of vulnerable children and their families.
  3. The impact of Covid-19 and the lockdown on children with cerebral palsy who attend day or residential specialist schools for children with cerebral palsy, motor disorders of complex needs has perhaps been less than those who attend generic special schools or mainstream schools. Parents have reported that these specialist providers have continued to provide ongoing therapy online or fast access to therapy advice because the therapists are staff members of the school alongside teaching staff and have an in depth knowledge of their child’s educational and therapy needs and how they inter-relate and impact on learning.
  4. Some residential providers who have continued under complete lockdown report that it has been “business as usual”, but the practical challenges will become greater once full lockdown is lifted, but social distancing remains.
  5. Some specialist schools have risen to the challenge of continuing to provide high quality education and therapy for their pupils, for example, by offering “teletherapy” and a full integrated curriculum appropriate for children with cerebral palsy, supported by a multi-disciplinary staff team, delivered remotely. A feature of these schools is that they already have strong technological capability in their infrastructure and skillsets in their staff, coupled with a pragmatic, “can do” approach to solving the problems posed by this unprecedented situation, and a willingness to go “the extra mile” for their pupils and their families. These models could provide a blueprint of best practice for children with complex SEND in the event of a similar future lockdown situation.
  6. One example of a model of online specialist educational curriculum and therapy support provided by Pace in Aylesbury, an independent special school for day pupils with motor disorders and an Outstanding provider, is described by the Head Teacher, Claire Smart, in her letter to Local Authorities, reproduced below.

 

7th May 2020

RE: Pace update for LEAs during period of Covid-19 Lockdown

Dear Colleague,

During this period of lockdown, our Pace school buildings remain closed at the time of writing. However, as you will hopefully be aware, our Pace school services have continued to be delivered remotely. Pace remains deeply committed to all of our stakeholders, particularly our children, families, local authorities and partner schools, during this challenging period. As we evolve and develop our approach using the resources and technologies available to us, it felt timely to write to update you on how this is working for our Pace children and their families. The response from families has been really encouraging, and we include some feedback from our children and families towards the end of this letter.

Our remote school provision is evolving rapidly and has been highly responsive to the needs and feedback that we are receiving from families. We are offering a range of accessible and high quality provision which offers children and young people a combination of integrated education and therapy delivered by Pace specialists to facilitate continued progress with their existing goals and EHCP outcomes whilst accessing a broad and stimulating selection of curriculum areas. We are trying hard to strike the right balance so that families find this supportive and helpful without feeling overwhelmed or under pressure. Activities and resources are available to families via Google Classroom. Live lessons take place using Google Meets and 1:1 sessions/teletherapy are being delivered using Microsoft Teams, as are annual review and CIN meetings.

The safety and welfare of all children continue to be our top priority and the principles within the Keeping Children Safe in Education (KCSiE) 2019 and our Child Protection Policy (including an addendum for this period of lockdown) apply. All of our remote provision is fully risk assessed and delivered in line with safeguarding recommendations issued by our host LEA Buckinghamshire. Our DSLs and school nursing team are working closely to monitor and remain in close contact with our most vulnerable families and additional support is in place in this respect.

Summary of Online/Remote Provision:

- Live group sessions

- Parent social/coffee and chat group

- Curriculum based activities (pre-formal and formal classes)

- Pre-recorded stories and sensory stories

- Communication challenges/activities

- Social group chat for kids

- Individual support with PODD and AAC

- Zones of Regulation activities and resources

- Wellbeing (including relaxation and mindfulness)

- Daily living skills activities and resources

- Webinars to support with specific issues delivered by therapists

- Physical challenges/activities

- Support with equipment issues at home, including liaising with other agencies

- Individual ‘teletherapy’ sessions (arranged directly between families and therapists)

- Annual review meetings as scheduled

- CIN meetings

- ILP (Integrated learning Plan) goal review meetings

Our integrated approach continues to be delivered by our specialist staff as follows:

- Teachers

- Conductors

- Speech and Language Therapists and Communication Assistants

- Occupational Therapists

- Physiotherapists

Academic Learning

The teaching team have taken the lead with setting up and for the most part with co-ordinating Pace’s remote curriculum offer through Google Classroom. Each class at Pace has a virtual classroom on Google Classroom where curriculum resources are available to children and families to access at a time that suits them. A broad range of curriculum subjects are being offered with a particular focus on the core areas of literacy, numeracy and science. The offer comprises of a number of different learning opportunities, connected to the learning that had been planned for the Summer term. We have reviewed practice across the different classes to ensure consistency and balance. The curriculum is being delivered through a combination of lesson materials that are uploaded for families to access at their own speed and live lessons via Google Meets. Teachers are being brilliantly inventive and ensuring that materials posted are engaging. They are utilising different media such as worksheets, slide shows, original video content as well as links to websites that support learning, or further knowledge of the topic being studied. We are supporting families through Parents meetings over coming weeks where ILP’s (Integrated Learning Plans) will be shared, and Parents will be actively involved in reviewing key priorities for their children. This will include talking through and identifying strategies that can be safely used at home to help their children continue to make progress towards their EHCP outcomes.

All our support and interactions are taking place with the knowledge that at this time there is an even greater need to be empathetic to each individual home situation and to be sensitive to how much each family can manage without feeling overwhelmed. Our core Pace value of being ‘child and family centred’ is very much in the forefront of our minds at the moment.

Conductive Education (CE)

The main aim for CE is to support and enhance a personality or belief in one’s self and ability to achieve challenges. The Conductor team have continued to ensure this is displayed in all of the support that is given at Pace – even more so now when both families and pupils are in situations that challenge their abilities and strength. The Conductors continue to work in transdisciplinary teams to deliver integrated programmes but also with their expertise and knowledge of the pupils try to ensure that the pupils are as active as possible and not overwhelming parents but supporting and showing them ways to achieve this “activity” at a differentiated level.

The remote Pace Curriculum is being supported by CE and the Conductors in the following ways:

- Planning mobility programmes with Physiotherapists (delivered 1:1) e.g. stretch sheets, active physical challenges, 1:1 advice where and as needed.

- Joining with group and individual chats with pupils and encouraging the resilience that the pupils have and being supportive. This has supported the mental well-being of pupils and families.

- Taking an active role in setting/delivering programmes using Google Classroom

- Taking part in pre-recorded sessions particularly linked to active hand function.

Pupils can see demonstrations and parents are given advice and tips as to how to best support pupils to be as independent as possible. At the end of this giving pupils an opportunity to share their work “end product”, encouraging meaningful feedback.

- Continuing to train and support staff and families with raising their skills and expertise in specialist facilitation techniques

- Working with colleagues proactively to ensure that pupils have the equipment they need at home and that families know how to use it safely. This has been critical to help safeguard against the risk of our students reducing their range of movement.

Occupational Therapy

Occupational therapy provision strives to mirror what is delivered at school as much as is possible during this period with an increased focus on mental health and wellbeing. The Zones of Regulation programme is familiar to the pupils and this is utilised in various guises to best meet each individual need. Additional relaxation and mindfulness activities are provided for pupils in response to the current situation. Therapy is also focussing on activities of daily living and the skills required that underpin successful engagement in schoolwork, selfcare and leisure, delivered using a variety of methods such as video, teletherapy and online activities using Google Classroom. These skills include but are not limited to attention, sequencing, coordination and visual perception. Activities such as Pace’s equivalent of the Getty Museum Art challenge is an example that incorporates all of the above-mentioned skills and more, in a discreet, fun way that can easily be carried out at home and adjusted to ensure they are appropriate for the pupils regardless of their physical and cognitive abilities. Therapists are available to respond to the needs of pupils and their families and provision continues to evolve based on this.

Physiotherapy

Initially students were sent individual exercise plans with ideas for things that could be carried out at home to assist in physical development. Enquiries were made with families about what equipment they already had at home and whether key pieces of equipment could be loaned by Pace in order to make physical activities easier and more fun. Equipment was then delivered to families that needed it and instruction given on its use and safety. Telephone, e mail or online support: Each family has been unique in their requirements during this time and the Physiotherapy team have been responding to the needs of each family individually through whatever means the family have needed at the time. Video calls and telephone calls with the student themselves or with the family to check in on how they are doing with the activities and provide practical support/suggestions where possible. Assistance has been given to families to embed physical routines into their day such as the use of splints, standing frames, regular changes of position and movement opportunities throughout the day.

Google Classroom has been used as a way of uploading activity suggestions through combined working with other therapists, teachers and conductors that look at the students learning goals. Physical challenges are being used to encourage students to participate where appropriate. Throughout the whole process communication with outside agencies and other professionals involved in the students’ care has been key to ensuring that each student’s needs are met. E.g. following up with wheelchair services where seating is an issue, supporting equipment needs, liaison with medical teams involved re medications and evolving physical symptoms like pain management. The annual review process has also been maintained, reports written, meetings attended on teams and new goals set where appropriate in phase transfer. Currently we are piloting the delivery of a small online motor programme. The programme will be done through via individual ‘teletherapy’ sessions first with each member of the group with the aim of then being able to deliver the session as a group so they all do it together. The initial individual sessions will highlight safety concerns for each child, specific instructions and will ensure individual advice on the hands-on skills the facilitator will need during the session. Once we are confident with the handler’s skills, the group would then be delivered online through PT/Conductor.

Speech and Language Therapy

Indirect provision, such as termly joined goals setting and planning for children’s language and communication programmes as well as their individual learning plans, parents’ meetings, ongoing class-based transdisciplinary liaison and working, liaison with external professionals (e.g., GOSH), annual review report writing, etc. continues to be provided as per normal, using online SharePoint and meeting platforms. Direct contact is being offered to families. In addition, a variety of group and individual activities are being provided. These offer opportunities to develop language, communication and literacy. These resources are for both children and parents to access in order to continue to meet different EHCP requirements, work towards the children’s specific speech, language and communication goals and support low and high-tech alternative and augmentative communication (AAC) use at home. These include, for example: - weekly sensory stories using low-tech AAC and providing aided language stimulation for our more cognitively involved children - individual teletherapy sessions to support, for example, specific AAC users or coach their parents how they might be able to support their children’s use of AAC at home - weekly small-group social communication and chat groups to provide verbal children with a safe, semi- structured online opportunity to interact with their class peers - regular, time-tabled tailored communication and language activities and challenges posted for individual children in their Google Classroom In addition, Parents are being actively encouraged to keep in regular contact, particularly if they have any specific questions regarding their child’s language, communication (AAC or verbal) or require direct support to manage AAC devices.

As previously stated, we are trying hard to strike the right balance so that families find that our remote provision is supportive and helpful without feeling overwhelmed or under pressure. To this end, we are invited regular feedback from staff and students alike, a snapshot of which is pasted below.

Summary of informal feedback and comments from our Students and Parents:

Students - “I did good feeling with my hands but enjoyed Monkey puzzle more”

- “We all really enjoyed this. We look forward to more homework”

- “In a group communication session, I asked how everyone was feeling at the start like - a super informal zones check. One child said she felt 'relieved' that we were still having communication and she could still talk with her friends.”

Parents

- “very nice resources online”

- “great lessons/selection of activities including ALL children and not SOME”

- “very happy with curriculum content; families/children miss 'socialising opportunities' - with peers”

- “looking forward towards possibility of on-line 'coffee morning' with staff”

- “A great story, we really enjoyed this – thanks”

- “Great book and quiz, thanks, another family favourite!”

- “A enjoyed this, she was very excited to see Michelle on her computer and asked - 'who' and 'read”

- “Thanks for all the support and resources which are great. :)”

I very much hope that you have found this update informative and encouraging in terms of the Pace provision that the students from your Local Education Authority are continuing to access remotely during this period of lockdown. If you would like any further information, please do not hesitate to get in touch.

Kind Regards,

Claire Smart, Headteacher

 

  1. I hope that this information will be helpful to the Committee.

 

Amanda Richardson

May 31st 2020

 

May 2020