Disability Commissioning Strategy/Plan · 2014-10-02 · their families on behalf of the JCB and...

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Durham County Council

April 2012 – March 2

2015

Disability Commissioning Strategy/Plan

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Contents

1. Introduction Page 3 2. Purpose Page 4 3. National and Local Context Page 4 4. Definition of Disability Page 6 5. Profile & Needs Analysis Page 6 6. Current Service Provision & Access Levels Page12 7. Current Performance & Efficiences 0 8. Gap Analysis Page 22 9. Commissioning Intentions Page 26 10. Appendix Page 34

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1. Introduction

The vision for disabled families in County Durham is to: “Work closely with service providers, families and communities to develop and maintain high quality, accessible, services for disabled children and young people in County Durham. “(Making Changes Together and the Disability Joint Commissioning Group Joint Statement Appendix 1) It is our clear goal to ensure that disabled children & young people can reach their potential and live ordinary lives’ in the communities where they live. The number of children and young people with additional needs is difficult to accurately define due to the complexity of that population and validity of data & double counting. However in County Durham we know that;

7,192 children & young people are identified as having Special Education

Needs (SEN) at school action plus 3,360 disabled children and young people receive Disability Living

Allowance 2,369 children and young people with statements of SEN (Jan 2011) 1,198 children and young people with Statements of SEN attend

mainstream schools 1,171 children and young people with Statements of SEN attend a special

school 79 children and young people with Statements of SEN attend independent

and non maintained special schools 12 children with Statements of SEN attend registered early years

education settings Other arrangements were made for 16 children with Statements including

elective home education and education at parents expense. Over 1,500 children and young people are members of the Children’s

Network 500 children and young people access services from the Sensory Support

Service 390 children and young people access the integrated children and young

peoples disability service 125 children and young people access out of county/independent non

maintained placements

The number of disabled children and young people is growing globally due to advances in medicine and technology that prolongs life according to the World Health Organisation & the World Bank. In the UK, there are 770,000 disabled children under the age of 16. That equates to one child in 20.

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99.1% of disabled children live at home and are supported by their families 52% of families with a disabled child are at risk of experiencing poverty The income of families with disabled children averages £15,270, 23.5%

below the UK mean income of £19,968, and 21.8% have incomes that are less than half the UK mean

Only 16% of mothers with disabled children work, compared to 61% of other mothers

It costs up to three times as much to raise a disabled child, as it does to raise a child without disabilities

56% of parents with disabled children and children with SEND reported there was a lack of sufficient childcare in their area

Caring for a disabled child can cause relationship problems. According to one study, 31% of couples report some problems, 13% cite major problems and 9% actually separate. Stress, depression and lack of sleep are other commonly experienced problems

Only one in 13 disabled children receive a regular support service of any sort from their local authority

Pupils with special educational needs & disability (SEND) are more than nine times more likely to be excluded than their peers in England

Source (Contact a Family) This commissioning strategy covers the period 2012 - 2015 and is supported by the overarching Joint Disability Strategy, the Transition Protocol, the Short Break Strategy & the SEND (Special Educational Needs & Disability) Strategy that are all endorsed by the Disability Joint Commissioning Group (DJCG) and the Joint Commissioning Board (JCB). It is envisaged that all strategies will need to be significantly updated in view of the national proposals outlined in the SEN Green Paper. (Support & Aspiration 2010)

2. Purpose

The purpose of this commissioning strategy is to understand and plan for the current and future needs of disabled children, young people and their Families to help them achieve good outcomes while ensuring Value for Money.

3. National and Local Context National Context

Nationally the Government want families to understand & access services for disabled children appropriately and to be central to all developments. Local Provision should reflect choice, information & empower families to make decisions.

The key focus areas for Government are:

Short breaks, - From 1st April 2011 the delivery of short breaks became

statutory following on from Aiming High for Disabled Children with a responsibility to produce a local statement involving parents by the 1st October 2011

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Meaningful transition, Autism and: Special Education Needs (SEN) Green Paper (Support and Aspiration)-

This proposes changes to the way in which we commission services with more personalised budgets, the introduction of a single assessment and a change in the age range for disabled children & young people, advocating services should be from 0-25 with a heavy emphasis on meaningful transition and communication.

Local Context A considerable amount of progress has been made locally and an overarching Joint Strategy (Appendix 1) outlines the following in relation to services for disabled children, young people and their families;

Principles Objectives Participation – Making Changes Together & Investing in Children Feedback

Alongside this commissioning plan cross agency protocols, policies and statutory procedures cover;

Transition Special Education Needs and Disability Short breaks (Including statement) Further education and employment Autism/challenging behaviour

Our local plans reflect what has been learned from Aiming High for Disabled Children & are aligned to the proposals in the SEN Green paper. (Support & Aspiration) We have developed Integrated Teams (One Point) which will enable services to be delivered in localities. The One Point Integrated Teams will provide universal & targeted services for all Children & Young People in County Durham and will contribute to early identification and intervention. One Point will provide services for the majority of C&YP with additional needs. For those disabled C&YP with the most complex of needs the development of a Specialist Integrated Disability Team has commenced and like the One Point Service will be operational from December 1st 2011. This service will be professional staff from the Children & Young People’s Disability Team, Continuing Health Care workers and a specialist autism worker. This will support holistic assessments, care plans and transition into adult services. Governance arrangements - The JDCG and the Inter Agency Transition Group (IATG) are responsible for the commissioning of services for disabled children & young people/young adults on behalf of the JCB who are ultimately responsible to the Children’s Executive Board. These groups see the Local Authority work in partnership with Health, the Voluntary Sector & Families to deliver change.

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The DJCG commissions services for disabled children, young people and their families on behalf of the JCB and reports progress on a regular basis for information.

4. Definition of Disability

The law defines disability in a number of different ways. For the purpose of this commissioning strategy, we have used the definition set out in the Disability Discrimination Acts of 1995 and 2005. “A person has a disability, for the purpose of these Acts, if he/she has a physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day to day activities.” For children’s services disability is defined using the ‘social’ model – Oliver 1990(as opposed to a medical model) as: ‘disadvantage experienced by an individual.....resulting from barriers to independent living or educational, employment or other opportunities.....that impact on people with impairments and/or ill health. When we refer to ‘disabled’ people and using the ‘social model’ we mean: “how society disables people by the way that it treats and excludes people whatever their impairment/ill health/ long term condition. The focus is on how and where society fails to include disabled people by ‘disabling’ attitudes and barriers and not on what disabled people cannot do”.

5. Profile and Needs Analysis

Population Profile While we acknowledge the DLA numbers for County Durham we are aware that this does not reflect all of the C&YP whom have an additional need and will fluctuate due to different approaches to assessment and diagnosis. As highlighted earlier in this document the level of need is diverse. In County Durham 3,360 children & young people are in receipt of Disability Living Allowance (DLA) from an overall population of 119,000. This represents approximately 3% of the total child population which is comparable with National figures of around 5% when considering that DLA is not received by every disabled child/young person. The DLA data which is collected nationally shows that we, like other areas have smaller amounts of children recorded under five & over 16 years of age. The reason for this is that many disabilities in young children, unless purely physical can go undiagnosed until they enter mainstream education. The lower 16 plus figures correlate with the statement process when the statutory responsibility to maintain the statement ends when a young person leaves school. The DLA data should only be considered in conjunction with other key SEN data that will be considered in this document.

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Table 1 - Overview of C&YP in Receipt of Disability Living Allowance

Age No of children in County Durham

Aged under 5 380

Aged 5 to under 11 1,170

Aged 11 to under 16 1,350

Aged 16 -17 460

Information about the types of disability is not made available for this cohort due to central Government recording that only records the number of recipients. Special Education Needs SEN The term 'special educational needs' (SEN) has a legal definition, referring to children who have learning difficulties or disabilities that make it harder for them to learn or access education than most children of the same age. Many children will have SEN of some kind at some time during their education. Help will usually be provided in their setting or school, sometimes with the help of outside specialists. Definition of SEN: Children have special educational needs if they have a learning difficulty which calls for special educational provision to be made for them. Children have a learning difficulty if they:

(a) have a significantly greater difficulty in learning than the majority of

children of the same age; or (b) have a disability which prevents or hinders them from making use of

educational facilities of a kind generally provided for children of the same age in schools within the area of the local education authority

(c) are under compulsory school age and fall within the definition at (a) or (b) above or would so do if special educational provision was not made for them.

In County Durham we have seen a consistent year-on-year decrease in the number of children and young people with SEN statements between 1st January 2001 (3,672) and 1st January 2009 (2,395) in County Durham which equates to a 34.8% reduction (1,277) over the period. The reduction of a large number of young people with statements is attributed to a change in SEN thresholds / bandings and funding formula, together with a large proportion of

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children and young people having reached the statutory school leaving age, left school and therefore their statements being discontinued.

Special Educational Need by type in County Durham

The majority of statements will identify more than one need and often these needs are linked. The chart below outlines the current position. The top three categories for statements are:

Behavioural & emotional Moderate learning disability Speech, language & communication

Chart 1 Statements by type and breakdown January 2011-chart 1a Pupils at School action plus – January 2011

Chart 1based on 2,441 C&YP

Number of Pupils with Statements

2%

2%

0%

20%

18%

16%

13%

12%

6%

4%

4%

3%

Moderate LearningDifficulties

Autism Spectrum Disorder

Behaviour, Emotional andSocial

Speech, Language andCommunication

Severe Learning Difficulty

Physical Difficulties

Specific Learning Difficulty

Profound and MultipleLearning Difficulties

Visual Impairment

Other

Hearing Impairment

Multi‐Sensory Impairment

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Number of Pupils at School Action+

2%

1%

0%

0%

0%

26%

24%20%

12%

9%

4%2%

Behaviour, Emotiona l and Socia l

Speech, Language and

Communication

Moderate Learning Difficul ties

Speci fic Learning Diffi cul ty

Other

Phys ica l Diffi cul ties

Autism Spectrum Disorder

Hearing Impairment

Severe Learning Diffi cul ty

Visua l Impai rment

Multi ‐Sensory Impairment

Profound and Multiple LearningDifficul ties

Chart 1a based on 7,192 C&YP

A definition of each statement type is in Appendix 2 Further guidance can be found in the County Durham SEN Policy 2011/12 Statutory Social Care Services County Durham has 3,360 disabled children & young people in receipt of DLA, of which 392 (11.6%) are severely disabled and receive a statutory service from the Children & Young People’s Disability Team.

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Chart 2 Current Disability Team Cases – by Type Recorded

Current Disability Team Cases (16‐Jun‐11)

By Disability Type Recorded

(Note: A Child may have more than 1 Disability Type)

21%

15%

13%11%

10%

10%

7%

4%

4%

3%

2%

Learning

Communication

Behaviour

Aspergers Autism

Personal Care

Mobility

Incontinence

Consciousness

Vision

Hearing

Hand Function

The C&YP who receive a statutory service will in many cases have dual diagnosis. The two most prevalent types of disability are learning & communication. 66% of the case load has a learning disability 47% of the case load have a communication disability 39% have a behavioural disability 34% have a diagnosis of autism/aspergers

Chart 3- Multiple Diagnosis Type – Caseload Disability Team

Current Disability Team Cases (16‐Jun‐11)

By Disability Type Recorded

(Note: A Child may have more than 1 Disability Type)

263

186155 135 123 122

8350 50 35 19

050

100150200250300

Learning

Communication

Behaviour

Aspergers Autism

Personal Care

Mobility

Incontinence

Consciousness

Vision

Hearing

Hand Function

Of the cases open to the Team for Disabled Children & their Families the overwhelming majority are classified as white British. A significant proportion of the cases are male. All of the children & young people known to the Children & Young People’s Disability Service are classed as Children in Need and of this caseload 23 are Looked after Children.

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The below table demonstrate the age and geography of these children & young people. Table 2 - Geography & Age of the Disabled Children’s Team

Count of Client Age Group

District 0 to 5 6 to 10 11 to 18 Over 18 Grand TotalDales 5 18 46 1 70 Derwentside 5 26 1 82 Durham & Chester- le-Street 8 21 59 3 91 Easington 13 16 38 67 Sedgefield 4 27 45 76 Out of County 1 5 6 Grand Total 36 108 244 4 392

Out of County Placements –Independent and Non Maintained Settings In County Durham some 125 children and young people access provision out of the County. (80 for education and others for short breaks/hospice) These out of county placements are accessed when the needs of a child’s statement cannot be met in county due to the complex nature of the case or due to the specialist nature of a placement such as a hospice. It is our intention to reduce the reliance on out of county placements/independent and non maintained settings by improving the provision in county. What Families in County Durham have told us they need through Making Changes Together Families want services in County Durham to recognise the child/young person first and foremost and then the disability. Key messages from disabled children, young people and families are that they would like to see improvements in a wide range of areas these include;

transition, information, access to universal services, continuation of short breaks, continuation of the participation process, Preparation for adulthood/independence, training for parents, improvement in childcare, early years provision, transport, leisure activities, improved access and equality to therapy services, embedding of CAF and lead professional, training, employment and education Staff training for a more inclusive workforce.

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The commonality of need for all disabled children, young people & families is a fully trained workforce, clear information and responsive commissioning.

6. Current Service Provision & Access Levels

In County Durham we have a wide range of services for disabled children, young people, parents and carers from birth into adult services across Health, Social Care & Education. It is acknowledged that the needs of children and young people will be individual to their disability and circumstances and therefore tailored commissioning will take place to ensure delivery of a holistic care package. Access to services is based on a child/young persons assessed need and services can be accessed through either, self referral, CAF, medical assessment/diagnosis or an initial assessment. For the purpose of this strategy services will be described based on access & levels of intervention i.e.;

Universal –One Point Universal Plus –One Point Targeted -One Point and Countywide Specialist Cross Cutting Services

Services will work holistically to enable disabled children & young people to reach their full potential and access wherever possible local provision. The services that are delivered range through the spectrum of need and at any given stage in a Child or Young Persons pathway they may access services from all levels.

Universal – One Point By universal services we mean the kind of things that are available to all citizens across the county and which are legally bound to be accessible for disabled children & young people. These include; Schools Further education providers Leisure & culture services Public spaces Hospitals & associated health services General Practitioners Transport (except where it is deemed that individual packages are

required based on need and criteria) Public information Early years settings

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It is our intention to ensure that universal services can meet the needs of majority of the population including disabled children & young people. This will be achieved where appropriate through the One Point integrated service that we deliver universal, universal plus and targeted services across the county in purpose built hubs. It is anticipated that majority of C&YP with a disability except for those requiring complex care packages will have their needs met by One Point.

Although access to universal provision has improved considerably in some areas of the county families are telling us that further improvements are required in attitudes and accessibility. One key area for development is the experience that very young disabled children, parents and carers have with universal services. 1165 number of children and young people with SEN attend mainstream schools in County Durham. This equates to 47% of all SEN.

Transport Transport can be split into two areas for disabled children & young people; Home to school transport provision General public transport

General public transport continues to be a major issue for all children & young people in County Durham. It is particularly so for disabled children & young people when they try to access public transport with confidence and independently. Young people in County Durham are reliant on a complex network of buses, many with different tariffs and also many that are reducing the service they offer. Some of the key issues disabled children, young people and their families face are the attitude of drivers on bus services, the lack of space on buses for wheel chair users and been afforded enough time to take a seat before the bus pulls away. These issues are in addition to the issues all residents face such as cost, reduction in some services and specific rural issues.

Targeted transport will be covered later in this commissioning plan. Universal Plus –One Point By universal plus services we mean the services that everyone accesses but with some additional support/equipment to ensure that they can be inclusive. The majority of these services will be available through the One Point service and its countywide hub model. Additional links to One Point are in place to ensure that more specialist support is available for families. Advocacy Independent advocacy is available for disabled children, young people and their families. County Durham offers independent advice and support to parents of children with special educational needs through our Parent Partnership Service.

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Natural Allies supports children & young people with disabilities, learning difficulties and additional support needs across the county to put across the views and feelings relating to the decisions that are made involving them, their education and their lives.

Information The main vehicle to provide information to disabled children & young people is the Children’s Network which is part of Safeguarding & Specialist Services. The Children’s network has a dual purpose and acts as a register for disabled children & young people which is a statutory function. The Children’s Network is the vehicle used to promote and deliver short breaks. It currently has over 1,100 members and delivers quarterly news letters and birthday cards to all members. The Children’s Network has delivered excellent value for money in regard to short breaks and has utilised a text service to great affect. The Children’s Network has developed excellent relationships with local businesses and this has enabled a membership discount scheme to be launched as well as donations to support events. Transition arrangements Transition support and arrangements are outlined in the cross agency Transition Protocol. Transition support and procedures cover a wide range of children & young people with additional needs as they move into adulthood. The process is either led through education or for those with the most complex of needs a social worker. To support the development of transition arrangements in County Durham a cross agency database has been developed and capacity building work has been undertaken with providers. Further development is required around planning, work experience, employment & the Inter Agency Transition Group has the responsibility to implement these changes.

The transition protocol provides further information about all transition arrangements for young people with additional needs moving into adult services.

Targeted – One Point By targeted services we mean that these services are targeted to meet an identified need of an individual or group of children & young people. Many targeted services will be delivered by One Point and the pathways and links that are established.

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Educational Psychology

The Educational Psychology Service, in partnership with others, aims to improve the quality of life of children and young people through the promotion of emotional well-being, achievements, progress and inclusion. The Educational Psychology Service is responsible for, and/or contributes to, a number of innovative and proactive projects aimed at raising standards across the county. These include:

a range of high quality training for professionals promoting emotional well-being and mental health supporting school improvement through consultation and coaching providing psychological therapies to individuals in schools and other

settings

The service consists of:

a team of educational psychologists Durham Portage Service the Movement Difficulties Support Service the Getting Along Primary Initiative the Durham Schools' Counselling Service the Autism Spectrum Disorders Support and Development Team

The service currently has 4,188 open cases, however not all of the cases will be receiving a service all of the time.

The Learning Difficulties and Disabilities Inclusion Service

The Learning Difficulties and Disabilities Inclusion Service work in partnership with schools, children and young people, parents and carers and other professionals and agencies, in order to seek and promote educational inclusion and achievement of children and young people with learning difficulties or disabilities.

The Learning Difficulties and Disabilities Inclusion Service provide:

Advice, consultancy and training to teachers, support staff and families Continuing Professional development training for Schools and

Communities of Learning Assessment of children and young people’s needs and advice relating to:

- General Learning Difficulties - Early Years - Speech and Language - Specific Learning Difficulties (Dyslexia & DCD) - Access Technology - Physical Disabilities

Sensory support service

The sensory support service is based on the Belmont Schools Campus and has a countywide remit to provide support services for Hearing Impaired (HI) and Visually Impaired (VI) children and young people including those with additional and complex needs.

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The population of sensory impaired children and young people remains stable over time at around 500 C&YP.

The service provides support to settings and also equipment to enable sensory impaired children to overcome the barriers imposed by the sensory loss. Further development is required across services to develop communication opportunities and increase access to universal services. The development of communication around British Sign Language (BSL) and Makaton will enable C&YP with sensory impairments to communicate with a wider range of people and will promote inclusion.

The Provision of Education In County Durham we have 10 special schools and a Pupil Referral Unit. 1,137 pupils attend special schools. Special schools are broken into two types; Those that provide education for children and young people with learning

difficulties and disabilities, i.e. Moderate, Severe and Profound and Multiple Learning Difficulties and Autism Spectrum Disorders.

Those who provide education for children and young people with social, emotional and behaviour difficulties

Villa Real, Durham Trinity, Glendene, Harelaw, Evergreen & the Oaks provide education for children and young people with learning difficulties and disabilities. Windlestone, The Meadows, Walworth, Elemore provide education for children and young people with social, emotional and behavioural difficulties. All pupils who attend special schools have a Statement of Educational Need and many will have a disability. Special schools placements are currently full to capacity; however future capacity may be increase with improvements in mainstream schools. Special schools provide a therapeutic and stimulating environment that also enables health professionals to work with the children & young people. All schools have a statutory responsibility to ensure that the needs outlined on a child/young person’s statement are met. Further development is required to enhance provision and increase the capacity of schools to meet the needs of children and young people with special educational needs and disabilities. Confident Schools, Confident Parents was developed to support schools to meet the needs of SEN children & young people. The majority of schools in the county have received this training and supporting materials. Another significant area for development is linked to the countywide therapy review and the provision of therapies in special schools. To improve the equity and choice of therapy will further support local provision and reduce the need for out of county placements.

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Maintaining statements The Local Authority has the responsibility for maintaining statements and schools are responsible for ensuring that a child’s needs are met. A statement is reviewed each year through the Statutory Annual Review process. Transport Transport is a major issue for disabled children, young people & families and is an area for significant development. Transport provision for disabled C&YP represents spend of over 5 million pounds.

The eXtreme group from Investing In Children have also created a programme to educate and train bus drivers about the needs of disabled people. This is further supported by the Bridge Card that makes drivers of buses aware that the user has additional needs and may need extra support or time to use public transport. The barriers that transport creates impacts on a wide range of opportunities for disabled children & young people and can significantly hinder transition into adulthood. This may be further increased with the reduction of DLA mobility allowance that is impacting on some families. Equipment Specialist equipment for children and young people with statements of SEN can be provided following an assessment by an appropriate professional. Specialist By specialist services we mean those services that are for a very small number of children & young people whom have the most severe and complex needs which have been identified through assessment. Social Care Services The Team for Disabled Children & their Families have the statutory responsibility for 392 severely disabled children currently. The team core functions are; Safeguarding of severely disabled children Completion of initial and core assessments as of the 1989 Children’s Act Developing and reviewing care plans Continual family support Transition arrangements

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The team currently has 23 staff and will integrate with continuing health care assessors to create one specialist team for severely disabled C&YP. This will see an increase in the team’s caseload, but will enable effective joint assessment and planning as well as interventions. Families have told us that they want to access one system instead of multiple pathways to services which is currently the case and the integration under a single management system will facilitate this development. Specialist Out of County Placements/Independent and non maintained settings We currently have 125 C&YP who access specialist out of county places. The vast percentage – 80 are placed through education through the statutory assessment and review process. The remaining 45 access specialist respite provision in hospices such as St Oswald’s and Butterwick. The table below outlines the 2010-2011 estimated costs for out of county placements. The costs are divided between CYPS and the Primary Care Trust. The figures relate to 125 children and young people. What this demonstrates is that we have gaps in our service provision that can lead to families opting to have children & young people educated out of the County. Table 3 - Out of County placements – Cost 2010/11

Source Costs Children and Young People’s Services £4,157,670,91 Primary Care Trust £1,505,450.49

Total £5,663,121.40

The above information in relation to Out of County Placements would tell us that although significant improvements to local provision have been made over to reduce the out of County places further identified gaps such as therapy provision in special schools needs to be commissioned against. A cross agency working group is currently commissioned to look at the issues that lead to out of county places. CAMHS –Child & Adolescent Mental Health Service(s) CAMHS is a provider of specialist mental health services to children & young people up to 18 years of age and their families in County Durham. CAMHS offers a range of therapeutic services including direct & indirect clinical work, assessment, consultation and training. The direct therapeutic work offered includes family therapy, cognitive behavioural therapy, counselling, psychotherapy, group work, play therapy and parenting skills development. Neuropsychological assessment including assessment of attention difficulties, hyperactivity and complex social interaction and communication difficulties is available.

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Multi disciplinary teams, including child psychiatrists, psychologists, nurses, social workers, primary mental health workers and administrators work across the six locality teams within County Durham & Darlington.

Historically gaps have existed in the provision of mental health services for disabled children and young people. A clear commissioning intention will be to narrow this gap through identifying needs and meeting their needs with services & support.

Cross Cutting Services Some services provided reach across the whole spectrum of need and are accessed at differing levels based upon individual needs. Short Breaks In 2011/12 in line with the short break strategy short breaks will be delivered throughout the calendar year and in settings such as special schools. This will improve value for money while improving the local offer to parents. The range of short breaks available has increased significantly and has enabled disabled children, young people and families to experience a range of activities that they previously could not. Short breaks are available across the spectrum of need from 0-19 & include DCATCH which has been accessed by over 300 under 5 disabled children who previously had found it difficult to access childcare in over 80 settings. Significantly, in response to families County Durham is one of the only authorities to continue with Dcatch and the feedback is universally positive. Overall around 45 providers deliver short break services from all sectors. In 2010/11 over 114,000 hours of short break activities were delivered. This figure does not take into account the number of activities that are accessed through the Children’s Network membership discount scheme.

The short break menu is diverse, good value and has delivered significant savings while changing the landscape of the services provided. The model has been so successful that it is to be adopted by Adult Wellbeing and Health. Further developments are planned to increase the participation of disabled children & young people in mainstream activities and to increase the countywide offer that is available for all disabled children. Significant developments in terms of not just quantity but quality have been made and County Durham strives to have an exciting and ground breaking range of short breaks available. Therapies Therapy services are delivered across the spectrum of need and are an area for development and increased equity. It is apparent that two levels of service exist depending on where families live and it is our intention to address this situation and enable families and settings such as school’s the support they need in local communities.

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7. Current performance & efficiencies

The main indicators that are used for disabled children & young people are;

1. Family satisfaction with the services provided 2. The number of short breaks that are provided 3. Reducing the number of high cost placements 4. The number of families accessing direct payments

Family participation has been crucial to the direction of travel in County Durham in relation to disabled children, young people and families. Through the Durham model we are able to receive objective feedback about the services we provide and also how we could improve them. The model enables a wide range of parents and disabled children and young people to have a continued dialogue with the LA and partners and has seen dramatic improvements. County Durham is committed to this process and is supported by Contact a Family to ensure that we practice participation not just consultation. Figure 1 illustrates the number of short breaks provided over the last two years and demonstrates that between 2008/09 and 2009/10 there was an increase of 33.2% in the number of overnight stays and a significant rise of 1087.5% in the number of hours of short breaks provided. April to December 2010 has seen the provision of 3,329 overnight stays and 114,894 hours this is a year on year increase of 37% in terms of the number of hours delivered and an increase of 14% in the number of nights. As the number of hours increases it is planned that the need for the amount of nights may drop. The target for 2011/12 is 110,000 hours.

Figure1: Number of short breaks provided to families with children with a disability

One of the key aims of the short break strategy was to use short breaks to reduce out of county placements and direct payments through commissioning a full range of short breaks. Where we have been particularly successful is in reducing these high cost placements throughout the AHfDC programme (2009/2011). This is highlighted in Figure 2 / Table 4 below.

2009/10 target 9,675 2010/11 target 70,000

9675

74755

114894

2500 2868 33290

20000

40000

60000

80000

100000

120000

140000

2008/09 2009/10 2010/11 Q3

Number Provided

Hours Overnight stays

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Figure 2: High Cost Placements

0

1

2

3

4

5

6

7

8

9

2008/09 2009/10 2010/11 2011/12

PCT, ED, SaSS

Residential

PCT, SaSS

Efficiencies Working in partnership with disabled children, young people, parents, carers, professionals and providers we have successfully reduced significant costs while continuing to deliver high quality services. By identifying those children and young people most at risk of family break down and commissioning bespoke provision we have successfully reduced the need for high cost out of county placements. Despite an increase in the number of placements in 2011/12 from 2010/11 the support needs and costs have significantly reduced as outlined in table 4.

Table 4:

New Placements Costs 2008/09 £1,502,550 2009/10 £592,405

2010/11 £423,838 2011/12 £498,079

As the table above demonstrates, we have seen a reduction in the number of high cost placements since the AHfDC programme commenced this has resulted in significant short term and long term savings for the Local Authority and Partners. Another development of note is the slight reduction in the number of direct payments during 2010/11. We are committed to improving the services we have in County Durham to meet the needs of our disabled children and young people’s population within the communities they live. The vigorous upwards trajectory of demand for direct payments that we have experienced since 2005 seems to have peaked in 2009/10 and has stabilised and declined over the first three quarters of 2010/11. This change in the trajectory looks to be very significant. Whilst it is still early days there would appear to be some correlation with the new menu of short break services. This is demonstrated in figure 3. This demonstrates that through the commissioning process we are meeting families’ needs with the services

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provided thus reducing the need for families to feel the need to commission services themselves through direct payment

Figure 3: Direct Payments

020406080

100120140160180

2004/5 2006/7 2008/9 2010Q1

2010Q3

DP

In 2012/13 we will again use the short break indicator to evidence performance along side our participation model that enables disabled children, young people & families to feedback directly about the services they access at twice yearly conferences and through electronic and paper feedback routes.

Elsewhere the commissioning plan will deliver efficiencies in the following areas;

Transport costs

Child care costs

Short break costs

Out of county school and college placements

8. Gap analysis

In County Durham we have a clear understanding of the number of disabled children & young people, the disabilities and SEN needs that they have. The table below highlights some of the gaps that we currently have in services for disabled children, young people and families in county Durham. Where as these gaps represent some of the biggest challenges we face, they do not reflect the continuation of current commissioning activity which forms the basis of our commissioning intentions. The gaps highlighted are outlined to improve the existing services that we have in county Durham and not to replace existing service provision.

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Gap No

Gap identified Strategic Response to gaps

1 The increased number of autistic children and young people locally and nationally required a whole system approach from early identification and assessment to a range of interventions and training across all areas of service delivery

Change in assessment procedure – A pilot is to commence in November in the North of the County

Interventions and training

Range of short breaks to be delivered

Support in schools and to one point

2 Therapy provision is not equitable across county Durham and can lead to families looking for out of county placements for disabled children. Therapy provision from a service users perspective can often be based on where they live and can appear to be disjointed and sporadic

Therapy charters to be developed and delivered in partnership with special schools

Improved therapy provision across the county that may include conductive education in relevant schools

Levels of therapy to be agreed and publicised

Training for settings/staff to deliver therapies as part of therapy plans in universal/universal plus settings

All Therapy provision is under review, SALT have produced a action plan to address issues raised

3 To improve the support that families and local settings receive to reduce family breakdown and the need for out of county placements gaps around short breaks will be commissioned against. To support other key strategic priorities short break plus will be developed to promote independence

Develop and deliver a full range of short breaks

Increase short breaks in local settings such as special schools

Widen the short break menu to meet families needs

Continue to work with families to evaluate the short breaks menu

Develop short breaks plus with links to independent skills

Strategic financial commitment to short breaks

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Gap No


4 Early identifications and support can often not meet the needs of families as effectively as is required –This gap is often the first contact that parents have of services and a negative experience can lead to a lack of trust in the local services provided

Improve the experience that families have when they access early years services

Embed CAF and Lead professional through One point service and connected services

Make it every bodies business

5 Number of professionals who can communicate in British sign Language (BSL) is a gap and prevents families for progressing and can lead to a range of associated difficulties – such as needing specialist out of county placements

Support a programme of BSL delivery and training for front of house workers/professionals and partners such leisure services

6 Gaps in transport are two fold – the provision of accessible public transport and maximising independent travel either individually or as a family – not paying for transport twice if families receive mobility allowance

Work with providers to train transport professionals around disability issues and to promote subsidised transport

Deliver independent travel training for pupils as part of the curriculum

Ensure that families who receive mobility allowances are using them to transport children/young people

7 A gap exists in the effective planning and managing of the meaningful transition of disabled children & young people into adult hood. This leads to a breakdown in placements, a lack of confidence in local provision, substantial costs and more importantly negative experiences for families

Deliver the transition protocol

Develop a cross agency database that can be accessed by all partners

Develop a work experience programme for disabled children and young people within partner organisations

Learn from audit of experiences of young people moving from CAMHS to adult services

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Gap No


8 Gaps in core skills impact on families experience in a range of universal settings- this again is two fold – the ability to be inclusive is both practical skills and equipment but more importantly it is attitudinal

Training audit to be undertaken

Training to be delivered imaginatively

Disability awareness to become a key competency in supervision/appraisal process

Develop a STARs system to promote good practice

9 Families repeatedly tell us they want a simple system with one assessment and a key person to support them through the range of services they access. CAF and the lead professional should be the person and the process. We have substantial gaps in the children’s work force of professionals who can and more importantly, who are willing to complete CAF and be a lead professional

Support One a Point and connected services to embed the CAF

Drive the Lead Professional Passport into One Point

Hold services to account

Integrated service for disabled children will deliver joint action planning and working together with children who require specialist assessments

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9. Commissioning Intentions

To enable equity of appropriate access to these services we will commission services in the following areas;

Universal Universal plus Targeted Specialist Cross Cutting Services

16 commissioning priorities have been linked to the gap analysis and theses intentions will be delivered throughout the course of the commissioning plan.

Commissioning Priority 1 – To increase support for service and settings at a universal level we will;

Service Area Actions Who is responsibleLinked to gap

number Universal 1. Commission support, training and advice to enable other

services and settings to meet the needs of disabled children, young people and families.

2. Ensure that all LA & Health staff access disability awareness training and that it becomes a regular part of supervision for appropriate professionals

3. Develop a STARS system to promote inclusion in all sectors based on inclusion and attitudes of staff

JCB, JDCG,DTIG, One Point

1,2,3,4,5,6,7,8,9

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Commissioning Priority 2 – To meet the advocacy needs of all disabled children, young people and families to navigate a wide range of services we will;


number Universal Plus 1. Re launch the parent partnership advocacy and support

service and ensure that it is resourced 2. Continue to commission advocacy services such as

Natural Allies for disabled children & young people

JCB, DJCG, DTIG 1,4,8

Commissioning Priority 3 – Information about services is vital to service users and professionals. To keep our families informed about a range of issues we will;


number Universal Plus 1. Commission the Children’s Network to deliver specialist

advice to disabled children, young people & families 2. Involve disabled children, young people and families in any

information that we produce for them 3. All communications will be parent friendly and available in

a wide range of formats

JCB, DJGC, DTIG 1,3,4,5,7,8

Commissioning Priority 4 – To support families at the earliest opportunity we will:


number Universal Plus 1. Commission Disabled Children’s Access to Childcare

2. Support One Point to be inclusive 3. Commission the Portage Service & LDDIS 4. Ensure Surestart centres are inclusive 5. Commission a new approach to assessing autism pre

school 6. Commission support services for autistic children 7. Support the Child Development Teams 8. Develop integrated working and therapies

JCB, DJCG, DTIG, One Point

1,2,3,4,5,8,9

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Commissioning Priority 5 – Transition into adult services is a key area for development, we will;


number Universal Plus 1. Support and drive the transition protocol into practice

2. Commission a transition data base to further enhance commissioning

3. Develop capacity with local providers 4. Develop a robust work experience programme for disabled

children & young people 5. Increase the paid employment opportunities for young

people

JCB, AW&H, DJCG, DTIG, Inter Agency Transition Group

3,6,7,8,9

Commissioning Priority 6 – To support children, young people & settings we will;


number Targeted 1. Have designated Educational Psychologists in all of the

Integrated hubs (One Point) 2. We will have specialist Educational Psychologists

centrally to provide services for disabled children & young people

3. Will work with partners to develop and deliver joint autism strategy & action plan linked to need and prevalence


1,2,3,4,7,8,9

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Commissioning Priority 7 – It is our intention to commission services to support special schools to deliver a full and holistic education for disabled children & young people. This will include;


number Targeted 1. Short breaks

2. Equity in therapy provision 3. Communication support 4. Transport 5. Training for staff around issues such as autism 6. Information for parents

JCB, DJCG, DTIG, 1,2,3,4,5,6,7,8,9

Commissioning Priority 8 –- To comply with the statutory responsibility placed on the Local Authority we will;


number Targeted 1. Continue to have a SEND policy

2. Ensure that the needs of children with severe and complex needs are assessed and met

2. Ensure staff are trained in Confident Schools – Confident Parents

3. Ensure that statutory reviews take place annually


1,2,3,4,7,8,9

Commissioning Priority 9 – To meet the needs of the 500 children & young people with a sensory impairment we will;


number Targeted 1. Ensure that the Sensory Support Service is adequately

resourced and supported 2. Provide additional equipment for the service 3. Commission specialist short breaks for sensory impaired

children and young people such as swimming 4. Commission sign language courses for families and

professionals


2,3,4,5,6,7,8,9

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Commissioning Priority 10 – Transport is a key area for disabled children young people and families, we will:


number Targeted 1. Work in partnership with families and the Integrated

Transport Unit to improve the experiences disabled children & young people have

2. We will commission an independent travel worker to support independence

3. We will commission disabled children and young people through Investing In Children to deliver training to transport providers

4. We will promote the Bridge Card across the county


6,8

Commissioning Priority 11 – To ensure that equipment is available working with our partners we will:


number Targeted 1. Commission appropriate equipment in a range of settings

to enable disabled children & young people to access 2. Commission leisure services to ensure that staff in leisure

settings can use equipment such as hoists

JCB, DJCG, DTIG, One Point & partners

2,3,4,5,8

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Commissioning Priority 12 – To support children and young people with the most complex of needs and ensure that the Local Authority fulfils its statutory duty, we will;


number Specialist 1. Ensure that the Children & Young People’s Disability

Team is adequately resourced and supported to meet the needs of our population

2. Continue to provide specialist provision to autistic children and young people

3. Reduce the number of specialist out of county placements through targeted commissioning matched to current and emerging needs

4. Integrate the disability teams with CDDFT Children’s continuing care assessors to ensure joined up working


1,2,3,4,5,6,7,8,9 (all gaps crucial to reducing pressure on specialist services)

Commissioning Priority 13 – To reduce the reliance on the number of specialist out of county places we will;


number Specialist 1. Work with parents to identify the reasons why they access

out of county placements to develop commissioning intentions to improve in county provision

2. We will work in partnership with organisations such as the North East Autistic Society to develop provision in county that meets the needs of our population

3. We will commission short breaks in and around special schools to increase parental confident in local provision

4. We will work with schools to enable them to work with disabled children to create the capacity that will be required in the future


1,2,3,4,5,6,7,8,9

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Commissioning Priority 14 – To meet the needs of children and young people with mental health needs we will;


number Specialist 1. Support our partners in commissioning services across

the County and ensure professionals are working together

2. Engage with key professionals to map gaps in service provision and commission against these gaps

3. Ensure smooth transition of young people into appropriate adult services


1,2,3,4,7,8,9

Commissioning Priority 15 – To support families, enable disabled children and young people to live ordinary lives as well as reducing the number of out of county places we will:


number Cross Cutting Services

1. Commission a wide range of short break services for disabled children, young people, parents & carers

2. Ensure all disabled children and young people have access to some kind of short break provision that will promote independence

3. Ensure that these services are commissioned in line with the model of participation in Durham and no money will be spent without the agreement of families

4. Deliver short breaks across the spectrum and will link to other key developments such as reducing out of county placements, increasing confidence in local colleges, improving local leisure activities and promoting the physical and mental health of disabled children & young people


1,3,4,5,6,7,8

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Commissioning Priority 16 – To ensure that therapy services are delivered in a timely and equitable way we will;


number Cross Cutting Services

1. Work in partnership with Health and review all therapy services & further commissioning activity

2. Ensure therapy services are delivered in schools 3. Support staff training 4. Increase services for autistic children & young people


2,3,4,8

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Appendix 1

Overarching Joint Disability Strategy

County Durham

Joint Disability Strategy

January 2011

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1. Statement of Purpose

Making changes together for disabled children, young people and their families to enable services to be delivered when and where they are needed based on holistic assessment and inclusive delivery. By creating a joint disability strategy that will be owned by all stakeholders a collective accountability will be created whilst underpinning the core participation values that are held in County Durham.

2. Aims of this Strategy

By working closely with service providers, families & communities can help develop and maintain high quality, accessible, services for disabled children and young people in County Durham. By utilising the expertise of families & service providers, services will be responsive to need and will meet the needs of families in County Durham namely:

Services with appropriately skilled professionals delivering timely

interventions based on assessed need To ensure disabled children are safeguarded, have the same life

opportunities as their non disabled peers and are supported to reach their full potential

To ensure disabled children will receive educational opportunities that are matched to the need(s) of the child

To ensure disabled children have equitable access to service provision delivered in locations that children & families can access

To support parents in the care of their child/children so disabled children can live with their family and can access their local community

To improve outcomes for every disabled child & young person in County Durham so that they are safe, healthy, active, achieving, respected, responsible and included through efficient coordination of existing and new resources

To reduce duplication and delay through services that are integrated and co-ordinated

To enable disabled children & young people to access mainstream provision

To ensure that providing support and services for disabled children, young people & families is everyone’s business

3. Definitions

The law defines disability in a number of different ways. For the purpose of this strategy, we have used the definition set out in the Disability Discrimination Act 2005. “A person has a disability, for the purpose of this Act, if he/she has a physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day to day activities.”

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4. Participation

The purpose of parent/children/young person participation is to enable parents/children/young people to get involved in service planning and decision making so that services meet the needs of families with disabled children. The aim is to ensure effective targeting of resources into services that will make the biggest impact on the lives of children & young people. This has proved highly successful in Durham. County Durham Children’s Trust has embraced making families central to all decisions around service delivery and this is particularly so in regard to children, young people & families with a disability. The County Durham Parents Steering Group (CDPSG) – Making Changes Together and Investing in Children have developed two models of participation that are unique to County Durham and are based on partnership & influence. By engaging with a wide range of parents and young people and linking those to specific areas of service design/improvements partners in Co Durham Children’s Trust have been able to utilise local expertise. This approach has led to significant success in regard to short breaks, information, lead professional, transport, early years, therapies & integrated service developments. The joint working of the CDPSG and the Disability Trust Implementation Group (DTIG), brokered by Contact a Family, has led to the delivery of the Every Disabled Child Matters Charter with valuable input from Investing in Children. Having a flexible agenda that is shaped by parents, children & young people enables local issues to be addressed through open dialogue with professionals and requires a change in culture. County Durham is nationally recognised as having an excellent model of participation and this is central to the delivery of this Disability Strategy.

5. Structures

To maximise the impact of the joint strategy and to create a cultural change around disability in County Durham this strategy will be owned by the Children’s Trust. The Disability Trust Implementation Group with the County Durham Parents Steering Group & Investing in Children will report directly to the Disability Joint Commissioning Group. The Disability Joint Commissioning Group membership has strong links to the Joint Commissioning Board & the Children’s Trust and these structures will be used to support the work streams aims and also the strategic aims of the strategy, namely: inclusion.

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6. Organisations that this strategy applies to

This strategy applies to all of the members of the County Durham Children’s Trust and the services they provide for children, young people & families. This strategy is concerned with making significant positive changes for disabled children, young people & their families through inclusiveness.

7. Who Does this Strategy Apply To?

This strategy applies to all disabled children, young people and their families as defined in the Disability Discrimination Act 2005 who live within the boundaries of County Durham.

8. Principles of this Strategy

That the welfare & safety of disabled children, young people & their families is central to all service delivery

Mainstream services will be delivered on the basis of equality of access

and inclusiveness

Equality & Diversity – children, young people & families will have equal access to assessment and to service provision regardless of their disability, gender, race or ethnic background

Assessments will be holistic and based on the premise that disability is a

socially constructed concept and that individualism of young people will be promoted

Young people with disabilities, sensory loss or mental health problems and

their parents/carers must have clear information about all services that are available to them to enable them to make informed decisions and understand the options available for the future

There must be a seamless transition between services for children and

young people and into adult services

Young people and their parents or carers should be at the centre of all decisions which affect their lives – a person centred approach

There must be excellent partnership working, information sharing and

communication between the young person, their family and all services potentially involved with them

Planning and service delivery will focus wherever possible on preventing

crisis and unnecessary anxiety for families. Early support will be actively delivered through the Common Assessment Framework

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8. Outcomes of this Strategy

Aiming High for Disabled Children sets out a core offer for families in regard to the services they receive. The core offer covers the following areas:

Information & Transparency – “The information provided should be

tailored to the individual needs of children and their parents and be readily accessible in a range of formats”

Participation & Feedback – “Disabled children and young people and their families are routinely involved and supported in making informed decisions about their treatment, care and support, and in shaping services”

Assessment –““Disabled children and young people receive child-centred multi-agency co-ordinated services from the point of referral through identification and assessment to delivery”

The above elements of the core offer are central to the strategy & will be incorporated into all of the work streams that focus on the Every Child Matters Outcomes. The overarching outcome is for families to see & feel a difference in the services that they receive. For this to be achieved families must be able to access mainstream provision that provides early support and guidance and as a result reduces the need for specialist provision. By using Common Assessment Framework (CAF) in conjunction with the Lead Professional Passport, to assess need and create a team around the child (TAC), families will be able to access the services they need when & where they need them. By delivering a range of high quality services that meet the needs of families the need for children & young people to access services out of county will be reduced.

The other significant outcomes but not exclusive are:

Reduction in multiple assessments Holistic approach to service delivery Short breaks for families of disabled children Good transportations links Use of existing resources/buildings – cost effectiveness Integrated pathways to universal & targeted services – seamless service

delivery Increase in use and accessibility of leisure facilities Equitable access across the County Lead Professional embedded across the County Reduction in out of County placements Reduction in the need for complex care packages Development of effective transition service

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9. Legislation & Good Practice

Human Rights Act 1998 Disabled children, young people & families have the same human rights as everyone else. Disability Discrimination Act 1995 In accordance with the Disability Discrimination Act (DDA) 1995 as amended by the Special Educational Needs & Disability Act 2001 this strategy will protect disabled children & young people from discrimination in schools & children’s services. Local Authorities (LA) and schools have to deliver improvements in access for disabled pupils. In 2005, the Disability Equality Duty was also introduced into the DDA, which asks the LA to prepare and publish a disability equality scheme. Children’s Act 2004 The Act places a duty on local authorities to make arrangements through which key agencies co-operate to improve the well-being of children and young people and widen services' powers to pool budgets in support of this. To ensure that, within this partnership working, safeguarding children continues to be given priority the Act places a responsibility for key agencies to have regard to the need to safeguard children and promote their welfare in exercising their normal functions. It also establishes statutory Local Safeguarding Children Boards to replace the existing non-statutory Area Child Protection Committees. In addition, it provides for regulations to require children's services authorities to prepare and publish a Children and Young People's Plan (CYPP) which will set out their strategy for services for children and relevant young people Improving the Life Chances of Disabled Children This sets out the aspiration that by 2025, disabled people in Britain should have opportunities to improve their lives and be included as equal members of society. The office for Disability Issues coordinates cross government work to deliver this vision. Early Support Early supports vision is to co-ordinate services for families with young disabled children. All LA’s should deliver on the Early Support principles. The Children’s Plan The Children’s Plan establishes the overarching strategy for children’s services. A key priority running through the Children’s Plan is to make services accessible for disabled children & young people.

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Aiming High for Young People Aiming High for Young People sets out a 10 year framework for the aspirations for what young people’s services, including those for disabled young people should achieve. The Autism Act 2009 The Autism Act 2009 outlines key responsibilities for Local Authorities and NHS bodies in relation to meeting the needs of adults in England with autistic spectrum conditions by improving the provision of relevant services to such adults by local authorities, NHS bodies and NHS foundation trusts. Framework for Continuing Care 2010 This practice guidance supports practitioners and others with responsibilities for NHS continuing healthcare in the implementation of the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. It provides a practical explanation of how the Framework should operate on a day-to-day basis and cites examples of good practice.

10. ECM outcomes as themes to incorporate work streams

One of the core aims of this joint strategy is the participation of disabled children, young people & families in shaping service design and improving services in County Durham. A key component to the Durham model of participation is empowering parents & children and young people to shape the agenda and where the focus of the work will be concentrated upon. To enable inclusion the strategy will highlight the 5 Every Child Matters Outcomes that the work streams will be aligned to and will therefore be able to link to the strategic priorities of the Children’s Trust that have a statutory responsibility to be inclusive through core offers. This will enable a level of flexibility and will ensure that the ethos of participation is central to the landscape in County Durham. The 5 Every Child Matters Outcomes are:

Be healthy Stay safe Enjoy & achieve Make a positive contribution Achieve economic well being

This strategy acknowledges that the key to improved outcomes for disabled children, young people & their families it to jointly set the agenda and therefore react to the local needs and issues.

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The Disability Trust Implementation Group & the County Durham Parents Steering Group will continue to use the Durham Model (Appendix 1) to engage key stakeholders in setting the agenda & being the catalyst for change. Each of the work streams will focus on the following impacts for stakeholders: Disabled Children & Young People 1. Lead more ordinary lives 2. Journey towards independence in adulthood 3. Improved emotional and physical health

Parents, Families and Carers of Disabled Child/Young Person 1. Working towards having a more ordinary life 2. Experience reduced stress and reduced worry 3. Have time for themselves & other children/family Local Authority, PCT & Partners

1. Deliver high quality inclusive seamless services to families 2. Prevent crisis through holistic prevention & early support 3. Reduce the number of children & young people who access services

outside of County Durham 11. Workforce

The Children’s Executive Board (County Durham’s Children’s Trust) set out their vision for improving services to children, young people and families in the Children and Young People’s Plan 2009 – 2012, which is: “Improving quality of life by helping County Durham’s Children and young people believe, achieve and succeed.” The strategy needs to ensure that the workforce can achieve this vision and meet the government's agenda within the 2020 strategy and other national guidance by ensuring that: In the 2020 Children and Young People’s Workforce Strategy the government set out its vision, which expressed that everyone within the children and young people’s workforce is:

Ambitious for every child and young person; Excellent in their practice; Committed to partnership working; Respected and valued as professionals. A modernised and professional workforce: To ensure that the children’s

workforce is skilled and qualified to deliver improved services through the use and provision of appropriate training and development opportunities.

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A workforce able to meet demand requirements: To develop, agree and implement workforce planning initiatives to proactively recruit and retain quality staff to meet need.

To identify recruitment ‘hotspots’ and target workforce planning initiatives accordingly.

A flexible & adaptable workforce: A remodelled workforce which embraces new and different ways of working.

An integrated workforce: To ensure the development of a workforce infrastructure to support the maintenance of inter-agency and multi-agency working practice including multi-agency training.

A stable & motivated workforce: high quality and motivated workers through the availability of career progression opportunities.

A safe & trusted workforce: To ensure that the workforce is monitored and regulated to safeguard and promote the wellbeing of service users in accordance with the Children Act 2004.

A diverse workforce: To address equality and diversity in the workforce and the benefits that this can bring to commissioning and delivering services. To identify and evaluate local need and issues and to respond to them in a strategic and structured way.

Next Steps To implement the Joint Disability Strategy we will link the following strategies/protocol: The transition protocol The short breaks strategy The Special Education Need(s) strategy The work of the Durham Model Each strategy/protocol will have specific action plans and will refer back to the main Joint Disability Strategy to ensure continuity. As this is joint strategy, accountability will be shared between all partners including parents. The strategy and accompanying documents will be implemented by the Disability Trust Implementation Group jointly with the Making Changes Together Group, the eXtreme group from Investing in Children with partners from adult services & the voluntary sector. This process will be overseen by the Disability Joint Commissioning Group & the Children’s Trust.

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Appendix 1 The Durham Model The Durham model is at the centre of all developments in County Durham for disabled children & young people. The model is nationally recognised as good practice brings key operational and strategic leads together with parents & young people to make positive changes together. This model provides a framework that enables all stakeholders to participate in the development of services for children & young people with complex needs. This model provides direction and governance in the development of services.

This model has a number of focus groups that are linked and report to the County Durham Parents Steering Group and the Disability Implementation Group. The process is governed by the Disability Joint Commissioning Group.

Parent SteeringGroup meetings

Parent Forum Conference

Outcomes from the focus groups fed back to parents

Outcomes from the focus groups fed back to parents

Parent ForumConference

Focus GroupsIssues chosen by

parents at the conference

Focus GroupsIssues chosen by

parents at the conference

The Durham Model

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Appendix 2

Special Education Needs by Type

Behaviour/Emotional Children & Young people with behavioural, emotional and social difficulties cover the full range of ability and a continuum of severity. Their behaviours present a barrier to learning and persist despite the implementation of an effective school behaviour policy and personal/social curriculum and may lead to more specialist educational arrangements. They may be withdrawn or isolated, disruptive and disturbing, hyperactive and lack concentration, have immature social skills or present challenging behaviours. Speech, Language & Communication Speech and language difficulties usually fall into three categories, (though there may be other speech/language disorders such as those caused by physical deformities, e.g. dysarthia); expressive disorders, receptive disorders and phonological difficulties. A child with an expressive disorder finds it difficult to express their thoughts and feelings through speaking and writing. Children with a receptive disorder have problems understanding certain aspects of speech. The child can hear words but can't always make sense of them, e.g. they may confuse a bell and a ball. Phonological disorder is a type of speech disorder known as an articulation disorder. Children with phonological disorder do not use some or all of the speech sounds expected for their age group. Elective mutism is considered to be a speech disorder, although it is not so much that the child can't speak but that he or she chooses not to speak in certain situations. This can be accompanied by other withdrawal activities. Learning Disabilities and Mental Disorders The incidence of children with severe to mild learning disabilities is expected to rise by 1% year on year for the next 15 years due to a number of factors and 40% of these children will have a diagnosable mental health disorder. This rate is even higher in those children with severe learning disabilities (this is a vital signs indicator). Across County Durham and Darlington there are approximately 1,200 children and young people with a learning disability and of these 480 will have a mental disorder, rising to 500 over the next 5 years. (Altogether Better Durham) Autism Autism is most usually defined as a triadic impairment of social interaction, communication and imagination. Autism is generally characterised as a spectrum or continuum of functioning and impairment.

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The most severe type of autism, Kanner’s Autism (SLD Autism) is estimated to affect around 10 to 30 births per 10,000 and is associated with significant and life-long learning, social and communication disabilities. Asperger’s Syndrome is usually held to represent the high functioning end of the autistic spectrum. Individuals with autistic symptoms, but who do not fit the strict criteria for SLD/Kanner’s Autism or Asperger’s Syndrome is generally diagnosed with Autistic Spectrum Disorder. Some children with another underlying diagnosis but who exhibit significant autistic behaviour and impairments may additionally be diagnosed with ASD. Recent figures quoted on the incidence of all Autistic Spectrum Disorders in the UK have been as high as 1% of children. The estimated number of children under 18 with an autism spectrum disorder (ASD) is 133,500. There is little evidence that the incidence of classic Kanner’s/SLD Autism is increasing, but it is certainly the case that the number of children receiving a diagnosis of Autistic Spectrum Disorder has increased markedly. Whether this is a result of better diagnosis and a widening of diagnostic criteria or an actual increase in incidence of ASDs is currently a matter of some debate amongst experts. The range of capability and disability in the autistic spectrum cannot be over-stated. Autism in its widest usage encompasses some children who will need minimal support by adulthood and others who will need life-long and intensive support in every aspect of their daily routine. Sensory Impairment Across County Durham around 500 children & young people are actively involved with the Sensory Support Service. Sensory impairments vary in degree and type and a small number of children and young people having multiple sensory impairments disabilities. Physical Disabilities There is a wide range of physical disabilities (PD) and those affecting pupils cover the whole ability range. Some pupils are able to access the curriculum and learn effectively without additional educational provision. They have a disability but do not have a special educational need. For others, the impact on their education may be severe. In the same way, a medical diagnosis does not necessarily mean that a pupil has SEN. It depends on the impact the condition has on their educational needs. There are a number of medical conditions associated with physical disability which can impact on mobility. These include Cerebral Palsy, heart disease, Spina Bifida and Hydrocephalus and Muscular Dystrophy. Pupils with physical disabilities may also have sensory impairments, neurological problems or Learning Difficulties. Some pupils are mobile but have significant fine motor difficulties which require support. Others may need augmentative or alternative communication aids.

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