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Building local and regional capacity for children with complex needs and reducing out of authority placements

Please be aware that this section contains information prepared in 2009 and may now be out of date. Some links may no longer work. We are reviewing this section.

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Introduction

Many local authorities' children's services, together with their partners, are experiencing challenges in securing appropriate provision for children and young people with a range of complex and low-incidence needs, including autism. They represent a relatively small group of children with very high levels of need. Despite additional support, many have been excluded from both mainstream and special schools; they are potentially the most vulnerable and least visible pupils in the education system. Some of these children are placed out of authority, typically meaning placement in independent and non-maintained special schools, rather than special schools maintained by other local authorities that may border that local authority area.

In 2006 The National Autistic Society (NAS) produced a report: Make School Make Sense - Autism and Education the Reality for Families today. It reported that  21% of children with autism attend a school located outside their local authority. Whilst 11% of children travel out of their local authority to go to primary school, this rises to 30% of secondary school pupils. These figures reflect parental perception that provision is more limited at secondary school level. The report noted that pupils who are described as ‘more able’ are much more likely to be in an independent special school. This indicates a shortfall of specialist provision for this group in the maintained special school sector.

The report recommended that local authorities should work to ensure that:

  • every child on the autism spectrum has local access to a diverse range of mainstream and specialist educational provision, including: autism-specific resource bases attached to mainstream schools, special schools and specialist outreach support.
  • There should be collaboration with neighbouring authorities to co-ordinate provision of suitable placements for children with more complex needs.
  • Authorities should also secure the provision of autism support and advisory services to mainstream schools and increase the capacity of specialist services for children with Asperger syndrome, including outreach services and tailored placements in resource bases and special schools.
  • There should also be an increase in the proportion of autism-specific placements (schools or resource bases) for secondary school age children on the autism spectrum.

General Statistics and Trends
In 2007, the Audit Commission Report Out of authority placements for special educational needs reported that over 11,000 pupils with a statement of special educational needs (SEN) are placed in out of authority special schools. These are most often children with severe behavioural, emotional and social difficulties (30%) and children on the autism spectrum (23%). Together these placements make up 62 per cent of the total costs of out of authority placements. The age groups with the highest number and spending on out of authority placements are ages 13-15.


Regional Partnership Research
The Regional Partnerships sought data from local authorities about the numbers, needs and costs of children attending out-of-authority day and residential non-maintained and independent day and residential special schools. The data provided essential benchmarking information for individual local authorities and regions, as well as an invaluable national picture. The analysis included details of the numbers, costs, needs and placement types as well as information about looked-after status.

Reasons for placement

Research conducted by the West Midlands Regional Partnership (see case study) demonstrated that it is behaviour that gives cause for concern which appears to be the single most frequent reason for out of authority placements and not access to a particular curriculum or approach. There were two clear groups of children and young people on the autism spectrum placed out of authority. One group had no additional learning difficulties and required access to a mainstream curriculum. They potentially had significant mental health issues with challenging behaviour and the potential for self-harm.

Typically, this group of children and young people ‘manage’ through primary school but the increased demands at secondary school, with the need to move around the school, greater social skills, the ability to shift between different members of staff with different styles and expectations, can lead to a breakdown in placement in some cases.

The other group of children and young people on the autism spectrum placed out of authority had significant severe and complex learning needs, with severe learning disabilities and needed a high level of support.

The lack of short break care for the families and the children and young people from both groups is often a factor in an out of authority placement. Work on the Aiming High for Disabled Children agenda (DCSF, DH) and particularly the improvements to short breaks provision will hopefully help to ameliorate this situation.

In exploring regional responses to low incidence needs, the National Audit of Support, Services and Provision for Children with Low Incidence
Needs (DfES, 2006) reported on the potential for building a regional
capacity to audit, monitor and moderate local practice as part of an approach to strengthen and develop local provision.

Importance of regional working

The Government believes that regional commissioning has the potential to:

  • Deliver better value for money by planning for, and aggregating across a number of authorities demand for low incidence services
  • Share costs for commissioning functions between a number of authorities
  • Share limited commissioning and market management skills across a wider geographical area
  • Enable more effective management of providers
  • Transmit good practice more easily from one authority, or provider, to another

(August 2007 www.everychildmatters.gov.uk)


Transitions from out of authority placements
The Government wants to see Local Authorities working with other agencies to develop local capacity and decrease the need for children to be educated in high cost placements, far from home. It is recognised that residential placements play a valuable role in the spectrum of provision and demand for such placements should be anticipated and planned for as part of the commissioning strategy. However, there are a number of concerns around out of authority placements including: the impact of living away from family and home community, vulnerability to abuse and neglect, difficult transitions beyond residential provision, inappropriate use of residential placements, high costs and poor outcomes for some.

In the Audit Commission's research parents expressed concerns regarding transition beyond the out of authority placement. Many were “extremely worried” about the continued availability of suitable provision. Key concerns centre on a lack of forward planning and fears that funding limitations might lead to an inappropriate placement. The Audit Commission found that during times of transition from school to further education and from children’s to adult services there were particular weaknesses in joint planning for children and young people in out of authority placements. Local authority officers’ most common concern about such placements was the return of pupils, particularly those with the most profound and complex needs.

Preparing for and managing change is important for all children, but this is particularly so for those with on the autism spectrum. Local authorities need clearly established policies and procedures for this including adequate record keeping and profiling methods so that information can accompany the children. Children's views should be taken into account when making decisions about placement.

Good Practice Recommendations


The Autism Education Trust's Report,  Educational provision for children and young people on the autism spectrum living in England: a review of current practice, issues and challenges identified the following key challenges and solutions for improving out of authority placements:

  • The joint commissioning of placements for children and young people on the autism spectrum so that integrated packages of support are available, enabling more children and young people to remain at home/within their own local authority.
  • A thorough analysis of need is key to the success of commissioning to ensure that those children and young people who require provision which is very different from what the LA usually provides gain access to this.
  • Analyses of need should be based on good diagnostic practice and liaison with health professionals so that accurate planning is based on known risks for associated difficulties.
  • Joint commissioning and planning is important. There is considerable variation in the relative proportions of joint contributions across the authorities. PCT contributions should be based on long term assessed needs
  • Every pupil in an out of authority placement should have a lead professional or key worker who manages and reviews the pupil’s care plan and ensures multi-agency support.
  • Local authorities and PCTs should be encouraged to determine long term outcomes for any child/young person on the autism spectrum at the beginning of an out of authority placement and monitor progress on these outcomes.
  • Addressing deficits in short break provision, mental health support and therapies (e.g. occupational therapy, speech and language therapy).
    Sharing of good practice on innovative, flexible packages of support.
  • Early planning regarding transition is vital. The Audit Commission found particular weaknesses in joint planning for children and young people in out of authority placements during times of transition from school to further education and from children’s to adult services.

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Links

Make School Make Sense - Autism and Education the Reality for Families today The National Autistic Society (2006)

Educational provision for children and young people on the autism spectrum living in England: a review of current practice, issues and challenges The Autism Education Trust (2008)

Out of Authority Placements for Special Educational Needs, Audit Commission (2007)

Transition Support Team -  Materials and information for the Transition Support Programme part of the Aiming High for Disabled Children Programme.

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Case studies


West Midlands Research
The West Midlands Regional Partnership commissioned a project in 2007- 2008 to look in detail at the out of authority placements for children and young people on the autism spectrum made by the West Midlands Local Authorities (see West Midlands Regional Partnership Innovation Project, 2007 – 2008). The project found that within the West Midlands region a small but significant number of pupils on the autism spectrum (151) were placed out of authority, generally as a result of the local authority's conclusion that it was unable to meet the complexity of needs within its own maintained schools and, a minority of these were placed out of authority in response to a First Tier Tribunal (Special Educational Needs and Disability) hearing and judgement.

The total annual bill for the 14 Local Authorities in the West Midlands for 151 children and young people on the autism spectrum in 2007 – 08 was approximately £16,865,000. The Region then had to consider whether this sum of money might have been spent differently to support these children, in particular whether they could have remained in provision closer to home if greater support had been given to families or the support in schools had been modified or increased.

Consideration was given as to whether it made more economic sense to continue to fund places for a relatively small number of children each year in out of authority places, being aware of the educational and family benefits and disadvantages of such placements.

Average costs per placement range from below £50,000 (for a day placement) to £225,000 (for a residential 52 weeks a year placement). The total amount spent by local authorities is dependent upon a number of factors including the availability of specialist placements nearby which can be accessed on a daily basis; the number of children and young people with complex needs in the local authority; the structure of funding within the local authority; and the authority’s own approach to within authority specialist provision.

The East Midlands Regional Partnership commissioned a review of regional activity in the East Midlands to support commissioning. This report concluded that East Midlands regional activity to support commissioning makes a difference to:

  • the knowledge base and quality of partnership between commissioners across the East Midlands
  • the quality of commissioning and planning within and across organisations
  • the coherence and continuity of commissioning across East Midlands Children’s Services
  • Value for Money
  • Controlled cost increases in specialist care and education placements

A priority for East Midlands commissioners is the group of children and young people on the autism spectrum with complex needs for whom statutory services struggle to provide effective and sustainable local solutions.

Tailor-Made Programmes Team (TMPT) provides specific packages of support for individual pupils with SEN. The programme caters for challenging young people with SEN, especially BESD and autism, who might otherwise be in out of authority provision.

TMPT aims to provide long-term support for pupils until the age of 16. It is based at a local authority learning centre and pupils are referred by the multi-agency complex needs panel. These pupils have often been excluded from special schools. The curriculum is broad and balanced but highly personalised to take account of the individual’s special needs. Much provision is one to one and the package includes appropriate support from social care and other agencies.

The programme has been running for ten years and has demonstrated that it successfully engages these young people, resulting in improved school attendance and many pupils gaining GCSEs. Places are limited to 10 at present at one learning centre but the aim is to expand the model across the authority and to extend the provision available to include college and work-based learning. Though costs are only slightly lower than the average cost of an out of authority placement (about £50,000 per pupil per year), the programme gives young people support to stay in their home community, rather than being placed out of county with the longer-term dislocation that this implies. (Source: Audit Commission 2007)

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