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					SCHOOLS, CHILDREN AND FAMILIES
         DIRECTORATE




 CHILDREN’S SUPPORT SERVICE

 ADVICE FOR ESSEX SCHOOLS ON
  THE EDUCATION OF ANXIOUS
    SCHOOL REFUSERS AND
PUPILS WITH LONG TERM ILLNESS
1.        MEETING THE NEEDS OF CHILDREN WITH A LONG TERM ILLNESS

          Some children may develop illnesses which can be life threatening, or be of such a
          nature that they result in substantial periods of absence from school.

          If pupils are unable to attend school for a period in excess of three weeks, as soon
          as this is identified the Local Authority (LA) can provide integrated support. Until
          such time as integrated support is provided, the school is responsible for providing
          work.

          It is essential that as much as possible is done to try to maintain a good quality of
          life for these children. Educational needs should be identified early on so that the
          appropriate support can be put in place as quickly as possible. Teachers from the
          Integrated Support Service will provide education for pupils in their homes or
          alternative suitable venues. Close liaison with the pupil’s school is essential and
          pupils should be kept informed about school activities and events.


          Children with long term illnesses:

                   account for a very small percentage of school absentees;
                   can experience a severe lowering of morale;
                   can be, through their illness, the cause of great stress within the family;
                   are probably unable to access the full national curriculum;
                   may frequently become socially isolated from their peers;
                   require sympathetic support from all agencies;
                   may occasionally develop symptoms of school refusal.

          In these circumstances support can be provided as follows:

          When requesting integrated support for a long term sick pupil, the school
          should fill in the appropriate referral form, enclosing supporting medical
          documentation and send it for authorisation to the Senior Caseworker,
          Children’s Support Service, County Hall, Chelmsford. CM2 6WN

          Once authorised, the referral will be passed to the appropriate Integrated Support
          Manager who will ask the school to hold, chair and document a planning meeting.

          At this meeting, each party will wish to explore how best to arrive at an agreed plan
          of action. The following describes some of the contributions that each party may be
          able to make towards an effective education and eventual reintegration programme
          for the sick pupil. The pupil will remain on the school roll with an understanding that
          a return to school is the eventual goal.




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        The Integrated Support Manager, in consultation with the Principal Officer,
        Children’s Support Service, and following negotiation with parents and school, will
        decide on the most suitable venue for tuition.

        School’s role is to:

               name a person with whom to liaise;
               host and chair regular review meetings;
               identify an appropriate programme of work;
               prepare a Personal Education Plan with appropriate targets. It is anticipated
                that the preparation of this plan will involve other professionals e.g. Health
                and Social Services;
               co-ordinate record-keeping (for example, School Action Plus, minutes of
                meetings, if appropriate);
               ensure all staff are kept informed;
               ensure appropriate arrangements are made for external examinations.


        Pupil’s role is to:

               be ready to work with the ISS teacher;
               be prepared to communicate their views;
               engage with other agencies as appropriate;
               prepare for reintegration as soon as possible.


        Parents’ role is to:

               work with all concerned, attending necessary meetings if possible;
               provide an appropriate working environment in the home;
               provide updated medical evidence as requested.


        Education Welfare Officer’s (EWO) role is to:

               make regular home visits to monitor progress;
               be involved in regular reviews and liaison with all parties.


        Integrated Support Service’s role is to:

               liaise with named person in school;
               liaise, where appropriate, with outside agencies;
               provide a flexible teaching programme;
               ensure appropriate course work and any other relevant material is returned to
                school;



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                   help set up an appropriate reintegration programme at the earliest opportunity
                    as soon as the pupil is ready to return to school.

        Health Service’s role is to:

                  offer medical treatment and advice where appropriate.


        Other involved agencies, for example Social Services, Child and Family
        Consultation Service’s role is to:

                  work, with others, for the benefit of the pupil;
                  attend review meetings if possible;
                  provide written reports where necessary;
                  be available to give appropriate advice.



2.      MEETING THE NEEDS OF CHILDREN WITH ANXIOUS SCHOOL REFUSAL

        The Local Authority recognises that a very small number of children experience a
        significant psychological difficulty, which results in extreme problems in attending
        school.

        We have drawn together this policy which takes account of research showing that
        anxious school refusal:

                   accounts for only a very small percentage of school absentees;
                   creates tremendous stress for the child and family;
                   can be more quickly and effectively managed with primary aged children;
                   is not sufficiently improved through either hospitalisation or attendance at
                    special units to enable a return to mainstream school;
                   should be identified early;
                   requires all support agencies to work together to support the child through
                    the school system.

        A range of professionals can offer support to children, families and schools in
        managing this difficulty more effectively. We recognise that such effective
        management can only be achieved where there is good multi-professional working
        practice.


        Identification

        A key issue with regard to children experiencing severe psychological problems
        over school attendance is that of identification. In considering the broad range of



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        professional knowledge and research, we accept that a set of characteristics can be
        identified by schools, which may serve as possible early indicators of a severe
        difficulty.

       Typical characteristics of anxious school refusal include:

               child refuses to attend school;
               child may be extremely anxious about leaving home;
               child has an obvious emotional upset such as sleep loss, loss of appetite,
                crying, tantrums, bowel upset;
               child at home with knowledge of parents;
               significant anti-social difficulties at home or at school;
               child has no significant physical illness.

        In the identification process, it is therefore, important that all these factors are
        considered.


        Early School-Based Actions

        The characteristics of a significant psychological difficulty over school attendance
        often emerge suddenly as far as the school is concerned, although the family may
        have been aware of the child’s anxieties for some time. It is essential that the
        school responds urgently where there is a possibility that a child may have such a
        difficulty. Schools should consider planning their assessment and support
        arrangements through the School Action Plus procedure.

        Early problem-solving meetings between parents and school staff can often lead to
        a resolution of these difficulties. Where this does not succeed, the involvement
        initially of the EWO is essential.

        The EWO will investigate further and recommend additional action to the family.

        Intervention

        Where early intervention at School Action stage does not bring about an improvement
        in attendance, one possible way forward, particularly where identification has occurred
        through the Health Service (for example, medical practitioner, psychiatrist, therapist)
        would be for the school to convene and chair a school based meeting. This meeting
        should follow the School Action Plus format, with attendance invited from:

               appropriate school staff (including Special Educational Needs Co-ordinator
                (SENCO));
               parents, and child as appropriate;
               EWO;
               Educational Psychologist (EP);



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               appropriate Integrated Support Service Staff;
               Principal Officer, Children’s Support Service;
               other professionals involved.

        The purpose of this meeting is to:

               explore case history, behaviour and consequences;
               emphasise the goal of a return to mainstream school;
               ensure parents are active partners in the process;
               let parents know what support is available;
               explore a range of strategies;
               agree what is to be done and by whom.

        During the planning meeting each party will wish to explore how best to arrive at an
        agreed plan of action. The following describes some of the contributions that each
        party may be able to make towards an integration programme. At all times the pupil
        remains the responsibility of the school where they are on roll.


        School’s role is to:

               host and chair regular review meetings;
               provide a named teacher with whom each party can liaise (usually the
                SENCO);
               supply appropriate information about a pupil’s capabilities, educational
                progress and programmes of work;
               provide a planned course of action to ease reintegration;
               provide set targets for an Individual Education Plan;
               provide a suitable working area within the school, where necessary;
               co-ordinate record keeping (for example School Action Plus, taking and
                distribution of minutes);
               ensure all staff are kept informed;
               be active in the monitoring of progress and the reintegration into school,
                using key staff to facilitate the transfer from ISS back into school;
               ensure that pupils who are unable to attend school, because of medical
                needs, are kept informed about school social events, are able to participate,
                for example, in homework clubs, study support and other activities;
               encourage and facilitate liaison with peers, for example, through visits and
                videos.


        Pupil’s role is to:

               be ready to work with the ISS teacher;
               be prepared to communicate their views;
               engage with other agencies as appropriate;



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               prepare for reintegration as soon as possible.

        Parents’ role is to:

               commit to a plan of reintegration;
               be willing to work together with all concerned;
               provide early communication if a problem arises or help is needed;
               agree to attend necessary meetings;
               reinforce, with their child, the value of a return to school.


        Education Welfare Officer’s role is to:

               assist with a reintegration programme, as appropriate;
               make regular home visits to monitor progress;
               provide on-going involvement in regular reviews.


        Integrated Support Service’s role is to:

               liaise with named person in school;
               be sensitive to the needs of the child and family;
               provide flexibility in teaching programme;
               be aware of the progress of the child, where necessary liaising with EPs.


        Educational Psychologist’s role is to:

               advise on the integration programme;
               advise on the learning programme;
               liaise with Child and Family Consultation Service;
               advise and support all parties, where appropriate.


        Child and Family Consultation Service’s role is to:

               consult with professionals;
               assess the child and family needs following referral from the family or
                professional agency;
               intervene with individual/family where appropriate.


        Medical Practitioner’s role is to:

               provide medical treatment and advice where appropriate.




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        Principal Officer, Children’s Support Service role is to:

               authorise the provision of integrated support when that is the agreed
                outcome following discussion at a multi-disciplinary meeting;
               review engagement of Integrated Support Service on a regular basis.


        Connexions Service

               Pupils aged 13 and over will have access to a personal adviser who may
                also access other networks to help them find ways to overcome barriers to
                achieving their potential.


        Record Keeping

        The current Code of Practice for the Identification and Assessment and Intervention
        of Special Educational Needs suggests that Anxious School Refusers (School
        Phobia) may be evidence of a significant emotional and behavioural difficulty. It is
        therefore, important that such a meeting is regarded as part of the School Action
        Plus process and recorded appropriately.

        When requesting support, the school should fill in the appropriate referral form and
        send it to the Senior Caseworker, Children’s Support Service.

        Recommendation for Integrated Support

        The school will be required to demonstrate that it has taken all possible steps to
        address or respond to the situation but has been without success.

        A range of options for intervention will be explored during the meeting. One
        possible action arising might be the view that a short period of involvement from the
        Integrated Support Service would be appropriate in order to achieve the long-term
        goal of a full-time return to mainstream school. Such a recommendation should
        usually incorporate advice from an EP.

        Recommendations for integrated support should include a strategy for a return to
        school.

        The Manager of ISS, in consultation with the Principal Officer, Children’s Support
        Service would also decide the venue for tuition, listening to contributions from other
        agencies. All parents and pupils are consulted before teaching begins. Targets
        would be set and a date for a six weekly review meeting arranged.




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        Review of Progress

        It is essential that all efforts are made to focus on an early return to school and the
        Integrated Support Service aims to build up the confidence of the child so that a
        return is successful.

        Where integrated support is provided for a child, it is essential that the place of
        delivery for the service is well planned. Providing integrated support in the child’s
        home can serve to reinforce difficulties in attending school. Review meetings to
        monitor progress will be necessary and these will require continuing documentation.
        It is expected that the child’s school will take responsibility for ensuring that
        appropriate reviews are undertaken.

        It is also important to link with other agencies in order to support a child’s
        educational opportunities up to the age of 16 and to maintain liaison with Further
        Education to ensure a successful transition to networks that can promote lifelong
        learning.

        When integrated support is agreed for a child, the school and ISS have certain
        responsibilities:

            The school retains the funding for the pupil and remains responsible for:
                ensuring half-termly work plans are available in all national curriculum
                 subjects which the pupil would normally be studying.
                the loan of appropriate resource materials, where possible. These will be
                 itemised and checked off when returned to the school;
                completing examination entries;
                examination fees;
                invigilation arrangements;
                providing timely and clear information to the school’s examinations officer
                 regarding entries and applications for special arrangements;
                making arrangements for SATs;
                assessment of coursework;
                career interviews;
                work experience placements;
                informing all other agencies of any alterations to the agreed plan of action.

               Integrated Support Service’s responsibilities include:
                 the delivery of a broad and balanced curriculum;
                 providing regular reports from specialist or reintegration teachers on the
                   pupil’s progress and achievements;
                 providing an opportunity for the child to comment on their report;
                 working with the mainstream school and EWO to ensure good attendance
                   whilst on ISS and if necessary, requesting a home visit;
                 completing accurate attendance records;
                 working with the child on an appropriate programme of reintegration;



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                 attending review meetings;
                 ensuring ISS teachers receive appropriate in-service training.

        On occasions, ISS may be withdrawn if the child fails to be available on a regular
        basis without appropriate medical evidence, or if a recommended therapeutic
        programme is not followed. All efforts will have been made to establish a way
        forward and the door will remain open if the child wishes to engage.




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