Good intentions, good enough?

Daniel Brennan, Assistant Psychologist at Ealing Intensive Therapeutic and Short Break Service (ITSBS) provides a summary of Lenehan, C. and Geraghty, M.  (2017) “Good intentions, good enough?: a review of the experiences and outcomes of children and young people with learning disabilities in residential special schools and colleges“, Department of Health.

This article forms part of the LASER SIG Newsletter September 2019. Learn more about the LASER SIG.

The Lenehan review is a broad survey of the provision of residential school placements across the UK. Published in 2017, the review involved consultation with a wide range of stakeholders including parents and carers, 30 schools and colleges, and 20 Local Authorities, in addition to OFSTED, CQC, and the SEND Tribunal. The review took place in the first years of the implementation of the Children and Families Act 2014, which seeks to empower families of young people with SEND, by offering more choice of educational and health provisions and improving the assessment of special education needs. In this context, Dame Lenehan’s focus on residential school placements is not so narrow as it might first appear; more than 6,000 children and young people spend much of their childhood in residential schools, many attending schools outside their local community. Moreover, residential school placements are estimated to cost the taxpayer approximately £500 million per annum. The Lenehan Review presents evidence from innovative projects across the country that show that outcomes for children and young people with SEND can be improved significantly, whilst reducing the cost of their education to Local Authorities.

“Some LAs have introduced their own PBS services, with one estimating a saving of £1.8M over 4 years by enabling children and young people to stay within their family homes and at local special schools.”

It is clear from the report that the population of children and young people who attend residential school is heterogeneous and their pathways to residential schools are varied. More than 70% of children and young people who attend residential schools fall into one of two categories; those with diagnoses of ASD, communication difficulties, or severe learning disabilities, who display challenging behaviour, and those with Social, Emotional, and Mental Health diagnoses, who display challenging behaviour.

For many of these young people, their mainstream school placements have been unable to support them adequately at earlier stages of development leading to an intensification of their needs. This tends to cause an increase in the severity and frequency of challenging behaviour over time and, in many cases, the eventual breakdown of the school placement. Children and young people with SEMH diagnoses are twenty times more likely, and those with ASD three times more likely, to be excluded from school than their peers without SEND. The remaining 30% of young people in residential schools are made up of those with Profound and Multiple Learning Disabilities, who require complex support from multiple agencies, and those with additional needs but without a learning disability, who usually have a physical disability. The former often seek residential school placement due to the complexity of their medical needs requiring additional care which would not be feasible in the home. The latter group are often young people who could be educated in local, non-residential schools if suitable accommodation was made for their disability.

However, Lenehan reports that these young people have usually sought residential placements after appalling (and sometimes multiple) experiences in local schools. The simple description of many young people’s experiences offers some recommendations for reducing the use of residential placements.

“Whether for a traumatised child supported to overcome their experiences, an autistic child struggling with anxiety but transformed by positive behaviour support, or a child with profound and multiple learning difficulties providing valuable skills to their community while on work experience, we know that the right support can be life-changing for these children and young people.”

The Lenehan review suggests there is a dire need for processes to identify those with additional needs early in order to maximise the impact of intervention. Secondly, there is a clear need for all mainstream and specialist schools to have a greater understanding of behaviour that challenges and to embed a Positive Behaviour Support approach to supporting these young people. Thirdly, there is a need for a more holistic approach to supporting young people with disabilities and complex needs which requires a multi-disciplinary, person-centred approach. Lenehan notes the work being carried out by the Gloucestershire Local Authority using a “whole system around the child” model as exemplary. The report also recommends that CCGs provide a greater range of mental health and short breaks services to reduce the pressure on families whilst also up-skilling parents to apply PBS strategies in the home.

Dame Lenehan notes the Intensive Therapeutic and Short Breaks Service in Ealing as a model for this kind of work. In addition to these recommendations, the Lenehan review suggests that the planning conducted by local authorities around the use of residential schools requires improvements. The report paints a picture of LAs that struggle to proactively fund services that will reduce the need for residential placements, such as intensive PBS teams, whilst also being reluctant to use residential placements due to high costs and the desire to keep children living locally.

Where LAs plan proactively to meet the needs of this population, such as in Essex and Hertfordshire, children and young people with additional needs have more positive experiences of schooling, are able to continue to live locally, and expensive, out-of-area residential placements can be avoided.

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