A professional's guide to EHCPs for children with complex needs
by Karin Bayley
Context
When a child or young person’s educational attainment and integration in school is impacted by their injury or condition an EHCP is a key tool in their rehabilitation plan. OTs play a pivotal role in assessing, identifying, and providing objective recommendations to help children and young people with special educational needs achieve their educational and functional aspirations.
Education, Health, and Care Plans (EHCP) - A brief History
Education, Health, and Care Plans (EHCPs) are legally binding documents outlining a child’s or young person’s (CYP) special education, health, and social care needs. They supersede ‘Statements’ of Special Education Needs (SEN) first suggested in the Warnock Report (1978) Special Educational Needs. This report recommended the use of a formal Statement detailing the support required to help integrate CYPS with special educational needs into mainstream classrooms. Warnock’s suggestions were incorporated into The Education Act 1981 which mandated that SEN statements be written for students.
By 2009 The ‘Lamb’ Inquiry found parents were increasingly dissatisfied with the lack of consultation and their limited rights to contest SEN statement findings. Lamb’s findings helped to influence the need for a change to the Statement of Special Education Needs to the current system of EHCP.
The EHCP, and the needs assessment process through which they are created, were introduced by The Children and Families Act 2014. Local Authorities (LA) guidance is set out in the Act and the SEND Code of Practice on how to deliver EHCPs. The Act initiated significant systemic reforms to policy for Special Educational Needs and Disabilities (SEND) and sought to enable a more joined-up, personalised and co-productive approach that placed CYPs and their families and carers at the heart of the system that operates today. Crucially, it introduced an appeals process for parents and carers.
Aim of the EHCP
The implementation of EHCPs was designed to deliver positive outcomes for CYPs in the areas of education, health, employment, and independent living, by building on their personal aspirations and providing additional support to achieve them. The EHCP must list the child’s special educational needs, including for children and young people with physical disabilities, mental health conditions, sensory, and developmental needs, and the provision required to meet each of these needs. This information must be specific, detailed, and quantified. Section 100 of the Children and Families Act 2014 places a statutory duty on governing bodies of maintained schools, academies, and pupil referral units, to make arrangements at school to support pupils with medical conditions. If a child is considered to be disabled, the school has specific duties to make arrangements for that child.
The EHCP Process
A written request must be made to the LA which has 6 weeks to make a decision to accept or decline the request for assessment. If the request is accepted, the Local authority has a further 12 weeks from the date of the assessment agreement to issue a draft EHCP, and then a further 2 weeks to make the final plan. In total, the process should take 20 weeks.
Nationally only 51% of EHCPs were issued by local authorities within the 20-week deadline according to Children’s Commissioner in June 2023. The overall number of pupils in England with special educational needs has risen from 16.6% in 2022 to 17.3% in 2023, and the demand for an EHCP has risen by 23% since 2021. The EHCP must be reviewed annually.
Advantages of EHCPs
It is widely appreciated that the EHCP has improved services for CYP with special educational needs in that it supports them to access any mainstream school in their local catchment area or, if appropriate, access a school outside of their catchment area. The EHCP also follows the child up to age 25, except in Universities and higher education settings, thus providing opportunities for greater continuity, consistency and support during childhood and early adulthood. Students aged 19 to 25 with EHC plans who are continuing in education may have a range of options, including attending; further education, training, a supported internship, or an apprenticeship (Department of Education SEND: 19-25-year-olds’ entitlement to EHC plans 2017)
In addition to this, the EHCP specifically includes parents in the decision-making process and promotes the inclusion and opinions of a range of professionals including Occupational Therapists (OT), Educational Psychologists, Speech and Language Therapists (SALT), and Physiotherapists. EHCPs must be reviewed annually and are subject to an appeal process.
Challenges of EHCPs
There are, however, challenges and criticisms of EHCPs. Funding and provision for additional support remain an issue as Professor Chris Drew (2019) pointed out in 'EHCP Plans – Pros, Cons & Criticisms' that as long ago as 2017, it was reported that over 4,000 children with approved EHCP plans still received no additional support. He also found families were experiencing significant stress and financial hardship when challenging a LA refusal to grant an EHCP. Likewise, schools can often struggle financially as they are required to meet the first £6000 of the cost of each child’s plan from current budgets, before additional government funding is provided. This is a significant barrier and major factor hindering schools from issuing plans. The position has not improved significantly since Drew’s work with continuing pressure on school budgets resulting in nationwide backlogs in both EHCP assessment and implementation of provision.
The role of occupational therapy in EHCPs
OTs are pivotal in assessing, identifying, and providing objective recommendations to help CYPs with special educational needs achieve their educational and functional aspirations. An OT is required to provide recommendations based on the needs of the child and not be limited or modified by the resources available. The College of Occupational Therapists 2016 ‘Education, Health, and Care Plan (EHCP) Occupational Therapy Information Request Guidance’ states that:
“The EHCP should be completed with the involvement of the child or young person and their family.”
Further on the guidance states,
“The focus of the report should remain on the occupational engagement and performance of the child or young person and their participation in their life roles.”
OTs work with CYPs to identify their goals alongside the family and carers to help improve the CYPs ability to carry out daily activities needed within an educational environment, for example, to reach both academic and non-academic achievements through addressing the physical, cognitive, psychosocial and sensory components of performance - American Occupational Therapy Association.
OTs complete Parts B and F of the EHCP assessment. Once provision is in place, they work with CYPs in a holistic fashion to improve occupational performance including, but not limited to:
- Developing fine motor skills such as improving handwriting, cutting, and sticking skills.
- Developing gross motor skills to help improve balance, hand-eye-coordination, bilateral integration skills, and strengthening and postural control.
- Daily living skills such as doing up buttons, managing to dress, and undress, for PE lessons, using utensils for washing, eating, and drinking.
- Sensory integration challenges impacting sensory-motor and emotional regulation.
- Visual discrimination difficulties which might impact the child’s ability to notice differences in objects and impact reading and learning.
- Improve play, attention, organisational, and socialising skills.
OTs also consider how most effectively to support a CYP with additional physical needs to improve daily functioning and increased independence by making recommendations for specialist equipment to help the CYP manage or improve specific tasks e.g., assessing for equipment to help with handwriting, postural seating needs, and hoisting. A key role of the OT is the ongoing monitoring, reviewing, and updating of the child and young person’s needs, including termly and the formal annual review.
Case study: Joel’s journey
Joel was a typically developing 2-year-old boy when he was involved in a road traffic accident. As a result, he was left with a significant acquired brain injury (ABI) which impacted all areas of his life from his mobility and function to cognition, sensory processing, and communication.
Findings from Joel’s occupational therapy assessment concluded that he would need ongoing occupational therapy input to address his sensory-motor needs. This also included providing ongoing postural support and equipment, maintaining his range of movement, providing regular review of his moving and handling needs, and to provide advice on adaptations needed to support Joel’s physical and sensory needs within the home and school.
The OTs assessment was incorporated into Joel’s EHCP application to ensure that the correct level of support and provision would be provided when he started attending school., This included the need for Joel to attend a specialist provision due to the level of physical and sensory support he required. The assessing OT also highlighted the different provisions needed to ensure his safety and access to the learning environment, including his need for specialist postural seating in school and hoisting for safe moving and handling and further assessing for hand splinting. Access to time in a quiet room with his therapist and/or a specialist teaching assistant to carry out his OT programmes was also recommended to maximise the benefit of the programmes., As part of joint working the school OT and Private OT regularly communicated, discussed, and agreed on functional goals for Joel.
Without the detailed information provided by the OT to support Joel’s EHCP, he would not have received the level of support, equipment and therapeutic input needed to help him access the learning environment both at home and school. OT therefore played a valuable role in the EHCP by providing assessment, goal setting, intervention, and monitoring. CYPs with OT support are better equipped to participate in school, community activities, leading to greater inclusion and socialisation regardless of complex needs.
What does this mean for you as a Case Manager?
The EHCP is a key tool in your rehabilitation plan for CYP clients whose educational attainment and integration in school is impacted by their injury. You should ensure an EHCP application and assessment is competed in a timely manner. The EHCP should demonstrate an integrated approach involving OT provision and school and parent/carer training and support is key. Be aware of the appeal process and ensure the parent(s). carers understand their rights. Where provision is limited by local financial constraints or statutory provider therapy availability, which is all too often these days, you should consider if private supplementary provisions is appropriate to achieve your client’s rehabilitation goals.
References and Links:
- Warnock Report (1978) (educationengland.org.uk)
- Education Act 1981 (legislation.gov.uk)
- The Lamb Inquiry - a review - Special Needs Jungle
- Children and Families Act 2014 (legislation.gov.uk)
- Occupational Therapist in Schools: Role, Skills, & Benefits
- Drew, C. (December 14, 2019). EHCP Plans – Pros, Cons & Criticisms. Helpful Professor.
- Occupational-therapy-contribution-guidance-notes.pdf (rcot.co.uk)
- EHCP Timeline - Education Advocacy
- Children’s Commissioner
- https://www.gov.uk/government/publications/send-19-to-25-year-olds-entitlement-to-ehc-plans/send-19-to-25-year-olds-entitlement-to-ehc-plans
