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Guidance on partnership working between allied health professions and education

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4. FEATURES OF GOOD PRACTICE

4.1 DIFFERENT WAYS OF SUPPORTING CHILDREN AND YOUNG PEOPLE

"By working in partnership with professional colleagues, [ AHPs] can help to overcome perceived boundaries between services and organisations, developing ways of working that will be of benefit to patients and people who use our services." Building on Success. Future Directions for AHPs12

Effective partnership working is built upon a clear understanding of the different roles each person has in supporting the young person. Increasing clarity and agreement about roles and responsibilities improves understanding, and leads to mutually supportive relationships. Clear remits, lines of communication and accountability characterise successful approaches to partnership working.

Understanding the universal, targeted, and specialist roles of allied health professionals

The work allied health professions do with partners to support children and young people includes a range of options which are increasingly referred to as:

  • universal,
  • targeted and
  • specialist support roles.

This approach encourages allied health professions to redefine their practice beyond their input or tasks. Their focus is more on what they can reasonably achieve for children and young people as outcomes. The distinction between the universal, targeted and specialist roles also allows allied health professionals to anticipate and prevent difficulties early. The universal, targeted and specialist roles are outlined in more detail in Appendix 5 with examples of current practice on the website. 13

NHS Lanarkshire, in collaboration with North and South Lanarkshire Councils, are carrying out and evaluating a motor skills development project. The project provides occupational therapy intervention at a preventative stage in line with health promotion principles. Training for education staff along with parents helps to ensure that children's motor skills are developing through effective support which is embedded in learning and teaching contexts.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworkings

The universal, targeted and specialist way of understanding what allied health professions do can also help allied health professions to build capacity in services, and be clearer about who they should be targeting based on vulnerability and risk. The different roles all require specialist, professional knowledge and skills.

The universal role enables allied health professions to benefit all children in a particular setting. An example of this universal role is where a speech and language therapist supports language development in the early years through a training course for nursery and early primary teachers. Staff development sessions can meet the health needs of a larger population of children. In addition other provision may be made within the universal role. For example, occupational therapists may advise education staff on health promotion programmes which can be used to improve co-ordination skills. Another example of the universal role is where allied health professionals and education staff work together to build the key skill of communication in line with Curriculum for Excellence.

NHS Forth Valley through their Communication Help and Awareness Team ( CHAT) target pre-school children in areas of socio-economic disadvantage. They do this by providing training for early years education staff and implementing whole nursery approaches to developing language and communication. CHAT also offer support and advice for parents through drop-in sessions and workshops. They also offer teenage mother and toddler groups and provide accessible information and advice for health and education colleagues. This has meant significant numbers of children have been able to enter primary school with improved levels of language and those who need more specific help are identified early.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

The targeted role enables an identified factor in health inequality to be tackled. The targeted role may be a further refinement of the universal role which involves targeting a recognised vulnerable group at risk of later literacy, learning and communication difficulties. In partnership, allied health professions and education staff are addressing potential health inequalities in an integrated and anticipatory way to improve outcomes for children. This is in line with the recommendations of Equally Well, 14 the Scottish Government's programme for reducing health inequalities across Scotland.

The targeted support role does not necessarily require the child or young person to be referred to a health professional. For example, those identified with a delay in developing good co-ordination skills may be supported by an occupational therapist identifying movement skills that can be incorporated into a physical education class. Many skills are best developed in a group setting with the child's friends, capitalising on their enjoyment of group learning. Often children learn more effectively as they set about their everyday tasks within the school or home environment. Practising skills, introduced by the allied health professional, in these real life contexts helps reinforce new learning and development.

West Dunbartonshire Community Health Partnership ( NHS Greater Glasgow and Clyde) speech and language therapists, together with West Dunbartonshire Council educational psychologists provide joint training for education staff and allied heath professionals. The training is on specific language impairment. It includes an overview of research, diagnostic criteria and cognitive assessment procedures. Joint training results in a shared vocabulary and understanding of how collaborative assessment and intervention can be effective and reduce duplication in support to schools, parents and children.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

NHS Greater Glasgow and Clyde and West Dumbarton Community Health Partnership run the Fizzy Programme in schools. This is a physiotherapy and occupational therapy programme to support children with motor co-ordination problems in school. The allied health professionals provide information, advice and training for support staff. Support staff then run the programme with children they feel need the programme. The allied health professionals are available for consultation and information throughout the programme. School staff can identify any children they feel have more significant problems and referral can be made if appropriate. This has become a rolling programme with schools taking ownership of the programme and using allied health professionals' expertise when required.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

The specialist role of an allied health professional is where a specific intervention is required and an individual young person is referred to a particular service for assessment and intervention as required. The specialist role is the one most often associated with an allied health professional. However, it may not always be the appropriate role. The universal and targeted role may benefit more young people and raise the overall level of skills within a school so that teaching staff are better able to meet the needs of a broader range of young people.

The Circle Collaboration (Queen Margaret University, NHS Lothian and Edinburgh City Council) have developed collaborative tools that describe therapy interventions and show how these can be carried over into the school setting and built into curricular activities. Intervention descriptions and therapy manuals help to develop a common language and explain what therapists do to help children develop and learn from these techniques.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

Describing the roles of allied health professions as universal, targeted and specialist in this way allows allied health professions, education staff and parents to work together more effectively. It also means allied health professionals' skills are used at the right level and their contribution has greater impact. Services can be provided without the need for referral while those with greater need can be provided with intensive support. A focus on outcomes rather than inputs and processes allows for more flexible and innovative services.

NHS Borders occupational therapists work consultatively with schools. The teacher and occupational therapist together discuss concerns about a child and agree possible solutions. This means that any advice is embedded in teaching approaches. Consultation is carried out in conjunction with parents, who understand that it may or may not lead to more direct involvement from the occupational therapist. Schools can request such consultation at any time which leads to more effective communication between professionals. The outcome is that children receive the right level of support at the right time.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

Education staff: We have referred throughout this document to "education staff". This term includes a very broad range of staff including class teachers, specialist teachers, support staff, senior managers in schools and educational psychologists. This is not an exclusive or exhaustive list, but illustrates the range of staff included within "education staff". Each one has a specific role in relation to partnership working.

Some of the most important roles in education are those of the class teacher and support staff. Very often they know the individual child and how he or she achieves best within the context of the classroom. The class teacher in particular brings this specialist knowledge of the child or young person in an education context as well as expertise on the learning and teaching process.

The contribution of allied health professionals will be more effective if they understand how school systems and arrangements work and how the curriculum relates to their own work with the child. Understanding the demands of a busy school day and the challenge for a teacher of meeting the needs of all the children in their classroom, is essential. This ensures support is practical and relevant and effective joint working is achievable. A willingness to share knowledge and skills, takes time and effort but allows all partners to contribute more to benefit the child. Partnership working involves listening to each other and learning from each other. It also means listening to the child or young person to understand his or her view.

In sharing roles everyone involved needs to acknowledge that parents, education staff and allied health professionals supporting a child each have a unique set of skills and perspectives on the child. The combination of the young person's own perspective and the shared knowledge and expertise of parents, allied health professionals and education, is what makes partnership working so effective.

NHS Lanarkshire, along with North Lanarkshire Council and South Lanarkshire Council, set up the "My view too" project to look at how the views of young people with complex learning difficulties were being sought. This was particularly in relation to attending their transition planning reviews. Standardised protocols for accessing the views of young people are now being developed along with a toolkit of advice and helpful hints for accessing their views.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

"What you said…"

It is everyone's responsibility to communicate what their role is - not for others to try and work it out.

(Allied Health Professional)

What comes over from our helpline is that too many assumptions are made about roles.

(Enquire)15

Issues to consider

1. What is your experience of the various roles of allied health professionals in addition to direct work with young people?

2. In what circumstances might indirect work be more effective than direct therapy?

3. What is the role of the class teacher and other education staff in partnership working with allied health professionals?

4. How confident are you that roles are clear to parents, young people and how do you know?

Signposts for improvement. Education and allied health professions can improve the quality and effectiveness of their partnership working by:

1. Ensuring that parents, allied health professionals and education staff are all clear about and respect each other's roles in supporting the young person.

2. Ensuring there is a shared rationale for indirect work so that this is not seen as a second best option for the young person.

3. Developing skills and knowledge within the education and health systems through training, awareness raising, modelling and shadowing opportunities.

4. Developing a shared language and common understanding of terms used locally to describe ways of working together.

4.2 PARENTS AS PARTNERS

"Parents and communities play a crucial role in outcomes for children. That role needs to be valued by parents and communities themselves, but also supported by the community planning process." Scottish Government (2007) Early Years Framework16

"In order to achieve success for all learners, educational establishments and services need to ensure positive relationships at all levels. They need to seek and build upon the views and evaluations of learners, parents and partner professionals." HMIE, (2009) Improving Scottish Education17

Partnership working between professionals is only meaningful and effective when it includes parents as partners. During the consultation process on this guidance, parents frequently commented that they were consulted after decisions had been made or plans prepared. Supporting children's learning: The Code of Practice18 is being revised in 2009 and restates good practice in relation to communicating with parents. This is repeated in full here as it addresses the points raised by parents during consultation. The good practice outlined here is also in line with the Getting it right for every child approach of identifying a lead professional. When two or more agencies need to work together to provide help to a young person and their family, there should be a lead professional to co-ordinate that help and link with parents and the child or young person.

Professionals should:

  • acknowledge and draw on parental knowledge and expertise in relation to their child
  • consider the child's strengths as well as areas of additional need
  • recognise the personal and emotional investment of parents and be aware of their feelings
  • ensure that parents understand procedures, are aware of how to access support and are given documents to be discussed well in advance of meetings
  • respect the validity of differing perspectives and seek constructive ways of reconciling different viewpoints
  • cater for the differing needs parents may have, such as those arising from a disability, or communication and linguistic barriers.

Information should be:

  • clear and understandable and avoid jargon
  • provided easily in accessible formats
  • readily available and provided automatically without a charge and without a fuss.

Communication works well when:

  • people have the interpreters they need
  • someone in authority takes responsibility for keeping parents up to date
  • people are told what has been happening between meetings
  • any information provided by parents is acknowledged
  • formal references to statutory procedures are avoided.

Effective working relationships develop when:

  • contact with parents is sensitive, positive, helpful and regular
  • parents feel included and are encouraged to contribute to discussions
  • positive, clear and easily understood language is used
  • parents are involved and processes and roles are explained from the beginning
  • parents are told what to expect and the next steps
  • times of meeting take account of parents' availability.

Meetings work best when:

  • parents are asked what times and places suit them best, taking account of any access need or family responsibilities
  • notes from meetings, and any papers to be considered, are sent out in good time
  • parents are invited to add points to the agenda, at the same time as everyone else
  • people attending are aware of their roles and the roles of others and they understand the child's or young person's additional support needs
  • there are no hidden issues, and no last minute surprises
  • decisions are made when parents are at the meeting, or agreed with them before the meeting takes place, not after the meeting has closed, unless further consultation takes place with them
  • ample time is given to allow people time to raise concerns, so that decisions are not rushed.

Identifying the way forward works well when:

  • all views are taken on board - including those of the child or young person
  • people are interested in learning from each other
  • people show an interest in general family priorities and take them on board
  • services are identified in agreement with the family and are responsive to individual needs.

Accountability and involvement:

  • who is responsible for what is clearly defined and understood
  • parents concerns are responded to quickly
  • decisions are open to scrutiny
  • parents have a clear point of contact who can answer questions, make decisions and ensure that agreed actions are taken
  • people do what they agreed within the timescale committed to - if a decision is likely to take time, parents are told and given some idea of when a decision is likely.

NHS Forth Valley speech and language therapists have focused on writing more accessible reports that young people with communication difficulties and their parents can easily understand. Young people and their parents are better informed and included in decisions about their care. This is done by simplifying and limiting the written content as well as using a range of visuals including symbols and photographs.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

"What you said…"

If you are involved with my child I need you to tell me things in a way that is meaningful for me.

(Parent)

Professionals need to know how much parents can help and what a resource we are for them.

(Parent)

Issues to consider

1. How do you know how effective your relationships are with parents and how do you gather information on their views?

2. How could your communication skills with parents be improved?

3. What steps can be taken to ensure real and effective parental involvement in assessment, planning, delivery and evaluation of interventions for children?

4. What do you do to support and encourage all parents to be informed about and involved in their child's education?

5. What efforts do you make to remove the barriers to parents taking a more active part in supporting their child?

Signposts for improvement. Education and allied health professions can improve the quality and effectiveness of parental involvement by:

1. Ensuring parental involvement is integral from the beginning.

2. Ensuring that all information is in a form that is easily accessible to parents and that you have consulted parents on how best to share information, e.g. in writing, by e-mail, phone call or face-to-face.

3. Recognising parents as equal partners with unique insights in meeting their child's additional support needs.

4. Check you are asking parents and taking account of their perspective when making decisions where everyone's position and contribution is respected.

5. Ensuring all staff are given and are providing good role models in working with parents as partners.

The spectrum (autism spectrum disorder) team of NHS Lothian allied health professionals and Edinburgh City Council visiting teacher and support service provide support and intervention for pre-school children and families. They provide support before, during and after the diagnosis process. This is done at home and in the child's education setting. Parents are given appropriate information. This reduces parent's anxiety by helping them understand their child's behaviour and how best to support them. The team also helps to co-ordinate services, support when children move from pre-school to primary and targeted intervention.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

4.3 PLANNING FOR BETTER PARTNERSHIP WORKING

This section examines strategic planning and planning to deliver services at school level.

Strategic planning for better partnership working

Single outcome agreements are the means by which Community Planning Partnerships19 agree the strategic priorities for their local area. These are expressed as outcomes to be delivered by partners, clearly showing how their individual contribution supports the Scottish Government National Outcomes. 20 Community planning is a process which helps public agencies to work together with the community to plan and deliver better services in their area. The Scottish Government and local government share an ambition for outcome focused planning and delivery of public services in Scotland.

The Single Outcome Agreement is relevant to the daily activities of education staff and allied health professionals. Leadership at an operational level needs to be supported by effective planning and communication at a strategic level. All planning at every level below the single outcome agreement needs to be in line with and contribute to the outcomes identified in the single outcome agreement. This includes planning to meet the needs of individual young people.

NHS Tayside with Perth and Kinross Council are implementing Early Talk (I CAN) an example of allied health professional practice that contributes clearly to the national outcome: "our children have the best start in life and are ready to succeed". This work, and similar examples across the country, contribute to meeting targets locally in the single outcome agreement.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

Senior managers in health and education with responsibility for service delivery can support effective partnership working through effective communication. The view of many allied health professionals is that managers are most effective when fully aware of the collaborative practice of their own staff and the different ways they work in partnership to deliver best outcomes for children and young people. An annual meeting of the relevant service managers helps set the context for service level agreements, where relevant and appropriate, and address any areas of concern. This includes agreeing a consistent approach to addressing the challenges which emerge as a result of difficulties in filling posts and dealing with temporary reductions in service. Individual service managers may seek the views of colleagues in their own service prior to such meetings. In this way they can jointly reflect on and evaluate the effectiveness of partnership working.

It is at this level that financial issues are likely to be addressed. In financial matters, all services need to focus on the best interests of the child and ensure that inter-service financial arrangements adhere to the principles of Getting it right for every child and best value. Planning at this level will consider the most efficient and cost-effective way to deliver support together for children that is appropriate, proportionate, timely and effective.

Service level agreements between education and health may be used to ensure all service providers are clear about expectations. The majority of service level agreements are between education and speech and language therapy. These vary in terms of formality and detail, reflecting local needs and arrangements.

Exemplars of service level agreements are available on the website. http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

Quality Management in Education ( QMIE221) states that "To fulfil the requirements of best value and to conform to accepted good practice, there must be mechanisms in place to link leadership and management decisions to the needs of all learners and the community at large."

Ultimately it is the community planning partnership which identifies the priorities and actions to improve outcomes in a local area. Local service level agreements, where relevant and useful, between education and health need to be set within the children's services planning process and link into higher level strategic priorities such as reducing health inequalities and raising attainment. Genuine collaborative advantage allows good partnership working at operational or practice level to influence joint strategic developments. Equally the community planning process can actively support and improve practice on the ground.

Jointly planning the delivery of services at school level

At the level of individual schools, the partnership between allied health professions and schools is made more effective when partnership working is discussed at the start of the school year and minuted or set out in a service level agreement. This however is more or less relevant depending upon the allied health profession and the size of the school. An arts therapist may have very limited contact with a school and an orthoptist may only visit at a set time to carry out screening tests. Where there is regular involvement with a school, an annual meeting can help schools to be clear what level of service they can expect. In turn it helps allied health professionals to work within their agreed remit and to agree timescales. The discussion which takes place to clarify the service to be provided also helps allied health professionals and education staff to understand the limitations within which each operates.

Dates for further planning and review meetings for individual children can be set jointly at the start of the year. This meeting will also make it clear who the allied health professional's line manager is and how to make contact if this is required. For example, a frequent cause for concern in schools is the absence of an allied health professional. In such cases it is important to maintain a culture of openness and dialogue around challenges. For example in dealing with vacancies or temporary reductions in service. It is also important that parents are kept informed of service changes affecting the support their child receives.

It is also useful when negotiating the school-allied health professional service level agreement to make practical arrangements. This includes arrangements for accommodation and other requirements for allied health professionals during school visits. The welcoming tone for visiting specialists is set by the head teacher and senior managers in the school. Where partnership working is effective, senior managers in school value the support for young people which is offered by allied health professionals and view them as part of the school's extended additional support team.

NHS Grampian have a school level agreement which clearly explains a general progression of activity from the speech and language therapy service during a block of time spent in the school. This details how they will work with education staff to support the child and those involved in the child's learning and teaching. This includes joint assessment, consultation including parents, jointly setting targets and demonstrating strategies to support these.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

"What you said…"

We meet termly with the speech and language therapy service manager to review our service level agreement. It stops little things becoming major headaches.

(Local authority)

The head teacher's attitude is pivotal to successful partnerships. The head teacher establishes a school ethos of welcoming and valuing the allied health professionals.

(Allied Health Professional)

Issues to consider

1. How does planning at a strategic level support activities at an operational level?

2. Are financial arrangements efficient and do they represent best value so that partners can deliver the best service possible to children and young people?

3. What is the value of a written record of agreement between the school and the allied health professional?

4. What are the issues that need to be addressed during the meeting at the start of the session in your context?

5. Is sufficient information made available to parents so they understand how decisions about services are taken?

Signposts for improvement. Education and allied health professions can improve the quality and effectiveness of planning for partnership working:

1. Developing good communication at strategic level across organisations.

2. Ensuring clear, two-way communication between practitioner level and strategic planning level.

3. Agreeing the broad structure of service delivery between the allied health professionals and the school at the start of a school session.

4. Addressing practical issues at the start of the school session including a named contact in the school for the allied health professional; a place to work; arrangements for planning meeting dates; arrangements for occasions when meetings are cancelled or an allied health professional is unable to attend; arrangements for occasions when a child or young person is absent from school.

5. Ensuring that the named contact in school knows how to make contact with the allied health professional.

4.4 PLANNING AND WORKING TOGETHER TO SUPPORT YOUNG PEOPLE

Planning to meet the needs of individual children and young people takes place in line with Getting it right for every child. One of the core components is streamlined planning, assessment and decision-making processes that lead to the right help at the right time for the child. Planning should take place in line with the Getting it right for every child practice model ( see here).

There are six parts in the practice model. Practitioners will combine some or all of these parts in the way most appropriate to the young person's needs:

  • Use the Well-being indicators to record and share information
  • Use the My world triangle to gather further information
  • Use the resilience matrix to organise and analyse information
  • Summarise needs against the well-being indicators
  • Construct a plan and take appropriate action
  • Review the plan.

There is a clear consensus that joint planning at the earliest possible stage is most helpful in meeting children's and young people's needs. Early and good communication between education staff, allied health professionals and parents is more likely to lead to meaningful planning and a meaningful plan for the individual child. It is also more likely that there will be a streamlined approach to planning so that the work of the allied health professional integrates well with learning targets in school. Learning targets are more likely to be reinforced at home if parents have also been centrally involved in planning. Planning is considered to be most effective when the young person's views are taken into account.

Joint planning addresses the question, how can we jointly collaborate so that our work together brings about better outcomes for this young person than if we were working individually? Allied health professionals and education staff work jointly on the relevant parts of a young person's individualised educational programme. Where a child or young person meets the criteria for a co-ordinated support plan, allied health professionals are involved in drafting relevant educational objectives in partnership with education colleagues. An integrated plan should also reduce the need for different review processes and so reduce the number of meetings parents, professionals and children and young people need to attend.

In NHS Lothian and Midlothian, East Lothian and City of Edinburgh Councils, allied health professionals and education staff plan together using a profile that details how the key aim for the child can be broken down into skills the child is currently confident with and the next steps to move towards their targets. These are written jointly in order that therapy strategies supporting the day to day learning can be embedded in teaching approaches. A profile for use with the child or young person is available.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

profile

On a practical note, if joint planning is seen as more effective and more efficient, there is a need to ensure that time is available for it. In the best practice, consultation time is made available in schools for staff to meet with allied health professionals and plan jointly. This may not always involve the class teacher directly, but may involve the member of staff with overall responsibility for managing support for all. The member of staff with management responsibility may gather the relevant information from class teachers and use this to plan jointly with the allied health professional. Priority must also be given to gaining the child or young person's own view on planning for their support.

The key message which is reinforced in the revised Code of Practice, 22 which is currently being considered by the Scottish Parliament, is that there should be a single integrated plan. In summary the Code of Practice states that every opportunity should be taken to ensure that there is an integrated action plan for a child or young person where more than one agency or service is involved. The aim should be to have one plan in line with Getting it right for every child. Such an integrated action plan may be made up of different elements. For example, an individualised educational programme may be included as part of a child's plan for a looked after child, a Profile that links therapy and teaching targets can be included in a co-ordinated support plan. In this way, the professionals working with the child or young person use one integrated action plan with shared educational objectives.

South Lanarkshire Council with allied health professional colleagues use the core principles of Getting it right for every child through a collaboration for inclusion group. A single plan and single review process allow vulnerable children to be tracked and prioritised for planning and delivery of services in partnership.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

Orkney Islands Council in partnership with nhs Orkney Health and Care's All Age Disabilities Service are in the process of implementing a multi-agency planning forum to ensure smoother transitional planning for children and young people with additional support needs. The forum is developing data sharing and commissioning arrangements for all life stages across the educational spectrum including pre-school; primary; secondary; further education and other adult services.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

Partnership working: From planning to action and review.

"The delivery of intervention requires a team around a child to structure the activities and interaction opportunities of a child's everyday life. It is therefore necessary and appropriate for teams rather than sole speech and language therapists to deliver intervention." Royal College of Speech and Language Therapists, (2006)

" Curriculum for Excellence can only be delivered through partnership working. The curriculum should be designed, managed and delivered in such a way that takes full account of each learner's individual needs and stage of development." Scottish Government (2009) Building the Curriculum 4: Skills for learning, skills for life and skills for work

Throughout our engagement with allied health professions and education, all were clear that what they consider to be examples of good practice in partnership working are often joint interventions. By joint interventions we mean ways of supporting a child or young person that involve collaboration and sharing of responsibility, skills and resources. Joint working provides the opportunity for skill building through skill sharing between allied health professionals, teachers and support staff in schools. This leads to more opportunities to reinforce effective strategies with young people. This in turn leads to increased progress in children's development and learning outcomes. Parents have a key role in contributing to the progress of their child by knowing how they may follow through a programme of work or supportive practice at home.

Allied health professionals can link children's learning targets with everyday functional skills for life. When allied health professionals plan programmes for children they take account of what the child or young person wants and needs. This personalisation and supporting children to take responsibility for their own learning fits well with the principles of Curriculum for Excellence. Embedding allied health professionals' interventions in teaching approaches can help children and young people to make the best use of their learning experiences. This shared commitment to using resources most effectively enables collaborative practices to develop. These collaborative practices integrate health and education support for children and young people.

NHS Ayrshire and Arran speech and language therapists along with East Ayrshire Council education staff have together designed interactive menu boards to be used in their schools for children with complex needs. This not only encourages children to generalise their use of communication aids into real-life situations, it also provides them with the means to make and express their own choices. The interactive boards are also used to facilitate choice across other areas of the curriculum enabling staff to facilitate communication opportunities and maximise joint education and speech and language therapy aims.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

As part of the health and wellbeing experiences and outcomes in Curriculum for Excellence, physical co-ordination and movement are key skills. Occupational therapy and physiotherapy services provide support to children and young people through a range of intervention programmes. These interventions promote the development of motor skills and motor co-ordination in children. These programmes are embedded in school experiences by training teaching staff through modelling and shared work. Sharing programmes in this way equips education staff with the skills and resources to continue providing the support to targeted groups of young people.

Dumfries and Galloway occupational therapists provide a visual template to education staff to help readily adjust the specialist seating of a child or young person with disability to suit their activity. This ensures the child is safe and adopting the best posture for whatever they are doing. This might be for eating or class work, or for being at the same height as their peers. The seating profile, including a photograph of the child in the correct position for comfort and access, is planned in consultation with the child. As this is shared with a range of education staff, parents and respite care staff, all those working with the child are confidently and consistently managing their positioning.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

As part of the literacy experiences and outcomes in Curriculum for Excellence, listening and talking are recognised as key skills. Many schools have introduced speech and language therapy led early intervention programmes to jointly support spoken language and communication skills. These early intervention programmes are for targeted children who need extra help with listening, talking, reading and writing because they have difficulties with language and communication.

NHS Lothian Speech and Language Therapists work with teachers within three mainstream secondary schools in City of Edinburgh Council to support teaching and learning for an identified group of learners with additional support needs and across the whole school. This partnership working has resulted in collaborative approaches to supporting literacy, as defined by Curriculum for Excellence within mainstream classes and in smaller groups.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

When teachers and allied health professionals combine their unique skills and knowledge, their combined interventions to support young people can be very powerful. Education staff, as well as knowing children and young people have an expert knowledge of learning and education. Allied health professionals know children well and have an expert knowledge of developmental issues, including mobility, motor skills, co-ordination and language and communication. Parents know their children better than anyone and are ideally placed to identify what works for their child and in the context of their family. Children and young people themselves have a view on their life at school and those working to support their learning.

"What you said…"

We recognise that allied health professionals may have skills we don't expect such as helping us with children's challenging behaviour.

(Teacher)

It's up to us I think to start from the curriculum and weave our therapy into the skills being developed.

(Allied Health Professional)

Issues to consider

1. How confident are we that we have created consultative structures, systems and practices which encourages all partners to be involved in planning, including parents and young people?

2. How close are we to producing a single plan in line with the principles of Getting it right for every child which may incorporate a co-ordinated support plan?

3. How are parents involved in delivering interventions?

4. How can we use Curriculum for Excellence to ensure the work of allied health professionals links closely to the outcomes and experiences?

5. Are partners clear about gaining consent to share relevant information and of their statutory duty to share information?

Signposts for improvement. Education and allied health professions can improve the quality and effectiveness of their joint planning and interventions by:

1. Ensuring time is available for effective joint planning with all relevant professionals, reviewing and evaluating as a key part of support for the young person.

2. Ensuring parents are centrally involved from the start in planning discussions and meetings.

3. Ensuring the young person's view is sought at each decision-making stage.

4. Having a streamlined process leading to a single shared plan with the child at the centre.

5. Being clear about which interventions are more effectively delivered together and which are more effectively delivered by a single service.

4.5 JOINT CONTINUING PROFESSIONAL DEVELOPMENT AND SELF-EVALUATION

"Staff in most sectors need more training together with those from other sectors to improve interagency working and to develop understanding of how to do the right thing with the right people at the right time to improve outcomes for each individual learner". HMIE, (2009) Improving Scottish Education

"There was also a call for more joint training initiatives aimed at therapists and education staff and specifically addressing the inclusion agenda" Scottish Executive (2003), Review of therapy services

One of the most effective ways of developing improved partnership working leading to better outcomes for young people is through joint continuing professional development ( CPD). Staff benefit greatly from opportunities to train with colleagues from other disciplines and these opportunities help them to work effectively in multi-disciplinary teams.

At all levels, effective processes are required for identifying training needs leading to improved partnership working. Jointly delivered and received training are particularly effective. Development opportunities can include a variety of learning experiences such as shadowing a colleague from a different profession, joint observation, lectures and workshops and participating in special interest groups. Curriculum for Excellence presents an ideal opportunity for joint CPD sessions. In particular, teachers and allied health professionals might consider how allied health professionals can be involved in literacy and numeracy across the curriculum and supporting in the delivery of health and wellbeing outcomes.

NHS Shetland speech and language therapy assistants train with their Shetland Council education colleagues how to use effective strategies with pupils who have complex additional support needs. This framework is designed to be used jointly by all those involved in working with children with additional support needs in school settings.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

During the engagement process when preparing this guidance, both teachers and allied health professionals expressed the view that joint training sessions at university level before and after qualifying would greatly benefit each sector. Their view was that such joint training would also build into pre-service training the notion that partnership working is at the core of service delivery. After qualifying, joint continuing professional development should aim to increase knowledge and understanding.

In addition to joint training leading to more effective outcomes for children and young people, CPD delivered by a single profession is a very effective way of increasing the capacity of other professions to remove barriers to learning. Finally, joint work around individual children and young people is in itself good continuing professional development for allied health professionals and education staff. Further examples of good CPD and practical activities can be found on the website associated with this publication.

The Therapy Inclusion Partnership ( TIP), a collaboration between NHS Lothian and City of Edinburgh Council, supports education staff with the inclusion of children who have additional support needs in mainstream schools and nurseries. The primary objective is to assist with reducing barriers to learning and to encourage participation in the school curriculum, thus enabling children and young people to achieve their full potential. Training, advice, practical modelling of support strategies and skills, as well as activity sheets enables the three therapy services to work closely with education staff to achieve aims relevant to the curriculum. TIP places the child at the centre and aims to provide the best fit for support that will ensure the most effective outcome for pupils and minimise the number of interventions the child requires to attend.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

Self-evaluation for improvement: how good are we at working together?

The Crerar review 23 says quite clearly that responsibility for providing an improving service lies with the people providing the service. Self-evaluation focuses on two simple but very challenging questions. How good are we now? and How good can we be? When partners carry out self-evaluation they look honestly and critically at their practice and the quality of service they provide.

This is an area of partnership working where there is significant room for improvement. Asking challenging questions about the quality of jointly delivered services is a challenge to the maturity of partnership working relationships. However, this does not mean that it should be avoided. Improvement will come about when partners honestly face up to challenges and identify these together with a view to taking action which leads to improved services for children and young people.

At a basic level, services should gather information from their key stakeholders relating to the quality of their performance over a year. For example, education staff ask allied health professions for feedback on the effectiveness of the partnership in improving services for children. Likewise, allied health professions ask colleagues in education about the effectiveness of their involvement in improving services for children over the year. Both services will involve parents and young people in identifying strengths and areas for improvement in the service they provide together. Using this information, allied health professions and education will be able to improve the service they offer. They will also be able to identify clearly their contribution to delivering improvements in children's services planning.

Western Isles allied health professions and education staff have established protocols for improving collaborative working. These involve regular meetings to reflect on their joint working. The minutes from the meetings as well as staff feedback have shown progress in a number of ways: increased joint responsibility and accountability for collaborative success, reduced number of complaints, greater staff satisfaction and improved working relationships. This development has improved the success of a care aims management planning system and ultimately improved the opportunities for parents and children/young people to be active contributors to the process and be better informed about any responsibilities allocated to the team around the child. Evaluations also show that collaborative working is valued by parents who say they feel they are being listened to and their opinions are valued.

More information is available from: http://www.scotland.gov.uk/Topics/Education/Schools/welfare/partnershipworking

"What you said…"

I have found training much more effective when I present with a teacher and she has shadowed my work. And because I have taken a whole class myself they see how we can swap roles and therefore trust what I'm saying more.

(Allied Health Professional)

The education department ask our parents' group all the time about what we think of the services they give us. It really makes a difference to be asked.

(Parent group)

s

1. Do we have an effective system in place for identifying joint CPD needs and for planning to deliver training jointly?

2. How do we evaluate the impact of joint CPD on staff and on children, young people and their families?

3. Do allied health professions and education staff have a shared understanding of what self-evaluation is and the purpose of self-evaluation?

4. Is there an effective process in place for carrying out joint self-evaluation of partnership working?

Signposts for improvement. Education and allied health professions can improve the quality and effectiveness of their continuing professional development and self-evaluation by:

1. Ensuring that both health and education routinely plan for joint training opportunities for staff, as providers and recipients, and consider the involvement of parents.

2. Encouraging the use of a broader range of CPD opportunities for staff to include work shadowing, special interest groups, joint working groups, and resource sharing initiatives.

3. Agreeing to evaluate jointly the quality of their joint services to children on an annual basis.

4. Involving all stakeholders, including parents and young people, in their self-evaluation process to plan for service improvement.