Unit 11: Children and Families and Special Needs

Unit Objectives

Introduction

Defining special needs

The different words used to describe people with special or additional needs can often serve to confuse rather than clarify the subject. Terms such as ‘disability’, ‘handicap’, ‘difficulty’ and ‘impairment’ appear interchangeable. Specific terms used in the past, such as ‘spastic’ ‘cripple,’ ‘feeble-minded’ and ‘cretin’ are now used as insults but remain part of our language. This change in language reflects society’s view of people subject to such labels. The use of terms also indicates the way services have been organised, either to protect able from disabled people, or to protect disabled from able people.

The language you use as a citizen or social work professional to describe a service user indicates a value base. ‘Value base’ denotes a set of beliefs that underpins a philosophy of care and the services provided. For example, this might include a belief that all children have the same basic rights regardless of race, religion, ability or attainment and should not be segregated from mainstream services because they appear to be different.
 

Activity 1

This activity should take you about 20 minutes.

Reflect on the experiences of your own childhood, in terms of your family, neighbourhood and schooling.

1. List the names or labels given to children or adults who were seen as different by virtue of having special needs.
    

2. Now put the list in two columns in the space below, according to whether you consider the terms positive or negative.

          Positive terms                                                                    Negative terms

Comment

We would be surprised if you were able to identify any positive terms, labels or names. While some may be less abusive or harsh than others, it is unlikely that any labels are ones you would like attributed to yourself. Many terms that you might have included are obsolete medical terms – such as cretin, imbecile, idiot, lunatic – that remain as part of everyday language and continue to reinforce a negative view of differences. Such terms appear today in the case notes of adults who as children were using services as recently as the 1960s.

The 1960s may have been the end of the ‘bad old days’, but how much have things changed?

You now need to consider how language as currently used indicates people’s value base in relation to those with special or additional needs. The next activity asks you to use a small number of contacts, to gauge public understanding of the terms used.
 

Activity 2

Comment

Although the terms impairment, handicap and disability are commonly used in the same context, their respective definitions are quite distinct. It is likely that you found one or more of the terms used to define another term. Equally, you may have encountered the view that two or three of the terms meant the same thing.

For the purposes of this unit, we prefer the following definitions, taken from the World Health Organisation in 1982. We recognise that these official definitions may seem complex. You might want to pause for a few minutes to think them through.

Impairment means a permanent or transitory psychological, physiological or anatomical loss, or abnormality of structure or function.

Disability means any restriction or prevention of the performance of an activity, resulting from an impairment, in the manner or within the range considered normal for a human being.

Handicap means a disability that constitutes a disadvantage for a given individual in that it limits or prevents the fulfilment of a role that is normal depending on age, sex, social and cultural factors, for that individual.

Here is an illustration of how these terms might be used. We might refer to a child’s impairment as spina bifida, resulting in a specific disability (unable to walk independently), leading to a handicap of not being able to use public transport or gain access to the local leisure centre.

Throughout the literature, you will encounter other definitions which may add to, or challenge, those given above. The major challenge may come from disabled people themselves, some of whom see definitions as tools used by able-bodied or non-disabled people to categorise the nature of disability. Michael Oliver, in The Politics of Disablement, refers to the questions used in a 1986 survey of disabled adults. In the survey the key words were ‘deformity’, ‘problem’, ‘difficult’ and ‘wrong’ – all used in the context of the persons interviewed. Instead of asking: ‘What is wrong with you?’ Oliver suggests the question should be: ‘What is wrong with society?’

In 1980, The Union of the Physically Impaired Against Segregation defined disability as:

The disadvantage or restriction of activity caused by a contemporary social organisation which takes little or no account of people who have physical impairments and thus excludes them from participation in the mainstream of social activities.

This unit uses the term special needs because it embraces the broadest definition of need, following the education Acts of 1981 and 1993. Ideally, we would prefer the term ‘additional’ or ‘specific’ needs. A child with an asthmatic condition has the same needs as one with epilepsy. These would include self-medication skills, perhaps dietary needs, and the need for positive responses from adults and other people in authority. We recognise that the term ‘special needs’ can be seen as patronising and emotive, but since it is a term with legal and professional currency, we have chosen to use it in this unit.

Barriers to Integration

The following activity is intended to show how the values and attitudes of others frame the world for the child with special needs.
 

Activity 3

Social Construction of Disability and Childhood

The process we considered in the last activity is termed ‘social construction’. If we take a view of disability as essentially a restriction imposed upon a person by others, we form a social construction of disability – something defined by society rather than by medicine or science. As societies vary, so does the way in which they define groups of people as valued or problematic.

This unit is concerned with children who have special needs. You have already begun to consider the social construction of disability; let’s now consider the social construction of childhood. This is necessary if we are to see children with special needs as children first and foremost.
 

Activity 4

This activity should take you about 30 minutes. It asks you to consider how ‘childhood’ is defined in the United Kingdom.

1. Write down your own definition of childhood in terms of your own experiences.
    

2. Select and write down an official definition of childhood using sociology text books or legal documents such as the Children Act 1989.
    

3. Compare and contrast the two definitions. When does childhood end and adulthood begin? What does being ‘a child’ mean? Is childhood an age? A status? A stage of development?
    

4. Consider to what extent the definitions apply wholly or in part to children with special needs.

Comment

According to the Children Act 1989, a child is considered to be someone under the age of 18 years. Official definitions will often confer adult status in terms of legal rights – the right to vote, the right to marry, to drive a car, to leave school. Thus adulthood, and by definition the end of childhood, occurs around ages 16 to 18.

Society tends to see adulthood in terms of starting work and leaving home – transitions that may occur for different people at different times. Thus adulthood depends upon who you are (How old are you?) and what you do (Where do you live? What work do you do?).

For children and young people with special needs, the social construction of adulthood and the end of childhood may be different. If society views adulthood as synonymous with financial, emotional and practical independence, then people with special needs may experience ‘infantilisation’ – being seen as children whose development is delayed. The continued reliance on others in tasks of daily living, the restriction of opportunity imposed by various barriers and the lack of appropriate support services, can contribute to a seemingly extended childhood.

Activity 5

Summary

In this session, you should have had the opportunity to reflect on your own values about children with special needs. If you are able-bodied, you may well have become aware for the first time of the absence from your life of children with special needs – you may have completed your educational experience segregated from children with various impairments. This will apply particularly if you are an older learner. You might have reflected on the ‘invisibility’ of children with particular needs and on how your particular life experience and opportunities would have been different had you been a child with an impairment.

In Session Two you will consider how needs can be identified by focusing on the child, not the impairment or the condition.

Introduction

Identifying needs is a complex process. Traditionally, services for all welfare users have been led by fitting people into available or existing facilities, rather than by identifying needs as a starting point. For the purposes of this session, we will ask you to put aside your knowledge of services and resources and concentrate on the needs of children with special needs, and the needs of their families and other carers. Needs are both essential (food, shelter, warmth and health) and relative (finance, independence, dignity, rights, and leisure), and therefore any identification of needs must take account of both elements.

A helpful definition of need appears in the Care Management and Assessment Guide produced by the Social Services Inspect orate and Scottish Office Social Work Services Group. They use the word ‘need’ to indicate:

… the requirements of individuals to enable them to achieve maintain or restore an acceptable level of social independence or quality of life, as defined by the particular care agency or authority.
 

Activity 7

The Needs of Children

The Needs of Other Family Members

Activity 8

This activity should take you about five minutes.

In terms of your identification of needs for Jasmin and her family, what categories of need should be the concern of the social worker?

Comment

In answering this question, you may have begun to think about needs for services – it is inevitable that we think about the social worker’s role in terms of the services provided by the social services department. However, we will address the question of services in Session 3. You will probably have recognised that most practical needs from the Care Management and Assessment Guide listed above, such as accommodation, education, employment, finance and transport, are the responsibility of other agencies. So which are the particular concern of the social worker? Our view is: all of them, in terms of enabling Jasmin and her family to identify their own needs.

For example, you may have suggested in your answer to Activity 8 that Mr and Mrs Benjamin need a short-term residential facility for Jasmin in a local children’s home. However, in terms of needs, it may be more accurate to say Mr and Mrs Benjamin need to discuss the desirability of some form of respite care. This may be met in many different ways – the common thread being that the service that is eventually provided should be needs-led rather than service-led. This means that the service has to fit the needs of the individual, rather than the individual having to fit existing services.

Since orphans – children literally without parents – are virtually absent in our society, all children, whether they have special or additional needs or otherwise, belong to a family. We therefore need to move onto considering the family relationships surrounding children with special needs.

Families and Special Needs

– the relationship between children and adults

– the task of parenting and the roles of men and women

– the expectations of children in terms of behaviour and achievement

– the extent to which families expect to be independent and self-reliant

– the roles of other family members

– the ways families experience services such as education and health.

Activity 9

Assessing Needs

The above list indicates the knowledge base for a social worker working with children with special needs. We will consider the issues of social work training and the debate between specialist and generic services in the final session.
 

Activity 10

Gender and ethnic considerations
 

Activity 11

This activity should take you about 15 minutes.

We believe that your gender identity – how you experience being a girl or a boy, beyond biological difference – stems from family experiences, cultural norms and wider social values.

In the previous situation study, Sarbjit is a 12-year-old girl. Remember when you were a 12-year- old girl or boy.

1. What expectations of you as a girl or boy were expressed by your parents, carers and other family members?
    

2. What were the expectations at school concerning your identity as a boy or girl?
    

3. What did you expect of yourself?
    

4. Do you think these expectations would have been the same if you were a child with a specific disability?
    

5. If you are a person with a disability, how might this set of expectations have been different had you been an able-bodied boy or girl?
    

6. How might these expectations differ for a boy or girl of a different race from your own with a specific disability?

Comment

The ways in which gender is expressed and confirmed varies between cultures. Within the United Kingdom, gender image is often associated with fashions of dress, hair styles, jewellery, facial hair, tattoos, and make-up. You may have identified specific activities such as sports, leisure pursuits, and pastimes. You may also have referred to different expectations within the family concerning roles and tasks or different expectations from teachers about achievements and behaviour in schools. You may have recognised that Black children with a specific disability experience double disadvantage or double jeopardy in that within a White, able-bodied society, children or young people who are different by virtue of race and ability are discriminated against twice.

Much of our thinking about gender identity in teenage years relates to the way children make the transition from childhood to adulthood. This significant part of the life course will also vary between different cultures. In some cultures, the transition from childhood to adulthood, for boys and girls, is marked by formal rituals, ceremonies or ‘rites of passage’. In other cultures, such transitions are more informal and haphazard. This is an important area for children with special needs, which you will return to in Session 5.

This activity should take you about 20 minutes.

Considering sexuality

Considerations of sexuality in relation to young people with special or additional needs have been ignored until recently. This activity asks you to compare opportunities and issues of sexual identity for two young women, similar in all respects other than their physical ability.

Jane is a White, 17 years old and a wheelchair-user in a residential school. Her cousin Sarah is of the same age, lives with her parents, is able-bodied and attends a sixth-form college.

Bearing in mind the expectations of a White society concerning young women and their sexuality, please answer the following questions.

1. What could Jane and Sarah expect to be able to do?

2. What could Jane and Sarah expect not to be able to do?

3. What could Jane and Sarah expect of their parents or carers in terms of advice, guidance or services?

Comment

You may have found it difficult to answer the questions. For example, it is not always easy to recognise young people with disabilities as sexual beings. The powerful cultural and media images we all absorb link sexuality with bodies that are flawless and perfect.

People express their sexuality in terms of fashion, dress, image and style as well as behaviour with others. In exploring these types of expression, young people require the opportunity to make choices. You may also have thought about the opportunities for both Jane and Sarah to have access to services such as family planning clinics and other advisory centres.

Summary

Many of the themes in this session would be the same for the identification of needs in relation to any other group of service users. That is precisely the point. The traditional medical model of needs and services for children with special needs has focused, often exclusively, on the impairment itself. Here we have tried to see needs in terms of the child or young person’s context – her family, carers and environment; her racial and gender identify; her age and sexuality; her life opportunities and the structural barriers to the realisation of potential.

If you are an able-bodied person, the activities may have enabled you to think about some of these issues afresh. If you are a person with a disability, we may not have introduced anything new, but you may have been able to put your personal experiences into a different context, or to have thought about the needs of children and young people with disabilities different to your own.

Introduction

In Session One we referred to the philosophy of care, and how this was reflected in the provision of services. Services have evolved over time, and at the time of writing this unit, legal changes are being implemented in the areas of health care, education and social services. We will look a the legal framework in Sessions Four and Five.

You will begin this session by attempting to map out the range of services provided by different agencies for children with special needs and their families. We don’t expect you to be familiar with all sectors and agencies that have a part to play, but the first activity will serve to help you check out the knowledge you already have in this field.
 

Activity 12

This activity should take you about ten minutes.

Service providers can be grouped into different sectors and agencies. Agencies are organisations. Some are charities, some are part of national and local government. Agencies operate within particular sectors. For example, social services are an agency within the statutory sector of the local authority.

In ten minutes, list as many as you can of the sectors and the agencies within those sectors that might provide services for children with special needs and their families.

Comment

As we indicated in Session One, your answers will depend on where in the United Kingdom you live. Although the sectors will be the same, the balance and levels of services will vary. The different sectors are as follows:

1. local authorities (London boroughs, metropolitan authorities, county councils, and district councils)

2. area health authorities

3. voluntary agencies and charities (the voluntary sector)

4. the private sector

5. non-profit based trusts and consortia.

It is likely that you identified the first four sectors. The last type has only gained public attention in the past few years. The balance of services between the different sectors has changed rapidly in recent years.

The National Health Service and Community Care Act 1990 signified a major shift for health authorities and social services departments, which are increasingly seen as enablers rather than providers of services. This has resulted in a growth of service provision in sectors 3, 4 and 5 – the private, voluntary and trust-based sectors.

In your list, you may have noted voluntary organisations such as MENCAP, The Spastics Society, The Association for Spina Bifida and Hydrocephalus, RADAR, Dr Barnardos the National Children’s Home, among others.

You may have mentioned some or perhaps all of these:

Heath authorities
acute medical services
paediatricians
family health services (including GPs and health visitors)
speech therapy
occupational therapy
long-term and short-term residential care
child and family psychological services

Social services
social workers
home care services
occupational therapy
family centres
funding for day-care and child minding

Local education authorities
schools (mainstream and special)
nursery schools
educational psychology
educational welfare services
residential special schools
careers advisory services

District housing authorities
housing adaptations and conversions
provision of local authority housing
welfare rights advice and benefits

Voluntary sector
parent support groups
social clubs
advocacy and campaign groups
toy libraries
pre-school play groups
play schemes
holidays and leisure activities
welfare visiting services
portage schemes
schools
long-term and short-term residential care
respite care schemes

Private sector
long-term and short-term residential care
schools
nursery schools and day-care

Who is really providing the bulk of care?

Even in areas where the list of services appears comprehensive you should recognise that the largest providers of care remain informal carers. There are an estimated six million carers in the UK for all client groups, and they are central to the concept of care in the community. Most of these carers are looking after someone within their immediate family.
 

Activity 13

This activity should take you about three hours in total, perhaps spread over two days.

From the four brief situation studies in Appendix 1, choose one family with which you find it easiest to identify (this may be in terms of your age, race or gender).

Your task is to research the services that are available in your area for the child and his/her family. In carrying out this activity, you may have clear ideas of what services should be available, but find they are absent. If this is the case, you are identifying gaps in service provision. You may also encounter difficulty in obtaining information. It may be difficult to read or understand or it may be produced in only one language (English). Such difficulties will indicate to you some of the practical problems facing any family that wishes to seek advice, support of services. You should therefore note down any difficulties encountered in carrying out the task.

You should be able to obtain written material and leaflets about services from such places as social services offices, health centres, the education department, Citizens Advice Bureaux, public libraries and volunteer bureaux.

You should come across the Community Care Plan, a document that all local authorities and health authorises are required to produce jointly under the National Health Service and Community Care Act 1990. This is available from public libraries and upon request from social services or health authorities.

When you have completed this activity (which you will find more or less difficult, depending on your location and access to information) move on to Activity 14.
 

Activity 14

Summary

One of the principles of the community care system is the separation of the identification of need from the provision of services. In the health services the former is done by the purchaser, who then buys the appropriate services from the provider, who may be from the state, the local authority or the voluntary or private sectors.

Social services have also divided into two wings, often called ‘customer’ and ‘contractor divisions’. What you have been examining in this session is the relationship between these two functions, and how the identification of need leads on to the purchasing of appropriate services from the providers or contractors. This is shown in the diagram on the next page.

Figure 1: Providing community care services

You will be able to take your learning further in this subject by examining the Community Care Plans for people with disabilities in your local area authority area. These are available upon request from the social services department or in your main library.

Introduction

This session deals with the legal context of working with children who have special needs and their families.

The Children Act 1989 received royal assent in November 1989, and was implemented on 14 October 1991. The act does not refer to children with special needs, but instead talks about children with disabilities. You will have begun to consider these terms in Session One.

It is useful to begin a consideration of the legal context with our ideas of what the law should do. As a result of the Children Act 1989, what does the local authority have to provide, and what can it provide? The next activity should help you to reflect further on this.
 

Activity 15

This activity should take you about 20 minutes.

Imagine that a child with a physical disability is a member of your family (she or he may be your birth child, or a relative). If you have difficulty in imagining a child, you may use the following example.

Katherine is ten years old. She has a spina bifida condition which restricts her mobility. She attends a mainstream primary school located one mile from her home.

Consider the following three questions and note down your answers.

1. What would you expect the local authority social services department to provide for the child in question and other family members?
    

2. What must the social services department provide under the Children Act 1989?
    

3. What may the social services department choose to provide under the Children Act?

Do not worry if this feels difficult because you do not know the relevant legislation. The objective is to consider, from a family perspective, what the law should mean for you and your young relative.

Aim to spend up to 20 minutes on this activity.

Comment

Before considering what you may have noted as services for Katherine and her family, we would like to make a few points about the Children Act 1989, and the law in general.

If this exercise seemed difficult, you are not alone. Very few people know what a local authority social services department should provide for them. This is particularly so in relation to children with special needs because children, their families, carers and communities have traditionally looked to health and education authorities as the prime providers of services.

Until the implementation of the Children Act 1989 services for children with special needs were provided under the National Assistance Act. In other words, children with special needs were seen as disabled adults who happened to be younger! The Children Act 1989 operates the children first principle which sees children with special needs as first and foremost the same as other children but with special needs. This entails locating all social services responsibilities for children, young people and their families – whatever their needs – under one statutory roof.

In Unit 3 of the module Using the Law in Social Work you will have considered the definition of children in need in terms of the Children Act 1989. Section 17 of the act defines a child as being in need if he or she is disabled.

The Children Act 1989 mirrors the National Assistance Act 1948 definition of disability stating that:

… a child is disabled if he is blind, deaf, dumb or suffers from mental disorder of any kind or is substantially and permanently handicapped by illness, injury or congenital deformity or other such disability as may be prescribed.

In response to Activity 1, you might have expected the social services to provide, or promote the provision of:

1. domiciliary and home care services
    

2. family centres, for example, a centre for carers’ support groups
    

3. day care. Like any child in need, a child with special needs should be provided with day care, including after school and holiday care.
    

4. advice, counselling, and in special circumstances, financial support
    

5. occupational therapy services, including the provision of aids and adaptations
    

6. transport to and from the services provided
    

7. assistance with family holidays and respite care schemes
    

8. information about services provided by both the local authority and other agencies
    

9. after care and the effective transition from childhood to adult services
    

10. a register of disabled children in their area.

The social services department has to provide the first service in the above list. In addition they may provide the rest of the list.

The provision of these services is based on the principles of the Children Act 1989, including the key concepts of partnership and representation, which we will now consider.

Partnership and Representation

One of the key principles of the Children Act 1989 is that of partnership between parents, carers, children and the authorities that provide services. Families have unique and special knowledge of their child and his or her needs, and are therefore best able to identify services that can enable them to carry out their parental responsibilities. The concept of partnership is particularly relevant to the concept of a needs-led service, which you have considered in Session Three. Without partnership, and clear channels for children and their families to express their views on services, authorities can easily slip back into providing the services that they consider best for the service users.

Children with Special needs and Child Protection

In recent years, professionals, parents and carers have become increasingly aware of the vulnerability of children with special needs to being abused by adults and other children. Some children with physical or learning disabilities are prone to accidents and injury, making it harder to distinguish between deliberate abuse and non-abuse. The situation for those undertaking investigations – police, social workers and health workers – is made more complicated by such children often having communication difficulties. Children with learning disabilities or communication impairment are particularly ‘soft targets’ for perpetrators of child sexual abuse in that such children are less likely, or able, to make disclosures and allegations about the abuse to which they have been subjected. It is important when working with children with special needs in any context to ensure that you are familiar with the area child protection procedures. You should contact your local social services or health authority for information about the area child protection committee. (See Unit 7 of this module, for more information.)
 

Review activity

You may have found that while your knowledge of the Children Act has increased, there are some gaps in your understanding of the law in relation to health, education and other areas of provision. We therefore move on to these areas in the next session.

Summary

This session has only been able to touch on some of the implications of the Children Act 1989 for social work practice with children with special needs and their families. There is more detailed coverage in the module Using the Law in Social Work.

Introduction

This session begins with a particular focus on the education of those with special needs.

Unlike the personal social services, which are specific and selective, education is a universal service. It is universal in that all children, irrespective of their abilities, needs, circumstances and identities, are required under the Education Act 1944 to receive full-time education, currently from ages 5 to 16. The local authority has a statutory duty to provide education for children with special needs from age 2 to 19, and in some circumstances may provide continuing education until the age of 21.

Following the 1978 Warnock Report, the Education Act 1981 determined that children with special needs should, wherever possible, be educated within mainstream schooling. LEAs must provide schools sufficient in number, character and equipment to offer an appropriate variety of instruction and training for pupils of different ages, abilities, and aptitudes. In particular, LEAs must have regard to the need for securing that special educational provision is made for children with special educational needs.

Section two of the 1981 act states that the objective is for all children to be educated in ordinary schools, while allowing for some circumstances in which segregated special schools will be retained. The act gives LEAs the duty to identify, assess and provide for those children and young people with special needs.
 

Activity 17

A small study of 36 children with Down’s Syndrome, half of whom attended special schools and half of whom attended mainstream schools, indicated that over two years, the children in mainstream schools made greater progress in terms of language development, numeracy, verbal fluency and comprehension (cited in Woolfson, 1991, p118).

Benefits for the other children

Children educated alongside those with special needs develop greater sensitivity, consideration and awareness.

Benefits for all children

Integrated education – be it in terms or race, gender and ability – enables all children to develop relationships with people different to themselves, and to develop attitudes of tolerance and acceptance.

The case against integration

Problems for children with special needs

Children may experience rejection from other children and lack the support from children with similar needs and disabilities.

Problems for other children

Other children may develop resentment of the special attention being shown to those with special needs, and may feel rejected themselves.

Problems for all

In the context of changing demands in education, teachers may feel under pressure to take in children for whom they are unable to provide an adequate service.

Parents of children with special needs may feel isolated and miss the valuable support networks that tend to develop around special schools.

Levels of integration

Many different points may have been made in your discussions for Activity 17. It might be helpful now to group these into three different levels of integration, as follows:

1. locational integration – when a special unit or class is located on a mainstream school campus
    

2. social integration – as above, but allowing for planned and desired integration at playtime, school meals, social activities, etc.
    

3. functional integration – where children with special needs participate as full and equally valued members of the school in all its aspects, supported by appropriate staffing, adaptations and resources as required to meet such objectives.

14% of the total school population have identified special needs met within their ordinary school.

0.8% to the total school population receive additional help from the LEA in their ordinary school or from a special unit within the school.

1.3% of the total school population attend a special school or special boarding school.

Children with Special needs and their Education – what is the Relevant Legislation?

We will now move on to considering how the education of children with special needs is assessed and provided.

The assessment and provision of education for children with special needs

The Education Act 1981 ended the previous system of categorising children according to their handicap, and replaced this with the concept of special educational needs. A child has special education needs if he/she has a learning difficulty which calls for special educational provision to be made for him or her. There is no sharp division between ordinary pupils and those with ‘special needs’. Special educational needs are the outcome of the interaction between the strengths and weaknesses of the child, and that child’s educational environment.

The Education Act 1981 has been superseded by the Education Act 1993, which contains a code of practice on special educational needs.

Activity 18

This activity should take you about 20 minutes.

Compare the definition of a disabled child from the Children Act 1989 (See Session 4) with the concept of special education needs from the Education Act 1981. Note down the similarities and differences.

Then think about whether the two apparently different definitions could result in more or less children being entitled to particular services. How can educationalists, social workers and health workers work in partnership, using different legislation?

In considering your views on the two pieces of legislation, you will need to draw on the materials in Session One on concepts and language, in particular the terms ‘disabled’ and ‘special needs’.

Comment

Many educationalists, including educational psychologists, have been dismayed by the use of a 50-year-old definition of disability in the Children Act 1989. The major differences are as follows.

The Education Act 1981 definition is a relative concept. In others words, while standards of attainment and achievement evolve in our society, some children will continue to have relative special educational needs. The Education Act 1981 therefore thinks of handicap in terms of relative disadvantage. By contrast, the Children Act 1989 definition focuses on absolute conditions – children are disabled by virtue of their disability. The definition in Session One therefore focuses on impairment and disability.

The Education Act 1993 (Code of Practice for Special Educational Needs) assumes that up to 20% of children – one in five – may have special educational needs at some point during their school years. It expects that the provision for such children will be in mainstream schooling unless this is not appropriate.

We now need to consider the process of identifying special educational needs, meeting those needs and delivering them. This process is set out in the Education Act 1993 Code of Practice.

Assessment and the statement of Special Educational needs

The assessment process for special educational needs is in five stages.

Stage 1: The teacher identifies a problem or need and designs a programme for the child, in consultation with the school special needs coordinator.

Stage 2: The special needs coordinator in the school takes the lead in gathering information and coordinating action.

Stage 3: The school refers to the LEA for assistance, and may involve an educational psychologist, or other support services, to assist, advise and re-design the programme.

Stage 4: If the school cannot meet the identified need, a multi-disciplinary assessment takes place involving other agencies such as health and social services (under Section 10 of the Education Act 1993).

Stage 5: The local education authority considers issuing a statement of special educational needs. If the statement is issued it must provide the appropriate help and services to meet those identified needs.

The Code of Practice expects that most needs will be met in the first two stages. School governors will need to include information in the school’s annual report for parents to explain how they identify and deal with children with special needs. Time-scales for the stages noted above are clearly laid down in the Code of Practice.

The next activity focuses on the role of the social worker in the stages of assessment for a particular child.
 

Activity 19

This activity should take you about 30 minutes.

Imagine that you are a social worker working with a Pakistani family whose second child, a ten-year-old girl appears to be developing a sensory impairment of restricted hearing. The family have been notified by the LEA that an assessment of special educational needs is to be undertaken.

Please note down your answers to the following questions.

1. What should be you role as part of this multi-disciplinary assessment?

2. What do you need to know to undertake this role effectively?

3. What values and principles of practice should you apply?

Comment

1. Your role
   
   Under the Education Act 1981, LEAs must inform social services through a nominated officer that an assessment of special educational needs is to be undertaken. Through the Education (Special Educational Needs) Regulations 1983, LEAs must seek advice from other agencies and supply other agencies with copies of representations and views submitted by, or on behalf of, the parents of the child in question. As a social worker you may therefore have to balance the roles of taking part in the assessment and being an advocate for the child and parents throughout the process. These practices will continue under the Education Act 1993, implemented from September 1994.
    

2. Your knowledge
   
   In order to give effective advice it is important to know how the system works. This requires knowledge of local procedures and of relevant parts of the Education Act 1993 Code of Practice and, the Children Act 1989.
    

3. Your values and principles
   
   The principles of empowerment and advocacy (which we will develop further in Session Six) are particularly important.

Now let’s look at some research findings about what parents expect of social workers.

A number of surveys have asked parents of children with special needs what they most expect from social services. A consistent comment that emerges is the expectation of support from professionals who are knowledgeable about their child’s condition, and who display a willingness to go and find out about issues.

Similarly, parents and carers expect social workers to understand the procedures that they, the family, are engaged with. Parents and carers expect social workers to know how schools admissions policies work, how schools try to meet special needs, and the role of the local education authority.

Anti-oppressive practice

Cultural bias in standard assessment mechanisms

The health system: working with community care

Like the education system, health is a universal service. For the parents and carers of children with special needs, various health professionals will be the first agency contacts, particularly for children with special needs identified from birth or in infancy. Midwifery and health-visiting services may identify development difficulties and thus engage the specialisms of paediatricians and other consultants.

(For further reading on child surveillance, see the Court Report of 1976).

It is essential to become familiar with the Community Care Plan in your area, to focus on services for children with special or additional needs.

Working Together and Coordinating Services

We have now established that the three primary agencies for children with special needs and their families are health, education and social services. Now let’s consider how these three organisations work together. Child protection agencies with their own bureaucracies often experience difficulties in liaison and cooperation – always to the detriment of service users.

Inter-agency cooperation: the requirements

Section 27 of the Children Act 1989 makes it a formal requirement for all key agencies to work together to promote the welfare of children. It is worthwhile noting the nature of these inter-agency responsibilities.

District health authorities have duties to inform LEAs of any child under five years of age who might have special educational needs.

Like social services, health authorities contribute to the multi-disciplinary assessment process towards the statement of special educational needs.

The function of coordinating inter-agency services lies in practice with the health authority and social services department as part of community care planning under the NHS and Community Care Act 1990.

The Disabled Persons Act 1986 requires social services departments to assess young people with disabilities for a range of services at the time they leave school, as outlined in the Chronically Sick and Disabled Persons Act 1970.

The Children Act 1989 empowers social services departments to combine assessments under the Children Act 1989 and the Chronically Sick and Disabled Persons Act 1970.
 

Activity 20

A multi-disciplinary assessment and coordination of services would therefore be required by all of the children and their families. All of the carers or parents of the children will have needs of their own – as will the children’s siblings. We will return to this theme in Session Seven of this unit.

In the case of all of these children and their families, the role of networks, support groups and voluntary organisations should be considered.

Transitions to Adulthood

We need to consider transitions to adulthood for one major reason: research studies have shown that agency cooperation and coordination can be inefficient when people with special needs cease to be ‘children’ and become seen as ‘adults’.

In Session One we suggested that the transition to adulthood for most children is defined more in terms of informal events such as leaving school or getting a job, rather than through a formal rite of passage or upon reaching a specific age. Our society tends to define maturity in terms of increased responsibility. It is therefore interesting to reflect on who can do what at what age.
 

Activity 21

This activity should take you about 15 minutes.

Try to answer the questions below, based on the law in England and Wales. The answers are set out below, so cover them up with a sheet of paper.

At what age can you legally do the following? Note down your answer next to each question.

1.	leave school	r
2.	join the armed forces	r
3.	obtain a driving licence for cars	r
4.	have sexual intercourse (heterosexual)	r
5.	vote	r
6.	have sexual intercourse (homosexual)	r
7.	drink alcohol in a pub	r
8.	have a lesbian relationship	r
9.	own a shotgun	r
10.	buy a pet	r
11.	live in or enter a brothel	r
12.	have a part-time job	r
13.	be convicted as a male of rape	r
14.	drink alcohol at home	r
15.	drink alcohol with a meal in a restaurant	r
16.	get married with parental consent.	r

Comment

The correct answers are as follows:

(1) 16, (2) 16 (with parental consent), (3) 17, (4) 16, (5) 18, (6) 18, (7) 18, (8) 16, (9) 14 (under supervision from someone over 21), (10) 12, (11) 16, (12) 13,
(13) 14, (14) 5, (15) 16 (16) 16.

We consider scores of 13 or above to be exceptional. As this exercise only took a few minutes, you may wish to try it with two or three colleagues or friends to see how far the answers are consistently right, or wrong.

You may find it hard to detect any logic in these age barriers. If you knew that the age for driving was 17 you would think that an older age was required for the possession of a gun.

Furthermore, these age barriers vary in other countries. In Scotland, people may marry at 16 without parental consent. In Greece, girls may marry 14 with parental consent – four years younger that Greek boys/men. In Italy, children may leave school at 14. In Luxembourg there is no lower age limit for criminal responsibility- which is ten in England and Wales and 18 in Belgium.

The age of majority – being seen legally as an adult – is 18, although you can’t be an MP in the House of Commons until the age of 21.

The picture for those with special needs is no less illogical or confusing.

Transitions to Adulthood: Practice Issues

Services and transitions

For the child with special needs and her/his family, the transition to adulthood stands as a major life change. It may involve changes in services and entitlements. Leaving school may involve separation from people and services that have been long cherished, and moving to a day centre with different arrangements, new staff, new relationships.

Managing change

As you will note from your own experience, some people welcome, cope well with and actively seek out new challenges, while others find such changes threatening, unwelcome and confusing. As a social worker, working with people experiencing change is often a vital task. We would therefore like you to look at your own mechanisms for coping with change in the next activity. This will help you to work more effectively with others who are facing changes.
 

Activity 22

This activity should take you about 20 minutes.

1. Head four separate sheets of paper as follows:
   
   1. 0–6 years, 2. 7–11 years, 3. 12–17 years, 4. 18–21 years.
    

2. On each sheet of paper list up to four significant life events that you remember from that era.
    

3. Then note any specific difficulties that you associate with each event.
    

4. Lastly, try to remember what happened to make things better.
   
   For example, on the first sheet, 0–6 years you may put:
   
   Going to school for the first time.
   -  Being away from mother.
   -  Frightened of the teacher.
   -  Hating the food.
   -  Better when taken to school by mother or best friend.
   -  Took packed lunch. Just got used to it.

Comment

If you have had traumatic events in your childhood, this may have been a difficult and painful exercise, but it is worth noting the contributions made by people who have experienced trauma and loss to the support and assistance others (the mother of missing estate agent Susie Lamplugh being a good example). Surviving difficulties is a common motivator to helping others.

However, apart from your own experiences, you will need to recognise how people from different cultures and backgrounds perceive and cope with events and life changes.

Helping other people prepare for change

Our focus so far in dealing with change has included your own experiences and the impact of change on other people. We now move on to consider the social work skills required for taking a proactive stance in helping others prepare for change.
 

Activity 23

This activity should take you about 20 minutes.

Please begin by reading the following situation study.

Frank is 18 and has been at a residential special school for the past 12 years. He has epilepsy and has periods of seizures (or fits), which effect him severely. The effects include: falling and injury, long periods of sleep in recovery, and short-term memory loss. Most of the time his condition is controlled by medication and he can lead a reasonably independent life. Frank wishes to seek employment but in the short term attends a local day centre. He has just been allocated a flat in a housing association unit, but it is in an area of the city with which he is not familiar.

You are Frank’s social worker. What would be your plan of action to work with Frank through the changes facing him and his family?

You should aim to write down up to six specific ways you would help Frank make the moves required. You should put your thoughts under various headings such as Work, Day Centre, Home (family), Home (flat).

Comment

A key part of your plan will have involved preliminary visits to both Frank’s home and the day centre. You might also have taken Frank to the housing association complex and the neighbourhood to begin familiarisation. Frank’s parents may have their own difficulties about accepting his desire for independence, and these need addressing. As a result of being at boarding school, Frank may have few links with young people in the area. These networks need to be worked on early, as support from people his own age will be vital for Frank. Defining your role and that of the workers at the day centre is important to avoid duplication and confusion. Although Frank, as the young person, has to be your primary focus of work, we suggest that you need to consider his whole system.

Summary

We recognise that this has been a long session, focusing on aspects of legislation and moving on to look at services for adults as transitions from childhood occur. We now wish to look at how services to people with special needs are seen by others in society. This will have a major impact on the effectiveness of the services in combating the oppression and experienced by children and young people.

Note: Activity 25 will involve you visiting a centre providing services for children with special needs.

Introduction

For the past 20 years providers of services to people with disabilities or special needs have been influenced by the theory of normalisation. We do not propose in this unit to go into great detail about the principles of normalisation; you will find a detailed treatment in Unit 4 of Social Work in Community Care. However, John O’Brien refers to five goals that services should aim to achieve for their users. We describe these on the next page.

1. Presence in the community – using ordinary services as ordinary citizens.

2. Ensuring choices – supporting the preferred options of people.

3. Developing competence – people acquiring meaningful and valued skills

4. Promoting respect – by developing and maintaining positive images.

5. Ensuring participation – by empowering people to control their services and developing networks of relationships.

We will now move on to considering what these principles of normalisation mean in practice.
 

Activity 24

This activity should take you about 20 minutes.

Referring back to the situation study in Activity 23, try to complete this activity about either the housing association flat Frank is to move to, or the day centre he is attending.

Compile a list of the features of the housing complex or the day centre that would contribute to the service being seen as deviant, different or devalued by the rest of the community. Imagine that Frank’s services are in your neighbourhood. What features of appearances would make these services stand out as different and be seen in a negative light? An obvious example would be if a service centre had bars on the windows, looking like a prison.

Try to think of six such negative features.

Comment

Your list will probably be a mixture of the obviously negative – such as the example given – and the more subtle. A sign outside a residential home, mini-buses with ambulance signs, or ‘donated by’ acknowledgements, all suggest images of dependence, sickness, charity and separation.

High fences that stand out from neighbouring buildings, disrepair of the buildings, and a location in an undesirable area are all answers you may have given. Even more subtle is the continued location of services on sites with very negative associations. In our work in this field, we have encountered day centres for people with learning difficulties and a unit for elder people being located in former workhouses.

Evaluating a Service

In order to get the ‘feel’ of a service centre, it is important to visit such an establishment as an observer.
 

Activity 25

We now wish to consider the tension between the need to make services clearly identifiable and the desire to make services discreet and as ‘normal’ and as everyday as possible.

Signs and symbols

In Session 1, we focused on language, terms and labels as an important area for study in terms of how service users with disabilities and special needs are viewed. We now wish you to look at the function and impact of signs and symbols.
 

Activity 26

This activity should take you about one hour.

We hope that by this stage in the unit, you will have become familiar with services in you area. Using whatever sources you are able to consult (telephone directory, service directories, handbooks, guides, information leaflets, etc.) research and note the names of centres and groups that provide services for children or adults in you area. This does not need to be confined to the field of disability or special needs. Then evaluate these names in terms of whether they convey positives or negative messages.

Comment

This might have been a difficult exercise, depending upon where you live. Our view is that the easier it has been to complete in terms of identifying service centres, the greater the degree of labelling in your area. If services, particularly residential centres, are quite discreet, the task may be harder for you but the service may perhaps be better for the residents/users. Recent trends have been to name homes by the house number in a street where every other dwelling has a number, instead of naming them The Woodlands Centre or Beechcroft. One of the most unfortunate and offensive centres we encountered was named Cripplecraft – a name that has now been changed. The use of such names is reinforced by the prominent display of signs outside the buildings, often primarily for the benefit of service funders, not users.

Messages for and from the Media

Session Three of this unit, focusing on the Children Act 1989, referred to the requirement to keep a register of Disabled Children. The act also requires authorities to publish information about all relevant services available to children with disabilities and their families. The dilemma for all service providers is how to produce information that is dynamic and effective, without drawing upon and reinforcing stereotypes of dependence and charity. For example, organisations such as MENCAP and The Spastics Society recognise that their names are now inappropriate and demeaning, but since they are charities dependent upon voluntary contributions, the decision to change their name, image or logo would result in a loss of income and public awareness.

Activity 27

This activity should take you about 20 minutes.

Imagine that you are day service worker in a centre for people with learning difficulties. You and your team have been asked to produce a logo or symbol for the centre for publicity materials. Design the logo in picture form. Show your design to somebody and ask them what they think it represents.

Comment

You will probably have approached this task in one of two ways. You may have produced a neutral design with which you feel comfortable – but which meant nothing to your viewer. Alternatively, you may have found yourself trying to represent the key terms learning and difficulty in a way that makes sense to the viewer but which is negative in terms of emphasising difference and disability.

We are not able to offer any easy resolution of this dilemma. One response may be to ask service users how they wish their centre to be portrayed and to give them the facilities and resources to produce their own materials. You might have a ‘people first’ group in your area, engaged in such work.

Activity 27

This activity should take you about one week to prepare and then 30 minutes to evaluate.

Compile up to ten press cuttings from local, regional and national newspapers, including pictures, that refer to any aspects of children with special needs. Write down the key terms or phrases used by the press to describe children in these stories, and comment on whether they convey positive of negative images.

Comment

Unless your local press deals with such issues with an extraordinary degree of sensitivity, the underlying images will invoke feelings of pity, suffering, bravery, burden and worthy causes. Reference to children suffering from Down’s Syndrome are commonplace; families or individuals are tragic and heroic. Accompanying photographs will feature ‘sufferers’ receiving cheques or equipment from fund raisers.

You may have noticed a pattern suggesting a hierarchy of good causes, with some areas of special needs conspicuous by their absence. Children with special needs are more newsworthy that their adult counterparts; physical disability gets a ‘better press’ than learning disability.

It is difficult for the media to promote positive images. It is hard to recognise achievement without appearing patronising. The media often promote negative images by seeming to publish only exposure of malpractice, an example being the coverage of the care of children with special needs in Romania. Such images convey a range of messages: pity for the children; the despising of those responsible; and a sense of cultural superiority (it would never happen in Britain!).

Summary

In this session you have worked on the structural and cultural issues that impact on the lives of children with special needs. Referring back to the definitions in Session One, we have focused on the handicap that people experience, preventing them fulfilling a role that is normal. We believe that how services are organised, viewed, see themselves, and the message they convey all have a profound impact on the service users.

You will now move on to Session Seven, addressing other parts of the jigsaw.

Introduction

So far in this unit, your enquiries and thinking will have focused on the identification of needs and the provision of services by three primary agencies: education, health and – most significantly, given the nature of this learning programme – the personal social services.

You will need to visit a Department of Social Security office or Citizens Advice Bureau in order to complete Activity 29.

Firstly, we wish to consider the issues of health in its widest sense, related to class and life opportunities.

Health and Class

The links between poverty, impoverished environments and the greater incidence of disease, disability, and premature death have been well documented in the Black Report: Inequalities in Health (DHSS 1980). It is important to consider these links between social class, illness and disability, as social workers need to understand the structural issues impacting on the lives of services users.
 

Activity 28

This activity should take you about 20 minutes.

Imagine two children with the same degree of physical disability related to spina bifida. They live in contrasting circumstances. Child A is in a professional, middle-class family; Child B is in a low income working-class family.

In the boxes below, compare and contrast their quality of life and life opportunities. To begin with, use headings such as ‘Housing’, ‘Health and the environment’ and ‘Welfare benefits’, adding more if you wish.

Comment

You may have considered some of the following points.

Housing

Child A is far more likely to live in a house with ground-floor access which is easier to adapt to his/her needs and which has a garden. He/she is likely to live in a safer, less polluted environment.

Child B is more likely to live in a flat or house with poorer facilities and amenities which may be overcrowded. He/she is likely to live in a polluted or impoverished environment.

Health

Research in the Black Report shows that middle class parents are more likely than working class parents to seek and receive appropriate medical help for their children.

For the vast majority of families including a child with special needs, financial matters have a critical impact on the way they function and cope.

Welfare benefits

Many entitlements to benefits are not taken up by potential claimants. Middle-class families are more likely to engage with a complex and confusing benefits system and feel able to challenge rulings and decisions.

We will look at the issue of welfare benefits in more detail, as financial concerns impact significantly on the quality of life experienced by all members of a family containing a child with special needs.

Benefits and welfare rights

For anyone trying to understand any benefit entitlement, the system is both complex and daunting. Most benefits are not taken up by many people for whom they are designed. One aspect of the social work task is to promote the application for benefits by potential claimants.

Activity 29

This activity should involve about one hour of research.

It is important that you gain some experience and knowledge of the benefits to which a family including a child with special needs could be entitled. You may undertake this activity at your convenience as it will entail visiting a Department of Social Security office or Citizens Advice Bureau. Return to the following comment when you have completed the exercise. In the meantime, continue with the unit after the comment section below.

Situation study

Simon is 12 years old, the only child of his parents Jim and Mavis Wilson. He has cerebral palsy and attends a special education unit attached to the local comprehensive school. Mr Wilson is unemployed. Mrs Wilson is employed as a dinner supervisor at Simon’s school.

What are the benefits to which this family could be entitled?

Comment

Smyth and Robins (1989) showed that all types of families including a child with special needs were financially disadvantaged relative to similar families without such a child. This study alone emphasises the social work role in maximising the take-up of appropriate benefit entitlements. You should have considered the following benefits.

For the family as a whole:

income support, housing benefit, disabled child premium and community charge benefit

For the child:

attendance allowance, mobility allowance, disability living allowance.

For the parents:

invalid care allowance.

Housing needs

Housing needs are very complex. For many reasons – community support, family proximity, employment, access to services and financial constraints – families may choose to stay in accommodation that on the surface may appear unsuited to the welfare of a child with special needs.
 

Activity 30

The Environment, Access and Recreation

In Session One we used the term handicapped as meaning the impact on the individual that results from their disability. The concept of being handicapped by society can often be best illustrated by considering the extent to which children with special needs – and by definition, their families – are denied access to facilities considered by most of us to be an essential part of community participation.
 

Activity 31

Comment

Little or no comment is required here. Your list should be evidence enough of the extent to which public places are often public only for able-bodied people in society.

Informal Carers and Care of the Carers

As with the great majority of children, the bulk of caring for children with special needs is undertaken by women, with little or no help from other family members. Studies have shown that 61% of women caring for a disabled child do so far at least 50 hours per week. The presence of a person with special needs seems to reinforce patterns of family care rather than change or challenge them. Wilkin (1978) reported that the fathers’ roles in most families with special needs children varied little from the dominant cultural pattern. More recent studies (Glendinning 1985) have found that, as in most studies of child care and domestic labour, fathers’ activity centred on the more rewarding and pleasurable aspects of parenting – not the routine and domestic.

Where women, as primary carers, get support from outside the immediate household, this tends to come from other women in the extended family, the neighbourhood or from support groups comprising mothers of children with similar special needs.

Last Pieces of the Jigsaw: the Needs of Siblings

Glendinning’s study (1983) showed that older children were often an important source of parental support which may detach them from socially and culturally expected childhood experiences. Studies of families including a child with either cerebral palsy or spina bifida found that 75% of siblings over seven years of age were expected to help in a large range of basic care activities.
 

This activity should take you about 20 minutes.

Refer back to the situation study in Activity 30 concerning the Wilson family. The girl with special needs, Simone aged five, has three siblings, Samuel aged 14, Gloria aged eight, and Malcolm aged three.

What might be the feelings and reactions of these three children towards their sister Simone?

Consider also the relationships between these siblings and their parents.

You should note down your thoughts under headings for each child.

Comment

Siblings may often feel resentful and neglected. They may be subject to very high expectations: moral expectations about being a good, considerate, caring child; educational expectations, to achieve for two, and to be above average to make up for the other child’s’ perceived deficiencies; recreational and sporting expectations, as with education.

You may expect the three children to have different reactions. As with any family, there will be different gender expectations in relation to the children. Gloria may be expected, as a young girl, to share with the mothering or domestic routine. Samuel may be under greater pressure to be responsible and to act as a mini-adult. Malcolm may feel displaced as the youngest child, and feel neglected by his parents. To meet Simone’s needs, Samuel and Gloria may be expected to take a greater part in caring for Malcolm.

Siblings may also be subject to over protective attitudes from parents and carers, based on the fear of accidents, and other life risks.

Employment and Independence

In 1977 a survey conducted by The National Children’s Bureau identified an unemployed rate of 19.1% among disabled school leavers, compared with 4.4% among school leavers generally. Given the much higher level of national unemployment today, the current figure for disabled young adults would be much higher.
 

Activity 33

Summary

In this session, you will have considered the often overlooked but important factors that impact on the lives of children with disabilities, their parents, carers and siblings. Much of the material in this and other sessions has focused on the underpinning knowledge and values that inform social work practice with children with disabilities, and their families. In the final session you will address the practice issues of beginning and ending work.

Introduction

From birth through adulthood the child with special needs and his/her family can come into contact with numerous professionals including doctors, therapists, nurses and social workers. As the different services become involved in care of the child and support of the family, continuity of care and collaboration between agencies can become difficult. Virginia Bottomley, as Secretary of State, spoke of the challenge of providing a seamless service based entirely around the needs and wishes of users of care and their carers. In this session we consider the social workers’ roles as they begin to work with children and their families at various stages in children’s lives.

Beginning Work

Work with a child with special needs and his/her family of carers begins at the point of a referral. The referral will either be from another agency (often education or health) or from the service users themselves. You have already considered how the image of a service – its name, publicity materials and environment – affects the relationship between service users and professionals that will follow. The process of assessment commences from the beginning of contact.

Assessment

The first thing to note about assessment is that it does not exclusively happen to the users of social services, nor is it peculiar to social work. In Session Five, for example, we looked at the process of assessment in education. At some time we are all subject to a form of assessment, be it a job interview or application to a college course. Within social work, formal assessment is used in different ways to enable the social worker to carry out specific functions, and we shall go on to explore some of these in detail.

Assessment of needs and strengths

In this approach, statements about people’s needs for assistance are balanced by statements about what they can do for themselves. This can help move away from a model of disability in which the focus is on the incapacity of the individual (as described in Session One). Thus, needs are specifically identified but so too are abilities or achievements. As an example, a person’s need could be described as requires help with feeding, although a strength could be can grip a spoon. These statements are seen as more helpful than the deficit approach of describing the person as being unable to feed his/her self. Similarly we might find a client described as needing assistance to develop his speech, but able to make needs known by gestures and signs.

The following activity is designed to show how such an approach can be used to provide the basis of working with a family.
 

Activity 34

This activity should take you about 20 minutes.

From the description of a child with special needs given below, compile two lists of what you consider to be his strengths and needs. A single page should be sufficient for your list.

Tom is nine years old but is functioning more at the level of a three-year old. He lives in a children’s home. He displays a number of behavioural problems and has little speech. If he wants anything he can be very annoying to the staff by dragging them to what he wants. If he want to go out, he gets his coat and stands by the door, and screams if he can’t get his own way. When another child has something that he wants he will take it off them but he can be helpful with children who have additional physical disabilities. Tom is generally very noisy and boisterous but when he gets the attention of staff, he can be very affectionate and kept occupied for a reasonable period. Although he can be spiteful to others, he has an endearing smile.

Comment

In compiling your strengths and needs list, you have probably found it easier when focusing on the positive comments. However, by referring to needs, instead of deficiencies or problem behaviours, you can work towards a more constructive and optimistic description. For example, translating the comment screams if he can’t get his own way into needs to respond to others without screaming adds a more positive dimension, suggests a task that should be carried out (i.e. teaching the appropriate skill), and resists the temptation to blame the child and define Tom just in terms of problems, which is unhelpful. In a similar war, dragging them to what he wants can be seen as a strength in being able to make his needs known.

Overall this approach can be helpful in clarifying problems and suggesting ways of working. This can be particularly useful when dealing with difficult behaviours. When such behaviours are in evidence, it is our experience that they often tend to be reported or recorded by parents or workers in inaccurate or very unhelpful ways. The types of descriptive phrases that are used include those which label behaviours as being manipulative, attention seeking, stubborn, or just simply bad. By using a strengths/needs list, you, as a social worker, can help carers and others working with the child and family to describe what the behaviour is rather than suggesting why it is being used. This can then be the basis of planned intervention in a way that is both positive and client-centred.

Assessments are rarely, if ever, used in isolation. Specific forms of assessment are often used in conjunction with others. For example, an assessment of disturbed behaviour undertaken by a psychologist could link into a functional assessment by an occupational therapist that focuses on specifics such as self-help skills. This helps to build up a wider picture of an individual. Many social services departments use an assessment framework called Individual Programme Planning (IPP). The rationale for this approach is that while many children and young people with special needs are resident in group care settings, or attend day care centres, the goal of work is to meet individual needs and to promote individual strengths.

Individual Programme Planning: the process

The IPP system works in the following way.

Identify individuals
Although some schemes aim to include all groups, a common starting point is to target or prioritise individuals. These might be children with special needs who are likely to encounter major moves or changes, such as the school-leavers we discussed in Session Seven.

Identify staff
Because a number of staff from different agencies are likely to be involved, it is helpful to appoint one person specifically to coordinate this process.

Gather information
If you are the worker coordinating the IPP process, you should gather information about skills such as communication, and activities such as leisure pursuits.

IPP meeting
When the IPP meeting is held other key people should attend as well as the service user and carers. Here particular goals or objectives should be set for a specified period and priorities should be agreed, with the person responsible for each action recorded (for example, ‘Arrange for attendance at a local swimming club and arrange transport – social worker.’).

Monitor and review
You should check on the progress of outcomes and the satisfaction of clients. The key to this process should once again be the user. It should be his/her IPP and not the property of the staff; something as far as possible done with rather than to the user.

How to gather information

As a way of gathering information, assessments can be used to measure ability. In the following activity, we look at some of the methods that might be used to obtain the required information, and some potential problems involved.
 

Activity 35

The outcome of the social worker’s task in carrying out an assessment will depend on how is it is undertaken as well as what is done. In the case of Mary, for example, although the problem of her not always answering questions accurately has been recognised, it would still be reasonable (indeed sound practice) to involve her as far as possible – carrying out an assessment with her rather than on her.

It is also worth mentioning here the specific role that we identified for you as the social worker in the work with Mary. We placed the task within the context of finding a residential placement, a role that very much fits in with purchasing services. Once again, the way in which this process actually works varies in different localities, depending on the way in which social services departments are organised. Of the particular model that we used, you will have seen that although its basis was that of purchasing a service – in Mary’s case a residential home – the social worker’s role also involved providing a service, namely an assessment. In you own area it may be the case that the assessment would be carried out by someone called a care manager or an assessment officer.

The check-list approach to assessing independent living skills

In the previous activity we introduced the idea of a check-list approach for assessment. This is commonly used and is seen as a useful way of identifying specific skills to be assessed and measuring competence. As a social worker you could use such a method in a number of ways. In the last activity, for example, you might have used a check-list to assess Mary’s level of skill in order to clarify the level of support needed and the appropriateness of the service – which in this case was the residential home. This method could also be very helpful in giving an information base to assess the level of potential risk, and with this in mind we feel that you will find the next activity helpful. (In both of these exercises we use situation studies which reflect some of the issues relevant to the transition from child to adult services discussed on Session Five.)
 

Activity 36

This activity should take you about 20 minutes.

In the previous exercise, we focused on the methods of collecting information for assessment. We now turn to the content of the assessment.

You should complete both parts of this task in this activity and the next one.

Read again the situation study of Mary in Activity 35 and then list up seven or eight general heading that would be helpful to assess (for example, basic education).

Comment

The list that you compiled should have included some of the following headings.

person or self
care mobility
basic education
communication
relationships
domestic
leisure
work
independent or community living skills

You may well have used different headings or found that some of them overlap. We would be the first to admit that not all of our own headings are exclusive or equally clear. For example, ‘communication’ is clearer than ‘community living skills’. Some of the headings can cover a wide range of skills while others may be more focused.

You will have considered how general or specific your own headings should be, perhaps differentiating between different types of mobility, one involving basic skills like ‘walking unaided’ and ‘propelling one’s own wheelchair’ and a second covering of the use of transport and road safety.

Whether your headings were broken down into more specific or general headings, either approach is perfectly valid, as is the use of other headings such as social skills. In our experience many different headings are used in the various published assessment lists; so don’t worry if your list looks very different to ours – you’re in good company.

Whatever headings are used it is important to remember that these are merely pointers. The test for how useful they are will be found in what comes under them, which is what we now turn to.

Activity 37

Ending Work

So far in this session we have concentrated on receiving referrals as a social worker and using the assessment process as a way of identifying needs – and therefore assessing the extent of support required. But if you are to meet the demands of new clients the question arises of how work with existing clients should finish to make room for them. It is to this question that we now turn.

A Task-Centred Approach to Social Work

An effective way of concluding work is through a task-centred approach. Here, as a social worker, you would aim to identify specific tasks when engaging in work with a client rather than just build a relationship under the umbrella of offering ongoing support. The agreed tasks could then form the basis of an agreement that clarifies the nature of your involvement. This can be extremely helpful to all parties. After all, if you put a car in a garage to be serviced you would not thank the mechanic if he or she decided to respray the vehicle as well. By using this method, you can effectively end work as you begin it.

To illustrate how this works, the next activity is split into two tasks. First it asks you to focus on identifying the tasks, and then it considers the context of an agreement.

Summary

In this session, you have considered the role of the social worker in beginning and ending work with families containing a child with special needs. First impressions are crucial. We believe that social workers have to be explicit about what they can and cannot do. The principles of partnership require negotiating skills from the outset. While agencies have a traditional tendency to fit children and their families into existing services, you are now required to start with addressing the strengths and needs of each individual potential service user and develop tailor-made packages of services and care.

Appendix 1
Situation studies

Gary
As a baby, Gary suffered from whooping cough. His parents were concerned about his slow progress and demanding behaviour. Now aged five, he is able to walk but his speech is limited to single words – mostly repetition or naming objects. His general health has been very good. Although he is prone to fewer tantrums than before, he can still be difficult to handle. The most disturbing behaviour is head-banging, and he can also be aggressive to others, mainly by biting. His parents describe him as needing constant supervision, and he rarely sleeps for more that five hours each night.

Nita
Aged four, Nita lives with her parents and two older brothers aged eleven and eight. Following a difficult birth, she suffered mild brain damage. Her developmental delay has caused some concern but she has responded well to a high level of stimulation. Her understanding and use of language in Gujarati is slightly below average for her age, but she understands few words in English. Within the family, Nita’s mother is the principle carer (her father works long hours in a family business) and she uses very little English.

Mark
Aged 11, Mark is partially deaf and almost totally blind. He is an only child of a professional couple who describe him as having a placid nature and a great sense of humour. When engaged in most activities he is very attentive and enjoys attention. His favourite activity is swimming. He is described as being very bright, learning new tasks quickly, and has a good memory. With little speech, Marks’ primary form of communication is by the use of signing, but quite a few of these signs are only understood by his parents.

Lisa
Aged 14, with cerebral palsy, Lisa is able to get around indoors in a wheelchair providing the building is fully accessible. She aims to be as independent as possible but does require assistance in some tasks such as getting dressed and bathing. She is very sociable and shares the interests of many of her peers, such as music, dancing and fashion, while academically she is doing very well. Lisa is interested in becoming more involved in sports.

Appendix 2

On-site questionnaire for Activity 25
 

	Yes	No
1. Does the building stand out in any way? If so, how?
2. Does it look like what it is (i.e. a house where people live, a school etc.)?
3. Is it well-positioned (for example, in relation to neighbourhood is it in a run-down well-maintained part of town)?
4. Is it easy to reach?
5. Does the building look well kept?
6. Do the grounds (if any) look well kept?
7. It is close to other care/health/education services (for example, special school next to hospital)?
8. Are there any labels or signs outside that stand out (for example, Home for Handicapped Children)?
9. Are there any vehicles with ambulance or ‘donated by’ signs on them?
10. Does the activity of the service appear in any way to generate nuisance value to the neighbourhood (such as noise, traffic, parking, etc.)?
General Overview 1. What type of image does the service give of its users? positive neutral negative
2. Would you object to living next to or near this service? (or if you do live nearby already, would you rather it was not there?)
3. Does this look like a service that segregates children with special needs from the wider community in any way?
4. From the impressions that you have made, does this appear to be a service that you, as a social worker, would be keen to use?

A useful way to gain the views that other people have of the service can be gained by asking informal questions locally. This can be done by asking three or four people that you might encounter in the neighbourhood, such as shopkeepers, postal workers and others working nearby, or people in the street. Rather than stopping people with a questionnaire, this could be done casually by asking questions such as:

Excuse me, do you live around here? Can you tell me where (name of service) is?

Do you know what sort of home/school it is?

Can you tell me anything about it?

The nature of some of the answers can often give you an indication of the way such services are seen by others, or what sort of reputation they have. If, for example, the service was a residential home in an ordinary house and people around did not seem to know what it was, it might add to the view that it is more successfully integrated than if people reply, Oh, THAT place, you can’t miss it!

Appendix 3
ECOMAP of networks and family links

Further study

Brown, H and Smith, H (eds) 1992, Normalisation – a Reader for the Nineties, Routledge.

Department of Health, 1989, An Introduction to the Children Act , HMSO.

Department of Health, 1991, Care Management and Assessment – Practitioners Guide, HMSO.

Department of Health, 1980, The Black Report – Inequalities in Health Care, HMSO.

Glendenning, C, 1983, Unshared Care – Parents and their Disabled Children, Routledge.

Glendenning, C, 1986, A Single Door: Social Work with Families of Disable Children, Allen and Unwin.

Jenkins, J, Felce, D, Toogood, S, Mansell, J, do Kock, U, 1988, Individual Program Planning, BIMH Publications.

Kellmer-Pringle, M. 1974, The Needs of Children, Hutchinson.

Oliver, M, 1990, The Politics of Disablement, Macmillan.

Seigman, M, Darling, R, 1989, Ordinary Families, Special Children, Guildford Press, New York.

Wilkin, D, Caring for Mentally Handicapped Children, Croom Helm.

Wolfensberger, W, Thomas, S, Passing – Normalisation Criteria and Ratings Manual, (2nd, edition), 1983, Canadian National Institute on Mental Retardation.

Woolfson, R, Children with Special Needs: A Guide for Parents and Carers, 1991, Faber and Faber.

Other Publications which you will find useful as sources of further reading include:

The Children Act 1989, HMSO, London.

The Education Act 1981, HMSO, London.

The Education Act (Special Educational Needs) Regulations 1983, HMSO, London.

The Education Act 1993, HMSO, London.

Warnock, M, 1978, Special Educational Needs: Report of the Committee of Enquiry into the Education of Handicapped Children and Young People, HMSO, London.

Ryan, J, and Thomas, F, 1980, The Politics of Mental Handicap, Penguin.

Swain, J, Finkelstein, V, French, S and Oliver, M, 1993, Disabling Barriers – Enabling Environments, Open University/Sage.

Lyon, C, 1991, The Implications of the Children Act 1989 on Children and Young People with Severe Learning Difficulties, Barnardos.

The Children Act 1989 Guidance and Regulations: Volume 6: Children with Disabilities, 1991, HMSO.