management

Clueing up for inclusion

Legislative change means more children with communication difficulties are now being educated in mainstream schools - but are our services keeping pace? In a small-scale study, speech and language therapy managers were asked how they are meeting the challenge. Myra Kersner and Ann Coxon report.

pecial education was placed within the educational system as a whole with the publication of The Warnock Report (1978) and was no longer viewed as a separate entity (Beveridge, 1993). However, in practice, this often resulted in different forms of segregation; for integration is usually dependent on the childs level of need, focusing on the level of support required to help the child cope with the existing system (Clark et al, 1995). In inclusive education, on the other hand, the majority of resources and focus is on the system and not the individual child (Stubbs,1997, p8). The aim of inclusion is for changes to be made within the educational system to enable all children to achieve curricular goals. Ainscow & Sebba (1996) suggest that inclusive education should be viewed as a process rather than a fixed state. Part of that process includes restructuring teaching approaches, pupil groupings and the use of support. Inclusion differs from integration in three important ways. Firstly, inclusion is considered to be a human right, regardless of the level or type of needs of the child; secondly inclusion is not merely an educational aim, rather it is part of the broader aim of creating an inclusive society; and thirdly all children are viewed as equal individuals with different learning needs (UNESCO, 1994). In the UK, the commitment towards the development of a more inclusive education system has been well documented. For example, between 1995 and 1999 the percentage of pupils with statements placed in mainstream schools increased from fifty four percent to sixty percent, while those placed in special schools fell from forty four to thirty eight percent (DfEE, 1999).

Implications
Ann Coxon Myra Kersner

Read this
if you are changing your style of intervention juggling numbers of places and types of cases considering service developments

There are implications, however, not only for schools but also for support services such as speech and language therapy in this shift of educational philosophy. Changes in provision have been necessary to accommodate the individual needs of children with communication problems now in mainstream schools. A small study was therefore set up to: investigate the ways in which the move towards inclusive education may have impacted on local services find out what changes have occurred within the services as a response to these developments investigate the nature of such changes, how they

are being implemented, and the effect of the changes on the staff and the structure of the service. Interviews were conducted with 10 speech and language therapy managers in the South East of England. The managers had to be in their jobs for at least two years at the level of paediatric service manager or manager of the schools team. The interview tapes were transcribed and analysed using a grounded theory approach (Strauss & Corbin, 1998) so that themes were identified from the data. Major themes meant that five or more managers gave the same response; minor themes that four or less gave the same response. There were considerable differences reported by the managers in the type of service offered and the ways in which they were organised: Seven of the ten ran a mainstream school-based service where therapists worked within a number of schools. They provided a service to all children with communication difficulties within these schools, irrespective of whether they had a Statement of Special Educational Needs. Two of the ten ran a local health centre-based service. After seeing the children initially at the clinic the same therapist then saw the children in school. They provided a service to children with communication difficulties in mainstream schools only who had a Statement of Special Educational Needs. One of the managers ran a child-based service where each therapist in the mainstream schools team was assigned to work with specific children. These children were on or above Stage Three of the Code of Practice (1994) and the therapist continued to work with them even if they changed schools. All ten interviewees reported that legislation had influenced their services (figure 1). Historically, there have been many instances of legislation impacting on services in England and Wales. The Code of Practice (1994; 2000) attempts to clarify speech and language therapists involvement in special needs provision although this does not preclude disputes and the use of litigation (Law et al, 2001). Speech and language therapy funding has also been affected by legislation. There is still confusion about who provides and funds the service and this has led to some difficulties in funding the provision for children in mainstream schools (Law et al, 2000).

Diversity and complexity

The biggest change reported by 80 per cent of the managers was an increase in the caseload of thera-

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pists working within mainstream schools. Another major theme was an increase in the diversity and complexity of the needs of children with SEN including communication difficulties in mainstream: the therapists are being asked to see children with a huge range of complex needs now within mainstream, and you suspect that five to ten years ago they would have been in a special school or unit. This goes some way to proving the effectiveness of the legislation regarding the inclusion of children with special educational needs into mainstream education. However, a minor theme was the reported insufficiency of funding to support the numbers of children on therapists caseloads and, when considering whether those needs are being met, this has to be seen against the backdrop of long waiting lists and poor funding and resources, and raises serious questions concerning prioritisation. Although the government speech and language therapy working group has suggested that future arrangements should encompass all children with communication difficulties, not just those with statements of SEN (DfEE, 2000), and the Royal College of Speech & Language Therapists agrees that access to therapy should not be seen as a priority for statemented pupils only (RCSLT, 1997, p3), evidence from this study illustrates that currently this is not always possible. The increase in multi-agency working, from the policy level of the local education authorities, to headteachers, classroom teachers, Special Educational Needs Coordinators (SENCOs) and learning support assistants, also emerged as a major theme. Indeed, the majority of those interviewed described collaboration with schools staff as one of the major factors which made their service successful (figure 2). Managers reported that increasing inclusion had led to changes in styles of working and models of service delivery, as more collaboration with other professionals was required when working within an educational context. They reported that schools were now aware of what speech and language therapy involved and this meant that they could work more effectively. The change in style of intervention by the therapists emerged as a major theme. Eight of the managers reported that their therapists spend a considerable amount of time training the education staff to carry out therapy in their absence. Although the majority of the interviewees saw this as an aspect of positive collaboration, four managers reported that teachers and parents found this style of intervention difficult to accept: I think that has been the hardest thing to get over [to schools] is that our input is not always direct, when we provide programmes and advice it is still speech and language therapy. I think another task that is very difficult is trying to get parents to understand that indirect work can be just as appropriate as direct intervention. A lot of parents still phone and ask us why their child is not receiving one to one therapy.

Important aspect
When there are limited resources and there is no therapist permanently on-site, training other pro-

working practices might be fessionals becomes an imporhelpful particularly for tant aspect of the therapists newly qualified therapists. work (Patterson, 2001). Indeed However, 70 per cent of the government speech and those interviewed reported language therapy working that training for SENCOs group concluded that, in and learning support assisfuture, arrangements will need tants was a major part of to be based on providing a their collaborative working range of therapy provision, not practices. This training was just direct intervention from about the role of speech the therapist (DfEE, 2000). and language therapists, However, the fact that many CHANGES REPORTED BY MANAGERS their services and how they teachers and parents are dissatKEY: can be utilised within the isfied with this form of inter1. Increase in caseload school. Training was also vention and do not understand 2. Increase in complexity of needs given on running groups 3. Multi-agency working the therapists ways of working 4. Working in the classroom and and carrying out therapy is a concern. It emphasises the not in a clinic setting programmes, and some was necessity for better communi5. Not enough funding for number organised specifically for cation, and for therapists to of cases SENCOs to help them recog6. Increase in threat of litigation explain the relative merits of nise mild language problems. different forms of intervention Six of the managers also to the education staff and to Figure 2 Factors reported by managers as reported that additional parents. It also underlines the those that make their services successful training was available for importance of evaluative studspeech and language theraies demonstrating that indirect pists. They said that their intervention is an effective staff had attended formal form of therapy (Wood, 1998). training sessions on collaboMuch of the collaboration in rating with education staff. the classroom was described as In addition, four managers being between the learning mentioned that informal support assistant and the thertraining from more experiapist, rather than between the enced therapists within the teacher and therapist which team was also an integral has been the focus of most of part of working within the recent research into collabSUCCESSFUL FACTORS REPORTED BY MANAGERS mainstream schools. oration (Stevens & Roulstone, KEY: 1991; Kersner, 1996; Miller, 1996; 1. Collaboration with school staff Wright & Kersner, 1999). It would 2. Collaboration with the local In agreement with Miller et seem that working with non education authority al (1995), fifty per cent of 3. Training of learning support teaching staff is just as essential assistants and SENCOs the managers felt that an aspect of work in a main4. Working in schools and not in working in mainstream stream setting as collaborating clinic settings schools should be seen as a with teachers. This is an area 5. Speech and language therapy specialism in its own right: I which warrants further investistaff training on working in mainstream schools feel quite strongly that it is gation and must be an important 6. Teamwork within the speech just as specialist a skill to consideration for all speech and and language therapy teams have knowledge about the language therapy services, parnational curriculum, working ticularly in terms of training. with teachers, and individual education plans and Despite the fact that the majority of managers planning, as it is to have knowledge about autism. described collaboration as one of the major facManagers commented that specific skills such as negotors that made their service successful, only three tiation needed to be valued as much as clinical skills. of those interviewed had written policies on colLarge caseloads, understaffing and lack of laborative working practices. A similar lack was resources have all contributed to the increasing found in Wrights (1996) study when none of the level of pressure on therapists working within teacher/speech and language therapist dyads mainstream schools teams. However, where maininterviewed had a written policy within their serstream therapists work from the same administravice about collaborative working practices. tive base, the managers reported that they are This is a pertinent issue. Collaboration does not just able to support each other and so reduce stress happen because teachers and therapists spend time levels and develop more effective teamwork. together in the classroom (Wright, 1996). Indeed, Six of the managers suggested that therapists several of the managers reported that their staff regwith specialist expertise who had worked in the ularly attended training courses on collaboration special schools which were now closing down and how to work effectively in mainstream might be re-deployed in central resources. schools, as well as running courses for the educaOutreach teams could then offer assistance with tional staff. Written policies about collaborative
NUMBER OF MANAGERS NUMBER OF MANAGERS

Figure 1 The main changes that have taken place in speech and language therapy services as a result of recent legislation

Valued

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Five steps to better practice

assessment and therapy; or the specialist therapists could act as a resource, their expertise being called on by mainstream therapists. This idea is seen as effective practice in inclusion by the DfEE (1999). Two managers however expressed concern about therapists with specialist knowledge being seen as experts as this could undermine the position of the mainstream speech and language therapists and adversely affect collaboration with teachers. The increasing numbers of children requiring therapy highlights the serious issue of understaffing as the managers described their mainstream therapy teams coping with long waiting lists. Whilst this in part is due to the lack of funding for additional recruitment, the lack of the appropriate skills for working in mainstream education among newly qualified staff was also cited as a related issue to be addressed. In addition, it was not possible for all therapists from the special schools which were closing to become members of the mainstream team automatically. Some of the managers in the study suggested that, as different skills were required, some therapists needed to undertake additional training before they could be re-deployed in this way. Another theme which emerged from the interviews involved speech and language therapy student education and training. Half of the managers felt that students did not have the skills or knowledge to work in mainstream schools, and that this was an issue which needs to be addressed. Although issues regarding litigation are often raised as an area of concern (Law et al, 2001) it is interesting that in this study they were only referred to by one manager. guage needs in England and dren in special and main1. consider operating a Wales - A project summary. stream settings. multi-site service from DfEE: London. We hope that there may Law, J., Lindsay, G., Peacey, N., be a commitment for a central resource Gascoigne, M., Soloff, N., increased funding to sup2. work with colleagues in Radford, J., & Band, S. (2001) port recruitment as well as other professions to Facilitating communication reorganisation of therapists working in an incluproduce a written policy between education and heath services: the provision for chilsive educational system so on collaboration dren with speech and language that services may continue 3. provide other needs. British Journal of Special to develop. From this professionals and Education 28 (3), 133-137. study there would seem to Miller, C., Morrison, K., be a need to investigate parents / carers with Pentland, B. & Stansfield, J. parental opinion about evidence-based (1995) Specialists and direct and indirect service information on styles Generalists. College of Speech delivery and to ensure that of working and Language Therapists parents can make informed Bulletin 513, 6-7. judgements about what 4. apply for funding to Miller, C. (1996) Relationships provision is offered. develop work with and As the findings of this training of support staff between teachers and speech and language therapists: influstudy highlight the encing practice by distance eduincreasing training role of 5. give students the cation. Child Language therapists when working opportunity to Teaching and Therapy 12, 29-38. with learning support experience work in Patterson, A. (2001) Training assistants it is important different environments. and Educating Colleagues, in for therapists to be supKersner, M. & Wright, J.A., ported in this work, possibly Speech and Language Therapy: the decision makthrough the use of funding from the DfES ing process when working with children. London: Standards Funds for speech and language. There David Fulton Publishers. is also a need for further investigations into the RCSLT (1997) The role of the speech and language ways in which support services are delivered and therapist in the multi-professional assessment of the ways in which all staff in the educational setting children with special educational needs. London: may work together effectively with speech and Royal College of Speech and Language Therapists. language therapists for the benefit of the chilStevens, L. & Roulstone, S. (1991) Speech theradren with communication problems. pists and teachers working together: a model for Myra Kersner is senior lecturer in the Department of the 1990s. Journal of Educational and Child Human Communication Science, University College Psychology 8, 84-92. London, and Ann Coxon is a speech and language Strauss, A. and Corbin, J. (1998) (2nd ed) Basics of therapist for Bracknell Forest Primary Care Trust. Qualitative Research: techniques and procedures for developing grounded theory. London: Sage Ainscow, M. & Sebba, J. (eds) (1996) Publications. Developments in Inclusive Education. Cambridge Stubbs, S. (1997) Towards Inclusive Education: The Journal of Education 26 (1). Global Experience of Save The Children (UK). Beveridge, S. (1993) Special Educational Needs in Camberwell: Save The Children Fund UK. Schools. London: Routledge. UNESCO (1994) The Salamanca Statement and the Clark, C., Dyson, A. & Millward, A. (1995) Towards Framework for Action on Special Needs Inclusive Schools: Mapping the fields in Clark, C., Education. Paris: UNESCO. Dyson, A. & Millward, A. (eds) Towards Inclusive Warnock, H.M. (1978) Special Educational Needs: Schools? London: David Fulton. Report of the Committee of Enquiry into the Department of Education (1994) Code of Practice Education of Handicapped Children and Young on the Identification and Assessment of Special People. London: HMSO. Educational Needs. London: HMSO. Wood, J. (1998) Styles of interaction used by learning Department for Employment and Education support assistants: The effectiveness of training. (1999) Special Educational Needs in England: International Journal of Language and January 1999. London: HMSO. Communication Disorders 33 (supplement) 614- 619. Department for Employment and Education Wright, J.A. (1996) Teachers and therapists: the (2000) Draft Revised Code of Practice for Special evolution of a partnership. Child Language Educational Needs. London: The Stationery Office. Teaching and Therapy 12, 3-16. Kersner, M. (1996) Working together for children Wright, J.A. & Kersner, M. (1999) Teachers and with severe learning disabilities. Child Language speech and language therapists working with chilTeaching and Therapy 12, 17-28. dren with physical disabilities: Implications for Law, J., Lindsay, G., Peacey, N. and Gascoigne, M. inclusive education. British Journal of Special (2000) Provision for children with speech and lanEducation 26 (4) 201- 205.

More effective
There was a diversity of responses when the managers were asked to describe changes which might make their services more effective. More funding and more therapists arose as a theme. Managers acknowledged that there had been some confusion over the source of funding (Law et al, 2000) but felt that generally there were not enough funds available. Three managers talked specifically about not being able to set up a mainstream service to secondary schools because of lack of funds. Another referred to difficulties at pre-school level: If I was going to make one major change, that would be to have more resources to put in services early enough so that we might even be able to prevent statementing. We recognise that the small sample of interviewees was taken from a limited geographical area so that any generalisations from the data may only be tentative. Nevertheless, it is interesting to note that several of the issues raised by the interviewees were reflected in a larger study which has recently been undertaken (Law et al, 2000) which was summarised in an article by Law et al (2001) as well as in the conclusions of the governmental working group (DfEE, 2000) which was set up to address the problems posed by the provision of services to chil-

References

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