Categories
Covid-19 NNPCF work

Covid 19 – the medium and long term impact, risks and opportunities for children and young people with SEND

Introduction

The immediate impact of Covid 19 and the response to the virus have been well documented – missing school, difficulty in accessing medical services, and the impact of lockdowns have all had a detrimental impact upon many children and young people ranging from academic, social, emotional, and physical implications. It is well understood howmany of these impacts on children and young people with SEND have been exacerbated by the additional challenges they and their families face. These are very real and have been recorded by Parent Carer Forums during the pandemic. NNPCF steering group members have been working closely with the government and NHS to escalate and address these concerns[1]

However, many of the medium and long term impacts of Covid 19 and the response to the virus have not yet been felt or understood. Reflecting on feedback from our 151 member forums, the NNPCF steering group has started to review the medium and longer term risks and opportunities the last year has presented for children and young people with SEND and their families. Looking beyond what is already well documented, we have attempted to focus on what is different about the experience of CYP with SEND. We have compiled a list of what can be done in the wake of the pandemic to mitigate these, as yet, unseen risks and take advantage of some of the longer term opportunities.

[1] See the NNPCF website, news section for our frequent updates on our work during the Covid 19 pandemic. www.nnpcf.org.uk

Key findings

  • Catch up

Whilst the government has made significant additional funds available for catch up and to compensate for lost time, it will be very difficult to implement effectively for CYP with SEND. Many of the resources and skills SEND services rely upon (e.g. CAMHS, SALT, OT, Ed Pyschs) were already scarce before the pandemic with long delays and waiting lists. As we recover, these pressures are likely to grow. Therefore, creative solutions coproduced with families and PCFs are required to meet the additional demand for these resources that catch up will need. Families have expressed concerns that for many the quality of annual reviews were already poor prior to the pandemic and many fear that in the absence of recent assessments or contact they will suffer further.

  • New harms

As well as lost time, we are also aware that many CYP with SEND may have suffered new harms – these may result in new conditions or needs being evident. There needs to be an increased focus on early intervention to address these concerns before they escalate. In addition, we are mindful that issues may not manifest themselves in obvious ways – for example, with trauma or increased anxiety presenting as behaviours that challenge. Schools and services must be alive to these often-hidden harms and respond accordingly.

  • Remote learning

Whilst the majority of CYP with SEND found remote learning very challenging, a minority prospered. For some, the absence of the stresses of a school environment meant they were able to learn more effectively. We would like to explore how a more blended approach might benefit these children and young people as a reasonable adjustment. However, a note of caution – this should not be confused with part time timetables, home education or off-rolling. Pupils should be able to access the full curriculum but in a reasonably adjusted way that works for them. We are aware this will pose challenges for schools but would like to build on some of the excellent innovative practice in some areas to explore how it could be built upon.

The quality of remote learning will continue to be important if children need to isolate following positive covid tests or if further lockdowns are necessary as a result of further waves of infection.

  • Elective Home Education

There has been an increase in the numbers of families choosing to home educate their children. We support the right of any family to make this choice, however, need to ensure that parent carers are making fully informed decisions about the implications of this and that we do not see the same children (many of whom may have SEND) seeking re-entry into school in a few months. We are concerned that some families do not understand that the remote support and online curriculums from schools will not be available if the chose to home educate.

  • Use of remote technology

The acceleration of remote technology has been welcomed by families in many respects. The avoidance of waiting times, travel times, and the ability to participate in sessions that were previously not accessible has meant families are keen to continue remote appointments in some cases. This may not always be possible or appropriate and must be agreed in coproduction with families. We are also aware of the barriers families can face when accessing remote appointments and meetings. It is essential that all decisions to continue or move towards remote access are made with the families and explore all the potential risks and challenges that may present barriers to access and inclusion, with reasonable adjustments being available where required. There is ongoing work within some regions exploring the benefits and challenges of digitalisation of appointments that would be helpful to explore further.

  • Transitions

We have seen increased concerns from Parent Carer Forums about the risks of transitions. Because of lost time, many CYP with SEND are ill prepared for important changes (e.g., changing setting, leaving education, turning 25, and ceasing an EHCP). Children and young people who are not ready for a change are more likely to fail and this may not happen immediately but in months or years’ time. A range of coproduced measures (from extra time and effort from both settings to repeating years) should be available to families to support them.

  • Mental health

The potential toll the response to Covid 19 has had on children’s mental health has been well publicised including the compound impact on those with SEND. We welcome the focus on children, young people, SEND, learning disability, and autism in the government’s mental health recovery plan. The need for a joined-up system wide approach is understood by all. Parent Carer Forums value being part of conversations exploring local approaches that take into consideration the nuanced needs of the SEND community in respect of mental wellbeing and mental health.

  • Vaccinations of carers

The vaccination of carers has led to some identification of opportunities to improve record keeping and services to families with SEND. In particular, records of those performing the role of the carer have improved as well as records of those with a learning disability or autism. This presents the opportunity to better support these families, particularly through a primary care setting through things such as learning disability health checks. We are pleased to see the positive conversations this has stimulated but are hearing from Parent Carer Forums there is still a long way to go in establishing fully fit for purpose records and registers locally. We also see the advantages these discussions present in the improvement of local data systems, and specifically Joint Strategic Needs Analysis records.

  • Employment opportunities

Many employment opportunities traditionally available to young people with SEND in sectors such as retail and hospitality have been impacted by the pandemic. In addition, many young people have not been able to complete training or courses aimed at supporting them into employment. Conversely, other sectors such as logistics and care have seen some growth. We welcome the recent announcements on supported internships and ask that any government employment recovery plans should include specific support and strategies for young people with SEND.

  1. Individual and Strategic coproduction

We have referred to the importance of individual coproduction with families several times in this document. Where communication with families was open, transparent, and families were involved in decisions about changes to services for their child/young person, satisfaction was higher and the impact on children, young people, and their families was mitigated. Through the pandemic, government and NHS guidance consistently stressed the importance of coproduction time and time again but sadly it did not always happen at a time when it was more important than ever. It is essential the culture of coproduction is emphasised by all at every opportunity.

The pandemic has also seen more areas recognise the contribution and importance of Parent Carer Forums. As the Ofsted / CQC local area SEND interim visits in Autumn 2020 highlighted, those areas that coproduced effectively, responded to the pandemic most effectively. It is essential we learn the lessons and reflect the importance of strategic coproduction in the output from the SEND review, NHS Long Term Plan, and new local area joint inspection plans.


Appendix – detailed analysis

TopicOpportunitiesRisks
The impact of missed support  

The impact that missed school, therapies and appointments has had on our children.
There is great awareness of the impact of lost time on all children, including those with SEND. The very balanced focus of the government’s catch up planning had reflected the need to identify the holistic impact of lost time on children. We are pleased that the additional monies made available explicitly focus on enrichment and well being “catch up” as well as academic focus.The delivery of this catch up is going to be difficult in many respects for children and young people with SEND. In particular, disciplines such as CAHMS, SALT, OT and EP services were very stretched prior to covid and it is unlikely that there are enough resources to be able to “catch up”. As such, new and innovative models of delivery will need to be developed might include more group sessions, training and support for parents teachers and TAs, use of online resources and better use of community resources such as the voluntary sector. Clearly, this is only appropriate for some services – for example, missed operations cannot be delivered in alternative ways.

Local authorities, schools, CCGS and providers should actively partner with parents and parent carer forums to understand individual and local needs and develop innovative services to support catch up. Effective coproduction is critical to the recovery.  
New harms  

As well as “lost time”, it is clear that new harm has been done to many children including those with SEND. This may include new conditions developing but also be expressed through increased anxiety and more challenging behaviour.
 It may be some time before the “new harms” resulting from Covid 19 become apparent.   Evidence shows that referrals in some areas are already increasing but anecdotal evidence suggests that we may see a surge following the September return to school.  

It is important the system is prepared for new harms that may emerge. This might include: An increased focus on early help to identify and respond to concerns quickly to prevent them escalatingA recognition that the “new harms” may manifest themselves as anxiety, mental health or behavioural concerns. It is critical that a joined up approach is taken and any issues are not exacerbated by addressing the symptom (e.g. behaviour) rather than the root cause.A redoubling of efforts to coproduce solutions with families and parent carer forums.
Remote learning  

Remote learning was very challenging for the majority of CYP with SEND. A minority, have however, prospered. What can we learn from this?
For a small cohort of CYP with SEND, remote learning has worked very well. The absence of some of anxieties of a social environment and a changing physical setting has been beneficial to some CYP with ASD, SEMH and sensory needs.

Many families have reported that their CYP have done their best work whilst at home. In some cases, the change of environment has challenged the received wisdom about what a CYP can achieve – perceived limitations have been removed and new opportunities have become available.

Many families report that they are more engaged in their child’s learning and are more aware of the support they need to learn.

In addition many families have reported that their CYP has been happier, less anxious and exhibited fewer behavioural issues whilst learning from home.

The increased availability and quality of remote learning resources (e.g. BBC bitesize and Oak academy) has increased the opportunity for remote learning.

We would like to work with the DfE to explore how a more blended learning approach could be effectively used to support some CYP. For particular cohort, a blended learning offer might form a very effective reasonable adjustment.  

Potential collateral benefits would include reduced school exclusions, improved academic performance and better preparation for a word of work which may increasingly become based on remote or blended working.    
Our membership reports that remote learning was beneficial to a minority of children with SEND. The majority did not prosper and benefit most from being in school.   Moreover, PCFs have reported that there has been a huge variation in the quality of remote learning. Some schools have provided things such as specialist materials, support from specialist teachers, pre learning,1:1 time when appropriate and differentiated work. Many, however, did not, further disadvantaging  CYP with SEND.  

There are significant risks for remote learning from the point of view of the CYP and family:
Blended learning should not be confused with home schooling and part time timetables. CYP should be offered a full curriculum, some of it delivered to them whilst at home.
Strain on families – supporting blended learning may present an additional and unsustainable burden on parent carers. Some schools did implement innovative and effective ways of supporting SEND learners at home such as use of TAs, pre-learning support for parent carers, use of break out rooms. This support should form a part of any blended learning package.
Any blended learning approach must be developed in coproduction with families and CYP.
The risks of increased isolation, social exclusion and even bullying may need to be considered. There may be safeguarding concerns around some families.

We also appreciate that it may be difficult from a school resourcing point of view to support a physical and virtual learning offer at the same time  

We would like to work with the DfE to put in place some guidance on what constitutes a minimum standard for CYP with SEND in any blended learning offer. This would include safeguards to ensure it was used only when it was the best solution for the CYP and was developed in coproduction with them and their family.    
Individual Coproduction  

Coproduction with parents was very varied in many instances with some schools and settings doing it well whilst others hardly communicated at all with families.
Risk assessments, where they have been done well have been welcomed by families. Families have felt heard in these processes and many have improved trust between families and schools. These conversations have enabled schools to break down barriers with families that may have existed for some time and allowed a better understanding of what life is really like for families.  

Moreover, schools have started to recognise parents as the experts in their children. Schools have seen new value of having good quality relationships with families.  

Some characteristics of good risk assessments include:
-A clear explanation what the process is and what it entails
-Focussed on the needs of the child, not the schoolOpen honest conversation
-An equal and reciprocal relationship with families  

The experience of a good risk assessment is offers a template for improving individual coproduction with families. The SEND review offers an opportunity to enshrine some of these best practices into a new, clearer definition and practice of good coproduction.    
Many families felt great frustration as many services they were entitled to or relied upon were withdrawn during parts of the covid 19 response. Often these changes were made unilaterally with little or no discussion or understanding of the impact that this would have on families. It felt as if coproduction was optional at times.  

In many cases, education risk assessments were not done well. Too often, we heard that schools did not explain to families what they were doing and put their own risks first above that of the child. Risk assessments were often seen through a safeguarding lens -with vulnerable children not being offered places at school unless it was deemed that they were not safe at home.  

In these instances trust between families and services (including schools) has been eroded  

There may be some work to be done in repairing the damage to trust and relationships between families and services. The NNPCF have asked for an increased focus on developing the culture and practice of coproduction across the SEND system through the SEND review, this may be more important than ever.
Strategic coproduction  

Likewise, there was a huge variation in the extent and quality of strategic coproduction with parent carer forums during the pandemic. Those that did it well, responded more effectively to the needs of families.
The crisis has brought home the value and impact of parent carer forums. More people are aware of PCFs and the importance of coproduction. PCFs report that they have been involved in more meaningful strategic coproduction than ever before, gathering information, interpreting the impact of changes on families, coproducing solutions and providing feedback.  

Remote working has enabled improved coproduction – it is often more parent friendly and means PCFs can do more.  

It is essential that we consolidate the gains made in strategic coproduction through the covid 19 crisis and translate them into wider areas of working. Again, the SEND review, the NHS long term plan and the new ofsted / CQC local area inspection framework  offer an opportunities to embed improved coproduction through better definition, guidance, sharing of best practice and training.    
The volume and level of work required from PCFs have increased dramatically. Many are reporting issues with burnout and concerns about sustainability.  

Coproduction has not been universally good.  Where it has been poor historically, relationships have often further deteriorated. When managing a crisis, many local areas, commissioners and service providers have simply forgotten to coproduce.  

A continued focus on the importance of coproduction is required through the SEND review, the NHS LTP and the new local area inspection framework.  
Use of technology to support CYP with SEND   Remote therapy / medical appointments/ remote working  

Remote delivery of services accelerated massively over the last year. In many cases this has been well received by families but does have some pitfalls and limitations.  
The increased use of technology has been welcomed by most families.

Benefits include:
-Saving time travelling and waiting for physical appointments that can be conducted remotely.
-Parents have been more engaged in allied therapy sessions – they can see and participate in remote sessions when physical sessions were often run 1:1
-It has been easier to get more people to engage in activities (e.g. annual reviews) because they do not have to travel.  

Guidelines around how and when remote technology can be used should be developed – these should aim to preserve the benefits whilst guarding against some of the risks and disadvantages.  
Not all interactions can be effectively conducted remotely. Some appointments do need to be face to face – e.g. physical tests and observations, some medication reviews, for families where there may be safeguarding concerns.  

Forums have also reported that the past year has highlighted the digital divide with access to technology being a barrier to services. In addition, gaps in the ability of CYP and families to use technology (e.g. not being able to type / being physically disabled) has further disadvantaged some of the most vulnerable. .    
Mental health  

There has been an increased focus and awareness of mental health issues. The implications for those with SEND have not yet been fully understood or felt.
The crisis has definitely raised awareness of More openness / conversations / awareness of mental health.      The mental health impact of covid 19 on all CYP has been well documented. trauma, isolation, loss and increase in anxiety.

In particular, those with SEND have experienced a wide range of potential mental health impacts such as heightened fear of C19 amongst some children, wearing (or not wearing) masks, testing and vaccines increases in isolation, OCD and eating disorders. In many cases covid conditions have accentuated existing issues.    

The crisis has also highlighted how fragile mental health services are for many of our children. Many areas were already seeing long waiting times for services  – these have been increased and interruptions in services may mean additional impacts  

In addition we have hear of increased instances of challenging behaviour  – often against parents and sadly of harm to other family members. In addition, we cannot forget the mental health of parent carers and other family members..  

We welcome the mental health recovery plan published by the government – in particular the focus on children, schools and those with SEND. We must ensure that a joined up approach is taken and the right support and reasonable adjustments are put in place for those with mental health concerns.    
Transitions  

Transitions are challenging at the best of times. During the pandemic, many CYP have not been able to prepare for important changes and as such are at increased risk of failing. This is particularly true of CYP with SEND.
Because of the disruption, there has been an increased focus on key transitions. People have recognised the need for earlier transition planning and are more aware of the need to support successful transitions.  

Government catch up funding can be used to support transitions. For example, the guidance on summer schools that proposes a focus on year 6 to 7 transitions is very welcome.    
We have been contacted by many parents who have been very worried about children and young people who are coming up to important transitions. Because of the disruption of the last year, many CYP have not been able to undertake or complete the programme of work that was planned in order to prepare them for an important transition. This could be a transition between key stages, schools or educational settings, leaving education or even coming up to the age of 26 when an EHCP will cease.  

We are concerned that if CYP are not properly prepared for a change (especially those with SEND) they are at increased risk of not transitioning successfully  -this may manifest itself in many forms such as academic failure, anxiety and mental health concerns or an inability to make the steps to independence that are required (e.g. getting public transport to college).  

We have asked the DfE to ensure that the right measures are put in place for these young people. These measures should be discussed and coproduced with the CYP and their parent carers and may include things such as:
Use of DfE catch up funding to provide additional educational or wrap around support
Closer working between the sending setting and the receiving setting (e.g. a very closely co-ordinated and graduated transition)
Delayed starts to allow CYP to develop the necessary skills and knowledge
Repeating years  


Opportunities for CYP in employment have been impacted – limited. Opportunities in retail and hospitality have fallen away  
Covid 19 Vaccinations

The roll out of covid 19 vaccinations offers opportunities to improve record keeping and delivery to services for those who are carers or have additional needs.    
The drive for covid 19 vaccinations may offer some opportunities for the support of families with CYP with SEND. I particular, the vaccination of carers may raise awareness with GP surgeries and provide an opportunity to improve record keeping (e.g. identifying carers, updating the learning disability register) and support (being able to provide support to carers, following up on annual LDA health checks)  

We would like to see the NHSE use opportunity that covid offers to further promote the needs for LDA registers, carers registers and annual LDA health checks.    
The vaccine roll out has again highlighted the “post code lottery” in parts of the NHS. Our membership have reported very different experiences in different parts of the country and with different GP surgeries (and even different GP receptionists!)  

The definition of “carer” has also been inconsistent with some areas taking a common sense approach and others only considering those in receipt of carers allowance.
Elective Home Education  

There has been a spike in those choosing to electively home educate and this represents an opportunity as well as a risk for families with SEND.
We have seen an increase in the number of families choosing to electively home educate their children. The experiences of home learning over lockdown and the increased availability of remote learning resources (e.g. BBC Bitesize, Oak Academy) have meant that more parents are confident to take this step for their children  

We would like to see local councils and the DfE support these parents and help them to give their children a high quality education.
We must ensure that families who are choosing to electively home educate their children fully understand the implications of their decision, for example:
-It is not an opt in / out system – that once they give up their school place it will no longer be available for them – they cannot easily change their mind
-Schools will not be providing them with remote support  
Employment opportunities  

Jobs in some sectors that have historically been employment opportunities for those with SEND (e.g. hospitality, retail) have been severely impacted by the pandemic.
Whilst some areas that have traditionally offered employment opportunities for CYP with SEND have been hard hit by the pandemic others (such as logistics and care) have boomed.

Also the opportunities offered by fewer migrant workers following Brexit may offer opportunities for employment opportunities for young people with SEND in areas such as agriculture.  
The impact of the pandemic has impacted job prospects for many young people with SEND in key sectors such as retail and hospitality.   Many young people have been unable to finish courses and training as a result of the pandemic (see transitions point above)    

Any government employment recovery efforts and plans should include specific mention of employment support and opportunities for young people with SEND

Leave a Reply