Commons Select Committee: Children's and adolescent mental health and CAMHS

This week, the House of Commons Select Committee on Health published details of their inquiry into children's and adolescent mental health and CAMHS. The details can be found here.

The Committee says:

In the light of concerns that have been expressed by the Chief Medical Officer and others about both the extent to which children and adolescents are affected by mental health problems and difficulties with gaining access to appropriate treatment, the Health Committee has decided to undertake an inquiry into children’s and adolescent mental health and Children and Adolescent Mental Health Services (CAMHS).

We would like to prepare a report to submit to the Committee. We know many children and young people with SEN/disabilities who have had contact with CAMHS services around the country. or, who have tried to gain access to these services. We would like our report to reflect these experiences: the good and the bad.

The Committee's terms of reference are broad and include:

• The current state of CAMHS, including service provision across all four tiers; access and availability; funding and commissioning; and quality. 
• Trends in children’s and adolescent mental health, including the impact of bullying and of digital culture
• Data and information on children’s and adolescent mental health and CAMHS
• Preventative action and public mental health, including multiagency working
• Concerns relating to specific areas of CAMHS provision, including perinatal and infant mental health; urgent and out-of-hours care; the use of S136 detention for under 18s; suicide prevention strategies; and the transition to adult mental health services

Can you help?

We would very much like to hear stories and experiences regarding access to CAMHS services and the quality of provision. Gaining access to people who know what they are doing and have the expertise to work with children with SEN and disabilities seems essential to us.

Below are some of the areas we would like to hear about:

(i) what was the nature of your experience e.g. why your child see CAMHS, how easy it was to access the service, how long did you access it for, who did your child see?

(ii) what was the quality of your experience e.g. what were the problems you identified during the process, and what were the good things?

(iii) based on your experiences, do you think there are any 'lessons' which should be learnt?

We promise to keep your details confidential and your stories will be reported anonymously (with no identifying details) and we will send you a copy of the draft report and recommendations for you to share your views on before we submit it. We don't claim to speak for parents, children or young people. We aim to provide an avenue for sharing experiences and campaigning. Our recommendations are based on the evidence we gather but they are worthless unless you feel they would help!

If you think you may be able to help, please contact us at educationalrightsalliance@live.com.

The deadline for submissions to the Committee is 19th March so we would ideally like all evidence with us by 12th March.

Thanks to all who contribute!

Ambitious about autism? It's time law-breaking was #ruledout

The Educational Rights Alliance welcomes the launch this week of Ambitious about Autism’s #ruledout campaign. Their report shines a much needed spotlight on the unacceptable problem of ‘informal’ and formal exclusions for children with autism. This term is taken to include the failure to educate children who are so-called ‘school refusers’.

The facts in the report are alarming:

• 4 in 10 children with autism have been excluded informally and therefore illegally during their time at school.
• 20% of children with autism have been formally excluded in the past 12 months.
• Over half of parents of children with autism say they have kept their child out of school for fear that the school is unable to provide appropriate support.  

It is hugely commendable that Ambitious About Autism has chosen to tackle this problem and that it has given a voice to some of the parents and children/young people affected.

The failure to educate pupils appropriately and in accordance with the law causes substantial damage to children and their families – emotionally and financially. The problem extends beyond autism to children with other disabilities and it is not new (indeed it has been highlighted before) so why has nothing been done to stop this law-breaking?

Tough on exclusion, tough on the causes of exclusion

In 2011, the Local Government Ombudsman issued very clear guidance on Local Authorities’ duties to educate children who are ‘out of school’ in its report ‘Out of school, out of mind’.

Last November, Ofsted issued a report confirming that too many children (it suggested 10,000), often the most vulnerable, are either missing out on full-time education or not getting the part-time education they are entitled to.

In addition to the obligations of the Education Act 1996 and the Equality Act 2010, the Government has also issued statutory guidance (guidance which must, legally, be followed unless there is a good reason to depart from it) on: exclusion, educating children who are out of school because of health needs, and alternative provision.

Yet despite the law, the guidance and the reports from oversight bodies, this problem still remains.

We believe any campaign must start by looking at the reasons for the problem. The common threads which run through all these reports are that local authorities and schools do not have the necessary expertise to educate children with disabilities (including autism), and they break the law.  

Ambitious About Autism’s recommendations are as follows:

• Every family of a child with autism knows their rights, and has the resources to help their child get the support they are entitled to at school
• Every school has access to an autism specialist teacher, to build capacity among schools staff and to support children with autism to learn and achieve
• Every local authority sets out in its local offer the support available in its area to ensure children with autism have access to quality full-time education.

We applaud the campaign but we think its demands should go much further. If the campaign is to focus solely on children with autism rather than work more inclusively across disability groups, we would like Ambitious About Autism to explore why children with autism are excluded. Why do schools not have enough expertise? What prevents them from accessing the support they need? Why do they not have enough expertise to manage challenging behaviour? Is that due to the types of approach used? Are approaches evidence-based? We also believe that parents and children and young people should be at the heart of the campaign.

Increasing Autism Expertise in Schools

The campaign is focused exclusively on children with autism so it requests access to 'specialist' autism teachers.

However, the Autism Education Trust (Outcomes, 2011) called for an autism expert teacher to be employed in every mainstream school. Ambitious About Autism is calling for schools to have access to specialist teachers. Why does the report call for less? We believe most schools already have access to specialist ASC services through LA ‘outreach’ programmes. Whether they access this support, and whether it is effective, is unclear.

Local Offer

The Children and Families Bill will oblige LAs to set out their services in their Local Offer. We are not sure what this adds. The Local Offer does not guarantee access to services for any child and it is something of a postcode lottery (national standards having been rejected by the Government). Further, there is no guarantee that a LA’s Local Offer will set out a comprehensive list of all services available, e.g. will it include independent or private providers, or providers who are geographically close but outside the local authority?

#Ruling out law-breaking

But we are most concerned that the key pledge, to inform parents of their rights, and to have the resources to help their child get appropriate support will only result, at best, in law-enforcement being left to parents. Parents and children need to be made aware of their rights but they must not continually be forced into a ‘policing’ role. Ambitious About Autism do not seem to be asking for any new resources to be made available to parents to change this situation.

The ERA asks Ambitious About Autism and those supporting its campaign to go further and ask for real and lasting change. This should include:

1.    Law-breaking must stop. The Government must ask that LA's and schools demonstrate that they follow the law in relation to their treatment of all children with SEN and disabilities. There should be sanctions for non-compliance.

2.     Alongside this, we need better enforcement of the law: we already have enough rules and laws. We don't need more, we just need them enforced. We need better oversight and accountability mechanisms. It cannot be left to parents to police. The campaign should make direct contact with Ofsted and ask them how they intend to police the law in this area. We believe Ofsted should oversee LA SEN teams. 

3.      The role of the Local Government Ombudsman in investigating complaints against local authorities should be highlighted. This is currently missing from the report’s companion “A Parent’s Guide.” 

4.      We should ask the Government to consider giving back to the Local Government Ombudsman jurisdiction to look at complaints about schools by parents. This jurisdiction should be extended on a national basis following the recent trial. Currently the only avenue of complaint is through a school’s governors and Secretary of State for Education.

5.     The LGO should update its guidance on all children out of school and bring it up to date with reference to the Equality Act 2010.

6.      We should improve democratic accountability. Let’s request that MPs and councillors ask questions of their LAs about the number of children out of school in their own area (this is not just a problem for children with autism but who have complex SEN).You can contact your MP directly via this link to make this demand.

7.      We should also ask the directors of all children's services to publicly commit to publishing details of how they will reduce the numbers of children missing out of education. This could be an objective of the Public Sector Equality Duty (PSED) under the Equality Act. They should also be asked to demonstrate how their staff have been trained on the law.

8.      Finally, we must campaign to ensure children's voices are truly respected in accordance with Article 12 of the Convention on the Rights of the Child

Above all, we need to say loud and clear: depriving any child of their education is unacceptable and the law-breaking must be #ruledout now.

Independent Supporters: the Department for Education responds

On 7 January 2014, the Department for Education announced that:

"More than 1,800 champions will be on hand from this September to help parents navigate the new special educational needs process following a £30 million funding boost".

In his press release, the Minister for Children and Families, Mr Edward Timpson, suggested that part of an Independent Supporter's brief would be to help "challenge" local authority decision-making on behalf of families.

  

We wrote to Mr Timpson on 16 January asking questions about the following:

·         The scope, purpose and mandate of Independent Supporters

·         The evidence supporting the introduction of the Independent Supporters through a pilot scheme

·         The financial cost of the service

·         The training and oversight of “Independent Supporters”

Read our letter of 16.1.14 in full here.

On 3 February, we received a response from Mr Timpson’s office. Read the response here

We are grateful for this response but we feel it leaves far too many questions unanswered so we are raising additional and follow-up questions which have been sent to both the Department for Education (DfE) and their strategic reform partner, the Council for Disabled Children (CDC). 

Our response

We have written to the DfE asking further questions. Our letter of 9.2.14 can be found here

We have also prepared a response document which can be accessed here.

But in summary, we have the following specific concerns:

1. The role of Independent Supporters is very unclear. Will they, for example, be able to help all parents and will they be able to advise and assist up to and including Tribunals? Or are they little more than a mechanism to help LAs move parents and children on to EHCPs?

2. It is not clear how these Independent Supporters will be identified and trained and how their impartiality and independence will be protected in practice.

3. The role of LAs in directing the work of Independent Supporters is not clear.

4. We are concerned at 'outsourcing' contracts to multiple private providers (or charity providers) and that there will be inconsistencies between LAs in standards, oversight and accessibility. We are also concerned that Independent Supporters may not be sufficiently trained (both on the law and the need for independence) to offer adequate guidance on complex issues or even be aware of basic safeguarding and data sharing obligations.

5. We are concerned at the lack of evidence and consultation to support these proposals. The lack of open engagement with parents and SEN charities is alarming.

6. We are concerned that some of the very important clauses regarding bidding for contracts to provide Independent Supporters, and the management and oversight of this national initiative will be set out in a contract with the Council for Disabled Children rather than in clear national standards. The DfE says this contract is covered by 'commercially confidentiality' and is therefore not disclosable. We find this unacceptable and believe that clear guidance on oversight, transparency and accountability should be issued and made open to consultation.

The ERA believes that the DfE is struggling to explain the detail of this initiative and how it will operate in practice. In such circumstances, the ERA feels it is simply unacceptable to commit significant sums of public money on a policy seemingly being created “on the hoof”.

We would ask all those working in this sector to start asking similar questions and to echo our call for open debate and consultation and for transparency on all issues relating to these reforms.

Demand a moratorium on the Children and Families Bill now

The Educational Rights Alliance has been following the progress of the Children and Families Bill keenly.

We have noted the following:

• the absence of real parental engagement and consultation

• the lack of involvement by children and young people

• the domination of large charity consortia in implementing these reforms 

• the lack of evidence supporting these reforms (see, for example, this article). This includes a failure to reference and build on the substantial evidence already gathered about the SEN system (academic and otherwise) and a failure to engage with the systemic problems widely documented in relation to inclusion and equality

• the limited and sketchy evidence gathered from Pathfinders. Many LAs are not trialing direct payments despite being offered extra money by the Government to do so. Many who say they are trialling direct payments are merely offering them for provision which could have attracted direct payments without a pilot (e.g. transport).

• the absence of evidence that the switch to Education Health and Care Plans will result in any improvement in access to education and equality for children with SEN/disabilities

• the failure on the part of all those groups promoting these reforms to explain what evidence they have that this Bill will make things better for children and young people

• the significant concern at the potential 'marketisation of SEN provision' - see SENDirect

• the anxiety expressed by some teachers/SENCOs that the switch to EHCPs will lead to a drive to reduce the number of children with legally enforceable provision

• the criticism of the new draft SEN Code of Practice. In particular, we note that it may actually make things worse for pupils as it erodes their rights. See responses from IPSEA, EDCM, CDC, Children's Commissioner

• the lack of a human rights based approach to this legal reform when the reform so clearly touches on individual rights

In view of all these concerns, we believe the progress of the Bill should be halted. 

We believe there should be a moratorium now and that a widespread, open consultation should begin.

The Educational Rights Alliance believes that reform which engages human rights must be forward-looking, progressive and inclusive. Human rights standards should run through this Bill like a thread. The lives and education of our children and young people are too important to be squandered on reforms which lack this commitment or any obvious evidence base.

We ask individuals with SEN and disabilities, parents, academics, charities, teachers, teaching unions,  and schools to stand with us and demand a MORATORIUM.

You can contact your MP directly via this link to make this demand.

And you can also take action by following IPSEA's action plan here.

Follow @ERA_tweet

The National Autistic Society Autism Accreditation programme - time for a change of policy?

The National Autistic Society has an Autism Accreditation programme that provides "autism specific quality assurance" to over 300 organisations throughout the UK and across the world. The aim of the programme is to improve the quality of care for people with autism by:

 "providing a unified standard of excellence in both policy and practice"

"presenting a systematic framework for continuous self-examination and development"

and

"giving guidance and support to the services who use our programme so that they can meet the established criteria required for accredited status."

Many different kinds of organisations have been accredited, including local authorities, NHS trusts, schools, education authorities and private companies. 

These aims are laudable and we support the NAS in its goal of improving services for people with autism and their families.

However, there are significant downsides to how this process works. Autism Accreditation doesn't publish the "established criteria" that must be met in order to be accredited. How high or low are these standards? We don't know. So how can families be assured that an accredited body is meeting a good standard, when there is no substantive information about what accreditation means? 

A more serious situation can arise if an organisation goes through the accreditation process and then fails, or passes but with weaknesses. There is no requirement on the part of the organisation nor Autism Accreditation to publish the service audit. In fact the opposite applies. The NAS website states:

"Autism Accreditation has gone to great lengths to make this [accreditation] process as fair and transparent as possible.."

and

"The evidence collated by the review team and the review team's findings are a matter of confidentiality between the service and Autism Accreditation and will not be shared with third parties without your consent"

Fairness and transparency only work one way though- to the benefit of the paying client and to the detriment of the service user. Certainly some organisations do voluntarily publish accreditation reports, but many do not. Why would an organisation that failed accreditation publish? Where does this leave service users and their families? Do they not have a right to know whether the service they are using is good or poor?

This was brought into sharp relief by a decision made by the Information Commissioner's Office on 6 January. It concerned the NAS's Autism Accreditation service and North Yorkshire County Council. NYCC asked Autism Accreditation to audit its service in 2012 as part of a strategic review. A local parent group asked to see the audit so they could respond more effectively to the Council's then consultation on autism services for children. The Council refused, and the parent group appealed to the ICO. (It is worth noting that a public body spending money on a public service did not deem it in the interests of the public to see how well that service was run.)

In his decision in favour of the parent group the Information Commissioner cited the following reasons:

• Failure to disclose [the audit] could potentially indirectly discriminate against autistic children as they would not have the benefit of knowing which schools the auditors consider to provide the best performance to meet their children's particular needs or if their child's school could be performing better as regards to the needs of their child. 

• There is a strong public interest in allowing the public access to information on how schools compare to each other and whether they provide as good a service as others. 

• The local authority can be called to account by parents. 

• Allow parents to make an informed choice as to the most appropriate schools for their children

• Allow for a more informed dialogue between parents and local authority. 

We believe the forthright reasons given in this case apply more broadly to the work carried out by NAS Autism Accreditation, particularly concerning potential discrimination. Given this clear decision by the ICO, and the unacceptable levels of confidentiality applied to audits, we are calling on the NAS to change its policy so that the default position is timely public disclosure of all audit/accreditation documents and evidence on public bodies written or collected by NAS Autism Accreditation . 

It is time to put people with autism and their families first, not paying clients.

Our letter to the NAS is attached.

Who are independent supporters?

On 7 January 2014, the Department for Education announced that: 

"More than 1,800 champions will be on hand from this September to help parents navigate the new special educational needs process following a £30 million funding boost".

In his press release, the Minister for Children and Families, Edward Timpson, suggested that part of an Independent Supporter's brief would be to help "challenge" local authority decision-making on behalf of families.

The Council for Disabled Children (CDC) has been appointed by the Department to develop the detail. They say they will:

"run an initial ‘trial’ phase over the next few months looking at different delivery methods and develop appropriate training. This will be achieved through a robust and transparent procurement exercise inviting bids from private, voluntary and community sector organisations to develop the services. CDC will assess the bids, ensure best value and commission the work".

The CDC has issued a briefing which sets out some of the detail around the proposal. The briefing also claims that:

"Independent Supporters will help to build resilience in families"

 And that:

"At its heart, Independent Support is intended to build family resilience and not encourage dependency."

Our response

We are concerned at the language used in this briefing, the apparent lack of engagement with parents on this issue and the absence of detail, so we have written a letter to the Minister asking for more information.

Read our letter here.

Ofsted and local authority SEN services

On 7 January 2014, in the House of Lords, Lord Nash made reference to an OFSTED study into local authority specialist services to investigate how children and young people with SEN have their needs identified.

Ofsted offers a potentially crucial form of oversight of LA practices and services so the Educational Rights Alliance has written formally to the head of  Ofsted, Sir Michael Wilshaw to ask about the scope of this study and to offer to participate.

Read our letter now and contact us if you have any views or you'd like to get involved.