EHCP example, personal account

Why might it be of interest?
It is virtually impossible for parents to fine online examples of EHCPs with the content available to read. We can find examples of parts of EHCPs and may well be able to put it all together – or the ideas together – to help us inform our young person’s EHCP but I thought it would be helpful to share the following document which was privately written. Most of the content, bar the outcomes, were included in the actual EHCP by the young person’s case worker at the time.

The case worker would not include the outcomes – even though these had been approved by a local authority representative at an annual review. Sadly the representative had left the organisation by the time the EHCP was being updated and there was no written record of her approval.

However, mum wrote these outcomes into Section A so that they form part of the legal document. We can’t know how thoroughly this section is read by decision makers but it makes sense to have something in the EHCP that shows what we are aiming for in the longer term.

Overview

The young person has Down syndrome (DS), Autism, hyperthyroidism, sensory sensitivities, low muscle tone and reduced stamina.

Higher Education and Employment

The young person has Down syndrome and Autism which manifests as a severe learning disability and rigid behaviours. Academically, she is working significantly below her chronological age and she is unable to engage in learning independently.

The young person has significant difficulty retaining information that has been provided verbally. When presented with an unfamiliar task, the young person is unable to process more than one visual or verbal instruction at a time and when presented with a familiar task, the young person is unable to follow more than three visual or verbal instructions. The young person associates specific tasks with specific objects, places and people and cannot generalise learning or even reliably repeat known splinter skills if in a different setting or with different people. Each time the young person is asked to work in an unfamiliar setting, she must start learning a familiar task again, as if it was a new skill and can miss out on learning opportunities that involve being in a new or different environment.

The young person is unable to read or write, as she cannot relate sounds to letters, and relies on symbols and pictures. The young person cannot understand symbols or pictures that express abstract concepts or pictures that are not a direct representation of the real-life thing.

The young person has significant delays in mathematics and limited progress in this area means that she is still acquiring the very basic functional skills for these disciplines. The young person is unable to understand numbers beyond 10 and is unable to mentally count objects; relying heavily on touch to identify the number of objects. She cannot identify the concept of “less” in functional situations using weights and measure.

The young person has very limited self-awareness and is unable to plan, navigate, organise time or equipment, make predictions regarding the unknown or to problem solve.

Independence and Independent Living Skills

In an unstructured setting, the young person’s default is to withdraw and not engage in any activities.

In a structured setting or event, the young person does not instantly try new activities and relies on watching others participate to understand about the world before she will engage.

Where there is a clear pattern to a sequence of events, with little variation within it, the young person will set it as a new routine. The young person becomes distressed if there are external changes to her set routines and the familiar people and environmental elements within them. If things go wrong or something unexpected occurs, the young person can become stuck. She also takes a long time – years in some instances – to meaningfully adapt to permanent change. However, the young person sometimes refuses to participate in her routine, without obvious reason and will simply remain still and refuse to move. Once in this mindset, the young person cannot independently resolve the difficulty and does not always respond to others that are trying to help her to return re-engagement.

The young person has clear sensory processing and modulation difficulties. She is sensitive to sound and exhibits sensory seeking repetitive behaviours such as flapping, rocking and side-stepping which interfere with the speed at which she completes a task.

The young person has no understanding of the value of coins or notes, has no understanding of comparative values and is unable to budget. She is vulnerable to financial abuse as she will hand money to people if they ask for it and is at risk of continuing to hand money over unless prompted to stop.

The young person is still learning to reliably put clothes on the right way round and is often not willing to dress herself and expect others to do this for her. She has not established a full understanding of dressing according to the weather or activity.  The young person is still developing the basic skills for bathing and is unwilling to brush her teeth or hair and cannot tolerate this done to her for any meaningful period.  The young person is still developing the skills for intimate care, bathing and hair washing.

The young person cannot complete domestic tasks independently and cannot look after a household environment. She is not safe to manage independently in a hot kitchen, does not understand the concepts of cooking time or temperature and is unable to make herself a hot or cold meal.

The young person is unable to navigate or plan a route to a set place. When out in the community the young person would be at risk of becoming lost, even in familiar places.

Community and Friendships

The young person is non-verbal and her use of alternative communication is severely limited. When the young person does use an AAC device to communication, she deletes her work straight away which often does not leave the supporting adult with time to read it. The young person does not recognise the need for or value using communication skills – beyond body language and a few low-key gestures which may have multiple meanings – to get her needs met.

The young person has difficulty transitioning from one setting to another, such as between school and home and the young person will often refuse to transition and back. Often transitions can be delayed by events that it is not possible to assist the young person with, such as a lit street light outside of her bedroom. This difficulty is particularly pronounced following long car journeys, as the young person refuses to get out of the car, and has resulted in the young person sleeping overnight in the car on a family holiday as she refused to go into the hotel.

The young person is not able to independently access the community. She is unable to access new places spontaneously and has difficulties adjusting when familiar community facilities are not available as expected. The young person would not be able to problem solve if met with the unexpected in the community and would not be able to problem solve or make a phone call for help.

The young person is a vulnerable young woman as she is at risk of wandering off with anyone who seems friendly, she does not understand inappropriate behaviour and does not have the communication skills to tell anyone about an incident. She does not have a sense of social rules concerning personal safety and does not understand ‘public’ and ‘private’, so she will undress in a public space and will leave a bathroom door open with strangers around.

Maintaining Good Health

The young person has an underactive thyroid and is, therefore, more at risk of gaining weight. The young person also has low muscle tone which reduced her stamina and results in slow walking. The combination of hypothyroidism and low muscle tone also places the young person at risk of postural asymmetry.

The young person has several repetitive, self-soothing behaviours (“grooves”) that she insists on carrying out, including flapping, tidying/re-arranging objects and running or flushing water and becomes distressed if prevented or interrupted from doing so. These behaviours can get in the way of the young person completing tasks and participating in activities, for example, the young person will not let go of her ‘flapping card’ during the day and so she may not be able to use both hands and it can restrict arm movement. The young person is very sensitive to sudden or loud noises.  The young person can also become highly anxious if things do not go right.

The young person expects that others will know what she is thinking and so she does not indicate her needs. She does not express discomfort or distress and will simply become still when these feelings arise. The young person refuses to get out of the car when she is taken for medical or dental appointments and consequently her health is not monitored.

Part E – Outcomes

• By the age of 25, the young person will have the specialist skills to hold a part-time working role, with a meaningful job description and clear duties, which meets her abilities and interests.
• By the age of 25, the young person will have the skills to live independently from her family, in an environment that she feels ‘home’ and from where she could spend time in the family home or on family holidays and happily return to her supported living.
• By the age of 25, the young person will have the skills required to participate in adult-led, communal domestic activities, so that she can independently carry out any task delegated to her from a rota of jobs.
• By the age of 25, the young person will recognise and follow a daily routine to wash independently, make choices about her clothes for both the weather and event and wear footwear appropriate for the situation.
• By the age of 25, the young person will be able to recognise how to express herself best for ‘audience’ and respond to questions, so that she will be able to reliably ask her mum, aunt, care worker or a waitress for chicken nuggets and chips.
• By the age of 25, the young person will participate in family and friends’ events, reliably reaching her destination and leaving the vehicle to enter a house or building for a social gathering or evening event so that she can maintain her social life.
• By the age of 25, the young person will be able to express her needs and wants ‘in the moment’, to choose and participate reliably in daily community activities, when supported by a pool of carers. She will be able to recognise and name the responsible adult supporting a community activity, be able to follow the instructions provided by that person and recognise that person is a safe point of return.
• By the age of 25, the young person will accept a routine of healthcare for medication, menstruation and healthy eating choices, where these things are supported by a varying place or person.
• By the age of 25, the young person is walking daily and participating in two different community exercise groups per week, attending annual health checkups, biannual dental checkups and any GP, dental or hospital attendances that her health may require.

Part F – Provision

The young person requires the following for all outcomes:

• To be taught in a specialist provision, with small class groups, a high staff to pupil ratio and a calm, highly structured, safe learning environment which offers a waking day curriculum that provides for a balance between novelty and familiarity and provides for continuity, consistency and communication between educational and residential provision.
• A provision which offers a high level of and consistency among staff, who are experienced at working with young adults with comorbid autism and Down syndrome, who can become familiar with and respond correctly to the young person ’s vocalisations and body language communication.
• A broad and balanced curriculum which teaches through frequent, short session and offers multi-sensory learning.
• A curriculum that offers a high level of repetition and over-learning of academic, social and life skills, through supported and education, training and extracurricular activities, offering an integrated and experiential approach across a range of different settings that teaches both splinter skills and skills to generalise learning, to ensure the best possible outcomes.
• A carefully planned approach to curriculum delivery where therapists, teaching staff and non-teaching staff have the flexibility to respond to the young person ’s needs ensures that the young person remains settled and comfortable to tackle new things and works outside of her comfort zone, without engaging in avoidance or stress management techniques.
• A provision that offers a whole school and holistic approach where therapists, teaching staff and non-teaching staff can deliver a flexible, integrated and seamless approach to learning across the waking day curriculum enabling global generalisation of learnt skills, at times which accommodate the young person ’s daily needs.
• A provision with the whole environment differentiated language and a high level of visual support where staff are proficient and experienced in the use of augmented and alternative communication, including Makaton signing, pictures, symbols, visual timetables and augmented alternative communication devices.
• A provision where both teaching and non-teaching staff use modified and structured language using appropriate short sentences, with rephrasing and repetition when required, to break information down into single items of information with contextual and situational clues and allowing for pauses to enable the young person to process language.
• A provision with an appropriate peer group of pupils, with access to more able peers, who can offer peer modelling and support for the young person to understand and learn new skills both in the classroom and in a wider setting.
• The young person requires a programmed approach to the delivery of integrated occupational therapy, across the variety of contexts and situations of a waking day curriculum, ensuring appropriate aids and adaptions are prescribed and in place, that the environment accommodates the young person’s sensory needs and that the young person’s fine and gross motor skills are developed across all learning environments. This programme will be devised by a qualified, occupational therapist with experience of working with young adults with comorbid autism and Down syndrome and will be integrated into the waking day curriculum through curriculum planning meetings, multi-disciplinary liaison and staff training. The occupational therapist will review the young person within her learning environment at least termly and update programmes as required. The occupational therapist will require an allocation of at least 20 hours per academic year to assess, develop integrated programmes, prescribe equipment, attend planning meetings, liaise with and train others, review the young person in her learning environment and update programmes as required.
• A devised safeguarding intimate care plan, developed by named safeguarding member of staff, in liaison with the multidisciplinary team working with the young person, an onsite nurse and The young person ’s parents, to ensure safe and consistent personal care.
• A provision that provides a home/key staff liaison, at least once a week, to facilitate good working relationships and to ensure consistency of approach.
• All therapists working with the young person will each require an allocation of 8 hours per academic year for conducting assessments, writing up review reports and attending annual review meetings.

By the age of 25, the young person has the specialist skills to hold a part-time working role, with a meaningful job description and clear duties, which meets her abilities and interests.

• A curriculum that can offer a structured and timetabled approach to provide the young person experience of a range of vocational options, appropriate to her skills and interests, so that the young person can choose one area to develop into a vocational role.
• A provision which provides training and accreditation against recognised occupational standards, where relevant, and where the vocational programme embeds employment-related skills – including communication, collaboration and problem-solving – directly into the teaching and which offers both theoretical and practical experiences.
• A curriculum that can develop vocational skills within a classroom setting and offer supported work experience, in placements which offer an autism-friendly environment and understand both autism and Down syndrome, to generalise learning from the classroom to the community.
• 1:1 Qualified NVQ level 2 support workers who are experienced with autism and Down syndrome and proficient in augmented and alternative communication and trained to at least stage 4 in Makaton, providing 27.5 hours of additional support per week in the learning environment. This support worker will proactively support the young person in her routines and transitions, monitor and react to the young person’s needs, act as 1:1 support during education and therapy sessions and carry out all therapy programmes devised for the young person.
• A provision in which teachers and support staff will praise the young person’s efforts and provide opportunities for the young person to demonstrate her strengths to maintain her self-esteem and motivation.

By the age of 25, the young person will have the skills to live independently from her family, in an environment that she feels ‘home’ and from where she could spend time in the family home or on family holidays and happily return to her supported living.

By the age of 25, the young person will have the skills required to participate in adult-led, communal domestic activities, so that she can independently carry out any task delegated to her from a rota of jobs.

By the age of 25, the young person will recognise and follow a daily routine to wash independently, make choices about her clothes for both the weather and event and wear footwear appropriate for the situation.

• A residential provision that can teach targeted personal care and domestic skills to develop healthy routines and patterns of behaviour to live independently from her family.
• A residential provision that can offer a high level of staff support, with an appropriate peer group that will help the young person begin to understand living independently from her family within a familiar term-time/holiday-time school pattern, so maintaining regular contact with family and friends and learning to return to independent living after a set time of contact.
• A comprehensive curriculum with a broad approach to learning, set across a waking day, which embeds the teaching and modelling of life skills throughout a functional setting.
• An individualised programme, developed collaboratively between teachers and specialist care staff, which supports and develops the young person ’s ability with independent living and self-help skills and is carried out across the waking day by all teaching and support staff involved in the young person ’s learning and care.

By the age of 25, the young person will be able to recognise how to express herself best for ‘audience’ and respond to questions, so that she will be able to reliably ask her mum, aunt, care worker or a waitress for chicken nuggets and chips.

By the age of 25, the young person will participate in family and friends’ events, reliably reaching her destination and leaving the vehicle to enter a house or building for a social gathering or evening event so that she can maintain her social life.

By the age of 25, the young person will be able to express her needs and wants ‘in the moment’, to choose and participate reliably in daily community activities, when supported by a pool of carers. She will be able to recognise and name the responsible adult supporting a community activity, be able to follow the instructions provided by that person and recognise that person is a safe point of return.

• A relationship and sex education curriculum, taught as part of the wider curriculum and devised and delivered by a specialist teacher, as part of a weekly timetable, that has been differentiated to take account of all the young person’s needs, to build upon and develop understanding of maintaining personal safety when she is both with peers and when out in the community.
• A curriculum which explicitly teaches understanding and identifying emotions and feelings.
• A curriculum which can be differentiated to integrate opportunities and motivators for the young person to initiate conversation, as an active communicator and request preferences and choices.
• A provision with an appropriate peer group of pupils, with access to more able peers and a mixed gender group, with whom the young person can develop her social skills, share interests, extend interactions, further emotional development and learn new skills both in the classroom and in a wider setting.
• A minimum of five 30-minute speech and language therapy session per term, carried out either as 1:1 sessions or group sessions consisting of no more than 4 participating students, delivered by an on-site, qualified and experienced, HCPC registered, speech and language therapist with knowledge and experience of working with young people with comorbid autism and Down syndrome, either within the learning environment or on a withdrawal basis, to focus on developing the young person ’s range of communication strategies for the real-world setting. The young person’s NVQ2 support worker must be available to attend all speech and language therapy sessions and attend as many of these sessions as is clinically required for the support worker to learn about the young person ’s difficulties and understand how to effectively support her to generalise learning and fully develop her communication in a range of settings.
• A designated computing device with software which provides the young person with an AAC system. This device and software must be assessed for by an HCPC registered speech and language therapist. This device should be kept charged and in good working order to enable the young person to use it, as required, throughout the waking day.  Both the device and the software installed should be reviewed by the speech and language therapist, on a termly basis, to ensure that the young person has access to both a device and software that best meet her needs and both the device and/or the software should be updated where there is a clinical need to do so. The SLT will also require an allocated 10 hours per academic year to set up, review within practical sessions and modify the AAC software so that it is tailored to the young person ’s needs and to trial new software where clinically indicated.
• An NVQ2 qualified support assistant should be trained by the speech and language therapist in programming and supporting the use of the AAC device. The support assistant should be responsible for any programming of small additions to vocabulary and set phrases that may be required between sessions and will work under the guidance of the speech and language therapist to assist with programming that is beyond small changes.  The speech and language therapist will need to provide 6 hours of direct training to teach the support assistant AAC programming and continue to develop the support assistant’s skills and understanding during the practical elements of the speech and language therapy sessions.
• A structured programme of speech and language therapy, which is integrated into all context and situations across the waking day curriculum, designed to promote a range of communication skills across a variety of settings, including signing and symbol support. This programme must be devised by an onsite, qualified, HCPC registered, speech and language therapist with knowledge and experience of working with young people with comorbid autism and Down syndrome and supported by all members of staff working with the young person. This programme must be reviewed at least four times per academic year to ensure it forms an integral part of all area of learning. An allocation of 24 hours of speech and language therapy, per academic year, is required for the SLT to prepare, revise and review a programme to practice, develop and generalise the skills taught in therapy sessions throughout the waking day.
• At least 30 minutes per term for the speech and language therapist to liaise with the young person’s parents to ensure consistency of approach during school holidays.

By the age of 25, the young person will accept a routine of healthcare for medication, menstruation and healthy eating choices, where these things are supported by a varying place or person.

By the age of 25, the young person is walking daily and participating in two different community exercise groups per week, attending annual health checkups, biannual dental checkups and any GP, dental or hospital attendances that her health may require.

• A provision which offers a range of supported and differentiated exercise classes for the young person to trial and participate in, for at least an hour, twice a week, alongside weekly timetabled opportunities to participate in similar off-campus community activities and events.
• An Individual health care plan to provide clear protocols to manage the young person’s medical conditions and medication administration. This plan should be reviewed at least annually and at any other point when the management of the young person’s health changes.
• A provision with staff who are experts in mental health and can be supported by an educational psychologist to work on expressing feeling and desensitisation to attending medical appointments.