Education Health Care Plans and spinal cord injury

When a child or young person attends nursery, school, college or university it is vital that they have the proper support in place to access their education and be fully included in all aspects of their education. An Education Health Care Plan brings educational and health needs together in one legally binding document.

This section includes:

  • EHCP and Education Q&A
  • Our Top Tips for Education Health Care Plans
  • Examples of SCI Needs and Support for EHCP Section B & F

At Back Up we have had an increase in the number of parents, schools and health professionals contacting us to request support around applications for Education Health Care Needs Assessments and Plans.

Many of the queries we are receiving are specifically around spinal cord injury and what to include in an EHCP. To make information more easily accessible we have worked with education solicitors to create this guide on EHCPs that is specific for children and young people with spinal cord injury.

*Please note that although we can support with EHCPs, we are not legal specialists. An Education Health Care Plan is a legal document and if you need further help and support we would advise and encourage you to contact organisations who specialise in EHCPs such as IPSEA. A comprehensive list of organisations can be found at the end of this section or Click here. *

EHCP and Education Q&A

What is an EHCP?

An Education, Health and Care Plan (‘EHCP’) is a legal document that outlines your child’s special educational needs, the additional support they will receive in school/college to meet those needs and the placement they will attend. It also outlines your child’s health and social care needs, but children/young people must have a ‘special educational need’ to have an EHCP.

It is a 2 step process:

  1. Apply for an Education Health Care Needs Assessment (EHCN) – this can be refused or approved.
  2. If the EHCN assessment is approved  – the next part of the process is assessments for a EHC plan to be created.
  3. Using assessments and reports from health and education professionals an Education Health Care plan will be drawn up. This plan can also be refused or approved.
  4. Once approved this is legal document and any support and provision agreed and stated in the plan must be delivered by the local authority and school.

The process of applying for an EHCP should take no more than 20 weeks from application, this can often feel a long and drawn out process but is valuable because, as a legal document, it helps ensure the child will get the support they need.  While most of the process is led by the school and LA, parents can also request to start the EHCP process or appeal if the EHCP is refused.  People who can help in the process include SENDIASS at the local authority who should give free and impartial advice.

Who is responsible for applying for an EHCP?

The first stage of applying for an EHCP is to apply for an EHC Needs Assessment. There is a number of people who can apply for an EHC Needs Assessment. This is the first stage of a two stage process to have an EHCP issued. A parent/carer, young person (if they are aged 16 -25), school/college all have the right to make a request for an EHC Needs Assessment. In addition, anybody else can make the request, preferably with the agreement of the parent/carer. This can include an advocate, solicitor, medical professional or social services.

Who can help me to apply for an EHC Needs Assessment?

Your child’s school/college may be able to help you, and they can make the request directly, preferably with your permission. If the school/college is unable or unwilling to assist then you can get additional help from a legal advice giving charity, advocate or solicitor. The charity, Ipsea [insert website link www.ipsea.or.guk] has a model request letter that you can download and fill in.

Can I apply for an EHCP if my child has a spinal cord injury?

Yes, you can request an EHC Needs Assessment. Any child or young person who has a learning difficulty or disability may require an EHCP. There is no set list of diagnoses that children have to have in order to qualify for an EHCP. Instead, it is about how your child’s needs and injury impact on them being able to access and participate in education. This is not just limited to physical needs, for example some children will also have associated mental health difficulties.

My child has a spinal cord injury but can walk with crutches, can we apply for an EHCP?

Yes, absolutely. It is not just about their physical needs associated with their spinal cord injury, it is about them as a whole and whether or not they have special educational needs and may require additional support through an EHCP.

My child has had a spinal cord injury for a very long time, can we apply for an EHCP?

Yes, the length of time your child has had a spinal cord injury for is not taken into account. There are young people who left education at 16 years, who may be 20 years old now and want to return to college. They can ask for an EHC Needs Assessment.

Do I need to get medical reports?

When making your EHC Needs Assessment request it is advisable for you to provide as detailed a description, as you can, of your child’s special educational needs. In addition to your description it is helpful to provide copies of reports that you have received from medical professionals, details from your child’s school/college and any other relevant documents you have. While it is not compulsory to provide this information it will help to support your case, and explain to the Local Authority the impact that your child’s spinal cord injury has on them receiving and participating in education. This does not just include the physical aspects of their needs.

The school/local authority has said my child doesn’t need an EHCP because he just has a physical disability and doesn’t have learning difficulties. Is this correct?

The legal test for whether a child/young person needs an EHC Needs Assessment is found at Section 36(8) Children and Families Act 2014. It tells us that the Local Authority must carry out an EHC Needs Assessment for the child/young person, if they are of the opinion that :

a) The child or young person has, or have special educational needs, and
b) It may be necessary for special educational provision to be made for the child/young person with an EHC plan

Section 20 Children and Families Act states that:

“(1) A child or young person has special educational needs if he or she has a learning difficulty or disability which calls for special educational provision to be made for him or her. (2) A child of compulsory school age or a young person has a learning difficulty or disability if he or she— (a)has a significantly greater difficulty in learning than the majority of others of the same age, or (b)has a disability which prevents or hinders him or her from making use of facilities of a kind generally provided for others of the same age in mainstream schools or mainstream post-16 institutions”.

As you can see from this the legal test confirms that it is not only children who have a learning difficulty, those with physical disabilities are also covered by the legislation.

Can my child go back to the school they attended before their spinal cord injury?

It all depends on whether that school remains a ‘suitable’ place for them. It is entirely possible for children to go back to the same school they attended before their spinal cord injury, but there may be some reasonable adjustments school will need to make.

My child’s place of education is not accessible and they are due to return to school after their SCI, what should the school be doing?

Schools have a legal duty to make ‘reasonable adjustments’ under the Equality Act 2010. This means places of education need ‘to take such steps as it is reasonable to have to take to avoid the substantial disadvantage’ to a disabled person caused by a provision, criterion or practice applied by or on behalf of a school, or by the absence of an auxiliary aid or service.

This duty is anticipatory, which means that school has to think and act on it before your child is at a substantial disadvantage. This means that any work needs to be done before your child is due to return to school. Having a meeting with school to discuss this would be a good idea.
There are some schools that by the nature of the building will not be able to make the required adjustments to enable your child to attend, and therefore in some cases it may be necessary for your child to move to an alternative school.

They have refused to assess my child for an EHCP? What can I do?

If the Local Authority refuses an EHC needs assessment for your child then they must give you a right of appeal against this decision, and notify you about the option to go through mediation.

Whilst there is an option to enter into mediation with the Local Authority, it is not a legal requirement. The requirement is simply for you to consider whether or not mediation may be suitable, speak to the mediation provider and obtain an information certificate if you do not wish to proceed.

To make an appeal to the Special Educational Needs and Disability Tribunal you will need to lodge your paperwork either within 2 months of the date of the decision letter from your Local Authority refusing the EHC needs assessment, or within 30 days of your mediation certificate, whichever is later.

In order to successfully appeal you will have to demonstrate to the Tribunal, as far as you can, that your child meets the legal criteria for an EHC needs assessment:

a) The child or young person has, or have special educational needs, and
b) It may be necessary for special educational provision to be made for the child/young person with an EHC plan
It is important to note that all appeals against refusal to carry out EHC needs assessments are paper only hearings, not oral hearings.

What does an Education Health Care Plan look like?

There is no template for EHCPs so it will potentially look different for every child. It must, however, have the following sections:

• Section A: Parent/carer and child/young person views and aspirations
• Section B: Your child’s special educational needs
• Section C: Your child’s health needs, that are related to their special educational needs
• Section D: Your child’s social care needs
• Section E: Outcomes – what your child is working towards achieving
• Section F: Special Educational Provision (to meet the needs described in Section B)
• Section G: Health Care Provision
• Section H: Social Care Provision
• Section I: Placement your child is to attend
• Section J: Personal Budget, if you have opted for one
• Section K: Appendices – the advice and information that was gathered during the Education, Health and Care Needs assessment and annual reviews of the EHCP

The LA are not gathering the right information about my child and the EHCP plan is not very detailed. What can I do?

If you have received a final EHCP then you will have a right of appeal to the Special Educational Needs and Disability Tribunal, and to consider mediation. This is likely going to be the best way to get improvements made to your child’s EHCP.

An EHCP has been approved how often should it be reviewed?

Once an EHCP is issued it must be reviewed, at least every 12 months. For children under 5 years old the Local Authority should consider reviewing the EHCP at least every 3 to 6 months.
Paragraph 9.166 SEND Code of Practice states that:
“Reviews must focus on the child or young person’s progress towards achieving the outcomes specified in the EHC plan. The review must also consider whether these outcomes and supporting targets remain appropriate”.

Therapies in School: My child needs to do physio during school time should this go in his EHCP?

Yes, any therapy provision your child needs must be written into their EHCP and it is important for it to be detailed in the correct section of the EHCP. It is also extremely important that the therapy is ‘specified and quantified’ appropriately, so you can be sure your child will receive the right level of therapy.

Any provision that “educates or trains” your child needs to be written in Section F of their plan, as special educational provision. It is about the difference the provision makes to your child, and not which department funds it that dictates which is the correct section. Typically physiotherapy may be provided by the NHS, but usually this does not make it health care provision under Section G. Instead you need to look at what physiotherapy is doing for your child, and if it is ‘educating or training them’ then it must be contained within Section F, not G.

My child has experienced a life changing SCI and might need some support with mental health at school should this go in an EHCP?

Yes, support around mental health can and should be written into your child’s EHCP.

Any provision that “educates or trains” your child needs to be written in Section F of their plan, as special educational provision. It is about the difference the provision makes to your child, and not which department funds it that dictates which is the correct section. Typically mental health support may be provided by the CAMHS, but usually this does not make it health care provision under Section G. Instead you need to look at what that therapy support is doing for your child, and if it is ‘educating or training them’ then it must be contained within Section F, not G.

My child needs the support of a TA to go the toilet, with their catheter and help with dressing for PE – does this go in an EHCP? If so which section should this go in?

Support from a TA/LSA needs to be written into your child’s EHCP, including the amount of hours required, any training/expertise that TA/LSA needs to have and whether there support is required during lunch/break times as well or just during class time. Any additional support required with toileting and dressing for PE can be included within this TA/LSA provision in Section F.
There may also be a health plan, under the school’s Medical Policy for specific support and provision around a child’s catheter, and there may also be additional provision under Section G, health care provision for this need.

Our Top Tips for Education Health Care Needs Assessments & Plans

Every EHCP assessment request form across the UK is unique to your Local Authority.

EHCPs form legally must all have the same sections across the UK, but there is not set format and the layout will be different depending on your local authority.

Some people find that EHCP forms are vague, the space to write seems small and not sure what to include.

  • Include a photo of your child to make it more personal
  • Include your child’s voice, such a letter from them
  • You cannot write too much. Include everything you can think of, the spaces to write sometimes appear limited – but you can use continuation sheets
  • Be clear and specific especially around what support is needed. Leave no room for interpretation for example ‘this would be helpful’ – LA’s can get around wording like this. Be specific regarding number of hours of support for example 3 hours 1:1 physio twice a week etc
  • Word’s like ‘might’ and ‘would’, need to be ‘must’ and ‘should’
  • Start gathering evidence from medical professionals as soon as possible. The LA have a duty to gather evidence but it is best to get all the evidence you can
  • Keep copies of everything
  • Record dates of when you submitted forms and documents – there is an EHCP timeline that LAs should stick too and there are also strict timelines for you to reply to things and if you wish to appeal
  • Remember ‘A well managed need is still a need’ – ensure all needs are stated
  • Worst day/ worst case scenario – Although this may be uncomfortable and difficult to discuss we encourage people to consider looking at what support a child or young person may need on their worst day/ worst case scenario.  Having this conversation can be tricky as it will involve discussing all the things someone cannot do independently, however in order to get the right support it is vital
  • If there is a Need stated in section B- it should have a provision in Section F. A good way to think of it is “If you have a need in B, it needs a friend in F”

Examples of SCI Needs and Support

EHCP Sections B & F

We have created this list to support children and young people with SCI when they apply for an EHCP.

Part of the EHCP process is to state needs and what support is needed. There are very specific needs and support required for spinal cord injury. These are some you may wish to consider to be included in an Education Health Care Plan.

*Please note this is not an exhaustive list and some may not apply, or there may be additional needs not stated in this list. Needs and support are dependent on the individual; the level of injury and age of the child or young person need to be taken into consideration. All needs must be carefully considered and personalised to the individual child or young person. Fully supported and in agreement with parent/guardian, the young person and any other supporting professionals such as medical etc

Section B – Need

Section F – Provision

What needs to be put in place to support the Need in Section B

Notes

Access classroom

Adjustable desk
Space to move around classroom furniture Ramps
IT software such as Eyegaze, Dragon etc
OT equipment splints
Teaching Assistant Scribe
Differentiated learning
Aspire may be able to assist with advice on IT equipment

Access playground

Accessible and inclusive play equipment
Teaching Assistant Support Inclusion
Seek advice from OT and play therapists

Access sports & PE

Staff training
Accessible transport
Accessible swimming pools and sports facilities
Free wheel, plinth for changing, hoists.
PE equipment, differentiated learning
STEP strategy

Administering Medication

Medical plan/policy
Accurate Record keeping
Trained member of staff
Safe but accessible place for medicine

Any other Additional Needs

Many children and young people also have other needs alongside needs around SCI.These can include learning needs,and  other medical conditions.
It is important that these needs are also included in an EHCP and follow same format – state the Need in Section B and the support needed in section F

Assistance with dressing/ changing for PE

Staff trained manual handling
Teaching Assistant
Accessible changing room
Accessible shower
Shower seat
Plinth
Hoist
Equipment
Place to keep spare clothing
Dignity

Autonomic Dysreflexia

AD training for all staff involved with student.
Understanding of unique signs to the individual
Medication held in secure accessible place
Emergency Procedures/ plan in place for individual student
Teaching Assistant to administer medication
Potentially training several members of staff in case off sick
Autonomic dysreflexia is a very raised blood pressure, usually with a headache and sometimes a skin rash. Emergency.
Such things as a very full bladder, bowel problems and skin sores can cause the condition.

Blood pressure

Monitoring equipment and accurate record keeping

Difficulty breathing, coughing or clearing secretions from lungs

Breathing function may be affected due to weakness of the chest and abdominal muscles. They may be more at risk if they have a cold or other infection.
Staff fully trained
Cough assist machine

Fatigue

Time out place
Adjustments in lessons for concentration, short tasks
Adequate breaks
Personalised timetable
Exam considerations

Headaches

Medication
Quiet safe space for student to go to for time out
Plan in place around severe pain
Can be affected by SCI/brain injury/condition/medication/blood pressure/pain & fatigue
For some this can be a sign of AD

Lack of sensation

Manual Handling training
Pressure Relief to avoid pressure sores Minimise risk of injury through risk assessment and safe environment

Maintenance of Wheelchair Equipment/ Walking Aids

Secure safe place for
Powerchair charger
Puncture Repair Kit
Ensuring certain staff can fix a puncture and naming who they are for awareness

Medical equipment

A safe secure place for medication and medical equipment. Member of staff trained

Memory & concentration

Short tasks
Differentiated learning
Personalised timetables
Quiet place to study
Teaching Assistant
Can be affected by SCI/brain injury/condition/medication/blood pressure/pain & fatigue

Mental Health needs

Mental Health Support & Therapies can  be included under SEN section B & F
Incorporated within school time to minimise absence
Differentiated learning
Safe space to go to for time out
Confidentiality

Mobility

Safe access
Consider distance between classrooms
Accessible doors
Environment
Fire safety etc
Ramps
Lift
Teaching Assistant Staff trained on Fire Evacuation safety
Also note crutches/ mobility aids and uneven surfaces

Nausea & dizziness

Training staff on how best to support with this
Allowing food/drink in class if this alleviates it

Nutrition/Dietary needs

Fridge for specialist foods
Personal cutlery  see also OT)
Dining table access with peers
Assistance carrying food to table
Assistance eating

Occupational Therapy

Equipment Assessment for all lessons as needed–
Writing tools
Laptop
Art materials
PE
Food Tech Sciences
Maths
Woodwork
Technologies
Music
IT

Pain or an intense stinging sensation caused by damage to the nerve fibres in your spinal cord

Staff training and understanding of impact of pain, management, strategies/techniques and medication individual to student.
Teaching Assistant support
Safe space for student to go to for time out.
Plan in place around severe pain
Can manifest in a number of ways unique to individual such as spasms

Personal Care – Bladder Care

Awareness of individual routines
Teachers understand and should not put barriers up
Dignity
Offer methods that avoid causing any distress for the child i.e. using a colour card to be excused without explanation and/or easy way of contacting teaching assistant such as bleeper if not with child all the time Exam considerations – supervised rest breaks
Template for bladder and bowel care 

Personal Care – Bowel Care

Awareness of individual routines
Teachers understand and should not delay students or put barriers up or make an issue- for example leaving a lesson discreetly or however the student wants to do this
Dignity
Offer methods that avoid causing any distress for the child i.e. using a colour card to be excused without explanation and/or easy way of contacting teaching assistant such as bleeper if not with child all the time
Exam considerations – supervised rest breaks
Template for bladder and bowel care 

Personal care -Toileting/intimate care

Teaching Assistant fully trained
Specialist equipment to allow for independent and/or assisted transfer
Plinths
Emergency pull cord in bathrooms
Hygiene Bins suitable for disposing of medical waste
Continence plans
Confidentiality and dignity at all times
Secure place to store intimate care products and equipment
Staff not sharing bathrooms with students
Allowing easy access to accessible toilets i.e. not locking them
Accessible fully equipped changing area in case individual needs to change clothing
Exam considerations – consider supervised breaks, where the clock stops while student has a break and then restarts.
This could include assistance with different types of catheters, emptying leg bags, bowel movements, accidental incontinence etc, assistance with intimate care such as menstruation or simply support for an individual to access the toilet such as transferring onto a toilet seat. Template for bladder and bowel care 

Physical aids for legs/ back/ hands etc

Splints/braces – care around these

Physio to support mobility, muscle tone etc

Area for physio to take place to avoid absence from school
Physio incorporated into PE
Physio plan
Specific hours and times need to be stated

Poikilothermia

Keeping classrooms, changing rooms etc a good temperature
Awareness of moving around the school and time spent outside playtime etc
Flexibility with uniform such as adding layers or lighter clothing option eg. removal of blazer in hot weather etc
Flexible during breaktimes i.e. if it’s freezing outside, allowing a child and a few friends a room to use to avoid getting too cold, or allowing a fan in a classroom
Inability to regulate temperature – can easily become cold or over heated

Pressure Relief to minimise risk of pressure sores

Staff training on correct manual handling to avoid compromising skin
Pressure Relief routine set with individualDignity
Skin tissue is more easily compromised and can break down quicker with spinal cord injury Lack of sensation

Trips

Anticipatory duty’ advance planning and considerations needed
Student/parent/ guardian involved in planning
Accessible: Accommodation Activities
Transport
Inclusion in all of these aspects with peers is key
Teaching Assistant
Overnight care
Equipment Medical information at hand

Social needs

Inclusive ethos across whole education experience
Lunch and break times with peers
Sitting with peers in class
After school clubs
Teaching Assistant support may be needed but awareness and understanding of giving child/ YP space and freedom

Spasms & Exaggerated reflex actions

A spasm may involve only one muscle or be more generalised and may be very short lived or last a long time.
Full understanding and training of the indivuduals physical and medical treatments for them.

Speech Language Therapy

Assistive Technology may be needed
Teaching assistant support
Therapy sessions

Transport to school/school trips

Accessible transport arranged
Included with peers, not separated
Teaching Assistant

Travelling around the school

Arrangements to leave class a bit earlier
A Teaching Assistant to support
A locker for school books or designated safe place
Consider distance between classrooms Consider electric doors or easy to open to allow independence

Ventilation

Fully trained staff – often need more than 1 assistant. 1 focused on ventilation and edical needs and another for secondary support plus support with education. Both of these support staff should still go under SEP – special educational provision as both support with access to education
Support from community nurses

 

Support plans, such as an EHCP, are called different names in different parts of the UK:

Scotland use a Coordinated Support Plan (CSP) to outline the additional support children and young people should get from schools.  A CSP acts much like an EHCP as it is legally binding but it also serves the purpose of bringing together professionals from health, education and social care teams.  For more information on the CSP process, see:

In Northern Ireland they also carry out assessments in a similar way with a coordinated approach but these are called Statement of Special Educational Needs

In Wales, they will shortly transition from SEN support plans to a plan called an IDP – an Individual Development Plan and they call SEN – Additional Learning Needs – ALN. All children considered to have Additional Learning Needs will have an IDP. This process will begin from 2020.

‘ALN (Additional Learning Needs) Transformation Programme’ which it is said will ‘transform the separate systems for special educational needs (SEN) in schools and learning difficulties and/or disabilities (LDD) in further education, to create a unified system for supporting learners from 0 to 25 with ALN…The ALN Transformation Programme also focuses on skills development for the education workforce, to deliver effective support to learners with ALN in the classroom, as well as easier access to specialist support, information and advice. “

Current information on SEN statements in Wales

To know more about the transition to ALN in your area please contact your local authority.

How the ALN Act will affect children, young people, parents and carers.

How the ALN Act will affect maintained schools and nurseries.

Additional Learning Needs and Education Tribunal (Wales) Act

For more information on EHCPs please see

IPSEA – Independent Provider of Special Education Advice (known as IPSEA)

Skybadger – £HCP help for disabled children and their families

 

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