SERVICES FOR CHILDREN WITH PROFOUND AND MULTIPLE LEARNING DIFFICULTIES (PMLD) AND ADDITIONAL HEALTH NEEDS

 

Introduction

At Northern Counties School we have a distinct population of children and young adults who have combinations of very complex physical, sensory, learning and health needs. These children have significant physical disabilities, which affect their gross and fine motor skills and have severe/profound learning difficulties. They may have a hearing or visual impairment and some have both senses affected making their disability very complex hence the term “profound and multiple learning disabilities”. In addition to their physical and learning needs, many of the children have significant health and feeding needs requiring close nursing supervision and medical care.

 

What do we provide?

We provide a multidisciplinary approach to the education of children and young adults (aged 3-19) with PMLD and complex health needs. Young people are provided with specialised integrated educational and therapeutic provision within an environment that encourages communication on all levels. The child centred approach ensures pupils have full access to a broad, balanced and relevant curriculum that is suitably differentiated to meet their individual needs. This service is staffed by specialist teachers, therapists and learning support workers together with full time on-site nursing support.

Rationale for the curriculum for pupils with profound and multiple learning difficulties

The curriculum for pupils with PMLD reflects the cross curricular and multidisciplinary nature of the work that we do. The curriculum is divided into three strands within which all of our sessions are embedded. The three strands of the curriculum are: Communication, Sensory exploration and Physical exploration. Cognitive development is embedded throughout the curriculum and promoted through all activities.

 

Highly structured and fully modified class programmes are provided by an integrated team of teaching staff, therapists and learning support workers. The focus is very much on individual programmes with an emphasis on multi-sensory approaches and experiences. Tasks and activities are structured carefully in order that they are relevant and purposeful for each pupil in order to maximise motivation; all activities are planned to enable learners to make sense of the world around them. We have an interactive, consistent and repetitive approach with activities presented over extended periods to allow children the time they need to process experiences and to develop and share their preference and interests.

 

Why do we teach what we do?

Due to the complex needs of our pupils we ensure that what we teach is fit for purpose. Therefore, all teaching must be meaningful to the needs of our PMLD pupils with curriculum content carefully selected in order to provide relevance, coherence and breadth and delivered at a suitable and appropriate pace. Needs led multi-sensory teaching and learning is utilised throughout which aims to provide a wealth of varied sensory experiences for our pupils within an active learning environment thus enabling them to:

 

  • be motivated to reach outside themselves
  • develop preferences
  • develop anticipatory skills
  • develop early concepts e.g. object permanence
  • begin to gain an early awareness of different concepts
  • develop tactual skills – as hearing and vision may be fragmented for our pupils tactual learning can be used as a connecting strategy. Through hand skills pupils learn to reach, hold, manipulate and explore with either hand or both hands together.

 

The complex nature of our children’s needs demand a high level of therapeutic input. Therefore the curriculum is built on explicit therapy based sessions including motor programmes, rebound therapy, hydrotherapy, individual physiotherapy and communication development sessions and switching groups. The therapeutic approach is implicit in all sessions across the curriculum with jointly planned sessions and targets being addressed.

 

The curriculum is topic based to provide a vehicle through which each individual can develop their range of responses, skills and interests over time. A three year rolling programme has been devised for the PMLD cohort which is differentiated depending on the class group learning needs. Each programme has taken into consideration the principles and key learning milestones outlined in ‘Routes for Learning’, an assessment framework developed specifically for children and young people with PMLD. The rolling programme provides teachers with a framework for planning what is to be taught within their class group. An element of flexibility exists whereby what is taught can be modified in order to meet the individual needs of the pupils. This may include covering a specific topic but differentiating the topic content and the pace in which it is delivered in order that it is appropriate for individual pupils.

 

Pupils with PMLD develop new skills at varying rates and progress will be measured in very small steps that require a highly structured teaching and assessment programme in which observation and interpretation of responses and progress over time will be needed. We use Routes for Learning in order to assess the cognitive and communicative abilities of our pupils with PMLD. We use this tool to do a baseline assessment for each pupil, but also as a means of formative assessment to track progress and determine the next steps for learning. The milestones indicated on the cognitive and communicative maps are based on developmental milestones which typically developing children normally pass through. However there is no requirement for pupils to go through these in any predetermined order, acknowledging the often idiosyncratic nature of learning in students with PMLD. Key cognitive milestones are highlighted and the belief is that every learner will go through these key milestones in order to progress.

 

This group of children and young adults have one to one support so that they can access the highly structured learning and assessment programme in order to identify, consolidate and develop individual skills and responses. The experienced staff work together to interpret and understand an individual’s range of responses and experiences in order to move their learning on at an appropriate pace. The environment is vibrant, stimulating and reactive, being carefully planned and organised to maximise the opportunities for each child to respond to and get feedback from it. This offers a range of multi-sensory cues and events that allow each young person to engage with their surroundings, peers and adults while experiencing a rich and varied range of activities.

 

We aim to:

  • Stimulate and motivate each young person to use all their abilities in all areas of development
  • Encourage each individual to function at their optimum level.
  • Scaffold opportunities for the young person to communicate their feelings, responses, preferences and choices in an increasingly consistent way and for the adults around them to respond appropriately
  • Value each individual’s needs and interests and provide enriched opportunities to explore the world around them in purposeful waysWe offer:
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  • High quality and specialised staffinga full therapy team and learning support workers.
  • All staff working in school are experienced and have received specialist training to support their work with children with complex needs including teachers of the deaf, a teacher of the visually impaired, and teachers for children with PMLD qualifications,
  • 1:1 support for each child
  • The young people are all taught within a small teaching group of 4 – 6 children. Each individual has 1:1 support in order for them to fully access the curriculum and all aspects of school life.
  • Therapeutic curriculum
  • Teaching and therapy staff work together to create individual timetables and programmes to meet the needs of each pupil. This is intended to be age appropriate in terms of topic content but developmentally matched to the child’s needs.

 

 

  • Full time Speech and Language Therapy supportIndividual mealtime management plans We aim at all times to develop the child’s expressive and receptive communication. This includes the use of Intensive Interaction, signs and/or on-body signs; cues and symbols; AAC (Alternative Augmentative Communication) including the use of switches such as Big Macs; and the writing of communication passports that shows each child’s individual profile of skills and approaches. We encourage and respond to all types of functional communication – facial expression, gesture, vocalisation, eye pointing and body language.

 

  • Specialist communication approaches
  • With direct input from our dysphagia trained speech and language therapist regarding textures and consistencies, individual plans, feeding and tasting protocols are devised and monitored regularly. All staff are trained to assist children effectively and ensure they enjoy their meal times safely. Staff are also trained to support children with alternative feeding methods such as gastrostomy.
  • Our full time therapists plan and implement a number of specialist programmes and interventions for groups and individuals:
  • Full time Occupational Therapy support
  • Our therapists provide specialist programmes such as access to technology (including Eye Gaze), switching, independent mobility, specialist seating and postural management programmes. Our occupational therapy team offers advice and support for families with regard to issues in the home and work closely with community based colleagues.
  • Physiotherapists
  • The NHS staff team who are based in school compliment our own service and they work with school teaching and therapy staff to provide individual programmes. They are available throughout the week and provide on call support in holidays and at weekends for our residential young people.
    • Hydrotherapy
    • Our on site facility with ceiling track hoists allows each individual two or three sessions each week to stimulate, encourage communication and maximise physical movement.
    • Rebound Therapy
    • Rebound is delivered on site with qualified staff which supports and encourages the child to be active and therefore able to engage in learning more effectively.
    • Light stimulation
    • Individual programmes are planned by our teacher of the visually impaired and delivered in a specially designed room to encourage the use of residual visual skills and develop functional visual abilities including locating, fixating and tracking.
  • Sensory Room 

 

  • An exciting and stimulating environment that is adaptable and used to encourage communication and switching skills using tactile, kinaesthetic, auditory, visual and olfactory stimuli.
  • Individual nursing care plans
  • We have full time nursing support during the school day available to children with complex medical requirements.
  • High quality personal care
  • We ensure that at all times we maintain the young person’s dignity and encourage active participation in routines where possible.
  • Family Support In which we work in partnership with parents, offering support and advice on a range of issues including access to additional services, benefits and opportunities.
  • Access to a 24 hour curriculum (for some children)
  • Flexible residential provision is made for some children and their families. The residential unit provides a warm, safe, supportive environment where the children can continue to learn through extended opportunities to develop their independence, personal and social skills and develop awareness of their own self as part of a wider community
  • School based clinics
  • The school based clinics are held regularly with visiting consultants of Paediatrics and ENT.
  • Links with external agencies 
  • Links exist to support periods of transition, particularly at the end of educational provision to ensure a package of care is established in other services. We also offer training and liaison to agencies providing home based programmes or respite, to ensure consistency in approach.
  • An open door policy
  • Parents are welcome to join in any aspect of the school day in order to develop a consistent approach to care and to share expectations at school and in the home.