Cerebral Palsy and Visual Impairment in Children: Experience of Collaborative Practice in Scotland
Chapter 5 Working Collaboratively by Janis Sugden
Children with a disability often have a multitude of professionals involved with themselves and their family throughout their childhood. In Chapter 4 you read about the roles of many of these professionals. Many parents can give examples of times when they have been overwhelmed by the number of professionals visiting them in their home. Parents can also relate to situations when they have been unclear as to why so many professionals are involved and what is the job of each person they see.
Within this section we would like to emphasise the importance of collaborative team working and suggest the need for a more defined key worker system to clarify the roles of those who might be involved with a child with a visual impairment and cerebral palsy. In the past the quality of this service has depended on the personnel involved and the area in which the child lives.
We would also like to propose a system (protocol) to clarify this process of professional involvement in an attempt to reduce demands on the child and the family whilst maintaining excellence of service provision to meet the child’s identified needs.
Quality provision for meeting special educational needs is best achieved within the context of a positive ethos of partnership between parents and schools, local authorities, education support services, and other agencies working with children and young persons.
The effective provision of services requires an inclusive strategy which is understood by all concerned, is operated collaboratively and commands the confidence of children, young persons and their parents.
Professionals in local authorities, schools and support services work with relevant voluntary and health sector organisations in a spirit of inclusion, partnership and collaboration. The contribution which each makes is valued equally and regarded complimentary. (SOEID, 1998)
A plan of action is necessary in order to provide a comprehensive support system for children with cerebral palsy to assess their level of functional vision throughout their educational careers. The following flow chart (Figure 5.1) identifies the relevant stages of assessment and intervention.
The child’s special needs can be addressed by collaborative interagency working. Team working has often been practised informally in many areas. The team should consist of all adults who will work with the child, including parents or guardians. In our model the core team consists of a team co-ordinator, who is a community paediatrician, the visiting teacher of the visually impaired (if the child is not in a unit which specialises in this field), the child’s teacher and an orthoptist. This core team will be assisted and advised by other specialists when required. Additional team members may include an educational psychologist, social worker, an occupational therapist, a physiotherapist, a speech and language therapist, health visitor, and an ophthalmologist. It is extremely unlikely that all of these professionals will be involved at any one time.
The following diagram (Figure 5.2) suggests a protocol to ensure a uniform procedure when the needs of the child are being addressed. Collaborative interagency working is achieved by relevant members, who have been selected from this team, meeting regularly, contributing joint aims and knowledge and planning together.
Multi-disciplinary assessment team
The benefits of multi-disciplinary working are improved communication and understanding between all those involved, whether professionals, parents or carers.
- For professionals it provides an opportunity to share skills and knowledge in order to establish an effective process of assessment, intervention, planning and review.
- For parents it allows their views to be taken into consideration and raises awareness of how their child’s needs can be met within their local community.
- For education authorities it can provide a good working structure to facilitate inclusion in schools and communities.
To be effective, this method of working requires a co-ordinated approach that involves clear task setting for appropriate core members of the team, clarity of workersÍ roles and responsibilities and regular communication and liaison patterns. The assessments can be completed either jointly or on an individual basis. A team meeting, including parents, will agree future involvement of all concerned.
A framework with practice guidelines to plan and provide for the child with cerebral palsy and visual impairment is essential. This framework must be transferable to individual team environments. A successful framework must have the following:
Agreed joint aims
- Joint Practice guidelines.
- Regular consultation and liaison meetings.
- Informal contact.
- Varied forums.
The aims of the team need to be clear to all involved, including the community.
The team aims to:
- provide specialist advice;
- provide ongoing assessment of a child’s functional vision;
- evaluate a child’s educational needs;
- offer support to families;
- link with other professionals who are not already members of the core team.
Joint practice guidelines/referral criteria
- There is a need for clear referral criteria.
- Any child from birth to school leaving age whose learning may be affected by impaired cerebral/cognitive processing of visual information, including cerebral palsy, may be referred.
- An effective process of assessment planning and review should be established.
Regular consultation and liaison meetings
- A continuity of practice within and between services, which is open, honest and understandable to all, is a priority. The trust, respect and tolerance of others is essential - especially parents. Professional roles can be made clearer by shadowing each other at work, in-service delivery and joint assessments of children.
- The team must have a co-ordinator who has responsibility for organising appropriate meetings, assessments and responding to referrals.
- Meetings should have an established agenda. The least intrusive, but effective assessment and intervention should be used.
- Regular feedback from users should be collated and responded to. This enables the team to evaluate the service provision and if necessary to make changes to improve the service.
- When a child with cerebral palsy and visual impairment is referred to the team, the co-ordinator will contact the family and introduce herself and the team to the family. This may be done very informally, initially by telephone, followed by a home visit from a team worker. It is a good idea at this stage to give the parents a written list of professionals who will be involved.
- Professionals also benefit from informal discussion between meetings.
- It is not always necessary for every member of the team to be present at all meetings. A large group of professionals can be very intimidating for parents and children.
- Meetings should, whenever possible, be held in the child’s local environment.
- The professional team can travel rather than the child and his family.
SOEID (1998) Manual of Good Practice in Special Educational Needs. Edinburgh: Scottish Office.