Following the most recent Ofsted report for schools across Derbyshire, it has finally been highlighted that schools are not providing the support and inclusivity needed for SEN children. The local authority have been issued with an improvement notice which aims to create more inclusive schools, improve the offer for SEN children in mainstream schools, to improve the golden thread of communication between the local authority's SEN department, schools and parents/carers and to make the application and provision of EHC plans quicker and more effective. 

The current structure of and offer from most schools is outdated and children are expected to fit into a very specific box in order to successfully access education. Unfortunately, the majority of children do not learn in this specific way and this includes children who are described as neurotypical as well as neurodivergent children and children with other sensory, physical and emotional additional needs.

Many of the typical school routines which still exist such as formal exams, pen licenses, sitting still and quietly and engaging in lengthy periods of difficult academic work without movement breaks, are not appropriate for a large majority of children. In some cases, children as young as 4 are expected to adhere to these strict and unhelpful routines leading to low self-esteem, poor physical skills, behavioural problems and higher instances of neuro-atypical development such as hyperactivity, sensory meltdowns and cognitive fatigue. 

The volume of referrals for specialist healthcare and special school provision has risen drastically each year for at least the last 5 years. Many children have to face lengthy waiting lists to see a children's health professional and alternative provision for educational placements are not always available. Special schools provide education for children with learning disabilities but what about the children who aren't suitable for special educational placements? They are often left in mainstream schools with a lack of much needed support or are taken out of school to be home educated by their parents- often as a last resort when their children refuse to go to school. 

The answer to the SEN crisis in Derbyshire needs to focus on improving the school environments in order to offer more flexible, creative, understanding and inclusive places so that less children are ostracized and more children feel like they are having their individual needs met. If these changes are not made we will see a continued deterioration in the education system including:

• a rise is applications for EHCP's and extra funding to support specific students 
• a rise in referrals for specialist interventions which leaves very complex children vulnerable to lengthy waiting lists as well as NHS services which are stretched to breaking point 
• more complaints against the SEND department which in turn will decrease public trust 
• more fines paid out by Derbyshire local authorities due to breaching timescales around EHCP assessments and provision
• more students requesting special school education or alternative provision which will have a cost implication on the local authority 
• a rise in tribunals and legal disputes due to lack of inclusion 

The cost implications for Derbyshire's local authorities and the NHS services are massive and will only continue to rise if changes are not made. Most importantly of all however, is the impact the education system is having on children across the county. Children who are not appropriately supported in school have a drastically increased chance of negative implications such as: 

• low self-esteem and low self-confidence leading to poor motivation to engage in important tasks
• poor mental health (eating disorders, depression, anxiety, self-harm) and more instances of children needing medication or specialist support for their mental health throughout their lives 
• delay in fine motor and gross motor skills due to lack of movement opportunities 
• poor play skills and socialization 
• problems with emotional regulation and behaviour 
• limited access to different activities and areas of school environments 
• more distractibility, hyperactivity and lack of concentration 
• poor eating and sleeping habits 
• limited life skills and independence in activities of daily living 
• lower academic achievements 

As a children's occupational therapist, I work across mainstream and special schools across Derbyshire and regularly witness first hand, the gaps in support and shortfalls which are leading to these failings. NHS occupational therapists are currently only commissioned in Derbyshire to provide targeted assessment and intervention to children who have been referred into our service. Whilst some children certainly require the targeted interventions, many of the children present with very similar issues and I feel that an occupational therapy service which worked universally across schools could offer an effective service to all children in all schools, reducing the need for individual referrals and creating a more inclusive environment where more children, especially those with SEN, are having their unique needs met and are supported to be themselves within their own school. 

Why an Occupational Therapist?

Occupational Therapists have a unique ethos, values and set of skills which no other single professional alone has. Occupational Therapists (OT's) believe in enabling all people to participate in the activities and tasks (occupations) which they need or want to do in order to make their lives happy, successful and enriched. OT's have an holistic view of problems which means they look at all surrounding forces, influences and factors which may be involved. For example, consider a child who is struggling with their handwriting. An OT would consider the physurrounding factors in order to assess and plan for intervention. This might include:

• Physical factors such as the pen/pencil's size and shape and how much pressure the child is using on their writing tool.
• Developmental factors such as the child's early life experiences, pre-writing skills, fine motor ability, cognitive ability, developmental stage and age, exposure to similar activities.
• Personal factors such as the child's hand and arm strength, their sensory preferences or avoidances, the child's motivation to write (or not), visual-motor integration and comprehension. 
• Environmental factors such as the sensory environment (is it too hot/cold, loud/quiet?) The physical environment including the height of the table for the child, how much support the seat is giving the child, if they have enough space to move, if they can see the board.

A lot goes into a task such as handwriting and OTs are trained to analyse activities in order to discover what the barriers are. As OT's have skills in creativity and innovation, as well as child-centeredness, they are able to problem-solve and find solutions which meet the specific needs of the child or children. The same aplies for groups or classes of children. If the basics are right, they are more likely to have a successful school experience. 

What can occupational therapy help with? 

Occupational Therapist's can provide support, training and intervention at a whole school/ whole class level. The skills and knowledge needed to create a flexible, inclusive and trauma-informed environment can be disseminated through the education system and schools will therefore be more accessible and inclusive places from the top down. Areas which OT's specialise in include, but are not limited to: 

• Classroom ergonomics such as good seating and access to the right equipment and aids in school
• Sensory processing and sensory environments
• Handwriting and recording work
• Physical impairment and disability
• Learning difficulties and disabilities
• Mental health, trauma and emotional regulation
• Fine motor skills
• Neurodiversity and divergency 

Occupational Therapist's can provide support, training and intervention at a whole school/ whole class level. The skills and knowledge needed to create a flexible, inclusive and trauma-informed environment can be disseminated through the education system and schools will therefore be more accessible and inclusive places from the top down. 

Please sign the petition if you think that providing universal occupational therapy in schools within Derbyshire should be introduced. 

For more information, please refer to the Royal College of Occupational Therapist's website: OT in schools - RCOT​      Why children and young people are a priority for RCOT - RCOT​      Our ambitions for children’s OT - RCOT

Links to relevant resources are below:

Improvement plan for children and young people with special needs and disabilities published by Derbyshire Education and Health Partnership - Derbyshire County Council​

Derbyshire County Council pay £349k after over 360 SEND complaints in just seven months​

Lack of SEND support in Derbyshire leaving families suicidal - MP - BBC News​

Bringing OT Into Schools | East London NHS Foundation Trust​Award for programme which has seen huge reduction in pupils needing specialist support - Swansea Bay University Health Board

There are many more resources online providing support and evidence for occupational therapy in schools including from other areas of the UK where Occupational Therapy is already universally available for all mainstream schools.