It is time for a change in special educational provision for those who have profound and multiple learning difficulties?
The UK is the only country in the world to use the term learning difficulty to define a specific category of disability or SEN. Children and young people who are assessed as having learning difficulties are further categorised into one of the sub-categories of moderate, severe, or profound and multiple learning difficulties (PMLD). This article is about provision for children and young people who are assessed as having PMLD. Unfortunately, there is no definition of PMLD that is sufficiently widely accepted that can confirm emphatically whether, or not, a person has PMLD. This lack of an agreed definition makes it difficult for determining the best pedagogical approaches and how outcomes should be evaluated, measured and moderated.
What is PMLD?
Generally speaking, those with PMLD are usually described as having an assortment of complex characteristics which might include:
- profound neurological and cognitive impairment
- multiple physical impairment
- multiple sensory impairment
- profoundly impaired communication
- obsessive stereotypies/challenging behaviour
- complex health difficulties that can be life-threatening or life-limiting.
These characteristics can be in all sorts of combinations, with the depth of different types of impairment varying significantly between individuals and often subject to marked changes in impact during different stages of a person’s life. Some characteristics might be associated with a specific genetic condition, whilst others might be concomitant and have no association with a child’s primary diagnosis of disability. Characteristics might be innate, whilst others might be acquired over time from environmental sources. These complex characteristics are difficult to reconcile with England’s relatively simplistic definition of learning difficulty, as stated in the SEN Code of Practice (2001), as something which “prevents or hinders them from making use of educational facilities of a kind generally provided for children of the same age” or “prevents or hinders them from making use of educational facilities of a kind generally provided for children of the same age.”
This simplistic definition of learning difficulty has done little to help rationalise the debate about inclusive education which has continued to impact on SEN provision since the late 1980s. The impact on the PMLD sector is probably best represented by the 15 years spent trying to make the first three P levels of the National Curriculum properly fit for purpose. Despite the efforts of many talented teachers and the pressure for pupil performance standardisation exerted by Ofsted and HMI, it is still not unusual for the parents of children with PMLD to question why a school is “wasting” their child’s time teaching P levels, instead of addressing the things they feel really make a difference to their child’s life. There are also many teachers who have also asked such questions over the past 15 years, especially when they have watched the wellbeing of pupils deteriorate because of inadequate therapeutic and clinical provision with no apparent accountability on the part of other service providers.
Winds of change
Since 2004, England has witnessed a continuing increase in its PMLD population, which is currently approaching a 30 per cent rise. It is important that provision for these complex learners is reappraised, especially as some of these children and young people are now also included in the new, closely allied category of complex learning difficulty and disability (CLDD) which the Specialist Schools and Academies Trust1 reports as presenting a particular pedagogical challenge. In 2011, the Secretary of State for Education stated his intention to “remove the bias towards inclusion”2 and this unambiguous statement should be regarded as a prompt for teachers to consider developing provision for PMLD that is far more holistic in scope than that represented by the first three P levels. With the opportunity also for schools to convert to academy status and enjoy more curriculum autonomy, teachers should feel increasingly empowered to consider whether there are more effective ways of promoting whole child progression than that which can be achieved solely by the historical practice of re-visiting the earliest stages of P level curricula. The need for schools to reappraise provision for PMLD would also be in keeping with what Hargreaves3 described some time ago as the need for schools to transform their teaching approaches from the largely standardised to the profoundly personalised.
I believe that emerging legislation can assist schools to develop PMLD provision that is as “profoundly personalised” as those idiosyncratic characteristics of their most complex learners. The Children and Families Bill describes how the education, health and social care needs of disabled children and young people will be defined within a “single plan” which families may then refer to when they commission services on behalf of their child. Given the long experience which many special schools already have in multi-agency working, this new legislation should be immediately appealing, particularly to schools that have already established good quality extended school services. Effective delivery of multi-agency provision can be facilitated by aligning education, health, social care and voluntary services within extended school provision and it is strongly recommended that schools invest in such developments. As academies can work free of local authority constraint, these schools can now employ staff on flexible, year round contracts to provide quality assured support to PMLD pupils outside of traditional school hours. A flexible workforce can do much to facilitate an effective 24-hour curriculum whilst also providing reliable, quality assured, short-break respite services. The changing role of local authorities to become “commissioners” of services, rather than providers, means that some services that are immediately relevant to PMLD learners will be put out to tender, giving schools the opportunity to bid for contracts and deploy extended school services to improve outcomes for pupils and their families.
Re-defining the workforce
The Department for Education’s new Teachers Standards (2012) include a number of references to distinctive SEN approaches, so it is essential that teachers working in schools catering for PMLD have the necessary skills and understandings to undertake their job effectively. There are new online training materials available to assist with this4, but online, modular learning must not be a substitute for high-quality training. Other opportunities, such as School Direct, can empower individual schools to resolve the long standing deficit in SEN trained teachers by including initial specialist teacher training as a core activity within their programmes of continuing professional development.
The new Teachers Standards also state that teachers must “develop effective professional relationships with colleagues, knowing how and when to draw on advice and specialist support”, but, as is well known, the rationing of speech and language therapy, physiotherapy and occupational therapy has been a serious issue for many years and it may be safely assumed that there will be no injection of additional NHS resources in response to the rising PMLD population. If the standard of PMLD provision is to improve, therefore, schools need to consider how such deficiencies can be addressed. High-quality training and flexible career structures for non-teaching staff are absolutely essential for promoting what Carpenter (2010) described as trans-disciplinary ways of working – that is, school staff who are suitably skilled and empowered to undertake tasks that might historically have been assigned to health or social care professionals. There is ample opportunity for schools to progress their non-teaching staff through incremental foundation degree courses, enabling them to acquire accredited therapeutic and clinical competencies that can support the education, social care and health management of children and young people with PMLD. Establishing programmes of continuing professional development that encompass undergraduate specialist training and extend to initial specialist teacher training ought to be featuring strongly in school improvement plans
Re-defining teaching and learning
Aird and Aird5 have long advocated the need for specialist curricula in response to the complex needs and learning styles of PMLD learners and some schools have developed excellent materials for use with these pupils. There is insufficient space here to describe distinctive PMLD pedagogical approaches in detail, but it is possible to summarise what provision for PMLD ought to feature:
- curriculum content should incorporate academic, developmental and therapeutic learning matter that is clearly referenced to diagnostic assessment criteria in areas such as wellbeing, sensory, cognitive, communicative, physical, social and emotional function
- the personalisation of learning should be a key feature within curriculum delivery and used to ensure curriculum relevance, breadth and balance on an individual basis
- staff should be absolutely familiar with each child or young person’s preferred learning style, competent in the use of any distinctive approaches/resources and skilled in the observation and recording of pupil response
- learning objectives should be carefully targeted and broken down into small, formative steps to promote incremental learning, as well as summatively to record and evaluate pupil progression
- curriculum delivery should be hands-on and sufficiently enjoyable and multi-modal to provide memorable experiences and motivate pupils to investigate, experiment and be curious
- planned learning opportunities should incorporate the careful deployment of teaching resources with consideration as to how the use of specific resources can augment impaired function and/or facilitate access to learning.
Life’s journey for PMLD learners can be a lonely, confusing and painful experience, sometimes of a relatively short duration, so it is essential that the current legislation is used to reappraise PMLD multi-agency working. There is a troubling tendency for different service providers to engage in the “start again syndrome”6, that is, not recognising assessment findings recorded by other providers, but instead initiating a new cycle of assessment which often only replicates existing intelligence and delays the delivery of important provision. Having a trans-disciplinary approach to PMLD provision, in which school staff have the accredited competencies to undertake, supplement, and interpret holistic assessment findings, could do much to help overcome this tendency and also provide an effective key worker role.
Over the years, much has been written about the need for a key worker, but rarely has there been inter-agency agreement about how to empower such a person, or about which key player should be held to account when service provision is not of an acceptable standard. We currently have the bizarre situation in which teachers can be held to account for a PMLD learner’s failure to make one National Curriculum level progress per year, but no obvious person to hold to account should that same person’s physical and/or mental health begin to deteriorate. Having a single plan covering people from birth to 25 years ought to mean a single point of accountability. Because schools have the greatest amount of daily contact with the greatest number of learning disabled children and young people, I believe that schools should undertake an overarching trans-disciplinary role and be empowered to quality assure accountability on the part of other service providers.
Evaluating PMLD practice
When preparing to reappraise their provision for PMLD, schools might find it useful to undertake some self-evaluation and assess their current provision against a small set of performance indicators. Answering the following questions may help schools to understand how they are doing.
1: How well does the school’s current provision identify and satisfy a PMLD learner’s needs for:
- curriculum breadth and balance in holistic terms?
- health, enjoyment and wellbeing?
- social inclusion?
- an individual learning style?
2: To what extent does the school ensure its resources and facilities are useful for:
- empowering progression within each child or young person’s learning targets?
- augmenting a learner’s impaired function?
- providing access to learning and social inclusion?
- facilitating good health and wellbeing?
3: To what extent does the school ensure that its workforce:
- has clear role definitions in which individual staff are suitably empowered to fulfil their particular roles?
- has the knowledge, understanding and skill to work in a trans-disciplinary way to ensure that an individual’s holistic needs are addressed effectively?
- has clear lines of supervision and accountability?
- has the opportunity to promote best practice, participate in continuous training and secure career progression?
- can provide flexible, out of school hours services?
4: To what extent do the school’s extended services:
- consider familial needs?
- enhance multi-agency provision and accountability?
- ensure that transition between different phases in an individual’s life are seamless and result in good outcomes?
- promote social inclusion?
Quick self-evaluation guides (such as the one above) can help schools reappraise their PMLD provision and ensure that it is as profoundly personalised as their most profoundly disabled learner. No doubt there will still be room remaining in any redefined provision for P level curricula because there is definitely a place for such provision; it just needs to know its place.
Richard Aird OBE served as the Headteacher of four special schools, most recently at Barrs Court Specialist (SEN) School and College in Hereford. Now retired, after 30 years of headship, Richard continues to work as an independent consultant and lecturer in SEN:
1: Carpenter, B. (2010), A vision for the 21st century special school (Specialist School and Academies Trust).
2: Department for Education (2011), Support and aspiration: A new approach to special educational needs and disability.
3: Hargreaves, D. (2006), Personalising Learning 6: School Design and Organisation (Specialist School and Academies Trust).
4: Department for Education (2012) Training materials for teachers of learners with severe, profound and complex learning difficulties.
5: Aird, R. and Aird, K. (2006), Distinctive Pedagogy and the Development of Specialist Curriculum Matter in the Education of Pupils who have Profound Multiple Learning Difficulties, The SLD Experience 46, 15-19.
6: Brandon, M., Belderson, P., Warren, C., Howe, D., Gardner, R., Dodsworth, J. and Black, J. (2008), Analysing child deaths and serious injury through abuse and neglect: what can we learn? (DCSF).