co-production: now you see it, now you don’t

Co-production is currently a Big Idea in public services in the UK. The previous post summarised my attempts to track down the theory behind it. That search has prompted some further thoughts. I’d found out where the idea of co-production came from, but it’s presented quite differently by the NESTA papers and Parent Carer Forums (PCFs).   How did it get onto their agenda, and why are their models of it so different to the model originally developed by Elinor Ostrom and Edgar Cahn?

co-production and Parent Carer Forums

Co-production isn’t mentioned in the 2007 paper Aiming high for disabled children: better support for families, which proposed parent engagement via parent carer forums – and the funding for them. Nor does it appear in the 2011 Green Paper Support and aspiration: A new approach to special educational needs and disability that heralded the new SEND legislation.

The first appearance I could find was in the April 2013 report Co-production with parent carers: The SE7 experience.  In June 2013 it pops up, frequently, in a Pathfinder Information Pack Engagement and participation of children, young people parents and carers. The ‘strategic participation of parent carers’ is described as:

“The participation of co-production with representative parents carers in strategic planning, decision making, commissioning and service evaluation. Over the last five years, the Department for Education have supported and funded the development of parent carer forums in every area across England. It is essential that Parent Carer Forums are involved in co-producing plans and implementation of the reforms. Forums are also members of the National Network of Parent Carer Forums (NNPCF), provide the opportunity to feedback at regional and national levels. Representatives from the NNPCF work strategically with Department for Education (DfE) and Department of Health (DH).” (p.3)

The information pack cites the National Council for Voluntary Organisations (NCVO)’s March 2011 Participation: Trends, Facts and Figures. Page 36 of the NCVO almanac reviews participatory methods used to involve communities in local decision making. Interestingly, co-production isn’t mentioned.

Participation: Trends, Facts and Figures in turn cites a study by Involve, set up in 1996 and part of the National Institute for Health Research. I couldn’t find a publication date for their People & Participation: How to put citizens at the heart of decision-making, but it was based on research carried out in 2004/05 and has an introduction by Hazel Blears as Minister of State for Policing, Security and Community Safety, a post she held until May 2006. The Involve study does refer to co-production – in the context of Arnstein’s ladder of participation (p.18) – but doesn’t mention Ostrom’s or Cahn’s work.

putting the production back into co-production

The term co-production isn’t trademarked, so there’s nothing stopping people using it to refer only to one component of the Ostrom-Cahn model, such as a dynamic group process (PCFs), active participation (Involve), or volunteering to ‘give back’ (NESTA). But using it in such different ways is confusing. A single sentence could point readers to co-production’s origins and why an organisation was focusing on only one aspect of it.

Significantly, presenting only one aspect of co-production as co-production, also means that a key component of the Ostrom-Cahn model has repeatedly been overlooked. That missing component is the non-money-based, or ‘core’ economy; the things people make or do (‘produce’) that have value or benefit, but that they don’t get paid for. A key tenet of both Ostrom’s and Cahn’s model of co-production was that this unpaid production is effectively ignored by the market (money-based) economy. Making the invisible economy visible was fundamental to the original model of co-production.

now you see it, now you don’t

Obviously, a group of people drafting an Education Health & Care Plan (EHCP) or reconfiguring the local speech and language therapy service, won’t need to measure the economic efficiency of the project using Ostrom et al’s methods. Nor will they need to set up a Cahn-inspired time bank before they can get on with the task. But if the people doing the planning take into account the views, wishes and feelings of children, young people, parents and carers, but overlook the unpaid activities they all do that contribute to the development and well-being of the child or young person, what’s happening is co-design, not co-production.

Co-production PCF-style encourages parent carers to complete surveys, take part in consultations and conferences, and work with their local PCF in planning services at ‘strategic’ level. For most parent carers, this is on top of their already time-consuming caring responsibilities. A few get a nominal remuneration via the PCF. Most don’t.

Involve’s ‘active participation’ and NESTA’s ‘giving back’ also expect people to engage with public sector services in addition to whatever unpaid activities they do already. Sometimes, that participation can result in a power-shift leading to increased ‘citizen control’. It can also result in citizens having even less free time (and thus fewer resources) than previously. If expenses aren’t paid, they can be out of pocket as well.

In all the new co-production models, the unpaid contribution of carers to the well-being of the people they care for is almost invisible. There are nods to it, in the shape of Carer’s Allowance and ‘celebrating’ it during Carers’ Week. Parent Carer Forums are well aware of unpaid production on the part of parent carers and frequently refer to it, but it’s not an integral part of their model of co-production, and one has to wonder why not. I’ll come back to that point later.

culture change

The Involve participation report devotes an entire section (2.4 p.22ff) to issues and tensions. It includes several paragraphs on culture change. Culture change is frequently cited as the reason new legislation hasn’t been properly implemented in public services.  Involve describes an organisation’s management culture as “a reflection of the values that underpin how they do their work” (p.26). PCFs frequently cite culture change as a key challenge, and see co-production as an important route to changing the values of public services, thus changing their culture.

Organisational culture is a reflection of values, obviously, but that’s not all there is to it.   Culture is an emergent feature of an organisation – an outcome of the interaction between a wide range of factors. I can’t better the Wikipedia list, attributed to David Needle’s book Business in Context: An Introduction to Business and Its Environment. The factors include “history, product, market, technology, strategy, type of employees, management style, and national culture”. Culture manifests itself as “vision, values, norms, systems, symbols, language, assumptions, environment, location, beliefs and habits.”

It is difficult to change people’s values, and one way to do it, in the case of implementing new legislation relating to people with disabilities (e.g. Mental Capacity Act, Children and Families Act, Care Act) is to ensure public services are aware of, and comply with, statutory requirements.

The current system explicitly expects people with disabilities and their carers – who together form one of the most vulnerable and resource-poor demographic groups – to enforce compliance, using their knowledge of the law, and via complaints and litigation. This is inequitable. And blaming culture change for the system not working, to me looks like an excuse.

I’ve lost count of the number of times I’ve heard organisational culture cited as the reason public services don’t carry out their statutory duties, or why new legislation isn’t being properly implemented. Culture change, apparently, takes years to effect and there’s not a damn thing anyone can do about that. Which provides a convenient excuse for poorly drafted legislation, non-compliance, and any failure of participation, engagement or co-production initiatives.

co-production has been framed

Earlier, I wondered why the invisible activities of children, young people, parents and carers have remained invisible in the co-production model adopted by Parent Carer Forums. After all, the forums are acutely aware of those activities.

The most likely explanation is that the idea of co-production has passed from one organisation to another, becoming transformed on the way by a process of conceptual Chinese whispers, and that few people have read Ostrom or Cahn. And so have missed their key point about activities in the non-money economy.  Parent carers are sometimes paid for participation, but that just makes participation part of the very money-based economy that co-production is supposed to help reform.

The NESTA authors clearly have read Ostrom and Cahn, and understand the informal non-money economy and the contribution it can make to communities. But they’ve framed tapping into that economy as “patients, pupils, parents or service users are being asked to do something, to give back and to help deliver the service.” (Challenge of co-production p.14)

To me this comes across as somewhat paternalistic. It frames co-production in terms of the state being in charge, service users being obliged to it for the services it provides, and being expected to ‘give back’. An alternative perspective, and the one taken by Ostrom and Cahn, is that the state exists for the protection of the people, that public services exist for their benefit, that people informally exchange activities, and that informal system of exchange can interact with public sector services so that everybody benefits.

Ironically, given the number of times Sherry Arnstein’s analysis of power structures has been cited alongside models of co-production, it’s not just unpaid activities that have remained invisible. Power structures have too.

references

Arnstein, S. (1969).  A Ladder of Citizen Participation, Journal of the American Planning Association, 35, (4), 216-224.

Boyle, D. & Harris, M. (2009).  The Challenge of Co-production: How equal partnerships between professionals and the public are crucial to improving public services, NESTA.

Britton, C. & Taylor, J. (2013).  Co-production with parent carers: the SE7 experience, Mott Macdonald & South-East 7.

Cahn, E. S. (2004) No More Throw-Away People: The Co-production Imperative (2nd edition).  Essential Books, Washington DC.

Department for Education (2011).  Support and aspiration: A new approach to special educational needs and disability: a consultation.

HM Treasury & Department for Education and Skills (2007). Aiming high for disabled children: better support for families.

Involve (2005/6). People & Participation:  How to put citizens at the heart of decision-making.

National Council for Voluntary Organisations (2011).  Participation: Trends, facts and figures. 

Parks, R.B., Baker, P.C., Kiser, L., Oakerson, R., Ostrom E., Ostrom V., Percy, S.L., Vandivort, M.B., Whitaker, G.P. & Wilson, R. (1981).  Consumers as Coproducers of Public Services:  Some Economic and Institutional Considerations, Policy Studies Journal, 9 (7), 1001-1011.

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can’t help it, root causes and strict discipline: part 3

It’s clear from responses to the previous two posts that some further explanation is required of how the Root Cause approach to behavioural problems works. People have raised issues such as:

  • Some of the children in my class are refugees from a war zone; I don’t know how to tackle the root causes of their behaviour. Other agencies don’t seem to know either.
  • I don’t have time to teach all the children in my class individually, never mind sort out their behaviour issues.
  • How do you find out what the root causes are anyway?   Children will lie and blame anything but themselves.

All behaviour has causes, ranging from an involuntary response to physiology or the environment, through to a deliberate, carefully planned, long-term strategy. All unwanted behaviour in schools has causes too.

the environment

Unwanted behaviour often emerges if the school isn’t sufficiently explicit about its expectations. Rules such as walking in single file in corridors, no talking at certain times, are health and safety related. They reduce the risk of accidents and allow teachers to be heard. Other rules (e.g. do what teachers tell you, hand in your homework on time) facilitate learning.

The Strict Discipline model uses reward and punishment to ensure children comply with the school’s behavioural expectations. But having an explicit behavioural framework reinforced by rewards and sanctions doesn’t mean all children will keep the rules. Nor that all children are able to keep the rules. And sometimes the behavioural framework itself can cause problems.

One school I encountered experienced ongoing ‘challenging’ playground behaviour. On the wall by the door from the Y3 cloakroom to the playground was a small card bearing 13 rules for playground behaviour. Expecting 7 year-olds to memorise 13 rules seemed a bit unrealistic, and any child who stopped to read them would create a bottleneck likely to result in somebody falling over or getting their head bashed as the door was shoved open. I won’t even start on the problems caused by the coat pegs and lunchtime arrangements.

But what can schools do if a child is persistently not adhering to an explicit, carefully thought through behavioural framework, and rewards and sanctions are having no effect? My suggestion was to investigate the root causes of the behaviour.

the child

Most of us are familiar with the Root Cause model in some form or another. We know from personal experience that the causes of behaviour aren’t always obvious. We are aware (thanks to Freud) that the causes can sometimes be deep-rooted. Teachers will be aware of the cycle of deprivation theory that’s widely misinterpreted (and sometimes presented) as the Can’t Help It model. If you’ve never undertaken a root cause analysis, it’s easy to assume the causes of problematic behaviour will be nebulous and difficult to identify. That a child’s unwanted behaviour will turn out to be rooted in a dysfunctional family dynamic, or the community’s cultural expectations, or whatever. That’s often not so, even for the most apparently challenging behaviour.

For example, a pupil with a diagnosis of autism and complex specific learning difficulties attending a residential school (so yes, the school had the capacity and expertise to tackle difficult behavioural issues) began exhibiting extreme distress and ‘school refusal’. Some careful probing with the student revealed the source of the distress not to be some obscure aspect of his ‘autism’, but anxiety about being asked to do things he couldn’t do, in three particular lessons. The kid was given an opt-out card for those lessons. If it all got too much, he could show the card to the teacher and go to alternative provision. The card was never used; knowing he had an escape route was enough to allow him to cope.

The school could have explored in more detail why these particular lessons were an issue, but in this instance they didn’t need to; the problematic behaviour was avoided by a pretty simple solution. I’m sure some of the Strict Discipline adherents will at this point say that if a ‘get out of jail free’ card was available everyone would want one, but this was an approach the school used frequently and that’s not what they found. It became a kind of badge of honour to have the card but manage not to use it.

children with special educational needs or disabilities (SEND)

Old Andrew complained that the Can’t Help It model made SEND an excuse for poor behaviour. It might, but in my experience, some teachers don’t know enough about SEND to make that judgement call.

Teachers in mainstream schools have always been expected to teach at least 98% of the child population; only very small percentage of children have attended special schools. But initial teacher training (ITT) has generally focused only on the 70% of children in the middle ability range. Not surprisingly, children with specific learning difficulties or disabilities have often been problematic for mainstream schools. I’ve advocated making SEND training an integral part of ITT.  Teachers have raised objections:

  • SEND training isn’t necessary. Direct instruction and explicit rules work.
  • How can teachers be expected to provide individual tuition to each child?
  • How can teachers be expected to learn about all those different conditions?

Direct instruction and explicit rules work      Direct instruction and explicit rules can be very effective. Whether the same direct instruction and explicit rules are effective for all children is another matter. Advocates of direct instruction and explicit rules also have a tendency to question the policy of educational inclusion, and to complain about objections to exclusion. Although their complaints might be valid, there’s a fine line between ‘wanting to get on with teaching and avoid disruption for children who want to learn’, and making problem children somebody else’s problem.

How can teachers be expected to provide individual tuition to each child? They used to be expected to do this, before the education system became standardised and performance-driven. Basically, if you are teaching a very varied child population, you can have high performance if you shuffle off the more challenging pupils elsewhere. Or you can have well-educated pupils who might still not meet a narrow performance measure.  You can’t have properly differentiated tuition and high performance based on a narrow measure.

How can teachers be expected to understand all those different conditions?   They don’t need to. Whatever a child’s diagnosis, for children with SEN in mainstream schools, teachers need to know about a handful of challenges (parents are usually a good source of information too – note the ‘usually’):

  • Visual processing – does the child screw up their eyes or complain of headaches? Do they persistently misread letters/numbers or find it difficult to find a visual target?

Make appropriate modifications to material. (One child I taught couldn’t see letters or numbers in their right visual field. Shifting everything to the left was effective). Avoid classroom clutter. Get their visual functioning checked; most local authorities have an educational sensory impairment service.

  • Auditory processing – does the child ‘zone out’ when you’re talking to them, or lose track of what they are saying to you? Do they confuse particular phonemes? Do they put their hands over their ears?

Speak slowly and clearly. Give them time to respond. Get some Jolly Phonics materials for visual/kinaesthetic reinforcement (and no, I’m not talking about Learning Styles). Keep the classroom quiet. Get their auditory processing checked; speech & language therapists can help.

  • Attention/executive function – Are they easily distracted? Is it difficult to get them to switch attention between topics? Or both? Do they find it hard to remember instructions?

Sit the kid at the side/back of the room. Give verbal and/or visual cues to signal the need to switch topic. Back up verbal instructions with written ones.

  • Motor control – is the child clumsy? A chair-rocker? Poor handwriting?

Do lots of physical activities that don’t involve fine motor control. Lots of exercise involving balance and using both sides of the body simultaneously. Get an occupational therapist to advise.

  • Anxiety and unwanted behaviour – if the child is anxious or behaving in a way that’s causing problems, there is very likely to be a reason for it.

Win the child’s trust. Get them to talk – sometimes it’s best to start with what they’re interested in rather than confronting the problem head on. Find out what’s going on and find ways to fix problems together. Compromise is powerful.  Sometimes all that’s required is knowing that a teacher is really on their side.

Some teachers will argue that they can’t implement any of these suggestions because they don’t have time or can’t get access to external support services. Or that the problems are intractable and outside their control. Those things might be true, but they don’t negate the Root Cause model’s effectiveness. They do indicate that public sector services have a long way to go.

 

 

 

can’t help it, root causes and strict discipline: part 2

The second of two posts analysing Old Andrew’s view of the behaviour of children with special educational needs.

special educational needs

In the Can’t Help It model that Old Andrew satirises in Charlie and the Inclusive Chocolate Factory, special educational needs (SEN) are conflated with disability. The child is seen as “ill with ADHD” or “on the autistic spectrum”. And we’ve all seen discussions about whether children ‘really have SEN’. According to one newspaper a 2010 Ofsted report claimed that “many of these pupils did not actually suffer from any physical, emotional or educational problems”.

The SEND Code of Practice defines special educational needs in terms of the “facilities of a kind generally provided for others of the same age in mainstream schools or mainstream post-16 institutions” (p.14). In other words, the definition of SEN is a piece of string. If the facilities generally provided are brilliant, there will be hardly any children with SEN. If they are generally inadequate, there will be many children with SEN.

special educational needs and disability

Another post referred to by Old Andrew is The Blameless Part 3: the Afflicted.   He again pillories Can’t Help It as assuming “if a child is behaving badly in a lesson they must secretly be unable to do the work, and that the most likely reason a child might be unable to keep up with their peers is some form of disability or illness”.

Andrew asks why “a child unable to do their school work would misbehave rather than simply say they couldn’t do it”, completely overlooking communication difficulties ranging from children physically not being able to put the words together if under stress, to feeling intense apprehension about the consequences of drawing the problem to the teacher’s attention in public, such as jeers from peers or the teacher saying ‘you can do it you’re just not trying’ (I’ve lost count of the number of times I’ve heard that statement masquerading as ‘high expectations’).

The second charge Andrew levels at Can’t Help It is the assumption that “medical or psychological conditions directly cause involuntary incidents of poor behaviour.” Leaving aside the question of who decides what constitutes poor behaviour, Andrew draws attention to the circular reasoning that Can’t Help It entails. If a medical or psychological condition is defined in terms of behaviour, then the behaviour must be explained in terms of a medical or psychological condition.

That’s a fair criticism, but it doesn’t mean there are no medical or psychological conditions involved. Old Andrew goes on to question the existence of ‘proprioception disorder’, linking it, bizarrely, to a Ship of Fools definition of purgatory. Impaired proprioception is well established scientifically. A plausible mechanism is the variation in function of the different kinds of sensory receptor in the skin and muscles. (The best description of it I’ve found is in the late great Donna Williams’ book Nobody Nowhere.) Whether Andrew has heard of ‘proprioception disorder’ or whether or not it’s formally listed as a medical disorder, is irrelevant to whether or not variations in proprioceptive function are causal factors in children’s behaviour.

It’s the Can’t Help It model that has led, in Andrew’s opinion, to a “Special Needs racket”. I’d call it a mess rather than a racket, but a mess it certainly is.  And it’s not just about children who don’t have ‘genuine disabilities’.  Mainstream teachers are expected to teach 98% of the school population but most are trained to teach only the 70% in the middle range. If teachers don’t have the relevant expertise to teach the 15% or so of children whose performance, for whatever reason, is likely to be more than one standard deviation below average, it’s hardly surprising that they label those children as having special educational needs and expect local authorities to step in with additional resources.

children as moral agents

Old Andrew questions an assumption he thinks is implicit in Can’t Help It – that the child is ‘naturally good’. I think he’s right to question it, not because children are or are not naturally good, but because morality is only tangentially relevant to what kinds of behaviours teachers want or don’t want in their classrooms, and completely irrelevant to whether or not children can meet those expectations. The good/bad behavioural continuum is essentially a moral one, and thus open to debate.

The third post Old Andrew linked to was Needs.  He suggests that framing behaviour in terms of needs “absolves people of responsibility for their actions”. He points out the difficulty of determining what children’s needs are and how to meet them, and goes on to consider an ‘extreme example’ of a school discovering that many of its pupils were starving. If the school feels it has a moral duty to the children, it would feed all those who were starving. But if the school attributes bad behaviour to going without food, it would “cease looking for the most famished child to feed first and start feeding the worst behaved… We would be rewarding the worst behaved child with something they wanted”.  Andrew concludes “Imagine how more contentious other types of “help” (like extra attention, free holidays, help in lessons or immunity from punishment) might be”… Whenever we view human beings as something other than moral agents we are likely to end up advocating solutions which are in conflict with both our consciences and our knowledge of the human mind”.

Andrew has raised some valid points about how we figure out what needs are, how they are best met, and about the Can’t Help It model. But his alternative is to frame behaviour in terms of a simplistic behaviourist model (reward and punishment), and human beings as moral agents with consciences and minds. In short, his critique, and the alternative he posits, are based on his beliefs. He’s entitled to hold those beliefs, of course, but they don’t necessarily form an adequate framework for determining what behaviour schools want, what behaviour is most beneficial to most children in the short and long term, or how schools should best address the behaviour of children with special educational needs (as legally defined).

Andrew seems to view children as moral agents who can control their behaviour regardless of what disability they might have. The moral agents aspect of his model rests on unsupported assumptions about human nature. The behavioural control aspect is called into question by research indicating that the frontal lobes of the brain don’t fully mature until the early 20s.  Moral agency and behavioural control in young people is a controversial topic.

conclusion

The Can’t Help It model is obviously flawed and the Strict Discipline model rests on questionable assumptions. The Root Cause model, in contrast, recognises that preventing unwanted behaviours might require an analysis of the behaviour expected of children, and the reasons children aren’t meeting those expectations. It’s an evidence-based model. It doesn’t rest on beliefs or absolve children of all responsibility. It can identify environmental factors that contribute to unwanted behaviour, and can provide children with strategies that increase their ability to control what they do.  To me, it looks like the only model that’s likely to be effective.

can’t help it, root causes and strict discipline: part 1

This week Old Andrew, renowned education blogger, has drawn attention to some of his old posts about children with special educational needs. He identifies two conceptual models that focus on children’s behaviour – and overlooks a third.  In this post, I describe the models and why teachers might adopt one and not the others.

the model muddle

In Charlie and the Inclusive Chocolate Factory Andrew satirises a particular conceptual model of children’s behaviour. I’ll call  the model Can’t Help It. This view is that children identified as having special educational needs, or those from deprived backgrounds, are not responsible for behaving in ways that are unwanted by those around them. The Can’t Help It model is the one that claims criminals abused or neglected in childhood can’t be held responsible for breaking the law. I don’t doubt it’s a view held by some people, and I can understand the temptation to satirise it. It’s flawed because almost everyone could identify some adverse experience in childhood that explains why they behave in ways that distress others.

But satirising Can’t Help It is risky, because of its similarity to another conceptual model, which I’ll call Root Cause. The two models have similar surface features, but a fundamentally different deep structure. The Root Cause model claims that all behaviour has causes and if we want to prevent unwanted behaviour we have to address the causes. If we don’t do that the behaviour is likely to persist. (Ignoring causal factors is a frequent cause of re-offending; prisoners are often released into a community that prompted them to engage in criminal behaviour in the first place).

I’ve never encountered Can’t Help It as such. What I have encountered frequently is something of a hybrid between Can’t Help It and Root Cause. People are aware that there might be causes for unwanted behaviour and that those causes should be addressed, but  have no idea what the causes are or how to deal with them.

If the TES Forum is anything to go by, this is often true for teachers in mainstream schools who’ve had no special educational needs or disability training. They don’t want to apply the usual a reward/punishment approach in the case of a kid with a diagnosis of ADHD or autism, because they know it might be ineffective or make the problem worse. But they know next to nothing about ADHD or autism, so haven’t a clue how to proceed. In some cases the school appears to have just left the teacher to get on with it and is hoping for the best. Teachers in this position can’t apply Root Cause because they don’t know how, so tend to default to either Can’t Help It or to a third model I’ll call Strict Discipline.

Strict Discipline has a long history, dating back at least to Old Testament times. It also has a long history of backfiring. Children have a strong sense of fairness and will resent punishments they see as unfair or disproportionate. The resentment can last a lifetime. A Strict Discipline approach needs a robust evidential framework it’s going to be effective in both the short and long term. In Charlie and the Inclusive Chocolate Factory, Old Andrew rightly eschews Can’t Help It and appears to opt for Strict Discipline, bypassing Root Cause entirely; he describes Charlie, despite “eating nothing but bread and cabbage for six months” as “polite and well-behaved”.

Good behaviour

This evaluation of Charlie’s behaviour begs the question of what constitutes ‘well-behaved’. Teachers who identify as ‘traditional’ often refer to ‘good’ and ‘bad’ behaviour as if both are self-evident. Inevitably, behaviour isn’t that simple. ‘Traditional’ teachers appear to see behaviour on a linear continuum. At one pole is strict adherence to social norms – whatever they are deemed to be in a particular environment. At the other is complete license, assumed to result in extreme anti-social activities.

The flaws of this behaviour continuum are immediately apparent because it’s based on assumptions. The norms set by a particular teacher or school are assumed to be reasonable and attainable by all children. Those are big assumptions, as shown by the variation in different schools’ expectations and in the behaviour of children.

Even very young children are aware of different behavioural expectations. What’s allowed in Miss Green’s class isn’t tolerated in Mr Brown’s. They can do things in their grandparents’ home that their parents wouldn’t like, and that would be completely unacceptable in school. That doesn’t make Mr Brown’s expectations or those of the school right, and everybody else wrong. We all have to behave in different ways in different environments. Most children intuitively pick up and respond appropriately to these variations in expectations, but some don’t. By definition autistic children struggle to make sense of what they are expected to do, and children with attentional deficits get distracted from the task in hand.

It doesn’t follow that children with autism or ADHD should be permitted to behave how they like, nor have all their ‘whims’ catered for. Nor does it follow that every child should be expected to behave in exactly the same way. What it does mean is that if a child exhibits behaviour that’s problematic for others, the causes of the problematic behaviour should be identified and appropriate action taken. In some cases, schools and teachers do not appear to know what that appropriate action should be.

In the next post I’ll look at the flaws in the Strict Discipline model in relation to children with special educational needs.

behavioural optometry: pros and cons

MUSEC is Macquarie University’s Special Educational Centre. Since 2005 it has been issuing one-page briefings on various topics relevant to special education; a brilliant idea and very useful for busy teachers. One of the drawbacks of a one-page briefing is that if the topic is a complex one, there might be space for a simple explanation and a couple of references only. The briefings get round that problem, in part, by putting relevant references on a central website.  One of their briefings is about behavioural optometry.

Behavioural optometry is based on the assumption that some behavioural issues (in the broadest sense) are due to problems with the way the eyes function. This could include anything from poor convergence (eyes don’t focus together) to variations in processing visual information in different coloured lights. The theory is a plausible one; visual dysfunction can cause considerable discomfort and can affect balance and co-ordination, for example.

Behavioural optometrists are sometimes consulted if children have problems with reading, because reading requires fine-grained visual (and auditory) discrimination, and even small variations in the development of the visual system can cause problems for young children. One of the reasons systematic synthetic phonics programmes are so effective in helping young children learn to decode text is because they train children in making fine-grained distinctions between graphemes (and between phonemes). But phonics programmes cannot address all visual (or auditory) processing anomalies, which is the point where behavioural optometrists often come in.

The MUSEC briefing on behavioural optometry (Issue 33) draws on two references; a 2011 report by the American Academy of Paediatrics (AAP), and a 2009 review paper by Brendan Barrett, a professor of visual development at Bradford University.  Aspects of the briefing perplexed me.  I felt it didn’t accurately reflect the conclusions of the two references because it:

  • doesn’t discriminate between treatments
  • overlooks the expertise of behavioural optometrists
  • equates lack of evidence for efficacy with inefficacy
  • assumes that what is true for a large population must be true for individuals
  • gives misleading advice to readers.

Discrimination between treatments

In its second paragraph the briefing lists three types of treatment used by behavioural optometrists; lenses and prisms, coloured lenses or overlays, and vision therapy. But from paragraph four onwards, no distinction is made between treatments – they are all referred to as ‘behavioural optometry’ and evidence (for all behavioural optometry treatments presumably) is said to be ‘singularly lacking’. Since lenses and prisms are used in what Barrett calls traditional optometry (p.5), this generalization is self-evidently inaccurate. Nor does it reflect Barrett’s conclusions. Although he highlights the scarcity of evidence and lack of support for some treatments, he also refers to treatments developed by behavioural optometrists being adopted in mainstream practice, and to evidence that supports claims involving convergence insufficiency, yoked prisms, and vision rehabilitation after brain disease/injury.

Expertise of behavioural optometrists

The briefing also appears to overlook the fact that behavioural optometrists are actually optometrists – a protected title, in the UK at least. As such, they are qualified to make independent professional judgments about the treatment of their patients. As Barrett points out, some of the controversies over treatments involve complex theoretical and technical issues; behavioural optometry isn’t the equivalent of Brain Gym. But teachers are unlikely to know that if they only read the briefing and not the references.

Lack of evidence for efficacy

Both references cited by the MUSEC briefing are reviews commissioned by professional bodies. Clearly, the American Academy of Pediatrics, the College of Optometrists or MUSEC cannot endorse or advocate treatments for which there is little or no evidence of efficacy. But individual practitioners are not issuing policy statements, they are treating individual patients. If they are using treatments for which a robust evidence base is lacking, that’s unsatisfactory, but a weak evidence base doesn’t mean that there is no evidence for efficacy, nor that the treatments in question are ineffective. Setting up RCTs of treatments for complex issues like ‘learning difficulties’ is challenging, expensive and time-consuming. As a parent, I would far rather my child try treatments that had a weak evidence base but were recommended by experienced practitioners, than wait for the Cochrane reviewers to finish a task that could take decades.

Populations vs individuals

The briefing paper says that “there is clear consensus among reading scientists that visual perception difficulties are rarely critical in reading difficulties and that the problem is typically more to do with language, specifically phonological processing.

Although this statement is right about the consensus and the role of phonological processing, one can’t assume that what’s true at a population level is true for every individual. Take, for example, convergence insufficiency (one of the areas where Barrett found evidence to support behavioural optometrists’ claims). According to the AAP report, the prevalence of convergence insufficiency is somewhere between 0.3% and 5% of the population (p.832).   So the probability of any given child having convergence insufficiency is low, but in the UK it still could affect up to 500,000 children. Although the report found no evidence that convergence insufficiency causes problems with decoding, comprehension or school achievement, it points out that it ‘can interfere with the ability to concentrate on print for a prolonged period of time’.   So even though in theory convergence insufficiency could be contributing to the difficulties of a quarter of the UK’s reluctant readers, it isn’t screened for in standard eye tests.

Advice to readers

The briefing recommends visual assessment for problems with acuity and refractive or ‘similar’ problems, but that’s not what the AAP recommends. It says:

Children with suspected learning disabilities in whom a vision problem is suspected by the child, parents, physicians, or educators should be seen by an ophthalmologist who has experience with the assessment and treatment of children, because some of these children may also have a treatable visual problem that accompanies or contributes to their primary reading or learning dysfunction.” (p. 829)

In the UK, that would require considerable persistence on the part of the child, parent or educator, although physicians might have more success.

The briefing also suggests an alternative to behavioural optometry; ‘explicit instruction in the specific areas causing difficulty’. Quite how ‘explicit instruction’ would improve problems with eye tracking, visual processing speed, visual sequential memory, visual discrimination, visual motor integration, visual spatial skills and rapid naming, never mind attention or dyspraxia where the difficulty is often discovered because the child is unable to carry out explicit instructions, is unclear.

Conclusion

I’m not claiming that behavioural optometry ‘does help children with reading difficulties’ because I don’t know whether it does or not. But that appears to be the nub of the problem – in the absence of evidence nobody knows whether it does or not. Nor which treatments help, if any. As the AAP paper says “Although it is prudent to be skeptical, especially with regard to prematurely disseminated therapies, it is important to also remain openminded.” (p.836)

I also had problems with the MUSEC briefing’s reading of Barrett’s conclusions. Although I wouldn’t go so far as to say the briefing is wrong (except perhaps about the lenses, and I’m not sure what it means by ‘explicit instruction’), its take-home message, for me, was that behavioural optometrists lack competence, that visual problems are unlikely to play any part in developmental abnormalities, and that if there are visual problems they will be limited to acuity and refractive or ‘similar’ factors. That’s not the message I got from either of the papers cited by the briefing. Obviously, on one side of A4, the authors couldn’t have covered all the relevant issues, but I felt that what they included and omitted could give the wrong impression to anyone unfamiliar with the issues.

References

American Academy of Pediatrics (2011). Joint technical report – Learning disabilities, dyslexia, and vision. Pediatrics, 127, e818-e856.

Barrett, B.T. (2009). A critical evaluation of the evidence supporting the practice of behavioural vision therapy. Ophthalmic and Physiological Optics, 29, 4-25.

reforming the SEND system – for good

In the previous post, I claimed that teacher training and targets were two factors that explained why the current SEND system couldn’t work  –  and why it has never worked effectively.  In this post, I’ll explain my claims about teacher training and targets and suggest how the SEND system could become both effective and sustainable.

 Teacher training

For any system – education, health or social care – to meet the needs of a varied population, two ingredients are vital; expertise and flexibility. Practitioners need the knowledge and experience to deal with any needs they might encounter and the system has to be able to adapt to whatever needs arise.

Bizarrely, teachers have always been expected to teach the 98% or so of children who attend mainstream schools, but have only ever been trained to teach the 80% who don’t have SEN, not the 20% who do. And since funding was withdrawn for special education Master’s degrees in the mid-1980s, SEN expertise has gradually leached out of the education system as a whole as special education teachers have retired. It’s only since 2009 that new SENCOs (special educational needs co-ordinators) have been required to be qualified teachers, and only recent appointees are required to have SEN training. There is still a massive gap in SEND expertise within the education system. How can teachers teach children if they don’t know how to meet their educational needs?

Targets

Setting targets sounds like an obvious way to improve performance. You set the target, expect someone to meet it whatever that takes, and provide some sticks and carrots for their encouragement. Targets, accompanied by sticks and carrots, were part and parcel of the early education system but were abandoned because they didn’t work.  And as quality control researchers have been telling us since at least the 1920s, performance depends on the factors that contribute to it. In the current education system, the measure of school performance is actually pupil performance in SATs or GCSEs. But how children perform in tests is influenced by many factors; their health, family circumstances, life events, quality of teaching, their own learning etc. Schools have little or no control over most of those factors, so to measure school performance by pupil performance in tests is pointless.

Despite the evidence, the current education system still sets targets.  And the sticks and carrots expected to encourage schools to raise their (pupil) performance mean that there are no incentives for a school to invest resources in the education of students who are unlikely to improve the school’s test results. If students aren’t going to meet the ‘expected standard’ however hard they or the school try, why invest resources in them? Why not focus on the children likely to meet the ‘expected standard’ with a bit of extra effort.

So, teacher training and targets have been major factors in marginalising the education of children with SEND. But even if the government had a forehead-slapping moment, cried ‘How foolish we’ve been!’, required all teachers to be trained to teach all the children in their classes, and abandoned its ‘expected standards’ criteria, it would take years to transform the system into a SEND-friendly one. Children with SEND don’t have years to spare and their parents have to deal with the here and now. So what needs to be done?

Parents can’t police the system

This post was prompted by a recent conversation I had with a parent carer forum. The parent carer forum was of the opinion that parents with good knowledge of the national framework and their local offer can use that knowledge to get commissioners and providers to make suitable educational provision for children.

It’s certainly true that knowledge of the national framework and the local offer (however incomplete) can help. How effective it is at getting commissioners and providers to meet their statutory obligations is another matter. Since the new system was introduced, I’ve been told repeatedly that it’s improved outcomes for parents and children. Maybe – but I have yet to see any. What I have seen is parents who know the national framework backwards having to resort to mediation, tribunal, formal complaint, the Local Government Ombudsman and in some cases being advised that their only option is Judicial Review – exactly the kind of problems that prompted the revision of the SEN system in 2014.

Until I had the conversation with the parent carer forum, I’d assumed these hurdles were the unwanted and unintended consequences of flaws in legislation that had been rushed through (the pilot study didn’t finish until after the legislation came into force). Then the penny dropped. The only explanation that made sense was that individual parents challenging commissioners and providers is the government’s chosen method of enforcing the new legislation.

That’s a terrible way of enforcing legislation.  For many parents of children with SEND, it’s as much as they can do to hold the family together. To expect parents in already challenging circumstances to police a flawed system that was rushed through at a time when LAs are struggling with huge budget cuts is, to put vulnerable families in harm’s way. Not only is that strategy likely to fail to bring about compliance on the part of commissioners and providers, it’s morally reprehensible.  For 150 years, if a school failed a child parents have been able to appeal to school boards, independent governors or their LEA for support. Not any more. Parents (and children with SEND) are on their own.

What needs changing and who can change it?

The system still needs to change and if parents don’t change it no one else will, so what to do? Since my family entered the SEN ‘world’ 14 years ago, I’ve seen parents fighting lone battles with their LA; the same battles replicated hundreds, if not thousands, of times. I’ve seen parents new to the system set up support or campaign groups only to discover they are just one in a long line of support or campaign groups that have either burned out or at best brought about change that hasn’t actually made much difference on the ground.

What the individual parents and campaign groups have lacked is focus and organisation. I don’t mean they’ve been unfocussed or disorganised; some of them could focus and organise for England. And there’s no doubt that parent groups were instrumental in getting the SEND system changed. It’s rather that there’s been a lot of duplication of effort and the focus has been on single issues or fighting on all fronts at once rather than on the key points in the system that are causing the problems.

I think the key points are these;

  • Mainstream teachers should know how to teach all the children in mainstream schools.
  • Each child needs an education suitable for them as an individual rather than for the average child in their age group, as the law already requires.
  • Assessment and funding should be the responsibility of separate bodies – the new legislation didn’t do away with the LAs’ conflict of interest.
  • There should be an independent body (with teeth) responsible for implementation and compliance that should support parents in their dealings with commissioners and providers. Parents should not have to resort to legal action except in extreme cases.
  • Parents struggling with the system need more support than they are currently offered. A buddying system matching up parents in similar positions dealing with the same local authority might help. As would training in negotiation.

Much of the negotiation undertaken by individual parents and parent groups is with schools, LA officers or the DfE. And problems with the SEND system are generally seen not as being with the structure of the education system or the SEND legislation, but with implementation. But the problem runs deeper than implementation, and deeper than the SEND legislation. It lies with the structure of the education system as a whole, and with the market model espoused by successive governments. Instead of lobbying LA officers and DfE officials who are trying to implement the law as it stands, groups of parents should be lobbying their local councillors and MPs to ensure that teachers are suitably trained, arbitrary targets are abandoned, and responsibility for implementing the system is distributed more widely. These changes won’t require significant new legislation, but they might require a big shift in thinking.

 

 

 

a short history of special education

In 2006 a House of Commons Select Committee described the special educational needs system as ‘no longer fit for purpose’. By September 2014 a new system was in place. Two years on, it’s safe to say it hasn’t been an unmitigated success. To understand why the new system hasn’t worked – and indeed can’t work – it might help to take a look at the history of special educational needs and disability (SEND).

A short history of SEND

Education became compulsory in England in 1880. Some local school boards set up special schools or special classes within mainstream schools for physically ‘handicapped’* children, but provision was patchy. What took people by surprise was the number of mentally handicapped children who turned up to school.

At the time, teachers were expected to teach according to the official Code – essentially a core curriculum – and many schools in the fledgling national educational system were seriously under-resourced. Teachers were often untrained, paper was very expensive (hence the use of rote learning and slates) and many schools operated in conditions like the one below – with several classes in one room. They just weren’t equipped to cope with children with learning difficulties or disabilities.

Shepherd Street School in Preston in 1902

Shepherd Street School in Preston in 1902§

Two Royal Commissions were set up to investigate the education of handicapped children, and reported in 1889 and 1896 respectively. Both recommended the integration of the children in mainstream schools where possible and that special provision (classes or schools) should be made by school boards. The emphasis was on children acquiring vocational skills so they could earn a living. Those with the most severe mental handicap were deemed ‘ineducable’.

The Royal Commissions’ recommendations, and many others made over the next few decades, were clearly well-intentioned. Everybody wanted the best outcomes for the children. The challenge was how to get there. After WW2, concerns about the special education system increased. Parents felt they had little control, the number of pupils in special schools was rising, and children were still being institutionalised or marginalised from society. In 1973 Margaret Thatcher, then Education Secretary, commissioned a review of the education of handicapped children, led by Mary Warnock, whose Committee of Enquiry reported in 1978. A year later Margaret Thatcher became Prime Minister and some of the Warnock recommendations came into force in the Education Act 1981.

The Warnock report introduced a very different way of understanding ‘handicapped’ children. They were no longer seen as being different, but as having special educational needs – as did up to 20% of the school population. Special educational needs were defined in terms of the support children needed, rather than in terms of their physical or mental impairments. What was envisaged was that many children in special schools would gradually migrate to mainstream, supported by Statements of Special Educational Need. And mainstream schools would gradually become more inclusive, adapting their buildings, equipment and teaching methods to meet an ever wider range of educational needs. The new system might have worked well if the rest of the education system hadn’t changed around it.

Context is crucial; one size doesn’t fit all

The Warnock recommendations were made in the context of a very flexible education system. In 1981 Local Education Authorities (LEAs), schools and teachers had a great deal of autonomy in what was taught, how it was taught and when. That all changed with the 1988 Education Reform Act that heralded a compulsory National Curriculum, SATS and Ofsted. Central government essentially wrested control of education from local bodies, something that had been actively opposed for the previous 100 years – few people wanted education to become a political football.

The new education system was at heart a one-size-fits-all affair. Governments find one-size-fits-all systems very appealing. They look as if they are going to be cheaper to run because professional training, equipment and resources can be standardised and performance can be easily measured. Unfortunately for governments, human populations are not one-size, but are very varied. If a universal service is to meet the needs of a whole population, it won’t do that if it’s designed to meet only the needs of the average person. A stark choice faces those designing universal systems; either they can design a system that meets everybody’s needs and resource it properly, or they can design a system that doesn’t meet everybody’s needs and then spend years trying to sort out the ensuing muddle.

The 1880 education system was one-size-fits-all and the next century was spent sorting out the problems that resulted for handicapped children. There was a brief period after 1981 when the education system took a big step towards meeting the needs of all children, but seven years later it flipped back to one-size-fits-all. The last 30 years have been spent trying unsuccessfully to limit the damage for children with SEND.

So what’s the alternative? The answer isn’t further reform of the SEND system, because the causes of the problems don’t lie within the SEND system, but with the broader education system. Two key causes are teacher training and targets – the subjects of the next post.

*I’ve used the term ‘handicapped’ because it was in widespread use in the education system until the Warnock Committee changed the terminology.
§ © Harris Museum and Art Gallery http://www.mylearning.org/victorian-school-and-work-in-preston/images/1-3215/