Warnock (1978)

Notes on the text
Preliminary pages Membership, Contents, Introduction
Chapter 1 General approach
Chapter 2 Historical background
Chapter 3 Scope of special education
Chapter 4 Discovery, assessment and recording
Chapter 5 Children under five
Chapter 6 Schoolchildren with special needs: introduction
Chapter 7 Special education in ordinary schools
Chapter 8 Special education in special schools
Chapter 9 Parents as partners
Chapter 10 Transition from school to adult life
Chapter 11 Some curricular considerations
Chapter 12 Teacher education and training
Chapter 13 Advice and support in special education
Chapter 14 Other education service staff
Chapter 15 Health service and social services
Chapter 16 Relations between professionals, confidentiality and coordination of services
Chapter 17 Voluntary organisations
Chapter 18 Research and development
Chapter 19 Priorities and resources
Summary of recommendations

Appendices

Appendix 1 List of contributors
Appendix 2 Categories of handicapped pupils
Appendix 3 Possible grid as basis for statistical returns
Appendix 4 Organisation of health service
Appendix 5 Research project on services for parents of under 5s
Appendix 6 Research project on pre-school education
Appendix 7 Research project on employment experiences of handicapped school leavers
Appendix 8 Survey of teachers' views on special education

Index

Report of the Committee of Enquiry into the education of handicapped children and young people

London: Her Majesty's Stationery Office 1978
© Crown copyright material is reproduced with the permission of the Controller of HMSO and the Queen's Printer for Scotland.

ISBN 0 10 172120 X

Chapter 5: Children under five
[pages 73 - 93]

INTRODUCTION

5.1 The earliest years of life have enormous significance for all aspects of a child's development. The survey of recent research in special education which was undertaken for us (1) drew attention to those studies which have stressed the very rapid physical, emotional and intellectual development that takes place during the first few years of life. The period between birth and four years of age is generally accepted to be that of the fastest intellectual development, while the years between one and three to four normally see a rapid development in language. Thereafter the rate of intellectual development progressively diminishes, and the learning of language becomes increasingly difficult. Education during the first five years of life is thus of crucial importance.

5.2 It is also widely held that there are periods, notably the very early stages in development, when a child is particularly sensitive to experience and quick to learn from it. The early experiences of children with physical, sensory or intellectual disabilities, and their opportunities for self-education, may however be very limited and their development correspondingly restricted. The development of young children, whether or not they have a disability, may also be hindered by difficulty in forming personal relations or by adverse social circumstances. As we pointed out in Chapter 1, children with disabilities or significant difficulties will need to be elaborately taught things which other children learn spontaneously. Their education, therefore, must start as early as possible without any minimum age limit. For some children educational help will need to be provided below the age of two. We understand that the law is ambiguous on the power of local education authorities to provide education for children under two. We consider that any doubts about their power to do so should be resolved and, if necessary, the law amended to give them this power.

5.3 In the earliest years parents rather than teachers should be regarded, wherever possible, as the main educators of their children. Parents of children with handicapping conditions will themselves have special needs, in particular the need for skilled support and help in developing in themselves behaviour and attitudes most conducive to their child's growth. The education service can help in these early years to widen the child's restricted range of experience and enable parents to give their child effective support.

5.4 If a suitable educational programme is to be devised at an early stage, it is vital that a child's special needs should be discovered and assessed without delay. In this chapter we draw attention to those aspects of the procedures described in the previous chapter for discovery and assessment which are particularly applicable to the under fives; and we consider ways in which early educational opportunities may be provided. Throughout we consistently stress both the needs of parents and the contribution they can make to their child's development.

I DISCOVERY

5.5 Many severe congenital abnormalities are recognised at birth or in the first few days or weeks of a child's life. Other disabilities or signs of special needs may be discovered in the early years by many people, particularly parents, health visitors, general practitioners and clinic doctors as well as professionals in services other than the health service. These professionals need to be helped, through training, to recognise early signs of special needs and to appreciate that social disadvantage and the disruption of family relationships, as well as physical and other disabilities, may give rise to educational handicap. They also need to know when and where to refer for special help and to understand the importance of working closely with parents and colleagues in other professions concerned with children with special needs and problems. We recognise that, however effective the various services are in providing special help for children whose parents consult them, there will always be some parents who will not use them and with whom it will be extremely difficult to establish contact.

Disclosure to parents

5.6 The discovery of a handicapping condition at or soon after birth needs to be disclosed very carefully and sensitively to the parents, for whom it is a matter of the deepest emotional significance. Even allowing for the fact that this is an extremely delicate and difficult task and that the parents' recollections may be confused or incomplete, much of our evidence indicates that disclosure is often handled badly. The findings of the research project carried out for us on services for parents of handicapped children under five under the co-direction of Professor Chazan and Dr Laing reveal that many of the parents in each of the five areas surveyed were dissatisfied with the insensitive way in which their child's disability had been revealed to them; the inadequate and often confusing information which they had been given about the nature of the disability; and the lack of guidance which they had received on how to cope with the child at home. (2) Apart from the unnecessary suffering caused, a side effect of clumsy or insensitive disclosure may be embittered relationships between parents and the professional staff on whose assistance so much will depend over the years to come. There is also a danger that parents may look for less reliable help outside the health and other services.

5.7 We believe that the discovery of a handicapping condition in a child should usually be revealed to the parents without delay. We recognise that where such a condition is only suspected and not confirmed, the medical and nursing staff will need to exercise discretion in deciding whether or not to tell the parents of their suspicions and at what stage. Where, however, the existence of a handicapping condition has been established, parents should be informed with the least possible delay. They should be given the news in private and, wherever possible, together unless particular circumstances make this undesirable. In hospitals, a prearranged plan involving medical and nursing staff and social workers should be implemented so that all those having contact with the mother and child act in concert. It is to be expected that, after the initial shock, parents will have further questions to ask about the handicapping condition, and they should have the opportunity to put these questions to the paediatrician or other hospital specialist in a further interview or interviews. Some of the mothers in the research project mentioned above felt that they had benefited from being accompanied at hospital consultations by a professional who could ask questions for them. We consider that, wherever parents feel in need of such support, they should be able to look to a particular professional, already known to them as a point of contact, to accompany them. We suggest below that this person should normally be the health visitor. Parents can also prepare themselves for interviews with medical and other consultants by formulating written questions in advance and they should be encouraged and helped to do so by the health visitor.

5.8 We regard it as important that, where the disability is discovered at birth, the mother should be allowed to keep her baby close to her unless there are medical reasons for removing the child, for example to an intensive care unit. Even in this eventuality, as frequent contact as possible should be encouraged between mother, father and child. This may help to reduce the chance of rejection and prevent any disturbing fantasies relating to the disability if the child should not survive.

5.9 All parents of children with disabilities need practical advice and guidance about the implications of their child's problems. However uncertain the diagnosis and prognosis of the handicapping condition, they should be given information at the time of disclosure about available facilities and supporting services so that they do not have the immediate impression of having to cope with their child's problems alone. The information will usually have to be repeated, since few parents can absorb the shock of the disclosure of their child's disability and consider the practical implications at one session. They should be given the name of someone who will act as a point of contact for them and arrange for them to discuss particular aspects of their child's future, for example the educational facilities available, with the appropriate professional. Parents of children who are disturbed or whose development is mildly or moderately delayed, no less than those of children with disabilities about which they are informed in the way described above, will need appropriate practical help, guidance and support.

5.10 Both the needs of the child and the nature of the services available will change over time, and the information given to the parents must be consistently updated. Such information will include details of educational facilities and voluntary societies, advice on claiming allowances and on short-term residential relief and genetic counselling. Leaflets such as those currently issued by the Voluntary Council for Handicapped Children and the Scottish Education Department are useful sources of such information. In addition, we see a clear need in all areas for readily available information about the facilities provided by the local authority in its education and social services capacities as well as by the area health authority. In some areas guides for parents have already been produced; for example, the Sheffield handbook on children with special needs contains comprehensive information about area health services, education services, family and community services, benefits and allowances and voluntary societies and organisations. We recommend that a handbook should be available for each area giving information about local facilities for children with special needs and their parents and that, where such a handbook is not already available, it should be produced under the aegis of the appropriate Joint Consultative Committee (or in Scotland the appropriate Joint Liaison Committee).

5.11 Resource centres on handicap can offer parents and others concerned with meeting the needs of children with disabilities ready access to information. At our request, the Institute for Research into Mental and Multiple Handicap has prepared a booklet describing how to set up a resource centre on handicap, in the light of experience at its Community Resources Centre. (3) (This Centre, which was based at the Stockwell College of Education, Bromley, Kent from 1976 to 1977, was sponsored as a piece of research by the Institute.) We hope that the suggestions in the booklet, which include the collection and organisation of material for use in a resource centre, will be followed up, particularly by citizens' advice bureaux, voluntary organisations and groups of parents of handicapped children as well as local education authorities.

A Named Person for parents

5.12 Even if information about available facilities and supporting services is provided, few parents will be able to make the best use of them without help, and many will be confused. The research project on services for parents of handicapped children under five which was undertaken for us revealed that many of the parents in the survey were in great need of someone to whom they could turn for help and advice at any time. In one of the areas in the survey, for example, 11 of the 30 parents interviewed thought that it would be difficult or very difficult to obtain more specialist advice on any matter which concerned them. Families from ethnic minority groups are likely to face particular difficulty in obtaining help and support for children with disabilities or serious difficulties, through lack of knowledge of what is available and, in some cases, language difficulties. More seriously, many professionals lack knowledge of the special problems that result from differences in cultural patterns.

5.13 We believe that there is a clear need for one person to whom the parents of children with disabilities or incipient special needs can turn for advice on the different services available to meet their child's needs. This should be someone who is well known to and accepted by them. The principle holds whether the children are under five, of school age or making the transition from school to adult life. We therefore recommend that one person should be designated as Named Person to provide a point of contact for the parents of every child who has been discovered to have a disability or who is showing signs of special needs or problems. Where a handicapping condition has been discovered, this person should be available to advise the child's parents on which services to contact and introduce them to those services. She should also ensure that the local education authority is provided with information about the child and then give to the parents the telephone number of the person in the authority's offices to whom the information has been passed. Where children are showing signs of special needs, her function will be to ensure that the parents' anxieties are treated seriously and that their concern about their child's development is followed up.

5.14 The interviews with parents conducted in the course of the research project mentioned above showed that, of those professional workers with whom parents came into contact, the health visitor was generally regarded as the most helpful. Indeed, in some areas in the survey the health visitor was the main source of information on aids, allowances and other forms of help available. In view of her ready access and general acceptability to families as well as her links with doctors and nurses we recommend that the health visitor should act as Named Person in the early years for most parents of children with disabilities and for parents of children showing signs of special needs or problems. In Chapters 9 and 10 we consider who should act as Named Person for parents of children with special needs at later stages in their child's life.

5.15 The health visitor should automatically assume the function of Named Person for the parents of every young child who has a disability or is showing signs of special needs, unless the child is referred for a full investigation by a multi-professional team. In that case it may be more appropriate for the Named Person to be someone who, besides being sensitive to the needs of parents, has particular expertise or interest in the area of the child's disability. We therefore recommend that, where a child's special needs have been assessed by a multi-professional team, the team should designate someone to serve as Named Person for the parents. In some cases they might nominate the health visitor to continue as Named Person, but in others they might decide that it would be preferable for the Named Person to be a social worker, educationist or other professional with particular expertise or interest in the area of the child's disability. In order that the parents should feel assured that there is always someone to whom they can turn for help they should be given the office telephone number of an officer of the local education authority who will have been provided with information about their child and, if the arrangement for their Named Person proves unsatisfactory, will put them in touch with another professional better placed to help them.

5.16 Where a Named Person is designated for the parents of a child from an ethnic minority group, that person should be someone with appropriate experience which will enable him or her to understand the problems facing such a family on account of both their background and their child's special needs. He or she should ensure that, where the parents have language difficulties, they have access to a professional who speaks their own language or, failing that, to someone who can accompany them at interviews with medical or other consultants and act as interpreter.

5.17 We recognise that health visitors are already heavily burdened and that our proposal that they should act as Named Person in the early years for the majority of parents of children with disabilities or incipient special needs may seem, at first sight, to be likely to impose an additional load. We are not, however, proposing that the health visitor should in every case provide further support herself, but rather that she should be able to put parents in touch with those who can. We are confident, therefore, that our proposal represents a manageable undertaking, particularly if the health visiting service is expanded in the period up to 1980-81 as proposed by the government. (4)

5.18 It is crucial, however, that the health visitor should have close connections with the education, social and other services and should work within a multi-professional framework. She may need, for example, to put parents in touch with an officer of the social services department who can arrange short-term residential relief, home help or other day care services. Links with the education service are essential both to help her to appreciate the importance of early educational opportunities for young children with special needs or problems, and to enable her easily to pass on to the education service information about these children. She should be in close touch with members of the special education advisory and support service proposed in Chapter 13, particularly home-visiting teachers working with any of the children and their parents for whom she is Named Person. She should ensure that, when a child for whose parents she has been the Named Person goes to school, the head teacher is informed of his special needs; in many cases this information will be provided by the school medical officer, with whom she will need to work closely, but she should supply any additional information that she has. Throughout, the health visitor should work in close consultation with the general practitioner.

5.19 Parents of children with disabilities or significant difficulties should also be informed at an early stage about voluntary organisations and associations of parents similarly placed. These can offer support and encouragement to parents, give information about the different services available and, in many areas, provide pre-school opportunities for young children with disabilities.

5.20 Voluntary organisations may also be an important source of information about facilities for temporary residential relief about which, as we have recommended, parents should be advised when they first learn of their child's disability. Where children with severe disabilities are living at home, it is imperative for some such relief to be available to the parents. In addition to the overriding requirement for day to day support, parents and other members of the family need to be able to take occasional holidays on their own. Moreover, emergencies such as illness or the death of a relative may require the provision of relief for families from looking after a severely handicapped child. We consider in Chapter 9 the various ways in which relief may be provided.

II ASSESSMENT AND RECORDING

Assessment

5.21 In keeping with our view that the need for special education may begin at birth, it is important that there should be no lower limit to the age at which assessment can be carried out. In the last chapter we proposed that the statutory procedure for assessment, for which we saw a continuing need, should be applicable to any child from birth. Moreover, the concept of different stages of assessment, each requiring more refinement and a wider range of expertise than the one before and culminating in full multi-professional assessment, which we put forward in that chapter, can be readily applied to children below compulsory school age, as we explain more fully below.

5.22 Children with severe congenital abnormalities apparent at birth, or with severe or complex disabilities discovered in the early years of life, will normally be referred directly for multi-professional assessment at our Stage 4 or 5 by the paediatrician or hospital consultant. Others, however, may be referred for multi-professional assessment in a variety of ways, usually following initial assessment or assessments at what could be regarded as broadly equivalent to one or more of our Stages 1-3. In the case of children attending nursery schools or classes, the procedures would be the same as those outlined in the previous chapter for children of statutory school age.

5.23 Where parents are anxious about their child's development, they may seek advice from the health visitor, clinic doctor or their general practitioner. In some cases initial assessment of the child's needs by anyone of these professionals may lead to the child's being referred directly for multi-professional assessment. In others, the health visitor or doctor may call on members of other services to carry out further assessments and to advise on whether a full investigation by a multi-professional team should be conducted. Where a child who is attending a playgroup or day nursery is presenting special problems, we would expect the staff, in close consultation with the parents, to seek advice through the health visiting service, the social services department or the proposed special education advisory and support service. The person consulted would then carry out an initial assessment and, in the light of the results, decide whether to refer the child directly for multi-professional assessment or to call on members of other services to conduct further assessments individually.

5.24 We have recommended that multi-professional assessment should be carried out at one or both of two stages, Stages 4 and 5, the second involving professionals with more specialist expertise. Stage 4, we considered, should take place wherever possible at a school or, in the case of children under five who are not attending school, in another setting which affords opportunities for sustained observation of children's responses to learning. This might be a nursery unit set up specifically to combine teaching with assessment, a day nursery or a play-group. Opportunity groups, which allow children with and without disabilities to play together and mothers of those with disabilities to meet each other (see paragraph 5.64), can provide a useful setting for assessment and one in which the mothers are very closely involved. Stage 5, as we recommended in the last chapter, should usually take place at a centre within the community other than a hospital. A hospital setting might, however, be suitable for some children, particularly those with severe and complex disorders, in which case it is essential that professionals from a wide range of services should be involved and the education service fully represented.

5.25 We are convinced that it is impossible to separate assessment from continuing treatment, care and education. Wherever assessment is carried out, it is a basic requirement that it should aim to discover how the child learns and responds over a period. The time required for effective assessment will depend on the particular difficulties and special needs of the individual child and in some cases may be considerable. Moreover, there may be a delay between assessment and the availability of a suitable placement, during which time the child may need to stay in the assessment unit. In these cases assessment, treatment, care and education will be inextricably linked. It is sometimes claimed that the provision of an element of care in all hospital-based assessment units would clog the units. We believe that such an element is indispensable, and that any congestion should be interpreted by the authorities as a sign of inadequate provision.

The SE Forms procedure

5.26 Although the SE Forms procedure was designed for children who are attending school, including those receiving nursery education, we see no reason why it should not apply also to children who have not yet started school. In their case the procedure will be initiated by the professional who refers the child for multi-professional assessment. The initiating form used will depend on the professional context in which the referral is made. The process of multi-professional assessment will be concluded, as in the case of children of school age, by the completion of Form SE4, renumbered as necessary in the light of our proposals in the last chapter.

Recording as in need of special educational provision

5.27 We have recommended that local education authorities should have the duty to maintain a record of children whom, on the basis of a profile of their needs prepared by a multi-professional assessment team, they judge to require special educational provision. We think that authorities should be empowered to record a child as requiring special educational provision from any age. They may wish to use this power in the case of a very young child with a severe and complex disorder assessed by a multi-professional team as being likely to have a continuing need for specialist help on a regular basis. We envisage that it would be unusual, however, for this power to be used. It would be more usual for authorities to defer a decision as to whether or not a child should be recorded until it becomes clearer, in the light of regular reassessment of his needs, whether his requirement for special help is likely to be a continuing one.

III EARLY EDUCATIONAL OPPORTUNITIES

5.28 It has long been recognised, both here and abroad, that children with impaired hearing need to start their education early. This is widely accepted as true also of those with other disabilities. Lack of opportunities to learn can restrict development in many ways and, in some cases, result in intellectual retardation or emotional disorder. Moreover, there is evidence that for children with severe learning difficulties the years before six may be critical for their grasp of language. (5) For all children with physical or sensory disabilities or showing signs of learning or behavioural difficulties, early education is the key to their individual development and the prevention or mitigation of later disturbances.

5.29 Wherever possible measures to stimulate or encourage the early development of children with disabilities or significant difficulties should be based on the home. The presence of wise and sympathetic parents and a favourable domestic setting will provide the best start in life. But if parental support is lacking or living conditions are unfavourable, compensatory measures may be needed if a child is to have the benefit of good care and education. Children in residential care, especially those in long-stay hospitals, will also have particular need of a warm relationship with one adult.

5.30 Among compensatory measures which may be taken we have been impressed by the 'nurture groups' which have been started in a number of primary schools in London for children approaching or over the age of five who are socially and emotionally affected by severe deprivation in early childhood. (6) Many are from ethnic minority groups and are suffering from severe emotional disturbance produced by the disadvantages associated with living in an impoverished environment combined with cultural confusion and a poorly developed sense of identity. The 'nurture groups' seek to provide, so far as possible, the normal relationships and experiences of early childhood which these children have missed. We believe that children under school age who are suffering from the effects of severe deprivation could also benefit from this specific, intensive kind of help.

5.31 Although we see parents as being the main educators of children wherever possible, we recognise that many parents will be unable to bear this responsibility without help and we therefore recommend that reinforcement and skilled support should be provided for parents of children with disabilities or significant difficulties in the earliest years. When a child has a handicapping condition, many of the parents' instinctive reactions are distorted. When a child with, say, a sensory disability fails to respond in the normal way with smiles or gurgles, the parents may find that, without skilled help, they are unable to give the child the stimulus he needs. So the natural difficulties of responding to the child may be compounded by a sense of helplessness on the parents' part, with serious consequences for the child's development.

5.32 We recommend that a range of different forms of skilled support for parents of children with special needs should be available in every area. The help given by a home-visiting teacher, for example, can be supplemented by the child's attendance at a normal playgroup or at an opportunity group where the parents are able to meet other parents of children with disabilities or disorders. The different ways of providing help and reinforcement for parents, which are by no means mutually exclusive, are considered below. A common feature is the central involvement of advisory teachers belonging to the proposed special education advisory and support service.

Home visiting teachers

5.33 A number of experimental projects in which parents of handicapped children have been trained to teach their children specific skills has shown that, with help and support, a large proportion of parents can contribute very substantially to their children's early development and education. In the Portage Project, based on a large rural area of Wisconsin, materials and procedures have been developed which enable visiting teachers to teach parents in their own home how to set and attain educational objectives for their children. Some of the teachers are professionals, others have no professional qualifications, but all receive special training of about one week and work under close supervision. They conduct a systematic programme of visits to plan with the parents a weekly scheme of directed activities based on continuing assessment and evaluation of the child's progress. Children with all types of disability and disorder aged between birth and six years who are shown through careful screening to have serious developmental delays are accepted. Recorded results show that some 60 per cent of the parents have been able to follow the programme adequately, and that significant gains have been made by the children, compared with a control group, in the areas of language and academic and social skills. (7)

5.34 The materials developed by the Portage team have been used by the Health Care Evaluation Research Team headed by Dr Kushlick, under the auspices of the University of Southampton Faculty of Medicine, the Medical Research Council, the Department of Health and Social Security and the Wessex Regional Health Authority. A home teaching service has been organised to train parents with severely retarded children under school age to carry out systematic teaching activities with their child at home; the service covers, broadly speaking, the Winchester and Central Hampshire Health District and the areas of the corresponding social services. During its first six months the project revealed that parents were very keen to help their children by teaching them specified activities. Even when away from home on holiday, most parents carried out some activities and recorded details of them. Moreover, where teaching activities ceased because of serious family difficulties, such as marital, health or financial problems, they were invariably resumed as soon as possible. Records of the children's development showed that several children made major gains in areas where they were particularly retarded and that all made progress.

5.35 We believe that a comprehensive peripatetic teaching service is needed which would show parents how to carry out systematic activities with the children and work directly with them. At present the only major peripatetic teaching service in England, Wales and Scotland providing home visiting teachers for young children with special needs is for those with impaired hearing. Members of the service visit children of all ages. The organisation of the service varies considerably between different authorities; some teachers work in isolation, some in groups and others in teams with a designated leader. Although peripatetic teachers of the deaf work mostly with children under school age, some spend a good deal of their time visiting and supporting children in ordinary schools, of whom some have only a minimal hearing loss and might sometimes be more effectively helped in other ways, for example in suitably staffed resource centres in the schools. Moreover, very few peripatetic teachers of the deaf have had any special training in work with parents or in the development of young children.

5.36 Peripatetic services also exist for children with visual or mental disabilities, although they are less widely available than the service for the deaf. The Royal National Institute for the Blind provides an education advisory service for parents of visually handicapped children, which is regarded by the Institute as an advisory rather than a teaching service. The advisers are, however, teachers of the blind by training, and use their experience as teachers in advising both parents and professionals. An increasing number of local education authorities has appointed peripatetic teachers of the visually handicapped, but many of them have little experience of dealing with very young children or of working with parents. Several local education authorities have appointed peripatetic teachers to visit mentally handicapped children below school age. Another form of peripatetic service is provided by some teachers attached to various types of assessment unit who similarly visit all young children with special needs who are attending the unit.

5.37 We recommend that there should be a comprehensive peripatetic teaching service which would cater, wherever possible, exclusively for children with disabilities or significant difficulties below school age. It should cover every type of disability or disorder - hearing and visual impairment, physical disability, behavioural and emotional disorders and learning difficulties of any kind. As we have shown, peripatetic teaching is at an early stage of development in some of these fields and in others does not yet exist. A considerable expansion will therefore be needed if there is to be a comprehensive service covering the range of handicapping conditions. We recommend that there should be scope for specialisation within the service: in particular, in view of the specific skills required for their teaching, children with sensory disabilities should be visited by teachers with related expertise. Individual teachers, however, particularly in rural areas, might see children with disabilities outside their own specialism.

5.38 In some areas, particularly those with scattered populations, it might not be practicable to organise a peripatetic teaching service for children under five separately from that for children of school age. In such cases peripatetic teachers working with very young children with special needs will require special training on the lines proposed below.

5.39 We consider that peripatetic teachers should work with and provide support for parents. They must therefore have an understanding of parental needs and cooperate closely with other professionals. Unlike the home teachers in the Portage Project, however, some of whom were not professionally qualified as teachers, peripatetic teachers should spend part of their time working directly with children. We envisage that their job would be as follows:

(i) to assess children's educational needs on the basis of trained observation;

(ii) to work with parents towards an educational programme for their child in the light of his assessed needs;

(iii) to work directly with and teach children on a regular basis; and

(iv) to maintain contact with other professionals in the various services concerned with meeting the needs of young children with disabilities or significant difficulties and their parents.

(v) to encourage and participate in meetings of groups of parents of young children with special needs; and

(vi) to put parents in touch with toy libraries, local forms of pre-school provision - playgroups, opportunity groups, day nurseries or nursery schools or classes in ordinary or special schools - and voluntary organisations.

5.41 It has been suggested to us that peripatetic teaching should be based upon a school, particularly a special school, because this would enhance the teachers' standing with their colleagues in schools in the area. However, it would not always be possible for peripatetic teachers to work from a special school, especially in a rural area, and it is important that they should be seen to provide a service for all children with disabilities or significant difficulties under school age, whether or not they are likely to be placed in special schools. Furthermore, it would be difficult for peripatetic teachers who were individually attached to different schools to maintain close links with their colleagues who specialised in particular areas of disability and to discuss aspects of their counselling work with other members of the service. We consider it preferable for peripatetic teachers to be part of our proposed special education advisory and support service and for individual teachers to be usually attached to an assessment centre, so helping to ensure that their skills are deployed as widely as possible. This would not, however, preclude the possibility of those who specialised in particular areas of disability having a second base in a special school if one were conveniently placed; indeed, it would be desirable for peripatetic teachers with expertise in relatively rare or complex disabilities to have close links with special schools catering for those disabilities.

5.42 We recommend that training for peripatetic teachers should be organised on an in-service basis. Training programmes should include inter-professional courses so that peripatetic teachers are made aware of the work of professionals in other services concerned with young children with special needs and their parents and come to recognise their own limitations in providing help for families with such children. The training should aim to increase the teachers' knowledge and understanding of child development in the early years and to develop their skills in observation and counselling. By counselling, in this context, we mean helping parents by being ready to listen to their problems and assist them to explain their needs. If the problems are concerned with educational provision, peripatetic teachers may be able to give direct help; if not, they should put parents in touch or see that their Named Person puts them in touch with other professionals who can help them.

Toy libraries

5.43 Peripatetic teachers need access to a range of toys, books and play materials which they can lend or recommend to the families of young children with special needs whom they visit. Toy libraries have provided a very valuable service and we commend the effort which has been put into them by many voluntary and statutory organisations. Not only do they make materials available, but they enable mothers to meet other families with similar problems in an informal setting and stimulate interest in the purpose of play. We think that it is desirable that they should also be organised by the education service and that they should be available on a wider basis, for example in clinics, day nurseries and assessment centres.

Parents' workshops

5.44 Another form of support for parents of young children with special needs is the group session or 'workshop'. The workshops which have been run for groups of parents of mentally handicapped children at the Hester Adrian Research Centre, Manchester University, have been designed to train the parents in child management, observation and teaching, on the basis that this will both help the child and serve to alleviate indirectly some of the root causes of parental problems, particularly feelings of inadequacy and perplexity. The success of the workshops in demonstrating the feasibility of involving parents in the early education of their children has led to suggestions that advanced courses should be established for parents who hope to be able to organise workshops for small groups of parents in their own neighbourhood. The leaders of the project at the Hester Adrian Research Centre recognise however that, even under expert guidance, parents' workshops are not always successful. They must meet the needs of parents who will differ in background, personality, intelligence and ability to express themselves; and a high degree of skill and sensitivity is required to run a small group of this kind.

5.45 Although some caution is therefore called for, we think that there is scope for extending the provision of workshops for parents of young children with special needs, so long as all the difficulties are understood. Where the children are attending schools there should be close contact between the workshops and the schools. Local education authorities may take the initiative in some cases; we have seen an effective approach in Devon, for example, where residential weekends are organised for parents of children with disabilities, involving lectures, discussions and opportunities for informal contact between parents and the professionals working with their children.

5.46 We hope that initiatives in organising group sessions will also be taken by other bodies. For example, voluntary organisations concerned with particular disabilities provide workshops, seminars and so on. It is unfortunate that these do not always attract the parents who most need help, many of whom are unknown to the organisations, or unwilling to join them. A voluntary organisation may, however, be able to reach the parents and bring some of them into a workshop if it has effective contacts with members of other agencies and professions such as health visitors, social workers and teachers, who will be in touch with a wider range of parents. Colleges and departments of education which have courses for teachers of children with special needs may also run workshops; and these are additionally helpful in giving teachers insight into parents' problems. Intensive group work in hospital settings, for example the Paul Sandifer Centre at Great Ormond Street in London, can also be most helpful where the hospital has special psychiatric and other resources. Within such major centres there are medical and other experts available to give talks, for example on genetic counselling, or psychiatric help when parents require it.

5.47 The initiative in organising group sessions and skilled support may also be taken by the parents themselves. In Southend, for example, where a group for parents of children with Down's Syndrome was set up by the local branch of the National Society for Mentally Handicapped Children at the suggestion of a local medical officer, group meetings have been successfully conducted by parents. (8) The leaders are in regular contact with the supporting services and different professionals attend group meetings whenever possible. We consider the conditions for the successful development of such groups in Chapter 9. Local radio can play an important part in furthering their establishment.

5.48 A group of parents of children with disabilities or significant difficulties may enlist the help of professionals to provide more specialist types of guidance. The Kith and Kids parents, for example, organised an intensive summer teaching programme for their children. In their 'Two-to-One' project, two volunteers (who might be parents) were recruited, trained and assigned to carry out individual teaching programmes, worked out jointly by the professionals and the parents, for each of the children participating. (9) This sort of approach can have the salutary effect of requiring professionals to respond to needs identified by the parents themselves.

Schools, classes and units

5.49 Nursery education (which can be provided for children in nursery schools from the age of two and in nursery classes from the age of three, unless exceptional circumstances require earlier admission) is of immense value. It not only contributes to a child's early development but also provides opportunity for the early identification of signs of special needs or problems in young children. As we have indicated, it can provide a very useful setting, too, for the assessment of a child's needs. We believe that young children with special needs can benefit very considerably from nursery education, whether on a full or part-time basis, and that wherever possible they should be educated in ordinary nursery schools and classes.

5.50 Nursery education has expanded modestly in recent years, mainly on a part-time basis. The extent of the provision is still insufficient. The proportion of two, three and four year olds attending maintained nursery schools and nursery classes in maintained primary schools in England and Wales in January 1977 on a full or part-time basis is shown below.

In Scotland the position was marginally better, with nursery education being available in nursery schools and nursery departments in September 1976 for 16.6 per cent of children aged three and four years. (10) Within these restricted numbers of children receiving nursery education the proportion of children with special needs appears to be very limited. In a survey of the provision for handicapped young children in the Grampian Region of Scotland, which was carried out for us by Dr Margaret Clark, 138 out of 2,441 children attending nursery schools and classes were considered to be handicapped (5.7 per cent) compared with 63 out of 617 children (10.3 per cent) in the sample of playgroups studied and 54 out of 321 children (16.8 per cent) attending day nurseries. (11) (The children in the day nurseries were normally admitted on account of some form of social deprivation.) There is other evidence to indicate that in some authorities at least children with disabilities are not receiving any preferential selection for nursery education. (12)

5.51 While recognising the financial constraints, we should like to see a considerable expansion of opportunities for nursery education for young children with special needs on a part-time as well as a full-time basis. We do not, however, believe that it would at present be either practicable or desirable to seek to achieve this through a policy of positive discrimination in favour of those with disabilities or significant difficulties in the admission of children to nursery schools and classes. Rather, we recommend that the provision of nursery education for all children should be substantially increased as soon as possible, since this would have the consequence that opportunities for nursery education for young children with special needs could be correspondingly extended.

5.52 If ordinary nursery schools and classes are to make satisfactory provision for children with a variety of special needs, a number of conditions must be met. First, the attitudes of the staff and the parents of all the children must be favourable. Secondly, the accommodation and equipment must be suitable. Thirdly, staffing ratios for non-teaching as well as teaching staff must be generous. Fourthly, the implications for all the children of accepting children with different disabilities and difficulties must be carefully thought out by all those concerned. Fifthly, teachers must have regular advice and information from specialist and advisory staff, in particular from members of the proposed special education advisory and support service, educational psychologists, speech therapists, physiotherapists, doctors and nurses. These considerations are discussed in more detail in Chapter 7 in relation to provision in ordinary schools for children with special educational needs of statutory school age.

5.53 The importance of generous staffing (particularly so far as nursery nurses are concerned) and of adequate accommodation as conditions for the integration of children with disabilities or disorders in ordinary nursery schools and classes was stressed by teachers interviewed in the course of Dr Clark's research project in the Grampian Region. Most of the teachers expressed willingness to accept up to one in ten handicapped children in their class. A third of the teachers in nursery classes, however, felt that their present staffing ratio was insufficient to cope with handicapped children, whilst a half considered their accommodation to be inadequate to take such children.

5.54 The admission of a child with a disability or serious difficulty to an ordinary nursery school or nursery class may be of inestimable value in helping to increase his self-confidence and pave the way for his successful integration into an ordinary primary school. If he is to be helped as effectively as possible, however, teachers must do more than merely accept him; they must devise for him such special programmes as they consider necessary, keep his progress under continuous review and encourage him to play with children without disabilities. The findings of Dr Clark's research project reveal that there is a need for much greater understanding by teachers in nursery schools and classes of the special needs of children with disabilities or significant difficulties and of the teacher's contribution to meeting them. In later chapters we consider how this understanding might be developed through training and closer relations with local authority advisers in special education.

5.55 Although we regard it as desirable that, wherever possible, young children with disabilities or significant difficulties should be educated in ordinary nursery schools and classes, some young children may require separate special facilities such as special nursery units attached to ordinary nursery or primary schools, special nursery classes attached to special schools or, for the very severely handicapped, special care units within special schools. We therefore recommend that special nursery classes and units should be provided for young children with more severe or complex disabilities.

5.56 We would expect a well-planned special nursery unit or class attached to an ordinary nursery or primary school to have the advantages over an ordinary class of being smaller and thus making it possible for the children to receive more attention, of providing more space and of facilitating the organisation of support services. Under our proposals in Chapter 12 a teacher in such a unit would be expected to have additional training in the teaching of children with special educational needs. A special nursery unit or class may be a more suitable form of provision than an ordinary class for a distractable, hyperactive child, for example, who needs to be in a small group.

5.57 Where facilities for nursing care, intensive treatment or teaching by special methods or with special programmes are needed, special nursery classes attached to special schools may be the most suitable form of provision. In some cases, early specialist assistance in such a class, for example in reading braille or in developing mobility and other specific skills, may enable a child to progress to an ordinary school. In others, where education in an ordinary school is likely to prove impracticable or ineffective, attendance at a special nursery class makes for educational continuity for young children. Attendance at the nearest suitable special school may however entail boarding away from home. In deciding whether or not very young children are to be sent away to boarding school a balance must be struck between the value of expert teaching and the inherent disadvantages of separation from family and home.

5.58 In all cases where a young child with special needs is attending a nursery school, class or unit, close links should be developed between the school and home, and parents should be involved as closely as possible in the work of the schools and classes. Those of us who visited Ysgol Delyn, Mold, were impressed by the way parents were encouraged to accompany very young severely handicapped children to the school and stay with them during the day.

Playgroups, opportunity groups and day nurseries

5.59 In order that the varying needs of children may be met as flexibly as possible, a range of provision for young children with special needs should be available, ideally in every area. We believe that this should include playgroups, opportunity groups and day nurseries as well as nursery schools and classes. It is important that there should be the closest possible cooperation between authorities and agencies, including voluntary bodies, providing services for the under fives, and some useful examples of different forms of local coordinating machinery were given in a circular letter issued jointly by the Departments of Education and Science and Health and Social Security in March 1976. (13) We return to the subject of coordination of services in Chapter 16.

5.60 If, as we propose below, playgroups and opportunity groups as well as day nurseries are to make an increasing contribution to the provision for young children with special educational needs, it is essential that their staff should have suitable training and that their links with the education and other services should be strengthened. We welcome the emphasis on the need to improve the educational content of the various forms of day care in a circular letter issued jointly by the Departments of Education and Science and Health and Social Security (14) to reinforce the one mentioned above and we consider below how such improvement might be achieved.

a. Playgroups and opportunity groups

5.61 Playgroups, which may be organised by a committee of parents or by private individuals, cater mainly for children over three years of age, although some accept children from two years. They have increasingly shown a willingness to accept young children with disabilities, who are thereby enabled to extend their range of experience by playing with other children, whilst their parents have an opportunity to meet those of children of the same age without disabilities and to see their child's abilities and disabilities from a different perspective. In addition, playgroups can offer parents support in working with their child. In the Grampian Region of Scotland, ten per cent of the children attending the sample of playgroups studied in Dr Margaret Clark's research project were perceived as handicapped, and all the staff in playgroups interviewed in the project were willing to accept some children with complex disabilities. The general attitude of the staff in the playgroups seemed to be one of acceptance of all children in the community whose parents wished them to attend.

5.62 We recognise that play groups would find difficulty in coping with a substantial proportion of children with disabilities or serious difficulties and that they may be unable to give much help to severely handicapped children who need constant individual attention. We think that there is considerable scope, however, for an increase in the provision made by playgroups for young children with special needs and we recommend that they should be prepared to accept young children with disabilities or significant difficulties wherever possible. They should be encouraged to do so by local authorities who, together with area health authorities, can offer them significant help not only through financial grants but also by making available suitable premises and professional advice.

5.63 One of the main difficulties faced by playgroups, according to the Pre-School Playgroups Association in its evidence to us, is making contact with parents of children with special needs. There is clearly need for much closer liaison between local authorities, health services and voluntary bodies so that, where a playgroup is considered to be a suitable form of provision for a particular child, the parents can be introduced to a playgroup in their area. Local radio can help to disseminate information about those playgroups willing to accept children with disabilities.

5.64 A special form of playgroup is the opportunity group, which seeks to bring children with and without disabilities together and enable their mothers to meet each other. We were impressed by evidence from one such group that all their parents 'were unanimous that the best support and understanding for parents of handicapped children comes from other parents of handicapped children'. Opportunity groups range from informal clubs, where mothers chat and children play, to structured sessions devised and supervised by psychologists and therapists. They are a valuable source of provision for children with disabilities up to the age of five and are especially willing to take children under the age of three. As we have already pointed out, they can provide a useful setting for assessment, and one in which parents are closely involved. They may not be suitable, however, for certain children, particularly the profoundly deaf, who need highly specialised and intensive language teaching and experience and severely physically handicapped children who need medical supervision and frequent, perhaps daily, physiotherapy.

5.65 We regard successful opportunity groups as a most significant development, particularly on account of their spontaneity and we recommend that much greater use should be made of opportunity groups as a form of provision for young children with disabilities or significant difficulties under school age. The pattern of their development throughout the country has, however, been uneven and we very much hope that groups will be started in areas where they do not already exist and that local authorities will promote their establishment. Where they do exist, local authorities should be ready to offer them support without detracting from their voluntary and spontaneous character.

5.66 In view of the increasing willingness of play groups to accept children with disabilities, and our proposal that the provision made for such children by both playgroups and opportunity groups should be increased, we recommend that their staff should receive suitable training in helping to meet the special needs of young children with disabilities. We welcome the development of short courses of training run by the Pre-School Playgroups Association and are glad to know that many playgroup leaders already have access to local authority training facilities. We would stress the importance of including particular reference in any training for playgroup and opportunity group staff to the problems of children with special needs. We also consider that such staff would have much to gain from courses of training organised on inter-professional lines, which we discuss further in Chapter 16. We further recommend that professional help and advice from members of the various supporting services should be readily available to playgroups and opportunity groups, and that members of the proposed special education advisory and support service, including peripatetic advisory teachers, should be in close touch with the groups and help their staff to devise suitable programmes for those children with special educational needs.

5.67 There is room, particularly in rural areas, for experimentation by local authorities with a multi-professional team approach to the support of different forms of provision for young children with special needs, such as playgroups and opportunity groups, day nurseries and nursery classes, which may be held in a variety of settings including play buses and caravans. We have learned with interest of the Canadian Mobile Team Project, which was designed to explore the feasibility of using hospital-based mobile treatment staff in a coordinated team approach to support the integration of multiply handicapped young children in local kindergartens and schools. The mobile therapists, together with a social worker, work closely with the children's teachers and parents on early developmental programmes, and in 1976 three mobile teams were supporting 107 children in the community. The assessment of the early results of the project is encouraging. (15) It is important that teachers should be closely involved in all such team approaches.

b. Day nurseries

5.68 Day nurseries are organised by the social services departments of local authorities or, in some cases, by voluntary or private bodies or by individuals, in which case they must be registered with the local social services department. They cater for children of all ages from six weeks to five years, usually from families in some category of social or economic need. Not only do they take younger children than do nursery schools but they are open for longer hours and remain open five days a week throughout the year. Some take a percentage of children with disabilities or significant difficulties or have a special unit for such children, and they are being increasingly used as assessment centres.

5.69 In some areas day nurseries are developing as a focus for all day care services in their locality and as a meeting place for groups of parents and child minders as well as mother and toddler groups and playgroups. A recent experimental project carried out as part of the Lambeth Inner Area Study in which a team of salaried child minders, specially recruited and trained for the purpose, was offered the support of a day nursery, found that the facilities of the nursery and the skills of its staff played a crucial part in improving the performance of the team. (16) There is clearly considerable scope for the further development of day nurseries as day care centres in this way. We recommend, however, that more educational opportunities should be provided for children attending day nurseries, particularly those with special needs. Peripatetic teachers should visit day nurseries and their staff should have ready access to the proposed special education advisory and support service. Wherever possible, they should have a permanent teacher on their staff who would be appointed by the local education authority and seconded to the social services department for the purpose.

5.70 We welcome the development of combined day nurseries and nursery schools. They have the advantage of concentrating the intensive family support, care and education of children from an early age. They represent a particularly flexible form of provision, offering opportunities for children to spend varying amounts of time in the day nursery and educational settings; in accordance with their individual needs. They thus offer considerable scope for helping to meet the needs of children who require special help. We recommend that the provision of combined day nurseries and nursery schools should be increased. We recognise that one question which may arise is who should be in charge of combined centres. This raises a number of sensitive issues which will need to be tackled as soon as possible.

5.71 Although the basic course leading to the award of the Certificate of the National Nursery Examination Board or the Scottish NNEB gives nursery nurses a good basic knowledge of normal child development, it does not adequately equip them to recognise in children signs of special needs and help to meet those needs. We are therefore glad to note that pilot courses leading to an advanced certificate of the Boards have been established, which are designed to give nursery nurses a deeper knowledge of children with special needs. We hope that further courses of this kind will be established and that nursery nurses employed in day nurseries will be encouraged to take them. Day nursery staff should also have opportunities to attend in-service courses organised on an inter-professional basis at which they would learn to recognise in children signs of special need and know when and where to refer for special help. Such courses would also enable them to meet teachers and other professionals involved in working with children with special needs.

CONCLUSION

5.72 This chapter has had three main themes: the crucial importance of early educational opportunities for children with disabilities or who are showing signs of having special needs; the role of parents as educators of their children and the need to provide them with skilled help; and the need for close cooperation between the different professions concerned. The three themes come together in the idea of the Named Person, who will provide a single and constant point of contact for parents, will be able to see that their anxieties are followed up, will be able to put them in touch with members of the different supporting services and will herself appreciate, through her own close links with the different services, the importance of early education in the development of children with special needs. However this person is known, whether as a Named Person, an interpreter or by any other name, we believe that such a person should be designated as soon as possible for every parent of a child who has been discovered to have a disability or whose development is giving serious cause for concern. We regard this as one of the cornerstones of the service, which should be available for parents of children with special needs.

References

(1) Cyril Cave and Pamela Maddison, A survey of recent research in special education (to be published by the National Foundation for Educational Research).

(2) For details of the research project see Appendix 5.

(3) Jobling M and Parfit J How to set up a resource centre on handicap (Institute for Research into Mental and Multiple Handicap 1977).

(4) Priorities in the health and social services. The way forward (HMSO 1977), p 10.

(5) Swann W and Mittler P 'Language Abilities of ESN(S) pupils', Special Education: Forward Trends, 3 No 1 (March 1976), 24-27.

(6) Boxall M The nurture group in the primary school (Inner London Education Authority 1976).

(7) Shearer MS and Shearer DE 'The Portage Project: A model for early childhood education' Exceptional Children 39 (1972), 210-217.

(8) See Pugh G and Russell P Shared care. Support services for families with handicapped children (National Children's Bureau 1977), pp 37-43.

(9) Jones A Two-to-One: A Kith and Kids Community Project (Inter-Action Inprint 1976).

(10) Department of Education and Science and Scottish Education Department statistics.

(11) For details of this research project see Appendix 6.

(12) Stevenson J and Ellis C 'Which three year olds attend pre-school facilities?' Child: care, health and development 1975, I, 397-411.

(13) Local Authority Social Services Letter LASSL(76)5 DHSS, Reference No S21/47/05 DES, Co-ordination of local authority services for children under five (9 March 1976).

(14) Local Authority Social Services Letter LASSL(78)1, Health Notice HN(78)5 DHSS, Reference No S47/24/013 DES, Co-ordination of services for children under five (25 January 1978).

(15) Cripps R (Project Director), Final Report on National Health Research and Development Project No 609-1006-20(A) (Mobile Team Project) January 1974 - November 1976 (unpublished).

(16) The Groveway Project: An Experiment in salaried childminding (Department of the Environment 1977).