In Bristol, we created the post of Inclusion Nursery Nurse (INN) to better meet the needs of children with complex health or special educational needs. Over the years the INNs have become a pivotal link between health and education services and brought many benefits to both the children and their families.
There are now four INNs in place, each forming part of a multi-agency team and funded jointly by the NHS and Children and Young People's Services.
The posts were created largely in response to Early Support, now part of the Aiming High for Disabled Children programme. Aimed at families with disabled children under five, its goal is to ensure that a young child is assessed and treated at the earliest opportunity, and it has succeeded in raising awareness about the many young children who require early assessment and multi-agency interventions.
Developed by parents, carers and practitioners, Early Support provides a standard framework with sets of materials and expectations applicable to both health and family services.
MULTI-PROFESSIONAL TEAM
Three days a week the INNs are based in a Child Development Assessment Centre and managed by a paediatric nurse with a specialist interest in children who have complex health needs and disabilities. Other members of the multi-professional team include psychologists, therapists, social workers and paediatricians.
Here, their role is to co-ordinate a multi-professional developmental assessment for children with complex needs and to act as keyworkers for up to six children and their families.
The assessment runs from 10am to 1pm, three days a week for six weeks, and fits in with the local school term dates. During what is like a shortened nursery day, the INNs use a multi-sensory approach with daily themed welcome times, textured messy play, social mealtimes and structured activities. These include one-to-one time when the INNs complete developmental information that forms part of the assessment process. Parents and carers attend all the sessions with their children, giving them an opportunity to see at first hand the specialist strategies they can then use at home.
At the end of the six weeks, the team produces a report highlighting the child's strengths and needs and recommendations for future provision.
For the remaining two days of the week, the INNs focus on outreach work, involving home visits and play therapy sessions. Each INN also runs an SEN/inclusion support group within children's centres to ensure their key children's parents can access service provision and to support centre practitioners and SENCOs.
The INN role is invaluable when children start education provision - a very daunting time for both the child and their families. Here, the INNs support both the children and the setting staff, be it in the form of advice, support for the child or resources such as communication books or visual timetables.
BENEFITS
In their beneficial role, the INNs:
- enable the health authority disability team to provide a holistic overview of a child's medical and educational needs
- help the needs of the child and family to be at the forefront of the Family Support Planning Meetings agenda
- provide families with a named professional whom they know and can filter information through to the other professionals involved
- provide information and emotional and practical support to the child and their family
- identify and address the needs of all family member
- help families in their dealings with agencies (health, social services, education, the voluntary sector).
THE FUTURE
The city-wide Community Children's Health (NHS) Partnership is striving for improved service delivery for these vulnerable children. Families should have confidence in their local disability services, and the role of the INN (and the wider disability team) can help build this confidence and strengthen positive relationships. The use of Early Support and the 'team around the child' principles enhances service delivery and makes it truly child-focused.
Despite the planned cuts in public funding, the role of the INN has been recognised and is secure, though it will have to evolve and split evenly between assessment and keyworker duties.
CASE STUDY: VIKKI TURNER
'I did a degree in early childhood studies and drama at the University of the West of England, based in Bristol. While studying, I worked at the university nursery, first volunteering and then for paid bank work while also deputising at the after-school club. After graduating, I worked as a room leader in a pre-school before taking up the job of Inclusion Nursery Nurse.
'I really enjoy the one-to-one contact, being able to work with the whole family and being able to devise strategies to help children communicate.
'There are challenges. There is sometimes a language barrier with some families, but it's rewarding when you're able to overcome it with the use of bi-lingual support. I also have learned so much about different cultures, religions and beliefs.
'The best part of my day is having parents thank me sincerely for everything and seeing strategies and ideas being put in place and working to support the family as a whole unit.'
CASE STUDY: ROBBIE
Robbie is a four-year-old boy with delayed speech and language; there were also concerns about his concentration and impulsive behaviour. The SENCO at his children's centre referred him to the NHS disability team, which in turn referred him for a developmental assessment.
The assessment report was completed after Robbie attended the six-week block and had been seen by the multi-professional team. The report was then sent to the Local Education Authority and a statement was awarded. It had previously been turned down because of lack of evidence. Robbie's father says, 'The report painted a perfect picture of Robbie.'
MORE INFORMATION
- Aiming High for Disabled Children, www.dcsf.gov.uk/everychildmatters/healthandwellbeing/ahdc/AHDC/
- Every Disabled Child Matters, www.ncb.org.uk/edcm/home.aspx
- Care Co-ordination Network UK, http://ccnukorguk.site.securepod.com/ccnuk/default.asp
- Early Support - Helping every child succeed, www.earlysupport.org.uk.
Gareth Jones is lead nurse for Children with Disability, Community Children's Health Partnership, North Bristol NHS Trust and Vikki Turner is Inclusion Nursery Nurse at Tyndall's Park and St Paul's Children's Centres
