6 surveillance - school-age children and young people
6.1 Although each child will receive a health check on entry to primary school, there is little formal child health surveillance beyond this point. For school-age children, both health promotion and the detection of problems should be a part of mainstream school life. (Health promotion is discussed in an earlier section of this guidance.)
6.2 The new GMS (General Medical Services) contract and the emerging Community Health Partnerships are essential building blocks in delivering health care for school-age children and young people. Hall 4 highlights that on average, school-age children are in contact with their GP twice per year between the ages of 5 and 14, rising to three times per year between the ages of 15 and 17. Each contact between a primary health professional and a child should be seen as an opportunity for ongoing child health surveillance, used to detect any health issues or concerns and to provide health promotion advice. Innovative approaches should also be developed to incorporate this within other key contacts such as immunisation points, interaction with the school nursing service, and in the context of the health promoting school concept.
The core programme of contacts
BCG (against tuberculosis)
Skin test then, if needed, one injection
Tetanus, diphtheria and polio ( Td/ IPV)
6.4 These immunisation contacts provide an opportunity for health professionals to check a child's immunisation status and to provide health promotion material and information about where children, young people and their parents can access support and advice if required.
Identifying problems and providing support
6.5 The majority of children with a serious disability or disorder will be identified in the course of their early and pre-school years. However, some needs will only become evident in a classroom context. Teachers get to know their pupils well in the first year of primary school and are already required to review each child as part of a baseline assessment process.
6.6 The Education (Additional Support for Learning) (Scotland) Act 60 was passed in 2004 and comes into force from Autumn 2005. The Act will replace the current Record of Needs system and marks a move from the term "special educational needs" to a much wider and more encompassing concept, "additional support needs". The new term incorporates any factor which causes a barrier to learning and could relate to social, emotional, cognitive, linguistic, disability, or family and care circumstances. For instance, additional support may be required for a child or young person who is being bullied; has behavioural difficulties; has learning difficulties; is a parent; has a sensory or mobility impairment; is at risk; or is bereaved. Some additional support needs will be long term while others will be short term and the effect they have will vary from child to child. However, in all cases, it is how these factors impact on the individual child's learning that is important, and this will determine the level of support required.
6.7 Under the new legislation, education authorities are required to identify, address and keep under review provision for the needs of all children and young persons with additional support needs for whose education they are responsible. They are also required to publish their policy and arrangements for identifying and addressing additional support needs, what the role and rights of parents and children and young people are, and who they should contact to obtain information and advice.
6.8 In identifying and addressing children's additional support needs, local authorities must seek and take account of information (including formal assessments) from other agencies such as health and social work services. When requested, health, social work and other agencies will be expected to provide advice and information, including reports and formal assessments, to assist the local authority in identifying a child's or young person's additional support needs and, where necessary, establishing a Co-ordinated Support Plan. This will be a statutory, strategic, long-term planning document for children and young people with the most complex needs, who require support from services outwith education to support their learning. Parents have new rights including the right to ask the education authority to assess their child for additional support needs, and to ask for a particular type of assessment, such as a medical assessment.
6.9 The Scottish Executive is preparing a Code of Practice to set out how the new system will operate, and on proposals for the timescale in which agencies must respond to an education authority request for assistance for an individual child. Primary care staff will need to be familiar with the provisions of the Act and the guidance provided in the Code, and clear and efficient referral pathways for expert assessment must be in place and familiar to teaching staff.
6.10 In the context of the school nursing framework 61, school nurses have a key role in delivering the aims of Hall 4 for school age children and young people. This is particularly relevant in relation to delivering the core programme but also in relation to identifying, assessing and delivering support to children with particular needs. The framework refocuses the nursing service in schools to ensure that best use is made of school nurses' skills and expertise. Nurses working in schools should focus less on routine surveillance of children and young people and take a more proactive approach to assessing and meeting the health needs of each school, promoting healthy lifestyles and healthy schools, supporting children with chronic and complex health needs, and supporting vulnerable children and young people.
6.11 NHS Boards are developing action plans for implementing the school nursing framework, which signalled that additional investment would be required to increase the number of staff to meet the new demands.
6.12 The transition from early years to primary school, primary school to secondary school, and from secondary school to employment or further education or training have been identified as vulnerable stages of development for children and young people. Transitions between geographical and agency areas can also be vulnerable points. The exchange of information within and between agencies at these points has been identified as a major weakness in the way that services are delivered to meet the identified needs of individuals and families. This is particularly relevant in relation to the needs of vulnerable children and the exchange of information that allows agencies to carry out integrated assessment of need and to track these individuals. It is particularly important that information is passed on where there are concerns about a child's welfare.
6.13 A transition record is already completed at the end of pre-school and passed on to primary schools, though practice currently varies across Scotland. NHS Boards and local authorities should work together to develop mechanisms for the transfer and use of this record by both school health and education staff, and ensure that these arrangements extend to partner providers of pre-school education. It is important that robust mechanisms are in place to ensure that any information about a child's health needs is transferred efficiently when a child transfers between institutions.
6.14 The years from the early stages of secondary school education and adolescence to adulthood are times of great change for young people. It is vital that in this period, young people feel supported, maintain self-esteem, and avoid a wide range of health-damaging behaviours and other hazards. Schools, working in partnerships with families and communities, can make a vital difference in this period.
6.15 The Additional Support for Learning Act includes provisions to strengthen future needs planning arrangements for those young people with additional support needs, who need extra help, to ensure a successful transition to post-school life. The Act requires that transition planning should begin at least 12 months before a young person will leave school. The Code of Practice, when finalised, will recommend that joint planning and preparation should be carried out by the education authority and identified future agencies well before this date. Education authorities will be required to provide information to other agencies at least 6 months before the young person leaves school to allow them adequate time to prepare.
6.16 Independent schools should ensure that arrangements are in place for pupils to receive health promotion advice and activities, including immunisation, consistent with this guidance.
Children outwith school
6.17 In planning and delivering the universal core programme of contacts, NHS Boards should make particular arrangements to identify those children who are not in school, and to ensure that they receive care and support consistent with this guidance. This will require close liaison between NHS and education authority services. These children and young people may include those who:
- Are home educated.
- Are in secure or special residential care with associated education provision.
- Are in hospital or residential respite care.
- Have been excluded from school.
- Are truanting.
6.18 The Framework for Nursing in Schools62 recommends that community, practice and school profiling should identify vulnerable groups of children and young people who may require extra or different support and help, and that school nurses should be supported to work in a range of settings in order to meet these needs. The Framework also recognises that the needs and problems of school age children and young people are not restricted to term time and can often be more exaggerated during the school holiday periods. It advises that this should be reflected in appropriate service provision.
6.19 These issues link with the following section on Identifying Need and Targeting Support.