MISS JILLIAN. I. CROSBIE BSc (Hons)MISS JILLIAN. I. CROSBIE BSc (Hons)OCCUPATIONAL THERAPISTOCCUPATIONAL THERAPIST

HCPC Registration No OT32493HCPC Registration No OT32493Website – www.crosbie-therapy.co.ukWebsite – www.crosbie-therapy.co.uk

Great Sankey Tel No. : 07910207961WarringtonWA5 3SG Email: jilliancrosbie@yahoo.co.uk

OCCUPATIONAL THERAPY REPORTOCCUPATIONAL THERAPY REPORT

CALEB M.......CALEB M.......

Date of Birth: 27.12.2004Date of Birth: 27.12.2004

Date seen: 24.11.2014Date seen: 24.11.2014

ChronologiCal age 9 years 11 months (Ca 9.11)ChronologiCal age 9 years 11 months (Ca 9.11)

Date: 27/11/2014Date: 27/11/2014

MISS JILLIAN. I. CROSBIE BSc (Hons)MISS JILLIAN. I. CROSBIE BSc (Hons)OCCUPATIONAL THERAPISTOCCUPATIONAL THERAPIST

HCPC Registration No OT32493HCPC Registration No OT32493Website – www.crosbie-therapy.co.ukWebsite – www.crosbie-therapy.co.uk

19 Southwold Crescent Great Sankey Tel No. : 07910207961WarringtonWA5 3SG Email: jilliancrosbie@yahoo.co.uk

Ref – ED/BL/18170

27th November 2014

OCCUPATIONAL THERAPY REPORT ON

CALEB M…………., BORN 27.12.20042 CONVERSE WAY, BEXHILL-ON-SEA, EAST SUSSEX,

TN30 2UH

Instructed by Tower HamletsLaw Centre791 St Anne’s StLondon

E14 7HJ

Date of Assessment 24th November 2014

Persons Present Caleb M…….. (Minor)

Sharon M……..(Mother)

Jillian Crosbie Occupational Therapist

Place of Examination

S…………. Community Special SchoolShirewater LaneLangneyEastbourne

Age 9 years 11 months (CA 9.11)

Reviewed Documents

A detailed review of all listed documents and reference to its contents took place by Miss Crosbie in preparation of the report between - 19.11.2014 -23.11.2014.

Medical Records/Documentation

• A letter of instruction received from Tower Hamlets Law Centre. Dated November 2014

• A Statement of Special Educational Needs amended on the 10/4/2014

• Letter dated the 30/4/2014 from Dr………. of East Sussex Health Care.

• Parent Advice for the Annual review dated 28/1/2013

• T……. School – Individual Education Plan dated 14/3/2014

• Speech and Language Therapy advice for annual review dated 23/1/2013

• Children’s Integrated Therapy and Equipment Service report dated 30/11/2012

• Occupational Therapy Review Report dated 25/5/2012

• Letter dated 8/10/2012 from Children’s Integrated Therapy & Equipment Service

• AR9 Occupational Therapy Advice for Annual Review dated 8/1/2013

• Annual report for Caleb M…….. from T……… School - Class 2P

• Letter dated 7/9/2010 from Dr. W L …………

• Letter dated 16/7/2014 from the S……. …….. Special School

• Ofsted report on T………. School between 12-13 of December 2013

• Appeal application together with reasons for appeal dated April 2014

• Local Authority response to reasons for Appeal dated July 2014

• Court Directions

• Tribunal bundle containing LA’s opposition to the appeal

• Psychologist report from Dr. Joyce ………. – Educational Psychologist. Dated 16/10/2014.

• Occupational Therapy Report Dated 17/1/2014

The views expressed in this report are based upon the documentation identified in this report and upon then available facts as I understand them and may be subject to revision in light of additional information which was not previously disclosed to me at the time of preparing this report.

Details of Examiner

I am a HCPC registered Occupational Therapist working in private practice with over 14 years clinical experience in the field of physical rehabilitation, intermediate care, trauma and mental health. I have worked extensively within both the NHS, Social Services and also within the private sector. My most recent appointment was providing clinical assessment and recommendations to ex-service men whom as a result of active service resulted in ongoing physical difficulties and trauma in addition to acquired mental health problems – post traumatic stress disorders.I have also worked extensively within the Expert Witness arena providing comprehensive assessments and clinical reports to support personal injury claims, appeals, tribunals and special educational needs applications.

I qualified from St. Martins College- Lancaster University with a Bachelor of Science (Hons) Degree in Occupational Therapy in 2000.

Instruction/Request

At the request of Tower Hamlets Law Centre I was instructed to fully assess Master Caleb M…….. with a view to assisting his mother Sharon M…….. in her appeal relating to part 2, and part 3 of her sons Statement of Special Educational Needs (SEN) against East S…… County Council.

note: Part 2 and part 4 of the child’s Statement has since been amended. Part 2 which reflects the child’s special educational needs was amended on the 10/4/2014. This amended section relates to the conclusive diagnosis of “Autism Spectrum Disorder (ASD) with related speech, language and communication difficulties”. Mrs. M stated she was happy with this amendment to his Statement.

Additionally, the original appeal contained a disagreement with part 4 (placement) of her sons Statement. Since the duration of the appeal the Local Authority have conceded with regards to the placement issue. Caleb now attends the S…… ……. Community Special School in Langney, near Eastbourne.

Part 3 of the Statement (provision) remains in dispute as outlined in all reviewed documentation.

I assessed Master Caleb M….. at the S…… ……. Community Special School on the 24th November 2014. Caleb has only been in attendance at the school for approximately 4 weeks.

Relevant Background Information

Family

Caleb is the 5th and youngest son of Sharon and David M………. Two of his older siblings have a diagnosis of Autism Spectrum Disorder (ASD) and have since transferred from a special school (T…….. School) to mainstream secondary education. All siblings are male. Caleb also attended T…… School from 2009 to October 2014. As part of the LA’s amendment to part 4 of this SEN statement (placement) Caleb now attends S…… …… Community Special School.

Medical

Caleb has a diagnosis of Autism Spectrum Disorder (ASD). He additionally experiences speech and language difficulties, some impairment around sensory processing and difficulties around social interactions and communication. Some hyperactivity and Attention Deficit Disorder (ADHD) has also been suggested. Mrs. M……. has stated that Caleb will be receiving some input from CAMHS with regards to this suggestion. Caleb also has irritable bowel syndrome (IBS).

Prior to my assessment and from review of all medical notes it would appear that Caleb has continued to have ongoing difficulties with his sensory co-ordination and proprioception responses in addition to ongoing difficulties with pronounced gross motor posturing and gesturing.

Education

Caleb’s previous attendance was at T……School near Hastings. He has recently been attending S…… ………Community Special School in Langney, Eastbourne. S……. ………Community Special School is a state run school and provides niche placement provision to children whom have quite profound special educational needs, ASD diagnosis and learning difficulties etc. but are able to follow a full curriculum. The school provides for approximately 68 pupils.

An individual education plan (IEP) was put in place during Caleb’s attendance at T…….. School in September 2014 and is due for review at his current placement in July 2015. In discussion with his class teacher Jan N……, his IEP will be tailored and reviewed once teaching staff have a better understanding of Caleb’s needs within their educational programe. This is due to Caleb’s short attendance at his current school.

Assessment

On the day of the assessment Caleb presented with a quite a high level of intelligence, and was fully engaged with all conversation detail. Caleb was able to grasp and respond to quite abstract and challenging assessment questions given to him by the therapist whereby he was encouraged to demonstrate a problem-solving type approach. Caleb appeared to welcome this form of engagement. Caleb was given the detail of the distance and time it had taken the therapist to visit him. The information included basic coordinates and geographical prompts to the area from where the therapist had travelled. Caleb appeared to use a formulated, mathematical approach and a verbal process of elimination, Caleb finally stated “it can’t be south of here, as you would fall into the ocean”. Eastbourne sits at the mouth of the English Channel. His final conclusion “North” and “towards Scotland” was correct.

At the beginning of the assessment Caleb did present with quite poor eye contact and appeared a little restless, but as the assessment progressed he appeared to relax and maintain good eye contact throughout. Caleb also demonstrated good initiation of subject topics and displayed very humorous and imaginative thinking. He referred to a girlfriend he had had at his previous school, T…… and stated that “when we get married I will be able to kiss her” adding “he was very much looking forward to this”.When the therapist questioned Caleb further regarding this relationship with this young lady the therapist asked if she was just a friend. Caleb stated it was more than just a friendship as he “loved her”. It appeared Caleb is remarkable in his ability to verbally distinguish between platonic relationships and affectionate relationships despite his young age of 9 years and 11 months.

Although quite buoyant in his overall presentation and a little excitable at times, Caleb talked enthusiastically with regards to his attendance at his new school compared to his previous school, T…….. of which he stated he disliked. He also enthused about the number of friendships he had made at his current school.He spoke at length with regards to his favorite subjects – swimming, computing and reading. He also appears to respond well to subjects and topics with a social and personal context as evident within the assessment.

Throughout the assessment, Caleb expressed strong affection for his mother Sharon M……….

Assessment Part II

During the assessment the Goodenough-Harris Draw a Person was administered. The purpose of the test is not to assess the drawing skills but to observe the child’s visual projection skills and current cognitive level. During the assessment Caleb drew a fairly crude picture of a female figure which on closer inspection was technically very basic with very little detail. There appeared to be an absence of clothing and upper/lower extremities, however a two dimensional aspect to the face was noted-pupils, eyelashes to the eyes.

His score for this assessment was given at approximately 22 which represents an approximation of 8-6 – mental age equivalent (MAE) which is below age appropriate for Caleb.

Memory

During the assessment Caleb was given a serious of memory cards in order to assess his working memory. Caleb appeared to enjoy this activity and was quick to verbally demonstrate his findings when asked by the therapist what he recalled from each card. Caleb was able to recall all detail from each memory card without fault or prompting. There were 5 cards in total.

Visual Perception

Caleb was presented with a “spot the difference” exercise by which he was asked to describe all differences between two faces presented on a highly chaotic and cluttered background image. This can be identified as demonstrating good visual perception in addition to a satisfactory level of figure ground technique.

Caleb made short work of identifying all differences between both images.

Secondly, Caleb was given a further visual perspective exercise. This involves placing a large picture card between you and the child and then placing it upside down or at various angles. This determines the child’s understanding of not only what they can see but how the image appears to other people. When asked “what can you see or what can I see?” Caleb was able to identify the different positioning and perspectives of the image in relation to himself and the therapist with no difficulty.

Emotional Understanding

Level 1 of this exercise involves the ability to recognize facial expressions from a series of photographs such as happy, sad, angry and afraid. Level 2 requires the child to ascertain the most appropriate emotional response from schematic drawings. Level 3 of the exercise involves presenting the child with situation-based stories (e.g. fear when an accident is about to occur). From this scenario a child should be able to predict how a character will feel or respond, given the obvious emotional content of the picture. Caleb demonstrated some difficulty in predicting the emotions appropriate to the pictures and the situation-based stories.

Caleb was then asked a small number of questions “what does it feel like” exercise.This is particularly valuable in assessing personal, aspirational and emotional behaviors. Caleb was asked “What would you do if you won the Lottery?” to which Caleb replied “I would buy a house”. Caleb was then asked “what would you do if you broke your leg?” A prompt of being happy or sad is sometimes given as an option if the child appears to struggle. Caleb however responded to this question in a very detailed manner. Caleb described this situation of having a broken leg as being a happy one. His reasons being that “I can lie in bed all day” and “I won’t have to go to school” and “everybody will do everything for me and I will be the “king of the castle”.

Reading

Caleb was not assessed with his reading skills due to the time constraints within his timetable and school lessons.

I can ascertain from the reviewed documentation and his mother’s account that Caleb is able to read and digest reading material to an above satisfactory level for his age. It is a subject he enjoys immensely.

Handwriting

Caleb was asked to write his full name during the assessment. Caleb appeared to struggle with this and some aspects of his handwriting appeared quite immature. When asked to write “Eastbourne “and “School”, Caleb was unable to copy and spell the words correctly. Caleb also applied letters on top of each other rather than in logical spaced format. Caleb has right handed dominance.

Sensory Processing

There have been some ongoing concerns regarding Caleb’s sensory processing abilities. On my observations there does appear to be some difficulties within this area but I argue that they present as mild to moderate. On occasions the therapist had to repeat certain questions. However, I believe in my clinical judgment that this is manageable and not entirely significant to his overall development. He remains a little unreceptive to certain stimulus but again in the overall picture and given the right guidance and direction this can be remedied. I do believe there is a behavioral aspect to this problem. His current school is aware of this issue and are confident they can address and manage Caleb's sensory processing difficulties. In my clinical opinion a sensory diet is not appropriate due to Caleb receiving a variety of appropriate stimuli from his lessons and the teaching staff.

Concentration/Attention

Caleb’s overall attention and concentration appeared good throughout all the above assessment exercises. On no occasion did he become distracted or lose concentration while taking part in the assessment activities, this was particularly significant during his response to abstract assessment questions. His response and elaboration to questions were highly detailed in their content.

Note: It would appear from my clinical opinion that Caleb fully engages when the topic matter is challenging and of interest to him.

Communication

During the assessment Caleb demonstrated a high level of communications skills. His verbal content remained applicable to the questions he was asked and he was able to respond and express himself appropriately throughout. His use of vocabulary and diction is of a remarkable level and on occasions his speech content was observed as quite “adult or grown up”. He is able to articulate and verbalize his thoughts remarkably well.

Social

Caleb stated that he has made a number of friends since his arrival at S….. ….. school in that he feels that he been accepted and in his own words “does not feel different”. He appeared to mix well with his peers within the classroom setting.

Mobili ty

Fine Motor Skills

Caleb’s fine motor skills where fully assessed at the time of the visit. He appears to have no difficulties in this area. Caleb’s hand grip is 100 percent within the normal rate for his age.

Gross Motor Skills

Caleb was assessed with his gross motor skills. Caleb was instructed to raise his arms, rotate his hips, attempt to touch his toes and stand on one leg. Caleb demonstrated full 180 degrees adduction/abduction at the shoulders and 90 degrees flexion/extension in both arms when outstretched. He was able to rotate his hips fully and provided approximately 90-110 degrees flexion/extension at the hip when bending. He was also able to able to stand on one leg without difficulty. Without prompting, Caleb demonstrated a supine, full leg extension position above his head with good effect on the floor.

Overall standing tolerance, transfer ability, balance and general gait were observed as above average level.

Numeracy

Caleb was given a simple money denomination task which involved an adding and taking away exercise with the use of coins. He was able to correctly add and take away the amount of coins with little or no prompting from the therapist.

Class observation

Caleb was observed in a Music class with his Music teacher and class teacher Jan N – two teaching assistants were also present. The Year 5 class was made up of 12 children all with special needs. Throughout the lesson Caleb appeared to enjoy himself immensely and responded well to all instruction and stimuli given. However, his sitting posture at times appeared quite restless and on occasions Caleb demonstrated unique gesturing and posturing positions. With prompting from the teaching staff Caleb was able to sit in a normal sitting position.

Community Assessment

Caleb was assessed in the community with his mother present. It was particularly noted that Caleb presented as quite different in his behavior when taken away from the school environment. Caleb appeared extremely restless, fidgety and quite agitated in his exposition. He also appeared to completely disengage from his surroundings and failed to engage at all with his existing companions. His posturing and gesturing appeared quite marked and the use of a ruck sack reining device was utilized by his mother in order to guide him throughout. Although this is not ideal, Caleb’s mother stated it was the only way that they could control him. Caleb has a history of running off.Additionally, Caleb’s posture and walking gait was also observed as a little disturbed and he presented with a stooped gait when walking.Caleb was also observed as a little demanding at times.

Throughout the community assessment Caleb was prone to frequently chew on a plastic apparatus attached to his ruck sack.

Other

Caleb has a history of absconsion when out on school visiting trips. This is documented in his clinical notes from his previous school. Caleb’s mother Mrs. M….. does have quite valid anxieties regarding Caleb’s potential to run away when out on school trips. At his current school, teaching staff are aware of this issue. Caleb presents as quite vulnerable and teaching staff have indicated that robust risk assessment and supervision will be in implemented prior to and on all outside school excursions.

When questioned further regarding this tendency to indeed wander or run off, Caleb demonstrated fairly good insight. He elaborated that “he just got bored and wanted to visit a certain attraction that appealed to him”.

Summary

Caleb is a delightful young man and he appears to be progressing well both academically and socially at his current school. This is highly evident in how he presents within a classroom setting. He appears to respond extremely well to robust structure and routine. This evidence has been supported by his class teacher Jan N…... His current school is aware of the issues documented from his previous school records (SEN Statement and IEP) and have reassured his mother Mrs. M….. that all issues will be managed and incorporated into his curriculum. Additionally, all outside school excursions are to be supervised and monitored vigilantly and accordingly.

In summary, Caleb appears to engage well with subjects that are of interest to him. On occasions his concentration threshold appears to disperse somewhat when faced with non-descript topics. He enjoys attention and rewards and when engaged he interacts with the subject and the subject matter fully. He appears particularly academic and quite interpersonal when faced with challenging and social contextual subjects for example he enjoys being asked questions or asked his opinion. Finally, he presents with a high level of physical energy which can on occasions manifest as restlessness or fidgeting during school lessons. The school has incorporated a variety of physical activities into their program to meet the demands of Caleb’s physical needs.

Conclusion

From an Occupational Therapy perspective Caleb is an exceptional young man and has progressed considerably since his arrival at his current school. This evidence is supported by teaching staff at his current school. He appears quite advanced and mature in a variety of areas of a more complex nature but a little immature in others. He responds extremely well to structure and routine. His tendency to exhibit inappropriate gesturing and posturing is significantly marked when outside of the school environment and some mild evidence of this trait has been observed during school lessons. It appears that Caleb has what can be described as surplus energy which manifests in his unusual physical posturing and fidgeting. There may be a boredom element to this behavior but on closer examination he appears to simply require a channel in which to exert his surplus physical energy. Something more organic may be a suggestion but this is outside of my level of expertise.

Additionally, his drawing, spelling and handwriting skills require some additional support which in my opinion can be managed appropriately by further assistance from a teaching assistant during lessons.

In conclusion Caleb’s current school – S….. ……. Community Special School is excellent in that they provide a strict but encouraging regime for children like Caleb who require the necessary routine and structure to progress and develop. Caleb appears to be prone to physical restlessness and fidgeting. His current school has implemented strategies to address his excess physical energy in the form of a rebound therapy activity during playtime hours.

Within the school environment Caleb is fairly high functioning, however he presents as quite different when observed outside and within the community. His fidgeting type posturing and gesturing is quite clearly marked and at times very unusual in its presentation. A recommendation is that a positive behavioral management plan or graded behavioral modification may be an option within the community to address this issue. Note: This recommendation would be exclusive from his school program. However I am confident that the school will incorporate elements of this behavioural approach into his IEP.

Conclusion Part II

Finally Caleb may present as a high risk when attending visits outside of school. He has according to clinical documentation and illustrated by his mother a potential to run away. This causes his mother considerable anxiety. According to his current school this will be managed and addressed by a robust risk assessment and controlled supervision during these trips.

Overall his current school is ideal for Caleb’s needs. Caleb presents as insightful, well read, intelligent and at times quite humorous. He has the potential to progress both socially and academically if presented with clear routines, boundaries and a rigid day to day structure.

Occupational Therapy response to Part II of the SEN Statement

I can confirm from my clinical expertise that Part II of Caleb’s statement accurately reflects the child’s special education needs. Caleb presents with ASD with mild to moderate social and communication difficulties. However, he presents at the higher functioning ASD bracket. I suggest no further changes should be made in light of my assessment findings.

Occupational Therapy response to Part III of the SEN Statement

In view of my assessment findings Caleb does not require movement breaks before every table top activity and every 10 minutes throughout an activity. Further provision of 10 minute movement breaks during school trips is also not advised . This would be detrimental to his learning and may disassociate him from his peers. An alternative recommendation is listed below.

Caleb does not require 1:1 adult supervision during school trips at this time. Teaching staff have assured both parent and therapist that a comprehensive risk assessment, monitoring and robust supervision will be put in place prior to and during all outside school excursions.

Recommendations

• Caleb presents with unusual gesturing and posturing which is exhibited on occasions during classroom lessons. It is particularly marked when outside of the school environment.

• It would be a recommendation that an hourly 5 minute movement activity in between lessons is put in place by non-trained staff in order to exert and channel some of his physical energy or restlessness. This should be fairly straightforward to implement as Caleb appears keen to demonstrate his physical abilities.

• A further recommendation would be that Caleb occupies a more physical role during some lessons in order to address his restlessness and fidgeting traits e.g. opportunity to move around, book retrieval etc. The previous suggestion of movement breaks every 10 minutes throughout a lesson is not advisable and could be considered detrimental to his learning.

• It is documented that Caleb is at risk of running away when out on school visiting trips. It is a recommendation that a robust risk assessment and close supervision be put in place prior to and during all outside visits.

• Caleb presents with below average drawing, handwriting and spelling skills. It is a recommendation that he receives additional assistance during lessons from a teaching assistant to encourage and develop his literacy and drawing skills.

Recommendations Part II

Non-Educational Needs

• Caleb demonstrates very usual marked posturing and gesturing when outside of the school environment and setting. The school appears to manage this well with clear boundaries and verbal prompting being provided for Caleb. His unusual gesturing is less significant within the school environment.

• It is a recommendation for Caleb to be assessed independently by an OT and to consider the option of a positive behavioral management plan or behavior modification within his community to address this issue. This would require a qualified Occupational Therapist to assist and develop a graded goal setting plan to enhance Caleb’s community living skills, social skills, personal behaviors and citizen learning experiences. I am confident that some elements of behavior modification will be incorporated into his educational plan at his current school.

• Note: This recommendation is only advisory and would be an exclusive provision outside from his current school and his special educational needs (SEN) statement.

All Occupational Therapy assessment findings and recommendations have been discussed and agreed upon with Caleb’s mother, Sharon M……….

STATEMENT AND DECLARATION

1. I understand my overriding duty is to the Court, both in preparing reports and giving oral evidence. I have complied with that duty.

2. I am aware of the requirements of Part 35 and Practice Direction 35, the protocol for instructing experts to give evidence in civi l claims and Practice Direction on pre-action conduct.

3. I have set out in my report what I understand from those instructing me to be the questions in respect of which my opinion as an expert is required.

4. I have done my best, in preparing this report, to be accurate and complete. I have mentioned all matters that I regard as relevant to the opinions I have expressed. All of the matters on which I have expressed an opinion lie within my field of expertise.

5. I have drawn attention to all matters, of which I am aware, that might adversely affect my opinion.

6. Wherever I have no personal knowledge, I have indicated the source or factual information.

7. I have not included or excluded anything which has been suggested to me by anyone, including those instructing me, without forming my own independent view of the matter.

8. I wil l notify those instructing me if , for any reason, I subsequently consider that the report required any correction or qualif ications.

9. I understand that this report wil l be evidence that I will give under oath, subject to any corrections or quali fication I may make before swearing to i t veracity and I may be cross-examined on my report by a cross examiner assis ted by an expert.

10. I have not entered into any agreement where the amount of payment of my fee is in any way dependent on the outcome of the case.

STATEMENT OF TRUTH

I confirm I have made clear which facts and matters referred to in this report are within my knowledge and which are not. Those that are

within my knowledge I confirm to be true. The opinions I have expressed represent my true and complete professional opinions on the

matters to which they refer.

Jil l ian Crosbie BSc (Hons)

Occupational Therapist