Members of the therapy team at St Nicholas School in Canterbury describe the Shared Goals Project, an innovative approach to supporting students with profound and complex educational needs

St Nicholas School in Canterbury caters for students with profound, severe and complex needs. The therapy team at the school has grown over the last 10 years but our accommodation has not! This has provided an opportunity for joint working. So often we have found ourselves puzzling about how best to support a child only to discover another member of the team just inches away wondering about their role with the same child. Clearly, the way forward was to work together as closely in thought and deed as we were in physical proximity! Thus developed an innovative approach to supporting students with profound/complex needs: the ‘Shared Goals Project.’

The therapy team includes a specialist teacher for multi-sensory impairment, two speech and language therapists, two occupational therapists, a physiotherapist and a range of skilled assistants. Many of us work part time at the school, which can make it difficult to ensure that the time
we needed for Shared Goals was set aside each week.

It was also key to the success of the Shared Goals Project that both parents and the class teacher be closely involved.

First (tentative) steps…
The therapy team identified a group of students whose needs are complex, sometimes unique, and for whom a multi-disciplinary approach was essential. The progress these students made on more conventional, standard programmes had been difficult to measure – they needed the team to integrate their work more closely.

The first things the team needed to consider were: how to devise long-term goals for each student that complemented and supported what each member of the team was working on how to devise short-term goals that enabled precise and regular measurement of progress.

Each professional:

  • contributed an aim related specifically to their area of expertise
  • contributed to the development of short-term goals by providing information about how the aims they had suggested could work with or might impact upon the aims developed by other team members
  • ‘ring-fenced’ Monday mornings to ensure that they were available for Shared Goals meetings each week.

The short-term goals are reviewed every six to eight weeks in order to measure progress and to ensure that the goals are appropriate. A worked example is shown on page 44, to illustrate the way in which goals are devised and monitored.

Troubleshooting
We all needed to develop our problem-solving skills! We identified a number of challenges that were compromising the success of Shared Goals and came up with ways to take the project further. We needed to be persistent. (See Table 1)

Table 1: Developing problem-solving skills

Challenge Solution
How can we be sure the short-term aim has been achieved, and that the aims are specific and measurable? We added a ‘measure of attainment’ for each goal to ensure that everyone working with the student would know when the aim had been achieved.
How can we make sure the work the student is doing is recorded regularly and consistently? We devised record sheets for each short-term goal and made sure these were easily accessible for all adults working with the students.
How can the class team work on Shared Goals when they need to work on individual education plans (IEPs)? The headteacher backed the project so that, for the students on the project, their Shared Goals provided the precise set of aims and progress measures. The school no longer used IEPs for these students.
How can we keep up with all this paperwork? We needed an admin assistant. This was key to the success of the whole project. We needed someone who could keep the paperwork organised, who could generate the record sheets and minute the meetings accurately and efficiently and ensure the regular reviews of each child’s goals happened at the right time. We were lucky to find the right person for the job!
What most matters to the students and their families? Parents were a vital part of the team and were invited to join us in the Shared Goals meeting for their child. This input was essential as it gave us an idea of how the goals were being achieved in all environments, and also helped us to realise what we needed to be working towards. As a result of the parents’ input we added a PSHE target to the shared goals.
What is preventing the students from working on their goals?  

On the road to success
After overcoming some of the challenges to the Shared Goals Project we began to see the impact on the whole school of this way of working. The feedback from primary and secondary teachers spurred us on.

‘I believe that Shared Goals Project has been great from a teaching perspective. At first, lots of reluctance primarily, but I think it has benefited the children and staff. Particularly, the support from other professionals has been invaluable. I think the “whole” school could
do with some input/training.’

Primary class teacher

‘I think the Shared Goals approach makes a lot of sense especially compared to the plethora of previous targets, awkwardly grouped under headings of “English”, “Science” etc. It has been fairly easy to run in S5 (class), partly I think because we have four students on Shared Goals so it is a large part of my thinking and planning… Termly review meetings are really useful – all the professionals together in calm, relaxed, planned time to reflect on each student and their needs.’
Secondary class teacher

Although we continue to have lots of work to do to further develop the Shared Goals Project, we now have the evidence to show that this is a worthwhile and effective way of supporting the students at the school who have profound needs. We have developed a system that shows the progress the students are making and measures the impact of the intervention they are engaging in. The Shared Goals Project has become a crucial part of how the school supports students with complex needs.

‘The setting of targets for the most profoundly disabled pupils is always a complex process. The Shared Goals Project has developed the target setting system, focused the shared work of the many professionals engaged with the pupils and carers and empowered the teachers. I believe it is an improvement on the system we used before and it genuinely places the needs of the pupil at the centre of the process. Over time I am convinced it will be seen to be the most effective way of helping these pupils make the progress they deserve.’
Headteacher

‘The volume of admin has grown hugely and I’ve had to organise my time more effectively to cope with it. I feel that producing accurate, well presented and user-friendly paperwork is a vital element in the success of the project.’
Administrator

Most importantly, we saw how it changed things for the students involved, and for their families. It has been a delight when parents have invited respite carers along to the meeting, thus ensuring that the students’ goals are being worked on in all areas of life, both at home and at school. ‘The Shared Goals Project ensures that both the school and us as parents are all working towards the same aims. My son has made fantastic improvements in his physical abilities since attending the school, and with meeting his teacher, physiotherapist and other professionals that are involved with his development, I feel confident that he is getting all the encouragement and most importantly genuine affection for him. The staff really care and it shows whenever I visit the school how much the staff are dedicated to their job.’

Child A
Short-term goal: To make a choice from two pictures.

Measure of attainment: Looks carefully at one picture to indicate choice.

‘Given us a better insight and understanding as to what they are doing to help our child to achieve.’

Child B
Long-term goal: To use smaller movements to operate the switches with facilitation at the elbow.

Short-term goal: To maintain grasp of grab bar independently with one hand, while using the other functionally.

Measure of attainment: Will maintain grasp independently for 30 seconds while using the other hand independently.

‘Linking curriculum to level of ability, allowing better access. Keeping us well informed.’

Child C
Short-term goal: To sit on a class chair – prompted at first with fingers on both shoulders and then on alternate shoulders.

Measure of attainment: Sits for five minutes.

‘He has exceeded his goal – next perceived goal will be around maintaining balance while reaching laterally for objects while sitting on a bench.’

We feel that the Shared Goals Project has been of tremendous benefit to our child and are very grateful to all those who work so hard to ensure its success. It has given us real insight into the activities and therapies our child is enjoying at school. A wonderful project!’

Child D
Long-term goal: To maintain head control for 30 seconds in order to look at the computer screen.

It has been a fantastic learning opportunity, as each member of the therapy team has become more aware of the skills and knowledge the team shares, and how this expertise can be used more effectively.

The Shared Goals Project also provides an opportunity to reflect and develop the interventions we are providing for students who have complex needs. Meeting individual needs is central to the programme. No team member struggles on alone, wondering if there is something more they should be doing. We have taken examples from each others’ work to guide us in developing our project. For example, the MOVE programme provided a good model of the way in which professionals can work together to support a student’s mobility principles which underpin the Shared Goals Project.

The next step for the Shared Goals Project is to extend it to include other students in the school who would benefit from this approach.

Current situation
James sits with support in his Leckey chair and manipulates and explores objects immediately in front of him with his hands and also through mouthing items. James responds purposefully and with enjoyment to physical movement activities. When bouncing on the therapy ball or being rocked on a wobble ball James will vocalise and give clear body language, which can be interpreted as a communication for more of the activity. During the session James notices what is going on around him. He looks towards items of interest on the floor. When he is engaged in a pleasurable activity James will engage in eye contact with an adult partner. He will briefly grasp a hoop to rock with a partner when prompted. During this time James is intolerant of his glasses. It is hoped that as he is able to focus his attention for longer periods he will be able to build up toleration to wearing glasses.

Long term goals

Physiotherapy
  • To develop sitting balance in a range of seating.
Speech and language therapy
  • To understand that his actions have an impact upon the environment.
Multi-sensory impairment/
visual impairment
  • To use hands to manipulate objects.
  • To tolerate glasses for increasing periods.
Information and communication technology
  • To activate a variety of switch toys and show awareness of his action on an outcome.
Occupational therapy
  • To recognise functional objects and handle appropriately.
Personal, social and health education
  • To develop skills in independent personal care.

Short-term goals to work on now

 Goal  Measure of attainment
To use a BigMack to request more of an activity. James will consistently use a BigMack to request more.
To maintain balance while reaching to left or right side to obtain object. James will maintain balance while reaching.
To release an object on request. Releases object when back of hand massaged and adult says ‘I let go’.
To press switch and look to reward. James presses switch and looks towards reward when prompted.
To use toilet chair. James will cooperate by sitting on the toilet chair for two minutes.
To give eye contact when asked to ‘Look at me’. James will respond to the instruction and give eye contact.

Strategies

  • Intensive interaction strategies are important – interpret his vocalisations and body language as attempts to communicate and respond really positively to these whenever the opportunity arises.
  • Ensure James is stable and comfortable in his Leckey chair. Sometimes work with James on the floor, providing opportunities for him to look at the range of activities around him. Allow James to lead you, through gaze or gesture, to those activities that he finds motivating or interesting.
  • Consistency is a key strategy in the support of James and his efforts to achieve his long-term goals. Team members should try to respond in the same way every time to help him understand the effect his actions have on his environment and those around him.

The Shared Goals Team at St Nicholas School consists of:

Rebekah Dwyer: Speech and language therapist
Heather Bovingdon: Speech and language therapist
Pam Davis: Specialist teacher, MSI, QTVI
Kamala Iddawela: Physiotherapist
Julie Chandler: Physiotherapy assistant
Ann Jeffrey: Occupational therapist
Lisa Whiley: Administrator
Hayley Woods: Therapy assistant
Jane Wiffen: Therapy assistant
Jo Robson: Therapy assistant
James Manning: Therapy assistant
Class staff and parents

This article first appeared in Special Children – June 2008

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