Defining complex additional support needs
As the previous section highlighted, there are many reasons why a child may have complex medical needs. Each condition has complex contributing factors, and the effects on each child and family is unique. Therefore, having one definition that addresses all children is difficult to do.
How to define what is meant by ‘complex medical needs’ was discussed in detail in The Right Help in the Right Place at the Right Time: Strategic Review of Learning Provision for Children and Young People with Complex Additional Support Needs (2012). In the review, the author Peter Doran stated that:
The conclusion was that there was no neat and easy definition, because of the many factors which came into play and the range of support needs so wide and diverse. The term however was recognised as having value as it recognised that some children and young people required a complex set of arrangements and input from a numbers of specialist practitioners to allow them to progress. The review resisted defining complexity by condition in recognition that the need for complex support and specialist professional inputs can change or develop over time.
The National Strategic Commissioning Group (NSCG) therefore uses a working description rather than a definition.
Complex additional support needs may arise as the result of:
the severity of one or more factors resulting in need, and/or
the combined impact of a number of separate factors, one or more of which may be severe.
A rigorous, clearly bounded and universally accepted definition is extremely difficult to formulate because of the multiplicity of factors and the impact of specific contexts in different local authorities. For that reason the National Strategic Commissioning Group (NSCG) is using a working description rather than a definition of children and young people with complex additional support needs:
Those in receipt of a Co-ordinated Support Plan as defined in the Education (Additional Support for Learning) (Scotland) Act 2009 [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] , i.e. where:
a.an education authority are responsible for the school education of the child or young person,
b.the child or young person has additional support needs arising from
i. one or more complex factors, or
ii. multiple factors,
c.those needs are likely to continue for more than a year, and
d.those needs require significant additional support to be provided
i. by the education authority in the exercise of any of their other functions as well as in the exercise of their functions relating to education, or
ii. by one or more appropriate agencies (within the meaning of section 23(2)) as well as by the education authority themselves.
Children and young people aged 3–18 who do not have a co-ordinated support plan but who have been assessed as stage 3 or 4 by a local authority under a staged intervention model as recommended by the Supporting Children’s Learning Code of Practice.
Children and young people aged 3–18 who attend a grant aided or independent special school.
Exceptional healthcare needs
A smaller group of children require even more support and are described as having exceptional healthcare needs. You can read about this definition on NHS Scotland’s specialist website. (Look at the link in the further reading section for more detail.)
5.1 Children with complex needs