Level A descriptor

Description of needs: Extremely complex and very challenging lifelong behavioural needs that significantly impact on all aspects of learning and living, severe learning difficulties (SLD) and likely to have a diagnosis of Autistic Spectrum Disorder (ASD):

Cognition and Learning

• Children and young people will continually present with such high levels of anxiety and complex behavioural needs that they find it extremely difficult to access learning and will therefore find it difficult to achieve at the level at which they may be cognitively able to.
• Will be learning at a chronological equivalent age equivalent of 12 months to 3 years throughout their lives, but likely to be using their cognitive ability to control their environment.
• Are likely to have an uneven profile and there will be significant gaps in higher levels of learning. Learning is likely to be mainly focused on specific personal interests.
• Attention will be fleeting with adult directed activities, even when suitably structured and differentiated, but will be able to maintain attention on something of specific personal intertest for longer periods.
• Are likely to have significant difficulty in moving away from activities related to their specific interests.
• Can develop some basic concepts of size colour, numbers, and position
• Are likely to have a diagnosis of Autism.
• Will find it very difficult to generalise their skills and knowledge to different contexts.

Communication and interaction

• Will have severe communication difficulties, which will affect both expressive and receptive communication skills.
• Will use a range of communication methods to express themselves, such as pointing, gesture, facial expressions, vocalisations and/or some spoken language to communicate. Spoken language may be echolalic.
• May use 1-3 keys words in short phrases
• Can use verbal communication to request, give information, direct, protest, ask simple questions, but may not choose to use it.
• Can use a combination of words, signs, and pictures in short sentences e.g. want more bubbles
• Relates only to the present (very little concept of the past /future). sequences in ideas in play

Social, emotional and mental health

• will all have an established history of presenting with extremely complex behavioural needs which can cause serious injury to themselves and/or those around them.
• will exhibit high levels of anxiety throughout the day, across all settings and consistently over time (months, years) which is expressed through multiple episodes of extreme challenging behaviour.
• will routinely exhibit extreme behaviours that challenge and threaten their quality of life and/or the physical safety of themselves and others e.g. through biting, kicking, punching, scratching, urinating, smearing faeces, throwing heavy objects, absconding, demonstrating sexualised behaviour. These are of higher intensity, frequency, or duration than other children and young people who present with very challenging behaviour within the school population.
• will find it very difficult work alongside other children and young people
• The presentation, impact and support required to meet extremely complex behavioural needs will significantly increase as the young person becomes older, stronger, and more aware of their physical abilities.
• may demonstrate sexualised behaviour and not have the cognitive ability to understand private and public space. Emerging and unresolved feelings around sexuality may result in high levels of anxiety and very challenging behaviour.
• may have OCD behaviours that are extremely difficult for them to regulate and for others to support.
• may be at greater risk of hospital admission and / or residential provision due to causing serious injury to themselves, their families and other carers / people who work with them, and risk of family breakdown.

Sensory, physical and medical

• are likely to have a diagnosis of Autism and have complex sensory processing needs that impact significantly on their learning and behaviour.
• will experience significant sensory overload which impacts on their ability to learn and engage with their surroundings.
• may have diagnosed mental health difficulties.
• may have an additional diagnosis of ADHD or attachment disorders.

Level A support needed

Curriculum, teaching, and learning

• A highly personalised pupil-led curriculum with a strong emphasis on the development of communication skills, self-regulation skills and functional skills in a range of contexts in preparation for their adult lives.
• An individualised multi-sensory approach to the curriculum with targets jointly set by the multidisciplinary team including SALT, OT etc, for example
• Supporting staff to manage sensory differences within the learning environment
• Supporting staff to facilitate functional independence
• A curriculum that supports reducing anxiety levels and increases tolerance of new experiences and confidence.
• A personalised communication plan that may include strategies such as objects of reference, signing and use of symbols.
• A high staffing ratio with capacity to respond quickly to escalating anxiety. Generally, this will be on a 1:1 or 2:1 basis but at times of crisis this may need to increase to 3:1 or 4:1 staffing to keep themselves and others safe.

Environment

• A secure highly staffed area of the school.
• A spacious, carefully planned learning environment which includes external spaces, with fluidity between areas to meet the complex needs of individual students.
• Flexible space that can be adapted easily to meet the needs of the children and young people and the curriculum.
• Immediate access to toilets and personal care facilities
• Immediate access to a safe, stimulating outdoor space.
• More than one external door so there is easy access and evacuation when necessary
• Following rigorous risk assessments children and young people need appropriate support to access community facilities in preparation for adult life.
• Very high levels of continuous support into and throughout their adult lives.

Behaviour support

• Regular behaviour assessment to support achievement and progress.
• Will have a traffic light Positive Behaviour Support plan.
• Ongoing dynamic risk assessments to maintain health and safety requirements.
• Will be accessing support from CAMHS (clinical psychology and/or psychiatry input) or the adult PBS team or are on the waiting list to be assessed.
• Many children and young people will need to take prescribed antipsychotic drugs and require frequent psychiatric review appointments and blood tests.
• Following risk assessment, some children and young people will require highly personalised transport arrangements to and from school, including individual transport with one or two specialist trained passenger assistants.

Multi-agency and family support

• There will be a high level of coordination with a range of agencies.
• A high level of contact with parents/carers to ensure consistency of approach and modelling strategies wherever possible, and to provide whole family support where needed.
• May need specialist input from a multi-professional team over time e.g. CAMHS
• Children and young people’ families require high levels of multi-agency support including respite and training on positive behaviour strategies to enable them to maintain their young person at home and to keep everyone safe

Staff training and expertise

• Staff working with these children and young people will:
• Be trained, skilled and experienced in building positive relationships and working with young people with high levels of anxiety and extreme and persistent challenging behaviour.
• Have personalised training around Positive Behaviour Support and the de- escalation of challenging behaviour, including specific training around the prevention and use of restrictive interventions.
• Be provided with regular opportunities for intensive whole staff group training around the changing positive behaviour support needs (including de-escalation of extreme challenging behaviour) of each individual student.
• Be specialists in behaviour and communication
• Be trained in delivering emerging sexuality programmes on a 1:1 basis, also working with the young person’s family and care providers
• Require ongoing high quality CPD and support so that they are continuously improving their skills and knowledge and have a good understanding of current research and practice in this area.