Specialist: Physical and Sensory

The CYP who has an audiological diagnosis of permanent:

• Moderate/ Severe/ or Profound bilateral sensorineural hearing loss.

They are prescribed hearing aids or wear auditory implants (e.g., cochlear implants). 

A high level of intensive support is required from the HI Service.

Their hearing impairment causes significant language delay which impacts upon their ability to access the curriculum and their environment.

Some CYP who are Deaf or derive very little auditory benefit from the provision of prescribed hearing aids/ cochlear implant systems may communicate using sign communication systems, such as British Sign Language (BSL). 

The CYP will:

• experience significant difficulties benefitting from incidental learning.
• will need access to visual communication. (This may be speech-reaching, written/ pictorial or signs to support access to communication and to learn about the world around them).
• communicate using spoken English as their first language. However, their severe/ profound hearing loss - even when aided or with use of cochlear implants - causes significant functional hearing difficulties to access spoken language and communication. 
• require the provision of a high/ intense level of additional to and different from specialist learning interventions to support auditory, communication, language and literacy development and access to the curriculum (e.g., pre/ post teaching of language/ concepts linked to the curriculum).
• require 1:1 provision to support access to communication and learning in the classroom (e.g., note-taking at GCSE and A-Level).
• need to have opportunities to develop their deaf identity by accessing deaf role models and other deaf peers. 

The CYP may:

• present as immature and may struggle in a large class as a result of their language delay and deafness, especially in subjects like drama and PE, which can be noisier, despite possibly being age appropriate or slightly below in some other subjects.
• suffer with anxiety about being different and may require to be taught with other CYP with a hearing impairment due to the impact wearing a hearing aid/implant has on their behaviour, social and emotional wellbeing.
• receive support from other professionals with a specialism in HI, such as the NHS’ SALT and the Auditory Implant Centre’s QToD. 
• be a BSL first language user or have a home language other than English.
• be profoundly deaf and will not easily access spoken language through the use of their hearing aids/auditory implants.
• require some or all of the curriculum to be modified.
• require a tailored reading curriculum adapted for the needs of deaf children who use BSL as their first language.

The CYP has a diagnosed visual impairment. These will typically align to the severe to profound visual loss criterion provided by NatSIP. 

They are likely to be registered as Sight Impaired (partially sighted) or Severely Sight Impaired (blind). 

They will have access to a QTVI from the Vision Impairment Service who will provide and support with the appropriate recommendations including access to a specialist Habilitation Officer when required. They will typically visit between six times a year and three times a week. 

They will need exam access support from Vision Impairment Service which should reflect the CYP’s usual way of working.

They will need specialist teaching from the Vision Impairment Service based on the Specialist Curriculum Framework for CYP with Vision Impairment 

The CYP may:

• have a deteriorating visual impairment.
• be learning to use alternative methods to access and record their learning e.g., Braille, touch typing, magnification, screen reader.
• have mobility and orientation skills are not in line with their age and stage.
• learn pre-cane/cane skills and may use a long cane.
• have difficulty in expressing their own emotions and will have difficulty in understanding the emotions of others.
• have ongoing difficulty linking language to meaning e.g., concept development.
• take additional time/use specialist support to develop their gross and fine motor skills in line with their age and stage.
• have significant difficulties with focusing, tracking, scanning, and vision-motor integration.
• suffer from significant vision fatigue.
• have a sudden, and permanent, severe loss of vision and has not yet been able to learn appropriate compensatory techniques.

Secondary

The CYP may:

• need a substantial package of support for preparation for adulthood, including work experience and employment.
• need specialist support to understand and develop professional and academic interactions (interviews/discussions).

The CYP has a long-term condition(s) that may be progressive/regressive condition(s).

The CYP will need a personalised and developmentally appropriate curriculum.

They have limited ability to contribute to self-care and are reliant on adult support for moving, positioning, personal care including drinking/eating.

The CYP has medical needs requiring regular intervention throughout the day within the setting. This impacts on their ability to access daily life safely (medical advice will have been provided). When these conditions are at their most severe, they may be life-threatening. 

The CYP may:

• be under-responsive to sensory input, leading to muted or delayed responses to sensory events, which impacts on their safety (i.e., high pain threshold).
• have long-term language/communication needs resulting from their physical disability and may access Alternative and Augmentative Communication (AAC).
• have physical and/or medical difficulties that require specialist equipment (e.g., hoist/standing frame).
• have difficulties chewing food or taking food orally.
• have an awareness of the deteriorating nature of the condition and longer-term outlook which impacts upon mental, emotional health and well-being.
• be a full-time wheelchair user.
• have very limited fine motor skills and requires specialist equipment to complete motor tasks.
• require regular rest breaks may be needed. 

Attention and concentration may be highly variable and sometimes fleeting. 

The CYP will need significantly altered exam access arrangements and/or alternative Key Stage 4 curriculum, e.g., ASDAN, Princes Trust or functional skills accredited courses.

A personalised medical, self- care and/ emergency evacuation plan may be required.