Northamptonshire’s countywide school nursing service has set up a dedicated pathway to ensure home educated children do not fall through the gaps. All electively home educated pupils are contacted by the service – with those identified as most in needed offered appointments. This case study showcases the important role of school nurses in the education system.
How the pathway works
The pandemic has meant there has been a rise in the number of electively home educated pupils. Estimates from the Association of Directors of Children’s Services suggest the figures may have jumped by as much as a third nationally. Home education however can mean pupils miss out on the opportunity of regular contact with school nursing services.
But in Northamptonshire that is not the case because of a home education pathway that was introduced back in 2017. The school nursing service for North and West Northamptonshire councils, which is delivered by Northamptonshire Healthcare NHS Foundation Trust, is specifically commissioned to provide support to all pupils resident in the county, not just those in school.
NHFT 0-19 Public Health Matron Pippa Gilbert, said: “We believe that all children, young people and families should have direct access into the school nursing service to support early intervention, prevent health problems developing and tackle some of the inequalities which impact health.
“Home educated children and families can miss out on the service as it is largely delivered in partnership with schools. We have always been there for them, but in the past much depended on whether we were aware of them or if they came forward for our help.
“Under this arrangement we have an agreement in place with North and West Northamptonshire councils that every autumn they will send us a list of the home educated pupils. Our administrators and school nurse assistants then input that information into our system, and we start the process of reviewing each child and family.”
All parents – or a young person themselves if over 16 – receive a letter informing them of the school nursing service and with contact details, including the Chat Health text number which enables them to speak to a school nurse via a secure text messaging service.
The service also assesses families on the voluntary home educated register for those considered at risk. This is carried out through a review of the health record, which alerts the service when children have been in contact with services such as social care, early help, been exposed to domestic abuse or safeguarding or exploitation concerns have been raised.
NHFT Public Health Matron Sue Stevens, who is the safeguarding lead for the service, added: “When this happens, we send them a letter inviting them to come in for an appointment. We book the appointment for a set time and place to try to encourage them to engage.
“If they do not come, that flags up as a non-attender and we either follow the family up with a phone call or home visit or alert other services.”
The full range of support
Home educated children can get access to the full range of school nurse services from immunisations and health assessments to advice and information.
Appointments can be booked at a local community clinic or nurses will visit the child’s home if necessary. These services are provided by all the county’s 45 school nurses.
Before the pandemic there were regularly 800 to 900 pupils on the voluntary home educated register but that has now increased to over 1,500. “There are a variety of reasons why parents choose to home educate,” continues Ms Gilbert.
“The pandemic has certainly been a big factor and increased the numbers. We do find some choose to home educate for a short period, but the important thing is that we now have a firm understanding of who is home educated and we can make sure we provide them with access to the full range of services and support.”
Dealing with anxiety-based school avoidance
As well as home education, the service works hard to provide help to those who refuse to go to school – known as anxiety-based school avoidance.
Ms Gilbert said: “Schools and other agencies let us know when a pupil is not attending school and we then follow that up often with a home visit. Sometimes these pupils have additional needs – autism, ADHD or dyslexia and we sometimes refer on to the local specialist services that offer assessment or advice and support in relation to special educational needs and disabilities.”
The support is proving invaluable to pupils. One of those who has been helped is 15-year-old Jess (not her real name). She has been home educated for the past two years after getting bullied at school.
During contacts with Jess the school nurse identified she struggled when there were changes in routine or social situations, prompting her to be visibly upset, covering her ears and shouting. She also had a disrupted sleep pattern and had become isolated from her friends.
The school nurse meets regularly with Jess for walk-and-talk sessions to help her manage her anxieties and sleep and she has also helped refer her to a specialist team for an autism spectrum disorder assessment.
In another case 13-year-old Lucy (not her real name) was redirected to the school nursing service following a CAMHS referral. The school nurse established a relationship with her mother via telephone and after several phone calls she eventually agreed the school nurse could visit their home.
There was evidence of hoarding in the property and the mother explained her daughter had learning difficulties and literacy issues. She has also been referred for an ASD assessment and the school nurse has arranged support for the mother from partner agencies as well as continuing to support Lucy, who is now going to school for two hours a day after two years without going.
Pippa Gilbert, 0-19 Public Health Matron, Northamptonshire Healthcare NHS Foundation Trust
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