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SEN services should be joined together

Regarding "New SEN assessment will fail without legal bind" (15 July), Emanuel Miller, a founding father of child and adolescent psychiatry in the UK, set up the first child guidance clinic in the East End of London shortly after the Second World War.

These clinics were staffed on a multidisciplinary basis and served the country well until they began to fragment in the 1970s with the advent of area health authorities, the implications of the Seebohm report for social workers, and the establishment of free-standing educational psychology services by local education authorities.

The medical director who led these clinics was a child and adolescent psychiatrist. The social workers were psychiatric social workers. The other member of the team was an educational psychologist.

Families were referred to the clinics by GPs. The children invariably had developmental difficulties of one kind or another, often with emotional underpinnings.

The medical director, interestingly, had authority to advise the LEA on schooling.

This model, re-enacted in the form of child and adolescent mental health services, will not work today for the many because of the very diverse and extreme nature of some children with special educational needs who require a wide range of assessment services involving: health, social care, psychology, physiotherapy, occupational therapy, speech and language, audiology, visual impairment, and teachers, particularly those who have the skills to work with those who are deaf or blind.

Rather than networking, which is what happens now, these services need to be brought together in one institution under the direction and guidance of a manager. The conjoint working can be done on a part-time basis as many of the professionals will have other duties elsewhere; but the team should have the power to issue an education, health and care plan to be implemented by the statutory bodies.

George Crowther, Consultant educational psychologist, Reigate, Surrey.

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