Children have been withdrawn from classroom work for one-to-one sessions in physiotherapy, speech or occupational therapy. Schools have tried to avoid these sessions coinciding with essential activities like reading and maths, but clashes have inevitably occurred. The daily routine of pupils with disabilities has tended to become fragmented and confusing.
Now Fountaindale school in Mansfield is aiming to bridge the divide between therapy and the national curriculum by encouraging teachers and therapists to work closely together in the classroom.
Since the Sixties, schools specialising in physical disabilities have increasingly turned to conductive education, using specially trained "conductors" to combine the roles of teacher and therapist. Fountaindale has responded differently. It has been influenced by the Peto method of conductive education but it has not adopted the system as a whole.
Over the past couple of years it has encouraged its teachers and therapists to dovetail their roles, be aware of each other's targets and avoid withdrawing pupils from the classroom to the therapy room where possible. Unlike schools which have tended to focus on conductive education in the primary years, Fountaindale is developing its integrated approach into key stages 3 and 4.
The school does not claim its approach is unique but it has gone further than many others in interlocking therapy and the national curriculum. Its relatively generous complement of therapy staff has helped it extend its integrated approach into the secondary stage.
"When I first started at the school in the Eighties there was no rationalisation as to when therapy went on,'' says Mark Dengel, Fountaindale's head for the past two years. "Therapy could cut into either core or foundation subjects of the national curriculum and was affecting the balance of provision that youngsters were getting. Some pupils were being withdrawn for intensive therapy for half-an-hour or more a day.
"We wanted to make changes and we had to decide where to begin. This year we have looked at English in particular and have made a start on technology. Next year there will be a focus on physical education and on science and the year after it will be on maths. We are working on the core subjects first and on those where the links with therapy are greatest."
In English, explains Mr Dengel, a pupil who has athetoid cerebral palsy and lacks hand control may be working at a computer on a task set by the teacher while the occupational therapist watches how she is operating the keyboard. If the pupil also has speech difficulties, the speech therapist may be at hand to help with the use of a Widget symbol writing program.
Another example of integrated working in English is the teaching of "yes'' and "no'' to a child unable to speak. The occupational therapist will help the child to open out his fingers to produce the Makaton sign for "no'' which the speech therapist will also emphasise and the teacher will encourage the pupil to use the sign to answer questions about a story which has been read.
A therapist may also spend a whole morning working with one group alongside the teacher. For instance, Jo Ballin, one of the two occupational therapists, will work with some of the junior pupils while they are reading or writing. She will be looking, among other things, at their seating and the position of their paper, making adjustments where needed.
These joint efforts in the classroom are strengthened by the "sparklers'' group on Wednesday afternoons. The teacher, physiotherapist, occupational and speech therapists and the classroom assistant sit down together to plan their individual but interlocking programmes for each child. "We exchange knowledge about each child and we all know what each other's aims are,'' says Angela Hallam, head of the primary department.
"Changing the culture," as Mr Dengel puts it, does not come easily and it takes time. "You have staff with different philosophical perspectives. The therapists are employed by the local hospital trust which is into an individual approach in areas like physiotherapy."
The change began with departmental meetings of the different disciplines and meetings of the managers of the hospital trust. Support at management level was a vital ingredient.
"Then we built up support meetings where once a month teachers, therapists, the medical team, classroom assistants, anyone else involved, would discuss two or three children in turn," explains Mr Dengel."We knew what the aims were - to get closer together with a better understanding of each other's perspectives. We had to do this before we could push the action needed for integrated working."
There were teething troubles when the system began. Trying to keep up with staffing changes was one. Another was attitudes. "Some therapy staff saw the new ways of working as merely bolt-on," he says, "while some teachers saw therapists' presence in the classroom as a hindrance." Some parents were uneasy too. They regarded one-to-one therapy as superior to therapy in groups and complained that their child was now getting only one individual session instead of three. They had to be persuaded of the advantages of the new approach.
Gradually improvements could be observed. By the time an OFSTED team inspected the school last May it was able to note "good examples of effective integrated approaches to the support of learning in the classroom which involve both teaching and medicaltherapy staff."
As for the pupils, they have probably gained the most. Speculating about the effects of the change on pupils' progress in the national curriculum is premature, but staff are convinced of other benefits. Ms Ballin believes the integrated approach has boosted pupils' confidence and self-esteem. Children are now being treated as entities, not as a bundle of fragments to be tackled separately and taken apart.