Robert and Louise eagerly anticipated the arrival of their first child, and when Clare was born they were elated. Their joy lasted on a few sort moments. Clare’s physical disability was obvious – only one ear, her chin depressed into her neck. The paediatrician advised an emergency tracheotomy.

Numbed with shock, Robert and Louise agreed to the operation. During the operation, Clare lost consciousness for 15 minutes. In spite of this she survived. As feeding was clearly going to be a problem, a nasogatric tube was fitted.

High school Support Teachers (Learning Difficulties) (STLDs) have a strategic role in enhancing outcomes for students with learning difficulties. This paper will explore the ways in which STLDs work. Firstly, this paper will discuss the four main ways in which STLDs may work, which combination of these ways is considered as best practice from the research literature and which ways of working are suggested in NSW government policy and support documents. It has been suggested by several research studies that some STLDs in NSW do not work in ways that are consistent with best practice and policy. There may be many reasons for this, however, this paper explores the possibility that particular school factors influence the work of STLDs. Each school factor is described and its possible influence on the way STLDs work is illustrated. This paper concludes with possibilities for modifying school factors where these factors may be negatively affecting the way in which a STLD works. Ultimately, the improved effectiveness of a STLD will impact on the education of students with learning difficulties.

Our knowledge of effective practices for improving the academic achievement of students in the primary and elementary years has increased dramatically in the last decade (Simmons & Kameenui, in press; Stringfield, in press). However, implementing an effective practice in one classroom or in a research context is very different from implementing and sustaining effective practice at the school‐building level. There is a great deal of collective wailing in the field these days about the feeble attempts to translate research into effective practice (Malouf & Schiller, 1995) that improves reading achievement in students who are at serious academic risk.

Defining the Family: “Paul is our son. We love him and we wanted him to have an ordinary life. Not much to ask for, an ordinary life ‐ but it can seem as distant as the moon when you are struggling to live with challenging behaviour.” A mother, quoted in the Mental Health Foundation Report (1997)