Specialist Supports

1. Specialist Supports Caroline Cantan National Programme Co-ordinator

2. Guidance on Specialist Supports • Group bringing expertise in different fields • Research and consultation • Issued July 2015 • Revised January 2016 with three amendments

3. Child with non-complex needs Primary Care Teams Child with complex needs Children’s Disability Network Teams Primary Care Services Support and consultation Transfer between servicesif and when child’s needschange Specialist support as needed by Primary Care and Children’s Disability Network Teams Direct individual assessment and short term intervention National Policy on Access to Services for Children & Young People with Disability & Developmental Delay Children with disability or developmental delay and their families

4. Children’s specialist supports • To provide highly specialised expertise to support CDNT for small number of children with exceptional needs • Network team would not have critical number of children requiring this service to develop/maintain expertise • Network teams and Primary Care will remain main service provider • Should be clearly demonstrable that these needs cannot be met solely by Primary Care or Network team

5. Children’s specialist supports cont. • Needs-led rather than determined according to diagnosis • Function based pathways which require high level of expertise • Specific skills not available at Network level e.g. clinical engineer

6. Children’s specialist supports cont. • Role in development and promotion of specialist skills in team members • Disseminate knowledge through consultation and training • Direct assessment and intervention on a short term basis when needed • Maintain high level of knowledge and skill • In a position to lead research

7. Children’s specialist supports cont. Required for a small number of children with exceptional needs in the following groups: • Children with Autism and/or ID and/or other developmental difficulties • Children with a physical disability • Children with a visual impairment • Children with a hearing impairment

8. Children with ID/ASD/other developmental difficulties • Extreme difficulties and exceptionally complex needs • Co-morbid disorders including mental health • Behaviours which are significant risk of harm to self or others • See Guidance for fuller description

9. Children with physical disability • Estimate 0.5% child population or 14% of children attending CDNT (3.5%) • Including:- • Management of posture • Management of tone • Casting • Hip and spinal surveillance • FEDS • Specialised seating • See Guidance for fuller description

10. Children with visual impairment • Estimate 0.2% population have VI • Multi disabled and vision impaired • Awareness of vision impairment especially with children with severe/profound ID • Specialised assessment where complexity • Assistive technology • CDNTs and PC links with specialist advice and supports

11. Children with hearing impairment • Estimate prevalence 3-4 per 1000 at school entry age • 40% have additional disability • Specialist assessment where complexity • CDNTs and PC links with specialist advice and supports – visiting teachers, National Cochlear Implant Programme

12. Staff considerations • Development of special interests and expertise • Continuity, succession planning • Support and mentoring • Need for good relationship between network and specialist • communication • where opinions differ • acknowledge Network level skills

13. Models of service delivery Designated member of the Children’s Disability Network Teams Where specialist input is required from a specific discipline, support may be provided at local/regional level by a clinician who is a member of a CDNT with particular skills and experience, working in collaboration with the other members of the teams.

14. Models of service delivery Designated members of CDNTs working together Where a team approach is required, specialist supports provided at local/regional level by designated members of CDNTs with particular specialist skills and experience, working together as a team at designated times

15. Models of service delivery Clinicians or teams on a CHO, regional or national basis Delivered as locally as possible for the child and family, with CDNT or PC team attending alongside the children and families with whom they work. In some cases, specialist supports will of necessity be centre or hospital based

16. Staff assignment • In most cases staff providing specialist support will also be working on a CDNT with all children with complex needs, so that their wider skills and experience are maintained • Consider need for succession planning and avoid expertise being invested in only one clinician

17. Determining local needs for specialist supports • On what geographic basis (local health office, regional or national) should this service be delivered? • How many children would need the service on this geographic basis? • Frequency of clinics, consultations etc. • Determine skills and WTEs required

18. Determining local needs for specialist services cont. • Mapping of existing expertise in the area • Decisions on how best to use these resources • Assignment of staff • Accommodation and equipment required • Establishing pathways and processes