Integrated Therapy Service for Children and Young People

Integrated Therapy Service for Children and Young People Frances Rowe, Service Manager

History of the ITS • Before October 2009 – 4 separate Trusts provided Paediatric Speech and Language Therapy, Occupational Therapy and Physiotherapy – patchwork of provision, different models of delivery and waiting times • October 2009: OneIntegrated Therapy Service commissioned • Provides: Integrated SLT, OT and PT to all of the county – for babies, children and young people aged 0 – 19 years • Delivered in: ITS clinics, Children’s Centres, pre-schools, mainstream and special schools, family homes, hospital wards and outpatient clinics • Integrated Area Teams: Taunton, Bridgwater, Yeovil and Wells

Challenges – and responses • Referral process: GP Choose and Book system a poor fit with the service – concerns and complaints Response: consultation with users and stakeholders on alternative model Outcome:May 2011:Single Point of Access – in-house referral point Telephone Advice Line, 09.00 – 12.00, four mornings per week, staffed by SLT, OT and PT. Professional advice and guidance, potential for acceptance of referral Successful and busy!

Challenges – and responses • 35% rise in referrals from 2009 – increased pressure on the service without additional funding Response: - Improved referral forms, specific information requested - Careful triage of referrals – ensuring appropriateness - Very close monitoring of referral rates & assessment clinics - Revision of reporting paperwork - Personalised care planning, evaluation of outcomes - Discharge if intervention not needed, re-referral guidance - Increased skill mix, flexible workforce moving where required Outcome: Longest wait for the service reduced from 2 years to 12 weeks and below by end of March 2012, despite increase in referrals

Next steps... Aim: For families and the wider children’s workforce to have the knowledge, skills and confidence to: - prevent problems increasing - support children with lower levels of need in daily life - identify those children who require specialist assessment & support Response: Fact File for Early Years, 0 – 4 years Fact File for School Age, 5 – 19 years

Fact File for Early Years Section One: Introduction • The Fact File for Early Years contains information on: • How to help promote children’s development in the areas dealt with by Speech and Language Therapy, Occupational Therapy and Physiotherapy • How to identify common and acceptable variations in young children’s development • How to decide which children may need additional support to promote their development • Practical Advice Sheets which you can also share with parents • How and when to refer for specialist assessment by the Integrated Therapy Service

Fact File for Early Years General principles of the Early Years Fact File • Many children and young people will show difficulties at some point in their development – most will progress given the right environment and simple strategies used by those around them • The Fact File for Early Years is intended to give practitioners information and confidence to be able to meet children’s needs and advise their parents/carers • Early identification of children needing extra support is vital – this does not always mean early referral • A small proportion of CYP will require specialist support from the ITS to enable them to carry out the activities that they need or want to do. This Fact File for Early Years will help you to identify which children or young people may require this specialist support

Fact File for Early Years • Section Two: Factors affecting children’s development and what you can do to help It is entirely normal for children to develop at different rates. You only need to be concerned about significant differences in obtaining expected milestones. Children develop at different rates based on several factors which include those that are environmental, cultural and innate. We can influence some of these but others are out of our control. • A child’s temperament • A child’s general health • Premature babies – more likely to show variations in their development • A child’s play experiences

Fact File for Early Years What you can do to help children’s early development 0 – 12 months 12 months onwards

Fact File for Early Years • Section Three: Common problems and acceptable variations in typical development Common variations in gait (walking patterns) There is a wide range of normal variation in children’s walking patterns. The following areas are often a cause for concern to parents and carers but are all normal variations that do not require physiotherapy assessment. e.g. Flat feet, intoeing, bow legs, knock knees etc.

Fact File for Early Years Section Four: Problems you may see and what to do If a child loses a skill they had already developed, this is a cause for concern. You should refer them to their GP and to the Integrated Therapy Service (ITS). If the action is to contact the ITS for advice, please use the Telephone Advice Line. 09:00 to 12:00 in the morning Monday, Wednesday, Thursday and Friday (excluding Bank Holidays) 0303 033 3002

Fact File for Early Years Problems you may see and what to do – 1 month

Fact File for Early Years Problems you may see and what to do – 9 months

Fact File for Early Years Problems you may see and what to do – 2 years

Fact File for Early Years Problems you may see and what to do – 3 years

Fact File for Early Years Problems you may see and what to do – 3 1/2 – 4 years

Fact File for Early Years Section Five: Advice Sheets for parents, carers and pre-school settings

Fact File for Early Years Advice sheets for parents, carers and pre-school settings • Baby talk • Basic communication strategies • Coping with lumps • Developing cutlery skills • Developing hand skills • Dressing skills • Fasteners • Finger feeding • Helping a baby develop rolling and sitting • Helping a baby develop standing and stepping • Helping a child develop their balance

Fact File for Early Years • Helping children with unclear speech • Learning to ride a tricycle • Messy play • Pre-school talk • Pre-writing activities • Rough and tumble play • Stammering • Talipes or club foot • Toddler talk • Trying new foods • Tummy time • Using both hands together

Fact File for Early Years Developing hand skills – why do some children find this difficult? You have been directed to this Advice Sheet because your child is having difficulty developing their fine motor / hand skills. These are the skills needed to complete activities like feeding, dressing, playing or drawing. There are many reasons why children have difficulty developing these skills including movement problems, learning difficulties or developmental delay. If you see no improvement after 6 months of using this Advice Sheet, please contact the Integrated Therapy Service for further advice What you may see Strategies and Advice

Fact File for Early Years Section Six: The Integrated Therapy Service and how to refer • What is the Integrated Therapy Service for Children & Young People? • Staff Teams – roles of SLTs, OTs and PTs • Area Bases – contact details • Who can refer? • How to make a referral • Telephone Advice Line • Making a written referral • Triaging referrals • Assessment • Intervention • Discharge

Fact File for Early Years Appendices • Appendix 1 ‘Integrated Therapy Service Referral form’ • Appendix 2 ‘Additional Information to Support Occupational Therapy Referral’ • Appendix 3 ‘Every Child a Talker’ monitoring form

Fact File for School Age Section One: Introduction • The Fact File for School age contains information on: • Typical development of children and young people in the areas that fall within the expertise of SLT, OT and PT • How to identify common and acceptable variations in CYP’s development • How to decide which children and young people may need additional support to promote their development. • Practical Advice Sheets which you can also share with parents/carers • When and how to refer for specialist assessment by the ITS • General principles of the School Age Fact File – as for Early Years

Fact File for School Age Section Two: Developmental milestones. 4 – 5 Years (Reception)

Fact File for School Age Developmental milestones. 5 – 6 Years (Year 1)

Fact File for School Age Developmental milestones. 6 – 7 Years (Year 2)

Fact File for School Age Developmental milestones. 8 – 11 Years (Key Stage 2)

Fact File for School Age Developmental milestones. Into the teenage years (Key Stages 3 and 4)

Fact File for School Age Section Three: Common problems and acceptable variations in typical development • Common variations in speech and language development • Common variations in children using their right and left hands for different tasks • Common variations in dressing skills • Common variations in gait (walking patterns)

Fact File for School Age • Section Four: Problems you may see and what to do The Problems Table, on the next pages, will help direct you to Advice Sheets relevant to your concerns How to use the Problems Table: • Identify your main concern • Look through the observations column on the left to find the most appropriate description of the area of difficulty • Follow this row along to the right to find the suitable Advice Sheet or Sheets, highlighted by a large dot

Fact File for School Age Section Four: Problems you may see and what to do • Some observations may have more than one recommended Advice Sheet. • Look at each Advice Sheet and either choose an individual Sheet or combine activities from two. This decision will depend on your observations of the child. • The Advice Sheets specify a time period for the activities to be implemented. After this time, if no improvement has been noted, please contact the Integrated Therapy Service by calling the Telephone Advice Line. • If your concern or observation is not listed on the table, please contact the Integrated Therapy Service by calling the Telephone Advice Line.

Fact File for School Age Problems you may see and what to do

Fact File for School Age Section Five: Advice Sheets for schools, parents and carers

Fact File for School Age Advice sheets for schools, parents and carers • Auditory processing • Balance • Ball skills • Bilateral integration • Calming • Confidence and self esteem • Core Stability • Crossing the midline • Developing fine motor skills • Dressing skills • Expressive language • Fasteners • Flexible (hypermobile) joints • Hand gym for the older child • Handwriting

Fact File for School Age • Letter and number reversals • Maximising attention • Motor planning • Organisational strategies for school and home • Pelvic stability • Perceptual skills • Pragmatics or social communication skills • Scissor skills • Shoes and socks • Shoulder stability • Speech sounds • Stammering • Transitions and settling to task • Tying shoelaces • Verbal comprehension (understanding language) • Vocabulary

Fact File for School Age Expressive language • Expressive language is the way we put words together into phrases and sentences to express meaning. It includes aspects such as word order, use of small function words such as 'of', and 'are' and word endings, for example those that signal plurals and different verb tenses. • Expressive language development follows a recognised sequence. If a child’s expressive language development is following this typical progression but at a slower rate than their peers, they have an expressive language delay. If they are not following this progression, their expressive language is considered to be disordered.

Fact File for School Age Expressive language • If you have used this Advice Sheet and not seen improvement after 3 – 4 months, please contact the Integrated Therapy Service. What you may see Strategies and advice Suggested resources

Fact File for School Age Section Six: The Integrated Therapy Service and how to refer As for the Fact File for Early Years

Fact File for School Age Appendices • Appendix 1 ‘Integrated Therapy Service Referral form’ • Appendix 2 ‘Additional Information to Support Occupational Therapy Referral’ • Appendix 3 ‘Communication Competencies in School’

Next steps... Aim: To ensure that those children and young people who have complex, high level needs that only a qualified therapist can assess, advise on or treat...and who it is predicted will be able to respond to this specialist input...receive the help they need, when they need it Response: Redefining the core service – care pathways and levels of intervention Further development and extension of the ITS Therapy Guidance Sheets for assessed and diagnosed conditions ...work in progress

Next steps... Aim: For partner services, e.g. schools/school clusters to have the opportunity to increase levels of therapy support and staff expertise and thereby further improve outcomes for children and young people Response: Prospectus of Additional Therapy Services available for commissioning: Additional levels of therapy Group work Training for staff Bespoke consultancy Drop-in clinics for staff and families Screening

Additional therapy services from the ITS In a unique position to provide high quality additional services • Working to NHS professional and clinical standards • Three therapies, integrated • Working alongside the core service, eliminating reduplication and miscommunication • Long experience of working within settings in Somerset • Familiarity with the county statutory processes • Well established joint working with Education services • Close working with other Health services • Safe, evidence-based practice – CPD, supervision, appraisal • HPC registered and monitored therapists • Trained and supervised therapy support practitioners • Regular safeguarding supervision • Value for money – commissioning of skill mix teams

Additional therapy services Commissioning of additional therapy services for Speech and Language Therapy, Occupational Therapy, Physiotherapy will help you to: • Enhance early identification and support • Raise educational attainment • Improve behaviour • Increase children and young people’s life chances

Integrated Therapy Service for Children and Young People