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

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Presentation on theme: "Integrated Therapy Service for Children and Young People Frances Rowe, Service Manager."— Presentation transcript:

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

2 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: One Integrated 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

3 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!

4 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

5 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

6 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

7 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

8 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

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

10 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.

11 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

12 Fact File for Early Years Problems you may see and what to do – 1 month ObservationsActionSee Advice Sheets (Section 5) Baby turns their head to the same side for the majority of their waking hours. Follow Advice Sheet If no improvement after 1 month, refer to the ITS Tummy Time Head flattening on the back or one side of the baby’s head. NB. Many babies have mis-shapen heads following delivery. This should correct itself as the baby develops. Follow Advice Sheet If no improvement after 1 month, refer to the ITS Tummy Time

13 Fact File for Early Years Problems you may see and what to do – 9 months ObservationsActionSee Advice Sheets (Section 5) Baby lifts their legs up when placed in a standing position. Follow Advice Sheet If no improvement after 2 months, refer to the ITS Helping a Baby Develop Standing and Stepping Baby dislikes physical play with an adult (e.g. being bounced / rough and tumble play). Follow Advice Sheet If no improvement after 2 months, refer to the ITS Rough and Tumble Play Baby has difficulty coping with solids e.g. gagging, choking on lumps. Contact the child’s GP or Health Visitor for advice and contact the ITS if needed

14 Fact File for Early Years Problems you may see and what to do – 2 years ObservationsActionSee Advice Sheets (Section 5) Child is unable to walk independentlyRefer to the ITS Child refuses to try new foods. Becomes faddy at mealtimes. Follow Advice Sheet If no improvement after 6 months, contact the ITS Trying new foods Child shows little or no interest in communication and interaction. Little pretend play, poor attention. Is not responding to simple instructions e.g. ‘Where’s your coat?’ Refer to the ITS Follow Advice Sheet Use Somerset Total Communication strategies Toddler Talk

15 Fact File for Early Years Problems you may see and what to do – 3 years ObservationsActionSee Advice Sheets (Section 5) Child is unable to undress.Follow Advice Sheets If no improvement after 4 months, refer to the ITS Dressing Skills Dressing Skills Additional Guidance 1 & 2 Child has difficulty with hand skills in comparison to peers of a similar age (e.g. threading, crayon skills). Follow Advice Sheets If no improvement after 6 months, refer to the ITS Developing Hand Skills Pre-writing Activities Child uses only 1 - 2 word combinations, or is echoing adult language or learnt phrases, or has word order which is unusual. Refer to the ITS Follow Advice Sheet Pre-school Talk

16 Fact File for Early Years Problems you may see and what to do – 3 1/2 – 4 years ObservationsActionSee Advice Sheets (Section 5) Child has difficulty with balance and gross motor skills in comparison with peers of a similar age e.g. falls frequently, is unable to jump with two feet together Follow Advice Sheets If no improvement after 4 months, refer to the ITS Helping a Child Develop their Balance Child is unable to attempt fastenings such as buttons and zips Follow Advice Sheets If no improvement after 6 months, refer to the ITS Fasteners Developing Hand Skills Child’s speech is difficult to understand or a limited range of sounds used Refer to the ITS Follow Advice Sheet Helping Children with Unclear Speech

17 Fact File for Early Years Section Five: Advice Sheets for parents, carers and pre-school settings ContentsRef noPage Baby talkCYP ITS ASEY00133 Basic communication strategiesCYP ITS ASEY00235 Coping with lumpsCYP ITS ASEY00336 Developing cutlery skillsCYP ITS ASEY00440 Developing hand skillsCYP ITS ASEY00543

18 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

19 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

20 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

21 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

22 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

23 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

24 Fact File for School Age Section Two: Developmental milestones. 4 – 5 Years (Reception) MovementHand & Finger Skills Language & Social Communication Uses playground/gym equipment independently (climbing frame with ladder slide, low balance beams, swings – may not be able to initiate the swing) Stands on one foot for 5 seconds or more ‘Gallops’ along for 4 – 5 metres Hops on one foot 5 or more times Copies square Draws a person with two to four body parts, includes head, legs, trunk and usually arms and fingers Holds instrument with proper tension and grasp (scissors, pencils, pen, paintbrush) Produces speech which is mostly intelligible Produces most consonant sounds but ‘r’, ‘th’, ‘l’, ‘ch’ and ‘j’ may still not be correct Simplifies some sound combinations e.g. ‘tain’ for ‘train’, ‘boon’ for ‘spoon’ Words may be less clear in sentences than spoken singly Attention skills are generally two-channelled i.e. the child can do a task while listening to a simple instruction

25 Fact File for School Age Developmental milestones. 5 – 6 Years (Year 1) MovementHand & Finger Skills Language & Social Communication Stands on one foot for 10 seconds Skips along for 4 – 5 metres Walks around classroom/ school avoiding collision with stationary objects/people Carries objects around classroom/school avoiding collision with stationary objects/people Can cut/draw/trace with accuracy and precision Uses blocks, beads, puzzle pieces to complete appropriate tasks Copies triangle and other geometric patterns Produces most consonant sounds but ‘r’ and ‘th’ may not be established Some words may be hard to understand in connected speech but clearer if repeated Some long words with difficult sound combinations may show errors Two-channelled attention should be well established across a variety of situations Many children can remember a sequence of 5 digits

26 Fact File for School Age Developmental milestones. 6 – 7 Years (Year 2) MovementLanguage & Social Communication By this age children should have acquired most of their developmental milestones for movement Basic motor skills acquired – improvement in speed and skills of tasks should be observed Able to use ball skills whilst running at speed and changing direction Accuracy with aim and throwing whilst on the move As for children aged 5 – 6 years (Year 1), plus: Uses adult-like grammar and word order in their oral language Has learned the ‘rules’ of conversational etiquette (e.g. “Excuse me”) Can start and sustain conversations over multiple turns (five or more) with two or more partners Produces stories that centre around a theme and contain a logical chain of events Becomes more explicit in their language when they recognise that the listener is not understanding

27 Fact File for School Age Developmental milestones. 8 – 11 Years (Key Stage 2) MovementLanguage & Social Communication Milestones are achieved.Has most speech sounds and sound combinations including ‘th’ and ‘r’ unless errors are related to dialect Certain sounds may be produced in a slightly unusual way giving a different quality to the child’s speech, e.g. a lisp, although this will not affect intelligibility Multisyllabic words may contain the occasional mistake Many children can remember a sequence of 6 – 7 digits Understands questions requiring inference or prediction e.g. ‘How do we know he is feeling sad?’ or ‘What could he have done?’

28 Fact File for School Age Developmental milestones. Into the teenage years (Key Stages 3 and 4) MovementLanguage & Social Communication Milestones are achieved.Speech can seem to deteriorate in clarity and become more mumbled Boys’ voices deepen Understands jokes and riddles based on ambiguity which is embedded in the structure of sentences rather than in individual words Able to extract key information from extended amounts of verbal information Knowledge of grammatical rules reaches adult level Develops knowledge of how stress changes the meaning of what is said Able to vary structure of language for different verbal and written purposes

29 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)

30 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

31 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.

32 Fact File for School Age Problems you may see and what to do ObservationsSpeech sounds: 111 Speech sounds immature and may be unintelligible.

33 Fact File for School Age Problems you may see and what to do ObservationsVerbal Comprehension: 121 Auditory processing: 31 Does not understand/ process verbal instructions..

34 Fact File for School Age Problems you may see and what to do ObservationsCore stability: 48Flexible joints: 68Maximising attention: 83 Can’t maintain an upright sitting posture for more than 10 minutes...

35 Fact File for School Age Problems you may see and what to do ObservationsCrossing the midline: 53 Hand gym for older child: 71 Bilateral integration: 39 Difficulty coordinating two hands together for an activity...

36 Fact File for School Age Section Five: Advice Sheets for schools, parents and carers ContentsRef noPage Auditory processingCYP ITS ASSA00131 BalanceCYP ITS ASSA00234 Ball skillsCYP ITS ASSA00338 Bilateral integrationCYP ITS ASSA00439 CalmingCYP ITS ASSA00542

37 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

38 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

39 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.

40 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

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

42 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’

43 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

44 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

45 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

46 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


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