Presentation on theme: "Integrated Therapy Service for Children and Young People"— Presentation transcript:
1 Integrated Therapy Service for Children and Young People Frances Rowe, Service Manager
2 History of the ITSBefore October 2009 – 4 separate Trusts provided Paediatric Speech and Language Therapy, Occupational Therapy and Physiotherapy – patchwork of provision, different models of delivery and waiting timesOctober 2009: One Integrated Therapy Service commissionedProvides: Integrated SLT, OT and PT to all of the county – for babies, children and young people aged 0 – 19 yearsDelivered in: ITS clinics, Children’s Centres, pre-schools, mainstream and special schools, family homes, hospital wards and outpatient clinicsIntegrated 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 complaintsResponse: consultation with users and stakeholders on alternative modelOutcome: May 2011: Single Point of Access – in-house referral pointTelephone Advice Line, – 12.00, four mornings per week, staffed by SLT, OT and PT. Professional advice and guidance, potential for acceptance of referralSuccessful and busy!
4 Challenges – and responses 35% rise in referrals from 2009 – increased pressure on the service without additional fundingResponse: - 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 requiredOutcome: Longest wait for the service reduced from 2 years to weeks and below by end of March 2012, despiteincrease 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: IntroductionThe 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 PhysiotherapyHow to identify common and acceptable variations in young children’s developmentHow to decide which children may need additional support to promote their developmentPractical Advice Sheets which you can also share with parentsHow 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 FileMany 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 themThe 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/carersEarly identification of children needing extra support is vital – this does not always mean early referralA 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 helpIt 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 temperamentA child’s general healthPremature babies – more likely to show variations in their developmentA 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 developmentCommon 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)
12 Fact File for Early Years Problems you may see and what to do – 1 monthObservationsActionSee Advice Sheets(Section 5)Baby turns their head to the same side for the majority of their waking hours.Follow Advice SheetIf no improvement after 1 month, refer to the ITSTummy TimeHead 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.
13 Fact File for Early Years Problems you may see and what to do – 9 monthsObservationsActionSee Advice Sheets(Section 5)Baby lifts their legs up when placed in a standing position.Follow Advice SheetIf no improvement after 2 months, refer to the ITSHelping a Baby Develop Standing and SteppingBaby dislikes physical play with an adult (e.g. being bounced / rough and tumble play).Rough and Tumble PlayBaby 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 yearsObservationsActionSee Advice Sheets(Section 5)Child is unable to walk independentlyRefer to the ITSChild refuses to try new foods.Becomes faddy at mealtimes.Follow Advice SheetIf no improvement after 6 months, contact the ITSTrying new foodsChild 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?’Use Somerset Total Communication strategiesToddler Talk
15 Fact File for Early Years Problems you may see and what to do – 3 yearsObservationsActionSee Advice Sheets(Section 5)Child is unable to undress.Follow Advice SheetsIf no improvement after 4 months, refer to the ITSDressing SkillsDressing Skills Additional Guidance 1 & 2Child has difficulty with hand skills in comparison to peers of a similar age (e.g. threading, crayon skills).If no improvement after 6 months, refer to the ITSDeveloping Hand SkillsPre-writing ActivitiesChild uses only word combinations, or is echoing adult language or learnt phrases, or has word order which is unusual.Refer to the ITSFollow Advice SheetPre-school Talk
16 Fact File for Early Years Problems you may see and what to do – 3 1/2 – 4 yearsObservationsActionSee 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 togetherFollow Advice SheetsIf no improvement after 4 months, refer to the ITSHelping a Child Develop their BalanceChild is unable to attempt fastenings such as buttons and zipsIf no improvement after 6 months, refer to the ITSFastenersDeveloping Hand SkillsChild’s speech is difficult to understand or a limited range of sounds usedRefer to the ITSFollow Advice SheetHelping Children with Unclear Speech
17 Fact File for Early Years Section Five: Advice Sheets for parents, carers and pre-school settingsContentsRef noPageBaby talkCYP ITS ASEY00133Basic communication strategiesCYP ITS ASEY00235Coping with lumpsCYP ITS ASEY00336Developing cutlery skillsCYP ITS ASEY00440Developing hand skillsCYP ITS ASEY00543
18 Fact File for Early Years Advice sheets for parents, carers and pre-school settingsBaby talkBasic communication strategiesCoping with lumpsDeveloping cutlery skillsDeveloping hand skillsDressing skillsFastenersFinger feedingHelping a baby develop rolling and sittingHelping a baby develop standing and steppingHelping a child develop their balance
19 Fact File for Early Years Helping children with unclear speechLearning to ride a tricycleMessy playPre-school talkPre-writing activitiesRough and tumble playStammeringTalipes or club footToddler talkTrying new foodsTummy timeUsing 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 adviceWhat you may seeStrategies and Advice
21 Fact File for Early Years Section Six: The Integrated Therapy Service and how to referWhat is the Integrated Therapy Service for Children & Young People?Staff Teams – roles of SLTs, OTs and PTsArea Bases – contact detailsWho can refer?How to make a referralTelephone Advice LineMaking a written referralTriaging referralsAssessmentInterventionDischarge
22 Fact File for Early Years AppendicesAppendix 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: IntroductionThe 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 PTHow to identify common and acceptable variations in CYP’s developmentHow 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/carersWhen and how to refer for specialist assessment by the ITSGeneral 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 SkillsLanguage & Social CommunicationUses 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 metresHops on one foot 5 or more timesCopies squareDraws a person with two to four body parts, includes head, legs, trunk and usually arms and fingersHolds instrument with proper tension and grasp (scissors, pencils, pen, paintbrush)Produces speech which is mostly intelligibleProduces most consonant sounds but ‘r’, ‘th’, ‘l’, ‘ch’ and ‘j’ may still not be correctSimplifies some sound combinations e.g. ‘tain’ for ‘train’, ‘boon’ for ‘spoon’Words may be less clear in sentences than spoken singlyAttention 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 SkillsLanguage & Social CommunicationStands on one foot for 10 secondsSkips along for 4 – 5 metresWalks around classroom/ school avoiding collision with stationary objects/peopleCarries objects around classroom/school avoiding collision with stationary objects/peopleCan cut/draw/trace with accuracy and precisionUses blocks, beads, puzzle pieces to complete appropriate tasksCopies triangle and other geometric patternsProduces most consonant sounds but ‘r’ and ‘th’ may not be establishedSome words may be hard to understand in connected speech but clearer if repeatedSome long words with difficult sound combinations may show errorsTwo-channelled attention should be well established across a variety of situationsMany children can remember a sequence of 5 digits
26 Fact File for School Age Developmental milestones. 6 – 7 Years (Year 2)MovementLanguage & Social CommunicationBy this age children should have acquired most of their developmental milestones for movementBasic motor skills acquired – improvement in speed and skills of tasks should be observedAble to use ball skills whilst running at speed and changing directionAccuracy with aim and throwing whilst on the moveAs for children aged 5 – 6 years (Year 1), plus:Uses adult-like grammar and word order in their oral languageHas 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 partnersProduces stories that centre around a theme and contain a logical chain of eventsBecomes 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 CommunicationMilestones are achieved.Has most speech sounds and sound combinations including ‘th’ and ‘r’ unless errors are related to dialectCertain 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 intelligibilityMultisyllabic words may contain the occasional mistakeMany children can remember a sequence of 6 – 7 digitsUnderstands 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 CommunicationMilestones are achieved.Speech can seem to deteriorate in clarity and become more mumbledBoys’ voices deepenUnderstands jokes and riddles based on ambiguity which is embedded in the structure of sentences rather than in individual wordsAble to extract key information from extended amounts of verbal informationKnowledge of grammatical rules reaches adult levelDevelops knowledge of how stress changes the meaning of what is saidAble 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 developmentCommon variations in speech and language developmentCommon variations in children using their right and left hands for different tasksCommon variations in dressing skillsCommon variations in gait (walking patterns)
30 Fact File for School Age Section Four: Problems you may see and what to doThe Problems Table, on the next pages, will help direct you to Advice Sheets relevant to your concernsHow to use the Problems Table:Identify your main concernLook through the observations column on the left to find the most appropriate description of the area of difficultyFollow 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 doSome 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 doObservationsSpeech sounds: 111Speech sounds immature and may be unintelligible.
33 Fact File for School Age Problems you may see and what to doObservationsVerbalComprehension: 121Auditory processing: 31Does not understand/ process verbal instructions.
34 Fact File for School Age Problems you may see and what to doObservationsCore stability: 48Flexible joints: 68Maximising attention: 83Can’t maintain an upright sitting posture for more than 10 minutes.
35 Fact File for School Age Problems you may see and what to doObservationsCrossing the midline: 53Hand gym for older child: 71Bilateral integration: 39Difficulty coordinating two hands together for an activity.
36 Fact File for School Age Section Five: Advice Sheets for schools, parents and carersContentsRef noPageAuditory processingCYP ITS ASSA00131BalanceCYP ITS ASSA00234Ball skillsCYP ITS ASSA00338Bilateral integrationCYP ITS ASSA00439CalmingCYP ITS ASSA00542
37 Fact File for School Age Advice sheets for schools, parents and carersAuditory processingBalanceBall skillsBilateral integrationCalmingConfidence and self esteemCore StabilityCrossing the midlineDeveloping fine motor skillsDressing skillsExpressive languageFastenersFlexible (hypermobile) jointsHand gym for the older childHandwriting
38 Fact File for School Age Letter and number reversalsMaximising attentionMotor planningOrganisational strategies for school and homePelvic stabilityPerceptual skillsPragmatics or social communication skillsScissor skillsShoes and socksShoulder stabilitySpeech soundsStammeringTransitions and settling to taskTying shoelacesVerbal comprehension (understanding language)Vocabulary
39 Fact File for School Age Expressive languageExpressive 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 languageIf you have used this Advice Sheet and not seen improvement after 3 – 4 months, please contact the Integrated Therapy Service.What you may seeStrategies and adviceSuggested resources
41 Fact File for School Age Section Six: The Integrated Therapy Service and how to referAs for the Fact File for Early Years
42 Fact File for School Age AppendicesAppendix 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 servicesWorking to NHS professional and clinical standardsThree therapies, integratedWorking alongside the core service, eliminating reduplication and miscommunicationLong experience of working within settings in SomersetFamiliarity with the county statutory processesWell established joint working with Education servicesClose working with other Health servicesSafe, evidence-based practice – CPD, supervision, appraisalHPC registered and monitored therapistsTrained and supervised therapy support practitionersRegular safeguarding supervisionValue 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 supportRaise educational attainmentImprove behaviourIncrease children and young people’s life chances