1. OT Show 25 th & 26 th Nov NEC Birmingham Eve Hutton, Reader in Children & Young People’s Health & Well- being, Canterbury Christ Church University & Therapy Service Manager, EKHUFT. eve.hutton@canterbury.ac.ukeve.hutton@canterbury.ac.uk eve.hutton@nhs.neteve.hutton@nhs.net

2. Aims of the session Research findings from the UKC-PostCarD Study Posted – An evidence based ‘train the trainer’ intervention.

3. A ‘hands on’ approach - building the confidence of carers of children with postural care needs at school: the UKC PostCarD study.

4. Background Qualitative interviews with teaching staff in mainstream schools.

5. Views of teachers and assistants “He is stuck in his chair again, and he’s being excluded because they don’t want to take the risk of him going out”. “We’re not the experts...very often I think, ‘if I do such and such, is it going to damage the child’s legs or whatever?’’ “He’s just stood up and strapped into this contraption, it reminds me a bit of the film Frankenstein, with the monster strapped to the table and then they tilt it up”.

6. What we found Lack of understanding about postural care Impact on child’s function and participation

7. Our conclusions Build capacity Participation and inclusion Working together Listen to the child Development of the ‘A-Z of postural care’ NIHR Research for Patient Benefit.

8. Aim of the UKC-PostCarD study Increase confidence Reduced concerns Supportive learning environment Inclusion.

9. Method Parent & teaching staff recruited to 10 workshops run by therapists who had been trained as trainers in Kent, Surrey and Sussex N =75 parents, teachers and teaching assistants who care for children with physical disabilities attending mainstream schools At Time 1 participants completed a UKC PC questionnaire and engaged in a 2 hour interactive postural care workshop Over the following 6 weeks participants received one to one follow up support from therapists Time 2 N= 63 completed the UKC-PC questionnaire again to assess effectiveness.

10. Participants knowledge and confidence in providing postural care before and after training All p<.001 n+65

11. Interviews with parents and teaching staff ‘‘It just put you in the in the position of the child, and made you think about how difficult it was trying to listen to the teacher talking, and trying to take in new information. You’re trying to focus on just keeping yourself upright, yeah, it was good to experience that first hand”. Teaching Assistant

12. Interviews with parents and teaching staff “It makes you more aware and have a much greater empathy for why things take much longer, and the pressure on her. The pressure for her to be sitting and to be thinking is actually a lot greater”. Teacher

13. Interviews with parents and teaching staff “For me, definitely reassurance. Before I started I didn’t really know much about all the equipment. So it was good to know that I am doing the right thing”. Parent

14. Interviews with parents and teaching staff “It gives you a lot more confidence. Having the knowledge as to what is good postural care, and what is good posture… to both able bodied children and disabled children, applying it to everyone”. Teacher

15. Conclusion from the study Increased the knowledge confidence and understanding of parents & teaching staff Promoted greater collaboration between parents, teaching staff and therapists Makes a valuable contribution to the delivery of Occupational therapy and Physiotherapy to children with PD in schools Should be more widely available.

16. Practical activity Work in pairs Adopt an unstable position (take care !) Play noughts and crosses (3 mins / 10 games) Left ‘O’ Right ‘X’ Use your non dominant hand as you play the game Discuss how instability affected your ability to concentrate, your performance, your emotions…

19. Components of the ‘train the trainer’ Workshop manual The training workshop Resources and materials.

20. International Classification of Functioning Disability and Health (ICF)

21. Benefits of the training Evidence based - effective Assists non-specialists responsible for the day to day care of children with PD. New ways of working – allows therapists to share knowledge with front line carers at a time of tightened budgets ( less contact time, fewer visits and higher workloads for therapists ) Collaborative and holistic in approach Supported by recommendations in NICE guidance and SEN Code of Practice Fills a gap in training for therapists – building confidence and capacity in carers.

22. Beneficiaries Schools – support for pupils with SEN & disability Nursery, secondary & special schools Parents- opportunity for support, network and training Workshop format facilitates discussion & the sharing of concerns ‘Closes the circle’ between research and improving care.

23. Call to action Train the trainer workshops available in Spring 2016 Canterbury Christ Church University 4 x 1 day workshops – 12 places Extend provision if needed Contact: Eve Hutton. eve.hutton@canterbury.ac.ukeve.hutton@canterbury.ac.uk

25. References Bandura ( 1989) Self-efficacy: towards a unifying theory of behaviour change. Psychological review 84, 191-215. Department of Health and Department of Education (2015) Special educational needs and disability code of practice: 0-25. https://www.gov.uk. https://www.gov.uk Hutton, E. and Coxon, K. (2011) Posture for learning: meeting the postural care needs of children with physical disabilities in mainstream primary schools in England - a research into practice exploratory study. Disability and Rehabilitation. pp. 1-13. ISSN 0963-8288.Posture for learning: meeting the postural care needs of children with physical disabilities in mainstream primary schools in England - a research into practice exploratory study. Hutton, E., Poole, C., Townsend, I., Mortimore, J., Godden, S., Jensen, J. and Ariss, T. (2009) A-Z of postural care: how to have a good posture when sitting, standing, exercising and relaxing, a guide for teachers and parents and everyone. Canterbury, UK: Canterbury Christ Church University.A-Z of postural care: how to have a good posture when sitting, standing, exercising and relaxing, a guide for teachers and parents and everyone. Hutton, E., Hamilton-West, K. and Hotham, S. (2012) Development of a reliable, valid measure to assess parents' and teachers' understanding of postural care for children with physical disabilities. The ( UKC PostCarD) questionnaire. Child: care, health and development doi:10.1111/cch.12242.Development of a reliable, valid measure to assess parents' and teachers' understanding of postural care for children with physical disabilities. Hutton E, Tuppeny S, Hasselbuch A ( 2015) Making the case for universal and targeted children’s occupational therapy. British Journal of Occupational Therapy ( in press). National Institute of Health & Care Excellence (2012) Spasticity in children and young people with non-progressive brain disorders. http://www.nice.org.uk/guidance/cg145. http://www.nice.org.uk/guidance/cg145 WHO ( 2007) International Classification of Functioning Disability & Health – Children & youth version. Geneva. WHO Press.

26. Disclaimer This presentation is the result of independent research commissioned by the National Institute of Health Research (NIHR) under its Research for Patient Benefit (RfPB) programme (Grant ref PB-PG-0110-21045). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.