1. Integrated Therapy Service for Children and Young People – May 2012 Frances Rowe, Service Manager

2. Background and Structure Service commissioned: October 2009. Therapy services merged from 3 Trusts. Detailed service specification from PCT and LA commissioners Provides: Integrated Speech and Language Therapy, Occupational Therapy and Physiotherapy for CYP aged 0 – 19 years Delivered in: ITS clinics, Children’s Centres and pre-schools, all mainstream and special schools, families’ homes, hospital wards and outpatient clinics Staff Bases:Taunton, Bridgwater, Yeovil and Wells

3. Sources of referrals to the ITS SourcePercentage Medical Consultants23% Schools23% Health Visitors21% GPs9% Pre-school settings8% Education services6% External therapists4% Parents/carers3% Internal referrals2% CAMHS1% TOTAL100%

4. Typical referral rate per year by therapy and age range TherapyAge RangeTotals Occupational Therapy0 – 4 years148 5 – 19 years438 Total for OT586 Physiotherapy0 – 4 years270 5 – 19 years266 Total for PT536 Speech and Language Therapy0 – 4 years910 5 – 19 years613 Total for SLT1,523 Total for service2,645

5. Current caseload TherapyCases Occupational Therapy1,119 Physiotherapy809 Speech and Language Therapy3,265 TOTAL5,193

6. Current staffing PostContractedAt work Service Manager1.00 CAMs / Professional Leads3.19 Clinical Lead OTs2.46 Band 6 and Band 5 OTs10.448.80 Clinical Lead PTs2.96 Band 6 PTs6.004.53 Clinical Lead SLTs3.15 Band 6 and Band 5 SLTs20.1419.14 Band 4 Therapy Support Practitioners5.804.98 Admin staff (all grades)10.409.60 Totals65.5459.81

7. Challenges and responses Response to previous concerns with Choose and Book referral system: Spring 2011: extensive consultation with referrers and families May 2011: introduction of ‘in-house’ Single Point of Access, plus Telephone Advice Line: Staffed four mornings per week by therapy team (simultaneously triaging new referrals) – immediate advice, guidance and potential direct acceptance of referral. Very positively received

8. Challenges 35% rise in referrals since 2009 (shorter waiting times, easier access, increased identification from training to schools/pre-schools/health visitors etc.) Increasing survival of children with very complex needs Ongoing ‘Flat cash’ funding plus staff sickness, maternity leave, vacancies Expectation for some families/referrers of long term/direct therapy, children retained ‘on the books’ until adulthood Resulting difficulty providing high levels of intervention when needed, timely reviews or frequent support for families/schools/pre-schools

9. Responses Increased skill mix – adding hours to the service Improved referral forms, careful triage, not accepting inappropriate referrals Focussed approach to clinical reasoning for therapy staff – ‘Care Aims’ Personalised care planning – specific and agreed objectives, evaluation of outcomes Discharging long term cases (where active intervention not needed) with guidance on advice/re-referral via Telephone Advice Line

10. Responses Waiting time initiative – below 13 weeks wait achieved across all areas in March 2012 Early Years Fact File and School Age Fact File delivering guidance on: Typical development Acceptable variations Identification of specific needs How to support needs, interventions to try ‘Red flags’ for when to refer immediately. Planned release: Summer Term 2012

11. Responses Re-design of core service and access/discharge criteria to: Make best use of available resources, focussed onto CYP for whom specialist support from the ITS is essential Provide advice/guidance/training for children’s workforce and families to support less severe and specific needs in everyday contexts Develop additional therapy services available for direct commissioning by schools/academies/school clusters or federations, etc.

12. Examples of additional services From Qualified Therapists: Individual or group therapy for CYP with complex, identified needs Training for staff in delivering therapy programmes One-off consultancy to meet specific development/learning needs in a school or preschool setting Drop-in Therapy Clinics for staff and families Screening e.g. for Reception children

13. Examples of additional services From Qualified Therapists: Whole class-based observation to identify supportive strategies and screen children or young people who may need to be referred More frequent liaison with school or preschool staff and parents/carers Wheelchair clinic liaison Coordination classes

14. Examples of additional services From Therapy Support Practitioners: Delivering individual or group therapy programmes Advising on modifications to the school environment and curriculum Training Learning Support Assistants and parents/carers Modelling how to deliver therapy programmes

15. Examples of additional Training 1. Topic areas for Speech and Language Therapy training Supporting pupils with Speech, Language and Communication Needs in school Speech Sound Development Listening and Attention Social Communication and Autism

16. Examples of additional Training 2. Topic areas for Occupational Therapy or Physiotherapy training Supporting pupils with Coordination Needs in School Sensory Integration / Processing Needs Accessing the Curriculum and the Classroom Environment Postural Management and Motor Development for pupils in School Supporting pupils with Learning Difficulties

17. Why commission additional services from the ITS? A comprehensive, professional NHS service – evidence-based practice Staff training and supervision from therapists with advanced clinical skills Three therapy disciplines in joint working model Different grades of staff to ensure best use of funding Long established partnership working with schools and pre-schools in Somerset Effective joint working with other statutory services/agencies