Transcript Integrated Therapy Service - Frances Rowe

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: 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
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.
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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
Observations
Action
See Advice Sheets
(Section 5)
Baby turns their head to the same side
for the majority of their waking hours.
Follow Advice Sheet
Tummy Time
If no improvement after 1
month, refer to the ITS
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
Fact File for Early Years
Problems you may see and what to do – 9 months
Observations
Action
See Advice Sheets
(Section 5)
Baby lifts their legs up when placed in a
standing position.
Follow Advice Sheet
Helping a Baby
Develop Standing and
Stepping
If no improvement after 2
months, refer to the ITS
Baby dislikes physical play with an adult
(e.g. being bounced / rough and tumble
play).
Follow Advice Sheet
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
If no improvement after 2
months, refer to the ITS
Rough and Tumble
Play
Fact File for Early Years
Problems you may see and what to do – 2 years
Observations
Action
Child is unable to walk independently
Refer to the ITS
Child refuses to try new foods.
Becomes faddy at mealtimes.
Follow Advice Sheet
See Advice Sheets
(Section 5)
Trying new foods
If no improvement after 6
months, contact the ITS
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
Fact File for Early Years
Problems you may see and what to do – 3 years
Observations
Action
See Advice Sheets
(Section 5)
Child is unable to undress.
Follow Advice Sheets
Dressing Skills
Dressing Skills Additional
Guidance 1 & 2
If no improvement after 4
months, refer to the ITS
Child has difficulty with hand skills in
comparison to peers of a similar age
(e.g. threading, crayon skills).
Follow Advice Sheets
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
Developing Hand Skills
Pre-writing Activities
If no improvement after 6
months, refer to the ITS
Follow Advice Sheet
Pre-school Talk
Fact File for Early Years
Problems you may see and what to do – 3 1/2 – 4 years
Observations
Action
See 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
Helping a Child Develop
their Balance
Child is unable to attempt fastenings
such as buttons and zips
Follow Advice Sheets
If no improvement after 4
months, refer to the ITS
Fasteners
Developing Hand Skills
If no improvement after 6
months, refer to the ITS
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
Fact File for Early Years
Section Five: Advice Sheets for parents, carers and pre-school settings
Contents
Ref no
Page
Baby talk
CYP ITS ASEY001
33
Basic communication strategies
CYP ITS ASEY002
35
Coping with lumps
CYP ITS ASEY003
36
Developing cutlery skills
CYP ITS ASEY004
40
Developing hand skills
CYP ITS ASEY005
43
Fact File for Early Years
Advice sheets for parents, carers and pre-school settings
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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
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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
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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)
Movement
Hand & 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)
•Copies square
•Produces speech which is mostly intelligible
•Draws a person with
two to four body
parts, includes head,
legs, trunk and
usually arms and
fingers
•Produces most consonant sounds but ‘r’, ‘th’, ‘l’,
‘ch’ and ‘j’ may still not be correct
•Stands on one foot for 5
seconds or more
•‘Gallops’ along for 4 – 5
metres
•Hops on one foot 5 or more
times
•Holds instrument
with proper tension
and grasp (scissors,
pencils, pen,
paintbrush)
•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
Fact File for School Age
Developmental milestones. 5 – 6 Years (Year 1)
Movement
Hand & Finger
Skills
Language & Social Communication
•Stands on one foot for 10
seconds
•Can cut/draw/trace
with accuracy and
precision
•Produces most consonant sounds but ‘r’ and ‘th’
may not be established
•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
•Uses blocks, beads,
puzzle pieces to
complete appropriate
tasks
•Copies triangle and
other geometric
patterns
•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
Fact File for School Age
Developmental milestones. 6 – 7 Years (Year 2)
Movement
Language & Social Communication
By this age children should have
acquired most of their developmental
milestones for movement
As for children aged 5 – 6 years (Year 1), plus:
•Basic motor skills acquired –
improvement in speed and skills of
tasks should be observed
•Has learned the ‘rules’ of conversational etiquette (e.g. “Excuse
me”)
•Able to use ball skills whilst running
at speed and changing direction
•Accuracy with aim and throwing
whilst on the move
•Uses adult-like grammar and word order in their oral language
•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
Fact File for School Age
Developmental milestones. 8 – 11 Years (Key Stage 2)
Movement
Language & 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?’
Fact File for School Age
Developmental milestones. Into the teenage years (Key Stages 3 and 4)
Movement
Language & 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
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
Observations
Speech sounds
immature and
may be
unintelligible
Speech sounds: 111
.
Fact File for School Age
Problems you may see and what to do
Observations
Does not
understand/
process verbal
instructions
Verbal
Comprehension: 121
.
Auditory processing: 31
.
Fact File for School Age
Problems you may see and what to do
Observations
Can’t maintain
an upright
sitting posture
for more than
10 minutes
Core stability: 48
Flexible joints: 68
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.
Maximising
attention: 83
.
Fact File for School Age
Problems you may see and what to do
Observations
Difficulty
coordinating
two hands
together for an
activity
Crossing the
midline: 53
.
Hand gym for
older child: 71
.
Bilateral
integration: 39
.
Fact File for School Age
Section Five: Advice Sheets for schools, parents and carers
Contents
Ref no
Page
Auditory processing
CYP ITS ASSA001
31
Balance
CYP ITS ASSA002
34
Ball skills
CYP ITS ASSA003
38
Bilateral integration
CYP ITS ASSA004
39
Calming
CYP ITS ASSA005
42
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
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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