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

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

Sources of referrals to the ITS

Source Percentage

Medical Consultants

23%

Schools 23%

Health Visitors 21%

GPs 9%

Pre-school settings 8%

Education services 6%

External therapists 4%

Parents/carers 3%

Internal referrals 2%

CAMHS 1%

TOTAL 100%

Typical referral rate per year by therapy and age range

Therapy Age Range Totals

Occupational Therapy 0 – 4 years 148

5 – 19 years 438

Total for OT

586

Physiotherapy 0 – 4 years 270

5 – 19 years 266

Total for PT

536

Speech and Language Therapy

0 – 4 years 910

5 – 19 years 613

Total for SLT

1,523

Total for service 2,645

Current caseload

Therapy Cases

Occupational Therapy 1,119

Physiotherapy 809

Speech and Language Therapy

3,265

TOTAL 5,193

Current staffing Post Contract

edAt work

Service Manager 1.00 1.00

CAMs / Professional Leads 3.19 3.19

Clinical Lead OTs 2.46 2.46

Band 6 and Band 5 OTs 10.44 8.80

Clinical Lead PTs 2.96 2.96

Band 6 PTs 6.00 4.53

Clinical Lead SLTs 3.15 3.15

Band 6 and Band 5 SLTs 20.14 19.14

Band 4 Therapy Support Practitioners

5.80 4.98

Admin staff (all grades) 10.40 9.60

Totals 65.54 59.81

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

Challenges35% 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

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

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 developmentAcceptable variationsIdentification of specific needsHow to support needs, interventions to try‘Red flags’ for when to refer immediately.

Planned release: Summer Term 2012

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.

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•  

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

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

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

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

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