Integrated therapy service for children and young people
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Integrated Therapy Service for Children and Young People. Frances Rowe, Service Manager – October 2013. History of the ITS.

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Integrated Therapy Service for Children and Young People

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Integrated Therapy Service for Children and Young People

Frances Rowe, Service Manager – October 2013


History of the ITS

  • Previously – 4 separate Health Trusts provided Paediatric Speech and Language Therapy, Occupational Therapy and Physiotherapy: complex patchwork of provision, different models of access/waiting times/delivery

  • October 2009: Integrated Therapy Service commissioned by Somerset Primary Care Trust working with Somerset Local Authority

  • ITS provides: SLT, OT and PT to whole county: babies, children and young people, 0 – 19 years, in an equitable and integrated model

  • Venues: ITS clinics, Children’s Centres and pre-schools, mainstream and special schools, family homes, hospital wards and consultant outpatient clinics

  • Integrated Area Teams: Taunton, Bridgwater, Yeovil and Wells


Sources of referrals to the ITS


Typical referral percentages per year by therapy/age range


Model

  • Single Point of Access – for all referrals

  • Clinical triage – by experienced therapists. Referrals accepted / rejected as inappropriate / signposted to more appropriate provision / further information requested within 20 working days to enable triage

  • Telephone Advice Line – open 09:00 to 12:00, Monday, Wednesday, Thursday and Friday, staffed by experienced SLT, OT and PT. Provides advice and guidance, with potential acceptance of verbal referral.

    Tel: 0303 033 3002

  • Reduced maximum waiting time – below 13 weeks from end of March 2012 onwards, despite increase in referrals


Model

Assessment – generally at area team clinics/other venues where appropriate. Subsequent appointments often in child’s preschool setting, school or home. May highlight a goal the ITS can help child achieve by providing a form of intervention.

Intervention – depending on child's needs and difficulties, one or more of following options may be agreed with parents/carers and/or setting:

  • advice and recommendations for achieving agreed goal

  • programme of therapy activities to be carried out at home and/or setting

  • training of parents or professionals to meet CYP's needs

  • review to check CYP’s progress after a few months

  • block of individual or group therapy sessions

    Discharge –when involvement of the ITS is not currently required, discussed and agreed with the parents/carers. GP/other involved professionals notified.


Model

  • Aim: to provide the wider children’s workforce and families with theknowledge, skills and confidence to

    - support children with lower levels of need in their daily activities

    - prevent their problems increasing

    - help them make accelerated progress

    - identify the children who need specialist assessment & support:

    The Fact File for Early Years (0 – 4 years)

    The Fact File for School Age (5 – 19 years)


Fact File for Early Years

Fact File for Early Years contains information on how to:

  • Help children’s development in the areas covered by Speech and Language Therapy, Occupational Therapy and Physiotherapy

  • Identify common and acceptable variations in young children’s development

  • Decide which children need additional support to promote their development

    by providing:

  • Practical Advice Sheets which professionals can use and share with parents

  • Guidance on when and how to refer for specialist assessment by the ITS


Fact File for School Age

Fact File for School age contains information on:

  • Typical development of school age children and young people in the areas covered by SLT, OT and PT

  • How to identify common and acceptable variations in CYP’s development

  • How to decide which CYP may need additional support to promote their development

    by providing:

  • Practical Advice Sheets to use and share with parents/carers

  • Guidance on when and how to refer for specialist assessment by the ITS


Where to find out more about the ITS

ITS website provides:

  • Information on the service – for professionals and parents/carers

  • Contact details for the area teams

  • How to refer, including contact details for the Single Point of Access and all referral forms

  • Details of the Telephone Advice Line

  • Printable copies of the Fact File for Early Years and Fact File for School Age

  • Printable copies of all Advice Sheets in the Fact Files:

    http://www.sompar.nhs.uk/our_services/childrenandyoungpeople/integrated_therapy_service/


Current evaluation

Evaluation is underway of user experience and effectiveness of:

  • Telephone Advice Line – telephone questionnaire with sample of users

  • Fact File for Early Years – written questionnaire to Health Visitors

  • Fact File for School Age – written questionnaire to school SENCos

    Results currently being collated and analysed. Generally very positive with some helpful suggestions for further development


Ensuring ITS is as effective as possible within resources

  • Requirement for specific information at referral, using guidance in the Fact Files

  • Careful triage of referrals – to ensure appropriateness

  • Close monitoring of referral rates and management of assessment clinics

  • Revision and streamlining of all paperwork e.g. clinical reports

  • Personalised and agreed care planning, evaluation of outcomes

  • Discharge if active intervention not needed, clear guidance on re-referral and use of Telephone Advice Line

  • Flexible workforce moving where needed


Ongoing challenges / responses

  • Ongoing rise in referrals since service commissioned in October 2009

    Referrals in Jan – Dec 2009: 2,180

    Referrals in Jan – Dec 2012: 3,888Increase of 78%

    No additional funding, no evidence of reduction in referrals during 2013

  • Increased complexity – in the needs of children who require ongoing ITS support: medical, developmental and social

  • Capacity of partner services and agencies –to support agreed care plans and therapy programmes

    Response


Next steps...

  • Revision of the core service – what will be provided

  • Revision of the care pathways and levels of intervention for different needs

  • Development of high quality, evidence based Therapy Guidance Sheets on managing complex needs for children with assessed and diagnosed conditions

  • Provision of traded services to providers and settings who have requested additional therapy provision

    ...work in progress


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