CONTENTS

IntroductionPage 3

Summary of current service deliveryPage 3

Purpose of the reviewPage 4

How the review has been carried outPage 5

Feedback receivedPage 6

Key messages from feedback receivedPage 10

Proposals for improving the servicePage 11

Next stepsPage 15

Introduction

Therapy services for children and young people attending special schools are provided by the Children’s Therapy Team for North Lincolnshire. This team was formed in May 2012 following a major re-structuring of therapy services provided by Northern Lincolnshire and Goole NHS Foundation Trust (NLAG).

The children’s therapy team consists of:

  • Occupational therapy staff (OT’s)
  • Physiotherapy
  • Speech and language therapy staff (SLT’s)

Working in special education is only one strand of the team’s work as it also covers early years settings, family homes, mainstream schools, the child development centre and children’s centres and links with the hospital.

Funding comes predominately from NHS commissioners but both special schools are buying in some additional time to ‘top up’ what is offered through core NHS services:

St Luke’s Primary Special School is funding an extension to the core Occupational therapy service to support children with specific sensory integration needs.

St Hugh’s Communication and Interaction Specialist College is funding therapy assistant time to extend the physiotherapy and occupational therapy provision available to students. A speech and language therapist is also funded 2 days a week to support excellence in developing communication skills across the school – and to work on the delivery of training and community projects.

Summary of current service delivery

Speech and language therapy

St Luke’s and St Hugh’s are covered by three therapists with an allocation of 8 half day sessions a week to cover a current caseload across both schools of 160 (97 at St Luke’s and 63 at St Hugh’s). Communication teams involving speech and language therapists and school staff (including a member of the senior leadership team) meet within both schools to coordinate work streams and agree priorities and practice to promote communication and interaction.

Clinical work within the schools includes assessment, advice, strategies, targets, and programmes of work to address communication, speech, language, alternative and augumentative communication (AAC), feeding and drinking needs as appropriate for each individual. Therapists offer support and training for school staff and for parents/carers as required. Work in school during term time is supported by some home visits during the school holidays. Transition planning across the two schools takes place within the summer term prior to moving to secondary school.

Physiotherapy

Physiotherapists offer input to both schools on a regular basis. The aim is to provide one half day session each week for each school, although this has not always been possible in recent months because of staffing difficulties.

The physiotherapists work closely with parents, school staff, other therapy colleagues and run joint clinics with the orthotist and consultants. There is a physiotherapy assistant, funded by St Hugh’s, who provides regular ‘hands on’ sessions for some students and works under the supervision of the physiotherapist.

Classroom staff/parents in both schools are given advice and programmes to support individual children – and to ensure the safe and effective use of specialist equipment e.g. standers.

There are currently 72 children on the special school caseload, with numbers split roughly half in half across the 2 schools.

Occupational therapy

The occupational therapists provide input into both St Luke’s and St Hugh’s and haveapproximately 82 pupils on caseload.There are two regular half day sessions each week, usually on a Wednesday, and a Thursday, with three occupational therapists having input across the 2 schools.

Therapists are also frequently involved in other contacts during the week, to carry out assessments, often for specialist equipment, contribute to ‘child in need’ meetings, offer intervention or training for staff and parents.

The occupational therapists work particularly closely with the physiotherapists.

Therapists liaise regularly with classroom staff and both head teachers. Many of the pupils are also seen at home, where therapists work with parents to provide and monitor specialist equipment, and advise on adaptations.

Purpose of the review

This review is being undertaken to ensure that the services provided by Children’s Therapy Team:

  • Make the best use of the therapy time available to have the greatest possible impact on outcomes for children and young people
  • Are delivered in partnership with school staff and parents (and the children and young people themselves)
  • Are evidence based
  • Are sustainable and realistic given the increasing level of demand
  • Are delivered efficiently and are good value for money

This is essential given:

Changes at a national level

The Children and Families Act 2014 makes radical changes to the way in which support is provided for children and families with special educational needs and /or disabilities. There is renewed emphasis on designing services around the needs of individual children and families, and on working in partnership at all levels. Whilst fully supporting the ambitions of the Act, this will demand additional time from the Children’s Therapy Team, due to the increased emphasis on joint planning and review.

The increasing level of demand for therapy services

There has been an increase in the demand for therapy support at both schools in recent years. This is due to:

  • The increasing numbers of children on roll at both schools
  • The increasingly complex needs of pupils related to improved survival rates for very premature babies and children with complex health conditions
  • The expansion of available evidence based treatments e.g. Botox, which require therapy support

How the review is being carried out

The review is being undertaken in stages:

This document represents the third step in the review (see diagram below).

Feedback was gained via:

  • Questionnaires sent out to all parents
  • Questionnaires sent out to all school staff
  • Attendance at a parents’ evening at St Hugh’s and a coffee morning at St Luke’s
  • Meeting with the Parents in Partnership (PIP) group for North Lincolnshire
  • Email contact with other stakeholders e.g. paediatricians
  • Ongoing dialogue with the senior management teams in both schools
  • Group discussions – therapy staff

Feedback received

St Hugh’s Communication and Interaction Specialist College

  1. Feedback from parents at St Hugh’s

Feedback was received from 12 parents. Key messages were that:

  • Speech and language therapy and occupational therapy services are generally well received
  • There is a mixed view of physiotherapy with some parents identifying a lack of provision
  • Parents highlight communication with home as an area which could be improved, some saying that they are unclear about who is seeing their child and how often, and would like more support with knowing how to help their child at home.
  1. Feedback from staff at St Hugh’s

Feedback was received from 19 members of staff ranging from teaching assistants to senior managers. Staff value physiotherapy, occupational therapy and speech and language therapy and feel that these services run smoothly most of the time. They particularly value:

  • The approachability of therapy staff and their helpful attitude
  • The positive relationships between therapy staff and children / young people
  • Therapy assessments, reports and advice
  • Therapists acting as a link with other health service staff and specialist centres
  • Opportunities to meet to discuss students’ needs and therapy advice on targets / strategies
  • Dedicated staff time in school to deliver therapy programmes e.g. physio assistant available through the service level agreement, in house speech and language key worker
  • Having a central point of contact in school for therapy matters i.e. a senior member of staff who would co-ordinate input, raise questions, make requests etc on behalf of school staff

Suggestions for improvements include:

  • Therapists attending review meetings
  • Increased availability of therapists in school to meet with parents e.g. parents’ evenings, drop in sessions
  • Further staff training – including more therapy input into the induction of school staff
  • Reducing the gap between assessments and programmes / equipment being available (although the latter is not within the control of the Children’s Therapy team).
  • Several staff mentioned that communicating by email would improve joint working, but that this presents security issues which need to be addressed
  • Greater clarity over which therapists are involved with which students e.g. where 2 occupational therapists are working in the school, it may not be clear who is working with an individual child
  • More regular opportunities for joint working, particularly in relation to students with the most complex needs – setting goals, discussing approaches and measuring change
  • Improved transition into adult therapy services and better therapy services for young people once they have left school

St Luke’s

  1. Feedback from parents at St Luke’s

4 parents returned their questionnaires. Approximately 15 parents attended the coffee morning.

Key messages from parents were:

  • Having therapy services on site is valued
  • There were a number of positive comments about the impact of therapy input and the progress that children had made
  • Therapy staff are viewed as approachable, supportive and helpful
  • Generally, parents feel that they were not ‘kept in the loop’ enough and want more information about:
  • What therapy their child is receiving
  • What this means in practical terms – day to day
  • Which therapists are involved and what happens in sessions
  • How best to help at home
  • Periodic Makaton sessions for parents would be welcomed – so parents can keep up with their children’s signing!
  • Parents are supportive of therapists working closely with school staff to ensure that, as far as possible, children’s needs were met through everyday classroom activities. They support the idea that therapists should be available to deliver specialist help when needed – through targeted sessions, problem solving etc – and that it is not necessary for them to see all children all of the time. However, theyemphasisethat therapists need to respondquickly when issues arise. They would welcome more information about specific programmes available in school e.g. MOVE
  • Parents feel that the school has an ‘open door’ policy – and staff are always ready to offer support and information – but they want more two-way communication so that parents, therapists and school staff cando more together in relation to setting goals, problem solving and learning from each other.
  • Parents welcome homework packs during the school holidays – but would like the opportunity to report back on how these have gone.
  • Some parents have found it difficult to get hold of therapists to sort out problems or get help. When children are discharged by occupational therapists, it can take a long time to get seen again if parents want a re-referral.
  • Inconsistent/lack of staffing in physiotherapy is a concern.
  • There are sometimes lengthy delays in the provision of equipment and this is viewed as very unhelpful (although parents recognise that this is often out of the control of therapists)
  • Parents would like therapists to attend annual review / single plan meetings which is not the case routinely at present, as this helps with communication and planning.
  1. Feedback from staff at St Luke’s

3 members of staff returned their questionnaires. Key messages are:

  • Occupational and speech and language therapy are generally working well
  • Physiotherapy has notbeen working well due to inconsistent staffing and insufficient time being allocated to the school
  • Communication via email – and being able to store therapy reports electronically – would assist with joint working
  • The service could be improved by: more training for school staff, more frequent progress reviews and equipment checks for some children, an OT to support the work of the CART team (communication aids)

Parents in Partnership Group (PIP)

The children’s therapy manager attended a PIP group meeting in July and received the following feedback:

  • It is essential that therapists attend single plan / annual review meetings as these are crucial for planning and partnership working. A report is also needed for these.
  • Parents accept that ongoing support does not always need to be delivered by a therapist – and that it can often be delivered effectively by a member of the schools staff – but feel that therapists need to provide some quality assurance in the delivery of specific interventions e.g. train the staff and update their knowledge
  • Communication between therapists and parents of children at special school could be improved
  • When specific interventions are delivered by schools staff, parents don’t routinely get an update on progress (whereas they would if a therapist was delivering it). This leaves them in the dark about what impact it has had.

Paediatrician

One paediatrician has recently raised concerns about physiotherapy provision at St Luke’s school, highlighting the impact of staffing difficulties on individual children. Lack of available physio staff has also jeopardised joint clinics, which have proved a useful mechanism for delivering ‘joined up’ services in the past.

Therapy staff

Therapy staff feet that the following are positive aspects of the service:

  • Being able to provide an on-site service, integrated into the school day
  • Examples of excellent joint working in both schools and a number of shared initiatives
  • They value the investment by both schools in additional staff time to supplement core NHS provision
  • Having a single point of contact in school is seen as helpful – as this assists with co-ordination and communication
  • They appreciate positive working relationships with staff in both schools

Therapists saw current challenges as:

  • Managing the increasing level of demand: they feel their intervention is becoming too watered down due to the size of caseloads, with a negative impact on what outcomes can be achieved (particularly given the large caseloads in speech and language therapy)
  • Ensuring that children with the highest level of specific need receive the biggest proportion of therapy time
  • Finding time to be pro-active and set up whole school approaches e.g. posture management, which could make a big impact across the schools and prevent problems arising
  • Spreading best practice across all classes – as they report variations between classes in how therapy advice and programmes are implemented
  • Finding better ways to communicate effectively with parents and staff, including use of email
  • Releasing time to attend annual review / single plan meetings
  • Lack of staffing in physiotherapy: it is an ongoing issue and has a knock on effect for the OT’s who try hard to support physio colleagues in ensuring children’s physical needs are met

Key messages from feedback

  1. Therapy expertise is valued and seen as making a real difference

The importance of therapy assessments, reports, programmes, training for school staff and joint working is highlighted. Also, the importance of having a school based service for this group of children and young people.

  1. There is concern about the level of therapy provision

Physiotherapyis highlighted as an area of real concern because of inconsistent staffing and a lack of allocated time. All parties involved in the consultation raised this as a concern.

The demands on all therapy services are increasing due to the additional children on roll at both schools at the increasingly complex needs of the special school population –which means that therapists feel that they are sometimes stretched too thinly to make a real impact. School staff and parents also feel that some children require a higher level of therapy support than is currently available.

  1. There is good joint working in both schools, but there is still more that could be done

There are positive working relationships between therapy and school staff in both schools, and examples of excellent joint working. However, this could be developed further, with a focus on ‘levelling up’ to ensure the best possible provision for all students, and the most effective use of joint resources.

  1. Some parents report that communication with their child’s therapist(s) needs to be improved

Current means of communicating with parents are not working well for everyone, and there is sometimes a lack of clarity for families about who is involved with their child and what is happening.

Proposals for improving the service

The Children’s therapy team has looked at the feedback received and put together some proposals for improving the service. We would like to hear what school staff and parents think about these.

To address concerns about the level of therapy provision we propose …

  1. Targeting therapy resources more effectively

We propose a graduated approach which takes into account the specialist skills of school staff and the supportive / adapted environment of a special school. This is to ensure that therapy resources are responsive to individual need, have an impact, and are not spread too thinly to be effective.

See diagram below

This means that:

  • Therapists would spend more time with the students who have a high level of specific need, and who require the skills of a therapist in order to achieve their potential
  • Therapy advice, programmes and support would be provided for children who have some specific needs, but responsibility for requesting further help or an updated programme will lie with parents and school staff. This would allow the system to be more responsive, reducing time wasted when children are reviewed before they have achieved their targets – and enabling children who are progressing quickly to be reviewed sooner.
  • Therapists would work with school staff to develop best practice across both schools in key areas – to ensure that students’ needs can be met as much as possible through everyday activities and the curriculum offer. This would free up therapy time for students with a high level or specific need or complex needs.

Examples of this are: