Wiltshire Community Child Health Services (WCCHS)

Contract Reference:780/Virgin/20160401

Schedule 2A – Service Specifications

Extract of Contract: Occupational Therapy

6.Integrated Paediatric Therapy Services – Occupational Therapy and Physiotherapy

Service description

An evidenced based, integrated community paediatric physiotherapy and occupational therapy service which caters for the complex needs of children and young people presenting with physical and cognitive problems. The new provider is asked to work towards a fully integrated paediatric physiotherapy and occupational therapy community model. As such this specification is to be used as a working document that will be updated as collaborative community services are further developed in line with Service Development Improvement Plans.

The Community Paediatric Therapy Service combines the skills of Physiotherapists (PT) and Occupational Therapists (OT) in one team. The Service will work with children with a range of paediatric conditions, i.e. congenital, neurological, developmental and musculo-skeletal difficulties.

The service will work with colleagues ensure the delivery of co-ordinated , seamless care.

The service will attend and support all relevant multidisciplinary meetings and will fully support the development of individual Education, Health and Care Plans where their professional expertise is required.

To support the development of children and young people to their full potential and to enable them to achieve maximum functional independence by preventing, minimising or reducing the effect of paediatric disorders.

Prevent or limit contractures and deformity
Develop strength, stamina and co-ordination of skills
Support children in their abilities to increase their independence with bathing, dressing, and feeding
Support children to take part in classroom activities by appropriate remediation of the difficulties or adaption of the tasks and/ or environment
Support children to have the necessary skills for meaningful engagement in play/leisure

It does this by providing therapeutic interventions and education.

Education includes:

Educating parents and carers of children with neurological, developmental or musculoskeletal conditions on how to implement therapeutic handling and activities into their daily routine.
Educating and supporting parents and carers on the long term care and management of clients with disabilities enabling, wherever possible, young people to self-manage long term conditions.
Advising and supporting education staff to ensure a child with a neurological or developmental condition reaches their maximum potential in their educational setting.

Key Deliverables

Development and delivery of a Wiltshire wide integrated model of paediatric Occupational Therapy and Physiotherapy.
Appropriate liaison with acute colleagues to facilitate transition between acute and community services
A service which is aligned with Local Authority Occupational Therapy and Disability specialist teams with a commitment to the further development of integrated working across organisational boundaries.
Delivery of therapies within special schools as appropriate and will support capacity building and deliver urgent assessment tribunal work, including reports, as requested by the SEND service.

Paediatric Occupational Therapists work with children experiencing acute/chronic illnesses, those with physical disabilities, and/or those with other motor or sensory difficulties which significantly impact on their function.

They may provide assessment and intervention in the following areas:

Seating includingprescription of seating to promote an optimal seating position to aid function, management and access to the environment.
Self Care Skills e.g. feeding, dressing, toileting etc.
Motor Abilitiesboth in gross motor and fine motor skills, with particular emphasis to developing good posture, purposeful hand function, perception-motor abilities and general levels of motor function to aid in daily life skills.
Sensory Skillshow the child processes, interprets and modulates sensory information from the environment (e.g. noise, touch, smells).
Perceptual/processing Skills visual perception, concept formation, sequencing, problem solving, memory, attention and motor planning.
Play Skillswillingness to engage in play andexplorationskills through play, e.g. turn-taking, attention.
Social Skills(where the difficulties are due to a primary physical difficulty) self-regulation,inter-personal relationships and practice of social skills in everyday situations to increase thechild’s ability and willingness to engage in meaningful activity.
Assessment of the Schoolenvironmentin conjunction with the advisory teachers for physical impairment ;visits to assess, advise and liaise regarding equipment, building adaptations, and other equipment that aids daily living.
Technologyto aid access to curriculum and communication through assessment of technology via liaison with education.

The role of the occupational therapist working with children and young people is to focus on those aspects of daily life, which present a challenge for the child. The service agrees goals with the child and family (and teaching staff where appropriate) and provides written advice and programmes to follow, updating them as required.

Daily life tasks addressed in occupational therapy for children may include activitiesor tasks from three main areas:

Self-care/self-maintenance such as washing, dressing, grooming, eating and drinking.
Play and leisure e.g. how a child plays, their preferred play, range of play and leisure activities, use of community activities, playing with others etc.
Productivity. This would be activities such as practical school tasks (e.g. negotiating the environment, carrying out class based routines and responsibilities, handling school equipment and materials) and age appropriate domestic tasks (e.g. making a snack, tidying a room, packing a school bag).

Paediatric Physiotherapistswork with children with a variety of symptoms and disorders e.g. cerebral palsy or other neuromuscular conditions, orthopaedic disorders, abnormalities of gait, respiratory disorders, rheumatology (including juvenile idiopathic arthritis, hypermobility, and chronic pain), Complications of prematurity and infants at risk of neurodevelopmental problems.

The service will work with adult physiotherapy services to continue to deliver and develop existing pathways for children with MSK difficulties with the aim of working towards a Wiltshire wide integrated MSK pathway.

Physiotherapists will work alongside colleagues delivering the national specialist pathway for children with Cystic Fibrosis (commissioned by NHS England) to ensure the delivery of seamless and coordinated care

Physiotherapists will work with colleagues from acute settings to support to Paediatric Orthopedic and Orthotic clinics as appropriate. The provision of an orthotics and lycra service is not part of this service specification.

Assessment and Interventions include:

Providing screening and advice for infants at risk of neurodevelopmental problems.
Monitoring development and providing timely neurodevelopmental physiotherapy to facilitate the acquisitions of skills for children that are delayed in their sensory-motor development.
Monitoring and maintaining skeletal alignment and/or maintaining muscle length in children with neuro-disabilities and other long term physical conditions so as to reduce the need for orthopaedic surgery and/or the degree of orthopaedic surgery required.
Identifying, orderingand monitoring appropriate supportive equipment (e.g.: postural management systems such as standing frames and sleep systems) in order to prevent long- term deterioration and maximise a child’s participation in activities of daily living.
Identifying, orderingand monitoring appropriate specialist equipment and aids to maximise a client’s participation, e.g. walking aids, mobility aids and splints.
Providing community rehabilitation physiotherapy in order to return children to their previous level of function, or improve their functional ability, following post-operative loss of skills or those caused by major trauma.
Where appropriate and available, hydrotherapy programmes may be provided including individual work with child in the hydrotherapy pool where required.

The service will operate four levels of intervention:

A ConsultativeService

Difficulties and circumstances experienced by the child related to Physiotherapy and/or Occupational Therapy can be facilitated or changed by other care givers (parents, teachers, support workers) with advice and only minimal support from the Physiotherapist/Occupational Therapist.

B Facilitator Service

Difficulties and circumstances experienced by the child related to Physiotherapy and/or Occupational Therapy can be facilitated or changed by other care givers (parents, teachers, support workers) with direct teaching and support from the Physiotherapist/ Occupational Therapist. Maintenance, support and review may be required.

C Direct Service

Difficulties and circumstances experienced by the child related to Physiotherapy and/or Occupational Therapy need direct therapist intervention for short periods of time in order to improve or facilitate change, or until problems resolve. For on-going level C service, evidence of therapeutic progress with the child is required. Reviews will be necessary.

D Urgent Assessment and Immediate Management

Difficulties and circumstances experienced by the child – related to Physiotherapy and/or Occupational Therapy – need direct therapist intervention to identify and prioritise immediate need. Intervention will be to resolve immediate needs. A programme of further management and intervention is developed, with progression to level C as soon as possible.

These services will be delivered from settings where clinically appropriate including Paediatric Assessment Centres, outpatient clinics and a range of community settings including Early Years settings and schools.

Outcomes

An increase in the health and well-being of children with additional needs, disabilities and complex needs through the provision of a range of specialist assessment and treatment programmes.
Maintaining and/or limiting the impact of deteriorating conditions on the child and family.
Improved function and/or better management of the child’s condition/development at home and in educational settings.
Improved attainment in school through better access to curriculum as a result of therapeutic intervention and advice, and recommendation of adaptations.
The wider children’s workforce (in schools, Children’s Centres and pre-school settings) have increased understanding of a child’s difficulties and increased knowledge of techniques and strategies for supporting them.