TVCC Interim School Therapy Services Contracted OT, PT and SLP Services Current manager of TVCC’s OT, PT and SLPs who work in the schools Project Manager for new Interim school therapy services Thanks for the opportunity to share what I have learned and our plans to date Looking for feedback from school leadership Training tool under development for teaching staff and service provider staff that will be available before the March break Referral forms will be on TVCC website as well.

Community Connector Visit to TVCC Regional rehabilitation centre serving children and youth with physical disabilities, developmental disabilities and/or communication needs, primarily in Southwestern Ontario Services provided to more than 8,000 children and youth every year StacyAccredited via CARF June 2, 2015

Community Connector Visit to TVCC TVCC Vision Our Clients at Their Best Stacy June 2, 2015

Community Connector Visit to TVCC TVCC Mission We provide rehabilitation services which support participation in all areas of life for children, youth and young adults: focusing on the strengths of individuals and their families at home, school, workplace, and community pursuing research, education and advocacy participating in a local and regional system of services StacyChange indent June 2, 2015

First Step in Special Needs Strategy for Integrated Rehabilitation Ontario Children’s Treatment Centres to manage contracts for contracted OT, PT and SLP at publicly funded schools LHIN/CCAC care coordinators no longer involved Short term plan for approximately 1 year Provincial advisory committee is reviewing proposals to come to common solutions Long term plan may not look like proposals Goal: minimize change because the long term plan is not yet determined Do important changes that will make a difference: reduce clinician travel, increase clinical time

Staying the Same after transition LHIN involvement with: all services in private schools nursing at school and home therapy (OT, PT and SLP) at home Important to note

Process to Request School Therapy until Transition School team refers to the LHIN (CCAC) LHIN Care Coordinator determines eligibility SW LHIN has a contracts with St. Elizabeth, VON, Paramed, Closing the Gap and TVCC to provide services in London, Middlesex, Oxford/Norfolk and Elgin Review TVCC is one of the service provider agencies for LM and O Families that had an existing relationship with TVCC could request TVCC to continue to follow KEEP USING THIS PROCESS UNTIL APRIL 1 OR TOLD OTHERWISE

Changing after Transition in Publicly Funded Schools School team will make referrals directly to TVCC TVCC will determine eligibility TVCC will determine which service provider agency Majority of schools in London, Middlesex, Oxford, Elgin, Huron, Perth, Grey and Bruce – the area of the SW LHIN TVCC remain a SP in London; Middlesex and Oxford

How the service is staying the same Amount of money allocated for therapy sessions Service provider agencies Eligibility for service Waitlist School board SLP Other TVCC services This is not the SNS proposals you may have heard of For every 6 children receiving therapy there are 4 waiting in Southwestern Ontario For service provider agencies – they have the choice to continue their LHIN contract for school services with TVCC or not

LHIN Priority for Therapy System as of Jan 2017 Level 1: immediate service Level 2: waitlisted – released by referral date Level 3: waitlisted Waitlisted as of Jan 2018: 13% of PT, over 40% of SLP, over 55% of OT Historically not shared with schools and families - ? Results in inappropriate expectations?

SLP Immediate Service New onset or worsening swallowing difficulties ACS system needed for basic needs ADD: post surgical Service as deemed necessary by clinician and approved by CC

SLP Waitlisted Level 2: Severe articulation, fluency, voice/resonance, severe emotional impact Level 3: Moderate articulation, fluency, voice/resonance, moderate emotional impact Max 3 blocks of treatment for level 2 = 30 visits Max 2 blocks of treatment for Level 3 = 20 visits Clinician will choose how to use allotted visits using best practices, family and school input.

OT Immediate Service Urgent swallowing Unable to access bathroom or classroom Skin integrity Toileting, lifting equipment Safety risk due to change in physical status

OT Waitlisted Level 2: school mobility, seating/positioning, teach school re: feeding, transfers, updated equipment, sensory concerns limit safety/attendance. ADD FM written communication equipment need Level 3: DD, severe FM, sensory limits participation Max 8 visits ? Add FM difficulties requiring equipment to Level 2

PT Immediate Service Acute chest Safety risk to ambulation/physical mgt Acute pain Post op ADD BOTOX Skin integrity Safety risk due to sudden change in physical status

PT Waitlisted Level 2: chronic chest, accessibility, revisions to orthotics, mobility equipment, (botox), equipment, teaching staff transfers Level 3: mobility/co-ord with moderate impact Max 8 visits

Transition to School School can refer to ISTS if school OT, PT or SLP assist needed for transition planning (discuss with preschool therapist) Preschool and School therapist will work out roles Accommodates for lack of Care Coordinator

Referral Process – New School: TVCC referral form, OT/PT/SLP referral forms Parent: Client Background Information form Parent: Consent and Authorization to Share School makes referral Changing because the LHIN care coordinator no longer involved Need the information to decide on the urgency of the child’s need school recommending the referral and outlining reason for therapy (estimated needs if a preschooler) and strategies and equipment already available and tried, reports, school contacts **Parent responsible to ensure that the school receives their 2 parts. The school will forward the complete package to TVCC. Schools will have all the forms and they also will be posted on our website. If eligible – may not get immediate service. Children with less urgent needs are waitlisted.

Details Specific to SLP Services Couple differences because school boards also have SLP

Referral Process JK SLP Preschool SLP refers to TVCC and school board simultaneously for JK students Preschool SLP completes the paperwork with the parent Referral to TVCC rather than LHIN is only difference

Board SLP and Contracted SLP Roles Board SLP follows children with primarily language difficulties and mild articulation Contracted SLP for children with moderate to severe articulation difficulties. Limited number of visits. (Change: group sessions will be allowed). No change to division of work– see: 2011 CCAC SHSS Program Criteria and Severity Level Definitions for SLP If needs moderate to severe speech/articulation/pronounciation of words then TVCC Interim School Therapy SLP addresses this need. TVCC Interim School Therapy SLP includes direct session to develop skills; the consultation is mainly with the parent for required followup at home.

Overall Impact for Children and Families Currently Receiving School Therapy Same service provider Similar models of service delivery LHIN Care Coordinator no longer involved Reports look different Slide refers to expected impacts with the changes Contracted service providers may opt out of contract Typewritten reports that summarize progress on goals will no longer use the LHIN format Care coordinator no longer calling re: school services.