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 SourcePercentage Medical Consultants23% Schools23% Health Visitors21% GPs9% Pre-school settings8% Education services6% External therapists4% Parents/carers3% Internal referrals2% CAMHS1% TOTAL100%

Typical referral percentages per year by therapy/age range TherapyAge RangePercentage Occupational Therapy0 – 4 years5.6% 5 – 19 years16.6% Total for OT22.2% Physiotherapy0 – 4 years10.2% 5 – 19 years10.1% Total for PT20.3% Speech and Language Therapy0 – 4 years34.3% 5 – 19 years23.2% Total for SLT57.5% Total for service100%

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: 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 the knowledge, 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: /integrated_therapy_service/ /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