Bath and North East Somerset
Community Health and Care
Services:
Children’s Occupational Therapy
and Physiotherapy Service
SD11
1.
Introduction
The current combined Children’s Physiotherapy and Occupational Therapy service
encourages the development of children and young people to their full potential by
preventing, minimising or reducing the effect of childhood disorders.
2.
Purpose
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Aims and Objectives
The Service works with children with a range of congenital, neurological,
developmental and musculo-skeletal difficulties. By enabling children and young
people to achieve maximum functional independence, the service strives to enable
them to take their place within their peer groups and wider society.
Occupational Therapists work with children and young people who have physical
problems - either from birth or as a result of an accident or illness - that impact on
their functional participation in daily activities i.e. in self-care, play and schoolwork
tasks. A smaller proportion of their caseload comprises of children with specific
developmental problems e.g. autism. They work with children and their carers to
help them to carry out the activities that they need, or want, to do in order to lead
healthy and fulfilling lives. They are experts in supporting the development of
independence and provide assessment, therapy and, where necessary, specialist
equipment.
Physiotherapists help to develop or restore movement and function to as near
normal as possible when a child or young person is affected by injury, illness,
developmental delay or other disability. Physiotherapists assess and treat children
and young people helping them achieve mobility and function. Treatment might
include specific exercises and ‘hands on’ therapy. Physiotherapists sometimes use
specialist equipment and mobility aids.
The child may be seen on an individual basis, as part of a group or in a clinic. The
setting and delivery of service is determined by the child’s need at the time together
with available resources. Assessments and interventions are delivered at the
Children’s Ward at the RUH, outpatient specialist RUH clinics, community clinics, the
child’s home and/or educational setting. The service is required to contribute
appropriately in the planning and delivery of Education, Health and Care Plans for
Children and Young People as per the SEND Reforms.
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3.
National/Local Context
This document has been developed in line with local and national policies, with a
focus on providing high quality care that promotes independence, social inclusion,
choice, and provides best value. A summary of the relevant policies is provided
below.
4.
The Policy Context
The service will also be delivered according to guidelines laid down in:
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5.
5.1
Children and families Act 2014
The Care Act 2014
SEND code of practice 2014
Better Care: Better Lives, (DoH 2008)
Aiming High for disabled children (DCSF)
National Service Framework for Children (DoH, 2005)
Every Child Matters (DCSF, 2004)
ACT care pathways and guidance (Association for Children’s Palliative Care
2009, 2011)
Healthy lives, brighter futures: The strategy for children and young people’s
health (DoH/DCSF, 2009)
NHS at home: children's community nursing services (DoH, 2011)
Getting it right for Children and Young People: Overcoming cultural barriers in
the NHS so as to meet their needs (DoH, 2010)
Achieving Equity and Excellence for Children (DoH, 2010)
Service Delivery
Service Model
The Community Paediatric Therapy Service combines the skills of Physiotherapists
(PT) and Occupational Therapists (OT) in one team. The Service works with children
with a range of conditions, i.e. congenital, neurological, developmental and musculoskeletal difficulties.
Purpose:
Therapists:
 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
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 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
They do this by providing both 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
Children’s 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. The service agrees goals with
the child and family (and teaching staff where appropriate) and provides written advice
and programs’ to follow, updating them as required.
They may provide assessment and intervention in the following areas:
 Seating including prescription 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 Abilities both in gross motor and fine motor skills, with particular
emphasis to developing good posture, purposeful hand function, perceptionmotor abilities and general levels of motor function to aid in daily life skills
 Sensory Skills how 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 Skills willingness to engage in play and exploration skills through play,
e.g. turn-taking, attention.
 Social Skills (where the difficulties are due to a primary physical difficulty) selfregulation, inter-personal relationships and practice of social skills in everyday
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situations to increase the child’s ability and willingness to engage in
meaningful activity.
 Assessment of the School environment in 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.
 Technology to aid access to curriculum and communication through
assessment of technology via liaison with education.
Children’s Physiotherapists work with children with a variety of symptoms and
disorders e.g. cerebral palsy or other neuromuscular conditions, orthopedic
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.
Assessment and Interventions include:
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Providing screening and advice for infants at risk of neurodevelopmental
problems.
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Monitoring development and providing timely neurodevelopmental physiotherapy
to facilitate the acquisitions of skills for children that are delayed in their sensorymotor development.
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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.
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Identifying, providing and 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.
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Identifying, providing and monitoring appropriate specialist equipment and aids to
maximise a client’s participation, e.g. walking aids, mobility aids and splints.
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Providing community rehabilitation physiotherapy in order to return children to
their previous level of function, or improve their functional ability, following postoperative loss of skills or those caused by major trauma.
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Assessment and provision of hydrotherapy programmes as appropriate including
individual work with child in the hydrotherapy pool where required.
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Assessment and provision of hydrotherapy programmes as appropriate including
individual work with child in the hydrotherapy pool where required.
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These services are delivered from settings where clinically appropriate including
Assessment Centres, outpatient clinics and a range of community settings including
Early Years settings and schools.
Key deliverables
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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
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Maintaining and/or limiting the impact of deteriorating conditions on the child and
family
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Improved function and/or better management of the child condition/development
at home and in educational settings
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Improved attainment in school through better access to curriculum as a result of
therapeutic intervention and advice, and recommendation of adaptations for
Integrated, holistic Education Health and Care Plan, as appropriate.
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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
Service Development - Opportunities and Issues to be addressed
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Therapy services for Children and Young People in B&NES are a core
offering of the area’s ‘Local Offer’ outlined in the Children and Families Act
(2014). The Children’s Speech and Language Therapy service is currently
provided by the local community health service provider. Closer alignment
and delivery of a combined and integrated Children’s Community Therapy
Service is desirable.
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The service needs to 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 B&NES wide integrated MSK pathway.
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The service will be expected to support individuals and families to achieve
identified and agreed specific outcomes and use effective and standardised
tools to assess, measure, track and report on progress, impact and outcomes
for clients as a result of engaging with the service.
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Increased service user engagement must be evident in the design,
performance monitoring and evaluation of future service provision.
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6.
Whole system relationships
The service works to ensure that a child or young person’s care is co-ordinated,
seamless and compassionate. This includes working across organisation
boundaries, including acute, community and voluntary sector. For children with
special educational needs or disabilities therapists appropriately attend all relevant
multidisciplinary meetings and fully support the development of individual Education,
Health and Care Plans where their professional expertise is required. There is an
expectation that the service makes the appropriate links with other service providers
including, for example, wheelchair services.
The current service is aligned with Local Authority Occupational Therapy and
Disability specialist team and is committed to integrated working across
organisational boundaries. Therapists deliver interventions within special schools as
appropriate and support staff capacity building as well as providing assessments and
reports as requested by the Local Authority SEND team
Physiotherapists 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 also work within the acute settings to provide specialist support to
Paediatric Orthopedic and Orthotic clinics as appropriate.
7.
Interdependencies and other services
The service works with:
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Health Visitors
SEND practitioners, SENCO’s
General Practitioners
Autistic Spectrum Disorder (ASD) Support Service
Primary Child and Adolescent Mental Health Service (PCAMHS)
CAMHS LD - neurodevelopmental Clinic (for children with moderate or greater
levels of LD and a mental health need)
Paediatricians
Acute Hospital (Children’s and Neonatal)
Schools and other Educational services
Children’s Social Care
Other allied health Professionals
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