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
Source
Percentage
Medical Consultants
23%
Schools
23%
Health Visitors
21%
GPs
9%
Pre-school settings
8%
Education services
6%
External therapists
4%
Parents/carers
3%
Internal referrals
2%
CAMHS
1%
TOTAL
100%
Typical referral percentages
per year by therapy/age range
Therapy
Age Range
Percentage
Occupational Therapy
0 – 4 years
5.6%
5 – 19 years
16.6%
Total for OT
22.2%
0 – 4 years
10.2%
5 – 19 years
10.1%
Total for PT
20.3%
Physiotherapy
Speech and Language Therapy 0 – 4 years
Total for service
34.3%
5 – 19 years
23.2%
Total for SLT
57.5%
100%
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: 0303 033 3002
• 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.
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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:
http://www.sompar.nhs.uk/our_services/childrenandyoungpeople
/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: 3,888
Increase 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