Review of therapy services to special schools
Children’s therapy team – North Lincolnshire
Summary of feedback and proposals for future service delivery
October 2014
CONTENTS
Introduction
Page 3
Summary of current service delivery
Page 3
Purpose of the review
Page 4
How the review has been carried out
Page 5
Feedback received
Page 6
Key messages from feedback received
Page 10
Proposals for improving the service
Page 11
Next steps
Page 15
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Introduction
Therapy services for children and young people attending special schools are provided by the
Children’s Therapy Team for North Lincolnshire. This team was formed in May 2012 following a
major re-structuring of therapy services provided by Northern Lincolnshire and Goole NHS
Foundation Trust (NLAG).
The children’s therapy team consists of:
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Occupational therapy staff (OT’s)
Physiotherapy
Speech and language therapy staff (SLT’s)
Working in special education is only one strand of the team’s work as it also covers early years
settings, family homes, mainstream schools, the child development centre and children’s centres
and links with the hospital.
Funding comes predominately from NHS commissioners but both special schools are buying in some
additional time to ‘top up’ what is offered through core NHS services:
St Luke’s Primary Special School is funding an extension to the core Occupational therapy service to
support children with specific sensory integration needs.
St Hugh’s Communication and Interaction Specialist College is funding therapy assistant time to
extend the physiotherapy and occupational therapy provision available to students. A speech and
language therapist is also funded 2 days a week to support excellence in developing communication
skills across the school – and to work on the delivery of training and community projects.
Summary of current service delivery
Speech and language therapy
St Luke’s and St Hugh’s are covered by three therapists with an allocation of 8 half day sessions a
week to cover a current caseload across both schools of 160 (97 at St Luke’s and 63 at St Hugh’s).
Communication teams involving speech and language therapists and school staff (including a
member of the senior leadership team) meet within both schools to coordinate work streams and
agree priorities and practice to promote communication and interaction.
Clinical work within the schools includes assessment, advice, strategies, targets, and programmes of
work to address communication, speech, language, alternative and augumentative communication
(AAC), feeding and drinking needs as appropriate for each individual. Therapists offer support and
training for school staff and for parents/carers as required. Work in school during term time is
supported by some home visits during the school holidays. Transition planning across the two
schools takes place within the summer term prior to moving to secondary school.
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Physiotherapy
Physiotherapists offer input to both schools on a regular basis. The aim is to provide one half day
session each week for each school, although this has not always been possible in recent months
because of staffing difficulties.
The physiotherapists work closely with parents, school staff, other therapy colleagues and run joint
clinics with the orthotist and consultants. There is a physiotherapy assistant, funded by St Hugh’s,
who provides regular ‘hands on’ sessions for some students and works under the supervision of the
physiotherapist.
Classroom staff/parents in both schools are given advice and programmes to support individual
children – and to ensure the safe and effective use of specialist equipment e.g. standers.
There are currently 72 children on the special school caseload, with numbers split roughly half in half
across the 2 schools.
Occupational therapy
The occupational therapists provide input into both St Luke’s and St Hugh’s and have approximately
82 pupils on caseload. There are two regular half day sessions each week, usually on a Wednesday,
and a Thursday, with three occupational therapists having input across the 2 schools.
Therapists are also frequently involved in other contacts during the week, to carry out assessments,
often for specialist equipment, contribute to ‘child in need’ meetings, offer intervention or training
for staff and parents.
The occupational therapists work particularly closely with the physiotherapists.
Therapists liaise regularly with classroom staff and both head teachers. Many of the pupils are also
seen at home, where therapists work with parents to provide and monitor specialist equipment, and
advise on adaptations.
Purpose of the review
This review is being undertaken to ensure that the services provided by Children’s Therapy Team:
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Make the best use of the therapy time available to have the greatest possible impact on
outcomes for children and young people
Are delivered in partnership with school staff and parents (and the children and young
people themselves)
Are evidence based
Are sustainable and realistic given the increasing level of demand
Are delivered efficiently and are good value for money
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This is essential given:
Changes at a national level
The Children and Families Act 2014 makes radical changes to the way in which support is provided
for children and families with special educational needs and /or disabilities. There is renewed
emphasis on designing services around the needs of individual children and families, and on working
in partnership at all levels. Whilst fully supporting the ambitions of the Act, this will demand
additional time from the Children’s Therapy Team, due to the increased emphasis on joint planning
and review.
The increasing level of demand for therapy services
There has been an increase in the demand for therapy support at both schools in recent years. This
is due to:
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The increasing numbers of children on roll at both schools
The increasingly complex needs of pupils related to improved survival rates for very
premature babies and children with complex health conditions
The expansion of available evidence based treatments e.g. Botox, which require therapy
support
How the review is being carried out
The review is being undertaken in stages:
This document represents the third step in the review (see diagram below).
Feedback was gained via:
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Questionnaires sent out to all parents
Questionnaires sent out to all school staff
Attendance at a parents’ evening at St Hugh’s and a coffee morning at St Luke’s
Meeting with the Parents in Partnership (PIP) group for North Lincolnshire
Email contact with other stakeholders e.g. paediatricians
Ongoing dialogue with the senior management teams in both schools
Group discussions – therapy staff
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1.Feedback
collected from
schools, parents,
therapists and
other partners
5.Service
delivered
4.Changes to
service delivery
confirmed and
communicated
to others
2.Feedback
collated and
proposals
developed
3.Proposals sent
out for
consultation
Process of the review
Feedback received
St Hugh’s Communication and Interaction Specialist College
1. Feedback from parents at St Hugh’s
Feedback was received from 12 parents. Key messages were that:
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Speech and language therapy and occupational therapy services are generally well
received
There is a mixed view of physiotherapy with some parents identifying a lack of provision
Parents highlight communication with home as an area which could be improved, some
saying that they are unclear about who is seeing their child and how often, and would
like more support with knowing how to help their child at home.
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2. Feedback from staff at St Hugh’s
Feedback was received from 19 members of staff ranging from teaching assistants to senior
managers. Staff value physiotherapy, occupational therapy and speech and language
therapy and feel that these services run smoothly most of the time. They particularly value:
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The approachability of therapy staff and their helpful attitude
The positive relationships between therapy staff and children / young people
Therapy assessments, reports and advice
Therapists acting as a link with other health service staff and specialist centres
Opportunities to meet to discuss students’ needs and therapy advice on targets /
strategies
Dedicated staff time in school to deliver therapy programmes e.g. physio assistant
available through the service level agreement, in house speech and language key worker
Having a central point of contact in school for therapy matters i.e. a senior member of
staff who would co-ordinate input, raise questions, make requests etc on behalf of
school staff
Suggestions for improvements include:
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Therapists attending review meetings
Increased availability of therapists in school to meet with parents e.g. parents’ evenings,
drop in sessions
Further staff training – including more therapy input into the induction of school staff
Reducing the gap between assessments and programmes / equipment being available
(although the latter is not within the control of the Children’s Therapy team).
Several staff mentioned that communicating by email would improve joint working, but
that this presents security issues which need to be addressed
Greater clarity over which therapists are involved with which students e.g. where 2
occupational therapists are working in the school, it may not be clear who is working
with an individual child
More regular opportunities for joint working, particularly in relation to students with the
most complex needs – setting goals, discussing approaches and measuring change
Improved transition into adult therapy services and better therapy services for young
people once they have left school
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St Luke’s
1. Feedback from parents at St Luke’s
4 parents returned their questionnaires. Approximately 15 parents attended the coffee morning.
Key messages from parents were:
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Having therapy services on site is valued
There were a number of positive comments about the impact of therapy input and the
progress that children had made
Therapy staff are viewed as approachable, supportive and helpful
Generally, parents feel that they were not ‘kept in the loop’ enough and want more
information about:
 What therapy their child is receiving
 What this means in practical terms – day to day
 Which therapists are involved and what happens in sessions
 How best to help at home
Periodic Makaton sessions for parents would be welcomed – so parents can keep up with
their children’s signing!
Parents are supportive of therapists working closely with school staff to ensure that, as far
as possible, children’s needs were met through everyday classroom activities. They support
the idea that therapists should be available to deliver specialist help when needed – through
targeted sessions, problem solving etc – and that it is not necessary for them to see all
children all of the time. However, they emphasise that therapists need to respond quickly
when issues arise. They would welcome more information about specific programmes
available in school e.g. MOVE
Parents feel that the school has an ‘open door’ policy – and staff are always ready to offer
support and information – but they want more two-way communication so that parents,
therapists and school staff can do more together in relation to setting goals, problem solving
and learning from each other.
Parents welcome homework packs during the school holidays – but would like the
opportunity to report back on how these have gone.
Some parents have found it difficult to get hold of therapists to sort out problems or get
help. When children are discharged by occupational therapists, it can take a long time to get
seen again if parents want a re-referral.
Inconsistent/lack of staffing in physiotherapy is a concern.
There are sometimes lengthy delays in the provision of equipment and this is viewed as very
unhelpful (although parents recognise that this is often out of the control of therapists)
Parents would like therapists to attend annual review / single plan meetings which is not the
case routinely at present, as this helps with communication and planning.
2. Feedback from staff at St Luke’s
3 members of staff returned their questionnaires. Key messages are:
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Occupational and speech and language therapy are generally working well
Physiotherapy has not been working well due to inconsistent staffing and insufficient time
being allocated to the school
Communication via email – and being able to store therapy reports electronically – would
assist with joint working
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The service could be improved by: more training for school staff, more frequent progress
reviews and equipment checks for some children, an OT to support the work of the CART
team (communication aids)
Parents in Partnership Group (PIP)
The children’s therapy manager attended a PIP group meeting in July and received the following
feedback:
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It is essential that therapists attend single plan / annual review meetings as these are crucial
for planning and partnership working. A report is also needed for these.
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Parents accept that ongoing support does not always need to be delivered by a therapist –
and that it can often be delivered effectively by a member of the schools staff – but feel that
therapists need to provide some quality assurance in the delivery of specific interventions
e.g. train the staff and update their knowledge
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Communication between therapists and parents of children at special school could be
improved
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When specific interventions are delivered by schools staff, parents don’t routinely get an
update on progress (whereas they would if a therapist was delivering it). This leaves them in
the dark about what impact it has had.
Paediatrician
One paediatrician has recently raised concerns about physiotherapy provision at St Luke’s
school, highlighting the impact of staffing difficulties on individual children. Lack of available
physio staff has also jeopardised joint clinics, which have proved a useful mechanism for
delivering ‘joined up’ services in the past.
Therapy staff
Therapy staff feet that the following are positive aspects of the service:
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Being able to provide an on-site service, integrated into the school day
Examples of excellent joint working in both schools and a number of shared initiatives
They value the investment by both schools in additional staff time to supplement core
NHS provision
Having a single point of contact in school is seen as helpful – as this assists with coordination and communication
They appreciate positive working relationships with staff in both schools
Therapists saw current challenges as:
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Managing the increasing level of demand: they feel their intervention is becoming too
watered down due to the size of caseloads, with a negative impact on what outcomes
can be achieved (particularly given the large caseloads in speech and language therapy)
Ensuring that children with the highest level of specific need receive the biggest
proportion of therapy time
Finding time to be pro-active and set up whole school approaches e.g. posture
management, which could make a big impact across the schools and prevent problems
arising
Spreading best practice across all classes – as they report variations between classes in
how therapy advice and programmes are implemented
Finding better ways to communicate effectively with parents and staff, including use of
email
Releasing time to attend annual review / single plan meetings
Lack of staffing in physiotherapy: it is an ongoing issue and has a knock on effect for the
OT’s who try hard to support physio colleagues in ensuring children’s physical needs are
met
Key messages from feedback
1. Therapy expertise is valued and seen as making a real difference
The importance of therapy assessments, reports, programmes, training for school staff
and joint working is highlighted. Also, the importance of having a school based service
for this group of children and young people.
2. There is concern about the level of therapy provision
Physiotherapy is highlighted as an area of real concern because of inconsistent staffing
and a lack of allocated time. All parties involved in the consultation raised this as a
concern.
The demands on all therapy services are increasing due to the additional children on roll
at both schools at the increasingly complex needs of the special school population –
which means that therapists feel that they are sometimes stretched too thinly to make a
real impact. School staff and parents also feel that some children require a higher level
of therapy support than is currently available.
3. There is good joint working in both schools, but there is still more
that could be done
There are positive working relationships between therapy and school staff in both
schools, and examples of excellent joint working. However, this could be developed
further, with a focus on ‘levelling up’ to ensure the best possible provision for all
students, and the most effective use of joint resources.
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4. Some parents report that communication with their child’s
therapist(s) needs to be improved
Current means of communicating with parents are not working well for everyone, and
there is sometimes a lack of clarity for families about who is involved with their child and
what is happening.
Proposals for improving the service
The Children’s therapy team has looked at the feedback received and put together some proposals
for improving the service. We would like to hear what school staff and parents think about these.
To address concerns about the level of therapy provision we propose …
1. Targeting therapy resources more effectively
We propose a graduated approach which takes into account the specialist skills of school
staff and the supportive / adapted environment of a special school. This is to ensure that
therapy resources are responsive to individual need, have an impact, and are not spread too
thinly to be effective.
See diagram below
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SPECIALIST: high level of specific needs
Specialist assessment
Hands on therapy sessions
and/or
Individual programme
Close liaison with home and school
Automatic reviews to update advice
Attendance at planning and review meetings
TARGETED: some specific
needs
Assessment, advice and/or a programme provided
Parents and staff can request further help
whenever needed
Therapists may recommend a programme which
can be delivered by school staff e.g. MOVE
UNIVERSAL: needs can
be met by school staff
Support from therapy staff to ensure
best practice across the school e.g.
posture management, alternative means
of communication
This means that:
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Therapists would spend more time with the students who have a high level of specific
need, and who require the skills of a therapist in order to achieve their potential
Therapy advice, programmes and support would be provided for children who have
some specific needs, but responsibility for requesting further help or an updated
programme will lie with parents and school staff. This would allow the system to be
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more responsive, reducing time wasted when children are reviewed before they have
achieved their targets – and enabling children who are progressing quickly to be
reviewed sooner.
Therapists would work with school staff to develop best practice across both schools in
key areas – to ensure that students’ needs can be met as much as possible through
everyday activities and the curriculum offer. This would free up therapy time for
students with a high level or specific need or complex needs.
Examples of this are:
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developing a communication friendly environment,
posture management,
the MOVE programme,
screening for fine motor, co-ordination and sensory needs.
Feedback from school staff indicates there is an appetite for training and skill building.
Individual students’ needs may change over time, and will need to be discussed with
parents, school staff and others involved in their learning and care in order to establish the
right level of therapy support at any one time. Factors which will affect the level of therapy
support provided will include:
 The child’s overall pattern of abilities and needs
A child may have a severe and specific difficulty in one area of their development, which can
act as a barrier to their overall progress. In this case, therapy intervention may help to
‘unlock’ their potential.
 The complexity of their needs
Children who have complex needs or rare conditions may require a higher level of specialist
support
 Transitions and changes in condition
The need for more intensive intervention may be triggered by a move between key stages,
transfer to college, or a change in staff in school. Similarly, surgery – or another major event
in the child’s life such as moving into foster care – may mean that a block of more intensive
input is required.
 Current priorities for the child and their family.
For example, a period of ill health or bereavement may mean that priorities lie elsewhere for
a period of time
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The capacity of school staff and parents to implement a therapy programme
It is important that therapy programmes are set up in partnership with the child, and his/her
family and school. Therapy programmes need to reflect the capacity of those in daily contact
with the child to carry out specific suggestions, and be realistic.
In order to move towards this way of working, we would need to:
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Develop a joint working protocol with both schools – which clarifies roles and
responsibilities using a graduated approach (as above)
Work with schools on prevention and early intervention wherever possible to stop
secondary problems developing e.g. posture management, awareness of sensory needs
Identify what training for school staff could usefully be provided by the Children’s
Therapy Team to help meet the needs of children at the targeted and universal levels
Support the school leadership team in quality assuring the delivering of specific
intervention programmes e.g. hydrotherapy, Madeleine Portwood programme, and
measuring outcomes
2. Developing a business case for more physiotherapy
This is in response to the high level of concern expressed and the lack of staffing in this
area compared to national benchmarking data.
To improve communication with parents, we propose ….
1. Providing parents with a leaflet about the therapy services available on entry to the
school so they know what to expect and how to contact us
2. Requesting that information about therapy services is added to the school website if not
already there (or links provided to the NLAG website), including contact numbers – and
how to get therapy help
3. Requesting that therapists names and photos are put up in school to increase visibility
4. Ensuring information is sent home at the start of each year to parents explaining which
therapists are involved with their child and providing contact details, including work
mobile numbers.
5. Maintaining contact through all possible means – phone, home/school book, letters,
written programmes, meetings, home visits – especially for those children who are
currently in need of a high level of therapy support
6. Putting a sticker or comment in the home/school book or a slip to be sent home each
time a child is seen in school by a therapist – so parents know what is happening and can
get in contact for help or further information
7. Therapists to attend review meetings for those children with the highest level of specific
needs (see above)
8. Therapists to make themselves available to parents in school via the most appropriate
means e.g. drop in at coffee mornings, parents’ evenings, by appointment
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To further develop joint working with school staff, we propose ….
1. Contributing to the induction of new staff so they have information about the therapy
services available in the school, and how to access these
2. Developing a safeguarding flow chart – which shows how school and NHS safeguarding
processes link together
3. Having a presence at some staff meetings (as felt appropriate by the head teacher) and to be
involved in relevant staff INSET
4. Meeting at agreed intervals with the key point of contact in school – to ensure good
communication and joint planning between the therapy team and the school’s SMT
5. Requesting that therapy staff be routinely invited to whole school events .e.g. sports days, to
develop visibility and relationships
6. Find technological solutions which will enable personal information to be emailed / shared
without breaches of security and confidentiality
7. Introduce a quality standard – that therapy reports and written programmes will be
available within 3 weeks of a child being seen
8. Increase links with the nurse in school – to join up the delivery of therapy and health plans
where appropriate
Other areas to address ….
Additional areas to consider are:
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The involvement of an OT on the CART team (communication aids)
Improved transition into adult services – although this would need to involved other
partners e.g. RDASH and the commissioners – and further discussion about the needs of 16
to 19 yr olds who leave St Hugh’s but who are not yet eligible for adult therapy services.
Next steps
We will now consult on these proposals by:
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Sending information about the proposals out to parents, school staff and other partners
Offering to attend any meetings or forums where these ideas could be discussed
We will then:
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Look at feedback and finalise future service delivery on the back of this
Communicate how the service will be delivered in future to parents, school staff and other
partners
Ensure close working with both schools to plan how best to implement any changes.
We will be implementing changes from January 2014.
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