Children’s Therapies

This document outlines the referral criteria for children requiring support from: Care Coordination; Occupational Therapy; Physiotherapy and/or Speech and Language Therapy.

Children’s Therapists may work as a single discipline service within the Children’s Therapies Service.  Where children or young people present with needs that require multi-disciplinary support, therapists will work jointly, as part of an integrated team.

Further information, including advice on universal strategies to support children’s development can be found on the Children’s Therapies website, The Pod: http://www.kentcht.nhs.uk/childrens-therapies-the-pod

Referrals can also be made on line via the website.

Referrals to speech and language therapy are accepted from parents and those with parental responsibility, as well as professionals working with a child.

Referrals to occupational therapy and physiotherapy must be made by a health, education or social care professional.

Please see the referral forms for the information that is required, prior to the referral being processed.

Education and Health Care Plans (EHCP)

New referrals from the Local Authority for Special Educational Needs for completion of an Appendix 4, as part of the EHCP process or tribunal processes are not accepted unless children meet the referral criteria as stated below.

This assessment should be requested through the agreed referral processes, as part of the local offer. If accepted the child/young person will be seen within our usual response times.

Care Co-ordination Service

Referrals for this service will be discussed within the Children’s Therapies triage processes.

This is a service for babies and children who present with an identified developing condition or disability which is impacting on, or has the potential to significantly impact upon their long-term development and / or function.

Initial referrals will be accepted from birth until a child’s 4^th birthday

Re-referrals will be accepted up until a child’s 12^th birthday, where specific care coordination needs are identified which are not being met by other support services or education

All referrals will triaged in the normal Children’s Therapies process, if a child appears appropriate for care co-ordination at triage, but they have not been referred for this, then the triaging clinicians can suggest that family be asked about care co-ordination.

All children should be triaged for how urgently they should be seen. This will usually fit in with the timescales as defined by the allocated pathway. If the infant or child is in hospital, the care co-ordination team may support with co-ordination for discharge.

All children must be contacted within the 18 week referral to treatment target.

Children referred to the Care Co-ordination Service will have a significant severe delay or potential in 2 or more areas of their development and will require ongoing support from at least 2 disciplines from within the Children’s Therapy team.

Pre-school Children with complex disability and their parents/carers will have an agreed support plan in place for next steps within 2 weeks following initial visit / appointment.

Exclusion criteria

Children will not be accepted into the Care Co-ordination service if they are referred after their fourth birthday unless:

• the family have moved into the area and have previously accessed an equivalent service
• the child has an acquired brain injury that results in significant developmental delay
• the child presents with a degenerative condition diagnosed after the fourth birthday
• they have previously been known to the care coordination team and are under 12 years

NB: referrals will not be accepted for babies and children who have complex medical needs and who do not meet the above criteria.  These children should be referred to the Children’s Community Nursing teams.

Physiotherapy

Early Years Physiotherapy

This is a service for babies and children who:

• Present with an identified neurodevelopmental condition or physical disability, which is impacting on or has the potential to impact upon their gross motor development and/or function.
• Demonstrate non-typical development of posture and movement resulting in difficulties with movement and functional skills (eg asymmetry, abnormal muscle tone).
• Present with developmental delay (such as not sitting independently by 8 months, not walking by 18 months).
• Due to preterm birth are identified as being at high risk of developing physical disability.  All babies under 28 weeks gestation and/or with 1000g or less birth weight will be monitored.  NB: East Kent - monitor all babies born under 32 weeks gestation.
• Had therapeutic hypothermia (brain cooling) after birth and/or had a brain injury (identified via brain scan) in the neonatal period.
• Have Cystic Fibrosis (East Kent) - managed through shared care services or by specialist centres.
• Have torticollis/plagiocephaly.
• Are toe walking, where there is also a presence of developmental delay, abnormal muscle tone or pain and/or asymmetric presentation.

School Years Physiotherapy

This is a service for children and young people who:

• Have an identified neurodevelopmental condition or physical disability, which is impacting on or has the potential to impact upon their gross motor development and/or function.

• Present with a severe physical impairment, where the underlying cause is exacerbated by psychological factors (such as Chronic Regional Pain Syndrome or CFS/ME). Referrals will only be accepted where the child/young person is actively supported by local Child and Young People’s Mental Health Services or is following a programme of rehabilitation led by a tertiary centre.
• Cystic Fibrosis – see Early Years criteria.

Exclusion criteria

Referrals will not be accepted for children who have:

• A single diagnosis of hypermobility with no associated functional difficulties or pain.
• Minor foot/gait anomalies - unless developmental or neurological symptoms are also present.
• Weight management needs.
• Musculoskeletal/orthopaedic problems (such as Severs, Osgood- Schlatter, chondromalacia patella, Perthes disease, sprained ankle, knee pain, back and neck pain).
• Minor orthopaedic problems (such as post-fracture).
• Post orthopaedic surgery (such as leg lengthening/spinal surgery), unless there is an underlying neurodevelopmental diagnosis or difficulty with home/school access.
• Idiopathic (sensory) toe walking, unless there is associated pain.

Occupational Therapy

The term ‘occupations’ refers to the everyday activities that people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life.  Occupations include things people need to, want to, and are expected to do.

For a child these occupations are primarily focussed around play and leisure, learning, and self-care (dressing, using cutlery, washing etc).

Early Years Occupational Therapy

This is a service for babies and children who:

• Present with an identified condition or physical disability which is impacting on, or has the potential to impact on their ability to participate in developmentally appropriate occupations and activities.

• Demonstrate non-typical development that impacts on their ability to participate in developmentally appropriate occupations and activities.
• Due to preterm birth are identified as being at high risk of developing physical disability.
• Had therapeutic hypothermia (brain cooling) after birth and/or had a brain injury (identified via brain scan) in the neonatal period.

School Years Occupational Therapy

This is a service for children and young people who:

• Have an identified condition or physical disability impacting on their ability to participate in developmentally appropriate occupations.
• Present with coordination (motor/fine motor) difficulties that impact their ability to participate in at least 2 age appropriate occupations (see definition).
• Present with sensory processing differences that are impacting on their ability to participate in at least 2 developmentally appropriate occupations, (see definition below), across a variety of settings.
• See Sensory Processing support pathway for further specific information.

Referrals for support for children’s co-ordination and sensory development need to document evidence of implementation of appropriate universal strategies prior to a referral being accepted.

Universal strategies include:

• Minor adaptations to the school/home environment
• Adapting activities using high street equipment / furniture
• Inclusion in an appropriate sensory - motor program such as Beam/ Fizzy or Sensory Circuits twice a week for at least 12 weeks where limited progress has been observed.

These strategies and adjustments need to have been implemented consistently over a period of 12 weeks and evidence of what was tried, when, where and how often is needed.

Further ideas for supporting children’s development and progress are available on The Pod which is the Children’s Therapies section - kentcht.nhs.uk/childrens-therapies-the-pod

Exclusion criteria

Referrals will not be accepted for children who have:

• A single diagnosis of hypermobility with no associated functional difficulties or pain
• Handwriting difficulties only
• Children who have been assessed by an OT previously and whose presenting needs would still be addressed by existing OT advice.

Speech and Language Therapy

Early Years and School years

This is a service for children and young people aged 3;0 years and over who:

• Have an identified speech, language and communication needs.
• Are not meeting the expected developmental norms for their chronological age.
• Are presenting with a specific communication difficulty, eg stammer, voice.
• Present with Selective Mutism (where education and family have attended training and put in support for 12 weeks with minimal progress).
• For school age children, documented evidence is needed that the school has carried out at least 12 weeks of support, (where the child or young person has made limited progress) before considering a referral.
• Present with a severe delay/disorder in their speech sound development.
• Present with 3 or more risk factors present (as per the information including in the referral form/Using the Language and Communication Need appendix).
• Who require specialist support to establish an augmentative/alternative communication system due to the child’s difficulties leaving them without a developing functional communication system.
• Have a diagnosis that is progressive or degenerative resulting in deteriorating communication abilities which requires specialist support to maintain communication skills and/or establish an augmentative/alternative communication system if required.

Referrals will be accepted for children younger than 3;0 years where they:

• Present with feeding and swallowing difficulties, please complete the additional information eating and drinking form
• Have a hearing impairment and are referred by the Teachers of the Deaf
• Are known to OT and PT  (are likely to be long-term AAC users).
• Have a diagnosed genetic syndrome and meet current referral criteria (e.g. Di George syndrome, Down’s syndrome)
• Are presenting with severe language or communication needs and a conversation between parent or professional and a speech and language therapist indicates the need for referral

Exclusion criteria

• Children/young people with global developmental delay whose language development is in line with their overall development.
• Children/young people with mild and moderate speech difficulties.
• Children/young people with a diagnosis of Autism where their language development/impairment fits with a diagnosis of Autism.

Exclusion criteria for eating and drinking

• Orally aversive due to sensory issues - this needs specialist MDT feeding clinic approach
• Children who eat a restricted range or amount - see information available on the Pod
• Difficulties with initial weaning - contact your Health Visitor/GP for support
• Parental anxiety around weaning - contact your Health Visitor/Family Hub
• Tongue-tie - contact the Infant feeding team up to six weeks of age or GP
• PICA - contact GP
• Feeding disorders/ARFID - refer to NELFT.