OCCUPATIONAL THERAPY SERVICE REFERRAL GUIDELINES. Reference number: CP164 Title: Children s Occupational Therapy Service Referral Guidelines

Transcription

1 OCCUPATIONAL THERAPY SERVICE REFERRAL GUIDELINES Reference number: CP164 Title: Children s Occupational Therapy Service Referral Guidelines Version number: 1 Policy Approved by: CASE(Clinical Audit Standards and Effectiveness) Date of Approval: 15 June 2009 Date Issued: Review Date: June 2011 Document Author: Managing Director: Paul Miller Helen Thorpe, OT Clinical Lead Deanne Middleton, Occupational Therapist

2 Version Control and Summary of Changes Version number Version 1, Draft1 Version 1 Draft 1 Date Comments (description change and amendments) March These guidelines replace the draft edition and reflect the new early years foundation curriculum. 15 June 2009 Policy approved at the CASE. Occupational Therapy Service Referral Guidelines Page of 52

3 Contents Page Introduction 4 Guidelines Statement 4 Key Features 4 Links to Other Guidelines/Policies 5 Scope of the Guidelines 5 Statutory and NHS Requirements 5 Consultation and Acknowledgement 5 Roles and Responsibilities 5 Procedure for Use 6 Review 7 Training Requirements 7 Monitoring/Audit Arrangements 7 Appendices Appendix 1: Occupational Therapy Service Referral Guidelines 8 Occupational Therapy Service Referral Guidelines Page of 52

4 1. Introduction These guidelines aim to provide useful information for those looking at the needs of young children with developmental difficulties, affecting predominantly their fine motor development and independence with self care activities. The guidelines were developed to help to support workers when deciding whether it is necessary to refer to the Children s Occupational Therapy Service. The Guidelines are based on the Early Years Foundation Stage (Department for Education and Skills 2007). 2. Guidelines Statement The following principles underpin the use of these guidelines: The guidelines outline what to expect from young children at different ages. The guidelines can also help identify when a referral to the Children s Occupational Therapist is required and how to undertake this process in a thorough and timely way. All young children develop skills at their own pace. Skills development can depend upon whether a child has received the opportunity to explore the skill in order to acquire it. Most children want to learn/are keen to explore and interact with their environment but some children will require additional adult support to engage in and explore the world around them. These guidelines, together with the advice leaflets, provide suggestions on how this might be carried out. 3. Key Features These guidelines are designed for use by colleagues working with children from Birth 60 months. Key features of the guidelines are: A targeted look at child s development. Use of open questions to seek more information about specific developmental motor skills and functional abilities at different ages. They offer an opportunity to reassure parents and colleagues and give suggestions on how best to continue this progress. They provide a trigger to offer specific advice and strategies around development opportunities. Additional guidance notes enable colleagues to make decisions about the most appropriate course of action for children with developmental difficulties. They should ensure that vulnerable families gain support from a familiar and trusted worker, who can act as advocate for the family and can reassure them about the referral process. They ensure appropriate referrals are made to the Children s Community Occupational Therapy Service. Occupational Therapy Service Referral Guidelines Page of 52

5 4. Links to Other Guidelines/Policies Department for Education and Skills (2007), The Early Years Foundation Stage Every Child Matters, Change for Children Early Years Foundation Curriculum CCHS Move and Play leaflets: Birth - 9 months 9-18 months 18 months - 2 years 2-3 years 3-4 years 4-5 years CCHS Let me try leaflets: Birth - 9 months 9-18 months 18 months - 2 years 2-3 years 3-4 years 4-5 years 5. Scope of the Guidelines These guidelines are intended to be used by support workers in Leicester, Leicestershire and Rutland in early years settings including all pre-school settings, child minders, day nurseries, children s centres. 6. Statutory and NHS Requirements This Guideline complies with the requirements of the NHS Litigation Authority Risk Management Standards. This Policy includes a requirement to conduct an Equality Impact Assessment on all new and reviewed policies which is a requirement of the Race Relations (Amendment) Act 2000 and the Disability and Discrimination Act 1995 and the Equality Act Consultation and Acknowledgement These guidelines were initially developed as a joint project between Leicester City Council, Leicester County Council and Children s Community Health Service. They were subsequently amended by Early Years Occupational Therapists to bring them in line with Early Years Foundation Stage. 8. Roles and Responsibilities A pilot launch for Early Years setting in Leicester City was undertaken in A further launch in Leicester City and Leicestershire will be undertaken by Children s Community Health Service in Autumn 2009 to a sample of Early Years settings, who will then be responsible for disseminating across all settings as appropriate. Occupational Therapy Service Referral Guidelines Page of 52

6 Children s Community Health Service will place this resource on the website to be available for downloading for Early Years settings. Individual settings may download the relevant guidelines from the website and use the resources to help children progress or refer on when appropriate. 9. Procedures for Use Support workers should:- Become familiar with the Therapy Development Guidelines for the relevant age (Birth 11 months, 8 20 months, months, months, months, months). Give direct advice to a parent/carer where appropriate to promote the next stage of a child s movement and functional development and to reduce any parental anxiety. Make sure that the child has access to a good role model, talk to parents/carers about the need to involve themselves in supporting their child s development and learning around specific tasks. Make sure that the child has access to good play provision/opportunities e.g. playgroup, nursery, etc. Advise the family on the importance of opportunity and give the relevant Move and Play or Let me try leaflet. Where they feel the child is functionally delayed or because of lack of opportunity to learn/practice skills. Support this by lending an appropriate play bag to ensure that parents have access to suitable resources. Demonstrate the use of resources for some parents where necessary and review the whole family s progress. Identify where a child s physical and functional abilities are affected as a result of reduced gross or fine motor function rather than a lack of opportunity. It may be possible to refer the family to the appropriate Move & Play leaflet and play bag, but progress will require very careful monitoring. Referring Children to Occupational Therapy Service Support worker should refer:- Those children who fulfil the referral indicators at any stage/those who experience significant difficulties due to a physical or processing problem rather than a lack of opportunity. Those children who have not made sufficient progress as part of a review of their development. Those children whose parents/carers have not been reassured and where anxiety about the child s progress persists. Process for Referral Support workers should:- Use the standard Single Point of Access (SPA) referral form included in these guidelines. Occupational Therapy Service Referral Guidelines Page of 52

7 Obtain parental consent for the referral. Complete all sections and give as much detail as possible, particularly about the child s physical presentation, level of movement abilities and the impact of their difficulties upon their function in everyday life. Attach the relevant completed guidelines with the referral. 10. Review These guidelines should be jointly reviewed in 2 years by a working party with members from each agency set up for this purpose. This will be initiated from CCHS Occupational Therapy service. 11. Training Requirements Launch events by Children s Community Health Service specialist therapists to sample of Early Years settings, who will cascade information to enable support workers to use the web based tools. 12. Monitoring/Audit Arrangements SPA Group will be made aware of the guidelines. Viewing of the tool on the website may be audited through automatic web link. Referrals in to the service may be monitored through internal audit of SPA referrals. Occupational Therapy Service Referral Guidelines Page of 52

8 Appendix 1 OCCUPATIONAL THERAPY SERVICE REFERRAL GUIDELINES CHILDREN FROM BIRTH - 60 MONTHS

9 Introduction These guidelines aim to provide useful information for those looking at the needs of young children with developmental difficulties, affecting predominantly their fine motor development and independence with self care activities. This information should help to support you when deciding whether it is necessary to refer to the Children s Occupational Therapy Service. The following principles underpin the use of these guidelines:- The guidelines outline what to expect from young children developmentally at different ages. These guidelines can also help you to identify when a referral to the Children s Community Child Health Services Occupational Therapist is required and how to undertake this process in a thorough and timely way. All young children develop skills at their own pace. Skills development can depend upon whether a child has received the opportunity to explore the skill in order to acquire it. Most children want to learn/are keen to explore and interact with their environment but some children will require additional adult support to engage in and explore the world around them. These guidelines, together with the advice leaflets, provide suggestions on how this might be carried out. Early intervention as a preventative measure is essential and evidenced: Every Child Matters P

10 Key Features of Guidelines These guidelines are designed for use by colleagues working with children from Birth 60 months. Key features of the guidelines are: A targeted look at the child s functional development. This includes sensori- motor skills, fine motor skills, play, and self help development against a background of their general development from Birth 60 months. Use of open questions to seek more information about specific developmental motor skills and functional abilities at different ages. This should encourage colleagues to consider not just what the child is doing but the quality of the child s activity. They offer an opportunity to reassure parents and colleagues that the child s development is progressing within an acceptable range, and give suggestions on how best to continue this progress. They provide a trigger to offer specific advice and strategies to promote functional development opportunities. Additional guidance notes enable colleagues to make decisions about the most appropriate course of action for children with developmental difficulties. These notes should be included with any referral. They should ensure that vulnerable families gain support from a familiar and trusted worker, who can act as advocate for the family and can reassure them about the referral process. They ensure appropriate referrals are made to the Children s Community Occupational Therapy Service. Draft 10

11 Birth - 11 Months Draft 11

12 Key Points for Birth 11 months When completing the checklist: Try to report on your own observations as much as possible rather than parental report. Try to describe the child s actions or movements in as much detail as possible. Ensure that you report on any known health issues or relevant family history e.g. family history of delayed development (motor, language or self care) or learning difficulties. The Children s Occupational Therapy Service will be looking to identify children whose sensori-motor development restricts their ability to engage and interact with their environment during developmentally appropriate daily living tasks. A child s functional development and play skills within the first 11 months will be closely linked to the child s development of sensori-motor movement and control. Be aware of the baby who has spent a lot of time supported in a car seat, baby bouncer or held on mother s knee. The Initial questions included in the checklist should highlight those children who have received limited opportunity to develop basic sensori-motor control skills. A lack of variety of play opportunities and play positions should guide you to identify positional play needs or environmental changes e.g. encourage child to attend to carer in a quieter room, play out of car seat, spend time on tummy and on the floor. Check that the child has appropriate sensory awareness, and that hearing and vision have been checked. Help a child who is not engaging with their environment due to disorganized sensori experiences. When completing the questionnaire, describe the child s skills and refer to Children s Occupational Therapy via Single Point of Access (SPA) if you note the following:- By 3 months: When picking the child off floor/bed adults have to fully support their head in order for child to look at you. By 6 months: Not kicking legs when having nappy changed; not moving both sides equally; not bringing hands together at midline during floor play. By 9 months: Not able to sit unsupported for 30 seconds, roll to both sides competently to look and reach for toys, or grasp and hold a toy with both hands when lying on back or when held in sitting by an adult. If the child struggles to move their fingers/hands to pick up small objects or toys. By 11 months: Not sitting independently. In sitting not able to balance and free hands for play activities. Carers having to constantly hold child in the bath. Not raising arms to help put on clothes. Draft 12

13 Occupational Therapy Development Checklist Birth - 11 Months Name: DOB: Age in Months: Please comment below; include as much information as you can. There may be more than one answer to each question. The brackets contain suggestions of possible answers/areas to comment on. 1. Which position if any, does s/he show a preference or strong dislike for? (e.g. crying, squirming or dislikes position being changed). Development Needed 2. How does s/he react when placed a) on their back and b) on their tummy? (e.g. Do they cry, hard to settle) 3. Which positions is s/he placed in on a daily basis? Where? (e.g. lying on back, on tummy, on side, sitting, standing on floor, on knee, in bouncy/ high chair, door bouncer, baby walker, at furniture). 4. What would happen if s/he were placed in a sitting position on the floor unsupported? (e.g. maintains balance, topples over). 5. What does s/he do when offered a small toy? (Grasp it, pass it from hand to hand, throw it, mouth it, bang it). 7. How does s/he explore or play with toys placed just out of reach? (Motivation, moving out of position to reach, co-ordination, vision). 8. How does s/he look towards a light source or look at an object held cm away? (Has vision been checked?) Draft 13

14 9. Does s/he show anticipation of daily routines? (e.g. feeding, bathing, getting clothes on, changing nappy). Development Needed 10. Please indicate any other concerns or relevant information (include known health issues and relevant family history). Draft 14

15 Action Tick the appropriate box Issue Move & Play leaflet Birth - 9 months to Parents/Carers and discuss activities. Check progress in 6-8 weeks. If you are concerned about a child s self help or self care development consider issuing the Let me try Birth - 9 months leaflet to Parents or Carers. Discuss the advice and activities enclosed and review in 3 months. Refer to other agencies for advice and support e.g. Sure Start, Family Health Visitor, Early Years Support Services. Liaise with the Children s Occupational Therapy Service regarding your observation if uncertain, prior to referral contact Head Office: Refer to SPA. See page 35 for guidelines and referral form. Draft 15

16 8-20 Months Draft 16

17 Key Points for 8 20 Months When completing the checklist: Try to report on your own observations as much as possible rather than parental report. Try to describe the child s actions or movements in as much detail as possible. Ensure that you report on any known health issues or relevant family history e.g. family history of delayed development (motor, language or self care) or learning difficulties. The Children s Occupational Therapy Service will be looking to identify children whose sensorimotor development restricts their ability to engage and interact with their environment during developmentally appropriate daily living tasks. Between 8-20 months children are becoming increasingly mobile and therefore should be more able to engage with their environment to use their hands and play. As they gain control of their bodies they learn to negotiate the space, coordinate their arms/legs to learn more about the world around them. Refer to Children s Occupational Therapy via Single Point of Access (SPA) if:- By 9 months: Not able to sit unsupported for 30 seconds, roll to both sides competently to look and reach for toys, or grasp and hold a toy with both hands when lying on back or when held in sitting by an adult. If the child struggles to move their fingers/hands to pick up small objects or toys. By 11 months: Not sitting independently. In sitting not able to balance and free hands for play activities. Carers having to constantly hold child in the bath. Not raising arms to help put on clothes. By 12 months: If the child can not maintain a play position that enables them to explore with their hands. If the child has not started to demonstrate an interest either in play or daily routines/self care skills e.g. dressing/feeding/nappy changes. By 18 months: If child cannot use a three fingered chuck-type grasp when building tower or posting objects into a shape sorter. If a child is not holding a drink from a lidded beaker when drinking. Not using a pincer grasp to pick up and feed themselves small foodstuffs, e.g. Raisins, banana pieces. Draft 17

18 Occupational Therapy Development Checklist 8 20 Months Name: DOB: Age in months: Please comment below; include as much information as you can. There may be more than one answer to each question. The brackets contain suggestions of possible answers/things to comment on. 1. How does s/he react to messy play activities? Development Needed 2. What would s/he do if they lost their balance when seated unsupported? (e.g. reach out with arms, take no action). 3. How does s/he move between positions? What sort of help does s/he need? (e.g. lying to sitting, sitting to crawling, crawling to kneeling, kneeling to standing) 4. How does the child play? (e.g. toys brought to the child by carer, siblings, do they cry out when they cannot get a favourite toy, do they constantly want to play with the same toys, position, how much adult assistance to play). 5. Dow does s/he respond to nursery rhymes and action songs? Will s/he clap hands to join in? 6. Can s/he pull apart toys e.g. cut and play fruit or push together beads following a demonstration? 7. When securely seated on the floor or in a high chair does s/he receive toys to the right and left hands in turn? Does s/he use both hands together in play? If No, please describe. Draft 18

19 8. Can s/he place objects into and take out of a container? (E.g. open container, single hole shape sorter or specific shapes in sorter). Development Needed 9. Can s/he build a tower of cubes? (describe grasp, control, and placement skills). 10. How does s/he help to dress and undress? (E.g. can they remove their own shoes and socks, do they push their arms and legs into trousers and shirts? 11. Does s/he press buttons on toys? (index finger, thumb, whole hand). 12. What does s/he do at mealtimes? (E.g. finger feeds, holds spoon, takes unloaded spoon to mouth, turns spoon upside down). 13. When standing independently can s/he squat down to pick up a toy from the floor? Describe any difficulties (e.g. needs assistance to stand up, do they get frustrated because they cannot get to their favourite toy). 14. What does s/he use to drink from? (bottle, lidded beaker, open beaker/cup). 15. Please indicate any other concerns or relevant information, (include known health issues and relevant family history). Draft 19

20 Action Tick the appropriate box Issue Move & Play leaflet 9 18 months to Parents/Carers and discuss activities. Check progress in 3 months. If you are concerned about a child s self help or self care development consider issuing the Let me try 9 18 months leaflet to Parents or Carers. Discuss the advice and activities enclosed and review in 3 months. Refer to other agencies for advice and support e.g. Sure Start, Family Health Visitor, and Early Years Support Services. Liaise with the Children s Occupational Therapy Service regarding your observation if uncertain, prior to referral contact Head Office: Refer to SPA. See page 35 for guidelines and referral form. Draft 20

21 16-26 Months Draft 21

22 Key Points for Months When completing the checklist: Try to report on your own observations as much as possible rather than parental report. Try to describe the child s actions or movements in as much detail as possible. Ensure that you report on any known health issues or relevant family history e.g. family history of delayed development (motor, language or self care) or learning difficulties. The Children s Occupational Therapy Service will be looking to identify children whose sensorimotor development restricts their ability to engage and interact with their environment during developmentally appropriate daily living tasks. Between the ages of months a child should be becoming a confident mover in play. They should be able to move in and out of a variety of positions from sitting kneeling standing and they are likely to show an interest in daily activities and may copy and imitate these. Their awareness of these routines should help to promote self-help skills, they may co-operate more when dressing but will also remove easier garments independently e.g. hat, socks. Their fine motor skills are refining and they begin to manipulate objects and toys of their choosing and will develop the hand-eye coordination to accurately place an object. Consider referring to Children s Occupational Therapy if: By 18 months a child cannot: Use both hands together to carryout two-handed tasks e.g. threading, spoon in a yogurt pot If they cannot take a spoon to mouth when seated in a stable position at a table By 24 months a child cannot: Sequence climbing on and off an adult chair or into the bath If they cannot maintain a stable sitting posture to use a potty or toilet If the child has not started to demonstrate an interest in daily routines/self care skills i.e. dressing/feeding Is not showing interest in playing with toys. If child is disturbed by change of position/certain noises. Draft 22

23 Occupational Therapy Development Guidelines Months Name: DOB: Age in Months: Please comment below; include as much information as you can. There may be more than one answer to each question. The brackets contain suggestions of possible answers/things to comment on. 1. How does s/he move in / out of play positions? (e.g. lying to sitting, floor to standing, standing to into the bath). Development Needed 2. How does s/he react when put into different play positions? (E.g. cry when on tummy, crawling, refuse to stand) 3. How does s/he get up and down the stairs? (e.g. carried by adult, crawls, walks with hand held, walks using rail/supervision). 4. When securely seated on the floor or in a high chair what does s/he do with a grasped toy? (E.g. Shakes it, holds it in both hands, transfers from hand to hand, mouths it, offers it to an adult, drops it, places it in a container). 5. When offered small objects e.g. Raisins or chocolate buttons what does s/he do to explore them? (E.g. pokes with index finger, emerging ability to pick up objects between thumb and index fingers). 6. How does s/he participate at mealtimes? (E.g. eats finger foods, holds a spoon, drinks from a bottle, beaker, cup). 7. How does s/he react to messy play activities or messy mealtimes? Draft 23

24 8. Does s/he enjoy nursery rhymes and action songs? Will s/he clap hands to join in? Development Needed 9. Please indicate any other concerns or relevant information, (include known health issues and relevant family history). Draft 24

25 Action Tick the appropriate box Issue Move & Play leaflet 18 months 2 years to Parents/Carers and discuss activities. Check progress in 3 months. If you are concerned about a child s self help or self care development consider issuing the Let me try 18 months to 2 years leaflet to Parents or Carers. Discuss the advice and activities enclosed and review in 3 months. Refer to other agencies for advice and support e.g. Sure Start, Family Health Visitor, Early Years Support Services. Liaise with the Children s Occupational Therapy Service regarding your observation if uncertain, prior to referral contact Head Office: Refer to SPA. See page 35 for guidelines and referral form. Draft 25

26 22-36 Months Draft 26

27 Key Points for Months When completing the checklist: Try to report on your own observations as much as possible rather than parental report. Try to describe the child s actions or movements in as much detail as possible. Ensure that you report on any known health issues or relevant family history e.g. family history of delayed development (motor, language or self care) or learning difficulties. The Children s Occupational Therapy Service will be looking to identify children whose sensorimotor development restricts their ability to engage and interact with their environment during developmentally appropriate daily living tasks. By the age or 2-3 years all children should move spontaneously showing control and co ordination, refining their basic motor skills to help them further develop their independent play and self careskills. They are likely to require much encouragement to persist at tasks but should have attained the basic level skills. They are learning new skills such as holding utensils, wanting to do more on their own, trying to make marks with crayons/paint. Children of this age will continue to fall and bump into objects and other children, from time to time. If this is happening a lot, encourage parents to continue sensori-motor experiences via local play group, play and stay sessions or tumble tots. Most children will quickly learn to refine their planning skills if they are exposed to challenges in a safe and supportive environment. Children will be exploring a variety of play opportunities. They should have adequate hand-eye coordination to pick up objects and place with accuracy, they should also actively use both hands in bilateral (two handed) activities e.g. threading, constructional play, cutting skills. Some children may not have mastered some activities of daily living due to limited opportunity. Toileting accidents will remain likely. Not all children will be ready to start toilet training but be aware of those children who may find accessing toileting difficult due to poor postural control and balance skills. There are a wide variety of potties and ring reducers available commercially, discuss the importance of a child feeling balanced and secure before they can access toileting. Toilet training may be delayed by parents who find nappies easier to manage. A child may never attempt to remove their own coat because this is always done for them. Consider issuing an I Can leaflet to encourage parents to offer the child greater opportunities. Refer to Children s Occupational Therapy via Single Point of Access (SPA) if advice and further play opportunities have failed to resolve areas of concern or address needs listed in the action points above. Consider referring to Children s Occupational Therapy if:- By 24months a child: If they cannot take a spoon to mouth when seated in a stable position at a table. If they cannot use both hands together to carryout two-handed tasks e.g. threading, cutting. Cannot negotiate space around them, starting and stopping with ease when pushing toys around on the carpet/floor. Draft 27

28 By 36 months a child: If they have not started to demonstrate an interest in daily routines/self care skills e.g. Dressing/self feeding. If they cannot maintain a stable sitting posture to use a potty or toilet. If they do not climb in and out of the bath on their own with parental supervision. If they cannot hold a pencil to copy horizontal line. If they always use fisted grip to hold pencil, utensils and small toys. Draft 28

29 Development Checklist months Name: DOB: Age in Months: Please comment below; include as much information as you can. There may be more than one answer to each question. The brackets contain suggestions of possible answers/things to comment on. 1. Can s/he avoid obstacles in their path? (e.g. does not seem to be aware of things in the way to go around). Development Needed 2. How do they play on a variety of play equipment such as the swings, slides, tunnels, play tents? 3. How does s/he get up and down the stairs? (e.g. carried by adult, crawls on hands & knees, hold adults hand, holds rails, down on bottom, two feet to a step). 4. Describe how s/he throws a ball? (e.g. big/small ball, forwards/backwards, under-arm/over-arm, without falling over). 5. How does s/he use both hands together? (e.g. push together and pull apart large Duplo type bricks, threading activities e.g. rod and beads, shoelace and cotton reels). 6. Can s/he build a tower of three using nesting cup or bricks? (e.g. describe grasp and placement skills). 7. Please indicate any other concerns or relevant information, (include known health issues and relevant family history) Draft 29

30 Action Tick the appropriate box Issue Move & Play leaflet 2-3 years to Parents/Carers and discuss activities. Check progress in 3 months. If you are concerned about a child s self help or self care development consider issuing the Let me try 2-3 years leaflet to Parents or Carers. Discuss the advice and activities enclosed and review in 3 months. Refer to other agencies for advice and support e.g. Sure Start, Family Health Visitor, Early Years Support Services Liaise with the Children s Occupational Therapy Service regarding your observation if uncertain, prior to referral contact Head Office: Refer to SPA. See page 35 for guidelines and referral form. Draft 30

31 30-50 Months Draft 31

32 Key Points for Months When completing the checklist: Try to report on your own observations as much as possible rather than parental report. Try to describe the child s actions or movements in as much detail as possible. Ensure that you report on any known health issues or relevant family history e.g. family history of delayed development (motor, language or self care) or learning difficulties. The Children s Occupational Therapy Service will be looking to identify children whose sensorimotor development restricts their ability to engage and interact with their environment during developmentally appropriate daily living tasks. Between months a child should be able to move skilfully, running and adjusting speed of movement and changing direction, stepping over small objects, climbing on/off familiar items e.g. sofa or adult chair, beginning to hop and skip, peddling a trike, climb steps using alternate feet. They should be able to use both hands together to carry out differing actions e.g. stabilising a container with one hand whilst twisting lid off with the other. Children may start to show a hand preference but the child who doesn t shouldn t cause concern. They should be able to skilfully manipulate toys during play. They should be able to feed themselves foodstuffs that have been cut up, using a fork to stab or a spoon to scoop. They should also be able to control fluids from an open cup. The child who chooses to explore mark-making or drawing activities should be allowed to explore freely and not be corrected to use a tripod grasp if they are not ready. Experience and opportunity are crucial to a child s development particularly when difficulties are linked to everyday self-help skills. Some children may not have mastered some activities of daily living due to limited opportunity. Toilet training may be delayed by parents who find nappies easier to manage. A child may never attempt to remove their own coat because this is always done for them. If you have concerns regarding a child s functional ability check that the foundation motor skills are present and offer advice in line with the I can leaflets then review the family s progress. Refer directly to Children s Occupational Therapy via SPA if the child:- Has not started to join in with daily routines/self care skills e.g. dressing Cannot scoop to load a spoon and take it to their mouth Lacks hand strength and dexterity to manipulate age appropriate toys. Lacks awareness of themselves in relation to objects in the environment, resulting in bumping into furniture. The child cannot integrate both hands into a two handed activity or the child cannot pick up and manipulate age appropriate toys or equipment. Draft 32

33 Therapy Development Checklist months Name: DOB: Age in Months: Please comment below; include as much information as you can. There may be more than one answer to each question. The brackets contain suggestions of possible answers/things to comment on. 1. How does s/he move around outdoors? (e.g. runs bumping into others, runs and stops in a controlled manner, moves little, plays away from others, stumbles, falls, trips). Development Needed 2. How does s/he move around indoors? (e.g. steps on toys and peers, aware of obstacles, walks around or steps over objects skilfully). 3. Describe the child s level of skill and confidence when using large play apparatus e.g. slide, tunnels, climbing frame. 4. Describe how s/he can throw and catch a large ball? (e.g. hand-eye coordination, use of two hands). 5. How does s/he manage two handed activities e.g. threading beads onto a lace or cutting with scissors? 6. How does s/he pick up small items and objects during play? (e.g. describe hand grips). 7. How does s/he choose to make marks on paper? E.g. finger paints, sponges, brushes, crayons? (describe grasp used). Draft 33

34 8. How does s/he feed themselves? (comment on position, equipment and technique) Development Needed 9. What does s/he drink from? (comment on equipment, skill, and control). 10. How does s/he access toileting? (E.g. needs prompting to toilet, asks for help with clothing & wiping, independent but needs assistance with wiping, can wash own hands) 11. Describe his/her dressing skills? (E.g. which garments can be removed or replaced independently). 12. Does s/he attempt to wash themselves/ clean their teeth? 13. What activities s/he will not attempt or avoid? 14. Please indicate any other concerns or relevant information, [include known health issues and relevant family history] Draft 34

35 Action Tick the appropriate box Issue Move & Play leaflet 3 4 years to Parents/Carers and discuss activities. Check progress in 3 months. If you are concerned about a child s self help or self care development consider issuing the Let me try 3-4 years leaflet to Parents or Carers. Discuss the advice and activities enclosed and review in 3 months. Refer to other agencies for advice and support e.g. Children s Centre/Sure Start, Family Health Visitor, Early Years Support Services. Liaise with the Children s Occupational Therapy Service regarding your observation if uncertain, prior to referral contact Head Office: Refer to SPA. See page 35 for guidelines and referral form. Draft 35

36 40-60 Months Draft 36

37 Key Points for months When completing the checklist: Try to report on your own observations as much as possible rather than parental report. Try to describe the child s actions or movements in as much detail as possible. Ensure that you report on any known health issues or relevant family history e.g. family history of delayed development (motor, language or self care) or learning difficulties. The Children s Occupational Therapy Service will be looking to identify children whose sensorimotor development restricts their ability to engage and interact with their environment during developmentally appropriate daily living tasks Between 4-5 years a child should be able to run at speed, stopping and changing direction rapidly to avoid obstacles. They should be able to climb confidently, jump off a step and climb the stairs independently using a rail to balance. They should have an understanding of the concepts in, out, through, under and over. They should be able to stand on one leg for 3 5 seconds and hop on their preferred foot. They should be able to skilfully manipulate toys during play using a combination of gross grasp patterns to hold and stabilise toys and finer pincer grasps to accurately manipulate objects. They are more accurate when throwing and catching, bouncing and kicking a ball. They should be able to use both hands together to carry out differing actions e.g. stabilising a container with one hand whilst twisting lid off with the other, or threading fine beads onto a lace. Most children will be establishing hand dominance but some may still be undecided. They should be able to feed themselves using a fork to stab and they may use a knife to cut up soft foodstuffs. They may need adult assistance to position their utensils. They should also be able to control fluids from an open cup. The child may dress themselves in garments without fastening although some items may be inside-out or back-to-front. They may pull down a zip and unlink it they may also try to fasten a large zip on a jacket. They should manage their own clothing for toileting. The child who chooses to explore mark making or drawing activities should be allowed to explore freely and not corrected to use a tripod grasp if they are not ready. They may draw randomly in circular scribble or may copy some simple pre-writing forms Experience and opportunity are crucial to a child s development particularly when difficulties are linked to everyday self-help skills. If you have concerns regarding a child s functional ability check that the foundation motor skills are present and offer advice in line with the I can leaflets then review the family s progress. Draft 37

38 Refer to Children s Occupational Therapy via Single Point of Access (SPA) if child cannot:- Plan, organize, and balance to sequence movements in and around objects as they seem to no know where they are in space. Hold objects or toys relevant to their age. Stab or scoop to load a fork or spoon and take it to their mouth. By 60 months climb stairs independently while using alternate feet. Or if problems regarding mobility are arising in school/p.e. lessons and are a safety issue. Draft 38

39 Therapy Development Checklist months Name: DOB: Age in Months: Please comment below; include as much information as you can. There may be more than one answer to each question. The brackets contain suggestions of possible answers/things to comment on. 1. How does s/he move around outdoors and use large apparatus? (e.g. describe the child s level of skill and confidence, or avoidance of activities). Development Needed 2. How does s/he move around indoors? (e.g. steps on toys and peers, unaware of obstacles, walks around or steps over objects skilfully). 3. How does s/he climb up and down the stairs? (e.g. holds adults hand, rail, two feet to a step, places one foot to each step in an adult manner, without assistance). 4. How does s/he respond to action songs? (E.g. joins in with words only, joins in with actions, attempts actions and words). 5. Does s/he enjoy messy play or craft type activities, name the activities enjoyed or avoided? 6. Describe his/her mark making skills, comment on tools, technique and any forms produced. Able to make pre-writing marks? 7. Describe the ease with which s/he picks up small items and object during play? (grasp pattern). Draft 39

40 8. Can s/he throw and catch a large ball? (hand-eye co-ordination, use of two hands). Development Needed 9. How does s/he organize themselves to tackle two handed activities? (E.g. threading onto a lace, working jigsaw puzzles, unscrewing caps on containers, or cutting with scissors). 10. What does s/he drink from? (comment of equipment, skill & control). 11. How does s/he feed themselves? (comment on position, equipment, preparation and technique). 12. Describe his/her dressing skills? (E.g. which garments can be removed or replaced independently, any fastenings managed independently; buttons, zips). 13. How does s/he access toileting? (E.g. asks for help with clothing and wiping, manages own pants but needs assistance with wiping, fully independent can wash and dry own hands). 14. How does s/he access bathing? (E.g. in and out of bath/shower, ability to wash independently). 15. Please indicate any other concerns or relevant information, (include known health issues and relevant family history). Draft 40

41 Action Tick the appropriate box Issue Move & Play leaflet 4 5 years to Parents/Carers and discuss activities. Check progress in 3 months. If you are concerned about a child s self help or self care development consider issuing the Let me try 4-5 years leaflet to Parents or Carers. Discuss the advice and activities enclosed and review in 3 months. Refer to other agencies for advice and support e.g. Childrens Centre/Sure Start, Family Health Visitor, Early Years Support Services. Liaise with the Children s Occupational Therapy Service regarding your observation if uncertain, prior to referral contact Head Office: Refer to SPA. See page 35 for guidelines and referral form. Draft 41

42 Early Identification and Referral Pathway Early Physical and Functional Skills When a concern about a child s sensori-motor, fine motor, or self care development is identified Strategies/suggestions to promote physical mobility and functional development have been shared with parent/carer/play setting Does child need referral to the Children s Occupational Therapy Services? (Use checklist/guidelines to help) No Don t know Yes Referrer reassures parent/carer Referrer offers general advice using Move & Play or Let me try leaflets and Physical development Play Bags if appropriate Re-check the Children s Occupational Therapy development guidelines Provide relevant Move & Play Let me try leaflet Review child s progress in 4-8 weeks Liaise with the Occupational Therapy Services for more advice Referrer informs the family about the referral process Referrer seeks parental consent to the referral and completes guidelines and referral form together Referrer gives advice/ relevant Move & Play, Let me Try leaflet Referral discussed at Single Point of Access Meeting The Children s Occupational Therapist will decide on appropriate course of action for first contact /assessment Referral acknowledged to family and referrer Appointment letters sent out by secretary First contact with Children s Occupational Therapy Services Draft 42

43 SUMMARY OF EARLY IDENTIFICATION AND REFERRAL PATHWAY GUIDANCE WHAT SHOULD I DO WHEN I HAVE A CONCERN ABOUT A CHILD S SENSORI-MOTOR, FINE MOTOR, SELF HELP SKILLS? Look at the Occupational Therapy Development Guidelines for the relevant age (Birth 11 months, 8 20 months, months, months, months, months). Give direct advice to a parent/carer where appropriate to promote the next stage of a child s movement and functional development and to reduce any parental anxiety. Make sure that the child has access to a good role model, talk to parents/carers about the need to involve themselves in supporting their child s development and learning around specific tasks. Make sure that the child has access to good play provision/opportunities e.g. playgroup, nursery, etc. Where you feel the child is functionally delayed or because of lack of opportunity to learn/practice skills, advise the family on the importance of opportunity and give the relevant Move and Play or Let me try leaflet. Support this by lending an appropriate play bag to ensure that parents have access to suitable resources. You may need to demonstrate the use of resources for some parents and review the whole family s progress. If you feel that a child s physical and functional abilities are affected as a result of reduced gross or fine motor function rather than a lack of opportunity, it may be possible to refer the family to the appropriate Move & Play leaflet and play bag, but progress will require very careful monitoring. WHICH CHILDREN SHOULD I REFER TO THE CHILDREN S OCCUPATIONAL THERAPY SERVICE? Those children who fulfil the referral indicators at any stage/those who experience significant difficulties due to a physical or processing problem rather than a lack of opportunity. Those children who have not made sufficient progress as part of your review of their development. Those children whose parents/carers you have not been able to reassure and where anxiety about the child s progress persists. HOW DO I REFER? Use the standard Single Point of Access (SPA) referral form included in these guidelines. Obtain parental consent for the referral. Complete all sections and give as much detail as possible, particularly about the child s physical presentation, level of movement abilities and the impact of their difficulties upon their function in everyday life. Attach the relevant completed Occupation Therapy guidelines with the referral. (Occasionally it may be necessary to return the referral if more information is needed). Draft 43

44 WHERE SHOULD I SEND THE REFERRAL? Send completed referral forms and guidelines to: Children s Occupational Therapy Service Children s Community Health Service Bridge Park Plaza Bridge Park Road Thurmaston LE4 8PQ Telephone: Fax: Feel free to enclose any relevant additional information. Draft 44

45 Children s Community Health Service Leicester City Community Health Service Single Point of Access (SPA) Referral Form Forename Surname Referrer Name: NHS Address Designation: Address Postcode Gender NHS or Unique No: DOB Tel No: h w Home Languages (including English) written spoken spoken m written Please tick if interpreter needed Language: The information from this form will be discussed with a professional team to assess the appropriate course of action. Please tick or circle all those you feel may be appropriate although based on the information provided SPA may decide on another course of action is more appropriate. Consultant Community Paediatrician School Paediatrician Dietician Physiotherapist Occupational Therapist Speech & Language Therapist Specialist Health Visitor Diana Service Multidisciplinary Team (MDT) Audiology if so Please state HV or School Nurse Number Diagnosis (If known) Reason For Referral; In order to process this referral appropriately it would be of great help if you could specify the nature of concern, how long this has been known. If the child is experiencing functional/developmental/behavioural difficulties please state the child s current abilities and difficulties (e.g. how do these difficulties affect the child at school/nursery/home): Draft 45

46 Details of any current medication and level of doses (If applicable/known) What course of action/advice has been tried by yourself to date: (if applicable) Is the child known to have S.E.N.? Y/N Action/Action Plus/Statement (please circle if appropriate) Looked After Child? Y/N If so please provide details of social worker Are or have any other services been previously involved? If so please provide details: Details of G.P./Health Visitor/School Nurse with contact telephone numbers if available/known & Details of Playgroup/Nursery/School attended (if any): Views of child/parent or carer: I consent to the above referral and any assessment that may be required. I consent to information being collated and passed to the appropriate statutory agencies as long as it is in the best interest of my child. Name & Signature of Parent/Carer Signature Date Please Return This Form To: Single Point of Access Children s Community Health Service Bridge Park Plaza, Bridge Park Road Thurmaston, Leicester, LE4 9BG Tel: Draft 46

47 On Receipt of Referral WHAT HAPPENS WHEN A CHILD IS REFERRED TO THE CHILDREN S OCCUPATIONAL THERAPY SERVICE? Referrals received are discussed by a multi professional team at a weekly Single Point of Access meeting. The team includes Paediatricians, Specialist Health Visiting, Speech and Language Therapy, Physiotherapy and Occupational Therapy. If the referral information suggests that a child may benefit from contact with professionals the referral will be copied to this Service/Team in addition to those requested. Additional information will be requested from the referrer in cases where there is not enough referral information to make a judgement of need. Parents and referrers will be sent a letter to confirm that the referral has been received; this will indicate the outcome of the discussion. The options are:- Occupational Therapy Assessment only: each referral is prioritised according to the child s needs. Children are categorised as an Urgent or Routine Priority, and placed on the waiting list accordingly. All children should be allocated a therapist within 18 weeks of referral. 0-3 Multi Disciplinary Assessment: this route is co-ordinated centrally and the co-ordinator will contact the family directly to arrange a link visit. The link visit is usually conducted by a Specialist Health Visitor. The aim of the link visit is to gather information regarding a child s development and needs and to share this information with other professionals who will be involved to prevent parents being asked the same questions repeatedly. Occupational Therapists will see children individually alongside this process. Multi Disciplinary Triage: this is a multidisciplinary screening appointment. If a child is referred to any agency and is thought to need input from two or more services of CCHS, they will be invited to attend a multi disciplinary triage appointment. Children should be screened by a Paediatrician, Speech and Language Therapist, Physiotherapist & Occupational Therapist. If, following screening it is thought that a child would benefit from individual services they will be placed on a waiting list for a full assessment and follow up as needed. Orthotic Clinic Triage: this is where it has been established that the child only requires input from the orthotic clinic to assess for provision of orthoses (footwear, insoles, splints, body brace). The referral is sent to the Orthotic Clinic Service via Children s Occupational Therapy Services for prioritisation. Draft 47