I follow a lot of different paediatric therapy pages on Facebook. They are often fantastic, informative, creative and interesting. Most are U.S. based.
I am struggling slightly with professional identity at the moment. My current specialism is in the physical strand of our community paeds service. I see children with brain injuries, cerebral palsy, developmental delay, congenital problems, upper limb musculoskeletal difficulties and post acute injury. My approach is function focused and I tend to see myself as a professional problem solver. Families come to my clinic generally after being referred by their paediatrician, general practitioner or school for specific solutions to specific problems. Children who cannot access the school curriculum because of their physical difficulty will receive assessment and appropriate equipment. The child with difficulties with self care will receive a graded dressing programme. The child with an upper limb difficulty will receive a splint if appropriate. The child with a brain injury will receive a community based rehabilitation package which involves supporting their family and school to implement strategies to continue their rehab. The approach comes from a risk reduction perspective. The children at the most risk of deformity, exclusion from school, or harm will be prioritised and their problem will hopefully be solved or managed as quickly as possible.
I certainly feel that I take a holistic approach and am taking an occupational approach. The difficulty I feel is I may be a bit out on my own out here. My international paediatric colleagues are very sensory focused and foundation skills based. Visual perception, executive planning, sensory processing, modulation, these are problems have hours of therapy given to them. IEPs are written to address these difficulties and provide resources to treat these problems.
Sometimes I feel that the children I treat get a bit of a raw deal. The children with severe physical and learning disabilities do not seem to get the hours of therapy their international peers with sensory difficulties get and I worry that due to the neurological and physiological nature of their disability they may be getting swamped in a sea of medical interventions with the basics of movement, interaction, communication, occupation and co-occupation being overlooked. These children who are trapped in the equipment we prescribe them are almost invisible. They are completely dependent upon their carers, they may not be able to communicate their needs easily and they may not be the child that is a risk to others or themselves.
As an occupational therapist I want to find a way of helping. I see potential in occupational therapists being much more actively involved in British state special schools and early years provision and not just the superbly funded specialist ASD schools and colleges. Working with teachers and parents to help include their child with severe physical and learning difficulties to be included in the curriculum in real terms. This extends to early years children with developmental delays. The reduction in local authority run childcare has created a pretty worrying situation for children with difficulties in my opinion. Some private nurseries have fabulous, dedicated staff who will implement strategies provided by therapists and go that extra mile that children with special needs require to fully integrate and make the most of their time at nursery. Other private nurseries provide the minimum that is required of them and struggle with inexperienced staff and high staff turn-overs. The difference for some of the children that attend these sessions can be very apparent. Children who attend an early years setting and have good attendance at school have been linked to better health and well being outcomes and make more successful adults (reference to follow).
The difficulty comes down to who pays for the “extra” service that makes a basic, safe early years and special needs education provision become a gold standard provision for some of our most vulnerable and invisible children. Schools don’t want to pay out. National Health Service occupational therapy services are stretched too thinly to provide this kind of service within education. The children are caught between getting a service that keeps them safe but that could serve them so much better. The new health and education legislation that was introduced in September 2014, certainly provides a new perspective for addressing these issues but they have yet to be implemented in real terms in the locality I work within.
I haven’t got any answers to this difficult problem and I am certainly not laying the blame on the NHS, education or the charitable special schools. I would consider a not for profit team of occupational therapists focused on education and early years inclusion, occupation, health and well being but as always money is the problem and I am a clinician, not a business person.
Peace out OT buddies,
Holly.
Sparkle Occupational Therapy 