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Child development service - investment required

Posted By Parent123

"Child development service - investment required"

About: Specialist Child Health & Disability / Pre-School Child Development

(as a parent/guardian),

The pre-school child development service in Lurgan hospital (southern HSC trust) have asked for my feedback:

Although individual therapists are very pleasant, personable and kind to my child, this service does not permit children to develop to their maximal potential.

Children at this stage need intensive, focused intervention to maximise neuroplasticity of the developing brain. My child has been ‘reviewed’ every 4-8 weeks by therapists which falls vastly short of what is needed to lead to improvement. We have sought private services to fill this huge gap.

The culture within the child development service is not one of promoting intensive therapy but instead of observation and review with suggestions for play activities given at each session. A massive service development exercise is required involving those who allocate funding. Leaders at the highest level need to understand the potential for a child’s brain to recover when given appropriate stimulus. Reviewing a child for an hour at 6 weekly intervals will not lead to change.

If an adult sustains a brain injury, for example a stroke or a traumatic brain injury, recovery is often (of course not always) expected and I believe the NHS provide much more intensive input in this situation. A child’s developing brain is vastly more capable of recovery and yet children are left with minimal intervention and no intensive therapy. It doesn’t make sense and is robbing children of independence.

This is an issue throughout the UK where it is clear that neurological rehab services for children are inadequate and doing a complete disservice to the potential in our children’s brains. Nevertheless, the campaign to increase funding should be led and promoted by the doctors and therapists working with the children - they need to let leaders in their organisations know that their ability to influence a child’s development is compromised by lack of staff, training, resources and time.

At present this service in the child development clinic offers regular review with minimal meaningful intervention possible with the constraints of only seeing a therapist every 4-8 weeks.

I wish to make it clear that the individual therapists are well intentioned, friendly and kind.  This service is a let- down for children and requires a complete re-design with significant funding to make it worthwhile.

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Responses

Response from Fionnuala McKerr, Service Lead Child Development Service, Children and Young People's Directorate, Southern Health and Social Care Trust about a year and a half ago
Fionnuala McKerr
Service Lead Child Development Service, Children and Young People's Directorate,
Southern Health and Social Care Trust

Submitted on 23/10/2023 at 10:01
Published on Care Opinion at 11:43

picture of Fionnuala McKerr

Thank you for taking the time to complete a Care Opinion, your feedback is important in helping us to understand your experience of our service. I am glad that you have found our staff to be kind and friendly towards your child, this is always good to hear and I will pass this on. I acknowledge your disappointment at our model of service. It is our intention to promote partnership working with parents and joint goal setting so that therapy becomes embedded into everyday activities of play movement and communication. Our rationale for this approach comes from the CanChild framework for child development. This framework is based on the International Classification for functioning disability and health. It advocates setting functional goals based on what is important to the child. I feel from your feedback that our service has not effectively communicated this.

As a service we strive to ensure that parents feel equipped with the necessary knowledge and tools to carry out recommended therapy activities at home, and feel supported by their child’s therapy team, and I am sorry that has not been your experience.

I also understand your view that an investment into intensive hands-on therapy is what you would like to see within our service. However the research by CanChild https://www.canchild.ca/ would recommend focusing on ways to improve function and participation of a child or young person within their community. We have recently invested in an outdoor therapy area, filled with play equipment so that therapy can happen in fun and functional way allowing challenge and achievement in an outdoor environment.

I plan to bring your feedback to the team to ensure we improve our partnership working with parents for setting functional goals.

If you would like to get in touch to further discuss any suggestions you may have to improve our service, please contact me directly

Fionnuala.mckerr@southerntrust.hscni.net

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Update posted by Parent123 (a parent/guardian)

There seems to be an assumption that my dissatisfaction with the service stems from my lack of understanding of the model of delivery. I can assure you it is in fact quite the opposite - it is my awareness of how children’s brains develop, the potential for recovery and educating myself on therapy methods that has led me to know that this service is far from optimal.

With regard the CanChild model to which has been referred:

1. It is a framework for how to set goals, not for how to achieve them, which is the key part of the service which is lacking. What is the framework you follow for this vital aspect?

2. The CanChild website refers to how the ‘F-words’ model is poorly applicable to the 0-2 age range based upon organisations that have attempted to implement the model.

Therefore, is this really the best framework to choose for a pre-school child development service? The response suggests that goals should be set based on what is important to a child - this is not a statement readily applicable to a 1 year old.

3. Within the CanChild evidence base you will see that there are papers backing the model of seeing a therapist once per week at baseline and then at times when milestones are approaching that a more intensive model should be applied - this is not something that I am aware of being on offer. In fact it is a far cry from what my child has been offered.

4. Of course integration of therapy into home life is an important principle. Parents should be empowered to carry out therapy activities, however, nowhere in the evidence base does it state that it is adequate for a therapist to only see a child once every 4 - 8 weeks.

I maintain my view that opportunities for children to gain independence are being lost due to this service. It could be so much better and the fact that these shortcomings are not acknowledged is a huge part of the problem.

With regard the outdoor play area - this is not a substitute for substandard therapy. There are very few useable pieces of equipment for young child in the 0-3 age range, and are any of the pieces of equipment even accessible for wheelchair users or children using walkers? I don’t believe so from what I have seen.

It is a pleasant environment no doubt, however it cannot be used to justify that meaningful investment is occurring in the development of children’s brains. 1 hour in a park every 6 weeks is not going to make a difference.

I am happy to engage further with the service directly, however, my efforts would not be worthwhile if the shortcomings in what is delivered are not seen.

Response from Fionnuala McKerr, Service Lead Child Development Service, Children and Young People's Directorate, Southern Health and Social Care Trust about a year and a half ago
Fionnuala McKerr
Service Lead Child Development Service, Children and Young People's Directorate,
Southern Health and Social Care Trust

Submitted on 01/11/2023 at 11:49
Published on Care Opinion at 12:18

picture of Fionnuala McKerr

Thank you for taking the time to post this further update. We would really like to discuss this further with you and would ask that you would contact me on 02837563212 or by email at Fionnuala.Mckerr@southerntrust.hscni.net

We are very happy to discuss this further with you

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