Community care
Community care
Feature
Redesigning our interventions
Occupational therapists from Evelina London share their learning from a development project to offer a consistent , timely and effective service – that can be integrated into family life – for children who have difficulties using their hands .
O ver three years ago , the Evelina London children ’ s community occupational therapy team reflected on the service we provide to children who have difficulties using their hands ; primarily children with cerebral palsy or obstetric brachial plexus palsy .
At that time , we offered modified constraint induced movement therapy ( mCIMT ), bi-manual therapy and / or task-based intervention , however the clinical reasoning for these approaches was inconsistent , as were the methods of providing the intervention . Due to growing waiting times , our intervention was not always timely .
What did we want to achieve ?
Our aims were to offer consistent , timely and effective intervention that could be integrated into family life . We wanted to ensure that evidenceinformed interventions were being considered for all children and that children could access this intervention when they needed it .
We set up a community-based upper limb service , offering interventions aimed specifically at improving the way children with upper limb impairments use their hands .
The many advantages to offering this specialist intervention within the community included : being able to respond to children ’ s needs in a timely way ; the value of our ongoing relationships with families ; our understanding of the environmental and social factors that impact on occupational performance and participation ; and our ability to adapt interventions because of our first-hand knowledge of these factors in families ’ lives .
What did we do ?
Our service redesign has been comprehensive and within our existing capacity . We started by reviewing our practice , our outcomes and the available evidence base . We benchmarked against other services and identified clear areas for improvement .
Opportunities to improve our occupational therapists ’ and assistants ’ knowledge and skills was offered , through in-house training , external training courses , regular supervision , case monitoring and reflection .
We created a standard operating procedure ( SOP ), with clear recommendations regarding the delivery format and dosage of intervention , depending on the child ’ s age . We also reviewed our triage criteria and prioritised infants under two years old , or those receiving their first block of intervention .
We created resources to support consistent practice , including programme templates , discharge reports and FAQs for parents .
To ensure that the whole team was aware of the new pathway , we gave in-service training , while a newsletter was shared with colleagues and stakeholders more widely across the trust and with referrers in the community .
We also presented our findings at Quality Improvement conferences within the trust .
We reviewed the outcomes following these changes and sought honest , unbiased feedback from parents following the intervention , through anonymous surveys and telephone calls from an independent staff member . Relevant changes to our process and resources were made based on this feedback .
46 OTnews September 2023