Active Lorikeets & Little Wrens early intervention programs › a2k › docs › TelehealthHandouts › Hando... · thumbs, toes, neck, stomach, chest, knees, back, chin, finger nails,

These slides remain the property of presenters 21 April 2014

If you experience connection problems 10min prior or during the session please ring the HNE Telehealth Help Desk 4985 5400 option 1 1

Welcome to Allied Health

Telehealth

Please complete your online evaluation at

https://www.surveymonkey.com/s/ActiveLorikeetsandLittleWrens

Active Lorikeets & Little Wrens

early intervention programs

Speech Pathology and Occupational

Therapy Program for Preschool Children

Angela Ellis - Executive Manager Community Health Services Lyn Nicol – Senior Speech Pathologist Ainsleigh Whelan –Senior Occupational Therapist 21/4/2015

© Gippsland Lakes Community Health 2013

https://www.surveymonkey.com/s/ActiveLorikeetsandLittleWrens




•East Gippsland :- Rural and remote

•It is home to a strong community of Aboriginal and Torres Strait Islander people with 8.5% of East Gippsland children being indigenous, ( 10.4% of East Gippsland children in Prep are indigenous compared with 1.4% for the whole of Victoria

•Australian Early Development Index indicates that children in East Gippsland are markedly developmentally vulnerable

• Higher proportion of families than the national average that experience social and economic barriers to accessing health services.

•Significant gaps in early intervention services ( in fact there was no public funded paediatric allied health service available in our catchment)

•Nil private providers in our catchment

A Bit About Us: Gippsland Lakes Community Health


•Long waiting lists for paediatric allied health services: -30.1 days for an initial assessment by a Occupational Therapist -33.3 days for an initial assessment by a Speech Pathologist •Poor priortisation for service, often the loudest parent receiving service ,first in first served, often not the child with the highest need •Inability to recruit Health Professionals to rural Australia •High work force pressures •We understood early childhood development and its relationship to long term health and well being •We knew speech and language delay or fine motor skill deficit can lead to poor learning and socialisation at school and beyond

•We had to make a paradigm shift , things had to change Active Lorikeets

Paediatric Services: Challenges




Aims of Active Lorikeets 1. To increase therapy opportunities for children with developmental delay. 2. To increase the capacity of families to develop their child’s communication and fine motor

skills. 3. To reduce waiting times for paediatric Occupational Therapy and Speech Pathology,

decreasing the demand and pressure on service providers. 4. To develop a sustainable service. 5. If proved effective , develop a resource to assist other health services deliver the evidence

based program. 6. Evaluate the program.


Active Lorikeets: What does it look like?

Screening • Use of the Brigance and the Renfrew Action Picture Test to determine the most appropriate therapy option. • Screens are scored by Allied Health Professionals.

Weekly therapy skills groups • Provide speech and fine motor development activities • These structured sessions are delivered by Allied Health Assistants with a Speech or Occupational Therapist providing advice

and assistance

Strategies and information provided • For teachers/parents • Through educational resources and information sessions

Home programs • Developed based on individual screenings • Parents are offered an opportunity to meet with therapists to discuss their programs

Linking and referring • Children requiring one to one intervention



The Referral Process © Gippsland Lakes Community Health 2013

Screening Tools © Gippsland Lakes Community Health 2013



Program Basics: Fine Motor © Gippsland Lakes Community Health 2013

• Hand Preference

• Pencil grip

• Scissor use

• Cognition

• Visual Motor

Program Basics: Language

•Sharing Books and stories

•Speech Sounds and Phonological Awareness

•Engaging in Conversation




Weekly Skills Group

• Small groups of children, between 4-6.

• The therapy groups are conducted over an eight week block during each school term.

• These groups occur outside of kindergarten times.

• Parents/carers are invited and encouraged to participate.

Therapy Session Template

Activity Equipment Instructions Skill Progress notes

Welcome

Visual Schedule

Inform participants the sequence of

activities within the session.

This skill will be important for

understanding a timetable in

the classroom. Assists children

to understand the structure

and routine of the sessions.

Hello Song

Carpet squares placed

in a circle

Participants sit on mats to sing the

‘Hello’ song, *Clapping* ‘What you

think my name is I wonder if you

know?

My name is……..

“Hello (child’s name) Hello (child’s

name) Hello (child’s name) it’s good

to see you here!”

Encourage each one to say their

first name.

Creates an opportunity for

each child to speak in a group

environment.

Assures the children can give

personal data clearly e.g.

name, age, address.

Story – Brown Bear,

Brown Bear, What

Can You See?

Brown Bear book

Read the story to participants

without asking questions

Listening skills. Children learn

to sit appropriately for a 5

minute story within a group of

peers.

Assists children to develop

prediction skills by using

stories using a clear pattern.

Gives children sentence

patterns to copy in their

speech.



Table top Activity

Making animal masks

Mask templates, scissors,

glue, tissue paper, elastic,

paper plate

Provide each child with a paper plate

with elastic string attached and eye

holes cut out.

Each child is given a different animal

template from the story.

Get the child to cut out the shape of

their animal (with the assistance of

their parent if required).

Put glue over the surface of the

mask/templates and stick on tissue

paper.

Fine motor development in hand

preference for using scissors

and picking up small objects.

Receptive language: Children

are required to listen to 1-step

and 2-step instructions and

make choices

Social skills: Children are taught

to take turns, share equipment,

and make requests in an

appropriate manner.

All children are encouraged to

tell some -one about what they

have made today and the story

read.

Eg

Hand preference consistent:

Thumb on top:

Two fingers lower hole:

Other hand guides paper:

Name tags

Cardboard, pencils,

plastic badge

Have all the children’s dash line

names on individual pieces of card

board. Each child to trace their name.

Put the name tag into plastic badge.

The children can find their name

badge at the start of each session.

Identify letters in their name,

practise letter orientation & learn

to recognise their name in print

form.

Hand preference consistent:

Pincer grip with index/middle

&thumb:

Placement of fingers along

pencil:

Pressure on pencil:

Mat Time

Sounds of the week:

/m/ and /s/

Body Parts

Picture cards

beginning with

/m/ and /s/, big

‘m’ and big ‘s’

card, pair of toy

binoculars

Simon Says board

Body parts dice

Place cards on the floor in front of

children.

One child has the binoculars, the

other children say ‘(name x2) What do

you see’.

Child looks at a picture and responds

‘I see a (name of picture).

Leader of the group shows the child

which pile to put it in ‘s’ or ‘m’

Play Simon Says- Give each child a

chance at being Simon. For example

children between 3- 5 years should be

able to locate the following: Eyes,

nose, mouth, hair, feet, ears, tongue,

head, legs, arms, fingers, teeth,

thumbs, toes, neck, stomach, chest,

knees, back, chin, finger nails, heels,

ankles & jaws.

Game: Create a dice with different

body parts on each face. Get the

children to roll it and then touch the

part that shows on the dice.

Sing heads, shoulders, knees and

toes.

Using the sentence pattern from

the story in another context.

Beginning identification of initial

sounds.

Identify and name body parts.

Following visual and verbal

instructions.

Being part of a group activity.

Waiting turns.

Parents are provided with the

opportunity to observe their

children in a formal learning

situation and interacting with

other children.

Goodbye Song

Carpet squares placed in

a circle

Good bye (child’s name) goodbye

(child’s name) goodbye (child’s name)

it was good to see you here!

Collect name badges for next week’s

session

Concludes the session, children

farewell one another & children

are aware that it is the end of the

session.

Home Practice

Home programs for

sounds of the week ‘m’

and ‘s’

Give out home programs.

Talk: About body parts

Listen: Listen to and sing heads,

shoulders, knees and toes

Do: Practice writing your name

Provides opportunities for

parents to interact with their

children focusing on learning

goals.



End of Term Review


Outcomes • Increased access to therapy for children with developmental delay • Increased capacity of families to develop their child’s communication and fine motor skills 1. 78% of parents reported good-to-significant improvements in their child’s fine motor skills. 2. 85% were confident in their ability to assist their child in developing speech or fine motor skills after completion of Active Lorikeets skill therapy group. 3. 95% were satisfied-to-highly satisfied with the Active Lorikeets program. 4. Most significant change stories revealed benefits to children and their families. • Reduced waiting times for paediatric Speech Pathology and Occupational Therapy services 1. Waiting times for Speech Pathology – reduced by 61% (from 33 to 13 days) 2. Waiting times for Occupational Therapy – reduced by 73% (from 30 to 8 days)

• Evaluation has been completed demonstrating it as an effective service delivery model

• Development of sustainable service 1. The program’s affordability has increased client access to services. 2. A skilled Allied Health Assistant workforce has been established. 3. A resource CD and training package created and formal evaluation and program report completed.




0

5

10

15

20

25

30

35

Speech Pathology Occupational Therapy

Number of days to see AHP from receipt of referral

Jun-11

Dec-12

Showing that there has been a dramatic reduction in waiting times for children to see the speech pathologist or occupational therapist, dropping from an average of 33 days to 13 days waiting time for speech pathology, and from 30 days to 8 days for occupational

therapy.

Click to add info

0

500

1000

1500

2000

2500

3000

OccupationalTherapy

SpeechPathology

Physiotherapy Dietetics Active Lorikeets Everybody'sDifferent

TOTALS

GLCH Hours of Paediatric Allied Health Services Delivered 2010-2012

2010/2011

2011/2012

With the implementation of qualified Allied Health Assistants GLCH has reported an increase of over 150% on paediatric allied health services delivered. All programs are designed and

supervised by AHPs





Developing a quality Allied Health Assistant workforce

Beyond Survival Redesigning HealthCare for a sustainable Future

VHA Annual Awards 2012

Current Workforce 3 Physiotherapists (2.2 EFT) 2 Occupational Therapists (2.0 EFT) 3 Speech Pathologist (2.2 EFT) 1 Dietician (0.5 EFT) 1 Podiatrist (0.8 EFT) 2 Exercise Physiologists (2.0 EFT) Planned Activity Coordinator and staff Health Promotion team 3 Service Access Workers

& 11 Allied Health Assistants


Benefits of the Allied Health Assistant Workforce Model

· Has reduced wait lists by over 50 %in two years · Increases service scope by implementing new programs Large gaps in available services regionally have influenced proactive service remodelling. · GLCH AH service delivered over 6000 hours above previous annual figures with no increase in public funding · Development of multi-disciplinary groups and 1:1 service delivery models supported by AHAs supervised by AHPs. Service models have been adjusted to meet client need with multidisciplinary group service delivery becoming the norm with an increase in services delivered being the gain. · Supports a highly skilled and flexible staffing profile · Reduces pressure on AHPs .Clients with complex needs are managed by AHPs with care plans developed often including additional service delivered by AHAs · Following assessment by AHP’s client with non complex needs can have service delivered by supervised AHAs · Increases scope of service provision in new areas ,e.g. paediatric services · Improved client outcomes and provides potential ways to meet complexity of client needs · Non clinical support provided to AHPs, increasing time available for service provision · Increased job satisfaction– staff retention



• Guide to developing a

supervision structure

• Providing the right supervision

and support

• Confidence that your AHA is

competent

Supervision of AHAs


• Shadowing Speech Pathologist and Occupational Therapist in individual therapy sessions

• Support to up-skill (cert III and IV AHA) and attend relevant personal development opportunities

• Internal In-services with AHP’s

• Continual informal and formal support from AHP’s

throughout the year

Training of AHAs




Occupational Therapy:

• Handwriting

• Scissors skills

• Behaviour

Speech Pathology:

• Conversations with children

• Book reading

• Speech sounds

Knowledge Base for AHAs



Contents of CD

1. AHA Training

AHA training documents AHA Active Lorikeets training check list Knowledge base for AHA’s in Active Lorikeets program

2. Marketing

Copyright terms and conditions Active Lorikeets Logo Example poster Example brochure

3. Letter Templates and Information Packages

Kindergarten expression of interest Kindergarten acceptance acknowledgement Parent invitation to participate Parents consent Active Lorikeets pre questionnaire Parent/teacher comments pre therapy Screen result Active Lorikeets post questionnaire

4. Home Programs

Occupational Therapy Speech Pathology - articulation

Home program cover Home program cover Color recognition Listening to the sound Fine motor skills Minimal pairs Gross motor skills Sound on its own Number concepts Sound in short words Upper and lower case letters Sound in a word Visual discrimination Sound in sentences Drawing a person Sound in conversation Follows verbal directions Identifies body parts Personal data response Rote counting Visual motor skills

5. Therapy Plans 6. Resources

How to use the Therapy Plans Screening Tools Session Skills Directory Active Lorikeets Book List Therapy Template Purchased Software and Games Useful Websites

Term 1 Therapy Plans

Term 2 Therapy Plans 7. Program Manual Term 3 Therapy Plans

Term 4 Therapy Plans 8. Evaluation Report




AHA Conference Increased capacity

Metro Launch Another 18 health services

NSW Telehealth




Where are we now? Little Wrens

Aims •To increase capacity of childcare staff in helping their children acquire speech and language, and fine motor skills within everyday activities.

•To increase capacity of child care staff in being aware of the needs of children with •developmental delays, allowing them to integrate these needs into the general program. Target Group •Children Attending Day Care who are presenting with additional needs who may not be able to attend allied health services due to parental commitments/work hours.

•Ages 3-4

•Delivered in Child Care centres in Lakes Entrance

Little Wrens

•Childcare staff identify appropriate children for the program and obtaining parental consent.

•Therapy groups: small groups between 4-6 participants attend a school term of structured group sessions focusing on speech, language and fine motor skills.

•Groups are facilitated by Allied Health Assistant (AHA) and a child care staff member.

•Provision of take home activities: A summary of the session and ideas for home activities are provided at the end of each session.

•Individual therapy: the provision of a referral pathway to speech pathology or occupational therapy for children with more specific needs.





Little Wrens©

PO Box 429 | 18 - 26 Jemmeson Street

Lakes Entrance VIC 3909

tel 03 5155 8300 e

[email protected]

www.glch.org.au


In summary

The initial objectives of Active Lorikeets have been achieved, increasing opportunities for pre-school aged children at risk of developmental delay to access services in a timely manner, with

families confidently contributing to their children’s development.

Active Lorikeets arose as an innovative way to deal with some common service delivery issues faced by rural health services.

It has grown to become an example of excellence in service provision and workforce

development and has enabled GLCH to become a pioneer in creating quality resources and training opportunities for other health services across Victoria.

Thankyou

Documents

Active Lorikeets & Little Wrens early intervention programs › a2k › docs › TelehealthHandouts › Hando... · thumbs, toes, neck, stomach, chest, knees, back, chin, finger nails,