RCOT's Professional Adviser for Children, Young People and Families, Sally Payne, reflects on how designing services differently can result in extending the reach of occupational therapy.
Handwriting is frequently identified as an area of difficulty when parents and teachers request assistance from a children’s occupational therapist. This is no surprise as despite developments in technology, handwriting remains the main means by which most young people demonstrate their learning at school. Children struggle with handwriting for many reasons and occupational therapists have the skills to identify these and explore solutions to enable children to present their ideas on paper.
Occupational therapists are however a limited resource and in some areas, children have to wait several weeks before they are seen. But do all children with handwriting difficulties need to see an occupational therapist before they can benefit from therapy interventions?
Historically, occupational therapists have focused on providing individualised, specialist services for children with occupational performance needs. But in a climate of increased demand with (usually) no increase in resources, a service model where each child is seen individually is no longer sustainable. Instead, we need to think about extending our reach and making the best use of our resources by providing more support for children with handwriting (and other) difficulties at universal and targeted levels.
Universal interventions are those that benefit everyone, for example, all pupils attending a school or early years setting. From an occupational therapy perspective, universal interventions help ensure that all children have appropriate opportunities to move, learn and develop independence skills. Taking handwriting as an example, universal interventions might include providing whole-school training to promote teachers’ understanding of the development of pencil grip or providing web-based information for parents about developing pencil skills through play.
Targeted interventions are for young people who need support to develop skills and reach their personal and academic potential, including children with and without a diagnosis. Targeted interventions don’t always involve direct input from an occupational therapist and children who benefit from them don’t have to be referred to the occupational therapy service. Targeted interventions are often delivered in partnership with parents or another professional. An occupational therapist might, for example, help set up a handwriting group which is continued by school staff or provide training for parents or professionals about a specific area of need (e.g. handwriting) for a particular group of children. Targeted interventions may be enough to address a child’s needs while children with more persistent difficulties may require onward referral for specialist intervention.
The needs of most children traditionally referred to occupational therapy for handwriting difficulties can be addressed by targeted interventions. Investing occupational therapy expertise in developing more universal and targeted interventions will free up therapists to provide specialist interventions for those young people who require highly personalised input to meet their individual needs. Please keep sending us examples of your universal and targeted interventions so we can demonstrate the value of working differently, and look out for a new RCOT Improving Lives, Saving Money campaign report in 2019 highlighting the role of occupational therapy with children and young people.
In summary, not all children need direct input from an occupational therapist to progress. Working in partnership with others and developing more targeted and universal interventions will extend our reach to more children and ensure more appropriate occupational therapy referrals, enabling us to focus our specialist skills and knowledge on the children who need it most.
Continue the conversation with Sally: @RCOT_Sally