Children’s Therapies

North and west Kent - Dartford, Gravesham, Swanley, Edenbridge, Maidstone, Malling, Tonbridge, Tunbridge Wells, Sevenoaks

East Kent - (Canterbury, Whitstable, Herne Bay, Sandwich, Aylesham, Faversham, Rural Swale, Broadstairs, Margate, Ramsgate)

This section outlines the access criteria for children requiring support from Kent Children’s Therapies – East, North and west Kent only.

Support for speech and language therapy is predominantly via our Talking Walk-ins (TIWIs) and School liaison with their School Link Speech & language Therapist. We accept referrals from parents and those with parental responsibility, as well as professionals working with a child.

Talking Walk-in Service (TIWI)

• Play-based drop-in sessions where you can speak to a Speech and Language Therapist, Family Hub worker or other staff.
• For pre-school aged children where there may be a concern about their speech, language or communication.

See our Talking Walk-in Service page for more details.

Referrals to occupational therapy and physiotherapy must be made by a health, education or social care professional.

Please see the referral forms for the information that is required, prior to the referral being processed.

Education and Health Care Plans (EHCP)

New referrals from the Local Authority for Special Educational Needs for completion of an appendix four, as part of the EHCP process or tribunal processes are not accepted unless children meet the access criteria as stated below.

This assessment should be requested through the agreed access processes, as part of the local offer. If accepted the child/young person will be seen within our usual response times.

Care Co-ordination Service

This is an NHS service for babies and children who present with complex therapy needs which is impacting on or has the potential to significantly impact upon their long-term development.

Parents, GPs, health visitors, or other professionals in health, social care, or education can make a referral to the Care Co-ordination service.

The team is made up of Specialist Nurse Advisors (SNA) and Care Co-ordinators working within the Kent Children’s Therapies team.

An appointment will be offered with a Specialist Nurse Advisor and a plan will be agreed. The support offered by the team may include;

• coordination of care with other professionals and organisations.
• information on local groups and other agencies
• support with transition into nursery and/or school
• team around the child meetings to share information with other professionals involved in the child’s care and put together a family plan
• referrals onto other agencies/services.

Access for this service will be discussed within the Children’s Therapies triage process.

If a child appears appropriate for assessment, then the specialist nurse advisor may call the parents/carers to offer the service.

Children who have been accepted will be contacted within 12 weeks from date referral received.

Children will have an agreed support plan in place within two weeks of assessment.

Who this service may not be right for:

We are unable to accept referral for babies and children who have complex medical needs and who do not meet the above access criteria. These children should be referred to the Children’s Community Nursing teams.

Occupational therapy

The term ‘occupations’ refers to the everyday activities that people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life. Occupations include things people need to, want to, and are expected to do. For a child these occupations are primarily focussed around play and leisure, learning, and self-care (dressing, using cutlery, washing etc).

Early Years Occupational Therapy – who do we support:

Children and babies zero to four years

• Identified neurodevelopmental condition or physical disability, which is impacting on or has the potential to impact upon their upper limb motor development and function.
• Non-typical development of upper limb and fine motor skills (for example, asymmetry, abnormal muscle tone).
• Developmental delay - impacting on their ability to participate in developmentally appropriate occupations and activities
• Born before 32 weeks gestation
  • Brain lesion on neuroimaging which is likely to correspond with abnormal developmental outcomes (i.e. PVL, IVH grade three to four)
  • Other risk factors indicating access include: Grade two or three Hypoxic Ischaemic Encephalopathy in the neonatal period/ Neonatal Bacterial Meningitis/Herpes Simplex Encephalitis/Neonatal Seizures/Severe neonatal sepsis/ bronchopulmonary dysplasia for which mechanical ventilation is still required at 36 weeks post menstrual age/Antenatal steroids not given/ Postnatal steroids given to babies born before 32 weeks gestation/CMV.

School Years Occupational Therapy – who do we support:

Children and young people five to 19 years (19 year olds would need to be in full time education):

• Have an identified physical illness, neurodevelopmental condition or physical disability impacting on their ability to participate in occupations they need or want to do.
• Present with coordination (motor/fine motor) difficulties that impact their ability to participate in at least two occupations they need or want to do (see definition above).
• Present with sensory processing differences that are impacting on their ability to participate in at least two occupations they need or want to do, (see definition above), across a variety of settings.
• Requests for support for children’s co-ordination and sensory development need to document evidence of implementation of appropriate universal strategies prior to being accepted.

Children's Therapies the Pod - sensory processing pathway

Children's Therapies the Pod - movement and coordination skills

Universal strategies include:

• Minor adaptations to the school/home environment
• Adapting activities using high street equipment / furniture
• Use of appropriate universal strategies within the school and home environment, examples of these can be found on the Children’s Therapies website – The Pod.

Kelsi website for role of schools and settings.

These strategies and adjustments need to have been implemented consistently over a period of 12 weeks and evidence of this should be attached to any request for support.

Occupational Therapy – who this service may not be right for:

We are unable to accept requests for support for children and young people with:

• A single diagnosis of hypermobility with no associated functional difficulties or pain
• Handwriting difficulties in the absence of other functional difficulties.

Children who have been assessed by an OT previously and whose presenting needs would still be addressed by advice previously offered by an OT.

Physiotherapy

Early Years Physiotherapy – who do we support:

Children and babies zero to four years presenting with a:

• Identified neurodevelopmental condition or physical disability, which is impacting on or has the potential to impact upon their gross motor development and/or function.
• Non-typical development of posture and movement (for example, asymmetry, abnormal muscle tone).
• Developmental delay (for example, not sitting independently by eight months, not walking by 18 months).
• Born before 32 weeks gestation
• Brain lesion on neuroimaging which is likely to correspond with abnormal developmental outcomes (i.e. PVL, IVH grade three or four)
• Cystic Fibrosis (east Kent only)
• Torticollis/plagiocephaly
• Other risk factors indicating access include: Grade two or three Hypoxic Ischaemic Encephalopathy in the neonatal period/ Neonatal Bacterial Meningitis/Herpes Simplex Encephalitis/Neonatal seizures/severe neonatal sepsis/ bronchopulmonary dysplasia for which mechanical ventilation is still required at 36 weeks post menstrual age/therapeutic hypothermia (brain cooling) after birth and/or had a brain injury (identified via brain scan) in the neonatal period.

School Years Physiotherapy – who do we support:

Children five to 19 years (19 year-olds need to be in full time education):

• Identified physical illness, neurodevelopmental condition or physical disability, which is impacting on their gross motor development and/or function.
• Access for children and young people with a diagnosis of Chronic Fatigue Syndrome, Functional Neurological Disorder, Long Covid and Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) will be accepted only when there is evidence of ongoing psychological support and intervention.
• Cystic Fibrosis – see Early Years criteria.

Universal strategies include:

• Strategies to improve gross motor skills and functional ability at school and home.
• Use of appropriate universal strategies within the school and home environment. Examples of these can be found on the Children’s Therapies website – The Pod.

Kelsi website for role of schools and settings.

These strategies and adjustments need to have been implemented consistently over a period of 12 weeks and evidence of this should be attached to any requests for support.

Speech and Language Therapy

Children and young people can access support for speech, language, and communication needs (SLCN) in several ways without a formal referral. This includes advisory sessions to discuss individual needs and plan next steps, as well as family hub and school-based interventions designed to support speech, language, and communication development. Not all children will need a referral - many can receive SLCN support directly through Family Hubs, nurseries, and schools.

Early Years and School years – who do we support

Babies and children who:

• have an identified speech, language and communication needs
• present with significant delay with their speech, language and communication
• are presenting with a specific communication difficulty, for example, stammer, voice, cleft palate and/or lip affecting their speech, language and communication skills and SLCN associated with deafness
• present with selective mutism (where education and family have attended training and put in support for 12 weeks with minimal progress)
• for school age children, documented evidence is needed that the school has carried out at least 12 weeks of support, (where the child or young person has made limited progress)
• who require specialist support to establish an augmentative/alternative communication system due to the child’s difficulties leaving them without a developing functional communication system
• have a diagnosis that is progressive or degenerative resulting in deteriorating communication abilities which requires specialist support to maintain communication skills and/or establish an augmentative/alternative communication system if required
• present with feeding and swallowing difficulties, please complete the additional information eating and drinking information Children's Therapies form.

Speech and Language Therapy – who this service may not be right for

We are unable to accept requests for support for children and young people with:

• Global developmental delay whose language development is in line with their overall development.
• Mild and moderate speech difficulties.
• A diagnosis of Autism where their language development/needs fits with a diagnosis of Autism.

We are unable to accept requests for eating and drinking support for children and young people who are:

• Orally aversive due to sensory issues - this needs specialist MDT feeding clinic approach
• Functional Dysphagia
• Esophageal Dysphagia
• Eating a restricted range or amount - see information available on the Pod
• Having difficulties with initial weaning - contact your Health Visitor/GP for support
• Tongue-tied - contact the Infant feeding team up to six weeks of age or GP
• Experiencing PICA - contact GP.

We are also unable to accept referrals for eating and drinking support where there is parental anxiety around weaning - contact your Health Visitor/Family Hub.

South east Kent - (Ashford, Folkestone, Dover, Deal, Hythe)

A child/young person can be referred to our service by someone who knows them well and has all the relevant information to complete the referral.

Sometimes we may decide on receiving a referral for your child that it is not appropriate or necessary for your child to be seen by our service. A letter will be sent explaining our reasons to the referrer.

When a child is referred to the service, they may need to be assessed by only one therapy or a combination of two or three.

Our therapy staff will triage the referral and at that point will accept or reject the referral according to the therapy criteria. They will also decide who needs to see the child at their first appointment and the details of this are included in the appointment letter. Referrals that are identified as particularly urgent are fast-tracked while all other referrals are offered an appointment as soon as possible.

Please note children and young people with a Canterbury, Faversham or Thanet GP need to refer to Children's Therapies the Pod.

Providing additional information

Additional information is required with some referrals, listed below. If there is insufficient information on the referral form to make a clinical decision on the appropriate route to the service, the referral will be rejected with a request for more information.

Completing the relevant forms will provide the therapist(s) with valuable information for planning the assessment.

Occupational Therapy

Children with mild to moderate motor coordination difficulties affecting school progress are required to have participated in a structured motor programme (Fizzy, Jump Ahead) at school for a minimum of 50 sessions.

Referrals will be returned where this is not the case. This must be evidenced on the additional information form.

Speech and Language Therapy

A referral to our speech and language service is only required for children who:

• are home schooled
• have a significant hearing impairment
• have a voice disorder
• have issues with eating, drinking and/or swallowing.

All other speech and language needs are addressed via school link therapy meetings and Special Education Needs Coordinator.

For pre-school children who need help with communication, see our Talking Walk-in Service - no referral required.  For your local venue Your local family hub - Kent County Council.

Feeding and drinking

If you are referring a child specifically for a feeding or drinking related concern then please attach a completed Eating and drinking information Children's Therapies form)

Hearing impairment

If you are referring a child with a recognised hearing loss, please include with the referral form:

• a recent report including details of their hearing loss, for example, audiogram / ABR
• an indication on the referral form how the hearing loss is impacting their speech, language and communication skills.

Physiotherapy

Where available, our physiotherapy referrals require a clinic letter/report to accompany the referral form.