Practice Settings for Interprofessional Allied Health: Paediatrics

Core Principles and Approaches in Paediatric Allied Health

Paediatric allied health practice is defined by the following characteristics: - Family-centred & collaborative: Involvement of the family in every step of the process. - Context-based: Recognising the environment and circumstances surrounding the child. - Team Structures: Services may be delivered by interdisciplinary teams, sole providers, or multidisciplinary teams. - Developmental approaches: Using an understanding of child development to guide practice. - Settings: Provision of services in both individual and group settings. - Delivery Modes: Utilizing both direct intervention and consultative models.

Practice Settings for Paediatric Allied Health

Allied health services for children are provided across various environments, including: - Community Health settings - Hospitals - Schools - Kindergartens - Childcare centres - Disability services - Private Practice settings

Holistic Understanding of the Child and Family

To provide effective care, practitioners must understand the comprehensive needs of the child and their family, including: - Context: The environment in which the child lives, their family situation, and the services/settings they attend. - History: Comprehensive background covering the child, family, pregnancy, birth, and developmental milestones. - Diagnoses/Challenges/Concerns: Documenting the specific reasons for referral. - Individual Factors: Identifying the child's interests and strengths. - Priorities: Establishing the specific goals and priorities of the child and family.

Underlying Developmental Challenges and Domains

Practitioners must assess and understand challenges related to: - Body structures and functions - Motor skills: Including strength, movement, and developmental milestones. - Sensory perceptual functioning - Emotional regulation - Cognition - Communication - Social skills - Environmental, cultural, and contextual factors and influences.

The Paediatric Assessment Process

Referrals: Can originate from a GP, paediatrician, school, childcare, family services, or through allied health self-referral.
Screening Referral: Involves gathering background information and considering referral priority and wait times.
First Appointment: Includes an interview with the child and family, rapport building, and further background information gathering.
Objective Assessment: Employs informal and/or formal assessment tools across domains such as: - Communication - Development - Motor skills - Play - Sensory processing - Self care - Feeding - Mental health - Regulation - Roles and tasks
In-situ Observation: Considering observations in relevant settings like school, home, and childcare.
Establishing Priorities & Goals: A collaborative and ongoing process established by the family and child.
Planning: Determining and planning the next steps for the child.

Selecting Assessment Tools and Methods

The selection of a specific assessment is influenced by: - Purpose of evaluation and the reason for referral. - Relevant histories (medical, occupational, family, and previous test results). - Priorities of the caregiver and the child. - Developmental and chronological age of the child. - Policy/requirements of the specific agency. - Theoretical frame of reference or therapeutic approach. - Tolerance levels of both the child and parent. - Available resources: Time, physical space, specific tools/tests, and the availability of parents and others.

Best Practices for Conducting Assessments with Young Children

Preparation and Environment: - Establish a relationship with the family first. - Be prepared by knowing the assessment order, protocol, and scoring; practice with typical children beforehand. - Set up and organize the assessment space. - Set the scene for both parents and the child.
Interpersonal Interaction: - Be flexible, positive, fun, and reward effort. - Set clear limits during the session. - Build a positive experience for the child. - Use language that is clear, simple, and positive.
Family Inclusion: - Involve the parent in the process if possible. - Acknowledge the feelings of both the child and parent. - Keep the parent involved, included, and empowered (recognizing "This is their child!"). - Maintain awareness of potential power imbalances between the practitioner and family.

Paediatric Intervention: Planning and Implementation

Intervention Planning: Grounded in goals established by families, the child’s interests, and their specific roles.
Frequency: Determination of how often intervention occurs.
Intervention Implementation: Dependent on various factors and can include: - Development of strategies with the people in the child's life (teachers, carers, parents). - Therapeutic intervention to build specific skills (e.g., communication or motor skills). - Prescription of specialized equipment to assist the child. - Providing opportunities for children to experience success.

Re-evaluation and Targeted Action

Reanalysis of Areas of Concern: Focused on the child and family, looking at the participation context; often involves reported information.
Review of Targeted Outcomes: Assessing what has been achieved; may involve re-administering assessment tools used in the initial evaluation to measure change.
Targeted Action: Determining next steps, which may include: - Establishing new goals and priorities. - Further intervention. - Discharge. - Referral to other professionals. - Recommendations or home programs.

Discharge and Professional Referrals

Discharge Considerations: Based on goals achieved, support networks of the child and family, family preference, and needs for long-term disability support.
Referral to Other Professionals: Allied health may refer to others to address specific needs, including: - Paediatrician - Psychologist or Psychiatrist - Exercise Physiologist - Podiatrist - Tutor - Counsellor - School Support Officer

Flow Chart Summary of the Evaluation Process

Referral
Gather Preliminary Data: From child, parents, referrer, and other key people.
Gather History
Select & Administer Assessment Measures
Revise Evaluation Plan (if necessary)
Analyse Child’s Performance
Discuss Initial Findings and Recommendations with Family
Set Goals and Priorities with Family
Document Evaluation Results: Generate a formal report.
Plan and Implement Intervention with Family
Re-evaluate when necessary (Continue from relevant steps above based on findings).

Summary of Practice Lessons

Working with children and their families is a fun and rewarding career path.
Conducting comprehensive, accurate, and meaningful assessments is challenging but rewarding.
Practitioners should maintain a range of assessment options to meet diverse family needs.
Collaboration with a team is necessary to provide the best service.
Working with the primary influencers (parents, siblings, teachers) is essential.
Always consider settings, context, culture, interests, and priorities in practice.

Further Information and Resources

Raising Children Network: Family-friendly child development resources available at https://raisingchildren.net.au/
Learn to Play: Information regarding pretend play available at https://www.learntoplayevents.com/play/

References

Lynch, H and Moore, A, 2016 “Play as an occupation in occupational therapy”, British Journal of Occupational Therapy, vol. 79, no 9, pp 519-520
McWilliam, RA, Casey, AM and Sims, J, 2009 “The routines-based interview: A method for gathering information and assessing needs”, Infants & Young Children, Vol. 22, no 3
Roger, S and Kennedy-Behr, 2017, Occupation-Centred Practice with Children: A Practical Guide for Occupational Therapists, John Wiley & Sons