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2007 Information to guide good practice for

physiotherapists workingwith childrenThe Association of Paediatric

Chartered Physiotherapists

THE CHARTERED SOCIETY OF PHYSIOTHERAPYTHE CHARTERED SOCIETY OF PHYSIOTHERAPY

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Foreword

3

All babies, children and young people are important. They each have their own

unique personality and potential. They deserve the best possible care and nurture to

support their health and development.

Physiotherapists who work with children are specialist practitioners who have the

right skills and specific knowledge to deliver appropriate care and educate and to

encourage family involvement.

Paediatric physiotherapists should have an understanding of:

  child development

  childhood diseases and conditions that may impact on development and wellbeing

  therapeutic interventions that enable and optimise development and wellbeing

  the need to place the child at the centre of planning

  the impact that having a disabled child or a child who is sick has on family life

  how to keep children safe

  how to ensure that children and young people make choices

  how to develop their own skills and practice

  how to develop services in line with the Government guidance committed to

improving quality and life chances for children.

Peta Smith

Chair Association of Paediatric Chartered Physiotherapists

November 2007

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2007 Information to guide practice for physiotherapists working with children

Table of contentsIntroduction

What is the purpose of this booklet? 5Who is it for? 5

How to use this guide 5

Supporting information 6

Building a business case 6

Section 1 – Physiotherapy as a profession

What is physiotherapy? 7

What is paediatric physiotherapy? 7

Relevant organisations 8

Section 2 – Physiotherapy practice

Legal and ethical framework 9

  What is the legal framework that governs physiotherapy? 9

Ethics and consent in paediatrics 10

  What are the consent issues for a paediatric physiotherapist involved with 10children and their families?

What is the role of the paediatric physiotherapist in safeguarding children? 13

  Checking staff against criminal registers 14

Factors influencing physiotherapy practice 15

  What are the factors that support physiotherapy practice? 15

  Paediatric competences and standards 15

  Workforce development – Continuing Professional Development (CPD) 16

  Evidence-based practice 16

  Moving and handling 17

Health and wellbeing 21

  Public health 21  Locations and settings 22

  Supporting practice 24

Section 3 – Providing high quality services for children and their families

What are the key factors that support the delivery of paediatric physiotherapy services? 25

Report writing to support assessment and planning based around the needs of children 28and their families

Legal and tribunal report writing 29

Assistive technology 29

Section 4 – UK Country-specific child-related policy

England 31

Northern Ireland 35

Scotland 37

Wales 39

Section 5 – Useful general information

Sports and leisure 41

Specialist holidays 42

Voluntary agencies and support group 43

Appendix – Resources and references 44

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Introduction

What is the purpose of this booklet?

This booklet provides guidance on good

practice for physiotherapists working with

children. It is designed to help address the

breadth of wellbeing of children, especially

those who may be positively affected by

paediatric physiotherapy.

It acts as a signpost to UK government policyand guidance, highlighting those which impact

on paediatric physiotherapy practice and shares

a list of contact details for a wide variety of

information, services and activities that may be

helpful for children and young people.

It is intended that this booklet and the

forthcoming document on ‘Competences

to deliver services for children and youngpeople who require physiotherapy services’

(to be published in 2008) will help and

support clinicians working within paediatric

physiotherapy services as well as those

commissioning, developing and delivering

services for children to ensure that children and

young people receive a high standard of care.

 

Who is this for?

  managers of children’s services

  managers and clinical leads for paediatric

therapy services

  managers of paediatric physiotherapy services

  clinicians working in paediatric

physiotherapy

  those commissioning services for children

and young people

  parents and carers.

The topics covered and information signposted

will assist in:

  Designing and implementing a service that

understands and addresses legislation and

national policy in order to improve

outcomes for children

  Commissioning and developing services that

meet the needs of children

  Facilitating the use of evidence-based

practice for effective paediatric physiotherapy

  Using competence frameworks to

ensure paediatric physiotherapy quality

service provision

  Linking to other organisations and services

to help provide individual children and

their families with the best opportunity to

fulfil their potential  Service review and redesign, providing a

robust business plan and investing resources

in a new way of working.

How to use this guide

The booklet is divided into five sections:

  Each section has a number of headings

relating to its content and identified withthe relevant page numbers. For the most

part, the references are included at the

end, however, for some areas, particularly

around the legal and consent headings,

additional references and reading are

located in the section

  Section 4 relates to children’s services

within England, Northern Ireland, Scotland

and Wales. Each country has a dedicated

chapter, which outlines its Children’s

strategy, child legislation, key policy papers,

CSP information papers and

implementation tools

  The word ‘children’ relates to babies,

children and young people

  The word ‘families’ relates to parents, carers

and members of the extended families.

The content of this guide is current at the time

of going to press, recognising that practice

and legislation evolve. The resource may be

accessed via The Chartered Society of

Physiotherapy’s (CSP) website www.csp.org.uk

linked to the Association of Paediatric

Chartered Physiotherapist’s (APCP) website

www.apcp.org.uk where it will be

updated regularly.

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The information collated within the booklet

is not exhaustive; it is intended to be used as

a resource and a guide and not as a definitive

document.

Links to relevant websites are included in order

to access current information.

Supporting Information

The booklet is intended to be read and used

in conjunction with additional published

information from the CSP and the APCP,

which is available from the CSP on 020 7306

6666 or www.csp.org/publications, or through

membership to the profession’s clinical interest

group, APCP, at http://www.apcp.org.uk/.

In particular, the guide supports and

references the Health Professions Council (HPC)

Standards of Proficiency(1), the CSP Rules of

Professional Conduct(2), CSP Core Standards of

Physiotherapy Practice(3) and the APCP Good

Practice Guidance(4).

Building a business caseThe CSP publication Making the Business

Case for Physiotherapy(5) provides support

in understanding the modernisation issues

in healthcare, factors influencing what

commissioners need to purchase and

developing the business case in order to win

contracts to provide a physiotherapy service.

Introduction

2007 Information to guide practice for physiotherapists working with children

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What is physiotherapy?

What does this mean for children andyoung people?

Children receive appropriate high qualityindividualised intervention and support tohelp them achieve improved outcomes

Children and families are provided with

timely information and advice

Children and young people have accessto professional practice which is based onassessed need and underpinned by robustclinical governance.

Physiotherapy is an allied health care

profession which promotes the health and

wellbeing of all. Physiotherapy is a sciencebased profession, committed to extending,

applying, evaluating and reviewing the

evidence that underpins and informs its

practice and delivery. Physiotherapists are

autonomous practitioners, responsible

for the assessment and interpretation of

investigations to provide expert, holistic

physical rehabilitation to those who require

such intervention because of accident, injury,ageing, disease or disability. They also use their

strong educational skills to teach, empower

and promote physical wellbeing

and independence by maximising

individuals’ potential.

What is paediatric physiotherapy?

Physiotherapists working with childrenand young people bring their generic

skills as physiotherapists. They may have

to cover a wide range of conditions from

respiratory, neurology and musculoskeletal

in differing environments and must be able

to demonstrate competence in all areas in

which they practise. They recognise that

children and young people are not adults and

that as practitioners working in this specialistfield they should have additional skills and

knowledge around:

 holistic child development

 anatomy, physiology, neurological and

psychological development from new born

to adulthood

 the recognition of the ages and stages from

infancy through transitions to adult life

 a range of child specific medical conditions

and disability and the impact they have on

participation and wellbeing

 the ability to recognise atypicaldevelopment and assess, identify, clinically

diagnose and offer a range of interventions

and options using their clinical judgement

and experience

 the understanding of the importance of

working in partnership with the children

and their families to help them gain an

understanding of their situation, teachingand empowering them so that they are

able to maximise their abilities and

life opportunities

 the understanding of the possibility for

involvement over a prolonged period if

a child has a long term condition for

which physiotherapy intervention could

be beneficial the ability to provide an advocacy and

educational role in partnership with the

child or young person as they progress

through key stages of development,

engaging with others to ensure consistent

optimum outcomes.

Paediatric physiotherapists have a duty tomaintain their clinical reasoning skills and

up to date knowledge within their specific

area of practice to ensure that interventions

are appropriate and effective. Continuing

professional development (CPD) to increase

specialist knowledge, skill and experience

can be gained through clinical working

with children, attending specialist courses,reviewing the evidence base, reflecting on

practice and undertaking research and is a ‘life

long’ experience for all physiotherapists(3).

Physiotherapy as a profession

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Developing competence to practise safely helps

to ensure consistent quality standards of care

and delivery of services for babies, children

and young people throughout the United

Kingdom.

Relevant organisations

Chartered Society of Physiotherapy

Tel: 020 7306 6666

www.csp.org.uk

The Chartered Society of Physiotherapy is the

professional, educational and trade union

body for 49,000 chartered physiotherapists,

physiotherapy students and assistants in the

UK. It aims to support its members and

help them provide the highest standards

of patient care.

Rules of professional conduct and standards of

Physiotherapy Practice (2, 3) set high standards

for CSP members’ practice and conduct.

Broader activity around the following supports

members in meeting these:

 Qualifying and post-qualifying education

 Professionalism and competence

 CPD and career development

 Research, evidence-based practice and

clinical effectiveness

 Professional networking and peer support

(face-to-face and virtual).

 

The Society is a member-led organisation,

governed by the CSP Council. This is made

up of elected CSP members and is supported

by a system of boards, branches, committees

and groups. The CSP provides a wide range

of member services and is also a campaigning

organisation, raising the profile and lobbying

on behalf of the membership and promoting

the physiotherapy profession.

Health Professions Council – HPC

Tel: 020 7582 0866 www.hpc-uk.org

The HPC is the UK independent regulator

for the allied health professions. It sets

standards of professional training, conduct

and performance for these professionals and

keeps a register of those that meet the above

standards. Action is taken if any registeredprofessionals do not meet the standards of the

HPC. Since 2006, all registrants must engage

in CPD and re-registration with the HPC is

linked to successful compliance with the CPD

standards. The HPC was created by legistration

called the Health Professions Order 2001

and replaced the Council for the Professions

Supplementary to Medicine.

Association of Paediatric Chartered

Physiotherapists APCP www.apcp.org.uk

APCP is the clinical interest group of the CSP

for Chartered Physiotherapists working with

children or an interest in children and their

physiotherapy. APCP has a national committee

which has representatives from the regional

branches. The Association also has affiliated

groups which have a specific interest in certain

areas of Paediatrics.

 Affiliated Groups of the APCP 

Neonatal Care Group

Critical Care Group

Neuromuscular Group

Paediatric Physiotherapists in Management

Services (PPIMS)

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Legal and ethical framework

What is the legal framework that governs

physiotherapy?

What does this section mean for childrenand young people?

Physiotherapists must understand and

adhere to the law and rules that governtheir profession thereby providing safetreatments in a safe environment forchildren and young people.

Chartered physiotherapists are regulated

healthcare professionals, required to adhere

to the rules and standards of the CSP, the

regulations of the HPC and the legal andpolicy frameworks of the country in which

they work. It is essential that physiotherapists

working with children also have knowledge

and understanding of relevant trust and

local authority policies relating to the care

of children. This is as relevant to private

practitioners who treat children as those

physiotherapists employed within the

public sector.

Sadly, legal frameworks relating to children are

often only reviewed following tragedy, as in

the cases of Victoria Climbié(6), Caleb Ness(7) and

the Kennedy Report(8).

Recent reviews in the UK have driven the

need for organisations to work more closelytogether, putting the child at the centre of

care and using modern technology to improve

communications. Increased movement in the

population has highlighted the need for better

access to information; for example, families

relocating within the UK, children entering the

country as asylum seekers, or during a transfer

to specialist care away from their family and

home locality.

It is essential for physiotherapists to

understand the national and local policy and

legislation which impacts on the way they

work and deliver services. The documents

listed below relate to UK-wide physiotherapy.

The subsections relating to England, Northern

Ireland, Scotland and Wales contain their

relevant documents.

United Nations Convention on the Rights of

the Child 1989 (UNCRC)(9)

The UNCRC was ratified by the United Kingdom

in 1991 and all four governments are committed

to implementing the articles, reporting to the

Committee on the Rights of the Child (one of the

United Nations’ treaty monitoring bodies) every

five years on progress. The Convention provides

a set of minimum standards relating to children

– defined as under 18 years. The standards mostly

address under 16 year-olds and acknowledgethe different needs of the 16-18 year group of

young people.

The CRC is grounded in the Universal Declaration

of Human Rights(10), which states that children

are entitled to special care and assistance as they

often lack the physical and political means to

defend their own rights. Addressing the civil,

political, economic, social and cultural rights of

the child, the standards sit in three categories:

  Provision

  Protection

  Participation.

Children’s right to express their views and

be heard in matters that affect them is now

enshrined in law (Article 12 of the UN Conventionon the Rights of a Child).

Paediatric physiotherapists should have the skills

to work effectively in partnership with children

and young people. These include having the

abilities and qualities to listen, respect and

respond to their views, priorities and wishes.

Disability Discrimination Act (DDA1995 updated 2005) (11, 12). The Disability

Discrimination Act aims to end discrimination

facing many people with disability.

Physiotherapy practice

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It gives disabled people rights in the area

of employment, access to goods, facilities

and services.

Human Rights Act (HRA 1998)(13)

The Human Rights Act includes the right to

liberty and security, the right to a fair trial,

the right to freedom of thought, conscience

and religion and the right to freedom ofexpression. It also prohibits discrimination. See

also CSP information paper relating to this(14).

The Children Act 2004 (15)

The Children Act (2004) provides the legislative

spine for the wider strategy for improving

children’s lives. This covers the universal

services which every child accesses, and

more targeted services for those withadditional needs.

The overall aim is to:

 Encourage integrated planning,

commissioning and delivery of services

  Improve multi-disciplinary working and

remove duplication

  Increase accountability and improve the

coordination of individual and joint

inspections in local authorities.

The legislation is enabling rather than

prescriptive and provides local authorities with

a considerable amount of flexibility in the

way they implement its provisions. The Act

introduced the role of Children’s commissioner

to actively seek children’s views and championtheir causes.

N.B. Section 12 of the Act allows development

of further secondary legislation and statutory

guidance in setting up databases or indexes

that contain basic information about children

and young people to help professionals in

working together to provide early support to

children, young people and their families.

Data Protection Act 1998(16)

The Data Protection Act gives individuals rights

regarding the personal data organisations

hold about them and gives organisations

responsibilities regarding that data.

Ethics and consent in paediatrics

What are the consent issues for a paediatricphysiotherapist involved with children and

their families?

What does this mean for children andyoung people?

Physiotherapists must understand andadhere to the law and local policy in fullyexplaining and seeking understanding ofthe intervention, and ensure consent isobtained according to guidance.

The position on consent in relation to children

is complex and at times confusing. Therefore,

it is important to be familiar with the extensive

body of literature including statute and case

law, professional guidance, NHS guidance

and scholarly writing on the ethical and legalapproaches to children’s consent. In addition,

since 2001 NHS Trusts and primary care

organisations have developed local consent

policies. Consequently, physiotherapists should

be aware of their contractual obligation to

follow local policy and procedure.

There are both ethical and legal justifications

for obtaining consent. The philosophical basis

of informed consent rests on the principle

of respect for patient autonomy, which is

associated with the notion of involving the

patient in the decision making process(17).

However, the law deals with the issue of

consent in a manner distinct from the

application of ethical concepts. The legal focus

is upon the concept of valid consent which, by

definition, has four elements: voluntariness,

competence, disclosure, and comprehension.

Therefore, for consent to be valid it must be

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given voluntarily without undue influence,

coercion, or force. In addition, the child giving

the consent must have the necessary mental

capacity or competence to do so at the time

of treatment, which has particular relevance

to children.

The law† recognises broadly three stages of

childhood with respect to consent. First, thereare very young children who lack the capacity

to consent to assessment and treatment. In

such cases it is usual for the person(s) with

parental responsibility‡ to give consent.

Second, there are ‘Gillick competent’ children.

A child under 16 can consent to assessment

and treatment provided he or she is competent

to understand the nature, purpose and

possible consequences of the proposedintervention(18). Finally, there are children over

the age of 16 who can give a valid consent

to any surgical, medical or dental treatment

without consent from the person(s) with

parental responsibility(19).

Up to age 18, where a child lacks capacity,

the person(s) or local authority with parental

responsibility can give consent on behalf ofthe patient.

The other two elements of valid consent,

disclosure and comprehension relate to the

idea that sufficient information must be

provided to the child (and their parents, carers)

so that he/she comprehends in a basic sense

the proposed intervention. Communicating

information in an age and cognitively

appropriate manner is a key element to

this process; e.g. use alternative or

augmentative communication, use of pictures

or photographs and the overall quality of

the child’s health experience.

 

The following texts are recommended for their

comprehensive discussion and explorationof not only valid consent but various other

important issues relating to the care of

children in health care.

 † Refers to England, Wales and Northern Ireland.

There are some exceptions in Scotland; see further

CSP (2005) Core Standards of Physiotherapy Practice

4th ed. London: CSP Standard 2

‡ Parents, guardians or any other persons or

authorities legally entitled to give consent on the

child’s behalf see further the Children Act 1989 and

the Adoption and Children Act 2002

Bibliography

Statutes:

Family Law Reform Act 1969. London:

HMSO; 1969.

Children Act 1989 Elizabeth II. Chapter 41.

London: HMSO; 1989.

Human Rights Act 1998: Elizabeth II. Chapter42. London: HMSO; 1998.

Adults with Incapacity (Scotland) Act 2000 asp

4. Edinburgh: TSO; 2000.

Adoption and Children Act 2002. London:

Stationery Office; 2002.

Mental Capacity Act 2005 Elizabeth II - Chapter

9. London: TSO; 2005.

Cases:

Chatterton v Gerson [1981] QB 432.

Sidaway v Bethlem Royal Hospital Governors

and others [1985]1 ALL ER 643

Gillick v West Norfolk and Wisbech Area

Health Authority and Department of Health

and Social Security [1986] AC 112 

Re R (A minor) (Wardship: Medical Treatment)

[1991] 4 All ER 177

Re W (A minor) (Medical Treatment: Court’s

 jurisdiction) [1992] 4 All ER 627

Re E (A minor) (Wardship: Medical Treatment)

[1993] 1 FLR 386

Professional Guidance on Consent

in Paediatrics:

British Medical Association. Consent, rights and

Physiotherapy practice

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choices in health care for children and young

 people. London: BMJ Books; 2001.

The Chartered Society of Physiotherapy.

Core standards of physiotherapy practice

4th ed. London: Chartered Society of

Physiotherapy; 2005.

URL: http://www.csp.org.uk/director/ 

libraryandpublications/publications.cfm

The Chartered Society of Physiotherapy.

Consent. Information paper PA60. London:

Chartered Society of Physiotherapy; 2005.

URL: http://www.csp.org.uk/director/ 

libraryandpublications/publications.cfm

The Chartered Society of Physiotherapy. Legal

work pack: 2005. London: Chartered Societyof Physiotherapy; 2005. URL: http://www.

csp.org.uk/director/libraryandpublications/ 

publications.cfm

The Chartered Society of Physiotherapy, North

West Paediatric Physiotherapy Managers

Group. Good practice guideline for obtaining

consent in paediatric physiotherapy . London:

Chartered Society of Physiotherapy; 2004.

The Chartered Society of Physiotherapy.

Human Rights Act 1998 . London: Chartered

Society of Physiotherapy; 2000.

Department of Health. Reference guide to

consent for examination or treatment. London:

Department of Health; 2001.

URL: http://www.dh.gov.uk/publications

Department of Health. Good practice in

consent: implementation guide: consent

to examination or treatment. London:

Department of Health; 2001.

URL: http://www.dh.gov.uk/publications

Department of Health. Seeking consent:working with children. London: Department of

Health; 2001.

URL: http://www.dh.gov.uk/publications

Department of Health. Complex disability

exemplar. National service framework for

children, young people and maternity services.

London: Department of Health; 2005. URL:

http://www.dh.gov.uk/en/Publicationsandstatist

ics/Publications/PublicationsPolicyAndGuidance/ 

DH_4123814

Department of Health. Consent: what youhave the right to expect – a guide for parents.

London: Department of Health; 2001. URL:

http://www.dh.gov.uk/en/Policyandguidance/ 

Healthandsocialcaretopics/Consent/Consentgen

eralinformation/index.htm

Department of Health. Consent: what you

have the right to expect – a guide for children

and young people. London: Department ofHealth; 2001. URL: http://www.dh.gov.uk/en/ 

Policyandguidance/Healthandsocialcaretopics/ 

Consent/Consentgeneralinformation/index.htm

Further reading:

Brook G. Children’s competency to consent:

a framework for practice. Paediatric Nursing.

2000;12(5):31-5.

Hedley M. Treating children: whose consent

counts? Current Paediatrics. 2002;12(6):458-62.

Vernon B, Welbury J. Consent for the

examination or treatment of teenagers.

Current Paediatrics. 2002;12(6):458-62.

Clayton M. Consent in children: legal and

ethical issues. Journal of Child Health Care.

2000;4(2):78-81.

Spencer GE. Children’s competency to consent:

an ethical dilemma. Journal of Child Health

Care. 2000;4(3):117-22.

Alderson P, Montgomery J. Health care choices:

making decisions with children. London:

Institute of Public Policy Research; 1996.

Alderson P. Young children’s rights: exploringbeliefs, principles and practice. London: Jessica

Kingsley; 2000.

Physiotherapy practice

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Dimond BC. Care of children. In: Dimond BC,

editor. Legal aspects of physiotherapy . Oxford:

Blackwell Scientific; 1999. p. 363-84.

General Medical Council. Seeking patient’s

consent: The ethical considerations. London:

General Medical Council; 1998. URL: http:// 

www.gmc-uk.org/guidance/current/library/ 

consent.asp

General Medical Council. Confidentially:

Protecting and providing information. London:

General Medical Council; 2004. URL: http:// 

www.gmc-uk.org/guidance/current/library/ 

confidentiality.asp

Sim J. Ethical decison-making in therapy

 practice. Oxford: Butterworth-Heinemann; 1997.

Smith F, Lyon T. Personal guide to the ChildrenAct 1989 4th ed. Croydon: Children Act

Enterprises Ltd; 2006.

Montgomery J. Care of children. In:

Montgomery J, editor. Health care law. 2nd ed.

Oxford: Oxford University Press; 2003. p.

289-318.

Websites:

Department of Health: http://www.dh.gov.uk/ 

PolicyAndGuidance/HealthAndSocialCareTopics/ 

Consent/ConsentGeneralInformation/fs/en

UNICEF: http://www.unicef.org.uk/youthvoice/ 

rights.asp

Disability Rights Commission:

http://www.drc-gb.org/ 

What is the role of the paediatric

physiotherapist in safeguarding

children?

What does this mean for children andyoung people?

Paediatric physiotherapists have a dutyof care to work collaboratively with

other services to safeguard children.This may involve sharing informationand liaising with other agencies aboutconcerns in accordance with local policiesand procedures and national guidanceas recommended in the Victoria Climbié

Report(6).

The second joint Chief Inspector’s Report

on arrangements to Safe GuardingChildren(20) states:

 All agencies working with children, young

people and their families take all

reasonable measures to ensure that

the risks of harm to children’s welfare

are minimised

  Where there are concerns about children

and young people’s welfare, all agenciestake all appropriate actions to address

these concerns, working to agreed local

policies and procedures in full partnership

with other local agencies.

Copies of the report are available from the

website at www.safeguardingchildren.org.uk

Every Local Authority and NHS Trust has aChild Protection (Safe Guarding Children)

Policy which must be adhered if there is any

suspicion through direct contact or information

that a child may be at risk of being harmed. All

physiotherapists must adhere to their

local policy.

There is also non-statutory guidance by

HM Government which provides detailed

information, a child’s version and a flow-chart

to support practitioners through the process.

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If a child informs a physiotherapist of a

situation, she or he should explain to the

child that in some cases the physiotherapist

is obliged to take certain actions that may

involve telling other people ‘and I may have to

do this even if you ask me not to’ .

 

A physiotherapist may wish to consider sharing

the information with the Welfare Servicesof their organisation and ask the Welfare

Services to take the necessary action. If a

decision is reached to take action, then the

professional who received the information

from the child needs to be satisfied that such

action has been taken (either by themselves

or by a third party such as Welfare Services),

and if the professional is not satisfied that

the third party has taken the agreed action,then the professional themselves then

needs to take action. This is, in essence, the

practical application of the first four steps

of the government guidance contained

in ‘What to do if you think a child being

abused’(21). In the summary, the Flow Chart

on page 12 and Appendix 1 on page 17

will be worth reviewing first. Appendix 3 is

very comprehensive offering guidance oninformation sharing and confidentiality issues

in these particular circumstances.

http://www.everychildmatters.gov.uk/resources-

and-practice/IG00182/ 

 

Checking staff against criminal registers

It is a criminal offence for people with certain

convictions to apply for and work with childrenand vulnerable adults. It is also an offence to

knowingly offer work to such an individual.

In defining “Working with Children” the

legislation makes no distinction between paid

or unpaid work. The Protection of Children

Act 1999(22), make some checks compulsory

and strongly recommends checks for

other positions.

Commonly known as ‘CRB checks’, this can be

done through the Criminal Records Bureau

(CRB) Disclosure service in England and Wales

and Disclosure Scotland for Scottish employers.

The Protection of Children Northern Ireland

(POC (NI)) and the Protection of Vulnerable

Adults Northern Ireland (POVA (NI)) provide

checks for Northern Ireland employers.

These are agencies set up to help organisations

make safer recruitment decisions. They

provide a service for organisations, checking

police records and, in relevant cases,

additional information held by Health and

the Education Departments.

Two types of CRB checks are available in cases

where an employer is entitled to ask exemptedquestions under the Exceptions Order to the

Rehabilitation of Offenders Act (ROA) 1974(23).

This includes any organisation whose staff or

volunteers work with children or vulnerable

adults. An organisation may apply for a check

to be undertaken. They are issued free to

volunteers. The two levels of check currently

available are called Standard and Enhanced

Disclosures.

Standard Disclosure

This is primarily available to anyone involved

in working with children or vulnerable adults,

as well as certain other occupations. Standard

Disclosures show current and spent convictions,

cautions, reprimands and warnings held on the

Police National Computer. If the post involves

working with children or vulnerable adults, the

following may also be searched:

  Protection of Children Act (POCA) List

  Protection of Vulnerable Adults (POVA) List

 

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Enhanced Disclosure

This is the highest level of check available

to anyone involved in regularly caring for,

training, supervising or being in sole charge

of children or vulnerable adults. Enhanced

Disclosures contain the same information as

the Standard Disclosure but with the addition

of any relevant and proportionate information

held by the local police forces.

If requested on the disclosure application

form, the check will also show if someone

applying for a childcare position is on either

of the two government-held lists of people

considered unfit for such work. In this case,

where a person who appears on the list is

applying for a childcare position, it is the

responsibility of the manager to ensure the

police are informed.

This check can be made only for those who

do work that involves regularly caring for,

training, supervising or being in sole charge of

children (under-18s) or vulnerable adults.

 

The CRB recognises that the Standard andEnhanced Disclosure information can be

extremely sensitive and personal. Therefore

it has published a Code of Practice to ensure

responsible provision of information. An

employer cannot demand disclosure for

existing employees. Retrospective checks may

only be carried out on existing members of

staff if the employee’s contract or conditions

of employment state that a police check canor may be carried out, or the employee has

given written consent. An employer recruiting

staff to work with children must include a

statement to that effect within the application

form, which the prospective employee must

sign, indicating their willingness to provide

a Disclosure. If the prospective employee

then refuses to provide one, the employer

should be within their rights not to proceed

with an application. Furthermore, when the

law requires a Disclosure and a prospective

employee refuses to apply for one, then the

employer would be within their rights not to

take the job application any further.

An individual applying for a Standard or

Enhanced Disclosure has to go through a

Registered Body or Registered Umbrella Body.

A copy of the Standard or Enhanced Disclosure

is sent out to the applicant as well as the

Registered Body.

Criminal Records Bureau Information Line:

0870 9090811

A joint publication from government bodies

has been published to assist in safeguarding

children(24).

Factors influencing physiotherapy

practice

What are the factors that support

physiotherapy practice?

What does this mean for children andyoung people?

Physiotherapists have a duty to continuelearning throughout their professional lifeand demonstrate they are utilising the bestintervention for the child or young person.

Paediatric Competences and Standards

The use of Competences by healthcare workers

has been identified as being important to

the commissioners of health services. APCPis developing a professional competence

framework to ensure providers meet the

standards required, not only under the

statutory frameworks as described below, but

also the standards set by the CSP and APCP.

This supports the delivery of consistent high

quality standards of care for children and

their families.

Competence is not just about knowledge, skills

and abilities or just about being able to

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demonstrate technical skill. It is also about

thinking, critical analysis and learning, the

assimilation of new learning with previous

learning, integration of new knowledge, skills

and abilities with pervious knowledge and

application of new learning in practice.

Skills for Health (SfH) is the sector skills

council for the healthcare sector licensed

by the Department for Education and Skills

(DfES); (DfEs has now been superseded by The

Department for Children, Schools and Families)

to develop the health workforce across the UK

(NHS, independent and voluntary). It works

with employers to identify the skills needed to

deliver high quality competent healthcare. The

SfH competence framework, in turn, is linked

to the NHS Knowledge and Skills Framework(KSF). The SfH competences are already

mapped against this framework with each

competence being linked to a relevant KSF

dimension and level.

SfH has developed a suite of National

Occupational Standards (NOS) for Children’s

Services These aim to describe the competences

required by healthcare staff workingwith children. http://www.skillsforhealth.org.

uk/tools/view_framework.php?id=115. 

APCP, supported by the CSP, are producing

guidance on workforce competence linking

to HPC and CSP standards, the KSF and

the National Occupational Standards. This

guidance will be specifically linked to SfH

Competences.

The working party looking at this aspect

of paediatric physiotherapy practice will be

producing the guidance which will supplement

this Guide to Good Practice in 2008.

Workforce development – Continuing

Professional Development (CPD)CPD is a systematic, ongoing structured process

of maintaining, developing and enhancing

skills, knowledge and competence both

professionally and personally in order to

improve performance at work.

The CSP expects its qualified, associate and

student members to maintain and develop

their skills, knowledge and competence

through CPD in order to provide safe and

effective practice (25, 26).

There is a strong link between evaluation,

learning and the enhancement of patient care

and quality of service.

Assistants and graduates learn good practice

in a variety of settings; e.g. hospitals, schools,

child development centres through CPD e.g.

formal learning, reflective practice, in-servicetraining and shadowing with a senior member

of staff(27, 28). All assistants and new graduates

should have a senior member of staff who is

responsible for their appraisal and who will

help identify specific areas of learning

required by that individual. There are

courses run specifically for assistants, for new

graduates and advanced practitioners working

in paediatrics(29).

Supervision and appraisal should also be

available to more senior staff to develop their

clinical reasoning skills and broaden practice(30).

See also relevant CSP information papers (31-35).

Evidence-based practiceThe evidence base for paediatric physiotherapy

is growing and practitioners can draw on a

range of resources to support decision-making

about which interventions may be most

appropriate for children and young people.

The most well used definition of evidence-

based practice is that it is the ‘conscientious,

explicit and judicious use of current best

evidence in making decisions about the careof individual patients.’ (36)

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A more recent definition is:Evidence-Based Practice (EBP) requires that

decisions about health care are based on the

best available, current, valid and relevant

evidence. These decisions should be made by

those receiving care, informed by the tacit and

explicit knowledge of those providing care,

within the context of available resources(37).

Paediatric physiotherapists have a duty to

have an up to date knowledge of their specific

area of practice to ensure that interventions

are appropriate and effective. They also

need clinical reasoning skills to fit the best

intervention for the child, family and social

situation. At times compromises may need to

be made but this needs careful documentation.

Sources of evidence for interventions

 Research

 Clinical guidelines, effectiveness bulletins

and other summaries of evidence

of effectiveness

 Clinical interest and occupational groups

 National guidance e.g. National Service

Frameworks, National Institute of Health

and Clinical Excellence guidelines

 Local standards and protocols

  Information derived from the use

of outcome measures

 Audit

 Expert opinion.

The use of physiotherapy time, the nature of

intervention and the longer term effects of

practice have become increasingly important

in the cost-benefit analysis within the NHS.

These and other external pressures have added

impetus to the use of outcome measurement

within routine physiotherapy clinical practice

and in physiotherapy research. The value

placed upon accurate, appropriate and timely

outcome measurement is demonstrated in theprofessional body standards and is expected to

be a key attribute of professional practice.

The CSP’s Core Standards(3) statephysiotherapists should select and use quality

outcome measures appropriate to the child.

The physiotherapist is advised to ensure that

the measure used can evaluate change in the

child’s health status and that they should apply

them in a timely manner. Audit guidance and

tools are provided in the CSP Core Standards(3).

Finding and using an appropriate

measurement tool is often a challenge to

physiotherapists, particularly when ensuring

the process remains child and family centred.

The whole process of assessment, goal setting,

management and evaluation must be focused

on ongoing collaboration with children and

their families, other professional groups

and service providers. Therefore, decisionsregarding use of measurement tools cannot

be taken in isolation but must form part of

this continuous process toward meeting the

requirements of these key participants(39, 40).

Moving and handling

What does this section mean for childrenand young people?

Physiotherapists are obliged to undertakefull risk assessments and to ensurethat everyone is trained in moving andhandling techniques necessary in the

care of a child or young person.

Moving and handling is an integral part

of paediatric physiotherapy practice and

paediatric physiotherapists must operate

within the legal framework of health and

safety law. These laws apply to the therapy

carried out by those working with children as

equally as the therapy that is carried out by

those working with adults.

In paediatric practice it is often more aboutthe posture that the therapist or carer has to

assume, or the equipment they have to work

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with, when carrying out therapy than the‘load’ they are handling.

All proposed intervention should be assessed

for any potential risks to either the child or

therapist and if a risk is identified and cannot

be avoided during the therapy activity this

risk must be assessed – physiotherapists are 

legally bound to formally carry out this risk

assessment and document findings. However,

this is just the beginning – a risk assessment in

itself is not helpful unless action is taken and

control measures implemented to reduce the

identified risk.

The risk assessment is part of a process which

identifies potentially hazardous moving

and handling that may be involved in theproposed therapeutic intervention. There are

four areas to include in a risk assessment:

1. Task

2. Individual (the handler)

3. Load (the child)

4. Environment.

The identified risk is given a grading of high,medium or low dependent on the likelihood

of injury occurring and the consequences

or outcomes for both the therapist and the

child. The risk is managed by the introduction

of control measures and these may include

for example: training, use of equipment or

adaptation of the proposed invention. The

outcome of the risk assessment may mean

that the therapist has to adjust the goals of

treatment to minimise the risks involved in the

therapeutic action.

Risk assessment is an ongoing (iterative) process

and should be reviewed at regular intervals or

when there is any significant change in the child,

therapist, task or environment.

Caring for dependent children may involve

constant repetitive manual handling. The child as

a ‘load’ may be mobile, flexible, precious, possibly

unwell or in pain, sometimes resisting and alwaysunpredictable. Sensory deficit has an impact on

the child’s ability to function. Movement, sensory

processing, perception, communication and the

environment in which handling and therapeutic

activities are taking place are all affected by the

sensory deficit a child may have; and these should

be taken into consideration in the risk assessment

process. Challenging behaviour can also affect

the child’s ability or willingness to move and thus

increase the risks when handling.

Delegation is commonplace within paediatric

physiotherapy practice and paediatric

physiotherapists have a duty of care to

themselves and people they work with be they

colleagues, the child or the carer.

They must assess the risk of injury and cumulative

stress associated with the moving and handling

of the children they are working with and take

all possible steps to reduce the risk. The paediatric

physiotherapist has ultimate responsibility for any

therapeutic activity they delegate to carers.

Documentation is of the utmost importance as

this provides a critical link between assessment,

clinical reasoning and the child’s functional

outcomes or goals.

The fundamental aim must always be to reduce

the risk of injury occurring to the handler as far

as is practicable whilst at the same time ensuring

the best possible outcome for the child.

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Legislation

 Health and Safety at Work Act 1974 (41). This

act forms the basis of all health and safety

law. It sets out duties for employers and

employees and covers all aspects of health

and safety in the workplace.

 Control of Substances Hazardous to Health

1999 updated 2002(42, 43).  Employers must not expose employees to

substances hazardous to health and a

suitable and sufficient risk assessment must

be carried out.

 Reporting of Injuries, Diseases and

Dangerous Occurrences Regulations

1995(44)

. Employers must notify the Healthand Safety Executive about accidents which

happen at work resulting in death, personal

injury or sickness where an employee is off

work for more than three days

 Management of Health and Safety at Work

Regulations 1999(45). Where an employer

employs five or more employees the

regulations place an obligation on the

employer to actively carry out a risk

assessment of the work place and act

accordingly. The risk assessment is intended

to identify potential health and safety and

fire risks and provide the employees with

a ‘safe system of work’.

 

Manual Handling Operations Regulations1992 updated 2002(46, 47). The regulations

came into force in January 1993 and are

aimed at preventing injury from manual

handling activities in the workplace. It

sets out a hierarchy of measures to risk

assess potentially hazardous manual

handling procedures. The regulations

apply when loads are moved by hand

or bodily force.

 Lifting Operations and Lifting Equipment

Regulations 1998(48). All lifting equipment

must be sufficiently strong, stable and

suitable for the proposed use. Lifting

equipment must be visibly marked with

appropriate information (i.e. weight limits,

size etc) Lifting equipment for lifting

people must be checked at least once every

six months and all lifting operations must

be carried out by competent personnel.

Useful resources

 Association of Paediatric Chartered

Physiotherapists. Paediatric manual

handling – guidance for paediatric

physiotherapists. London: Association of

Paediatric Chartered Physiotherapists; 2001.

 The Chartered Society of Physiotherapy.

Guidance on manual handling for chartered

physiotherapists London: Chartered Society

of Physiotherapy; 2002.

 Dimond BC. Legal aspects of physiotherapy.

Oxford: Blackwell Scientific; 1999.

 Mandelstam M. Manual handling in health

and social care: an A-Z of law and practice.London: Jessica Kingsley; 2002.

 McAtamney L, Corlett N. Rapid upper limb

assessment (RULA). In: Stanton N, Hedge

A, Brookhuis K, Salas E, Hendrick HW,

editors. Handbook of human factors and

ergonomics methods London: Taylor and

Francis; 2004.

 http://ergo.human.cornell.edu/ahRULA.

html Rapid Upper Limb Assessment Guide

  http://ergo.human.cornell.edu/ahREBA.

html Rapid Entire body Assessment Guide

 www.hse.gov.uk Publications

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Transition issues from paediatric toadult services

‘Transition should never be considered a

 sprint, a baton pass or simply the event of

transfer between paediatrics and adult care.

Transition is in reality a marathon, starting

on the day of diagnosis. Transition is an age

and developmentally appropriate process,

addressing the psychosocial and educational/ vocational aspects of care in addition to the

traditional medical areas. Transition starts

within paediatrics but continues on into adult

 services and is therefore, by definition, a

 paediatric and adult concern.’ (49)

Any physiotherapist who encounters young

people in their working practice needs to

ensure they address the important issues raisedduring adolescence. One of the most important

issues raised during this stage of development

is that of transition. Transition can be defined

as ‘the purposeful, planned movement of

adolescents and young adults with chronic

 physical and medical conditions from child-

centered to adult oriented health care

 systems.’ (50). Transition has been recognised as

an important standard of care in several major

policy documents(51-53). Careful planning and

delivery of treatment is essential to facilitate

a young person’s independence and successful

transition to the adult world. This is best

addressed as part of a multi-disciplinary team,

where the physical, physiological, psychological,

social, educational and vocational needs of a

young person can be met(54). Careful planningand delivery of treatment is essential to

facilitate independence and transition to the

adult world. The key to successful treatment

is empowerment of the young person

thus instilling a sense of responsibility and

ownership of their illness, as well as providing

opportunities for the development of a young

person’s confidence and capacity in dealingwith everyday life. One way this can be

achieved is through co-ordinated transitional

care planning.

Physiotherapists need to recognise therole they can play in assisting with the

development of age and developmentally

appropriate transitional care plans for young

people. The patient/ therapist relationship

allows for ongoing continuity and support

which young people identify as an important

aspect of care(54). Physiotherapists can facilitate

a young person in identifying needs and

potential barriers to ‘growing up and moving

on’ (51) and assist with the development ,

planning and co-ordination of transitional care

packages.

A qualitative study identified transitional care

packages as needing to be:

1) Multidimensional – addressing all

areas of a young person’s life2) Coordinated (multi-disciplinary)

and individualised

3) Supportive – seeing the samehealthcare professional ateach appointment

4) Developmentally appropriate

5) Age appropriate – facilities/information.

 Early preparation of young people (especially

those young people with disability and/or

complex or long term conditions) and their

families for transition to adult services is

advantageous, ideally in early adolescence (54,

55). A coordinated, planned and individualised

approach to transition will assist with

identifying those skills that are needed for

independent adult living, as well as aiming to

assist with maximising health outcomes (51, 54).

A key area of transition for physiotherapists

to take a lead in is addressing the exercise

related risk factors of common morbidities

of childhood onset disease; e.g. osteoporosis,

cardiovascular disease and obesity. The latter

are important since adolescence is the time

when adult health promoting andself-management behaviours become

established. Transition planning should also

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provide support for parents/carers throughthe process.

In a Delphi study of transition involving young

people, their parents and rheumatology

professionals, staff knowledgeable in

transitional care were considered best

practice but only currently feasible in a few

UK hospitals(56), and there is a current lack of

formal training opportunities in adolescent

health in the UK(57). This deficit is currently

being addressed by a Department Health

funded intercollegiate e-learning project

in conjunction with the Royal College of

Paediatrics and Child Health(58). Furthermore

a new national multidisciplinary Association

for Young People’s Health is to be launched in

early 2008 which also aims to promote multi-disciplinary training and education in young

people’s health including transition.

Useful webites:

UK

Transition Information Network.

Website: http://www.transitioninfonetwork.

org.uk

DreamTeam website of the Adolescent

Rheumatology Team at Birmingham

Children’s Hospital.

Website: http://www.dreamteam-uk.org

Transition Pathway

Website: http://www.transitionpathway.co.uk/ 

No Limits.Website: http://www.nolimits.org.uk

Moving on up.

Website: http://www.movingonup.info/ 

ACT – the Association for Children’s Palliative

Care. (Publishes ‘Transition Care Pathway: A

Framework for the Development of Integrated

Multi-Agency Care Pathways for YoungPeople with Life-threatening and Life-limiting

Conditions’ (2007). Available from ACT online

shop). Website: http://www.act.org.uk/ 

Youth Health TalkWebsite: http://www.youthhealthtalk.org/ 

Australia

Royal Children’s Hospital, Melbourne –

Transition to adult services.

Website: http://www.rch.org.au/transition

Canada

Disability Ontario Online Resource for

Transition to Adulthood – D.O.O.R. 2

Adulthood

Website: http://www.door2adulthood.com

SickKids – Good 2 Go Transition Program.

Website: http://www.sickkids.ca/good2go

USA

Health Care Transitions.

Website: http://hctransitions.ichp.edu/ 

Adolescent Health Transition Project.

Website: http://depts.washington.edu/healthtr/ 

index.html

Kentucky Cabinet for Health and Family

Services – Transition Resources.Website: http://chfs.ky.gov/ccshcn/ 

ccshcntransition.htm

Health and wellbeing

Public Health

The health and wellbeing of the people living

in the UK is becoming increasing high in the

profiles for governments. Public Health addresses

the health needs of the population from the

cradle to grave and encompasses education,

prevention of illness, empowering the individual

to make healthy choices and redesigning services

to support this philospohy. The CSP documents

provide the policy background and advice to

support physiotherapists in promoting health

and wellbeing(59-62)

.

For children there is a huge opportunity

for physiotherapists to undertake work to

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invest in the ongoing health and wellbeingof the younger population. Major areas

where physiotherapy can become engaged

is in a proactive approach in preventative

and self management of health conditions

and encouraging the family focus to take

full responsibility for the health of all

members of their family. Forecasts of the

health of our future generations is grim.

Strategies are needed to develop and to

address obesity, mental health problems,

smoking and substance misuse in children and

younger people, to address relationships and

prevention of teenage pregnancies and to

promote active life styles amongst the youth.

The CSP has provided information papers on

public health relating to each of the four UKcountries(59-62). This document also references

the policy documents and guidance produced

by the individual countries in relation to public

health. Individual physiotherapists need to

identify local population needs and look at

how to address them, how to link activity

with local government targets, and how to

influence commissioners in demonstrating that

physiotherapy has a prime role to play in thepublic health of the local community.

When addressing public health issues it is

essential to consider not only health but

also social care in the community including

public transport, access to leisure facilities and

schools in assessing how best to input and

influence the wellbeing and the health of

the population.

Locations and settings

Children and their families accessing

paediatric physiotherapy

What does this section mean for childrenand young people?

Paediatric physiotherapists work in a

variety of locations and settings. Theseinclude hospitals, clinics, child developmentcentres, Children Centres, Extended Schoolprovision, Childcare provision and EarlyYears settings, children’s own homes,hospices, social care respite provision,mainstream schools and special schools

Where possible, children should have access

to their physiotherapy in the setting mostappropriate for their assessment, treatment

and on going support and enables them to

achieve their outcomes. Working in a variety of

settings should help improve communication

and collaborative working with others who

are supporting the child. Children may also

respond in different ways in different places and

paediatric physiotherapists should be mindful of

this when they are discussing and deciding on thebest location with the child and family.

The paediatric physiotherapist should ensure

that the locations they work in or the settings

they visit are fit for purpose, providing a

safe environment for children to have their

assessments, interventions and on going support,

and meet the child’s needs and developmental

potential.

In order to support children in various settings,

the paediatric physiotherapist should have the

skills to tailor their intervention, communicate

well with staff and family and share skills and

knowledge so that all involved are holistically and

collaboratively working with each other to help

meet the child’s needs.

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The paediatric physiotherapist should also takeaccount of their personal safety and adhere to

their local lone working policies when planning

assessments or treatment sessions.

Early Years settings, schools and colleges

Physiotherapists working in Early Years settings,

schools and other educational establishments

should work in partnership with the other early

years practitioners, school and college staff so

that the children and young people benefit from

co-ordinated, integrated support to facilitate

them achieving the best possible outcomes (63).

Paediatric Physiotherapists should adhere to the

SEN Code of Practice and demonstrate good

practice in treatment of children(64, 65).

It may benefit children to have the

involvement of paediatric physiotherapy

to support them achieve their outcomes

within their educational settings. Paediatric

physiotherapy services may tailor the way

they deliver to meet children’s needs.

Children in hospital

Work was undertaken ahead of the fullChildren’s NSF in response to the Kennedy

Report. It addressed the environment of

the child in hospital and the fact that

child-friendly, safe and effective treatment

helps reduce the time spent in hospital and

disruption to the family’s life.

The NSF (52) is divided into three parts and

considers children’s rights and vulnerabilities

in addition to care provision for children and

involvement of parents.

Part one: Child-centred Hospital Services

Secondary care teams should work closely

with community based services for prevention

and treatment, integrating care around

each child’s specific needs and delivering aplanned and co-ordinated care pathway. This

section also encourages asking about a child’s

safety, looking for signs of neglect or abuse,

and taking a multi-agency approach to childprotection if necessary.

Staff should treat children as children and

not mini-adults, pitching services for children

and young people at an appropriate level and

ensuring that play, recreation and education

are built into service provision.

Sharing information with parents, children

and young people in an appropriate manner

is essential, including outcomes and bad news,

and addressing and obtaining consent.

Health care workers should work in

partnership with children, young people and

their parents in both the treatments and

in shaping services, taking into account the

wider lifestyle of each child in treatment,convalescence and prevention of future

deterioration. This encompasses ethnicity,

education and development of the child

towards adulthood and the provision of

transition between services.

Part two: Quality and safety of care provided

Clinical governance provides annual evidence

of child-focused multi-agency service planningand delivery and ensures safe, evidence-based

and audited services by trained workforce for

all children within hospital settings.

Part three: Quality of setting and environment

The treatment of babies, children and young

people should be child-friendly in healthy and

safe settings.

Health promotion should be highlighted in

addition to care provision.

Tertiary Care

Tertiary hospitals predominantly deal with

children with conditions that are rare,

intractable, complex, unusually severe, or

complicated by other disorders, who aretherefore thought to do better if they are

referred to tertiary services for diagnosis

or treatment.

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National Institute for Health and ClinicalEffectiveness (NICE) guidelines set the age

limit for access to tertiary paediatric services at

nearer 21/22 years.

Hospices for children

There are over 20,000 children living with life

limiting diseases. Association of Children’s

Hospices (ACH): ‘works together with other

organisations to support the development

of best practice and provision of children’s

hospice services across the UK’. The hospices

provide physical and emotional support in a

home from home atmosphere. The hospices

provide specialist staff and equipment to

support specialised play and laughter as well

as medical care. The role of the hospice

includes care for the child and for the family,including bereavement counselling.

Information on UK based children’s

hospices can be obtained from:

www.childhospice.org.uk

Supporting practice

Interactive CSP – iCSP

The interactiveCSP (iCSP) networks provide

opportunities for physiotherapists to

communicate and share knowledge with

one another. There is a paediatrics network

which covers all aspects of practice and service

delivery and a network dedicated to healthcare

policy on which many of the policies andActs are featured to assist physiotherapists to

understand their impact on practice.

 

iCSP – is a free, easy-to-use website accessed

via www.interactivecsp.org.uk, enabling

CSP members and APCP members to share

knowledge based on each user’s specific

clinical, professional and workplace interests.

It provides quick access to resources, includingdocuments, news, events and useful websites,

and also to peers through email

and online discussions.

APCP moderates the paediatric network onthis website and manages the content of the

network, under the leadership of APCP public

relations officer.

Physiotherapy practice2.

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What are the key factors that supportthe delivery of paediatric physiotherapy

services?

Delivery of high quality services is high on

the government agendas and much of the

policy work focuses on how to improve

and maintain services designed around the

needs of the users. Many of the key factors

that influence the delivery of high qualityservices for children and their families can be

divided into four categories; Clinical Services,

Governance, Quality, including appropriate

use of workforce skills, and the Knowledge

and Skills required to deliver the services. The

four sections have been divided into core,

desirable and extended factors and linked to

the relevant drivers.

Clinical Services:

  Core

 Skilled assessment by appropriately trained

staff in a location suitable for individual

children’s and family’s needs. This would be

available for children, having a wide variety

of diagnoses(66)

 Mutually agreed goals that are reflectiveof the child’s needs (National Workforce

Competency Framework Section 2

(Assessment of Health and Wellbeing)(67)

 Formation of a package of care/care

pathway that meets the child’s assessed

clinical need. This will include a 24 hr

postural management programme

when appropriate

 Regular communication between therapists

and families, including the copying

to parents of all letters to other

professionals(68, 69) 

 Liaison with the training of other agencies

involved with the child and their family,

e.g. MDT(70)

 Regular use of outcome measures to assess

the effectiveness and cost efficiency ofservice delivery(71)

 Clear and transparent discharge from

services at the appropriate time(72).

  Desirable

 Hydrotherapy availability, ideally in a child

friendly environment

 Provision of an orthotics service

 Access to rebound therapy

 Gait analysis by a trained practitioner

 24/7 services delivery (in hospital settings)  Involvement in the development of care

pathways for a variety of conditions

 Prescribing, including the use of

Botulinum Toxin

 Direct access to assistive technology

 Access to therapeutic horse riding.

  Extended Health promotion activities

 Developmental massage

 Complementary therapies

 Palliative care.

Governance:

In this section all entries are considered core,

as issues of clinical governance arenot optional.

 All staff are professionally registered,

where appropriate, and will work to the

standards of their professional body(3)

 All staff make user involvement

central to service delivery(73)

 All staff are part of an ongoing process

of Professional Review and Development

(PRD) involving the production of

professional portfolios and participation

in ongoing training, both internal and

external

 All NHS staff are subject to a KSF,

which will support their professional

development (74)

 All staff are CRB checked to an

enhanced level(22)

 All staff are expected to use measurable

outcome tools to assess the effectiveness

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  effectiveness of their practice. These willinclude those recommended by APCP(71)

 All staff participate in the appropriate

mandatory training, e.g. Safeguarding

children

 All staff partake in some form of supervision,

either formal clinical supervision or some

form of mentorship or peer review.

A regular log of attendance will be keptaccording to local trust policy

 All staff are involved in audit of

their practice

 All staff are aware of and take part in

risk assessment, in moving and handling

and in other areas of their practice,

according to local trust policy(75)

 All staff are aware that it is their

responsibility to deliver services in a costeffective way, which falls within budget.

Quality:

  Core

 All services are delivered in a timely

fashion. Waiting times will be regularly

audited(76)

 All interventions are delivered in a childcentred way at a location appropriate to

that child’s needs(73)

 All interventions are based on the best

available evidence(53)

 All staff work to APCP, CSP and HPC

standards as well as to local service

standards

 

The service is constantly reviewedto ensure it continues to utilise the most

appropriate workforce, both in terms of

grade and skill required, in order to deliver

a cost-effective, sustainable service(67) 

 The service provides regular training to

both families and other agencies to ensure

the delivery of best practice(68)

  The service contributes to the

production of educational statements andother statutory documentation(64, 77) 

  Individual members of the service are

responsible, as autonomous practitioners,in ensuring the quality of the service

they deliver

 The service is proactively risk managed

to ensure that it is always fit for purpose

 The service liaises with other providers,

both other agencies and the voluntary

sector, to ensure that the needs of the child

remain central to all The service uses the facilities available

to it e.g. IT, accommodation, in the most

cost effective and efficient way, to ensure

the sustainability of service delivery.

Desirable:

 Members of staff support the team around

the child approach (TAC) by acting as

Key workers.

 The service supports the co-location

of appropriate staff (68)

 There is a specialist post, with

research and development at the core

of its purpose

 A specialist transition service is in place

 The development of income generating

activities is considered, in order tofurther boost activity

 The development of a Patient and Public

Involvement Forum (PPI) within the service

supports user involvement(72).

  Extended

 A consultant physiotherapist post which

spans trusts, promotes and supports

research and development within

the specialty.

Knowledge and Skills:

  Core

 All paediatric physiotherapists are

registered with the HPC (basic legal

requirement)

 All staff participate in an induction processappropriate to their workplace(78)

 All staff are experienced in working with

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  children and have achieved the commoncore of children’s competencies

 All staff have achieved the competencies

necessary for their professional body

  Individual staff members’ KSF outlines in

the NHS reflects those knowledge and skills

that they need to be part of the children’s

workforce(38)

 

All staff members participate inpostgraduate training appropriate to

the demands of their job.

Desirable

 Further specialisation within the service

to meet specific need, supported by

postgraduate training

 Links to academic institutions, particularly

those involved in paediatric physiotherapy

research.

  Extended

 Specialists in the following areas:

Gait analysis; diagnostics; injection therapy;

neonatology; mental health.

Working in partnership with children,families and other service providers

Working in partnership is one of

the fundamental skills of paediatric

physiotherapists and is a crucial element

of their involvement with children and

their families. For some children and young

people there is an even greater need to work

in partnership with children, young people andtheir families and other service providers.

‘Children and young people who are disabled

or have complex health needs receive co-

ordinated, high quality child and family-

centred services which are based on assessed

needs, which promote social inclusion and,

where possible, enable them and their families

to live ordinary lives.’ (79) 

Another example: states:‘Delivering services to disabled children is a

corporate responsibility and improvements

in outcomes for children and their families

can only be achieved by close collaboration

between parents, professionals and agencies

working with children and their families’ .(68)

To support the delivery of these standards,

paediatric physiotherapists should have the

skills and qualities to work in partnership with

children, young people parents and carers,

other professionals and service providers.

The concepts and ethos of multi-disciplinary

working has expanded over the last few years

and working in partnership with children,

families and other service providers is one ofthe key features for the children’s agenda

across the whole of the UK.

Effective inter-agency working is underpinned

by two aspects of the Every Child Matters

integrated working focus and includes

the workforce reform and multi agency

working. The workforce reform includes the

introduction of the Common Core Skills and

Knowledge for the Children’s workforce to

ensure all professionals have the knowledge

and skills to work effectively with children and

families and access to training when relevant.

Multi agency working brings professionals

from different agencies together to meet

the needs of children and families and jointly

agree the delivery of the actions arising from acommon or specialist assessment.

In England, the Common Assessment

Framework and the role of the Lead

Professional are mechanisms to support the

process of multi agency working(80, 81).

‘The Common Assessment Framework for

the children and young people (CAF) is a shared assessment tool used across agencies

in England. It can help practitioners develop

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a shared understanding of a child’s needs, sothey can be met more effectively. It will avoid

children and families having to tell and re-

tell their story. The CAF is an important tool

for early intervention. It has been designed

 specifically to help practitioners assess needs at

an earlier stage and then work with families,

alongside other practitioners, to meet them’ .(80, 82) 

Paediatric physiotherapists in England will

need to have a working knowledge of the

Common Assessment Framework and its

purpose and function. They will need to

know how to complete a CAF pre-assessment

checklist(83) and a CAF and the arrangements

and practice for processing CAF within their

local areas. They will also need to have

an understanding of how their specialistassessments can be supported by the CAF.

Sharing information is an integral part of

agencies working together to support children

and their families. With children, adherence

to the CSP’s Rule 3(84) is essential and the DH

has published guidance to support workers in

understanding their responsibilities(82).

For some children and especially those who

may require long term intervention, a

coordinated approach through interagency

working may be established practice. The team

around the child concept, key worker or lead

professional involvement and child focused,

family centred planning facilitate integrated

working practice as well as enabling children

and young people and their parents to bekey decision makers and central to all

planning (85-88).

Report writing to support assessment

and planning based around the needs

of children and their families

Paediatric physiotherapists are required to

prepare reports for children for a number ofreasons. These include:

 Following initial assessment of a child

to inform the referrer Following re-assessment at regular

intervals during the child’s involvement

with physiotherapy

 To refer to another professional or service

 To support a referral to a tertiary centre

 To support a child into an educational

setting

 Following a request for an assessmentfor Statement of Special Educational

Need (SEN)

 To support an SEN Tribunal dispute

 To support a legal case.

All physiotherapy reports should comply with

the CSP Core Standards, the APCP Guide to

Good Practice and the APCP Guidance onSEN (3, 4, 65).

It may be necessary for some reports to be

accompanied by additional information as

listed below. This is especially the situation

if the report has been requested as part of

a legal case or if the child and family are

involved in an SEN Tribunal case.

The following gives some advice as to what

is recommended to be included both in the

report and with the report.

 The reason why the physiotherapist is

writing the report including who made

the request

 How long the physiotherapist has known

the child and family

 Whether the report has been undertaken

in collaboration with the child and family

 The liaison and communication between

different physiotherapists and reasons for

not communicating if this is the situation

 The physiotherapist’s involvement with the

child and family, including interventions

and within different settings

 How much they know about the otherservices involved with the child and family

 A developmental history of the child (from

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  their own observations if known previouslyor from the parents)

 The concerns of the child and family

 What is reported by families and what

is actually observed or demonstrated

during assessment

 Detailed clinical observations

 Results from standardised validated

paediatric assessment tools where thisis clinically appropriate

 Summary of child’s strengths and difficulties

 Physiotherapy intervention necessary

 Consideration should be taken when

writing reports to ensure the language is

understandable and accessible to all those

who may wish to read it

 All reports prepared for education purposes

should be written with the aim of providing

information to staff in order to support the

child’s inclusion and promote their physical

wellbeing and function within the

educational setting(65) 

 Consent

 Parental copies.

Legal and tribunal report writing

All reports written for solicitors and SEN

tribunals should be accompanied by a

curriculum vitae. The CV should include:

 Why the physiotherapist feels they are

competent to write the report, to include

their HPC registration, CSP membership and

specialist group membership

 The physiotherapist’s paediatric experienceand whether this has been within acute,

specialist, tertiary or community settings

 Their communication with other

professionals involved

  If for a tribunal, whether they have worked

with children in mainstream and special

schools settings

 

Confirmation of whether they haveattended the CSP Expert Witness course

 A summary of their CPD Portfolio

 A summary of their portfolio ofinvolvement with legal cases or

SEN Tribunals.

Assistive Technology

Assistive technology (AT) is an umbrella

term for a wide range of products. A

commonly accepted definition is “..any

item, piece of equipment or product systemwhether acquired commercially off the

 shelf, modified or customized that is used

to increase, maintain or improve functional

capabilities of individuals with disabilities.”  (89).

Therefore in terms of devices or equipment

it includes walking sticks to environmental

control systems, or simple dressing aids to

communication aids.

The benefits and purpose of AT are in many

respects self evident(90). When appropriate

equipment is provided in a timely manner

it allows children to move around their

environment, communicate with others and

take part in developmentally appropriate

activities that they would be unable to do

without this technology. It also enables the

family and carers to look after a child in

activities which the child cannot undertake

independently such as personal care, e.g.

hoisting, bathing and toileting.

Physiotherapists are routinely involved in the

assessment and prescription of some AT devices

such as standing supports or orthoses. However

it is important to have an understanding of awider range of AT so that one can understand

the role that AT plays in family life and when it

might be a solution to a problem.

Community equipment services play an

important part in helping people to develop

their full potential and to maintain their

health and independence. A wide range

of equipment and adaptations can now beprovided from 138 services in England with the

majority of items being provided within seven

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days of a professional decision being made.Additional resources may be found through

the Foundation for assistive technology

– www.fastuk.org

ICES (Integrating Community Equipment

Services) is a Department of Health funded

initiative across health and social care to

develop community equipment services in

England, remove unnecessary barriers for users

and modernise services(91).

The mission of the ICES Team is ‘To support and

encourage the development and integration

of people centred equipment services for

the enhancement of health, wellbeing and

independence’ . Further information can be

accessed via http://www.icesdoh.org/

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All member countries of the UK have beendeveloping frameworks of care for children

to ensure that they have good quality services

available to them. The section on England

addresses many of the common issues across

the UK. The following sections relate country-

specific work to local policy drivers.

Each country’s framework is summarised in

this section and link to the standards set by

the United Nations Convention on the Rightsof the Child 1989(9). Each country’s section

outlines their Children’s strategy, the national

Child legislation, key policy papers, and

implementation tools. The sections also refer

to relevant CSP information papers.

What does this mean for children andyoung people?

Physiotherapists must be aware of thepolicy drivers and guidance in orderto deliver the high quality servicesfor children and young people set bythe Government.

England

Change for Children is the programme oflocal and national action through which the

whole system of children’s services is being

implemented(92). The changes are described

in Every Child Matters and include revision

of The Children Act, the standards of service

design and the way that services are delivered.

Considerable emphasis is placed on cross-

professional working, involving and centring

services on the child and their family and

raising the quality of services for all children

and young people from birth to age 19(53, 92).

A range of guidance documents has been

produced, including statutory guidance under

the Children Act 2004(15).

The children’s strategy in England is called

Every Child Matters and sits under theDepartment for Children, Schools and Families,

where the most recent developments are sited

and should be viewed in addition tothe Department for Health’s website.

Every Child Matters (September 2003)(53)

Every Child Matters sets out theGovernment’s aim to ensure that everychild has the chance to fulfil their potentialby reducing levels of educational failure,

ill health, substance misuse, teenagepregnancy, abuse and neglect, crime andanti social behavior among children andyoung adults.

Every Child Matters focuses action on four

main areas:

 Supporting parents and carers

 

Early Intervention and effective protection Accountability and integration, locally,

regionally and nationally

 Workforce reform.

The key messages from Every Child Matters are

the cornerstone of the Government strategy

and the NSF supports that vision; that every

child should be supported to:

 Be healthy

 Stay safe

 Enjoy and achieve

 Make a positive contribution

 Achieve economic wellbeing.

The Common Assessment Framework  (CAF)

looks at the best way of sharing an initial

assessment amongst professionals that

may be requested by anyone identifying a

child with unmet needs. The common front

sheet of the assessment will be held by a

named service, for access as needed and

updated appropriately by other professionals

engaged in the welfare of that child. Sharing

information and the development of trust

between organisations is crucial in providingquality and seamless services and to prevent

duplication(80, 93).

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The Framework for the Assessment of Childrenin Need and Their Families addresses the wider

needs of the child and their family(94).

Choosing Health focuses on nine key areas

where people can make healthier life choices.

The policy targets children, especially where

they are unable to make a choice (too young

or passive e.g. passive smoking)(95).

Public Health in England  supports

physiotherapy involvement with children in

addressing the issues laid out in the policy(59).

Children’s Trusts – set up in response to Lord

Laming’s report, the government expects

children’s trusts to be introduced to all

areas by 2008 and led by local authorities

and supported by health and voluntary and

community sectors(6).

The trusts work on pooled budgets, joint needs

assessments and use of the CAF, joint training

in common issues and working in teams to

one manager. 35 pathfinder Children’s Trusts

were announced in 2003 to test out the

theory of the Trusts and to help design policy.The Trusts all set up independently of one

another in response to local circumstances

and are therefore running in widely different

manners, but all to the Every Child Matters’

key outcomes.

National Service Framework for

children, young people and maternity

services (2004)(52)

 The National Service Framework for Children,

Young People and Maternity Services (NSF

Children) was published in England in October

2004 as part of The Change for Children

programme. It covers health service provision

for children from gestation to adulthood,

extending to 25 years for those living with a

Learning Disability. The CSP has published an

information paper to support implementation

by physiotherapists(96).

The Framework puts into the contextof children the commitments of the

Government reflected in the NHS Plan and

the NHS Improvement Plan, to put the

patient at the centre of service provision, to

encourage partnership working and improve

communication in order to focus the services

around the child and its family. It also

emphasises the driving force behind

the NSFs; to raise standards of care andreduce inequalities of provision across the

country(97, 98).

Implementation of this NSF will challenge

the profession but offers a wide platform of

opportunity to place physiotherapists as key

players in the development and provision of

children’s services.

The Children’s NSF is aimed at everyone who

comes into contact with, or delivers services to

children, young people or pregnant women.

The NSF is divided into three parts:

Standards 1 – 5, described as the Core

Standards, the first five standards address

service provision for all children, young peopleand their families and carers to achieve high

quality service provision for all children and

young people;

Standards 6 – 10, for children covered by the

first five standards, but who have particular

needs; Children and young people who are

ill; Children in hospital; Disabled Children and

Young People and those with Complex Health

Needs; Medicines for Children and YoungPeople;

Standard 11, for mothers and babies, from

pre-pregnancy to three months post-birth,

again in conjunction with the previous

standards as applicable.

There are also seven exemplars, demonstrating

practice using the NSF:

 Complex disability

 Maternity services

UK country-specific child-related policy4.

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 Asthma

 Autistic spectrum disorders

 Chronic Fatigue Syndrome / Myalgic

Encephalopathy (CFS / ME)

 Acquired brain injury

 Discharge and support of children requiring

long term ventilation in the community.

Supporting documents include:The Information Strategy: which addresses

the key information technology challenges

that need to be met in providing services for

children and their families; challenges that

face national agencies and local organizations

across all care settings(99).

Supporting Local Delivery: produced jointly

(DH & DfES): sets out the national support thatwill be provided to local agencies to support

them in implementing the National Service

Framework for children, young people and

maternity services. It also identifies how the

NSF, and the wider health agenda, fits into

the Every Child Matters - Change for Children

programme, and what this means for health

organisations(100).

The website is regularly updated and the

source of current information: www.dh.gov.uk/ 

PolicyAndGuidance/HealthAndSocialCareTopics/ 

ChildrenServices/ChildrenServicesInformation/ 

fs/en

Removing Barriers to Achievement sets out

the government’s vision for giving childrenwith special educational needs (SEN) and

disabilities the opportunity to succeed; it also

sets out a programme of sustained action and

review over a number of years to support early

years settings, schools and local authorities in

improving provision for children with SEN(63).

It gives government commitment to

partnership working between local authorities,

early years settings, schools, the health service

and the voluntary sector.

It incorporates government strategy forimproving childcare for children with SEN and

disabilities.

Its main focus is on working together to unlock

the potential of the many children who may

have difficulty learning, but for whose life

chances depend on a good education.

There are four key areas:

1. Early Intervention

2. Removing barriers to learning

3. Raising expectations and achievement

4. Delivering improvements in partnership.

Early Support: Helping every child succeed

Early Support, accessed via: www.

earlysupport.org.uk is the central government

recommended mechanism for achieving

better co-ordinated, family-focused services

for young disabled children and their families

across England(101). It stems from government

priorities for restructuring children’s service

in response to Every Child Matters and the

National Service Framework for children. It

builds on existing good practice to integrateservices in partnership with families who use

services and is designed to ensure that the

services provided are well co-ordinated and

responsive.

Early Support puts the needs of families with

young disabled children first. It is designed to

ensure that professionals deliver services which

are well co-ordinated, family centred, timelyand responsive.

The principles and approach of Early Support

are reflected in a set of materials and resources

including:

  information booklets for families on

conditions or disabilities

 a family pack containing a family held

file, the family service plan and

standardised information about services

which may help the family

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 a monitoring protocol for deaf babiesand children

 developmental journals for babies and

children with visual impairment and for

babies and children with Down Syndrome

 a service audit tool to help both

practitioners and strategic planners

 a professional guidance for those working

with families using the Early Support

approach.

 Aiming high for disabled children: supporting

families HM Treasury and Department for

Education and Skills 2007 is a report on the

Government’s Disabled Children Review and

highlights the need to ensure that every

disabled child can have the best possible start

in life, and the support they and their familiesneed to make equality of opportunity a reality,

allowing each and every child to fulfil their

potential(102). It addresses:

 Access and empowerment

 Responsive services and timely support

  Improving service quality and capacity

 Next steps.

Sure Start Children Centres

The Sure Start Children’s Centre programme

builds on existing good practice and is based

on the concept that providing integrated

education, care, family support, health services

and support with employment are key factors

in determining good outcomes for children

and their parents.

The Centres are places where children under

five years old and their families can receive

seamless holistic integrated services and

information, and help from multi-disciplinary

teams of professionals. All Sure Start Children’s

Centres will have to provide a minimum range

of services including:

 appropriate support and outreach services

to parents/carers and children who havebeen identified as in need of them

  information and advice to parents/carers on

a range of subjects, including: localchildcare, looking after babies and young

children, local early years provision

(childcare and early learning) education

services for three and four year olds

 support to childminders

 drop-in sessions and other activities for

children and carers at the centre

 

links to Jobcentre Plus services.

Sure Start Children’s Centres in the

most disadvantaged areas will offer the

following services:

 good quality early learning combined with

full day care provision for children

(minimum ten hours a day, five days a

week, 48 weeks a year)

 good quality teacher input to lead the

development of learning within the centre

 child and family health services, including

ante-natal services

 parental outreach

 family support services

 a base for a childminder network

 support for children and parents with

special needs, and

 effective links with Jobcentre Plus to

support parents/carers who wish to consider

training or employment.

The Government is committed to delivering

a Sure Start Children’s Centre for every

community by 2010 and are expected to use

the Early Support approach and materials todeliver high quality services for families of

young disabled children. The Children’s Centre

Practice Guidance provides support in the

development of Children Centres and Section

17 is dedicated to ‘Working with disabled

children’(103)

Website: http://www.surestart.gov.uk/

Extended Schools

Children succeed best when they are healthy,

self confident and well motivated. Extending

UK country-specific child-related policy4.

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the range of services that schools can offer iscrucial to making sure children and families are

given support they need to thrive.

Extended Schools core offer of services

includes:

 A varied menu of study support activities

such as homework, sports and music clubs

 High quality childcare provided on primary

school sites or through local providers

 Parenting support

  Identifying children and young people

with particular needs to ensure swift and

easy referral to a wide range of specialist

support services such as speech and

language therapy, child and adolescent

mental health services, family support

services, intensive behaviour support andsexual health services

  ICT, sports and arts facilities, and adult

learning for the wider community.

Additional support information may be

obtained from: www.everychildmatters.gov./ 

uk/ete/extendedschools

Additional useful websites to support childwellbeing:

Choice for Parents, the best start for children:

Ten year strategy for childcare 2004 DfES www.

everychildmatters.gov.uk

Improving the Life Chances of Disabled

People: 2005 PM’s Strategy Unit www.

everychildmatters.gov.uk

Right from the Start 1994 SCOPE: www.rightfromthestart.org.uk

The Lead Professional: Practitioners’

and Managers’ Guides 2006 DfES www.

everychildmatters.gov.uk

Implementation of the Lead Professional Role

2006 DfES www.everychildmatters.gov.uk

Toolkit for Managers of Multi-agency Teams2006 DfES www.everychildmatters.gov.uk

Making It Happen: Working together for

children, young people and families: wwwecm.gov.uk

Services for Disabled Children- a review

of services for disabled children and their

families: 2003 Audit Commission www.audit-

commission.gov.uk

Integrated Approach: Best Practice in Multi

Agency Working: Find out more aboutinformation on structuring teams; advice on

common problems; checklists and toolkits;

glossary; success factors – the strategy and

practices that have worked for other teams;

fact sheet. Available online www.ecm.gov.uk/ 

multigencyworking

Care Co-ordination Network UK 2004 New

Standards for Key Working: Available www.york.ac.uk/inst/spm/ccnukstandards.htm

Audit Commission 1993: Children First: A

Study of Hospital Services. HMSO, London

Audit Commission 2002: Special Educational

Needs: A Mainstream Issue. Available online

www.audit-commission.gov.uk

Department of Health 1997: The CaldicottCommittee: Report on the review of patient-

identifiable information. HMSO, London

Department of Health 2003: Specialised

Services National Definition Set: 23 Specialised

Services for Children, HMSO, London.

Education Act 1981: HMSO London.

Northern IrelandOur Children and Young People – Our

Pledge is a ten year strategy (2006 – 2016) to

produce improved outcomes for all children

and target services towards those who

need help, to narrow the gap in outcomes

between those who do best and those who

do worst(104). The Government’s vision is

for all children and young people living inNorthern Ireland to thrive and look forward

with confidence to the future.

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By 2016, the strategy’s target is for all childrenand young people to be:

 Healthy

 Enjoying, learning and achieving

 Living in safety.

The main emphasis within Northern Ireland

(NI) at present is to develop working together

in multi agency teams, inclusion and improved

collaborative working with Education.

The “Standards and Guidance for Promoting

Collaborative Working to Support Children

with Special Needs” , is a pilot project currently

running in special schools within NI. It gives

guidance on the promotion of collaborative

working between Health and Education

Professions supporting children with specialneeds in special schools, working together

to best meet the needs of children(105). It

endorses joint responsibilities for policy

development, implementation, service delivery,

commissioning and accounting. It outlines

standards to promote collaborative working

at all levels and identifies needs for

partnership agreements.

The Children’s and Young Peoples funding

package (Peter Hain MP) was the allocation of

funding to directly address the most pressing

needs of children and young people. There has

been funding for extended schools, additional

early years provision, more counselling and

therapy support, increased youth provision,

better provision for looked after children and

improving child protection arrangements.

The aim is to reduce under achievementand improve the life chances of childrenand young people.

‘Fit Futures’ is looking at joining health,education and sport in seeking to reduce

obesity in children. The aim is to stop the rise

in childhood obesity by 2010(106)

.

Families Matter: Supporting Families in

Northern Ireland 2007, emphasises the

Government’s determination to improve life

chances for children and young people(107). Its

vision “Our Children and Young People, Our

Pledge” looks at moving parents into a central

position in policy terms and strategic direction.

It aims to empower and assist parents tobe responsible in helping their children

reach their full potential. The drivers for the

document are Every Child Matters: Change

for Children programme, ten-year children’s

strategy and The Child Poverty Review.

The Children’s Strategy is to assist

organisations to work together at alllevels; facilitating better informationsharing, putting together commonstandards and ensuring the focus remainson the child or young person.

Health for all Children, This recommends a

move away from a medical model of screeningfor disorders, with greater emphasis on health

promotion, primary prevention and targeting

effort on active intervention for children and

families at risk). www.dhsspsni.gov.uk/hssmd

15-04.pdf

A Healthier Future is organised around five

themes, investing in health and wellbeing,

involving people – caring communities,responsive combined services, teams which

deliver and improving quality. Targeted groups

are children who need care or extra support

and people with learning disabilities.

The following additional articles address

wellbeing of children in Northern Ireland and

may all be located on; www.dhsspsni.gov.uk

The Children (Northern Ireland) Order 1995

UK country-specific child-related policy4.

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The Education (Northern Ireland) Order 1996The Special Needs and Disability (Northern

Ireland) Order 2005

The Disability Discrimination Act 1995

Code of Practice on the Identification and

Assessment of Special Educational Needs 1998

Supplement to the Code of Practice on the

Identification and Assessment of Special

Educational Needs 2005

SCIE Report to Managing Risk and Minimising

Mistakes in services to Children and Families

Best Practice – Best Care 2001 A Framework

for Setting Standards, Delivering Services

and Improving Monitoring and Regulation

in the HPSS

A Healthier Future – A Twenty-Year Visionfor Health and Wellbeing in Northern

Ireland 2004

Department of Education Northern Ireland.

Standards and guidance for promoting

collaborative working to support children

with special needs - pilot project. Bangor:

Department of Education Northern Ireland;

2006. URL: http://www.deni.gov.uk/print/ 

collaborative_working_document.pdf

Children’s and Young Peoples Funding Package

Peter Hain 2006

Fit Futures Implementation Plan 2007

Office of the First Minister and Deputy First

Minister. Our Children and Young People -

Our Pledge. A ten year strategy for children

and young people in northern ireland 2006- 2016. Belfast: Office of the First Minister and

Deputy First Minister; [2006]. URL: http://www.

allchildrenni.gov.uk/tenyearstrategychildren1.pdf

Co-operating to Safe Guard Children (Northern

Ireland) 2003

Understanding the needs of Children in

Northern Ireland 2006

The Disability Discrimination (Code of Practice)(Schools) (Appointed Day) Order (Northern

Ireland) 2006

A Northern Ireland Review of AdvocacyArrangements for Disabled Children and

Young People with Complex Needs 2006

Care Standards for Northern Ireland. http:// 

www.dhsspsni.gov.uk/index/hss/governance.htm

Clinical Governance and Risk Management:

Achieving safe, effective, patient focused care

and services National Standards 2005.

 Scotland

Health and Education are devolved to the

Scottish Parliament.

The approach for children and young

people in Scotland is based on the United

Nations (UN) Convention on the Rights of

the Child (Article 24).

This recognizes the right of the child to

the highest attainable standard of health

and to facilities for the treatment of illness

and rehabilitation of health. No child

should be deprived of the right of access to

health care services.

Scotland’s children need to be safe,

nurtured, active, healthy, achieving,included, respected and responsible in

order to become successful learners,

confident individuals, effective contributors,

and responsible citizens.

There is an emphasis on providing care

locally with effective interagency working.

  Where possible, with regard to safety and

quality, hospital care is delivered as locallyas possible.

NHS Reform (Scotland) Act 2004(108)

This Act provides the legislative basis for

the establishment of Community Health

Partnerships (CHPs) which are considered

vital for the modernisation and redesign of

NHS Scotland and of joint services with LocalAuthorities. The priority is working towards

a decentralised but integrated health and

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social care systems. In particular, CHPs willseek to close the health gap, reducing

health inequalities.

In relation to child health:

Children and young people, their parents and

carers are involved in the design of services.

Areas highlighted include:

  More care for children is provided closer

to home  Guidelines for the management of common

childhood conditions by primary and

secondary care are agreed and

implemented

  Services and initiatives to improve the

health of children are developed further,

for example around the growing

prevalence of obesity in children and

young people

  Children with additional needs have shared

assessment by relevant agencies, agreed

coordinated care plans and monitoring

of outcomes

  Clear processes are in place to agree

funding arrangements for children with

complex needs

  Services for vulnerable families areintegrated with local authority services in

a way that ensures referral access by all

relevant agencies and joint working

amongst health, education and social

work staff.

Education (Additional Support for

Learning) (Scotland) Act 2004(109)

The Act replaces the system for assessment

and recording of children and young people

with special educational needs, including the

Records of Needs process, established by the

Education (Scotland) Act 1980.

Additional Support for Learning legislation

requires agencies such as NHS Boards to

respond to requests for help from educationauthorities within a period of ten weeks,

including services based in the community andmanaged by CHPs.

The process for assessment and recording

educational support needs is detailed in the

publication, Statutory Guidance relating to the

Education (Additional Support for Learning)

(Scotland) Act 2004(110). Agencies must adopt

an integrated approach to assessment,

intervention, planning, provision and review.

There is a duty to help an education authority

unless the help asked for:

  is incompatible with the agency’s statutory

or other duties; or

 unduly prejudices the agency in its

discharge of its own functions.

A response to a request for assessment should

be made within ten weeks.

Health for All Children(111)

To be implemented throughout the UK this

recommends a move away from a medical

model of screening for disorders, with greater

emphasis on health promotion, primary

prevention and targeting effort on activeintervention for children and families at risk.

Building on Success: Future Directions for

Allied Health professionals 2002(112)

Shaping the future of Allied Health

Professional; key areas includes service design,

clinical governance, research and development,

career pathways, recruitment and retention.

Delivering care, enabling health, Scottish

Executive November 2006(113)

This builds on the national strategy for

nursing and midwifery and the AHP

strategy; Building on Success. It considers the

contribution of Nursing, Midwifery and AHP

services (NMAHP) to health care policy in the

key areas of culture, capability and capacity.Delivering for Health is the policy context

for health care in Scotland. The document

UK country-specific child-related policy4.

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considers the NMAHP contribution to meetingthe identified need of Scotland’s population.

Enabling is described as being fundamental

to Allied Health professional practice and

services.

Supplementary information relating to

Children’s Services in Scotland can be found

at www.scotland.gov.uk/Publications

The Information Management and

Technology (IM&T) Strategy (2002)(114) 

Published by the Scottish Executive Health

Department recommended that all Scottish

NHS Boards implement The Support Needs

System (SNS) by 2004. SNS was established

in 1993, with the aim of enabling early

identification, assessment and monitoring of

children with additional support needs in a

consistent manner across Scotland. Additional

information may be obtained via: http://www.

isdscotland.org/isd/3397.html.

Additional articles address wellbeing of

children in Scotland.

Education (Additional Support for Learning)(Scotland) Act 2004

Emergency Care Framework for Children and

Young People in Scotland http://www.scotland.

gov.uk/Resource/Doc/149108/0039634.pdf

Children’s Cancer Services in Scotland Working

Group: The Future of Cancer Services for

Children and Young People in Scotland

2005 http://www.scotland.gov.uk/Resource/ Doc/77843/0018193.pdf

Delivering for Health 2005 http://www.

scotland.gov.uk/Resource/Doc/76169/0018996.

pdf

Joint Inspection of Children’s Services and

Inspection of Social Work Services (Scotland)

Act 2006.

Tertiary Services for Children in ScotlandPlanning the Future Conference – 11 June 2004

http://www.sehd.scot.nhs.uk/cyphsg/documents/ 11June2004.pdf

National Framework for Service Change in

the NHS in Scotland 2005 – Child Healthcare

Services in Scotland http://www.sehd.scot.

nhs.uk/nationalframework/Documents/ 

ChildHealthcareReport.pdf

Building a Health Service: Fit for the Future:

Scottish Executive 2005 www.scotland.gov.uk

Delivering a Healthy Future: An Action

Framework for Children and Young People’s

Health in Scotland: A draft Consultation 2006

Getting It Right for Every Child: Review of

Children’s Hearings Systems: 2006 Scottish

Executive www.scotland.gov.uk

Getting It Right for Every Child:

Implementation Plan: Scottish Executive 2006www.scotland.gov.uk

The Same As You: A review of Services for

people with Learning Difficulties: Scottish

Executive 2004. www.scotland.gov.uk

Publication-SCLD Bulletin: Scottish Consortium

for Learning Disability: Contact 0141 4185420

www.scld.org.uk

Wales

Designed for Life

‘Building upon the work already begun in

Building for the Future, Improving Health

in Wales and Health Challenge Wales, this

 strategy will outline how we will get there. It is

called Designed for Life; this encapsulates our

whole approach. Design needs to be inspired, yet practical, actively planned, modelled and

built by experts. High quality design is durable,

 safe and effective – it delivers to people what

they want. In short, it is fit for purpose, and

our purpose here is an improved quality of

life for the people of Wales - adding not just

 years to life, but life to years. Much of the

achievement will rely on good partnerships,

especially across the NHS, public health, localgovernment and voluntary organisations.’ (115)

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Over the past few years’ paediatricphysiotherapy services in Wales have engaged

with the health Modernisation agenda set out

by the Welsh Assembly Government. National

strategies such as Designed for Life have been

supported by the development and publication

of Children’s NSF for Wales and by the

Children and Young Peoples Specialist Service

Standards(115-117).

Children’s National Service framework

(Wales)(116)

The overall aim of the Children’s NSF is that “all

children and young people achieve optimum

health and wellbeing and are supported in

achieving their potential” . The scope of the

Children’s NSF includes all children and young

people from pre-conception to 18th birthday,

for whom NHS Wales and local social services

authorities have a responsibility. Special

consideration will be given for transition

management into adult services beyond the18th

birthday for those requiring support services.

The framework contains 21 standards and 203

key actions, which are based on the 42 Articles

of the UN Convention on the Rights of the Childand the Assembly’s seven core aims for children

and young people. A Self-Assessment Audit Tool

has been designed as part of a performance

measurement system for the Children’s NSF

for use by all statutory organisations that

deliver services for children and young people,

including the delivery of maternity services.

Children and Young People Specialist ServiceStandards ( CYPSS)(117):

‘Children are special and some children need

very specialised health services to diagnose and

treat their diseases. There has been considerable

change in the configuration and range of

 specialist services available to the children of

Wales in recent years. Many services have been

developed but some have not proved sustainable

because of concerns about continuity of care, or

workload or staffing levels’ .

In 2002 it was agreed that any review of tertiaryservices for children in Wales should:

  define in detail what are specialised services

for children

 review the incidence and prevalence of

diseases which require specialised care

 assess the quantity, quality and costs of the

existing provision

 assess how any undesirable variations in

cost, volume and quality of existing

provision can be reduced

 propose options for improvement.

Specialist Services under review include:

 Neonatal

 Paediatric intensive care

 Paediatric specialist medicine

 Paediatric neurosciences

 Paediatric oncology and palliative care

 Paediatric specialist anaesthetics and surgery.

For easy to read aide memoirs and synopses of

all the above documents go to the following site:

www.healthcarealliances.com

Therapies for ModernisationIn addition, the publication in 2006 of a specific

Therapies Strategy for Wales has contributed to

the transformation of the delivery of Health and

Social Care in Wales(118).

‘This document sets out important objectives

and key actions applicable across the entire

 physical, social and psychological spectrum of

wellbeing, health improvement, accident and

ill health prevention and the management of

illness, injury and disability. It provides a platform

from which therapists and their support staff

 should be engaged and employed to support

and deliver service provision, developments and

modernisation across Wales.

Some of this agenda is challenging, but the

 potential benefits are considerable. This strategy

 provides a framework from which action and

more detailed work will be required at a local

level to fully explore how these benefits will

UK country-specific child-related policy4.

Useful general information5.

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be realised. The Government, commissioners, providers, professionals and the public must seize

the opportunities and work together to ensure

that Wales secures the powerful contribution

of the Therapy Services to its health and social

care agenda.’ 

Sport and leisureFor many of the children and young people

that physiotherapists work with opportunities

to participate fully in sporting and leisure

activities can seem very limited and they may

be asked for advice.

The English Federation for Disability Sports

(EFDS) provides details of local Disability Sports

Development Officers and of their own Regional

representatives. These individuals should be

able to advise on all local sporting activities,

and will possibly be able to work with

physiotharapists to develop new opportunities.

EFDS website provides a vast array on

information ranging from funding

opportunities to information on specific sports.Information relating to disability sporting

events around the country can be found on

EFDS’ website: www.disabilitysport.org.uk

The EFDS also produces a quarterly magazine

‘Inclusive Sport’.

Disability Sports Northern Ireland.

Website: http://www.dsni.co.uk/ 

NI Gillian McKenna (gillian.

[email protected])

Federation of Disability Sport Wales (FDSW).

Website: http://www.disabilitysportwales.org/ 

Sport Scotland.

Website: http://www.sportscotland.org.uk/ 

Other useful websites relating todisability sports include:

British Gymnastics

Website: http://www.british-gymnastics.org/ 

British Blind Sport.

Website: http://www.britishblindsport.org.uk/ 

UK Deaf Sport

Website: http://www.ukdeafsport.org.uk/ 

Mencap Sport.

Website: http://www.mencap.org.uk/html/ 

mencap_sport/ 

Useful general information

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WheelPower – British Wheelchair Sport.Website: http://www.wheelpower.org.uk/ 

CP Sport England & Wales.

Website: http://www.cpsport.org/ 

For more specific information on

competing in disability sports at National

and International levels:

British Paralympic Association.

Website: http://www.paralympics.org.uk/ 

Cerebral Palsy International Sports and

Recreation Association

Website: http://www.cpisra.org/ 

British Amputee and les Autres Sports

Association (BALASA).

Website: http://www.fastuk.org/atcommunity/ 

orgview.php?id=2633. Tel: 01204 494308

Sport specific sites of interest include:

The Wheelchair Football Association

Website: http://www.thewfa.org.uk/ 

National Wheelchair Tennis Association of

Great Britain.

Website: http://www.btf.org.uk/ 

WheelchairTennis/ Great British Wheelchair Rugby

Website: http://www.gbwr.co.uk/ 

Great Britain Wheelchair Basketball Association

Website: http://www.gbwba.org.uk/ 

British Amateur Swimming Association

– Disability Swimming.

Website: http://www.britishswimming.org/vsite/ 

vnavsite/page/directory/0,10853,5026-142732-159948-nav-list,00.html

Halliwick Association of Swimming Therapy in

the UK.

Website: http://www.halliwick.org.uk/ 

The Art of Swimming - Shaw Method.

Website: http://www.artofswimming.com/ 

Swimming and CP.Website: http://www.cerebralpalsysource.com/ 

Treatment_and_Therapy/swimming/index.html

New Age Kurling.Website: http://www.kurling.co.uk/ 

International Blind Sports Association – Goal

Ball and other sports

Website: http://www.ibsa.es/eng/ 

The British Ski Club for the Disabled

Website: http://www.bscd.org.uk/ 

The British Disabled Angling Association

Website: http://bdaa.co.uk/ 

British Blind Sports.

Website: http://www.britishblindsport.org.uk/ 

International Federation of Blind Sports.

Website: http://www.ibsa.es/eng/ 

The Clavert Trust offers adventurous outdoor

activities for people with disabilities at their

three Centres England – Scottish Posture and

Mobility Network

Website: http://www.calvert-trust.org.uk/ 

Riding for the Disabled. Provides

comprehensive information relating to

localities and the Association’s activities.

Website: http://www.riding-for-disabled.org.uk/ 

The Fortune Centre of Riding TherapyWebsite: http://www.fortunecentre.org

The Federation Riding for the Disabled

International

Website: http://www.frdi.net/ 

MS Trust. Hippotherapy – a new movement

experience: what fun! .

URL: http://www.mstrust.org.uk/publications/ 

opendoor/0605_10_11.jsp

Revive MS Support. Hippotherapy.

URL: http://www.revivemssupport.org.uk/index.

php?option=com_content&task=view&id=25&It

emid=99999999

Calvert Trust Riding for the Disabled – Exmoor

Equestrian.

Website: http://www.equinetourism.co.uk/ 

equineestablishments/calverttrust.asp

Royal Association for Disability and

Rehabilitation (RADAR). has a range of

Useful general information5.

Useful general information5.

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useful publications including ones relating toaccessible holidays and leisure pursuits

Website: http://www.radar.org.uk/radarwebsite/ 

The following charities provide

wheelchair training courses for children

and young people:

Whizz Kidz.

Website: http://www.whizz-kidz.org.uk

The Association of Wheelchair Children.

Website: http://www.wheelchairchildren.org.uk/ 

The Scottish Posture and Mobility Network

Website: http://www.spmn.org.uk/ 

Specialist holidays

These are some of the national organisations

that provide and support specialist holidays forthe disabled client often incorporating activities

for the family/carers. There may be local

organisations that provide /fund such holidays.

If so, information may be obtained at your

Tourist Information Centre/Local Council.

Calvert Trust Activity Holidays for the Disabled.

Website: http://www.calvert-trust.org.uk/ 

Royal Blind Society – holidays.

Website: http://www.royalblindsociety.org/ 

holidays.htm

Enable Holidays

Website: http://www.enableholidays.com

Disability Now – accessible holiday

accommodation.Website: http://www.disabilitynow.org.uk/ 

directory/adv_accomm.htm

John Grooms Holidays – Provides the highest

quality holidays for the disabled

Website: http://www.johngrooms.org.uk/ 

landing.asp?id=9

Tall Ships Youth Trust – Supports the personaldevelopment of young people through crewing

tall ships. Website: http://www.tallships.org/ 

Voluntary agencies and support groupsThere are many easily accessible voluntary

agencies and support groups both nationally

and locally for children, young people and

their families/carers. Below are just a few of

the well known national agencies but it is

worth investigating local voluntary agencies/ 

support groups.

Contact a FamilyWebsite: http://www.cafamily.org.uk/ 

Scope UK.

Website: http://www.scope.org.uk/ 

High/Scope UK.

Website: http://www.high-scope.org.uk/ 

HemiHelp.

Website: http://www.hemihelp.org.uk/ 

Erb’s Palsy Group.

Website: http://www.erbspalsygroup.co.uk/ 

BLISS – the premature baby charity

Website: http://www.bliss.org.uk/ 

National Association of Toy & Leisure Libraries.

Website: http://www.natll.org.uk/ 

The Variety Club Children’s Charity.Website: http://www.varietyclub.org.uk/ 

Cerebra: for Brain Injured Children and Young

People.

Website: http://www.cerebra.org.uk

Whizz Kidz.

Website: http://www.whizz-kidz.co.uk

YoungMinds. Young people and mental healthissues including advice and information sheets

on eating disorders and self harm

Website: http://www.youngminds.org.uk/ 

g

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Appendix – Resources and references

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Other relevant Clinical Interest Groupsand Occupational Groups (CI/OGs)

There are nearly 40 CI/OGs recognised by

the CSP and new ones continue to develop.

Interest groups represent a distinct field of

physiotherapy clinical practice that may be

specific to a client group, a clinical area or

a specific treatment approach or modality.

The occupational groups all represent

physiotherapists working in a specific

occupational area.

The following recognised CI/OGS link to

paediatrics:

Acupuncture Association of Chartered

Physiotherapists: AACP www.aacp.uk.com

Association of Chartered Physiotherapists in

Cystic Fibrosis: ACPCF

Association of Chartered Physiotherapists in

Energy Medicine: ACPEM

www.energymedphysio.org.uk

Association of Chartered Physiotherapists in

Electrotherapy: ACPIE

Association of Chartered Physiotherapists in

Independent Hospitals and Charities: ACPIHC

Association of Chartered Physiotherapist

Interested in Neurology: ACPIN www.acpin.net

Association of Chartered Physiotherapists in

Reflex Therapy: ACPIRT

Association of Chartered Physiotherapists

in Management: ACPMwww.physiomanagers.org.uk

Association of Chartered Physiotherapists in

Occupational Health and Ergonomics: ACPOHE

www.acpohe.co.uk

Association of Chartered Physiotherapists in

Orthopaedic Medicine and Injection Therapy:

ACPOM www.acpom.org.uk

Association of Chartered Physiotherapists in

Oncology and Palliative Care: ACPOPC

www.acpopc.org.uk

Association of Chartered Physiotherapists forPeople with Learning Difficulties: ACPPLD

www.acppld.org.uk

Association of Chartered Physiotherapists in

Respiratory Care: ACPRC www.acprc.org.uk

Association of Chartered Physiotherapists in

Sports Medicine: ACPSM www.acpsm.org

Association of Chartered Physiotherapists inTherapeutic Riding: ACPTR

British Association of Bobath Trained

Physiotherapists: BABBT www.bobath.org.uk

British Association of Chartered

Physiotherapists in Amputee Rehabilitation:

BACPAR www.bacpar.org.uk

British Association of Hand Therapists: BAHTwww.hand-therapy.co.uk

Chartered Physiotherapists Interested in

Massage and Soft Tissue Therapies: CPMaSTT

Chartered Physiotherapists in Mental Health:

CPMH www.cpmh.org.uk

Chartered Physiotherapists Promoting

Continence: CPPC

Craniosacral Therapy Association of Chartered

Physiotherapists: CTACP

Chartered Physiotherapists Working as

Extended Scope Practitioners: ESP

Hydrotherapy Association of Chartered

Physiotherapists: HACP

Haemophilia Chartered Physiotherapists’

Association: HCPA

International Support Group for Chartered

Physiotherapists: ISC4CP

Medico-legal Association of Chartered

Physiotherapists: MLACP

Organisation of Chartered Physiotherapists inPrivate Practice: OCPPP www.physiofirst.org.uk

pp

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Physiotherapy Pain Association: PPA.Physiotherapy Research Society:

PRS www.prs-uk.org

The following CI/OGs are not formally

recognised by the CSP but also address

children within the specialty:

Association of Chartered Physiotherapists

working with Acquired Brain InjuryRenal

Burns

Paediatric Physiotherapists in Management

Service

NB Those CI/OGs without a website may be

contacted by logging onto the CSP website;

www.csp.org.uk/specialist group section.

Working Party Lead Project Officer: Leonie Dawson, CSP

Clinical Policy Officer

Project officer: Mary Harrison

Sarah Crombie

Felicity Dickson

Linda Fisher 

Carol Mackay 

Terry Pountney 

Diane Rogers

Peta Smith

Lorna Stybelska

Laura Wiggins

 Also acknowledgement for their

contributions:

Fiona Down

 Julia GrahamGeraldine Hastings

Stephanie C Phillips

Dr Janet E McDonagh

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Education (Additional Support for Learning)

(Scotland) Act 2004.; 2005. URL: http://www.

scotland.gov.uk/Publications/2005/08/15105817

 /58187

111. Campbell H, Hill J. Health for all children

(HALL 4) 2004. Website: http://www.dhsspsni.

gov.uk/hssmd15-04.pdf

112. Scottish Executive. Building on success:

future directions for the allied health

professions in Scotland. Edinburgh: The

Stationery Office; 2002. URL: http://www.scotland.gov.uk/Resource/Doc/46729/0013995.

pdf

52

Appendix – Resources and references

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53

113. Scottish Executive. Delivering care,

enabling health. Harnessing the nursing,

midwifery and allied health professions’

contribution to implementing Delivering

for Health in Scotland. Edinburgh: Scottish

Executive; 2006. URL: http://www.scotland.gov.

uk/Resource/Doc/152499/0041001.pdf

114. The Scottish Executive Health Department.

Information management and technology(IM&T) strategy Edinburgh: The Scottish

Executive; 2002.

115. Welsh Assembly Government. Designed

for life: creating world class health and social

care for Wales in the 21st century. Cardiff:

Welsh Assembly Government; 2005. URL: http:// 

www.wales.nhs.uk/documents/designed-for-

life-e.pdf

116. Welsh Assembly Government. National

service framework for children, young people

and maternity services in Wales. Cardiff: Welsh

Assembly Government; 2005. URL: http://www.

wales.nhs.uk/sites3/home.cfm?OrgID=441

117. Welsh Assembly Government. Children

and young people’s specialist services -

standards. 2005 -.

Website: http://www.wales.nhs.uk/sites3/page.

cfm?orgid=355&pid=13958

118. Welsh Assembly Government. A therapy

strategy for Wales: the contribution of

therapy services to transforming the delivery

of health and social care in Wales. Cardiff:NHS Wales; 2006. URL: http://new.wales.gov.

uk/docrepos/40382/dhss/403821215/Therapy_

Strategy_Final_Engl1.pdf?lang=en

2007 Information to guide good practice for physiotherapists working with children

Notes

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