Editorial: Cutting pediatric therapy in two to promote inclusion. Part 2: Implications

paediatric therapists have essential skills that parents, nursery staff and teachers do not have

In Part 1 I argued that in my view paediatric therapists typically do two sorts of work: one is essential health treatment; the other is helping a baby or infant acquire new understanding and skills. The second of these is primarily an education function and so it seems wrong to offer it in hospitals or clinics.

Therapists could instead work/play with children at home or in their nursery, kindergarten or first school where others are also supporting the child’s education. This would promote inclusion in the natural places of childhood. (And, if paediatric therapists are offering health treatment or education, there is nothing they do that needs to be called ‘therapy’.)

Individual therapists (using the present term), therapy departments and therapy teams should test the validity of the division I have made between health treatment and education:  

• Is it a valid distinction?
• Are some individuals and teams performing both functions?
• Are some individuals or teams doing just one or the other?
• Is there something that is neither health treatment nor education that needs to be called ‘therapy’?

What could follow from this line of reasoning?

1. Paediatric therapists could be called something new, for instance, ‘early child and family support specialists’.
2. The word ‘therapy’ could be reserved for work that has no evidence base and for people who sell their services to parents in the market place.
3. Initial and in-service training for paediatric therapists could have a stronger element of the art, science and psychology of how babies and infants learn.
4. Initial work in education mode with a new child could be:

• • to establish a working relationship with parents to begin supporting them in their role of bringing up their child.
  • to establish a working relationship with others around the child in nursery or first school to begin supporting them in their work.

5. Much of this work would be in an advisory capacity – establishing collective competence in which everyone’s understanding and skills are shared. The structure for this could be the Team Around the Child (TAC) approach.
6. In education mode, paediatric therapists have essential skills that parents, nursery staff and teachers do not have. For this, direct contact is essential so that the child’s strengths and needs can be established and appropriate approaches established.
7. In this new work, all opportunities would be taken to reduce or eliminate waiting lists so that ‘early’ support does not have to come late. This could include pressure being taken off therapists by:

• • therapists in education mode sometimes working indirectly with a child by advising other people who are also teaching the same things (eg: sitting, rolling, answering 'yes' and 'no', holding a spoon, drinking from a cup...)
    
  • fewer children needing to come regularly to the hospital or clinic for ‘therapy’.

8. Budgets would need to be readjusted. Working more in the community will add travel costs. Reducing visits to therapy departments should mean they can be scaled down in terms of physical space, staffing and physical resources.

 

Comments welcome.

Peter Limbrick, July 2021