Children’s occupational therapy (OT)

This page contains materials produced by Hounslow and Richmond Community Healthcare NHS Trust (HRCH). On 1 July 2024, all adult and children’s community services in the London Borough of Hounslow provided by HRCH transferred to West London NHS Trust. Whilst we are in the process of re-producing these materials, patients and referrers can still refer to the information contained within them.

What is occupational therapy?

Occupational therapy is a type of health care that assists people of all ages who are experiencing physical, sensory or cognitive difficulties.

Occupational therapy can help these individuals in gaining independence and performing work, leisure and activities of daily living (ADLs) that are meaningful to them.

An occupational therapist supports people with removing barriers that might be impacting on a person engaging in meaningful activities in their day to day lives. This may be through making adaptations to the activity, the environment or supporting skill development within the individual.

What is paediatric occupational therapy?

Children’s occupational therapists (OTs) work with babies, preschool and school aged children who have physical, developmental or sensory difficulties, to help them with skills that they need to succeed in everyday life.

This may include:

Self-care tasks, such as getting dressed, bathing, brushing teeth, using the toilet, using cutlery and eating meals.
School skills such as sitting at the table, organising belongings, handwriting, using scissors, focusing.
Play skills, including developmental play, ball skills, messy play.
Play Skills including ball games, sensory play, using hands and fingers appropriately to operate toys such as twisting or pushing buttons, using play equipment, like in park playgrounds (climbing, balancing etc.)
Sensory processing skills, such as responding to information received by the senses (e.g. loud noises, bright lights, different textures)

Not only does occupational therapy help with general issues such as the ones listed above, we are also able to help with more specific conditions such as:

Autism
Physical disabilities such as cerebral palsy, genetic syndromes
Developmental Coordination Disorder/Dyspraxia

Our service

Who do we see?

The pre-school team see children from 0 until they start Reception class at school.

If a child is within this age range, without complex physical needs such as cerebral palsy, they can be seen by this team.

Who do we not see?

Children who have an EHCP. It is up to the school setting to commission an independent OT to provide input for children with an EHCP.
Children who attend a special school. Special schools should have their own resident Occupational Therapist.

What is the pathway?

If a child has sensory processing differences, parents will first be asked to watch a virtual workshop on sensory processing and fill in and send back a short questionnaire, prior to their child being placed on the waiting list for assessment.
If a child has eating difficulties, parents will first be asked to watch a virtual workshop on eating difficulties and fill in and send back a short questionnaire, prior to their child being placed on the waiting list for assessment within our feeding clinic.
Most initial assessments take place at Heart of Hounslow, and follow-up can be arranged virtually, in clinic or at nursery/ preschool as appropriate.

Current waiting times:

Initial pre-school assessment appointment = Approximately 8 months

Initial feeding assessment appointment = Approximately 3-5 months

Follow up appointment = Approximately up to 3 months

Who do we see?

Children from Reception class onwards.
Children who attend a mainstream school setting.

Who do we not see?

Children who have an EHCP. It is up to the school setting to commission an independent OT to provide input for children with an EHCP.
Children who attend a special school. Special schools should have their own resident Occupational Therapist.

What is the pathway?

Initial assessment: Depending on the needs of the child, the OT is able to complete an initial assessment in clinic at the Heart of Hounslow; at the child’s school or virtually via video call. Following this initial assessment, the OT will write a goal programme to be implemented at home and at school by the adults in the child’s life. There is a strong focus on the OT working with school staff to support the child with school related needs.

Follow up appointment: 3 months after the initial OT appointment, once the Parent or School have been able to try putting in place strategies/recommendations from the goal programme, the Parent or School can call the OT service to request an OT review appointment. This review appointment can be completed virtually, at School or in clinic, depending on the needs of the child.

Current waiting times:

Initial school age assessment appointment = Approximately 12 months
Initial feeding assessment appointment = Approximately 3-5 months
Follow up appointment = Approximately up to 3 months

Who do we see?

This team sees children from 0-18 with complex needs that are impacting all functional areas.

Children in this stream commonly have conditions or diagnosis of neurodevelopmental conditions such as SMA or cerebral palsy, traumatic brain injuries, down syndrome or other genetic conditions and neurological upper limb difficulties.

What is the pathway?

OT’s working within this team aim to work holistically to support children and their families withing virtually as well as in the clinic, nursery/school and home settings (as assessed to be suitable).

OT input may include individual or group sessions, liaison and where possible joint working with relevant professionals such as physiotherapy, speech and language therapy, specialist/acute services, SENS Physical disability team, school/nursery SENcOs, Portage etc.

Children within this stream, up until the age of 5 will be able to access our equipment clinic to be assessed and if appropriate, provided with suitable self-care equipment (e.g. bath aids) and specialist seating (following which a referral to the Hounslow Social Services OT service will be made).

Children from this stream will also be able to access our monthly neuro Upper Limb Clinic in which assessment and if required splinting can be provided (either through fabrication or ordering of ‘off the shelf’ items)

Current waiting times:

Initial assessment appointment = Approximately 6 weeks

Who do we see?

We provide the OT provision under section F within a child’s Education Health and Care plan. We are based in the centres and units around the Hounslow Borough.

We are not commissioned to see children in mainstream schools with EHCPs and the school needs to commission OT for these children.

How does our service work?

We provide assessment and reviews as outlined within the child’s EHCP. In every EHCP there are “direct” and “indirect” hours.

Direct hours make up time spent directly with the child.

Indirect hours make up the time spent on resource creating, administration and liaison with teachers, parents and professionals.

We use a classroom-based model of intervention in our centres and units which means that we do not pull out children to see individually without a staff member such as an LSA or TA present. This is because we believe in therapy being provided throughout the day at school through upskilling of staff and not just in the time spent with the OT. As such, we do not provide 1:1 weekly OT sessions in our service.

We aim to base our intervention within a Tiered Model of Intervention, in line with RCOT (Royal College of Occupational Therapy) guidance. This model is based on the concepts of Public Health model used in the UK and also the Response to Intervention (RtI) model used in the Educational Systems in North America (National Association of State Directors of Special Education, Inc 2005; AOTA 2009 as cited by Chu, S., 2013). This approach is known in England as the Wave Model, defined as a multi-tier method to address the needs of students with SEN or disabilities within three waves of support: universal, target and specialist (Norwich, 2013; DfE & Skills, 2006 as cited by Riveria and Boyle (2020).

The tiers of input are described below:

Universal level: Services provided to all children, young people, and their families).
Targeted level: Services for children who are at risk of, or already experiencing difficulties.
Specialist level: Children with complex needs requiring an individual approach.

Occupational Therapists across the service support children and young people with Autism Spectrum Disorder.

Social Communication Pathway

For individual queries on waiting times for assessment for autism, please contact the Social Communication Pathway Coordinators:

Email: hrch.socialcommunicationpathway@nhs.net

Telephone: 020 3771 5983

Useful links

Social Communication Pathway

The video below is for parents of children who are on the social communication pathway (otherwise known as the autism pathway).

It explains the process we follow in Hounslow.

Introduction to Hounslow HRCH Social Communication Pathway

NHS website: Help for families of autistic people

This website has useful tips, advice, and further links from the National Health Service.

National Autistic Society

For safe, accurate and up to date information on autism, including support, guidance, and advice, as well as information on campaigning for improved rights, services, and opportunities to help create a society that works for autistic people.