Hillingdon Talks
The service will let you know which team is most appropriate for your child to see at their first appointment.
Your child's speech, language and communication skills will be assessed by the speech and language therapist. This might be through a combination of formal or informal assessment, observation, and discussion with parents and others involved with the child or young person, such as teachers and child minders.
Once a referral is received and accepted, the following happens:
- We ask the parents to contact the service within two weeks to arrange a suitable date and time for the appointment
- Once contact with the service has been made a suitable appointment will be offered within six weeks of the referral being accepted
- The appointment will be confirmed in writing and parents will be sent a case history form and patient registration form to complete and bring with them to the appointment.
- After the appointment, a report is written including the findings and outcomes from the appointment and a care plan, target and strategy.
If parents do not contact the service to arrange an appointment within two weeks, the child is discharged and a letter is sent to the parent and the referrer to let them know. Similarly, your child will be discharged, if you do not attend the appointment and do not contact us to let us know you can't make it.
If you cannot attend the appointment or require an interpreter, please contact the CITS advice on 01895 488 200 or email citsadmin.cnwl@nhs.net and we can rearrange the appointment to another date and time and/or book an interpreter.
What happens at the first appointment?
The appointments last between 45 and 60 minutes. If you are referred to the Child Development Centre (CDC) for the appointment, please allow plenty of time for parking.
During the appointment the therapist will:
- Ask about your child's development so far and discuss any worries you have
- Watch, listen to and play with your child
- They may watch your child eating and drinking
- Talk with you about child's speech and language development and/or eating and drinking skills based on what was observed during the appointment
- Agree the next steps and a care plan with you for your child.
You can expect the assessment to run as follows:
- You and your child will be given a chance to settle and feel at ease. There will be activities set up for you and your child. There may also be other families in your assessment
- The therapist will talk to you about your child's general development, discuss why your child has been referred, how they communicate with you and other people and any concerns you have
- The therapist will observe your child playing and may join in, if your child is happy for them to do so
- In the observation, the therapist will assess what your child understands and is saying through play and then discuss that with you
- The therapist may use books and pictures with your child, as part of the assessment.
Once the assessment is finished, the therapist will explain whether your child needs speech and language therapy and what they think would be the best therapy for your child. You will also be given a chance to put forward your views. The next steps will then be agreed. This will be your child's care plan.
Parents are expected to be heavily involved in their child's therapy because they are with them everyday. The therapist will give you ideas of what you can do at home to help your child. It is important that you follow this advice and start to make the small changes that are suggested because it will really help develop their child's speech and language skills.
Initial assessment report
After the assessment, the speech and language therapist will write a report. This report will contain the following information:
- Your child's current speech, language and communication needs
- A description of what will happen next (the care plan)
- Advice on how you can help your child at home until the next therapy sessions.
This report will be sent to:
- You, the parents
- Your GP
- The person who referred your child to the team
- Your child's nursery or school
- Any other professional working with your child.
We will ask for your permission before sending the report to the nursery/school and other professionals. It will be important for the nursery/school to receive this report so that they can follow the same activities for your child at school.
What are the next steps?
- Group therapy
- Joint therapy sessions with other members of the disciplinary team
- A programme of activities for home and nursery
- Phone or clinic review of speech and language and/or eating and drinking skills at an agreed time scale.
The next step may include discharge if the team believe no further input is required.
What will happen in speech and language therapy?
Children learn best when they are interested and having fun. Play-based activities are perfect for children to develop their language and communication skills. We use pictures, toys, books, and other things that will keep your child’s attention and interest them in what we are doing.
Sometimes the therapist will advise on small changes that you and the other people who support your child can make to help them to develop their speech and language.
You may be asked to come to a parent-only workshop. This will give you time to listen without being distracted. It also gives you time to talk through your concerns and you can get support from other parents.
Sometimes therapy will be provided in a group. This will help your child to develop their turn-taking skills and to learn from other children. It develops skills that will help them at school.
You will be expected to support therapy at home
Most therapy input will start with a parent-only workshop.
Parents and people who are involved in the day-to-day care of your child will be asked to carry out games and activities between our therapy sessions. Older children also learn when they are relaxed and engaged, so although the sessions may be more formal, we try to make sure they are interesting and fun.
This is an extremely important part of the therapy. We need children to use and practice their new skills in everyday life. Your child will be offered the most appropriate therapy for their needs.
Parent-only workshops
Our parent-only workshops are a very important part of speech and language therapy.
Parents are their child’s best therapist. They can help them every day at home. This is an extremely important part of the therapy. We need children to use and practice their new skills everyday because without this follow-up at home, it is hard for children to make progress.
At the parent workshop we are able to give lots of ideas of how to support children at home. Parents are able to:
- Hear more about their child’s difficulties
- Ask questions
- Talk to other parents
- See things they can do to help their child at home
- Practice these strategies.
We will give parents ideas of things to do at home in their everyday life that will help develop their child’s speech language and communication skills. Your therapist will explain the next therapy sessions with you at the workshop.
Why can't I bring my child to the workshop?
We understand that it can be difficult to find someone to look after your child. However, the workshop is an important part of your child’s speech and language therapy and it is vital for you to come so that you can make a difference and support your child at home.
At the workshop, there will be lots of new information and it is important that you can concentrate on what the therapist is saying. It is very difficult to concentrate fully when you are watching your child at the same time.
What happens if I don't attend the parent workshop?
Please contact the CITS advice on 01895 488200 or email citsadmin.cnwl@nhs.net if you are unable to attend an appointment for any reason or if want to discuss your appointment further.
This is an important part of the therapy. If you do not attend this session and do not contact us to cancel, your child may be discharged.
Future therapy sessions
Following your parent workshop, you will be offered other therapy sessions. Your therapist will tell you what these sessions will be.
This will usually be group therapy. This may be targeted at developing a certain communication skill such as language, speech and/or social communication but will also have an impact on other communication skills. Group therapy is a really effective way to develop good social skills that are needed to do well at school.
Your child may be offered individual sessions, if this is more appropriate. Your therapist will discuss why this might be a better way to support your child.
Following a referral
It is recommended that school staff first get advice from their link speech and language therapist or call the advice line to help decide next steps.
If following advice a referral into the service is needed children attending a Hillingdon mainstream state school will be assessed at school within six weeks of the referral being received by the service.
Parents do not need to attend the assessment but you will be sent a letter informing you of when the speech and language therapist is due to visit your child at school.
The therapist will contact you after the session to give feedback on the assessment, ask you questions about your child’s communication at home, answer any questions you might have, listen to any concerns and offer advice and signposting as needed. This will be done over the phone or in a meeting at school.
Sometimes when a referral is received, parents will be offered a parent only drop in appointment to discuss the concerns and to agree next steps.
How will my child be assessed?
The therapist will assess your child using the following methods:
- Observing your child in a lesson or the playground
- Talking to school staff
- Talking to you as the parent
- Working with your child.
Initial assessment report
After the assessment, the speech and language therapist will write a report. This report will contain the following information:
- Background information
- Summary of speech, language and communication strength and needs
- Strategies that will help your child at school and at home
- Future speech and language therapy recommendation and their care plan.
This report will be sent to:
- You, the parents
- Your GP
- The person who referred your child to the team
- Your child's school
The report will be part of your child’s clinical records which can be seen by other health professionals.
Therapy sessions at a Hillingdon mainstream state school
If your child attends a mainstream state school in Hillingdon, their therapy sessions will take place in school and you do not need to attend. You are welcome to contact the speech and language therapist and observe a session once every term or you can arrange an appointment to meet the therapist and talk about how the sessions are going by contacting the advice line on 01895 488200.
The speech and language therapy sessions are designed to empower school staff to support your child’s speech, language and communication needs throughout the school day.
Direct therapy sessions with your child may be used to:
- Model interventions and strategies for school staff. This is so that school staff can continue to run intervention sessions between therapist’s visits and use strategies in the classroom. These sessions may be individual or as part of a group
- Review and re-assess their speech, language and communication needs.
We also hold indirect therapy sessions with school staff parents, carers and other professionals. This is so that everyone working with your child understands their needs and has strategies to support them across the school day. These sessions are just as important as the direct therapy sessions.
Examples of indirect sessions might include:
- Jointly setting and reviewing care plans and targets with school staff, parents and carers
- Training school staff on classroom strategies that can be used to support a range of children and young people
- Attending a multi-professional meeting to discuss your child’s needs, for example,. annual review meeting or a team around the child/family meeting
- Meeting with parents or carers in school.
How will I know what is happening at the school sessions?
Your speech and language therapist will send you a care plan each term to inform you about your child’s therapy. You will also receive a copy of any reports about your child.
You are welcome to contact the therapist if you would like to meet with them in school, talk with them on the phone or observe a session. In addition, where possible, the therapist will try to contact you to keep you updated and to answer any questions that you might have.
If you want to speak to your child’s speech and language therapist with any questions or concerns, or to update us on any issues, you can contact the CITS advice line on 01895 488200 or email citsadmin.cnwl@nhs.net and the therapist will get back to you as soon as they can.
Therapy sessions for young people not attending a Hillingdon mainstream state school
If your child attends a private school or attends an out-of-borough school, does not have an Education, Health and Care Plan or is being home educated then you will be offered follow-up review sessions each term in a community clinic or health centre.
At these sessions, the speech and language therapist will review your child’s speech, language and communication needs and update the care plan or advise you and the school.
Further support
You can support your child/young person’s speech, language and communication skills at home. The service has a range of videos, advice sheets and strategy sheets which you can use, as well as a list of useful websites and local support groups.
There is also lots of advice for schools and you can signpost your child’s teacher to look at these too.
The service will let you know which team is most appropriate for your child to see at their first appointment.
Your child's speech, language and communication skills will be assessed by the speech and language therapist. This might be through a combination of formal or informal assessment, observation, and discussion with parents and others involved with the child or young person, such as teachers and child minders.
Once a referral is received and accepted, the following happens:
- We ask the parents to contact the service within two weeks to arrange a suitable date and time for the appointment
- Once contact with the service has been made a suitable appointment will be offered within six weeks of the referral being accepted
- The appointment will be confirmed in writing and parents will be sent a case history form and patient registration form to complete and bring with them to the appointment.
- After the appointment, a report is written including the findings and outcomes from the appointment and a care plan, target and strategy.
If parents do not contact the service to arrange an appointment within two weeks, the child is discharged and a letter is sent to the parent and the referrer to let them know. Similarly, your child will be discharged, if you do not attend the appointment and do not contact us to let us know you can't make it.
If you cannot attend the appointment or require an interpreter, please contact the CITS advice on 01895 488200 or email citsadmin.cnwl@nhs.net and we can rearrange the appointment to another date and time and/or book an interpreter.
How will my child be assessed?
Children with a hearing impairment will find it difficult to hear in environments with background noise or poor acoustics. Pre-school children will therefore be seen at home or nursery and school aged children in a quiet room.
During the appointment the therapist will:
- Talk to you, the school, the nursery staff and anyone else appropriate about your child's general development
- Discuss how your child communicates with you and other people, talk about your concerns and discuss why your child has been referred
- Observe your child interacting with you and others
- Assess how your child is communicating with you and their level of understanding
- Discuss communication methods with you. For example, use of gesture and visuals
- Assess how your child is developing their listening skills using their hearing aids or cochlear implants
- Discuss your child's speech and language skills with their teacher of the deaf and any specialist centres.
- Watch your child in a lesson or in the playground
- Watch your child talking to a member of school staff or you
- Work with your child.
Once the assessment is finished, the therapist assess and explain what they think would be the best therapy for your child. You will also be given a chance to put forward your views. The next steps will then be agreed. This will be your child's care plan.
Parents are expected to be heavily involved in their child's therapy because they are with them everyday. The therapist will give you ideas of what you can do at home to help your child. It is important that you follow this advice and start to make the small changes that are suggested because it will really help develop their child's speech and language skills.
If your child is school aged, the assessment session will take place in school.
Parents do not need to attend the assessment but will be given notice by letter when the therapist is due to visit your child at school.
The therapist will contact the parents after the session to give feedback on the assessment, ask them questions, answer questions from parents, listen to any concerns and offer advice. This will be done over the phone or in a meeting at school. You will be given ideas that will support your child at home.
Initial assessment report
After the assessment, the speech and language therapist will write a report. This report will contain the following information:
- Your child's current speech, language and communication needs
- A description of what will happen next (the care plan)
- Advice on how you can help your child at home until the next therapy sessions.
This report will be sent to:
- You, the parents
- Your GP
- The person who referred your child to the team
- Your child's nursery or school
- Any other professional working with your child.
We will ask for your permission before sending the report to the nursery/school and other professionals. It will be important for the nursery/school to receive this report so that they can follow the same activities for your child at school.
Your child will usually be seen at home or in the nursery. The therapist may accompany you to a specialist centre to make sure of good discussions about joint therapy targets, and suggestions of things that will help your child at home or in nursery.
Children learn best when they are interested and having fun. Play based activities are perfect for children to develop their language and communication skills. Your therapist will use pictures, toys, books, and other things that will keep your child’s attention and interest them in what we are doing. They may bring new toys and games or use ones that you have at home. They will show you how you and nursery staff can make small changes at home and at nursery to help develop your child’s listening and attention skills and to improve the use of their cochlear implant or hearing aids.
They will show you and the nursery staff which games to play and toys to use to develop their speech and language skills.
Sometimes the therapy will advise small changes to you and the other people who support your child that will help the child develop their speech and language.
Therapy sessions for young people attending a Hillingdon mainstream state school
Therapy sessions for your child will take place in school and you do not need to attend although you are welcome to contact the therapist and observe a session and discuss how the sessions are going.
The therapist will liaise closely with your child and teacher of the deaf and may visit together to make sure the school and your child/young person get the best support.
The aim of therapy sessions is to empower school staff to support your child/young person’s speech, language and communication needs throughout the school day.
Direct therapy sessions with your child may be used to:
- Model interventions and strategies for school staff. This is so that school staff can continue to run intervention sessions between the therapists visits and use strategies in the classroom. These sessions may be individual or as part of a group
- Review and re-assess their speech, language and communication needs.
We also hold indirect therapy sessions with school staff, parents/carers, other professionals. This is so that everyone working with your child/young person understands their needs and has strategies to support them across the school day.
Examples of indirect sessions might include:
- Jointly setting and reviewing care plans and targets with school staff, parents or carers
- Training school staff on classroom strategies that can be used to support a range of children/young people
- Attending a multi-professional meeting to discuss your child/young person’s needs. For example annual review meeting and child/family meeting
- Meeting with parents/carers in school.
How will I know what is happening at the sessions?
The speech and language therapist will contact you and you are welcome to arrange to meet with them in school or talk with them on the phone or observe a session. In addition, where possible, the therapist may visit you or contact you at home in the holidays to continue the support and feedback about progress. They will be able to keep you updated and to answer any questions or queries that you might have.
If you want to speak to your child’s speech and language therapist with any questions or concerns, or to update us on any issues you can contact us on the CITS advice on 01895 488200 or email citsadmin.cnwl@nhs.net and the therapist will get back to you as soon as they can.
Hillingdon Moves
First appointment
Once your child’s referral has been received, they will be seen within six weeks. The initial appointment may take 45-60 minutes during which the physiotherapist will start by asking some questions about your child’s birth history, development and any concerns that you may have.
The child’s needs and areas of difficulty in movement will then be assessed. This may involve your child being undressed in order for an effective assessment to be made. You may wish to bring shorts for your child to wear. Any areas of concern and the treatment plan will then be discussed with parents/carer(s).
Follow up appointments will be discussed and arranged between the parent/carer(s) and Physiotherapist on an individual basis.
Therapy sessions
Follow up physiotherapy sessions usually last approximately 30-45 minutes and parent/carer(s) are expected to stay with their child throughout the session.
Physiotherapy treatments include activities to help them move , stretches and exercise. Your child’s physiotherapist may use their hands to help your child move in a way that encourages strengthening of their muscles. Children learn best when they are interested and having fun. Play-based activities are perfect for children to develop their motor skills. Older children also learn when they are relaxed and engaged, so although the sessions may be more formal, we try to make sure they are interesting and fun.
Treatments take place on an individual basis or in a group session, depending upon the child’s needs.
Therapy programmes
Children and their parent/carer(s) are encouraged to take an active part in their physiotherapy treatment. If appropriate, an individual home exercise programme that complements the treatment they receive in sessions is provided. This programme may also be taught to school staff, if appropriate.
Parents / carer(s) and any other people who are involved in the day-to-day care of your child will be asked to carry out exercises, games and activities between our therapy sessions. We will support and teach you how to help your child move / carry out exercises during the therapy session so that you feel confident supporting your child at home. This will enable your child to progress on their physiotherapy targets. You are your child's best therapist. This is an extremely important part of the therapy. We need children to use and practice their new skills in everyday life.
Where will the physiotherapy sessions take place?
At the Child Development Centre (CDC). Sometimes we offer home and school/nursery visits, if suitable.
Please contact us via the CITS advice on 01895 488200 or email citsadmin.cnwl@nhs.net if you are unable to attend an appointment for any reason or want to discuss your appointment further.
What is hydrotherapy?
Hydrotherapy is the use of water in the treatment of different conditions. Hydrotherapy differs from swimming because it involves special exercises that you do in a warm water pool. The water temperature is usually 33–36 degrees Celsius, which is warmer than a typical swimming pool.
Exercises are carried out under the supervision and assistance of a physiotherapist. The exercises are adjusted to help range of movement or strength, depending on the symptoms.
Benefits of hydrotherapy
The physiotherapist will suggest hydrotherapy as an option as part of your child/young person's physiotherapy treatment.
Children/young people particularly benefit from physiotherapy after they have had botox injections or surgery or if they are unable to participate in land based exercises due to pain. The warm water can also be beneficial in relaxing muscles for children with spasticity (stiff muscles).
Whilst your child/young person is attending a hydrotherapy block, they will not be seen for land based physiotherapy sessions at the Child Development Centre.
When is hydrotherapy not advised?
All medical conditions should be disclosed to your physiotherapist prior to consideration for hydrotherapy. Hydrotherapy is contraindicated in the following situations, if the child/young person has:
- a fear of water
- open wounds
- a heart condition such as cardiac failure or resting angina
- shortness of breath at rest
- chlorine sensitivity
- acute diarrhoea/ vomiting/pyrexia
Before the hydotherapy session
Prior to hydrotherapy your physiotherapist will set joint goals with the child/young person and their parents/carers. These goals will be reviewed after the hydrotherapy block has been completed. Parents/carers will also need to sign a consent form and fill out a short medical questionnaire for their child/young person.
What will happen during the session?
On arrival at the pool you will be met by the physiotherapy assistant who will orientate you to the pool and changing rooms. Your child/young person will then need to get changed into their swim suit.
Once both the child/young person and therapist are ready, your child will be asked to get into the hydrotherapy pool.
The pool is accessible with a shallow ramp and different depths of water. For children/young people unable to step into the water there is a wheelchair available that a child can be transferred into and then wheeled into the water. Usually parents/carers are encouraged to come into the water to observe the session and better understand how they can support their child in the pool environment. However, if this is not possible parents/carers can observe the session from the side of the pool. Parents or carers should remain in attendance throughout.
The pool is accessible and has small steps into it and different depths of water. For children/young people unable to step into the water a chair hoist is available to use. Parents/carers can observe the session from the side of the pool and should remain in attendance throughout.
Hydrotherapy sessions last 20 minutes and your child/young person will be with a qualified physiotherapist for the duration of the session. The therapy session will be carried out working on your child/young person’s own individual goals and will be tailored to their needs.
Some hydrotherapy sessions may be in the form of a group with multiple children in the pool at the same time with a qualified physiotherapist in attendance. If invited to a group session your physiotherapist will talk through this with you prior to the session.
At the end of the session your child/young person will be supported to get out of the pool (if required) and they can then use the changing rooms to get changed.
What do I need to bring to the session?
- Their swim suit
- Their towel
- A drink for after the session is finished as the pool area can be warm
Where are the sessions held?
The hydrotherapy pool is based at the Jubilee Pool at the rear of Hillingdon Manor School (Harlington Road, Uxbridge, UB8 3HD). Sessions take place on a Monday morning.
Unfortunately, there is no parking on site. Please consider coming on public transport if possible. The nearest bus stop is Lady Craig Court and Barwick Drive which are both served by A10, U4 and U7 buses. Alternatively, Hillingdon Hospital is a short walk away and it may be easier to park and walk if you and your child are able to.
What is Cerebral Palsy?
Cerebral Palsy (CP) is the term used for the physical disorder caused by brain injury or dysfunction occurring before the age of two. There are many different causes of CP and the degree of functional impairment varies in each child from nearly normal function, to pronounced functional impairment.
Children with CP often have increased tone (spasticity) in certain muscles while other muscles may be weakened. This can interfere with children’s ability to move and to learn to walk. Spasticity can also cause pain, and, over time, shortening of muscles and tendons. When joints do not move normally they become permanently stiff because the soft tissues tighten around them (known as a contracture).
In some children, the imbalance in the hip joint can lead to pulling of the head of the thigh bone out of its position in the hip joint leading to hip dislocation. Imbalance in the back, can lead to a curved spine or scoliosis.
There are many different treatment methods to decrease spasticity and to prevent contractures and hip dislocation. These may include exercise or stretching and positioning programmes from your physiotherapist, the use of splints during the day or at night or drug treatments to reduce the tightness in muscles. This does not describe all the treatments available. It is very important that the right treatments are available at an early stage to help prevent problems developing in order to achieve the best possible outcome.
What is CPIP?
CPIP is a follow-up programme for children with cerebral palsy or suspected cerebral palsy, allowing early detection of changes in muscles and joints with the option of earlier treatment for your child.
What is the purpose of CPIP?
The purpose of CPIP is to make sure that children with risk of developing
contractures or hip dislocation are detected early enabling timely intervention.
The goal is that no child should be affected by severe contractures or hip
dislocation and that every child should achieve the best function possible.
Research has shown that x-rays of the hip taken at the right time can help us to spot this problem earlier – and take steps to reduce the chance of it getting worse.
The follow-up within CPIP involves the child’s physiotherapist who will make an assessment of the child’s muscle tone, joint motion, ability and function twice a year until the child is aged six. After that, an annual assessment is made until the child reaches adulthood. These assessments help the physiotherapist decide how often your child needs to be seen for treatment and what treatment options are best for your child. Regular assessment and early treatment combine to improve outcomes.
X-ray
Children with CP should have an x-ray at two years of age. If your child is mildly affected, you can expect one further x- ray aged six years. For those more severely affected there will be annual x-rays until age eight years and then every other year. This is because there is a greater risk of dislocation in more severe cases. All children will be invited for a final x-ray at age 16.
How successful is CPIP?
Children treated under a similar programme in Sweden experienced significantly fewer hip dislocations. Significantly fewer children from this group developed contractures and scoliosis through participation in the programme. There was also a decrease in the number of major orthopaedic operations performed for hip dislocation and the cooperation between the different specialists involved in the care of children with CP improved.
Participation
All the information from the CPIP assessments is stored in a secure NHS database. We can learn from experiences across Scotland to improve care in the future. The child’s community paediatric team and doctor are able to get a CPIP report, showing the child’s development over time and give warning signals showing when there is a need for intervention. This is fundamental in order to initiate the right treatment at the right time for each individual child.
Only anonymised information (that cannot be traced to you or your family) will be used in research. This means that a single child will never be identified when experiences from this follow-up programme are compiled into general reports. By carrying out research on the information available in the CPIPS database, we can improve our knowledge regarding changes over time in different types of cerebral palsy. The different treatments can be compared as to how they affect final outcome.
Further Information
For more information regarding CPIPS, please contact your own physiotherapist or orthopaedic surgeon.
Contact details
Children’s Integrated Therapy Service (CITS)
Phone: 01895 488 200
Lines are open Monday to Friday (excluding bank holidays)
9am to 5pm
Email: citsadmin.cnwl@nhs.net