Introduction:Parent/carers of disabled children want timely and personalized support. Research suggests that technology may address some limitations associated with traditional methods of communication with therapists (e.g. letter, telephone). This exploratory study examined United Kingdom (UK) parents and carers views on the use of digital technology (i.e. computers/phones) in supporting their child and the potential for its greater use in the care of children with complex needs. Methods:An online survey was distributed via special schools and support forums/networks. Questions explored use of and attitudes to digital technology in the care of children with complex needs. Descriptive statistical analyses and content analyses were undertaken on the data. Results:Respondents were 43 parents/carers whose children used rehabilitation services prior to the COVID-19 pandemic. The majority used digital technology frequently to support their child and saw the potential for greater use in rehabilitation services - provided this was not at the expense of in-person therapist contact. Conclusion:Parents and carers held positive views of digital technology as a tool to support their child and enhance rehabilitation services. Recommendations include regular service consultation on parental/child attitudes to digital service delivery and longitudinal studies to assess related health outcomes.

Objective Describe families’ experiences of interventions to improve continence in children and young people with neurodisability, and health professionals’ and school and social care staff’s perspectives regarding factors affecting intervention use.Design Four online surveys were developed and advertised to parent carers, young people with neurodisability, health professionals and school and social care staff, via societies, charities, professional contacts, schools, local authorities, and national parent carer and family forums, who shared invitations with their networks. Survey questions explored: difficulties helping children and young people use interventions; acceptability of interventions and waiting times; ease of use and availability of interventions, and facilitators and barriers to improving continence.Results 1028 parent carers, 26 young people, 352 health professionals and 202 school and social care staff registered to participate. Completed surveys were received from 579 (56.3%) parent carers, 20 (77%) young people, 193 (54.8%) health professionals, and 119 (58.9%) school and social care staff. Common parent carer-reported difficulties in using interventions to help their children and young people to learn to use the toilet included their child’s lack of understanding about what was required (reported by 337 of 556 (60.6%) parent carers who completed question) and their child’s lack of willingness (343 of 556, 61.7%). Almost all (142 of 156, 91%) health professionals reported lack of funding and resources as barriers to provision of continence services. Many young people (14 of 19, 74%) were unhappy using toilet facilities while out and about.Conclusions Perceptions that children lack understanding and willingness, and inadequate facilities impact the implementation of toileting interventions for children and young people with neurodisability. Greater understanding is needed for children to learn developmentally appropriate toileting skills. Further research is recommended around availability and acceptability of interventions to ensure quality of life is unaffected.

BACKGROUND Children and young people with neurodisability often need help to achieve socially acceptable bladder and bowel control. Approaches vary depending on whether or not the impairment results from spinal cord pathology that impairs motor control and sensation of the bladder and bowel. Currently, there is uncertainty about which interventions are effective. OBJECTIVE The objective was to summarise the available evidence on and current practice for improving continence in children and young people with neurodisability. DESIGN A systematic review of the effectiveness, cost-effectiveness and factors that modify intervention implementation, alongside a cross-sectional, online survey of current practice with health professionals, parent carers, school and care staff and young people with neurodisability. RESULTS Twelve databases were searched in the review, resulting in 5756 references; 71 studies (72 papers) were included in the analyses. Most of the evidence was for children with spinal cord pathology, which involved evaluations of pharmacological approaches and surgical techniques, whereas the evidence pertaining to those with non-spinal-cord-related pathology tended to be for behavioural interventions. The methodological quality of studies was rated as being moderate to poor. There were three robust qualitative studies about the experience of continence among children with spinal cord pathology. We found substantial heterogeneity across the interventions that we evaluated in terms of quality, study design and outcomes measured. No economic studies were found. The results were synthesised narratively and reported in text and tables. We did not find any eligible studies evaluating interventions using toilet and clothing adaptations in the review, although the survey highlighted that these types of interventions are frequently used and considered. In total, 949 people responded to the survey: 202 health professionals, 605 parent carers, 122 school and social care staff, and 20 young people. The survey results illustrated the different roles that professionals have in improving continence, highlighting the importance of a multidisciplinary approach to supporting children and young people and their families. Clinicians employ a range of assessments and interventions to improve continence or independent toileting, depending on the needs of the child. LIMITATIONS Quantitative studies in the review were not methodologically robust. The survey had a risk of response bias. CONCLUSIONS Our research found a dearth of good-quality evidence for many of the interventions currently in use, and no evidence of experiences of implementing interventions for children with non-spinal-cord-related pathology. There was also no evidence of cost-effectiveness of any of the interventions. FUTURE WORK There is a need to involve young people and families in the design of high-quality evaluative research for interventions that aim to improve continence. This is especially the case for children with autism and learning disability, who have been neglected in previous evaluative and qualitative research. We recommend better training for health, education and care professionals about toileting, informed by evidence and the lived experiences of children and their families. We recommend a joined-up multidisciplinary and holistic approach to improving continence to maximise independence, dignity and comfort. It is vital that children and young people with neurodisability have early access to regular, integrated assessment of their bladder and bowel health, and are fully supported with appropriate personalised treatment. STUDY REGISTRATION This study is registered as PROSPERO CRD42018100572. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 73. See the NIHR Journals Library website for further project information.

This book has been designed to provide educators with practical strategies and approaches to support the motor and coordination development of children within an educational setting. Difficulties with movement and coordination can significantly affect participation and learning, in Early Years settings and schools, but many of these children can be supported through changes to their educational environment, or the implementation of universal strategies. This invaluable resource demonstrates how professionals can positively impact on children’s educational progress, outcomes and social participation. This book: Combines perspectives of occupational therapy and special educational needs, using evidence-based research to provide professionals with the knowledge and confidence to enhance quality first teaching skills for all children, in all settings. Promotes inclusion and participation in activities that affect pupil progress, such as handwriting, self-care, lunchtime, physical activities and play. Offers a range of activities, tips and guidance to help improve progress and academic achievement for all children. Taking a holistic approach to early learning and teaching, this is a vital resource for teachers and trainee teachers, teaching assistants, SENCOs, student occupational therapists and all practitioners working in Early Years settings.

This article describes an evaluation of universal resources designed to support motor development in Reception and Year 1 children. Four schools (Year R-Year 6) in the South East of England, three with high numbers of disadvantaged children participated. Senior leadership influenced take up of the initiative. Health and wellbeing practitioners and occupational therapy students contributed to 'roll out' of the resources with support provided by the authors over 12 weeks. Interview and focus group data from participating staff were gathered alongside examples of schoolwork from pupils. School staff needed access to support when incorporating universal strategies. The initiative contributed to schools working towards Healthy Schools targets. At the end of 12 weeks, improvements in children's sitting position, handwriting and lunchtime skills were noted, warranting further exploration of this approach to address the needs of children with poor motor skills at school entry.

This report describes the evaluation of POSTED (Postural Care in Education) Train the Trainer workshops. The workshops, delivered at Canterbury Christ Church University, Centre for Work Based Learning (2016-2017) are part of the dissemination of original research arising from an NIHR Research for Patient Benefit study. Funding to support the evaluation was available through a Higher Education Innovation Fund award from Canterbury Christ Church University (2016-17). POSTED is a ‘Train the Trainer’ intervention. Children’s occupational therapists and physiotherapists attend a one day POSTED training workshop that equips them to deliver an evidence based training intervention to parents and teachers who manage the postural care needs of children at home and school. The training package builds the knowledge, confidence and skills of parents and carers in postural care. The training has been evaluated and found to be effective in increasing knowledge and confidence and reducing the concerns parents and teachers have about postural care for their child (Hotham et al 2017, Hotham et al 2015).

BACKGROUND:Parents and school staff lack knowledge and confidence when providing postural care to physically disabled children. This can act as a barrier to the successful implementation of therapy. To address this problem, we developed a novel training programme to improve knowledge and confidence in providing postural care and evaluate the impact of the training programme in parents and school staff. METHODS:The postural care training programme included three elements: a 2-h interactive workshop facilitated by physiotherapists and occupational therapists, a follow-up home/school visit and a follow-up telephone call. The Understanding, Knowledge and Confidence in Providing Postural Care for Children with Disabilities questionnaire was utilized to evaluate the impact and includes subscales assessing knowledge and understanding, concerns and confidence in providing postural care. The Understanding, Knowledge and Confidence in Providing Postural Care for Children with Disabilities questionnaire was completed at baseline and 6 weeks later. The training programme was delivered to N = 75 parents and school staff. Of these, N = 65 completed both baseline and follow-up measures and were used in the data analysis. Participants and therapists were also invited to provide further feedback on the overall training programme via interviews and focus groups. RESULTS:Paired samples t-tests were used to determine statistically significant differences between baseline and follow-up scores for each of the three subscales. Mean levels of understanding and knowledge and confidence improved (P < 0.001), while concerns decreased (P < 0.001). Qualitative data were collected via interviews and group discussions providing an in-depth perspective on how participants experienced change. DISCUSSION:Results suggest improvement in knowledge, understanding and confidence in parents and school staff that care for children with significant physical postural care impairments.

Abstract Personalised budgets are promoted as the person-centred alternative to generically provided services. Nine parents/carers of disabled children (aged 18 years or younger) who accessed at least two rehabilitation therapy services (physiotherapy, occupational therapy, and speech and language therapy) were recruited from one region in England. Focus group/interviews explored their views on the proposed introduction of personalised budgets. Parents and carers viewed a personal health budget with caution and perceived benefits were tempered by their experiences of current provision. Concerns were raised about entitlement and how a personal budget would work in practice.

Personalised budgets are promoted as the person-centred alternative to generically provided services. Nine parents/carers of disabled children (aged 18 years or younger) who accessed at least two rehabilitation therapy services (physiotherapy, occupational therapy, and speech and language therapy) were recruited from one region in England. Focus group/interviews explored their views on the proposed introduction of personalised budgets. Parents and carers viewed a personal health budget with caution and perceived benefits were tempered by their experiences of current provision. Concerns were raised about entitlement and how a personal budget would work in practice.

ABSTRACT Children with Down Syndrome typically experience difficulties with attention to task and lack motivation when learning to write. This article provides an evaluation of the HWT (Handwriting Without Tears) method applied as an intervention to promote handwriting among children with Down Syndrome attending mainstream school in the Republic of Ireland. In the absence of standardized measures, a purpose-designed HWT group task participation scale and pre- and postintervention teacher/parent questionnaire were developed by the first author and used to investigate the participation of 40 children with Down Syndrome in HWT activities. Positive changes in participation in HWT activities were recorded in group data and in teacher/parent reports. Tentative findings suggest that hands-on multisensory learning approaches such as HWT may encourage children with Down Syndrome to participate in activities that promote handwriting skills. Further research and the development of robust measures to evaluate handwriting intervention for this population of children is required.

Participatory research, user involvement, consultation, co-production, and service user participation are terms and approaches that ensure the beneficiaries of research shape how it is developed and conducted. While such approaches are accepted practice there is little guidance for researchers on how to conduct such activities with parents/carers of children with complex health needs. Using insights from a series of consultation activities, the authors explore ways to work effectively with parents/ carers when care responsibilities and other constraints may restrict or limit their ability to participate. We defined children with complex needs children as those who use two or more therapy services (Occupational therapy, Speech and Language Therapy and Physiotherapy) on a regular basis.

This article makes the case for increasing the reach and the impact of children's occupational therapy in the United Kingdom, through inclusion of universal and targeted services alongside specialist provision. It is proposed that achieving a greater balance between these different levels or tiers of provision can promote the health, well-being and participation of all children, including those with additional needs. During a time of austerity, we argue that a broader offer also distributes finite public resources more effectively – potentially reducing pressure on scarce specialist resources. Sustainable options for meeting greater population need are proposed and occupational therapists are encouraged to evaluate the effect of changing the balance of provision to inform future commissioning.