Problems

• Increasing waiting lists leading to not meeting Key Performance Indicator (KPI) of 8 weeks waiting time

• Complaints with regards to therapy provision.

• Poor engagement with therapy from some families

Intervention A new pathway was designed which included:

• A structured cyclical multidisciplinary assessment clinic

• Post-diagnostic coaching conversations with parents using the GROW model (Goal, Reality, Options, Wrap-up) and tools such as life wheels to determine family-centred goals

• Parent education programmes including a new programme (called My C. H. I. L. D. – Communication, Health, Independence, Learning and Development) and Intervention incorporating coaching

• Multidisciplinary review through team planning days to coordinate care

Strategy for Change To manage increasing caseload sizes, two strategies were implemented to achieve effective outcomes:

• A parental coaching approach involving supporting families to identify goals for intervention, solve problems and develop their own plans under therapists’ guidance.

• The multidisciplinary team was inspired by the successes of the local Earlybird programme to develop the My C. H. I. L. D. programme to empower and educate parents (of children with disabling conditions other than autism) through a series of interactive and practical workshops. In February 2015 Care Quality Commission inspectors gave the My C. H. I. L. D. programme specific mention as an area of good practice.

• Team planning days are arranged three times a year to facilitate discussion around intervention based on the family’s priorities and child’s needs.

Effects of Changes

• Children have been seen within 8 weeks of acceptance, enabling the KPI to be met.

• Co-ordinated multidisciplinary assessments, resulting in diagnosis over 6 week period.

• Parent programmes and Team Planning days assist clinicians in managing larger caseloads.

• An Evaluation Report is written after every My C. H. I. L. D. programme. Parents have provided very positive feedback through post-programme questionnaires. All families have feedback that they agree/strongly agree that they feel more confident to meet their child’s needs since attending the programme.

• There has been a 66% reduction in complaints compared to previous year.

• Initial impressions are that there is better parental engagement through family driven goal setting and empowerment. Future research will include investigating transformational learning related to this new pathway.

Message for others It is possible in these times of austerity to manage increasing numbers of referrals while maintaining quality of care. Adopting family-centred practices including coaching and parent education programmes has enabled participation of children and their families.