OT on the Road

Aaron Preston, the founder of The Great Little OT Practice, tells us about a project he took on last March to deliver OT to children in the Scottish Highlands

Can you explain a little about your practice and

the changes you have had to make during the pandemic?

The Great Little OT Practice is a family-owned, independent OT practice based in North Essex. We focus exclusively on the treatment of children and young people and our passion is helping young people to be as independent as possible. We are able to provide comprehensive OT support to children with various conditions ranging from mild delay through to complex brain injury and autism. I set the company up in 2018 and we have gone from strength to strength, meaning that we have been able to expand the service we offer as well as the team we have in place. We now have me and three additional professionals. Nobody could have predicted the scale of the pandemic and it seemed to hit all sectors hard almost immediately, this was certainly not what I had anticipated within the first two years of practice. The very nature of our practice means that we are working face-to-face with some of the most vulnerable young people in society. Face-to-face therapy stopped overnight and we had to think very quickly around how we could continue to support these families at arm’s length throughout the first lockdown. We were able to switch our business model to a virtual one within a few days, this enabled therapy to continue for some of the families and meant that as a business we were able to ride out the lack of income which lasted for almost four months. The virtual model is not suitable for all children and it requires a confident person at the other end of the lens to facilitate instructions as well as additional planning and materials from the OT. Those that did engage well continued to make progress, it also provided a valuable link during what was and still is a challenging time for everyone. Our return to work in June was littered with confusion over PPE, risk assessments, dilemmas over what equipment we can and can’t take, but we found our way through and have been back successfully seeing families again which has been amazing. Our earlier experiences with virtual working during the first lockdown meant that in lockdown 2.0 we were able to refer back to that model as well as see those families that were happy to have us visit them in their homes.

How did your work in the Scottish Highlands come about?

Being my own boss has led to various things that I never thought possible, the one I am most proud of is the links we now have with the Scottish Highlands. Last year I was contacted via my social media pages by a daily from Inverness. They had already had a physiotherapist and conductive educator travel up to offer an intensive week of therapy for various children with additional needs, and wondered if this is something I would consider. I had never done anything like that before, it sounded exciting but slightly worrying at the same time! What would I need for the week of intensive therapy 600 miles from home with children I have never met before? How would I manage to deliver it? Obviously, I jumped at the chance and my first trip up there was in March 2020, just before the country went into lockdown.

Can you explain the project and the patients you have been working with?

The project has now led to a return trip which I will be completing at the end of November. I see this as a long-term investment into helping these families in the Highlands. The Scottish Highlands is such a vast area and local services, despite their amazing work and best efforts, are simply unable to deliver the intensity of treatment that so many of these children need. During my time there I am able to work with a range of children with complex needs, this includes varying types of cerebral palsy, autism, ADHD, developmental delay, Retts syndrome and many more. I take a holistic approach to treatment which incorporates direct therapy, environmental assessment, equipment assessment/ advice and training support to the parents. It sounds a lot, but the benefit of an intensive week is that we have the time to make real progress across many areas, and in a short space of time. I take with me a car packed full of kit ranging from electrical stimulation devices, toys and consumables, weighted blankets and a pop-up sensory room. The Craigmonie Hotel in Inverness kindly let me use one of their function rooms for the week which enables me to set up a temporary therapy centre where the kids can come and have some fun. I would like to give a shout out to a charity called Dream Believe Achieve Highland. They work tirelessly to fundraise in order to provide grants to children in the highlands which they can then use to pay for some of their private therapies. Their ongoing support makes a real difference to these families.

What are the key outcomes/benefits for the children and families taking part?

The key benefits to the families initially are the intensity and variety of what I can offer over the course of the week. All therapy is goal-focused and agreed with the family before we start. This enables me to do some planning before I get there. The frequency of sessions within the week allows us to constantly review, evaluate and change as we go. A good example of this is with a patient called Lola, she came with strong food aversions and wouldn’t eat any vegetables. We broke down this barrier using structure play and by the end of the week, she was handling, cutting and eating vegetables. She maintained these skills once I had left. A longer-term benefit is the relationships built whilst I am there, you can’t achieve that with occasional visits. The children and families need to know you have trust in your ability to help them. I believe we can achieve that initially in the week and then when I am back in Essex they know they can always call on me for advice whenever they want. I continue to provide support via Zoom and social media in between my visits.

What have you taken away from the experience?

This is a hugely rewarding experience for me, I am passionate about my job and just the thought that I am now able to support so many families 600 miles from home is just amazing. Children never give up and we should not give up on them, I simply provide opportunities for them and their families to learn, and they always surprise us. I have always valued the importance of building a good relationship, taking the time to listen and understand is equally as important as the therapy I deliver and this is why I will continue to support these families in whatever they need, all year round.

Children never give up and we should not give up on them, I simply provide opportunities for them and their families to learn

I have recently returned from a week of intensive therapy up there which was fantastic, albeit delivered slightly differently due to the COVID-19 pandemic. This meant full PPE, temperature checks, risk assessments, an air purifier running all day in the room and fewer families to witness the progress as the week went along. I managed to cram a lot of things into my car for the journey, which meant I was able to set up quite an exciting pop-up therapy clinic within the Craigmonie Hotel (who provide a function room for free) inclusive of a large sensory room which went down a hit with the kids. It also meant I was able to accommodate treatment options for a wider range of kids, including Cameron who recently had spinal fusion surgery to correct his scoliosis, he has been unable to sit independently outside of his equipment for many years. During our second session, we gave him the chance and the correct base of support and he amazed us. This was the first time he had sat on his own for years and he loved it.

Is this something you anticipate continuing?

Absolutely, I will continue to travel and provide therapy for as long as they will have me. We already have two single week blocks planned for March and September this year which we are very excited about. For more information please visit thegreatlittleotpractice.co.uk.