thoughts on a Nursery with a unit with dedicated to provide therapeutic input?

[tinytalkt]

Hi all,
Im new to mumsnet. I work in a field related to special needs. I was keen on hearing your thoughts on opening a nursery (for all children) but with a unit that provides facilities for children who may have speech/language needs, occupational therapy needs etc. In this case therapeutic input could be provided within the school. additionally if parents have concerns they can be seen by a professional within the nursery. yes or no? would be great to hear your thoughts.

I would say that sounds fantastic but I'm not sure how many children who don't need the therapeutic services you would attract because surely you are going to have to charge above normal nursery rates to cover your costs.

That sounds like a wonderful idea. I would certainly be interested but I would be concerned that children without additional needs may be a bit sidelined. But u could see it being a wonderful thing for families with childreb where one sibling has additional needs but another doesn't. Ot children who have slight developmental delays within the normal range that parents are anxious about.

Yes yes yes

I have dc who needed intensive salt and social skills groups at this age. I tried so hard to find a nursery like this and since st Christopher place in London closed down I’m not aware of any nursery provision like this.

Christopher place used to do groups and classes where you could come with your child as well iirc

I would be very happy for my nt dc to go to a nursery like this - provided 50% of dc were typically developing so they could have necessary peer experiences

Thanks all thats super fantastic feedback.
Yes working in the field i know how hard it is for parents to balance work life, drop up pick up etc then also arrange for therapy sessions. This would cut that out.
I was thinking of having it as a 'typical' nursery, but just with this added benefit of having a professional onsite. ofcourse nursery fees would be the normal area rate, but additional charges will be made for those children who need the extra input, so as to be fair to all the parents.
Yes! inclusion is key and i come across so many parents who are worried to send their children to nursery because they're not sure how the staff, child will cope etc this would help I think.
Groups are a fantastic idea too, definitely would incooporate those as well as potential drop in clinics for those who want a chat with a professional for any concerns theyre having

Most kids in this position have a pt placement at the sn nursery for this input (alongside mainstream), or visiting slt/ physio/ OT at the mainstream nursery to provide therapy and advice to key workers for current therapeutic goals.
I suspect if you attempted to run a nursery with an sn unit alongside, it would very quickly just become an sn nursery, as demand far outstrips supply.
We had a nursery at our catchment primary which had very good sn provision. We were advised not to send dd2 there as she would not get what she needed in terms of peer / social relationships and academics. (Dd2 has cp w mobility and communication issues).
We have used all types of provision, to be honest. My least favourite was the sn placement alongside ms. It was essentially ‘just’ a therapeutic environment, not a nursery.
Dd2’s primary placement was fantastic. She was the first sn kid who required adaptations, which were made and they were fantastic. The 1-1 staff supported her to integrate. Within a year, the two intake classes (small school) were completely swamped with children with a high level of need, and so it became less a mainstream school that was accessible, and more an sn unit.
I welcome the idea of more mainstream facilities that can provide a therapeutic backdrop, but I don’t know how you prevent it becoming solely an sn placement. And that needs money... is it financially viable without govt funding?

Mamaryllis- fair point. I worry about that too- the inclusion aspect is what is motivating me to push for this idea. My aim would be to invite and incoporate children with mild-moderate needs - we're talking more language/speech delays, mild OT/physio needs etc. Would that be too restrictive? Or perhaps having only a few places for children with needs thus to ensure the ratio of 'typical' to sn stays at level that still provides the element of inclusion.

with pre-school I feel its a different piece of pie compared to ms- needs to academic ratio is not as high as the curriculum isnt as pressurizing and as intense and is more play focused which is the area of therapy i have specialised in.when it comes to ms, it gets more nitty gritty in terms of balancing the functional goals with the academic.

working alonside the NHS profesisonals, I feel with the recent cuts theres a huge gap in provision- preschool is the right age to provide intervention to ensure positive results before the child enters school where the gap will widen. given the waiting lists currently it seems we arent meeting this aim of providing intervention as early as possible. surely providing such provision will help?

I think there are so many kids like my dc. Mild needs and too mild for ehcp/ss but still needing lots of support and input - would be amazing if we’d had this

Also having nt kids there as well would make it even more beneficial for kids with sn - social role models etc

The more provision (and types of provision) the better. If you are limiting the ratio of sn to nt, and additionally limiting to mild needs, I think you will struggle to fund and utilise ft therapists. That’s not to say it’s not a great idea, but in terms of providing therapy, if the target group are those who do not qualify for support, how would you manage intake and determine need?
(I’m pondering how it would work in practice - if needs are great enough to require therapists on site for a small number of children, then you are likely to also need a higher staff to child ratio, which also raises costs).
How big a setting? I think running a big enough nursery with a small sn unit would work - In my experience these tend to deal with specific needs in the guises I have dealt with them previously eg hearing impairments. To employ physio, OT, SLT ft would be lovely but pricey. And if you go down the route of running a regular nursery but having professionals visit, that’s how most settings work - if you are employing those staff for a set number of hours pw, rather than having them ft employees, that might be a very beneficial way for parents to access private therapists without nhs waitlists - but still the issues surrounding how that cost is covered.
Have you run a budget to see what the numbers look like at different sizes?

Have you done the sums? Most nurseries offering a standard place are struggling to balance the books these days. I've got no idea how you'd make enough to fund specialist resources, never mind highly qualified staff. Most nurseries are struggling to make enough to pay the average nursery nurse and unless they're part of a chain, most nurseries don't make much of a profit, if any.

It's a great idea but I think if it was financially viable, it would already be much more common. However, if you could get it to work it would be great!

SALT is very pricey - we pay £70 for half an hour. OT is £100 per hour.

There are also many interventions staff could be trained to deliver without special qualifications eg ICan’s Talkboost, Bricks for Autism Lego Therapy. It would be great if staff could get onto a Hansen course - More than Words/It Takes Two to Talk, but they would be able to use the techniques in the books as they are designed for parental use even without going on a course. Those sort of things that could be done in any setting but often aren’t would be so valuable and as a parent I would be willing to pay a reasonable premium for them.

I wonder if SALT and OT with small kids having a career break would be interested in doing a few hours?

The problem with the ‘few hours’ model rather than having them on site is that it is essentially already offered free by nhs. Dd2 has SLT/ OT and physio visit nursery and work with her and her keyworker. We didn’t pay a premium - it was normal sn provision. The issue is the postcode lottery and dx aspect. If you are targeting children with mild enough needs to not yet be dx, they aren’t entitled to funding because they aren’t far enough on in the system - it’s a fine line between accessing private support and then having that discounted at EHCP.
Hmmm - op can you arrange to have a coffee with your local Inclusion Coordinator? There are usually five or six covering different settings in each area - they would have low down on the variety of settings already present, and might be able to offer some ideas wrt accessing funding (this is usually done at the individual cold level after the IncO assesses in setting - but they would know what pots of money are available - if any)

Mine got nothing Mama - always on the border. Not deaf enough to get teacher of the deaf? Not behaving badly so school not willing to allocate TA time, signed off nhs salt but private salt confirmed what I thought that he still needed help. If you are not causing trouble in classroom or fitting into the criteria you get nowt. I have met many mothers in my position

Totally - I understand that. (Ds1 is ADD/ ASD but was not a ‘problem child’ so not a priority for school to ensure he met his potential - it took until y5 for his teacher to strongly suggest we pursued private assessment and therapy as she recognized he was falling through the cracks and would be in danger of dropping out.
That’s really my point though - I think an inclusive ms setting will be virtually impossible to run, as it will be quickly overwhelmed by a very high percentage of children with very disparate needs, because they haven’t (yet? will ever?) been assessed as meeting the threshold for funding. So it won’t be financially viable. It’s really hard.
Of course, every setting should have well trained staff who are able to implement a number of different interventions commonly used in the sn community - but training and retaining them with financial security is also costly.
On the whole though - as I said, the more provision the better - I’m just trying to figure out the best approach to ensure the business is on secure financial footing (and I hope the op is able to figure that out).

FWIW, I’ve always turned in the other direction - I’ve been on the boards of several different pan disability children’s charities and not for profits which provide extra-curricular opportunities for kids and youth with disabilities. This means we can offer therapeutic, sporting, and social sessions to a wider range of children. They are accessible to Low-income families as we rely heavily on grant-writing for both operational and equipment costs, keeping session fees low or free.
I know how hard it is to balance the books, and to try to apply an expert level of therapeutic provision to a ms childcare setting will be hard. I really hope it’s possible. Every child helped is a child helped.

(I should say we rely on grant writing, donations, fundraisers, and volunteers - it’s an expensive business )

Sounds very impressive Mama! I hope it didn’t sound as if I was having a go. Just wish I didn’t always have to fight so hard and dreaming of a better world!