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BSO Outreach: 1st Place Parents and Children's Centre, Southwark

The BSO has run a weekly osteopathy clinic for children aged 0-5 years at the 1st Place Parents and Children’s Centre since 2007. The centre is situated near Southwark’s Aylesbury Estate, in an area that has experienced great social disadvantage and exclusion.

The first patient of the day comes in and heads straight for a box of toys and books in the corner. He sits on the floor exploring its contents, immediately oblivious to everything else in the room.

In an instant, he has demonstrated one of the first challenges of providing osteopathic care for children: BSO community clinic tutor Andrea Rippe and his mother have a quick discussion about whether he’ll tolerate lying on the treatment table for treatment.

In fact, he’s very calm as Andrea begins work. Unlike some of this clinic’s young patients, he doesn’t wriggle about, squirm or kick. His mother reads a story book to him, showing him the pictures by holding the book over his head as he is treated.

As she treats him, Andrea is assisted by two senior BSO students. Because of the particular approaches needed in treating children, this BSO outreach clinic is a demonstration experience for the students. They don’t have their own patient lists, but instead they assist, learn from and work with either Andrea Rippe or her fellow community clinic tutor Anna Scullard, who both have specialist experience in paediatric osteopathy.

There’s an ongoing dialogue between Andrea, her students and the little boy’s mother about what she is doing; what’s she’s aiming to achieve and things to be aware of when treating a child who, like this little boy, has been diagnosed with a condition which causes hemiplegia. This means that he has difficulty controlling muscles on the left side of his body, affecting his gait and use of his left hand and arm. He has recently had an MRI scan to discover more about his condition.

Andrea and her team agree to a short break in treatment, so that the little boy can choose some new toys and books to keep him interested. Then they resume gentle stretching techniques.

“I like bringing him to this clinic,” says his mother. “As well as treatment, they give me lots of advice: I can ask about practical things like what sorts of shoes to buy for him. I’m trying all the alternatives available for him: at this clinic I think they are helping him.”

1st Place Parents and Children’s Centre is situated in the shadow of the Aylesbury housing estate. Bright, clean, modern and colourful, it offers a range of services including a drop-in club for parents and toddlers, a weekly fathers’ group and a range of different opportunities for parents around child development, returning to work and other subjects. The centre also has a range of statutory and voluntary organisations offering health services other than osteopathy, such as health visiting, midwifery, family support, support for children with special needs etc. This is part of the enhanced Children’s Centre services on offer in the borough of Southwark, which aims to offer a wider range of approaches for parents to meet their children’s needs in addition to visiting their GP. The borough’s health visitors were involved in setting up the BSO’s weekly osteopathy clinic , and it is the health visitors who refer children to it.

“The BSO’s outreach clinic at 1st Place makes treatment available to a completely different population, who may never have heard of osteopathy or contemplated non-medical intervention for their children’s treatment,” says Andrea Rippe.

“The 1st Place centre is here for everyone, but our target audience is one that might not engage even with the statutory health services that you and I might take for granted. That might be because of language difficulties, cultural differences or previous experiences which they have had – they may not be accessing or actively avoiding mainstream services. We reach out and offer a slightly different entry point to engage them with basic services,” continues Nicola Howard, director of 1st Place. “With the weekly osteopathy clinic, we’re reaching out to families for whom there might otherwise be a financial barrier to accessing osteopathy: this weekly clinic is free.”

Whilst Andrea prepares to see her next patient, Anna Scullard and the students who are working with her greet a mother and two small daughters. One of the students immediately gets down on the floor, reading to and playing with the older girl, so that Anna can find out more about her sister’s condition. As Anna works on the girl’s stomach and back, she also gives her mother practical advice about the importance, with young children, of regular exercise and establishing daily routines such as toileting.

The mother accepts Anna’s tips gratefully. She is heavily pregnant with her third child and is finding everyday life with a young family increasingly tiring.

“It’s so helpful that this osteopathy clinic is available at the 1st Place Centre, just around the corner from where we live,” she says. Echoing the experience of so many other families during the recession, she also mentions that redundancy has made it a tough year for them, including financially.

“Working in this clinic is a real privilege particularly because the service we provide is free for the community,” adds Anna Scullard. “It is a huge relief for us not to have to consider the financial implications of a course of treatment when managing a child's condition.”

Free treatment is an obvious benefit for patients using this weekly BSO outreach clinic, but what are the benefits to senior BSO students who attend it?

“The holistic approach to healthcare is much more immediate in paediatric osteopathy,” explains Andrea Rippe. “Paediatric patients reflect more immediately their internal and external environment – their ‘reservoir of compensation’ to buffer life stressors is much smaller than most adult patients, so altering one aspect of their world can have substantial repercussions for their health status. This outreach clinic also reinforces the importance of observation as well as clinical testing, and the importance of environmental factors on health of babies/children.”

As well as needing to use very different approaches to treatment from those the students are learning in their everyday contact with adult patients at the BSO, the children attending this outreach osteopathy clinic are attending with very different complaints – such as cerebral palsy or developmental delay – thus providing students with understanding of the edges of the range of ‘normal’. This all firmly underpins many of the principles of the bio-psycho-social model of health.

“Equally as importantly, the students are able to observe the varying cultures, ethnicities and socio-economics of the patients presenting to 1st Place and how that might influence the family dynamics, expectations of the child and interactions with the child,” says Anna Scullard. “They can see first hand how this may influence health and development in those very important early years.”

“I like working with patients who come to the BSO’s outreach clinics which are based within the NHS, like this one at the 1st Place Centre,” says final year student Paul Johnson. “We get to see very different patients here. They often know very little or nothing about osteopathy before they come to us, so you learn a lot about how to talk to them and to communicate what they can expect, what you are doing and so on.”

Another patient arrives. His mother speaks limited English, so his father is translating what she is saying as they start to explain what’s wrong with their small son.

“For the BSO’s weekly clinic here at the centre, we get good take-up and good feedback. It is very rare that people don’t show up for their appointment,” says Nicola Howard. “We’re also finding that the clinic is being accessed by both families using our nursery as from the wider reach area– they can have a chat with a health visitor who can then make the referral.”

As she finishes working with a chirpy toddler and prepares for her next patient, a newborn baby, Andrea Rippe sums up:

“Anna and I both get so much from working at this clinic. It’s about the opportunity to offer treatment to people in my local community; the lovely atmosphere at 1st Place; the feedback from patients; the excitement of students as they learn and make discoveries about paediatric osteopathy and, most of all, the chance to make a real difference to people's lives.”

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