Barriers to sport and physical activities for children with special health needs are being removed, explains Helen Sugden

A range of sports and physical activities are being prescribed by paediatricians and school nurses as part of the strategy to treat the special health needs of children with autism, diabetes, low self-esteem and attention deficit disorder.

The project, Young Persons' Positive Moves, started in September 2006 and forms part of the Changing Lifestyles sports and physical activity strategy for the borough of Gedling in Nottingham. It builds on the success of a GP referral service for adults, running in Gedling since 2003. The exercise 'prescriptions' are selected from a range of activities designed to be beneficial, fun and an introduction to physical activity. Thirty-eight young people aged eight to 16 have taken part so far.

The scheme is a joint initiative by Gedling borough council, Nottinghamshire County teaching primary care trust and Gedling Schools Sports Partnership. It recently won funding to continue for a further year.

The team that set up YPPM looked closely at the barriers that might be expected for children with special health needs wanting to participate in physical activities. These include:

  • difficulty accessing buildings and equipment;
  • lack of appropriate transport;
  • the need for a higher coach to child ratio;
  • family feelings that their child's participation is unwelcome;
  • institutions believing that special health needs can only be addressed through separate, costly activities.

Nottinghamshire County teaching PCT consultant paediatrician Dr Emma Filmore says: 'A physical activity-based project such as YPPM addresses some of the young people's health needs not previously met in any health provision.'

It began with 14 referrals for young people with a range of conditions. Activities have included football, swimming, gymnastics, dance and sessions in a purpose-built youth gym. All staff involved are experienced in working with young people with special health needs, and have been given training by the paediatric team when necessary.

Family friendly

Young people can take part in as many or as few activities as they wish, and are encouraged to bring along a friend or family member to take part with them. Young people and their families can use the programme for two school terms.

Daniel Thompson-Dixon, aged eight, was referred by a paediatrician for autism and a weight problem. He has been taking part in football, dancing, swimming and youth gym. His mother, Ingrid Dixon, says: 'I can see he is getting good exercise and he always wants to go. It has given him motivation to keep going with exercise. He gets on with some others on the course but continues to have clashes of personality at times. His older brother Tyrone also goes to the programme to support his brother.'

Louise Reeve describes the experience of her son Lewis, who is eight: 'Lewis was referred by a paediatrician because he finds it difficult to make friends and has behavioural issues that cause him anger.

'The paediatrician felt that being able to let frustration and anger out in sport would help to build up his confidence. Lewis goes to football on Mondays and youth gym on Sundays. There's still a long way to go but it has been very positive.

'All the children on the programme have some problems so everyone gets support from everyone else,' Ms Reeve adds. 'If you went to a 'normal' gym you might be criticised by other parents, but in this case no-one is judged on ability or behaviour.'

A celebration event held at the end of every term provides an opportunity to recognise the success of the young people and capture their thoughts and comments, along with those of parents, carers, coaches and referrers.

Netherfield Boys and Girls Football Club development officer Mark Flynn, who has coached some of the children on the programme, says: 'I have noticed that the activities have lifted their confidence and self-esteem no end. Some children are very reserved at first, but you can tell within a few weeks that they are starting to talk and work with each other. Once they realise that there are no barriers, they start to relax and benefit from the teamwork and company of others. We have offered places in our club to some of the children.'

Feedback has shown that ensuring health professionals are involved in the training of YPPM coaches has given families and children confidence that their specific needs are able to be met. It also shows that the confidence of the young people involved has grown as a result of taking part.

On the MEND

Parents and carers have taken the project a step further by forming a community group, Positive Moves Extra, which provides follow-on activities. The group came about because many of the young people finishing their time on the programme wanted to carry on. Group members are currently trying to secure funding to help sustain their activities.

YPPM is not a weight-management programme, although some young people attending might be obese. A second programme aimed at weight management is currently being developed - Mind, Exercise, Nutrition - Do it!, or MEND. Nottinghamshire county council and Nottinghamshire County teaching PCT have got funding to deliver MEND in Gedling over two years. The programme will start in October this year and offer a nine-week course of physical activity, nutritional support and behavioural therapy for young people and their families. Afterwards, the children will have the chance to move on to a YPPM programme.

A great deal of evaluation of weight-management programmes for young people has been carried out, but far less has been done for programmes aimed at children with special health needs. One of the next steps for YPPM is to get funding for a formal evaluation. The project managers hope that a robust evaluation backing up our initial positive findings would help the programme to be replicated regionally and nationally.

Helen Sugden is exercise and promotions officer at Gedling borough council.