PORTSMOUTH CITY COUNCIL

CHILDREN FAMILIES AND LEARNING

SAFEGUARDING

Procedure Number: 41/07/CF Title: CHILDREN WITH DISABILITIES - INTEGRATED PAEDIATRIC

OCCUPATIONAL THERAPY SERVICE

Date of Issue: 14/12/07 Effective Date: 31/01/08 Sector: Children’s Social Care Issuing Officer: Vaughan Tudor-Williams, Senior Manager,

Specialist Services Contact: Michael Henning-Pugh, Manager, Children With

Disabilities Team Procedures Cancelled: N/A Signed: Name: Stuart Gallimore Designation: Head of Safeguarding

* * PROCEDURE * *

YOU SHOULD ENSURE THAT:

• You read, understand and, where appropriate, act on this information • All people in your workplace who need to know see this procedure

• This document, if printed off Intralink, is properly filed in a place to

which all staff members in the workplace have access

• You are aware that only the version of the policy found on Intralink is guaranteed to be the most recent issue

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Purpose To make explicit the role of the Paediatric Occupational Therapy service that is integrated into the Children With Disabilities Team, and describe its relationship to the community-based Occupational Therapy Team located within the Portsmouth City Teaching Primary Care Trust (PCTPCT) To ensure the occupational therapy needs of children and young people with disabilities are responded to in a consistent and timely manner. Scope This policy applies to all children and young people between the ages of 0 to 19 years who require the services of an Occupational Therapist. This policy will provide guidance to all staff about the management of cases where there is a need for specialist input from the occupational therapy service.

This policy will be adopted and operated by all employees of PCC, but especially those located within CSC.

This policy has been formulated and agreed between CSC and PCTPCT. Policy This policy is issued to ensure that procedures are clear and readily available in a standard format, and to assist staff by setting out clear guidance, responsibilities and lines of accountability. Exclusions

• Children and young people who do not meet the eligibility criteria. • Children and young people over the age of 19 years. • Children and young people who are not ordinarily resident in

Portsmouth. References to legal, central government and other external documents

• National Association of Paediatric Occupational Therapy: Code of Practice

• Children Act 1989 & 2004 • National Service Framework: Standard 8 • Every Child Matters • Aiming high for disabled children: Better support for families • Chronically Sick and Disabled Children Act 1970 • Education Act 1996 • The Special Educational Needs and Disability Act 2001 • Housing Act 1989

Portsmouth City Council references etc

• CSC Eligibility Criteria Policy • PCTPCT Occupational Therapy Eligibility Criteria • Children and Young People’s Plan

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• SWIFT/ICS – SWIFT/Integrated Children’s Systems, the PCC client recording system

Abbreviations and Definitions

• PCC – Portsmouth City Council • PCTPCT - Portsmouth City Teaching Primary Care Trust • CSC – Children’s Social Care, a term used to distinguish what would

have been called Social Services or social work for Children and Families

• CYPP – Children and Young People’s Plan • ASC – Adult Social Care • ECM – Every Child Matters • Portsmouth 8 – the Portsmouth outcomes for children that pre-date the

ECM 5 • Intralink – PCC web site for corporate documents and information

Delegation All employees have a responsibility for implementing the policy within the locally agreed guidelines. Authority to vary procedure Head of Safeguarding

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CHILDREN WITH DISABILITIES - INTEGRATED

PAEDIATRIC OCCUPATIONAL THERAPY SERVICE

CONTENTS

1 Introduction 2 Purpose of service 3 Criteria for referral 4 Framework for referrals, assessments, and involvement 5 Case Management Responsibility Appendix 1: Criteria for PCTPCT Occupational Therapy Service Appendix 2: Standards and Criteria for Assessment and Provision of Equipment for Children to Use in Their Home

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CHILDREN WITH DISABILITIES - INTEGRATED

PAEDIATRIC OCCUPATIONAL THERAPY SERVICE

1 Introduction 1.1 Occupational therapy is a health related profession concerned with

improving a person’s occupational performance. In a paediatric setting, an Occupational Therapist deals with children whose occupations are usually as players, pre-schoolers or students.

1.2 The Occupational Therapist evaluates a child’s performance in relation

to what is developmentally expected for that age group. If there is a discrepancy between developmental expectations and functional ability, the Occupational Therapist looks at a variety of perceptual and neuromuscular factors that influence function.

1.3 Based on a knowledge of neurology, kinesiology, development, medical

diagnosis, and current research, the Occupational Therapist can select the children whose neurological factors interfering with learning and behaviour have the best potential for remediation through occupational therapy.

1.4 In order to promote a more integrated and co-ordinated service as set

out in recent legislation and guidance such Every Child Matters (ECM), the National Services Framework (NSF) and Aiming High, PCC employs a senior paediatric Occupational Therapist. Although an integral part of the Children With Disabilities Team, the Senior Paediatric Occupational Therapist also co-ordinates the Community Paediatric Occupational Therapy Team.

1.5 Within the Children With Disabilities Team, the Senior Paediatric

Occupational Therapist provides a point of contact for new referrals in situations where CSC staff have identified a need for occupational therapy input. These referrals are then taken to the Community Occupational Therapy Team for consideration and, where it meets the eligibility criteria, allocation for assessment.

2 Purpose of service

The purpose of the service is: • To give therapeutic advice and support to parents or main carers within

the boundaries of the child’s gross and fine motor development or perceptual difficulties.

• To address specific areas of physical difficulty.

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• To offer programmes of therapy that will encourage and facilitate the child or young person’s development and postural management.

• To loan equipment that will compliment occupational therapy

programmes.

• To identify the need for specialist equipment for use in the home, which may be supplied by other agencies.

3 Criteria for referral

The Paediatric Occupational Therapy service provides a service to:

• Children between the ages of 0-19 years who live within the catchment area of PCTPCT and PCC.

• Children who present with functional impairments that are inconsistent

with their other areas of function and development, and which affect their development, performance and independence in daily activities especially with regard to fine motor skills, pre-writing and handwriting skills, and daily living activities.

• Please refer to Appendix 1 for the criteria relating to specific care

groups.

4 Framework for referrals, assessments, and involvement 4.1 Where the need for occupational therapy input is identified, the worker

should in the first instance direct all such enquiries to the Senior Paediatric Occupational Therapist, who is based within the Children With Disabilities Team.

4.2 If it is agreed that the case would appear to meet the eligibility criteria for

the service, a formal referral will need to be made to the service. The referral can be made direct to the Senior Paediatric Occupational Therapist in writing or via e-mail.

4.3 Upon receiving a referral the Senior Paediatric Occupational Therapist

will acknowledge receipt within ten working days. At this point the referral will be recorded in SWIFT/ICS as a Profile Note, and the involvement of the Senior Paediatric Occupational Therapist will also be recorded in SWIFT/ICS.

4.4 The Senior Paediatric Occupational Therapist will take all new referrals

to the weekly allocations meeting of the Community Occupational Therapy Team. The referral will be prioritised against the service’s criteria, and a decision made as to whether the case is a high or low priority.

4.5 Upon allocation, the responsible Occupational Therapist will contact the

family to confirm receipt of the referral and give an indication of the likely waiting time as determined by the level of priority. If the wait for a service is likely to be a significant period of time, or the timescale is uncertain,

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the Occupational Therapist will maintain regular contact with the family to update them on progress.

4.6 During the assessment visit, the Occupational Therapist will outline the

role of the Occupational Therapist and explain how they may be able to assist the child or young person. A baseline assessment will then be completed to evaluate the child or young person’s physical, psychological and social needs using a wide range of assessment tools. This process will be completed with the input of the parent/main carer(s). An analysis of the respective findings will then indicate what, if any, further intervention is required. The primary emphasis is placed on overcoming functional difficulties that occur in daily life and which may present at home and/or school.

4.7 The Occupational Therapist may offer advice and recommendations in

respect of appropriate play and activities, to improve areas such as sensory, perception and the use of upper limb functioning.

4.8 They may also offer other advice, assess equipment needs or make

recommendations around suitable techniques in relation to issues such as:

• laying • seating • general moving and handling as appropriate • purposeful use of upper limbs and hand function • development of personal independence

all of which will be relative and pertinent to normal development levels, and in consultation with other professionals.

4.9 Any goals and/or treatment programmes identified during the

assessment will be given in writing to the parent(s)/main carer(s), where appropriate.

4.10 Treatment programmes may be initially delivered on a weekly basis to

establish techniques and reinforce home programmes, and will be reviewed at six weekly intervals, or as appropriate in consultation with the parent/main carer(s) within the first five years, and thereafter on a needs led basis.

4.11 Where the Occupational Therapist has identified a need for special

equipment to assist with seating or toileting, provision will be made for loan equipment. See Appendix 2 for details of the criteria for the provision of equipment to children for use in their home.

4.12 Where appropriate, the Occupational Therapist will also provide

information about, or refer on to, other agencies or professionals such as social care, schools, speech and language therapy, physiotherapy, portage, play specialists, treatment centres, special interest groups, or other professional therapists.

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4.13 The Senior Paediatric Occupational Therapist will also undertake liaison and assessment visits to any environment where the child's individual needs need to be considered including playschool, school, other treatment centres, and make recommendations for any necessary adaptations.

4.14 The Senior Paediatric Occupational Therapist will also prepare

Statement reports when requested. These reports will clearly state any need to be addressed within the school environment.

4.15 Transfer of occupational therapy responsibility and treatment will take

place as and when required (e.g. when starting or changing school), and will adhere to the reporting guidelines of the Community Occupational Therapy team.

4.16 A child or young person will be discharged from the Occupational

Therapy service at the point where the Senior Paediatric Occupational Therapist determines that the programme has remained unchanged for longer than three months.

5 Case Management Responsibility 5.1 For specific guidance on recording involvements in the client record

system, refer to the SWIFT guidance. 5.2 The Senior Paediatric Occupational Therapist’s involvement with a child

will be recorded as Community Occupational Therapist in the Involvements tab. If the child is not already an open case to a team within CSC, the Children With Disabilities Team will be recorded as the Key Team.

5.3 Although the Senior Paediatric Occupational Therapist may work with

some children who are already known to CSC, it is also likely that they will be involved with children who either do not require a service from CSC or who do not meet its eligibility criteria. In these cases there is no need for a social care referral to be opened on SWIFT.

5.4 Where there is already an open referral in respect of a child, the

Children With Disabilities Team will always be the Key Team, and the social worker or social services assistant will always be recorded as the Keyworker.

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APPENDIX 1

PAEDIATRIC OCCUPATIONAL THERAPY SERVICE

Portsmouth City NHS Teaching Primary Care Trust Introduction In the Paediatric Occupational Therapy Service we evaluate children’s physical, psychological and social needs using a wide range of assessment tools. Following the assessment, analysis of the results indicates what further intervention is required. The emphasis is on overcoming functional difficulties that occur in daily life and which may present at home or at school. Criteria for referral (please read criteria for specific care groups)

1. Children between the ages 0-19 who live in the catchment area for PCC and PCTPCT.

2. Children who present with functional impairments, which are

inconsistent with the child’s other areas of function.

Development and Performance in 1. Fine Motor Skills 2. Pre-writing and Handwriting Skills 3. Activities of daily living

CARE

GROUPS

REFERRAL INDICATED REFERRAL NOT INDICATED Group 1 Infants and children with Special Needs (0-5)

• Children with Physical Disabilities (PD) e.g. Cerebral Palsy, Spina Bifida, Erb’s Palsy etc. • Children with congenital abnormalities, which affect their development eg limb deficiency. • Children with Severe Learning Disabilities (SLD) • Children with Profound Multiple Learning Disabilities (PMLD) • Children with uneven pattern of development, with obvious deficits in the following functions:

▫ Postural-motor function eg weak

muscle tone ▫ Motor-planning function eg sequencing,

spatial orientation, imitation etc ▫ Fine motor skills ▫ Activities of daily living eg self-dressing,

self-feeding etc.

• Children without uneven pattern of development, though they could have mild to moderate learning disabilities. • Children with mild to moderate general developmental delay. • Autistic children with obvious deficits in sensory, perceptual and behaviour. • Children who present with Primary emotional and behavioural difficulties not related to any underlying dysfunctions. • Children who present with behaviour problems because of poor parenting skills and stress within the family dynamic.

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CARE GROUPS

REFERRAL INDICATED REFERRAL NOT INDICATED

Group 2 Mainstream school children with Specific Development Disorders

• Mainstream school children presenting problems in the following areas:

▫ Postural-motor function ▫ Perceptual function ▫ Motor planning function ▫ Fine motor skills ▫ Handwriting skills

• These children may have a diagnosis of dyspraxia, developmental co-ordination disorder, sensory integration dysfunction etc. • The key is the range of dysfunctions described above.

• Children with Dyslexia (unless the child presents dysfunction described under “Referral indicated”). • Children without uneven pattern of development, though they could have mild to moderate grade learning disabilities. • Children with general developmental delay. • Autistic children with obvious deficits in sensory, perceptual and behaviour. • Children who may be labelled as “slow learners” but without problems in sensory, perceptual and motor functions. • Children who present with primary emotional and behavioural difficulties.

CARE

GROUPS REFERRAL INDICATED REFERRAL

NOT INDICATED Group 3 Mainstream school children with specific medical diagnosis (5-18 years old) or 19 years old in certain situations.

• Children with physical disabilities

integrated into mainstream school eg Cerebral Palsy, Hemiplegia etc.

• Children without uneven pattern of

development, though they could have mild to moderate learning disabilities

• Children with general developmental delay

• Autistic children without obvious deficits in sensory, perceptual and motor functions

• Children who may be labelled as “slow learners” but without problems in sensory, perceptual and motor functions

CARE

GROUPS REFERRAL INDICATED REFERRAL

NOT INDICATED Group 4

Children at special schools and units (2-18 years old)

• Children who have an obvious need

for occupational therapy input at present stage of development (see criteria section 1)

• Many children attending these special schools would have been seen by the service at an early age

• School therapists will prioritise the needs of all children referred and provide input according to the available resources

• Children who have no obvious

need for occupational therapy input at present stage of development (see criteria section 1)

• Children without uneven pattern of development though they could have mild to moderate grade learning difficulties

• Autistic children without obvious deficits in sensory perceptual and motor functions

APPENDIX 1

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APPENDIX 2 EQUIPMENT FOR CHILDREN TO USE IN THEIR HOMES

Standards and Criteria for Assessment and Provision Portsmouth City Council and Portsmouth City Teaching Primary Care Trust.

(Revised version of an existing document produced by Hampshire Social Services and

Occupational Therapy Service in consultation with Michael Mandelstam.)

Forward This document has been produced as a joint effort between Portsmouth City Council (PCC) and Portsmouth City Teaching Primary Care Trust (PCTPCT). It is a response to the need to clarify the responsibilities of the different statutory agencies to provide specialised equipment for disabled children to use in their own homes. This document has been annotated by Michael Mandelstam, author of Community Care and the Law, so that staff are clear about the statutory responsibilities to assist children and families. We hope that it will ensure that all children with disabilities receive a fair and equitable service from staff employed in both PCTPCT and Children’s Social Care (CSC) in Portsmouth. Updated November 2007. Standards of Service – Children’s Equipment Provision 1. The assessment of the child will be carried out by an Occupational

Therapist employed as a specialist in the field of paediatrics. 2. Assessment for a simple chair may be carried out by other

Occupational Therapists who must have attended a training course approved by the Senior Occupational Therapist, on seating for children.

3. There should be evidence that the therapist carrying out the

assessment has a sound knowledge of the family and home situation. 4. Wherever possible the child must be assessed with the equipment

requested, prior to provision. 5. The carer must be assessed to ensure that correct handling techniques

are used. 6. The therapist and the parent/carer should agree how the equipment will

be used (including the period each day) and this should be recorded and copied to parents/carers.

7. Use of equipment will be reviewed after six months as part of a

standard paediatric review. 8. The request for provision must be made on the CSC form DP2 –

Special Equipment Request Form. The DP2 should be accompanied by a form identifying assessed needs of child and carer and those which will be met by requested provision, options which have been explored and the reasons for their rejection; and the level of priority.

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9. The prescribing therapist will be informed by Equipment Specialist Occupational Therapist about the decision to provide and then b) inform child/carer.

10. Normally, no child who meets the criteria should wait more than ten

working days from the day the request is submitted to being notified about the decision not to provide.

11. The prescribing therapist must ensure:

a) that the equipment, when delivered meets the identified needs. CSDPA 1970 s.2 demands this: i.e. needs must be met: equally, equipment which does not meet needs, or is surplus to them, should not be provided

b) that the child and the carer understand the safe use of the

equipment. e.g. for negligence litigation considerations.

c) that the equipment is marked and numbered and that copies of relevant documents, instructions etc are returned to the equipment record system e.g. for negligence/Consumer Protection Act 1987, Part I considerations

d) that the OT team co-ordinator is informed when equipment

has been received so that prompt payment can be made 12. If Family Link/Respite families require specialised equipment the child

should be assessed according to following criteria and Children’s Act Section 17 finance should be requested. The CSC worker will need to be involved. Children’s Act 1989 S17 explicitly provides for provision for the family i.e. not just the child with a disability.

Criteria for the issue of special equipment to children with disabilities These criteria apply to the provision of equipment purchased through CSC from the Disabled Person’s Equipment Budget allocation. General Criteria The general criteria must be met before the provision of any service. Ref: Occupational Therapy Practice Manual.

1. The child must be under 19 and be in full-time education to receive services from his budget allocation. The needs of children over this age will be met from adult budget.

2. The child must be resident in Portsmouth for more than half the year

excluding time spent in a residential school.

3. Equipment will only be provided from this budget for the child’s permanent place of residence. If equipment is required for use in places other than this, alternative funding will need to be sought.

APPENDIX 2

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4. No equipment will be provided from this budget for use at school, either

day or residential, college – this is the responsibility of the Education Department. Duty under s.2 (1)(c) of the CSDPA: to assist people to take advantage of the education facilities available to them; plus s.2 (1)(e) the “additional facilities” are not qualified by “in his home”, in the way in which “adaptations are s.322 of the Education Act 1996 in relation to assistance by the “local authority”.

5. Only very specialised equipment will be supplied from this budget to

children in residential care. It will be the responsibility of the provider of care to ensure a range of appropriate equipment is available to meet the needs of the children in this situation. Circular LAC(86) 6, referring to provision by Social Services of equipment for people’s individual needs in residential care homes – under s.2 of the CSDPA.

6. If the child requires a short-term loan of an item because he/she is in

the recovery phase after an illness or accident resulting in a temporary short-term disability, illness or accident, eg hospital bed, wheelchair etc. See Continuing Care Guidance.

7. No equipment which is used exclusively as a treatment medium will be

provided under this heading – this is the responsibility of the NHS. See Continuing Care Guidance.

Criteria for the issue of equipment to assist a child to eat Equipment may normally be issued in the following circumstances: 1. The child is unable to eat or drink, or be fed with ordinary standard

equipment (see below). 2. The carer requires both practical and/or emotional support. 3. The provision of specialised equipment will maintain or improve

independence in eating and drinking.

Equipment The types of equipment which will normally be considered are as follows:- Small items Cutlery Plates and dishes Plate guards Dycem mats

It will be expected that parents, or those acting in this role will purchase these items.

Raised boxes and platforms

Raised/lowered tables

Provided by CSC.

Large items Neater Eater Charitable funding may

APPENDIX 2

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Robotic Feeding Arm be bought for these items in conjunction with CSC. These items will only be considered appropriate if they significantly reduce the need for carers to assist.

Criteria for the issues of seating for children A: Seating may normally be issued to a child for functional purposes in the following circumstances:

1. The seating will promote, maintain or assist a child to develop self-help skills in eating and drinking, washing and dressing. or

2. The seating will promote, maintain or assist a child to improve hand function to enable play and recreational activity or to write and use technology.

As part of the assessment the child’s sitting ability according to the Chailey Levels must be identified. Those children whose sitting ability is at level 5 or above when doing a functional task will not be considered eligible.

3. The seating will contribute to the prevention of deformity. and

4. Will contribute to the safety of the child whilst involved in activities of

daily living.

Consideration may be given to the provision of seating to enable a child to participate in specific programmes, but only if it can be clearly demonstrated that they require seating under criteria A1 or 2 as well.

B: Seating may be issued to enable a child to sit in a comfortable chair but with good postural support in the following circumstances:

1. A home visit has been made to establish:

• types of chair available at home and the potential for adaptation • space within the home for a special chair

2. There is agreement between child, carer and therapist that the chair

meets the identified needs and will be used effectively.

APPENDIX 2

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3. The child meets the criteria for issues of specialised seating for functional purposes or is supplied with a specially adapted wheelchair.

4. The chair above all others will enable a carer to more easily look after a

child with multiple disabilities.

In order for a recommendation for a leisure chair to be accepted it will be necessary to meet criteria B1, and 2 or 3 plus any combination of the following:

5. The chair will accommodate and/or support a deformity in deteriorating

conditions.

6. Other types of seating/chair have been considered and excluded, the reasons for exclusion should be identified in the report accompanying request.

7. The child will be enabled to participate in recreational activities.

8. The child will be enabled to participate in family activities.

9. The child is over the age of 10* (or there are exceptional

circumstances). * it will be assumed that a child under the age of 10 will have been supplied with alternative positioning equipment i.e. wedges, prone boards, side lying boards and standing frames so normally a relaxation chair will not be supplied. The supply of these items will normally be the responsibility of the NHS.

Exceptions would be made for terminally ill children where the prime consideration may be comfort, or for those children whose fixed deformities are such that a standard chair would not be suitable and a leisure type chair is the only option. Criteria for the issue of equipment to assist a child to use the toilet Equipment which is commercially available and generally necessary for all children to learn toilet training, e.g. toilet seat insets, potties, foot boxes, will not usually be provided by CSC. Equipment may normally be issued in the following circumstances:

1. To assist the carer when a child is dependent.

2. When equipment will enable the child to gain, maintain or promote independence eg rails, potty chairs, supportive eating.

Criteria for the issue of equipment to assist a child to bathe or be bathed Bathing equipment can be provided normally in the following circumstances:

APPENDIX 2

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1. To provide assistance for the carer so that child is maintained in a safe position during bathing.

2. To help the carer to assist and handle a child in the bathroom. With

reference to Manual Handling Operations Regulations 1992 HSE Guidance on Regulations.

3. To enable a child to be independent for bathing.

4. To enable a child to transfer in and out of the bath independently.

5. Criteria for the provision of complex expensive bath equipment e.g.

Manger Bath Aid will be the same as for adults i.e. medical need must be demonstrated, or a continence problem must be present and the provision of an over-bath shower with board must have been rejected on the grounds of safety. Ref- Occupations Therapy Practice Manual 6.

Positioning and Standing The funding for the provision of this equipment is normally the responsibility of the Health Authority. This would apply to wedges, rolls and standing frames as for all these items their primary function is positioning. All functional activities for which they will be used will be secondary. Equipment is normally issued for the following reasons:

1. To prevent deformity.

2. To keep hips in a good position.

3. To improve posture against gravity.

Seating in a Car Normally the provision of car seating is the responsibility of the parents or those acting in this role. Under s.2(1)(d), there may be circumstances i.e. use of “services other than aforesaid etc (i.e. no s.29 services which do not apply to children), in which provision/assistances with transport might be a duty. Mobility The provision of all mobility equipment is normally the responsibility of the Health Authority. Wheelchairs and wheelchair inserts, buggies and some tricycles will be supplied via the wheelchair services, according to local policies guidelines. All other mobility equipment will normally be the responsibility of physiotherapists.

APPENDIX 2

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Communication Information technology for educational purposes will normally be supplied by the Education Department. Providing communication equipment would be excluded if it was not “necessary” for the SSD to provide, because the education authority was doing so. However, if the education authority was not doing so, educational items can not simply be excluded from the ambit of “additional facilities” etc and CSOP Act s.2(1)(c) imposes a duty in relation to taking advantage of educational facilities. Speech and Language Therapists assess for equipment to assist with verbal and non-verbal communication for use at home, which assists speech. Funding in normally sought from charitable sources. Handwriting equipment should be assessed by the Paediatric OT Service, and supply of the necessary equipment arranged in conjunction with the Education Department. Alarms and Call Bell Systems These will only be considered by CSC when a baby alarm is not considered suitable. Parents will be expected to purchase baby alarms as they would for any other child. Leisure Activities The technician service can be requested to adapt existing or commercially available equipment (bought from other funds) to enable a child to participate in leisure activity. CSC will not purchase equipment solely for this purpose. Leisure equipment may be purchased in the following circumstances:

1. The needs of the child fall within the eligibility criteria for help from the Department.

2. A need for leisure equipment is established as contributory to the

safety, comforts or convenience of the child.

3. Participation is a particular leisure activity will contribute to the child’s ability to take part in mainstream leisure provision.

APPENDIX 2