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9.10 Countywide Children's Occupational Therapy Criteria for the Provision of Adaptions

SCOPE OF THIS CHAPTER

This guidance sets out the eligibility criteria for the provision of minor (up to £250) and major adaptions from the Occupational Therapy Service.

RELEVANT LEGISLATION AND GUIDANCE

The Children Act 1989

The Housing Grants, Construction and Regeneration Act 1996

'Guidance for Restrictive Physical Interventions', Department of Health (July 2002).

Disability and The Equality Act 2010

RELATED CHAPTER

See Countywide Children's Occupational Therapy - Fast Track Assessments

AMENDMENT

This chapter was revised in March 2013 with regards to the eligibility criteria.


Contents

  1. Adaptions
  2. Ramping
  3. Door Handles, Door Closing Mechanisms and Door Locks
  4. Changes to Doors and Doorways
  5. Stair Lifts
  6. Safety Adaptations
  7. Window Safety - (locks, jammers and restrictors)
  8. Exterior Fencing and Gates
  9. Safe Space or Padded Rooms
  10. Sound Proofing
  11. Heating Adaptations
  12. Toilet Adaptations
  13. Extended Facilities
  14. Additional Toilet
  15. Additional Bath/Shower room
  16. Additional Bed room
  17. Additional Ground Floor Bedroom and Bathroom Extension Facility
  18. Access to Kitchens
  19. Ceiling Track Hoists
  20. Environmental Control Systems


1. Adaptions

Minor Adaptations: Minor adaptations to a persons property are completed under section 2 of the Chronically Sick and Disabled Persons Act 1970, which gives Local Authorities a duty to arrange for one or all of a wide range of services where they are satisfied that they are necessary to meet the needs of permanently disabled persons resident in their area. This includes, ' the provision of assistance for that person in arranging for the carrying out of any works of adaptation of his/her home, or the provision of any additional facilities designed to secure his/her greater safety, comfort on convenience'.

A minor adaptation is a scheme of work that costs less than the amount that will be considered eligible for a disabled facilities grant. The upper limit for a minor adaptation is currently £250.

The Children & Young People's Department (CYPD), arranges and funds minor adaptations in private properties (i.e. owner/occupier and privately rented). Public sector home adaptations are the responsibility of the Housing Authority/Housing Association, who can use their own housing budgets to fund adaptations. Please note the provisions of adaptations in public sector accommodation are subject to local agreements and policies.

Major Adaptations: The current legislative framework governing Disabled Facilities Grants adaptations is provided by the Housing Grants, Construction and Regeneration Act 1996'.

Major adaptation works in Local Authority or Housing association properties are not governed by the above legislation, but often they will mirror the legislation as a measure of good practice.

The occupational therapy worker will assess the needs of the service user, family and carers and decide the most appropriate method of meeting the need in the most cost effective way. Recommendations will be forwarded to the relevant Local Authority for provision.

If the recommendation is for minor works or equipment and the service user/ parent/guardian rejects this and wants a major adaptation instead, the following will be considered:

  1. Is the preferred option 'necessary and appropriate', considering factors such as dignity, promoting independence, growth, safety etc?
  2. Would it 'significantly improve', the development of independence of the service user?

Guidelines on Restrictive safety adaptations and equipment for children with a permanent and substantial disability inclusive of those with challenging behaviour:

Restrictive adaptation interventions should only be used when a situation warrants action. Support packages and Behavioural Management should always be used in the first instance to try and avoid the need to employ a restrictive physical adaptation.

Any adaptation should be in the best of the interest of the child and maintain their behaviour positively. Provision should be reasonable and proportionate to the circumstances, whilst giving regard to other members of the family.

Currently there is 'Guidance for Restrictive Physical Interventions', which has been issued by the Department of Health (July 2002).

The Royal College of Nursing have issued 'let's talk about restraint - rights, risks and responsibility' (2008)

Guidance on Provision of Adaptations

External Provision: The Housing Grants, Construction and Regeneration Act 1996 Chapter 53 Section 102 published the definition below with regard to what is meant by a dwelling.

"Dwelling means a building or part of a building occupied or intended to be occupied as a separate dwelling, together with any yard, garden,

Outhouses and appurtenances belonging to it or usually enjoyed with it."

This clarifies that to 'facilitate access to and from a dwelling' can include adaptations such as rails, path alterations and hard standings.

Hard standing and dropped kerbs - this is a level car parking area with access from the road.

  1. Hard standing will not be provided to prevent car vandalism;
  2. Will not be considered in place of parental supervision appropriate for the developmental age of the disabled child;
  3. Hard standing will not be provided as a result of families having difficulty parking a car outside their property;
  4. For those with challenging behaviour, provision will be considered as part of a behavioural management strategy and an understanding of how safe vehicle transfers are managed in the wider community;
  5. For those with challenging behaviour, provision will only be considered if behavioural management strategies have been exhausted;
  6. Housing legislation (Disabled Facilities Grant) requires staff to identify that this is a necessary and appropriate need, which relates to access by the disabled applicant to and from the dwelling.

Consider:

  1. The service user (driver or passenger) is dependent on their vehicle to get out. A clearly defined need for car journeys must be discussed and the service user should be unable to walk or have considerable difficulty in walking due to a permanent and substantial disability;
  2. The disabled child has little awareness danger/road safety and where no alternative arrangements can be made;
  3. Developmental age against chronological age;
  4. Very young siblings;
  5. Behavioural strategies.

NB: although an OT may assess for and recommend that a kerb is dropped to the local council, permission to proceed is required from the Highways department, who may deem it unsafe or inappropriate.

Access to gardens: Access to gardens will be considered where this is 'reasonable' and 'practicable'

Statutory Instrument 2008 No. 1189 adds to the list of mandatory works:

  1. Facilitating access to and from a garden by a disabled occupant; or
  2. Making access to a garden safe for a disabled occupant.

Access does not imply that we should fund the provision of patios, drying areas, terraces, raised beds or the whole garden. More realistically we would try to provide access to existing areas, where it is reasonable or practicable to do so. Access will not be considered for the purpose of therapy.

Cases will be assessed on an individual basis

Railing and step adaptations - This includes grab rails, handrails by a path, half steps, and shallow steps.

  1. Only one entrance will be considered for adaptation unless there is a clearly defined need. For example: The need for a child to have independent and safe access to garden facilities;
  2. Handrails by a path will only be provided where the service user is unable to manage due to a slope or steps as a result of their physical impairment and the purpose of the handrail is, for example, to enable the child to have safe access to a car for transport purposes or access to the garden for play;
  3. Adaptations will not be provided solely for a fire exit;
  4. Path widening will only be considered where the service user needs to use a walking frame or wheelchair;
  5. Guide rails will be considered in essential areas if the service user is blind or partially sighted.

Consider:

  1. Height and diameter of rail;
  2. Does child use a walking aid;
  3. Will provision improve child's potential for independent mobility.


2. Ramping

Only one entrance will be considered for adaptation unless there is a clearly defined need, for example, the child requiring access to the garden to access play facilities that will enhance their overall developmental progress.

  1. Only the entrance which is the easiest, most appropriate to need and most cost-effective will be adapted;
  2. A ramp may be provided if a service user's mobility is dependent on the use of a wheelchair (indoors / outdoors) and qualifies for a NHS chair or if the person or anyone caring for them is at risk from the current method of access. For example, a ramp would not be provided if the carer can safely negotiate a wheelchair up and down small steps.

Consider:

  1. Is a ramp the safest option? If the service user occasionally walks with a frame or artificial limb consider shallow steps or a ramp with steps;
  2. Which type of ramp is most suitable?
  3. Is the ramp to be fitted on communal steps and how will this affect other people?
  4. Will the permission of anyone else be needed before the work is done?
  5. Is the door threshold level or, if not, can it be adapted?

Step lifts: may be provided if the guidelines for a ramp have been met but there is insufficient space for the provision of a ramp of the appropriate gradient and the service user is unable to walk up and down steps, for example, where there are a number of steep steps to reach the property.

Consider:

  1. Is the person using the lift a wheelchair user or are they able to walk?
  2. Is outside lighting and power supply needed?
  3. Will the lift be at risk from vandalism or misuse?

Internal Provision - Stair rails, grab rails and horizontal rails

  1. Rails will not be provided for exercise or treatment purposes;
  2. The Department will not fit a first stair rail, as this is the responsibility of the owner/landlord;
  3. Maybe provided to facilitate functional development when this has the potential to maximise a child's independence.

Consider:

  1. An existing stair rail may be replaced if it is unsuitable. For example, where the service user has a poor grip;
  2. Grab rails will be considered where the service user is unable to manage internal steps to access essential facilities only;
  3. Horizontal rails will be considered in essential areas where either there is insufficient room for the service user to use their normal walking aid or if the service user is blind or visually impaired.


3. Door Handles, Door Closing Mechanisms and Door Locks

Any consideration for provision of the above for those who present with challenging behaviour must be subject to a risk assessment and following consultation with a manager, a multi-disciplinary decision maybe required.

  1. A door handle or lock may be changed or provided, for example from a knob to a lever handle, or re-positioned, to promote independence;
  2. Specialised door handles, door closing mechanisms or locks maybe considered as part of a behavioural management strategy.

Consider:

  1. Safeguarding and Restraint;
  2. Purpose of the provision and whom this is for;
  3. Siblings;
  4. Environmental risks.


4. Changes to Doors and Doorways

Any consideration for provision of the above for those who present with challenging behaviour must be subject to a risk assessment and following consultation with a manager, a multi-disciplinary decision maybe required

  1. May be provided where the service user is unable to get through the doorway, to get in and out of a room where access is essential or a carer is unable to give assistance to the service user;
  2. Maybe provided to facilitate functional development which has the potential to maximise a child's independence?
  3. A specialised door maybe considered as part of a behavioural management strategy - e.g. stable door;
  4. A second external doorway for fire escape purposes will not be provided through social care but will be at the discretion of local council.

Consider:

  1. Construction of door - (Glass, wooden, upvc);
  2. Width of doorways - suitability for future;
  3. The impact on other members of the household;
  4. Removal of the door;
  5. Door furniture - (hinges, kick plates, handles, locks, closing mechanism).


5. Stair Lifts

  1. Stair lifts will only be provided where essential facilities are not available on the ground floor;
  2. They will not be recommended where a service user has access to a suitable bathroom and toilet downstairs and where there is adequate and appropriate space to sleep, having taken into account the accommodation needs of the family, the age of the child and anyone else caring for the person;
  3. They will not be recommended if the provision will be detrimental to the development of the child's independent mobility. (liaison with appropriate health colleagues may be required).

Consider:

  1. Is the service user unable to manage the stairs?
  2. Is the service user or carer at risk from the current method of using the stairs?
  3. Are the stairs suitable for fitting a stair lift? (Seek advice from stair lift reps.);
  4. Does the lift need to be in immobilised when not in use, for example if there are other children in the household who might play with it?
  5. Is the service user able to use a stair lift? Do they need to attend the Disability Living Centre for an assessment?
  6. Is the service user able to get safely on and off the lift at the top and bottom of stairs?
  7. Does the service user have a disability that contra-indicates the use of a stair lift? For example Epilepsy;
  8. Would a vertical lift or ground floor extension be a better long-term solution?
  9. Is it possible for the service user to sleep downstairs?
  10. Is there room for other members of the family to use the stairs safely?
  11. Are there pets, which might be at risk?
  12. Does the lift need a folding platform or hinged track?
  13. Future cost of servicing for the service user;
  14. Type of controls that are needed for example joy stick, push button;
  15. Safety harnesses required;
  16. Will the stair lift be suitable in the longer term?

Vertical lifts may be provided if the service user is unable to manage the stairs.

  1. Access to essential facilities is not available on the ground floor;
  2. A stair lift has been considered and is not appropriate. For example, the service user is a wheelchair user or would be unsafe using a stair lift;
  3. A stair lift is likely to be inappropriate in the future. For example, the service user's condition is likely to deteriorate.

Consider:

  1. Can the service user enter and leave the lift independently?
  2. Could a carer get the service user safely in and out of the lift?
  3. Does the service user need a padded lift car, for example do they have epilepsy?
  4. Does an alarm or telephone need to be fitted as the service user is using the lift alone?
  5. Is there enough room for a lift to be fitted?
  6. If there is insufficient room, is it possible to install an external lift shaft or would an extension to the ground floor be more appropriate?
  7. Have the needs of the rest of the family been considered?
  8. Are the facilities to be reached upstairs adaptable, for example, the bathroom and doorways?
  9. If the service user is anxious about using a lift can this be overcome by viewing or trying out a lift?
  10. Will the size of the lift accommodate a larger wheelchair if needed in the future?
  11. Future cost of servicing for the service user.


6. Safety Adaptations

Stair and Door Gates

Any consideration for provision of the above for those who present with challenging behaviour must be subject to a risk assessment and following consultation with a manager, a multi-disciplinary decision maybe required

  1. A specialised gate maybe considered as part of a behavioural management strategy when it is to prevent access to stairs or an area of the home;
  2. Will only be considered when the service user is over the age when a safety gate is usually necessary;
  3. Will not be considered in replacement of expected parental supervision.

Consider:

  1. Safeguarding and Restraint;
  2. Purpose of the provision and whom this is for;
  3. Height and position of gate;
  4. Method of fixing and closing;
  5. Environment;
  6. Siblings.


7. Window Safety - (locks, jammers and restrictors)

Any consideration for provision of the above for those who present with challenging behaviour must be subject to a risk assessment and following consultation with a manager, a multi-disciplinary decision maybe required

  1. Window locks, jammers and restrictors will not be provided for security or vandalism reasons;
  2. Will not be provided in replacement of parental supervision;
  3. Window grills and shutters will not be provided;
  4. Provision will be considered when the disabled person's vulnerability is as a result of their medical condition, and not due to developmental norms related to the child's age.

Provision will be considered when the service user is unable to understand danger and is at risk of injury from falling from a high window or escaping through a window and when alternative solutions are not practical. Window restrictors will not be considered if existing window locks are sufficient to safeguard the child, but restrict ventilation to a room during warm weather.

Consider:

  1. Safeguarding and Restraint;
  2. Fire risks;
  3. Restrictors v jammers;
  4. Purpose of the provision and whom it is for;
  5. Siblings;
  6. Ventilation;
  7. Rooms to be fitted in.


8. Exterior Fencing and Gates

  1. Will not be provided for the purpose of security or vandalism;
  2. Will not be considered where existing fencing or gates would meet the child's needs but are in a state of disrepair;
  3. Will not be considered to keep other children and dogs in or out;
  4. Fencing and gates will not be provided in replacement of parental supervision. e.g. If and when fencing or a gate has been recommended parental supervision relevant to the child's developmental age would still be an expectation to ensure the safety of the child; no fencing or gate or standard fencing is in place;
  5. Provision will only be considered when the disabled child's vulnerability is as a result of their medical condition, and not due to developmental norms related to the child's age;
  6. Provision will only be considered when the service user is unable to understand danger and is at risk of injury due to wandering off the property and when alternative solutions are not practical;
  7. Either provision maybe considered in order to create a safe space for the child, for the whole garden or where by a part of the garden is sectioned off;
  8. Will be considered when high fencing and /or high gate is already in situ but the disabled child continues to be able to climb over and leave the boundaries of the property;
  9. Ironmongery will be provided for the purpose of the child's disability and not for security reasons.

Consider:

  1. Safeguarding and restraint;
  2. Purpose of the fencing and whom it is for;
  3. Foot holds;
  4. Height and construction;
  5. Planning restrictions;
  6. Siblings;
  7. Behaviour management;
  8. Garden levels/layout;
  9. Boundaries - whom they belong to.


9. Safe Space or Padded Rooms

Any consideration for provision of the above for those who present with challenging behaviour must be subject to a risk assessment and following consultation with a manager, a multi-disciplinary decision maybe required

A safe space is a safer area or room for someone who may need it. The safe space is not a substitute for supervision. They can be 'off the shelf' or 'made to measure' and can be considered for the purpose of a safe environment for sleeping or as a safe environment allowing a disabled child with severe challenging behaviour a place to 'calm down' when in a heightened state of emotion.

Provision is normally considered as part of a behavioural support programme to address the challenging behaviour in the long term.

Provision of any such recommendation would be at the discretion of the local borough or district council.

  1. Will not be considered where provision will inhibit the independence of the child e.g. by preventing a child independently accessing a toilet;
  2. Will not be considered as an alternative to parental supervision appropriate to the child's developmental age;
  3. Provision will be considered as part of a behavioural management programme;
  4. If provision is made, this will be subject to review and may result in the removal of the safe space if provision is assessed as no-longer being appropriate;
  5. Provision maybe considered when a child with challenging behaviour or a learning disability has a disturbed sleep pattern and the provision is as part of a behavioural management programme;
  6. Provision will be considered when a safe area is required on a temporary basis;
  7. Provision maybe considered to provide a calming area, when all other options have been explored.

Consider:

  1. Safe guarding and Restraint;
  2. Siblings;
  3. Purpose of provision and whom it is for;
  4. Fire risks;
  5. Anticipated length of time to be used;
  6. Behaviour management;
  7. Made to measure or off the shelf;
  8. Flooring;
  9. Lighting;
  10. Room to be used in and furniture;
  11. Windows.


10. Sound Proofing

Any consideration for provision of the above for those who present with challenging behaviour must be subject to a risk assessment and following consultation with a manager, a multi-disciplinary decision maybe required

Soundproofing of a wall adjoining another property will be considered if a child with severe challenging behaviour is causing /or is likely to cause a breakdown in community relationships. This to be considered as either a part of a behavioural management strategy to enable the child to remain at home or when the child with severe challenging behaviour has undergone a behavioural management programme but still continues to frequently disturb the neighbourhood with making exceptionally loud noises.

Consider

  1. How the child would be heard if requiring attention;
  2. Use of monitoring system;
  3. Re-housing;
  4. Carpeting the wall;
  5. Would the provision of soundproofing have an effect on the child's safety and wellbeing in terms of being heard by a carer.


11. Heating Adaptations

Change of Heating Appliance

  1. Running costs will not be considered as a reason for changing heating systems;
  2. Will not be considered simply as a replacement for an existing heating system that is in a poor state of dis-repair.

The type of heating will not normally be changed on medical grounds, although this may be considered in exceptional cases where the service user is unable to control their body temperature because of, for example a spinal injury or muscle wasting disorder

Consider:

  1. Has the child's carer/s considered Government-funded schemes for improving heating systems?
  2. Can the heating system be updated through the local councils 'home improvement' scheme?
  3. Control of Heating - involves the adapting the controls of existing heating;
  4. Has the provider of gas / electricity been consulted regarding adaptations to controls?
  5. Has the service user accessed Government-funded schemes for improving heating systems? Examples include the rent-added scheme. This is a scheme whereby someone can have central heating installed;
  6. Will the provision of adapted controls allow/promote the child to achieving a greater level of functional independence?

Additional Heating - only rooms which are used by the child for significant periods of time should be considered for additional heating

  1. Additional heating may be considered where a child is unable to generate sufficient body heat, for example a child with a muscle wasting disorder;
  2. Re-cover themselves during the night and where a carer's rest would be disturbed.

Consider:

  1. Type of heating required;
  2. Will the existing boiler tolerate additional radiators on the system?
  3. The provision of an independent heating appliance, for example, an electrical wall heater.


12. Toilet Adaptations

Toilets raised on plinths

  1. Can be provided only where a raised toilet seat has not been deemed appropriate and where increasing the height of the toilet will enable the service user to get on and off independently;
  2. Can be considered if the increase in height is required for the successful use of equipment over the toilet.

Consider:

  1. Have the needs of other household members been considered?
  2. Has the overall required height been considered?
  3. Could a change in height affect transfers from other equipment e.g. a wheel chair.

Additional toilet (upstairs or down)

Any consideration for provision of the above for those who present with challenging behaviour should be considered only after appropriate behavioural management strategies have been implemented or as part of a behavioural programme.

  1. Will not be considered as a result of a child refusing to access a toilet, and a supportive behavioural management programme has not been implemented;
  2. Will not be considered simply as a replacement if the existing toilet is in a poor state of dis-repair;
  3. Will not be considered as a result of a child's difficulty accessing a toilet if it is understood that these difficulties will diminish with further growth and development, and where difficulties can be managed in the short term through supervision and the use of equipment;
  4. Will be considered when the existing toilet cannot be accessed safely or independently due to the person's physical impairment, or if an outside toilet is not considered to be appropriate;
  5. Will be considered when assisted or supervised access is unsafe or difficult due to space limitations e.g. placing both child and carer at risk;
  6. Will be considered when installation of a stair lift or vertical lift is not feasible or does not meet the need;
  7. Will be considered when continence cannot be maintained by using the existing toilet because the service user's physical impairment prevents them from getting to the toilet in time.

Consider:

  1. Can access to existing facilities be improved?
  2. Has medical advice been sought to assist in assessment?
  3. Is the child likely to achieve continence?
  4. Has a commode been considered?
  5. Would it meet the long-term need?
  6. If living downstairs, is there access to bathing facilities?

Wash/Dry Toilets

A toilet that can both clean and dry the service user eliminating the need to self clean.

Only one specialist toilet will be provided where it is not possible to independently maintain reasonable personal hygiene after toileting.

To consider when a child / teenager with restricted movement wishes to have independence in toileting hygiene.

And/or

When a child / teenager with limited understanding is unable to achieve personal hygiene skills following toileting and where family / carers would like to move towards a more age appropriate strategy for meeting their toilet hygiene.

And/or

In readiness for the onset of girls puberty

And/or

To allow the child/adolescent age appropriate control, dignity and privacy over intimate care tasks

  1. Will only be considered when a child has had the opportunity to develop independent personal toilet hygiene skills but their functional abilities remain limiting;
  2. Will be considered where the provision will allow the child independence in toilet hygiene;
  3. Will be considered to assist carers in the completion of personal hygiene tasks if provision will reduce hoist transfers;
  4. Will be considered in readiness for the onset of girl's puberty;
  5. When a child/teenager with limited understanding is unable to achieve personal hygiene skills following toileting and where family/stroke carers would like to move towards a more age appropriate strategy for meeting their toilet hygiene.

Consider:

  1. Equipment or as part of an adaptation;
  2. Childs upper limb / hand function;
  3. Independent for assisted transfer;
  4. Servicing and maintenance and whether family can manage this financial commitment long term;
  5. Versatility of 'douche' pressure and position;
  6. Size of aperture;
  7. Need for accessories;
  8. Need for a plinth;
  9. Whether bathroom is used by all family members;
  10. Transfers on and off toilet;
  11. The compatibility of specialist equipment to be used in conjunction with the toilet. For example, shower chair;
  12. Position of controls and method of activation;
  13. Efficiency of different types of toilet seats/inserts.

Adaptations to existing bathrooms- Adaptations will not be considered on the grounds of medical needs or pain relief.

Any consideration for the provision of the above for those who present with challenging behaviour and/or sensory modulation difficulties should be considered only after appropriate therapy strategies have been implemented or as part of therapy support programme.

  1. Will not be considered until appropriate equipment solutions have been exhausted and proven to be unsuccessful;
  2. Will not be considered simply as a replacement when the existing washing facilities are in a poor state of repair;
  3. Will not be considered as a result of over crowding in the property;
  4. Will be considered when supervised or independent access to bathing or showering facilities is unsafe due to the child's physical impairment;
  5. Will be considered when access to bathing or showering facilities is unsafe due to space limitations, placing child and/or carer at risk;
  6. Will be considered if provision will result in attaining or maximising a child's level of independence.

Consider:

  1. Type of adaptation - over bath shower, level access shower, bath hoist, alternative bath;
  2. Other family members;
  3. Childs chronological and developmental age;
  4. Future needs;
  5. Layout of the bathroom;
  6. Accessibility of the bathroom.

Over bath shower -

  1. Will be considered to assist in developing skills in independence;
  2. Will be considered as a solution for those children who have incontinence difficulties.

Level access shower -

  1. Will be considered to assist in maximising a disabled child's independence;
  2. Will be considered when a child cannot be safely transferred into a bath;
  3. Will be considered to maximise space within the current bathroom.

Bath hoist -

  1. Will considered when bathing equipment is unable to meet the transfer need;
  2. Can be considered to assist a carer with safe transfers of the child.


13. Extended Facilities

Extensions should always be the last resort as a solution to the assessed needs of the child. Re-housing maybe an alternative and more practical solution that should be investigated.

Completion of building works can give rise to stressful situations and should not be entered into without due consideration and discussion with the family. Often it is possible to adapt within the existing property to meet the need and this solution will always be considered prior to any new build.

Provision of extensions can take a considerably long time to complete and whilst work is under way alternative accommodation for the disabled child may need to be organised by the family.


14. Additional Toilet

Any consideration of the above for those who present with challenging behaviour should be considered only after appropriate behaviour management strategies have been implemented or as part of a behavioural management programme.

  1. Will not be provided as a result of over crowding;
  2. Will not be considered when the difficulties are age appropriate;
  3. Will be considered if the existing toilet cannot be accessed safely or independently due to the child's physical impairment;
  4. Using the existing toilet causes severe risk to carers, for example, there is not sufficient space for carer to assist;
  5. Continence cannot be maintained by using the existing toilet because the service user's physical impairment prevents them from getting to the toilet in time;
  6. Will be considered if provision will promote the attainment of skills for the child's longer term continence development.

Consider:

  1. Use of converting available space within the existing property in the first instance;
  2. Can access to existing facilities be improved?
  3. Toileting Programme;
  4. Dignity;
  5. Emotional well being of child;
  6. Medical condition;
  7. Access to the toilet.


15. Additional Bath/Shower room

  1. Will not be considered as a result of over crowding;
  2. Will not be considered if existing bathroom can be suitably accessed and adapted to meet the need;
  3. Will be considered when space limitations in the existing bathroom do not allow the disabled child's needs to be safely met;
  4. When a child's needs are long term and they will not be able to access the existing facilities in the future;
  5. When it is unsafe for a carer to provide adequate support;
  6. When provision will maximise the disabled child's dignity and level of independence when other solutions are impractical;
  7. When it is considered that direct access to bath/shower room facilities from a bedroom will benefit the disabled child and carers positively, for example a very dependant child who requires hoisting.

Consider:

  1. Growth of child;
  2. Longer term care needs;
  3. Space;
  4. Layout of property;
  5. Layout of bathroom;
  6. Specialist equipment required within the facility, including hoists;
  7. Shower versus bath;
  8. Changing area.


16. Additional Bed room

Any consideration for the above for those who present with challenging behaviour should be considered only after appropriate behavioural management strategies have been implemented and all other options have been exhausted.

Families are expected to be flexible in the use of living space and to consider, for example, using an upstairs room as a lounge, dividing, sharing or swapping bedrooms, or converting a ground floor reception room into a bedroom.

  1. An additional bedroom will not be considered as a result of over crowding;
  2. Will not be considered if the disabled child already has access to suitable sleeping/bedroom facilities;
  3. Will be considered when the child is unable to access an existing bedroom and provision of a stair lift or vertical lift is unsuitable;
  4. Will be considered if the ground floor reception rooms are too small for a bedroom;
  5. Will be considered if the use of a reception room as a bedroom has a detrimental effect on family life. (provision would be at the discretion of the local council/housing association);
  6. Will be considered when the existing bedroom is too small to facilitate safe care of the disabled child and the need cannot be met by a re-organisation of the living space.

Consider:

  1. Growth of child and long term care needs;
  2. Layout of property;
  3. Re- housing;
  4. Safe guarding;
  5. If provision on ground floor are washing and toileting facilities accessible;
  6. Has the child's ability to contact a carer been considered?
  7. If to be provided as a ground floor facility are family comfortable with child being on a different floor to them;
  8. Would a loft conversion be a more cost effective solution?

Additional bed room - loft conversion

Will be considered only on rare occasions when a child with a disability that results in challenging behaviour is sharing a bed room with a sibling and as a result of their behaviour the sibling is at risk, and all other practical options/solutions have been exhausted. In such circumstances provision will only be considered as part of a behavioural management support package and with the knowledge that the challenging behaviour is a long term standing problem. (Provision will ultimately be at the discretion of the local council and housing association).


17. Additional Ground Floor Bedroom and Bathroom Extension Facility

The provision of a ground floor purpose built bedroom and bathroom facility will be considered if the disabled child meets the criteria for an additional bedroom and bath/shower room as above, and it is considered that following a feasibility visit with appropriate colleagues that a purpose built provision is the most cost effective solution to meet the long term needs.

Specialist Baths - a bath that is purposely designed to meet the needs of those with very high needs, and incorporates an adjustable high/low facility and will only be considered in exceptional circumstances.

  1. Will not be considered if a standard bath with adaptations and appropriate equipment will meet the assessed need;
  2. Will not be considered for the disabled child with high levels of dependency and care needs;
  3. Will be considered to facilitate safe moving and handling practice throughout the child's growth and development;
  4. Will be considered as an option to allow the family flexibility in meeting the disabled child's/teenagers personal care needs;
  5. Will be considered when the child has high dependency care needs but there is limited space available;
  6. Will be considered if the care needs are long terms and provision will ensure that personal care can be provided safely and effectively for the short and long term future.

Consider:

  1. Space;
  2. Who will use the bath;
  3. Drainage;
  4. Combined bath and changing facility or separate;
  5. Capacity of water tank;
  6. Integral internal handles (could be a contra-indication);
  7. Weight of the bath - does it affect the floor structure);
  8. Internal and external dimensions;
  9. Medical condition;
  10. Families ability to manage on-going financial commitments to service contracts once specialist equipment is out of warranty.

Hi/Lo Wash hand basin

A powered wash hand basin that can be adjusted in height to facilitate access to washing facilities for those who are permanent wheelchair users. This provision will only be considered in exceptional circumstances and only following the completion of a full functional occupational therapy assessment to establish the functional benefits of any such provision. Hi/lo wash hand basin:

  1. Will not be considered if a standard wash hand basin fitted at an appropriate height with adaptations and appropriate equipment will meet the assessed need;
  2. Will not be considered for those children who do not have the physical and/or cognitive ability to perform personal care tasks independently;
  3. Will be considered for those children whose independence in personal care will be promoted and maintained.

Consider:

  1. Space;
  2. Type of taps to be used;
  3. Electrical supply;
  4. Medical condition;
  5. Type of wheelchair; shower/toilet chair to be used.

Body Dryer: To consider when a child / teenager who have restricted upper body movement preventing them from their maximum independence and dignity when drying themselves as part of their personal care.

Consider

  1. Environment - space;
  2. Controls on the drying unit;
  3. Ability to stand;
  4. If to be used in a seated position consider type of shower chair / stool to be used.


18. Access to Kitchens

  1. It is the responsibility of the service user to provide his/her own kitchen appliances;
  2. The extent of the adaptation will be dependent on the child's home situation in terms of environment, carers and their anticipated capabilities;
  3. Children should be encouraged to participate in family life and share meal times with family;
  4. To consider when it is felt a disabled child or young person can achieve a level of self care and independence skills.

Cases will be assessed on an individual basis

Consider:

  1. Is the service user wheelchair dependent and do they requires extra space for manoeuvring?
  2. Is the requirement to enable care of the child by a single carer for supervision purposes?
  3. Are lever taps / tap turners an alternative to moving the sink?
  4. Is extra space for essential equipment needed?
  5. Do power points require moving in order to give access?
  6. Is insulation required under the sink or hob to protect the service user's legs?


19. Ceiling Track Hoists

Will be considered when the need is long term and permanent.

Consideration should be given when the child is unable to reliably and consistently weight bear for an assisted transfer and/or is totally dependent on a carer for all transfers.

Will be considered when carers are finding it increasingly difficult to either lift a child or assist with transfers.

Points to consider:

  1. Room to room transfers and transfers within a room;
  2. Need for single track, turntables or H hoist system;
  3. New build or existing dwelling;
  4. Ceiling and wall structure (spacing of ceiling joints);
  5. Door headers;
  6. Double hinged doors;
  7. Manual or electric traverse;
  8. Height of ceiling/height of lift for clearance;
  9. Potential weight of child;
  10. Spreader bar design;
  11. Bed position - present and future.

NB Provision of ceiling track systems will usually be funded as part of a disabled facilities grant or major adaptation. However, if the need is perceived as urgent and other equipment cannot be used as an interim measure, then this need will be met through social care funds.

Powered Door Openers

An automatic door opener that allows a child/young person (who is an independent wheelchair user) to independently access and egress rooms. These are usually provided as part of an Environmental Control System (as assessed for and funded by the Local Primary Care Trust)

Where a child/young person does not meet the Clinical Commissioning Group's eligibility for an environmental control system  a powered door opener will be considered if the need is permanent and long term and where the service user will achieve a significant level of independence e.g. ability to access and egress the property independently.

Points to consider:

  1. Type of automatic door opener required;
  2. Space - consideration for door swing;
  3. On-going maintenance costs;
  4. Where independent access is a need and not a preference.


20. Environmental Control Systems

Environmental control systems are funded by the local Clinical Commissioning Group. Referrals will be made to the local Primary Care Trust, and joint visits between the Clinical Commissioning Group assessor and the Disabled Children's OT are advisable. It is the responsibility of the Children & Young Peoples Department to pay for the associated essential electrical and joinery work required to facilitate the installation of the equipment. This could include power points, changing of door locks to Yale type model.

End