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9.4 Countywide Children’s Occupational Therapy - Referrals and Assessment


This guidance details the role of the Occupational Therapy Service and sets out the referral and assessments process. Occupational Therapy is a specialist service for children and young people generally concerned with the promotion of independence due to the limits imposed by a physical and/or learning disability.


Chronically Sick and Disabled Persons Act 1970

Disabled Persons Act 1986

National Health Service & Community Care Act 1990

The Children Act 1989

Carers and Disabled Children Act 2000

The Disability Discrimination Act 2005

Safeguarding Disabled Children and Young People - Inter-agency Practice Guidance


1. Introduction
2. Role of the Local Authority Occupational Therapy Service
3. Thresholds and Eligibility for Assessment
4. Referral and Assessment Process
  4.1 Child Contacts
  4.2 Referral and Decision Making
  4.3 Prioritisation
5. Levels of Assessment and Timescales
  5.1 OT Initial Assessment
  5.2 Specialist OT Assessment
  5.3 Fast Track Assessment
6. Reviews

1. Introduction

1.1 The purpose of this document is to set out the procedure that should be followed when receiving referrals and undertaking assessments in relation to the Children's Occupational Therapy Service. Its aim is to ensure that contact with the OT Duty Officer and responses given are consistent across the service.
1.2 All work undertaken should be compliant with relevant legislation issued in relation to Children's OT Services (see Countywide Children’s Occupational Therapy - Legal Framework).
1.3 The procedure complements Nottinghamshire's Safeguarding Children Policy and Procedures. Staff should be familiar with these documents and ensure they are complied with at all times.
1.4 A copy of this document will be available at each OT Duty Point

2. Role of the Local Authority Occupational Therapy Service

2.1 OT is a specialist service generally concerned with the promotion of independence due to the limits imposed by a physical and/or learning disability. The core role of the Local Authority OT is to undertake Specialist OT Assessments of children with substantial and permanent disabilities. This may lead to the provision of minor or complex equipment and/or adaptations. The assessment may occur as part of a social worker core assessment or as a stand alone specialist assessment depending on need

OT equipment and adaptation can not be prescribed:

  1. As an alternative to adult supervision or where it would be reasonable to expect those with parental responsibility to provide a safe environment in relation to developmental norms e.g. garden fencing for a 6 year old;
  2. As an alternative to strategies and programmes aimed at managing challenging behaviour;
  3. As a means of achieving general house hold repairs or maintenance which, under normal circumstances, would be the owner/landlords responsibility e.g. replacing rotting windows or broken window panes.
2.3 It should be noted that where the OT service becomes aware that a parent/carer is using restrictive practices, further assessment will be required. In most cases, and in all cases that involve locking children in, a referral must be made to the appropriate children's field work team.
2.4 It is recognised that the OT has to strike a balance between the "ideal" solution from the service user's point of view and the resources available and has a responsibility to work economically and efficiently with regard to the Council's resources. This balance is not always a matter of recommending the cheapest option, it is a concern for effective solutions for individuals, bearing in mind that other people also have a claim on the Council's resources. The most economically appropriate options must therefore be considered first. Staff will be expected to demonstrate this in their recording, particularly of recommendations for major equipment and adaptations. Staff to be aware of the need to recycle equipment from stores where appropriate.

3. Thresholds and Eligibility for Assessment


Children and young people who will be eligible for an Initial Assessment by the OT service will fall into one of the following categories:

  • Children with a severe physical disability;
  • Children with complex health needs;
  • Children with a severe learning disability;
  • Children with severe autism.

A child will be deemed to have 'severe' autisms if he/she is eligible for a service from the Children's Disability Team or is in receipt of one of the following:

  • Short Break in a specialist placement e.g. Minster View, The Big House, Contract Care, etc;
  • Education at a Special School for Autism.

4. Referral and Assessment Process


Child Contacts

  4.1.1 All Contacts are taken through the dedicated Children's OT Duty Point which is open Monday to Friday, 9.00 am - 4.00pm (excluding bank holidays).
  4.1.2 A Contact record will be completed on all enquiries to the OT service.
  4.1.3 The outcome of the Contact should be made clear to the referrer within 24 hours and recorded in framework episode.
  4.1.4 The response to a Contact may be that no further action will be taken, but that in itself is a decision and should therefore be recorded. If this is the outcome a letter should be sent to the referrer confirming the outcome of the duty contact.
  4.1.5 All NFA's will be recorded on the OT referral database. A Quality Assurance Audit will be carried out bi-monthly in respect of this by either the OT Team Manager or Senior OT.


Referral and Decision Making

  4.2.1 When a contact is received a decision whether to progress to an OT referral will be made immediately by the duty worker in line with the threshold criteria described in paragraph 3.1. In exceptional cases contact may be tasked to the OT Team Manager or OT Duty Manager for guidance and this will be responded to within 24 hours.
  4.2.2 All referrals will progress to an OT Initial Assessment which will be completed within 10 days. The outcome of an OT Initial Assessment may be NFA, Specialist OT Assessment or Fast Track.
  4.2.3 Where the OT Initial Assessment leads to a Specialist or Fast Track Assessment, the OT Initial Assessment episode will be closed with the recommendation in place. It is important to recognise that an OT Specialist or Fast Track assessment is not a Core Assessment. Where a social care Core Assessment is required this will be completed via the appropriate social work team.
  4.2.4 Where it is felt that other statutory services may be needed to promote the development and welfare of the child (S17,CA 1989) or where there is reason to suspect the child is suffering or likely to suffer harm (S47,CA, 1989) a referral will be made to the relevant field work team.
  4.2.5 Where it is felt that a child has additional needs that can be met by universal and targeted services, the professional referrer or most involved professional will be advised to undertake a CAF to consider the child's need for early preventative and targeted provision.
  4.2.6 Where it is likely that an assessment may lead to a major adaptation/ DFG, or where the parent/ carer's expectation is that this might be the outcome, a copy of the Children's Occupational Therapy Service - Disabled Facilities Grant Information leaflet will also be provided.

All NFA's resulting from an OT Initial Assessment will be recorded on the OT Referral database. A Quality Assurance Audit will be carried out bi-monthly in respect of this by either the OT Team Manager or Senior OT.

A letter is sent out to the referrer and the family advising them of the outcome of the initial assessment and any signposting that may be appropriate.



  4.3.1 If the threshold for a Specialist OT Assessment is met, the OT Manager or a Senior OT will decide on the level of priority. Priories have been designed so that children with the greatest need/s receive a timely assessment and service.
Priority 1. Safeguarding needs - children who are referred for an OT assessment in terms of Safeguarding e.g. joint working potential section 47 case, access visits, functional assessment, Joint peer assessment, potential breakdown of formal or informal care, potential immediate threat of injury to carers or children such as moving or handling issues.
Priority 1a.

Referrals for severely disabled young children who are in hospital (frequently) or are working towards being discharged home from hospital (CDC) and need joint working with our health peers to facilitate a collaborative early intervention approach in order to maximise the child's early developmental years.

e.g. feeding, seating, re-housing, bathing issues
Priority 1b.

Children who have had an assessment of need completed and the need has been identified as a major adaptation (as when these cases becomes 'active' with the local District or Borough Council, the need to allocate is high to ensure the build is completed smoothly) or a child who has specialist equipment in 'situ' and requires a re-assessment of need to ensure continued safe positioning and use

Also children who require an access visit for a new property.
Priority 1c. Children who require OT input in order to facilitate an adjustment to a current situation or piece of equipment, which is having a severe detrimental impact on their health and wellbeing. In that it is causing pain/discomfort and /or progressing a deformity through incorrect positioning which impacts negatively on their functional and/or social development.
Priority 1d Children who have been assessed for a 'sitting' service, but this cannot commence until appropriate OT provision is in place.
Priority 2. Children who have complex needs, but are not considered being at risk if OT assessments/provision is not immediate i.e. they do not fit into the priority 1 category and therefore immediate intervention is not a necessity to their current health and social wellbeing

The budget for major house adaptations is held by local district councils. This is a central budget shared by adult and children's services. Ordinarily district councils progress major adaptations in date order. The Children's OT service and local district councils have agreed however that, in certain situations, the OT service may request prioritisation of a build. These circumstances are:

  • Reduced life expectancy - where adaptation will assist with the child's care in the later stages of life;
  • To prevent a child coming into the care of the Local Authority.
It should be noted that although this arrangement is in place the local district councils will manage all priority requests (both children and adults cases) in date order.

5. Levels of Assessment and Timescales


OT Initial Assessment


An OT initial assessment will be carried out by a duty worker within 10 days of a referral being accepted by the OT service. An OT Initial Assessment is a brief evaluation of the child's needs and should look at the whole of the service user's situation rather that just a single functional aspect. If an initial assessment has been completed recently e.g. last 12 months, it will be at the discretion of the OT Team Manager as to whether an updated initial assessment is required. The purpose of an OT Initial Assessment is to ascertain:

  • Is this a child in need;
  • Nature of the service required;
  • Who should provide this service.

Dependent on the circumstances, an OT Initial Assessment may be completed by:

  • A telephone conversation with the parent/carer/referrer;
  • Contact/consulting with other agencies to gather information;
  • Visiting the child and family at home;
  • Consultation with the Team Manager.
  5.1.3 Not all needs identified in an OT Initial Assessment can be met through the provision of OT equipment and/or adaptation and in some instances assessment rightly conclude that the needs of a child can be best met by other services. The parent/ carer will be made aware of this in the letter detailing the outcome of their referral to safeguard against any unrealistic expectations they may have of the service.

OT Initial Assessment may lead to one or more of the following:

  • Signposting on to universal, targeted or other specialist services (complete CAF referral if required) or advice the professional referrer or most involved professional to undertake a CAF;
  • Referral to field work services;
  • A Specialist OT Assessment;
  • OT Fast Track Assessment;
  • Advice to parent/carer regarding equipment and/or adaptation available for purchase from high street retailers.

Following completion of the assessment the parent/carer will be provided with a Service Plan, signed and dated by the worker, detailing the outcome of the assessment and the recommendations made. A copy of the Complaints leaflet will also be provided.

Outcomes of the initial assessment are:

  • NFA;
  • Progress to a Specialist OT Assessment (SOTA);
  • Progress to a Fast Track Assessment (FT).
The service user and family are informed of the outcome by an appropriate letter, detailing the OT services timescales for assessment.
  5.1.6 In instances where the parent/carer does not agree with the recommendations made, or where the parent/carer is unhappy with the assessment process, the OT Team Manager will make contact with the family in an attempt to agree a way forward. If this approach is unsuccessful, the CSM will offer to meet with the family.


Specialist OT Assessment

  5.2.1 All Specialist OT Assessments will be carried out by a qualified Occupational Therapist or Occupational Therapy Assistant under supervision of a qualified worker. Assessments will be prioritised using the criteria described at paragraph 4.3, and allocated within 6 months of the referral being accepted (or within 6 months of the decision to progress to a Specialist Assessment following completion of an Initial Assessment or Fast track provision).
  5.2.2 Parents/carers will be informed of the outcome of their referral and be given an indication as to how long they may have to wait for an assessment. They will also be informed of how the OT service proposes to keep in contact with them throughout this period (see paragraph 5.2.3).
  5.2.3 If the case has not been allocated within 12 weeks, the Duty Officer will send out a letter to the family to reassure them that their referral has not been forgotten and to gather. This process will be repeated every 12 weeks until the case is allocated. These letters are uploaded into the service users records and case noted.

A Specialist OT Assessment will consider the holistic needs of the child and family within the context of the provision of equipment and adaptation. A Specialist Assessment may lead to the provision of equipment and or adaptation with the aim of:

  • Maintaining the child's care within their care environment;
  • Ensuring that the child's carers are fully supported to care for the child and young person as safely as possible;
  • Assisting a child/young person in reaching their individual maximum level of independence and potential;
  • Enabling a child/young person to stay safe, enjoy and achieve and be healthy;
  • Safeguarding and promoting the welfare of the child.
  5.2.5 Following completion of the Specialist Assessment the parent/carer will be provided with a Service Plan, signed and dated by the worker, detailing the outcome of the assessment and the recommendations made.
  5.2.6 In instances where the parent/carer does not agree with the recommendations made, or is unhappy with the assessment process, the OT Team Manager and CSM will follow the procedure detailed at paragraph 5.1.6.


Fast Track Assessment

  5.3.1 Fast Track Assessments are used in situations where equipment and /or minor adaptations have been assessed by health colleagues and an assessment has therefore already been provided. Fast Track Assessments can also be used in situations that are not complex and where provision of simple equipment and/or adaptation will meet the needs of the child.
  5.3.2 Fast Track Assessments can be undertaken by the Duty Officer and the OT Assistant and will be completed in line with the timescale and communication strategy described in relation to Specialist Assessments.
  5.3.3 Fast Track Assessments should not be used when working with complex situations. It is important to note that the term Fast Track does not mean that the assessment timescale will take priority over all other assessment options.
  5.3.4 Again, if a parent/carer is dissatisfied with the service he/she has received, then the OT Team Manager and CSM will seek to reach a resolution as detailed at paragraph 5.1.6.
  5.3.5 Further information regarding Fast Track Assessment is provided in the Children's Disability Service - Occupational Therapy Operational Guidance - Fast Track Assessments.

6. Reviews

Children's cases that will automatically be placed on review will fall into the following categories:

  • All children under the age of 5 years with modular/specialist seating needs;
  • All children waiting for a major adaptation either through a Disabled Facilities Grant or council adaptation;
  • All children who are subject to a child protection plan and/or where the OT or OTA may have concerns regarding safeguarding as a result of parenting skills/capacity.
6.1 All other cases will routinely be closed to the OT service with a letter summerising the OT intervention that they have received to date and detailing how a new referral can be made to the service should circumstances alter in the future.
6.2 Where a child is open to a social worker, where possible reviews should be co-ordinated.
6.3 Where an OT has in-depth involvement with a CIN or LAC he/she will attend reviews.

A distinction needs to be made between a requirement/need for a review and the need for a new assessment i.e. new need should be processed as a new referral to the service. This is to ensure that those children already known to the OT service do not take priority over those children awaiting assessment.

A review a assessment may result in the following outcomes:

  • NFA;
  • Progress to OT Intervention;
  • New OT referral opened if a new need is identified.