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9.5 Integrated Children’s Disability Service Occupational Therapy (ICDS-OT) - Policy for Receiving Referrals and Undertaking Assessment

SCOPE OF THIS CHAPTER

This policy details the referral and assessments process for the ICDS Occupational Therapy team. 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.

RELATED CHAPTERS

Integrated Children’s Disability Service Occupational Therapy - Legal Framework

Integrated Children’s Disability Service Occupational Therapy Guidance for the Loan of Equipment

Integrated Children’s Disability Service Occupational Therapy Guidance for Recommending Minor and Major Adaptations

AMENDMENT

In January 2021, this chapter was updated throughout and should be re-read.


Contents

Caption: contents list
   
1. Context
2. Policy Scope
3. Thresholds and Eligibility for Assessment
4. Referral Process
  4.1 Referrals
  4.2 Referral Outcomes
  4.3 Communicating the Outcome of Referrals
5. Types of Assessment / Intervention Steps
  5.1 Proportionate Assessment Step
  5.2 Occupational Therapy Assessment (OT Assessment) Step
  5.3 Seating Assessment and Intervention / Seating Re-assessment and Intervention Steps
  5.4 Moving and Handling Assessment / Moving and Handling Re-assessment Steps
  5.5 OT Assessment for Residential and Short Breaks Step
  5.6 Focused Intervention Step
6. Types of Assessment Form Used Within Assessment / Intervention Steps
  6.1 Property Assessment Form
  6.2 Housing Needs Assessment Form
  6.3 Bed Assessment Form
  6.4 Specialist Bed Rail Review Form
  6.5 Assessment of Second Address Form
  6.6 Specialist Seating/Postural Assessment Form
  6.7 Moving and Handling Assessment Form
  6.8 Sling Assessment Form
  6.9 Restraint Risk Assessment
  6.10 Just Checking Agreement Form and Just Checking Assessment Tool
7. Prioritisation and Timescales for Case Allocation and Assessment
  7.1 Prioritisation of Assessments
  7.2 Timeframe for Allocation
  7.3 Communicating with Families


1.Context

Caption: Context table
   
1.1 The Integrated Children’s Disability Service Occupational Therapy (ICDS-OT) team provides specialist assessment for disabled children and young people resident in Nottinghamshire up to the age of 18, who have a permanent and substantial disability which has an adverse effect on their ability to carry out normal day to day activities within the home environment.
1.2 Occupational Therapy aims to provide support and intervention to help children and young people with disabilities develop to their full potential, taking into account the stage of development the child/young person has reached. It can assist with overcoming practical problems and maximising a child/young person's independence in their own home, as well as supporting parents/carers to care for their disabled child/young person safely.
1.3 The ICDS-OT team employs Service Organisers, Occupational Therapy Assistants (OTAs) and qualified Occupational Therapists (OTs) who all may be involved in the assessment of children and young people.
1.4 Qualified Occupational Therapists are registered with the Health and Care Professions Council (HCPC) and to maintain this registration comply with HCPC’s ‘Standards of Conduct, Performance and Ethics’, ‘Standards of Proficiency’ and ‘Standards of Continuing Professional Development’.
1.5 This policy complements the Nottinghamshire Safeguarding Children Partnership (NSCP) safeguarding procedures and guidance and Nottinghamshire’s Pathway to Provision.


2. Policy Scope

2.1 The purpose of this policy is to set out the procedure that should be followed when the ICDS-OT team receive referrals and undertake assessments, aiming to ensure that the service offered by the team is consistent.
2.2

Whenever the words ‘child’ or ‘children’ are used within this document this should be taken to read ‘child or young person’ or ’children or young people’.

2.3 Whenever the words ‘family’ or ‘families’ are used within this document this should be taken to read ‘parent(s) and/or carer(s)’.
2.4 Where documents are sent to families this may be via post or via secure email (Cryptshare).
2.5

Occupational Therapy equipment and adaptations cannot be prescribed:

  • 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; window locks/restrictors; stairgates; cupboard locks;
  • As an alternative to strategies and programmes aimed at managing challenging behaviour;
  • As a means of achieving general household repairs or maintenance which under normal circumstances would be the owner/landlord’s responsibility e.g. replacing rotten window frames; broken windowpanes; repair to driveway/paths.
2.6 It should be noted that if the ICDS-OT service becomes aware that a family is using restrictive practices, further assessment will be required.
2.7 This policy is supported by ‘ICDS-OT Legal Framework’, ‘ICDS-OT Guidance for the Loan of Equipment’ and ‘ICDS-OT Guidance on Recommending Minor and Major Adaptations’. It also interacts with other organisation’s policies including those of the Integrated Community Equipment Loan Service (ICELS) and the policies of the seven local District Councils within Nottinghamshire, particularly in relation to adaptations and housing.
2.8 In instances where the family do not agree with the outcome of a referral, an assessment or the recommendations made, or where the family are unhappy with the assessment process, the OT Manager or Senior Practice Consultant will make contact with the family in attempt to agree a way forward. The family can pursue the Council’s complaints process if they feel this is required.


3. Thresholds and Eligibility for Assessment

3.1

To be eligible for assessment by the children's Occupational Therapy team the criteria are as follows:

  • Child lives in Nottinghamshire and is under the age of 18;
  • Child has a severe physical disability;
  • Child has complex health needs;
  • Child has a severe learning disability;
  • Child has severe autism.
3.2

A child will be deemed to have severe autism if they are eligible for a service from the Children's Disability Service (Social Care) or is in receipt of one of the following:

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


4. Referral Process

Caption: Referral and Assessment 1
   

4.1

Referrals

  4.1.1 Referrals requesting an assessment are taken directly through the Occupational Therapy Duty point which operates Monday-Friday 08:45-16:30 (excluding Bank Holidays).
  4.1.2 Referrals are accepted from families, children and professionals or people involved in their care.


4.2

Referral Outcomes

  4.2.1 When a referral is received a decision on whether the child is eligible for assessment will be made immediately by the Duty Worker in line with the eligibility criteria described in 4.0. If required, a referral may be tasked to the OT Duty Manager for guidance and this task will be responded to within 48 hours.
  4.2.2

A Proportionate Assessment may be completed by the Duty Worker if it is needed to gather more information about the child and family’s needs and/or assess:

  • Whether a child is eligible for further assessment by the IDCS-OT team;
  • If a service is needed and if so, who should provide this service.
  4.2.3

Outcomes of a referral may include:

  • Signposting to other ICDS services. Where the referral indicates that a child has needs that would benefit from a graduated response the ICDS-OT team may recommend referral to the ICDS Specialist Support Team to gain further information prior to undertaking Occupational Therapy assessment;
  • Signposting to universal, targeted or other specialist services. This may involve advice to the professional referrer/most involved professional to complete an EHAF;
  • Advice/guidance to family regarding non-specialist equipment available to purchase from high street retailers;
  • Referral to the Multi Agency Safeguarding Hub (MASH) where the referral indicates that Social Care involvement may be needed to promote the development and welfare of the child (s.17, Children Act 1989) or where there is reason to suspect the child is suffering or likely to suffer harm (s.47, Children Act 1989);
  • Further assessment(s) by the ICDS-OT team. More than one assessment may be progressed as an outcome of a referral (e.g. a Seating Assessment and a Proportionate Assessment);
  • Focused intervention by the ICDS-OT team;
  • Contribution to an Education, Health and Care plan by the ICDS-OT team.
  4.2.4 Referrals considered eligible for assessment will be tasked to the OT Duty Manager to be progressed and this task will be responded to within 48 hours.


4.3

Communicating the Outcome of Referrals

  4.3.1 The outcome of the referral should be made clear to the referrer at the point of referral. If applicable, an indication of how long the family may have to wait for an assessment will also be given, as well as details of how the ICDS-OT team proposes to keep in contact with the family during this period.
  4.3.2 Where it is likely that an assessment may lead to major adaptations or a Disabled Facilities Grant, or where the family’s expectation is that this may be the outcome, a copy of the ICDS-OT Disabled Facilities Grant Information Leaflet will also be provided.


5. Types of Assessment / Intervention Steps

Caption: Types of Assessment / Intervention Steps
   

5.1

Proportionate Assessment step

  5.1.1

Proportionate Assessments and Occupational Therapy Assessments cover broadly the same information but in different levels of detail.

  5.1.2

Proportionate Assessments may be used in scenarios such as:

  • Gathering further information about a child’s needs;
  • Situations that are not anticipated to be complex where provision of simple equipment and/or minor adaptations are likely to meet the child’s needs;
  • Situations that are likely to be complex but where simple equipment and/or minor adaptations may provide a short to medium term solution whilst awaiting further assessment; or a Housing Needs Assessment could be provided;
  • Assessment for specialist equipment for Deaf, deafened or hard of hearing children;
  • Focusing on one area of need (e.g. assessment for a showerchair) where the child is already known to ICDS-OT and other needs have been addressed.
  5.1.3 Proportionate Assessments may be carried out by the ICDS-OT Service Organiser, Occupational Therapy Assistants or qualified Occupational Therapists.
  5.1.4

Depending on the circumstances, a Proportionate Assessment may be completed by:

  • Telephone conversation with the family and/or referrer;
  • Video call through NCC approved software;
  • Consultation with other agencies to gather information;
  • Visiting the child at home.
  5.1.5

Following a Proportionate Assessment, if needs are identified then recommendations will be made to meet the child’s needs. This may include one or more of the following:

  • Signposting to other ICDS services such as the ICDS Specialist Support Team;
  • Signposting to universal, targeted or other specialist services, or advice to the professional referrer or most involved professional to complete an EHAF;
  • Referral to Social Care;
  • Advice to family regarding non-specialist equipment available to purchase from high street retailers;
  • Provision of equipment and/or minor adaptations.

Further assessment by the ICDS-OT team. More than one assessment may be progressed as an outcome of a Proportionate Assessment (e.g. a Seating Assessment and an Occupational Therapy Assessment).

  5.1.6 Once completed, a Proportionate Assessment will be tasked to a Senior Practice Consultant/OT Manager for authorisation.
  5.1.7 If a Proportionate Assessment has been completed by the Duty Worker, the family will be sent written confirmation of the outcome of the assessment. A signed and dated copy of the Proportionate Assessment can be provided on request.
  5.1.8 If a Proportionate Assessment relates to one area of need, a signed and dated copy of the Specific Area of Need document can be provided on request.
  5.1.9 In other circumstances, following completion of the Proportionate Assessment the family will be provided with an electronically signed and dated copy of the assessment and careplan detailing the outcome of the assessment and the recommendations made, with a request to sign and return a copy. Work towards the agreed recommendations will commence once a signed copy of the Proportionate Assessment has been received from the family, or their verbal/written agreement with the needs and recommendations has been recorded in casenotes.


5.2

Occupational Therapy Assessment (OT Assessment) Step

  5.2.1 Proportionate Assessments and Occupational Therapy Assessments cover broadly the same information but in different levels of detail.
  5.2.2 OT Assessments may be carried out by either an Occupational Therapy Assistant or a qualified Occupational Therapist.
  5.2.3 OT Assessments are completed by visiting the child at home.
  5.2.4

Following an OT Assessment, if needs are identified then recommendations will be made to meet the child’s needs. This may include one or more of the following:

  • Signposting to other services;
  • Referrals to other services;
  • Advice and guidance;
  • Provision of equipment and/or minor adaptations;
  • Recommendation of major adaptations;
  • Further assessment by the ICDS-OT team. More than one assessment may be progressed as an outcome of an OT Assessment (e.g. a Seating Assessment and Intervention and a Moving and Handling Assessment).
  5.2.5 Once completed, an OT Assessment will be tasked to a Senior Practice Consultant/OT Manager for authorisation.
  5.2.6 Following completion of the OT Assessment the family will be provided with an electronically signed and dated copy of the assessment and careplan detailing the outcome of the assessment and the recommendations made, with a request to sign and return a copy. Work towards the agreed recommendations will commence once a signed copy of the OT Assessment has been received from the family, or their verbal/written agreement with the needs and recommendations has been recorded in casenotes.


5.3

Seating Assessment and Intervention / Seating Re-assessment and Intervention Steps

  5.3.1 The ICDS-OT team will complete a Postural Seating Assessment form within a Seating Assessment and Intervention/Seating Re-assessment and Intervention step in order to make provision of specialist seating to support postural needs.
  5.3.2 Wherever possible, assessments and re-assessments of seating will take place at Seating Clinic in order to give access to refurbished stock and expedite provision.
  5.3.3 Following provision of seating, a Seating Careplan will be provided which will illustrate how to manage the child’s posture when seated.
  5.3.4 For children aged under the age of 5 years at the closure of their seating intervention, a re-assessment will be offered after 6 months. If needed, families can request an earlier re-assessment via the OT Duty point.
  5.3.5 For children 5 years old and over at the time their seating intervention is closed families should request a re-assessment when required by making a new referral to the ICDS-OT team via the OT Duty point.
  5.3.6 Information on how to identify when a re-assessment is needed will be provided to families at the time the seating intervention is closed/closed to review.


5.4

Moving and Handling Assessment / Moving and Handling Re-assessment Steps

  5.4.1 The ICDS-OT team will complete Moving and Handling Assessments (with Sling Assessments as needed) in order to provide advice, education and/or equipment to facilitate a child being moved or handled at home.
  5.4.2 Assessment may need to take place in different environments and/or in collaboration with other agencies or teams.
  5.4.3 Following assessment/re-assessment, a Moving and Handling Careplan will be provided which will illustrate how to move and handle the child.
  5.4.4 Families should request a re-assessment when required by making a new referral to the ICDS-OT team via the OT Duty point.


5.5

OT Assessment for Residential and Short Breaks Step

  5.5.1 Occupational Therapy assessment or intervention relating to short breaks are only provided where a specific service has been commissioned.


5.6

Focused Intervention Step

  5.6.1

Focused Interventions may be used in scenarios such as the following:

  • To arrange repair/replacement of equipment which continues to meet a child’s needs;
  • To arrange the loan of short-term equipment;
  • To joint work a case when an intervention is held by one worker who asks another worker to complete a defined piece of work on their behalf;
  • Completing a Property assessment form;
  • Completing a bed rail review.
  5.6.2 Focused Interventions may be carried out by the ICDS-OT Service Organiser, Occupational Therapy Assistants or qualified Occupational Therapists.


6. Types of Assessment Form Used Within Assessment / Intervention Steps

Caption: Types of Assessment Form
   

6.1

Property Assessment Form

  6.1.1 A Property Assessment is used to assess and document information about a potential property being considered for a child and family and the likelihood that it could meet a child’s needs. This could be at the request of a family considering private purchase/rental, a housing authority or housing association.


6.2

Housing Needs Assessment Form

  6.2.1 A Housing needs assessment is used to document the environmental features a child would need from a property as a result of their disability in order to assist them/housing authorities/housing associations to identify a property suitable for them and their family.


6.3

Bed Assessment Form

  6.3.1 A Bed Assessment is used to assess whether a child needs a specialist bed, and if so, what features the bed should have.


6.4

Specialist Bed Rail Review form

  6.4.1 A Specialist Bed Rail Review form is completed every 12 months for children who have been provided with specialist bed rails.


6.5

Assessment of Second Address Form

  6.5.1 An Assessment of Second Address is used to assess and document information about a second address used by a child.


6.6

Specialist Seating/Postural Assessment Form

  6.6.1 The Specialist Seating/Postural Assessment form sits within the Seating Assessment and Intervention/Seating Assessment and Re-intervention steps and is used to assess a child’s postural needs in sitting.


6.7

Moving and Handling Assessment Form

  6.7.1 The Moving and Handling Assessment form sits within the Moving and Handling step and is used to assess the risks involved with moving and handling tasks.


6.8

Sling Assessment Form

  6.8.1 A Sling Assessment is used to assess what type of sling may meet a child’s needs when being hoisted.


6.9

Restraint Risk Assessment

  6.9.1 A Restraint Risk Assessment is used to identify risks as a result of behaviour, activity or situation and consider the options to reduce these risks.


6.10

Just Checking Agreement Form and Just Checking Assessment Tool

  6.10.1 Just Checking is an activity monitoring service including discreet door and movement sensors that can assist in the assessment of children.
  6.10.2

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.
  6.10.3

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.


7. Prioritisation and Timescales for Case Allocation and Assessment

Caption: Prioritisation and Timescales
   

7.1

Prioritisation of Assessments

  7.1.1 The OT Manager or Senior Practice Consultant will review the referral and if a child is eligible, will decide the priority of the assessment. Cases will be allocated in date order unless given a priority timeframe.
  7.1.2

Examples of assessments indicating a priority timeframe include:

  • End of life;
  • Some Looked After Children/safeguarding;
  • Children who require Occupational Therapy input in order to facilitate an adjustment to a current situation of piece of equipment which is having a severe detrimental impact on their health and wellbeing.
  7.1.3 Priority timeframes can be 10 working days, 35 working days or other timeframe agreed by two Senior Practice Consultants and/or OT Manager on a case by case basis.


7.2

Timeframe for Allocation

  7.2.1

Below are the target timeframes from the date a referral is accepted to the date an assessment is allocated:

    Focused Intervention 5 working days
    Proportionate Assessment by Duty Worker 2 working days
    Proportionate Assessment by OTA 35 working days
    Proportionate Assessment by OT 35 working days
    OT Assessment by OTA 35 working days
    OT Assessment by OT 10 months
    Seating Assessment / Re-assessment 35 working days
    Moving and Handling Assessment / Re-assessment 35 working days
  7.2.2 These target timeframes are correct at the time of publication however they are reviewed on a regular basis in line with team pressures and as such the timeframes listed on Procedures Online may not be up to date. Up to date target timeframes can be obtained by contacting the ICDS-OT Duty point.


7.3

Communicating with Families

  7.3.1 If an assessment has not been allocated within 12 weeks the family will be contacted to reassure them that they not been forgotten and to gather updated information, allowing the case to be reprioritised if necessary. This process will be repeated every 12 weeks until the case is allocated.

End