Occupational Therapy Services Procedure

Railing and step adaptations

Description:

Grab rails, handrails by path, extra steps, and shallow steps.

Criteria:

• The child is at risk because of limited mobility;
• Only one point of access / egress to property will be considered for adaptation unless there is a clearly defined need, e.g.: access to garden to play;
• Handrails by a path will only be provided where the child is unable to manage due to a slope or steps;
• Adaptations will not be provided solely for fire exit purposes;
• Path widening will only be considered where the child needs to use a walking frame or wheelchair or a parent / carer needs to assist.

Factors to be considered:

• Would a change of walking aid solve the problem? Is liaison with physiotherapist required?
• What happens at the end of proposed rails? Will the child cope independently on other pathways?
• How often will it be used?
• Consider height of rails in relation to age / development;
• Consider camber of the ground.

Ramping

Description:

Ramps can be permanent or temporary. They can be made of timber, concrete, metal or plastic.

Criteria:

• The child’s mobility is dependent on the use of a wheelchair and qualifies for an NHS wheelchair / buggy, and they or their parent / carer is at risk from the current method used to negotiate access, e.g.: a ramp would not be provided if the carer can safely negotiate a wheelchair / buggy up and down small steps;
• Only one point of access / egress to property will be considered for adaptation unless there is a clearly defined need, e.g.: access to garden to play.

Factors to be considered:

• Is a ramp the safest option? If the child occasionally walks with a frame or artificial limb consider shallow steps or ramp with steps;
• Which type of ramp is most suitable?
• Is the ramp to be fitted on communal steps and how will this affect other people? Do you need their permission?
• Is the door threshold level or if not can it be adapted?
• Which entrance is the easiest and most cost-effective to adapt?
• Consider age appropriate skills / long term predicted mobility;
• Consider cost - obtain minimum of two quotes. Are refurbished parts available?

Ramp construction factors and specifications:

• The optimum gradient for a wheelchair ramp is 1:15, i.e.: for every 10mm in height the ramp must extend 1500mm;
• Where there is insufficient space for the provision of a ramp at 1:15 gradient, individual assessment must be considered;
• Consideration needs to be given to whether the wheelchair will be self propelled or attendant propelled, and the individual capability of the carer;
• All ramps must have a level landing area at the top measuring a minimum of 1000mm square (ideal:1500mm if turn,1200mm if straight);
• All ramps must have 100mm raised edge on all exposed edges;
• All ramps must have non slip surfaces;
• Level resting areas are to be fitted to all long ramps;
• Handrails, with crossbar, must be fitted;
• Water authorities stop valves can be moved higher if they are in the way of the ramp.

Step lifts

Description:

An external lift which provides access to the property.

Criteria:

• Criteria for a ramp has been met, but there is insufficient space for the provision of a ramp of the appropriate gradient;
• Existing access cannot be adapted in a more cost effective manner, and a step lift is considered reasonable.

Factors to be considered:

• Is the child using the lift a wheelchair user or able to walk?
• Is outside lighting and power supply needed?
• How often will it be used?
• Will the lift be at risk from vandalism or misuse?
• Feasibility and cost of groundworks;
• Would rehousing provide a more suitable solution?

Hard standing

Description:

A level car parking area.

Criteria:

• The child is unable to reach the car parked on the road;
• The child cannot safely get in and out of the car on the road, e.g.: due to environmental barriers, narrow road, dangerous bend.

Factors to be considered:

• Will not be provided to prevent car vandalism or parking difficulties;
• Will not be provided for storage of wheelchairs or scooters;
• Consider the child’s long term needs in relation to the style and type of car, e.g.: size, ramped/lift access in/out of car.

Dropped kerbs

Description:

Lowering a kerb to allow access.

Criteria:

• For cars, see criteria for hard standing;
• For wheelchairs, the child is unable to reach the car or house safely via existing dropped kerbs.

Factors to be considered:

• Works need to be authorised by the highways department.

Vehicle storage

• Storage for wheelchairs or scooters is not provided;
• Car ports and garages are not considered essential facilities and are therefore not provided;
• Automatic garage doors will be considered if the garage is also the main entry for independent access to the property.

Stair rails and hand or grab rails

Criteria:

• The department will not usually fit a first stair rail, as this is the responsibility of the owner/landlord;
• A second stair rail will be considered if the child is unable to manage the stairs with only one stair rail;
• A set of stair rails at a different height will be considered if the child is unable to manage the existing stair rails;
• An existing stair rail may be replaced if it is unsuitable, e.g.: where the child has poor grip;
• Grab rails will be considered where the child is unable to manage internal steps or transfers;
• Horizontal rails will be considered in essential areas where either there is not room for the child to use their normal walking aid or if the child is blind or visually impaired;
• Grab rails will not be provided for exercise or treatment purposes.

Factors to consider:

• Consider age appropriate skills/long term predicted mobility. Is a short term solution appropriate?
• Consider height of rails in relation to age/development;
• Consider use of rails by other family members.

Stair lifts

Description:

An electrically operated lift which fits on a straight or curved flight of stairs. Standing or seated models are available with a range of controls.

Criteria:

• The child is unable to manage the stairs safely;
• The child or parent/carer is at risk from the current method of using the stairs;
• The child is able to safely transfer on / off the lift at the top and bottom of stairs;
• The child is able to sit safely;
• Will only be provided where essential facilities are not available on the ground floor, i.e.: toileting, bathing and sleeping facilities.

Factors to be considered:

• Are the stairs suitable for fitting a stair lift? (Seek advice from reps);
• Is there room for other members of the family to use the stairs safely?
• Does the lift need to be in immobilised when not in use? E.g.: consideration of siblings;
• Is the child able to use a stair lift? (Do they need to attend the Disability Living Centre for an assessment?);
• Consider long - term needs;
• Would a vertical lift or ground floor extension be a better long-term solution?
• Are there any risk factors (e.g.: epilepsy, LD) that require risk assessment?
• Is it possible for the child to sleep downstairs?
• Consider the future cost of servicing for the child and family and ensure understanding of their responsibilities.

Vertical lifts

Description:

An electrically operated lift designed to travel between floors through the ceiling.

Criteria:

• The child is unable to manage the stairs;
• Access to essential facilities is not available on the ground floor;
• A stair lift has been considered and is not appropriate, e.g.: the child is an essential wheelchair user or would be unsafe using a stair lift;
• A stair lift is likely to be inappropriate in the future, e.g.: the child’s condition is likely to deteriorate.

Factors to be considered:

• Can the child enter and leave the lift independently or with parent/ carer’s assistance;
• Does an alarm or telephone need to be fitted as the child is using the lift alone?
• Is there enough room for a lift to be fitted? Consider wheelchair circulation space throughout the home;
• Are the facilities to be reached upstairs adaptable, e.g.: bathroom and doorways? Is the bedroom large enough to accommodate wheelchair circulation if required and hoist/carers both sides of the bed?
• Consider the needs of the rest of the family;
• Consider the need to try lift at DLC;
• Consider the size of child, wheelchair and future needs;
• Consider the future cost of servicing for the child and family and ensure understanding of their responsibilities;
• Consider long term use of the lift by future tenants, i.e: fitting of the largest lift practical within the available space;
• Would re-housing be a more cost effective solution?

Changes to doors and doorways

Description:

Doors may be widened, re-hung to open the opposite way or from the opposite side, removed, made into half doors or altered to a robust, concertina or sliding doors.

Criteria:

• The child is unable to get through the doorway to get in and out of a room where access is essential;
• A parent/carer is unable to give essential assistance to the child;
• There is a risk of injury to self or others due to challenging behaviour, e.g.: continual slamming or kicking of door.

Factors to be considered:

• Which type of door would be easiest for the child and family to manage?
• Would it be more suitable to remove the door or leave it open?
• How will it affect other members of the household?
• Have kick plates been considered?
• Has a door closing mechanism been considered?
• What type of door fittings are needed? E.g.: style of handle;
• Would changes to door fittings solve the issues? E.g.: reposition existing fittings or change to a different style;
• Will a heavy duty door be a hazard?
• Is this a general repair issue?
• Consider whether behavioural management support is required;
• See also: “Safety” for guidance regarding locking mechanisms.

General Criteria

• Where the child is unable to maintain personal hygiene independently or with age appropriate support and/or access suitable bathing facilities independently; equipment and/or adaptations should be considered;
• When a child needs assistance from a parent/carer to wash, consider basic equipment to make it easier and safer for the parent/carer;
• Where the child has severe long term continence problems or difficulty managing menstrual hygiene, as part of their disability needs, consider equipment and adaptations to promote independence.

The following sequence of solutions should be considered, taking into account transfer method, sitting balance, postural needs and level of ability:

1. Grab rails;
2. Bath support/bath board/shower board/bath seat;
3. Swivel bather;
4. Bath lift - consider requirement for 6 monthly service and need for others to use the bath - will the equipment need to be moved on a regular basis?
5. Over bath shower;
6. Level access shower (see Adaptations protocol).

Over Bath Showers

Description:

Thermostatically controlled shower over the existing bath.

Criteria:

• Unable to use bathing equipment safely to bathe;
• Provision would enable age appropriate independence, e.g.: would enable older children with ASD to bathe independently.

Factors to be considered:

• Have the child’s long-term needs been considered? E.g.: lifting legs over side of bath;
• Have the needs of other household members been considered?

Level Access Shower 

Description:

Flush with the floor shower area. Space is often created by removing the existing bath.

Criteria:

• Where use of a bath or over bath shower is not possible or safe;
  
  Or
• Where a level access shower will increase the age appropriate independence of the child;
  
  Or
• Where safety for parents/carers is increased with a level access shower.

Factors to be considered:

• Is sufficient space available, including space for necessary equipment;
• Have future needs been considered? E.g.: changes to condition, changes in equipment, access to facilities - e.g.: will a shower stretcher be required? Will direct ceiling track hoisting be required from the bedroom?
• Consider workable access for carers;
• Have the needs of other household members been considered?

Combined Shower and Toilet Cubicle

Description:

A small cubicle that can be plumbed in with a small footprint, consisting of a shower over the toilet.

Criteria:

• Unable to access existing bathing and toileting facilities.

Factors to be considered:

• Cost effective;
• Minimal disruption;
• Can be removed easily at a later date;
• Is it appropriate to meet the child’s needs? E.g: child needs to be independently mobile without aids.

Changing Shower / Bath to Alternative Bath

Description:

Fitting / refitting a bath in a level access shower.

Criteria:

• Will not be considered if the existing facilities are meeting the child’s needs;
• May be considered in exceptional circumstances where the child can be more independent by using a bath or in relation to an identified medical condition. E.g: consider standard bath, bath on a plinth or height adjustable bath.

Factors to consider:

• Transfer method and need for additional hoisting, including possible access for mobile hoist;
• Size of bath, e.g: for equipment;
• Height of bath, e.g: for carers and transfers;
• Consider other family members.

Creating More Space in the Bathroom 

Description:

Enlarging existing bathroom facilities.

Criteria:

• Where the child cannot use existing facilities or parents/carers cannot provide assistance due to lack of space.

Changing the Use of a Room

Description:

Creating a bathroom, toilet, bedroom or kitchen in a different room.

Criteria:

• Where access to existing or adapted essential facilities is not possible;
  
  And
• Where eligibility criteria for the specific facilities recommended are met.

Factors to be considered:

• Have the needs of other household members been considered?
• Is re-housing a more suitable option?

Criteria:

• Where the child does not have primary responsibility for meal preparation, minor alterations may be considered, e.g.: lowering a small section of work surface for snacks and drink preparation and door widening;
• The child is unable to use or is at risk using existing facilities;
• Where the child is wheelchair dependent and requires extra space for manoeuvring;
• In exceptional circumstances whereby the child has primary responsibility for meal preparation, extensive adaptations will be considered.

Factors to be considered:

• Would a suitable table be an alternative?
• Consider using equipment prior to major adaptations;
• Consider use of facilities by others;
• Consider access to hand washing facilities, e.g: wet wipes;
• Consider safety factors;
• It is the responsibility of the family to provide their own kitchen appliances;
• Access to dining facilities is not considered a statutory requirement, except in exceptional circumstances where this is considered essential in relation the child’s disability.

Additional Toilet 

Description:

New toileting facilities provided where appropriate, either upstairs or down.

Criteria:

• The existing toilet cannot be accessed safely or independently, e.g.: due to distance, level of pain and/or difficulty;
• Installation of a stair lift or vertical lift is not feasible or does not meet the need;
• Using the existing toilet causes severe risk to parent/carers, e.g.: due to insufficient space for them to assist;
• Continence cannot be maintained by using the existing toilet.

Factors to be considered:

• Can access to existing facilities be improved?
• Has medical advice been sought to assist in assessment?
• Has a commode/potty chair been considered?
• An outside toilet is not considered to be appropriate.

Specialist Toilet / Wash dry toileting Facilities

Description:

A toilet with wash and dry functions.

Criteria:

• When a child has an awareness and comprehension of toileting needs;
• To increase age appropriate independence;
• To ensure dignity and privacy, as appropriate;
• Only one specialist toilet will be provided.

Factors to be considered:

• Have other options been considered and deemed inappropriate / unsuitable? E.g.: wet wipes, commercially available bottom wipers and carer support;
• Consider other equipment that may be used in conjunction with the specialist toilet, e.g.: wheeled toilet chairs and transfer equipment;
• Consider age appropriate skills;
• Refer to Specialist Wash / Dry Toilets Guidelines document.

Toilets Raised on Plinth

Description:

Toilet raised from the floor. The platform can be of wooden or concrete construction.

Criteria:

• Where increasing the height of the toilet will enable the child to get on and off independently;

Factors to be considered:

• Has other equipment has been considered and deemed inappropriate?
• Is there a possibility a toilet chair will be needed in the future?
• Have the needs of other household members been considered?

Creating More Space

Description:

Enlarging existing toilet facilities.

Criteria:

• When the child cannot use existing facilities or parents/carers cannot provide assistance due to lack of space, more space may be created by making the bathroom and toilet into one room.

Control of Heating

Description:

This could include adapting the controls of the existing heating appliance.

Criteria:

• Where the child has primary responsibility of control of heating and is unable to manage the existing appliance.

Factors to be considered:

• Consultation with the provider of gas/electricity regarding adaptations to controls;
• Where the child does not have primary responsibility of control of heating, consider commercially available alternative controls;
• Have the family accessed Government-funded schemes for improving heating systems?
• Is there another form of heating, e.g.: use central heating instead of a gas fire?

Change of Heating Appliance

Criteria:

• Where the child has primary responsibility of control of heating and is unable to manage the existing appliance;
• May be considered in exceptional circumstances, where safety measures are unable to effectively reduce the risk of injury to the child.

Factors to be considered:

• Running costs will not be considered as a reason for changing heating systems;
• Is there another form of heating, e.g.: use central heating instead of a gas fire?
• Have the family accessed Government-funded schemes for improving heating systems?

Additional Heating

Criteria:

• Where the child is unable to generate sufficient body heat due to medical reasons and alternative commercially available solutions have been ineffective.

Factors to be considered:

• Medical opinion needs to be sought to assist in assessment;
• Only rooms which are regularly used by the child for significant periods of time should be considered.

Bathing and Toileting

Criteria:

• Child meets criteria for additional toilet and bathing facilities;
• The existing facilities are not accessible long term and cannot be adapted to make them suitable for the child, e.g: use of stairs, stair lift or vertical lift.

Factors to be considered:

• Would re-housing represent a more suitable option? Consider Nottingham City Homes Policy;
• Layout of present accommodation and access to a suitable bedroom and essential facilities;
• Size of bathing area, including equipment, carers and transfer method.

Bedroom with Bathing and Toileting Facilities

Criteria:

• The existing facilities are not accessible long term and cannot be internally adapted to make them suitable for the child, e.g: use of stairs, stair lift or vertical lift;
• There is no suitable ground floor space within the existing structure that could be used as a bedroom, e.g: only one reception room on the ground floor;
• Where there are two reception rooms, and the remaining reception room is too small to be used as a living room, e.g: due to the size of the household.

Factors to be considered:

• Would re-housing represent a more suitable option? Consider Nottingham City Homes Policy;
• Families are expected to be flexible in the use of living space, e.g: re-organisation of living and bedroom spaces;
• Where there have previously been two separate rooms which have been converted into a through room, consideration should be given to reinstating the divide;
• Bedroom extensions will not be built due to overcrowding (children of the opposite sex under 10 years of age are expected to share, same sex siblings can share until age 21);
• Has proximity to parent/carer at night been considered?
• Has consideration been given to distance/isolation from the rest of the family?
• Layout of present accommodation and access to essential facilities;
• Size of proposed bedroom and bathing area, including equipment, carers and transfer method;
• Where behavioural problems are a factor, has lack of supervision at night been taken into consideration?
• Where a child is unable to share a bedroom due to disability needs, and needs cannot be met by reorganisation with the property, medical evidence must be sought and alternative strategies must have been trialled;
• Bedroom extensions will not usually be built as part of a re-housing package as this would be an inappropriate let.

Criteria:

• Suitable bedroom facilities are not accessible within the property;
• Suitable bathing facilities are accessible within the property;
• There is no suitable ground floor space within the existing structure that could be used as a bedroom, e.g: only one reception room on the ground floor;
• Where there are two reception rooms, and the remaining reception room is too small to be used as a living room, e.g: due to the size of the household.

Factors to be considered:

• Would re-housing represent a more suitable option? Consider Nottingham City Homes Policy;
• Families are expected to be flexible in the use of living space, e.g: re-organisation of living and bedroom spaces;
• Where there have previously been two separate rooms which have been converted into a through room, consideration should be given to reinstating the divide;
• Bedroom extensions will not be built due to overcrowding (children of the opposite sex under 10 years of age are expected to share, same sex siblings can share until age 21);
• Has proximity to parent/carer at night been considered?
• Has consideration been given to distance/isolation from the rest of the family?
• Layout of present accommodation and access to essential facilities;
• Size of proposed bedroom and bathing area, including equipment, carers and transfer method;
• Where behavioural problems are a factor, has lack of supervision at night been taken into consideration?
• Where a child is unable to share a bedroom due to disability needs, and needs cannot be met by reorganisation with the property, medical evidence must be sought and alternative strategies must have been trialled;
• Bedroom extensions will not usually be built as part of a re-housing package as this would be an inappropriate let.

Fencing to Garden

Criteria:

• In exceptional circumstances, fencing will be considered where commercially available fencing is not sufficient to secure the garden and enable safe play with age appropriate supervision;
• The need is owing to disability, or challenging behaviour, as a result of a diagnosed disability, not due to lack of supervision.

Factors to be considered:

• Consider behavioural support in the first instance;
• Fencing will not be provided due to neglect/need for repairs to current fencing;
• Will planning permission be required?
• What is the effect on neighbours?
• Height of fence 1.8-2 meters should be the maximum height;
• What size and area are to be fenced? For example, in some instances an area up to 30sqm is reasonable if the garden is very large;
• What materials should be used?
• Are the garden gates secure?
• All cross struts should be on the outside of the garden to prevent climbing;
• Parental supervision will still be required;
• What is the general state of the garden? Is there rubbish, broken glass etc., posing a health risk?
• Only one area will be fenced, usually the back garden.

Cleaning of Garden

Will not be carried be out by WLD OT service.

The Council will not do this if tenants are themselves responsible for the state of the garden.

Access to Garden

• Levelled access to a garden will be considered where appropriate. ‘Access,’ refers to the provision of access to existing areas where reasonable and practical.

Factors to consider:

• Will provision promote safety and independence;
• What is the most reasonable and cost effective way of accessing the garden;
• Parental supervision will still be required;
• Will there be movement of structures or drain district heating;
• Is the access shared;
• Access may not be provided to the whole garden;
• Does not apply to the provision of desirable aspects such as patios, raised area, etc.

General Criteria

• Where there are behavioural/safety issues, please refer to the Environmental Restraint Policy and Home Safety Risk Assessment;
• Locking mechanisms will not be provided without a Home Safety Risk Assessment being undertaken. This must include multi-disciplinary input to ensure holistic assessment;
• Behaviour management strategies should be considered as a first option. Consideration should also be given to ensuring that the child has appropriate levels of supervision in place.

Factors to consider:

• Assistance with safety features is considered where there is a significant risk of harm, in their home environment, due to the child’s disability;
• The behaviour causing the potential risk is having a negative impact on essential daily living skills;
• The provision of safety features is not a substitute for behavioural management, support and effective parenting skills;
• Provision of safety features should only be considered when the child requires higher levels of parental supervision/responsibility than would be expected of a child of that age and where their needs cannot be met by commercially available solutions;
• A fire safety check from the fire service must be requested by the allocated OT where any restrictive adaptations to doors and/or windows are provided;
• Any safeguarding concerns as a result of the use of locks on bedroom doors against OT advice should be referred to the Social Work Team Manager.

Safety Gates

Criteria:

• The need is owing to disability, not age and inexperience;
• The person is at risk of falling down the stairs or requires limited access to certain areas of the home to promote safety;
• Should only be considered if commercially available models are not suitable to meet the child’s needs. Please note that ‘tall’ stair gates are available commercially.

Factors to be considered:

• Would a barrier put the child at extra risk? Consider use of Environmental Restraint Policy and Home Safety Risk Assessment;
• Consider benefits v risks:- E.g. Is the child likely to attempt to climb?
• Would assistive technology be a better option? 
• What fixings will be used? - never use keys;
• Do other members of the household need access to rooms/facilities?
• What height of gate is required?
• Strength and durability of materials to be used.

Boxing In

Criteria:

• The boxing in of household fixings / items e.g. pipes, meters, televisions, wires etc may be considered where a child is likely to injure themselves or property due to challenging behaviours owing to disability.

Factors to be considered:

• It is expected that as far as possible children will be supervised;
• Has behavioural management been considered;
• Have commercially available options been explored?

Safety Glazing

Criteria:

• Should only be considered if the child is likely to throw themselves against or injure themselves on the windows in their bedroom or main living area;
• It is expected that children would, as far as is possible, be supervised in all other rooms;
• The whole house will not be done as a matter of course.

Factors to be considered:

• Is fire safety an issue? Has a fire safety check been requested?
• Consider ventilation;
• Consider repositioning furniture/other items to restrict access to windows;
• Consider type of safety glazing, e.g. safety film, secondary glazing or Perspex.

Fire Guards / Radiator Covers

Criteria:

• Will only be considered if the child is at considerable risk of burning/injuring themselves owing to disability and commercially available items have been proven to be ineffective.

Factors to be considered:

• Does the fire guard / radiator cover present additional risks? e.g climbing / sharp edges;
• Would relocating the radiator/fire out of reach, be a suitable option?
• Would restricting the use of/disconnecting the radiator/fire be a suitable option?

Window Locks

Criteria:

• Will not usually be provided but can be considered in very exceptional circumstances for example, where a child has challenging behaviour and commercially available window locks have been proven to be unsuccessful.

Factors to be considered:

• Has behavioural management been explored?
• Is fire safety an issue? Has a fire safety check been requested?

Change of Windows

Will only be considered where commercially available window locks are unsuccessful and the need is owing to disability

Factors to be considered:

• Is fire safety an issue? Has a fire safety check been requested?
• Consider ventilation;
• Consider positioning and type of lock to be used;
• Consider positioning, size, and type of opening.

Flush Light Fittings

Criteria:

• In exceptional circumstances, alternative lighting will be considered where commercially available lighting is not sufficient to ensure the child’s safety with age appropriate supervision;
• The need is owing to disability, or challenging behaviour, as a result of a diagnosed disability, not due to lack of supervision.

Factors to be considered:

• Consider use of assistive technology to support parental supervision;
• Consider behavioural support;
• Consider repositioning furniture away from light fittings to restrict access;
• Consider relocation of lighting.

Padding of Walls

Criteria:

• Will be considered in a specific area where a child is repeatedly putting themselves at substantial risk of injury, for example a child head banging the wall beside the bed;
• Will only be considered where supervision is not possible, for example, at night when parents/carers are asleep

Factors to be considered:

• What is the cause / trigger of the behaviour? Has behavioural support been tried?
• A room will not be padded to provide a “soft play area”;
• Only a specific area will be padded. A whole room or more than one area will not be considered.

Soundproofing

There are significant safety implications that can result from soundproofing a room, for example, a child will not be able to attract attention in an emergency or it could potentially lead to the isolation of the child. Soundproofing will be considered on an individual basis, following careful assessment and identification of any risks.

The provision of equipment

The following guidelines illustrate the circumstances in which Nottingham City Council, Children and Families Services may loan equipment. This is not an exhaustive list. Provision of equipment is based upon an Occupational Therapist’s assessment of needs. The Occupational Therapist will initially consider the provision of stock items available via ICELS. Refurb stock will be considered where appropriate to meet need. Where these items are not suitable, the item will be ordered via ICELS as a special.

Specialist alternatives to commercially available equipment (such as stair gates, fire guards, fridge locks, window and cupboard locks) will only be supplied when the needs of the child are not met by the commercially available products.

A direct payment is a payment that equals the amount it costs NCC to supply the standard equipment. The child/family can then add their money to this to buy a preferred piece of equipment.

If the family would prefer a Direct Payment, this must be provided where there is an assessed need (see ICES Direct Payment Policy).

General Guidance

• Where the child is unable to maintain personal hygiene independently or with age appropriate support and/or access suitable bathing facilities independently; equipment and/or adaptations should be considered;
• When a child needs assistance from a parent/carer to wash, consider basic equipment to make it easier and safer for the parent/carer;
• Where the child has severe long term continence problems or difficulty managing menstrual hygiene, as part of their disability needs, consider equipment and adaptations to promote independence;
• Where compliance in relation to bathing is identified as the presenting issue (e.g. challenging behaviour), consider advice/guidance/behavioural support. Please note that bathing equipment will not be issued to address compliance e.g. restraint.

The following sequence of solutions should be considered, taking into account transfer method, sitting balance, postural needs and level of ability:

1. Grab rails;
2. Bath support/bath board/shower board/bath seat/paediatric bath seats;
3. Swivel bather;
4. Bath lift - consider requirement for 6 monthly service and need for others to use the bath - will the equipment need to be moved on a regular basis?
5. Over bath shower;
6. Level access shower (see Adaptations protocol).

Factors to consider:

• Basic minor bathing equipment should be considered before more costly equipment;
• Relevant medical factors e.g. seizures, spasms, altered sensations;
• Behavioural Factors - see above;
• Postural control;
• Ability to transfer;
• Consider family situation and needs of the household i.e. is there space for a bath lift? Will equipment need to be removed to enable others to bathe?
• Type/contours of the bath;
• Safety;
• Continence/menstruation.

See separate document entitled “Guidance on Bathing Equipment”.

Provision of equipment should be considered:

• Where a child is unable to use the toilet safely and/or independently (appropriate to their developmental stage);
• Where assisting a child to use the toilet presents a risk to carers;
• To promote development of toileting skills if specialist support or positioning is required.

Factors to consider:

• Would commercially available equipment meet needs? If so, provide advice and guidance;
• Basic equipment should be considered before more costly equipment;
• Consider long term prognosis;
• Consider child’s ability including developmental stage in relation to provision;
• Consider facilitating toilet training;
• Consider family situation and the needs of the household;
• Consider child’s toileting method at school/nursery?

• To be used in conjunction with current legislation;
• Equipment will not be provided for the sole purpose of carrying out treatment;
• Decision making for hoists and slings should only be done after specialist training and assessment;
• Liaise with physiotherapy to determine physical abilities, transfer methods and transfer potential.

If moving and handling equipment is provided a full risk assessment and handling plan must be completed, signed and provided to the family.

None lifting equipment

E.g. rotunda’s, transfer boards.

Should be considered as a first option to give independence or assist parents/carers.

Standing Hoists

Consider where independent transfers are not possible but where a child is able to weight bear and a standing hoist is appropriate to their age/size.

Mobile Hoists

These should be considered where independent transfers are not possible and parents/carers are unable to assist safely in any other way.

Consider available space, number of carers and long term needs

Consider for a short term use.

Gantry Hoists

Used generally where there is insufficient space for a mobile hoist, property does not accommodate a ceiling track/wall mounted hoist or where appropriate for short term use.

Ceiling Track Hoists

A ceiling track hoist should be considered:

• Where there is insufficient space for a mobile hoist;
• Where the parent/carer is unable to use a mobile hoist or it’s frequent use will place unacceptable levels of stress;
• When a child would be enabled to transfer independently and this is age appropriate;
• Where use of a hoist is considered to be long term.

Factors to consider:

• Provision should be based on the OT assessment of need and a Moving and Handling Risk Assessment and Handling Plan completed;
• Ceiling track hoists will not be provided in all rooms and will only be provided where necessary and appropriate;
• Room layout - two separate tracks where needed (i.e. where transfers need to be completed in two rooms i.e. bedroom and living room. Two tracks are preferable to a continuous track to minimise travelling and facilitate transfers into special equipment;
• Continuous tracking may be considered where transfers will be reduced e.g where a shower stretcher is required;
• Structure - the ceiling may need to be strengthened or a wall to wall track may be preferable.

Slings

A Moving and Handling Assessment is required prior to provision of slings. A Handling Plan will subsequently be required providing full details of loop attachments and use.

The following sequence of solutions should be considered,

1. Consider standard stock slings;
2. Consider refurb slings;
3. Explore new purchase of slings.

Factors to be considered:

• Consider length of time in the sling (e.g. type of material if left in situ);
• Consider style of sling i.e. anti spasm/deep back sling;
• Consider access for toileting;
• Consider provision of bathing sling;
• As a general guideline two slings will be provided for general use and one for bathing however provision will be considered on an assessment of needs led basis;
• Consider how the sling will be fitted;
• Dual fixings will generally not be provided (please refer to local arrangements). When contemplating dual fixings, consider the impact upon positioning.

Slide sheets

Should be considered when assisting to roll or reposition on a bed or other flat surface, or to assist in the fitting of slings.

The following sequence of solutions should be considered,

1. Consider standard stock slide sheets;
2. Consider refurb slide sheets;
3. Explore new purchase of specialist slide system.

Factors to consider:

• Number of carers needed;
• Carer Access to Bed;
• Tissue viability;
• Method of inserting and removing slide sheets.

Neater Eater

Should be provided where this will enable a child to feed themselves independently, where all alternative cutlery has proven ineffective.

Factors to consider:

• An assessment is essential prior to provision;
• Can this be joint funded via continuing care?
• Consider the motivation of the child and age appropriateness. Such equipment requires practice and should only be considered for children that consider this a meaningful activity;
• Consider the interaction between child and carer that will be lost if this is provided.

Nursery/Low chair

This should be considered where minimal support is required to promote function/independence/play and a commercially available chair is not suitable.

Factors to consider:

• Provision would only be considered if needs cannot be met by a standard commercially available nursery seat;
• Consider transfer ability and carer’s needs in relation to moving and handling;
• Consider base of support;
• Consider safety needs i.e risk of tipping;
• If minimal support is required for toileting also consider dual purpose provision if appropriate.

Chair raisers

Should be considered to facilitate independence in transfers or to enable a parent/carer to assist transfers without undue strain.

Should not be considered if the chair is of an unsuitable design for the child or is in too bad a state of repair.

Alternative chairs will not be provided simply because a chair is in need of repair or the child has no suitable chair to raise.

Factors to consider:

• Should always be considered as a first option with standard seating to aid transfers;
• Consider suitability of chair i.e. style of feet, arm support to assist sit to stand;
• Consider access to chair i.e walking frame/standing hoist;
• Consider safety of overall height of chair after raising;
• Consider needs of other household members.

Postural management seating should be provided if a child is unable to sit unsupported and/or is at risk of developing postural abnormalities. Specialist seating should be provided to maximise independence and increase function in every day tasks i.e. socialising, play and feeding.

A specialist seating assessment should be completed prior to provision of postural management seating with multi disciplinary liaison where required i.e. with Physiotherapists.

Agreement is in place for all requests of brand new postural management seating (chairs) to be funded on a 50:50 basis between health and social care.

The following sequence of solutions should be considered,

1. Refer to outcome of seating assessment;
2. Consider standard stock seating;
3. Consider refurb specialist seating;
4. Explore new specialist seating.

It is the duty of the parent/carers to provide a suitable place for a child to sleep, where a standard commercially available bed meets the child’s needs.

Specialist equipment should be provided where commercially available equipment does not meet the child’s needs.

• Beds/Bed equipment should be provided to maximise independence and minimise risk of falls;
• To assist parents/carers to carry out personal care and support safe moving and handling;
• Where there are concerns regarding a child’s safety due to challenging behaviour, owing to their disability, a multidisciplinary Environmental Restraint Risk Assessment should be completed prior to provision of bed sides. This should consider alternative interventions e.g. behaviour support, assistive technology etc.

Profiling Beds/Adjustable height beds

These will only be supplied where a fixed height bed does not meet the following needs:-

• Safe carer support during personal care tasks;
• Safe repositioning or transfers;
• Safe moving and handling.

Factors to consider:

• Location of the bed;
• Long term needs. Smaller beds will only be provided where there is a clearly identified need;
• Consider whether a two or four section bed is required. i.e. four section beds are sometimes not suitable for younger children as the sections are not suitably placed and can result in entrapment;
• Consider continence and tissue viability needs;
• Consider access for Moving and Handling equipment.

Specialist mattresses are provided by health i.e. pressure relieving mattresses.

Bed Sides

• Will be provided to minimise risk of falling where child has no independent mobility;
• Where a child has some independent mobility, an Environmental Restraint Risk Assessment should be completed prior to provision of bed sides;
• Where there are concerns regarding a child’s safety due to challenging behaviour, owing to their disability, a multidisciplinary Environmental Restraint Risk Assessment should be completed prior to provision of bed sides. This should consider alternative interventions e.g. behaviour support, assistive technology etc.;
• The following sequence of solutions should be considered;
  1. Refer to outcome of Environmental Restraint and Risk Assessment where applicable;
  2. Consider standard stock bed sides;
  3. Consider refurb stock specialist bed sides;
  4. Explore new specialist bed sides.

Factors to consider:

• Are bed sides required?
• Are these age appropriate/would commercially available rail meet the child’s needs;
• Type/height of rails;
• Will providing rails place the child at a greater risk of falls e.g. ability to kneel/stand/climb;
• Risk of entrapment; consider infill wedges;
• Size and age of the child;
• Would a low or a high/low bed better meet the child’s needs?
• Would a bed/door sensor with implementation of behavioural techniques better meet the child’s needs?
• 0-18 year olds children and young people who are defined as a ‘child’ in terms of their height and weight according to ‘EN50637:2017 Medical Electrical Equipment, Particular Requirements for the basic safety and essential performance of medical beds for children’ must be provided with a bed that meets these standards. A bed which doesn’t meet the standard can be used in exceptional cases. A bed risk assessment stating why the needs of the child outweigh any risks associated with using a bed which doesn’t meet the standard, would need to be in place.

Specialist Beds

Should only be considered in exceptional circumstances where;

• Standard stock beds do not meet the child’s needs;
• To facilitate independence, safety and carer support.

The following sequence of solutions should be considered:

1. Refer to outcome of Home Safety Risk Assessment and/or Bed Risk Assessment;
2. Consider specialist beds in refurb stock;
3. Explore new specialist beds.

Factors to consider:

• Where there are health needs, consider funding through continuing care;
• Consider location of the bed;
• Consider long term needs. Smaller beds will only be provided where there is a clearly identified need;
• Consider whether a two or four section bed is required. i.e. four section beds are sometimes not suitable for younger children as the sections are not suitably placed and can result in entrapment;
• Consider continence and tissue viability needs;
• Consider access for Moving and Handling equipment.

Bed levers

Should be provided to enable child to sit up and/or turn over and transfer independently.

Factors to be considered:

• Position of bed lever;
• Entrapment;
• Type of bed e.g. slatted/double.

Mattress Elevators/ Pillow Lifters

Should be provided to enable independence in sitting up and transfers where neither bed-lever, nor other minor equipment will meet the need and where it will reduce manual handling.

Only specialised equipment to enable independence in preparing food and drinks will be provided after items that are commercially available have been tried and unsuccessful. Items that are readily available in kitchenware shops, department stores etc are not provided.

Factors to consider:

• Whether provision of an item of equipment will reduce dependence on parents/carers, and will facilitate age appropriate independent living skills.

Perching Stool

To promote independence in kitchen activities where a child has poor standing tolerance, but can otherwise carry out ordinary household tasks safely and where an ordinary kitchen stool is not suitable.

Factors to consider:

• Space available;
• Age appropriate skills;
• Height.

Trolley

To enable a child to transport food, drink or other items from, to and within the kitchen safely.

Factors to consider:

• Not to be used as a walking aid;
• Consider alternative commercially available equipment;
• Environment e.g. space, thresholds, steps.

A device to be used to enable parents/carers to ensure safety of the child when unsupervised (e.g. in bed), with minimal disruption to the child/parent.

Need arises due to disability/impairment rather than age/lack of experience, this would be responsibility of the parent/carer.

Audio monitor should be considered as first option. Visual monitor will be considered only where more extensive monitoring is required e.g. challenging behaviour.

Factors to consider:

• Privacy of the child.

Epilepsy monitors

Can be provided via Assistive Technology or parents can access through independent charities (e.g. MuirMaxwell Trust).

Factors to Consider:

• Advice from local and national Epilepsy Service.

Assistive technology

There is a full range of assistive technology, which can be provided by OTs, FSWs and SWs - refer to assistive technology staff for support re this provision.

Items available can increase safety and independence. Individual assessment of need is required for these items.

Assessments of need in second home/Short breaks placement i.e. direct payment support workers home

Where it is identified that a child spends a significant amount of time in a second home, an assessment for equipment can be completed by the allocated OT. Provision of equipment in this home will be proportionate to the time spent at the home and will be dependent upon ‘need’.

Consideration will be given to transportation of equipment (by the family) between the sites where appropriate rather than dual provision as a first consideration.

Provision of equipment in residential care units

Refer to separate ICES policy.