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Q&A Session- Adapting for Children with Behaviours that Challenge & the Law


	Melinda, OT, local authority (anonymous)
	I am an OT working in housing in a London borough (I prefer not to disclose which borough to the other participants in this course). The borough only administers mandatory DFG’s so work covering up to £30K. There is no discretionary grants. Children’s adaptations are complex and usually require discretionary grants to top up. We are currently unable to fund children’s adaptations over £30K or those with complex needs. Where does this leave us as a LA as we have assessed for eligible needs that we are currently unable to meet? This has an impact on my work as the OT’s refer the family to the housing register as they are unable to adapt the existing property. The issue is we do not have any properties to meet these needs and if we do they still require adaptations that will be in excess of the mandatory DFG. I have requested a copy of the RRO (Regulatory Reform Order) to confirm what is covers but have not received a reply from anyone? Kier, Childrens’ OT Team Manager, Surrey CC.
	Could therapeutic equipment be referred for using DFG funding in a room adaptation to make it safe and useable for a child with behaviour that challenges, e.g. ceiling mounted hug swing, wall mounted bubble tube etc.? The example we have is a safety room adaptation that allows the child time to de-escalate in a safe room where the use of this equipment is part of the de-escalation approach used by parents/carer. Lydia, OT, York City Council
	Is it possible to ask a question in advance, not really an adaptation as such but about the use of high sided beds and Safespaces? In a meeting recently a social work manager has said they have taken legal advice and there needs to be a DOLS application for the provision of high sided beds, and that this applies to beds in children’s own homes as well as at overnight Short Breaks Facilities.It has been my understanding that for children at home, parents could make the decision for them to have a high sided bed or Safespace.
	Kester, OT, Shropshire
	I’m assessing a child who directs his severe anxiety towards his mother causing him to bite, kick, pull her hair. The childrens emotional wellbeing service are working closely with the child and supporting the parent on how to implement the positive behaviour support plan strategies they have devised from his functional behavioural assessment. Please can you discuss the protection of parents in these situations. Such as what duty do services have to provide parents with training in safe physical de-escalation techniques? If Michael or Sara have knowledge of whether authorities do provide this I’d be grateful of this being shared as well. Our authority used to train workers, and provide training for parents, using Team Teach but this was stopped (many years ago) as it felt it was no longer an appropriate robust enough model. I am relatively new in post so do not know the ins and outs. I’m more familiar with legislation relating to adult social care and the services we support adult care givers with.
	Caireen, Childrens’ OT, RB Greenwich
	Q1 The recent Foundations document reads as if extensions, additional bedrooms, sensory rooms, etc. can all be readily provided via a DFG and/or through discretionary funding and that the council will provide these adaptations for children with behaviours that challenge. The range of challenging behaviour is very broad and the needs relate to behavioural management, sleep management, sensory needs, overcrowding issues and parenting training; none of which are Social Care OT’s area of speciality. For physical disabilities, we trial a range of other interventions, including rehousing, before considering extensive adaptations, whereas all the other interventions (rehabilitative input) for challenging behaviour are not within our area to input/trial. When discussed with Foundations, they don’t cover the OT assessment side of things, so where are the assessment tools, criteria and guidance to ensure fair and equitable access to adaptations for behaviours that challenge? Many children would benefit from things like sensory rooms so which would be regarded as an essential need? Without clear criteria and guidance, if the only document relating to this is the Foundations document, where everything can be supported as a safety need, OTs will be put in a position of having to pass all cases through for major adaptations, additional rooms, sensory rooms, safe spaces, etc. The list could be endless of clients and requests. Q2 In the case of overcrowding where, irrespective of any disabilities in the household, they would still be needing an extra room/s, should adaptations funding be used to provide the additional bedroom/s? Q3 Where a family is requesting an additional room for challenging behaviour needs, if Housing would not regard their need as warranting an extra bedroom or extra room to be used as a sensory room, should the adaptations funding be paying for additional room/s? Q4 If services trained in input for ASD, sensory, behavioural and parenting needs are involved and determine that adaptations are needed for e.g. extra rooms, padding, locks, etc. should these services be the services making the recommendations for DFG funding, instead of everything coming through Social Care OT services? Q5 Additional locks requests to reduce the risk of absconding while taking restraint/deprivation of liberty and fire safety into account. I’m finding very mixed approaches by different authorities with no clear guidance for consistency. Nicola, OT, Belfast NHS I am a paediatric OT in Northern Ireland working in a team whose primary role is with children who have physical difficulties but attend mainstream schools, part of that role is housing and school adaptations. The team is receiving significantly higher numbers of referrals for housing assessment and adaptation for children with Autism who are at mainstream schools and have average cognitive ability. These referrals include information from the family who report a lot of challenging behaviours and sensory issues and the family feels a housing adaption is required. The difficulties we encounter is determining: 1) what is a significant and lasting behaviour and/or sensory issue that warrant housing adaptation 2) all interventions have been tried and are unsuccessful (often advice is sought from MDT, but there is potential that in the future these interventions may be successful) These decisions are especially difficult for those children in mainstream schools who are average cognitive ability and should have potential to change with the right support / intervention. Please come back to me if you require any clarity Shelley, OT, Independent What would the criteria or argument (if any) be for a sensory room/ safe space extension if a child had his/ her own significant sized bedroom? Samantha, OT, Independent Please could you ask about the use of safe spaces snd safety beds for children and what documentation is good to use for these children? I.e risk assessments. We have lots of discussion about safe spaces and how they are utilised. Often been given to children from a young age and then when they hit teenage years it is likely to be removed as too restrictive. I currently work for the local authority and it always seems to be a topical discussion with people voicing many opinions. Gemma, OT, Surrey CC
	I have questions about a case which I would like to put forward for next weeks session. I am working with “M” a 15yo young person living with a condition which results in him expressing himself in severe behaviours which challenge. M is approx. 6’1” tall and described as extremely strong. M has been able to pull cupboards off from walls in the past and is physical with his care workers. He has a minimum of 1:1 support at all times but it can be up to 3:1 support depending on the activity that is being completed. At home he requires a minimum of 2:1. M is independently mobile but often uses a wheelchair indoors however this is to contain him and manage his behaviour rather than his ability to stand an walk. M lives with his parents and three sisters in a 3 bedroom semi-detached house. M has his bedroom on the ground floor (used to be the living room) and there has been an extension to provide a bathroom for him. At the time of the original adaptation he was walking and there was only 2 sisters. It was agreed that his ground floor bedroom would be shared living room and once he was sleeping the family could use a spare bedroom as the living room. As a Borough Council owned property an architect was paid for to look at adaptations. However, M’s father and the architect designed an adaptation which far exceeded what could be recommended under the DFG including space for care workers, high ceilings effectively doubling the size of the house. There was an OT involved at the time but M’s father chose to avoid including that OT in the designs until he was forced to by the Borough Council. At that time it was agreed that M’s father’s company would fund this adaptation. Since that time several changes have occurred. The company did not fund the adaptation. New sister was born therefore all bedrooms are being used leaving the family without a living space. M has grown and his behaviours have become more intense. At his school he has a team of 5 care workers who rotate every hour to give 1:1 care. Due to the location of the family home it has never been possible to fulfil the package of care. The family have declined respite as they want their son home. Family are locking M in his room when he’s at home as they struggle to manage him. CAMHS have ended their involvement The family have asked for a new adaptation with the intent of the Borough and County council funding their original project. As the OT involved I can agree the present environment does not meet his needs. However, the family proposed designs try to replicate the school environment. It is my clinical opinion that the success of school is through the high level of support that is provided to M and without the 5 care workers he would express himself in the same way as he does at home. My concern is that any adaptation at home would make no difference without corresponding changes to the package of care. I have raised my concerns with the social worker, the social worker team leader and recently with the service manager however I have yet to get an answer to confirm if they are able to support with increasing the POC to support with adaptations. To further complicate the case, the Borough Council are reluctant to engage with me and whilst they do respond to queries they are not quick to come back and are difficult to pin down with answers. I can see this case going to court and I want to make sure that I have done everything correctly to try and get the support this family clearly need.


	Kate, OT service, Sussex
	Hello Viva Access, please find below questions from my team for the training next week. There are quite a few questions, and I’m sure Michael will answer most of them as part of his talk so might not need to go through all them in the Q&A section. Feel free to edit, if you’ve already received similar questions from others, Looking forward to seeing you next week. Questions: What legislation supports the Transition process between services where the services might use different legislations eg CDSP, Care Act and HGCR, eg. Restrictive practice: Can you provide examples of when something restrictive in the home setting might become a deprivation of liberty and would need to be assessed under DOLS, and decision made under court of protection. What pathway / process should be followed if there is a restriction introduced e.g. stairgate, lock on a door, or bed with high sides / safespace. How often should reviews of restrictive practice take place? If a young person turns 16 and there are restrictions in place, do we need to review it and do MCA assessment at the point they turn 16? What is the legal framework for restrictive practice for those under 16? What is our responsibility and that of parents as decision makers?. What if a restriction has been put in place by parents / carers privately – would we need to do a restrictive practice assessment for something put in place by parents? What does the case law say about restrictive practice and what needs to be included in assessments. What legislation supports the need for safety at home e.g. provision of an additional space where there is challenging behaviour– e.g. need for space to regulate emotions, sensory needs, preventative measures to reduce incidents of challenging behaviours? What alternative funding routes are there for adaptations / equipment e.g. social care funding? E,g, where DFG is not available / eligible (2^nd homes, temporary accommodation). What legislation covers private landlords’ responsibilities if we have assessed need for adapts and they decline and what is reasonable for them to agree with. how can we challenge their decisions? What changes are being introduced with Liberty Protection Safeguards, and will this cover the home setting and clarify DOL situation for 16-17 year olds?

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Q&A Session on Adapting for Children with Behaviours that Challenge – and the Law

Q&A Session- Adapting for Children with Behaviours that Challenge & the Law

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