Children’s SafetyBest Practices in Risk Reduction

Catherine O’Leary, OT Reg. (Ont.)

COTA Health

SYMPOSIUM 2008Working Together for Kids & Teens with Disabilities

What is Risk?

• What is risk? (not so obvious)– Long wait time– Wrong information provided– making a risky situation worse– sending funding letters to the wrong funding

sources– not finishing the job– lack of knowledge

Why Address Risk?

In –home referrals for children with safety issues Service Providers who were hesitant to take on

these referrals due to lack of experience/ knowledge

Pediatrics needs were different than adults in the variety of equipment, need for ongoing support and changing nature of the service

Need to ensure consistency across the organization

Purpose

To provide a best practice assessment and management guidelines for Occupational Therapists for use with paediatric clients with issues relating to safety in their home and community.

Why is Best Practice Important?

•To ensure appropriate information is provided in a timely manner to address current and future needs. This information should include researched support for its use or be considered the most common and gold standard treatment.

• Balloon Play

• You be the Therapist, understanding the role of the therapist and how the system currently works.

Lets Play with Risk

What Safety Concerns? Where? Who’s concerns?

OH MY GOD That’s not safe.Obvious child safety issues in a home.

Obvious child safety issues in a home.

Children with developmental and/or sensory issues are at higher risk in

the home….

So are their parents!

Discharge or Pre-Discharge visits

HOME• .

Families living with a disability

•Caregiver Stress

• High Fall Risk

•Back problems

Increasing Safety & Quality of Life

End of Life Comfort Care

Identifying Issues

• Not enough information (referral)

• Not the correct supports or forms to support quick and efficient support of familes

• Therapists fearful of equipment issues (What if I am wrong?)

Identifying Roles

• Who is responsible for what?

• Who supports whom?

• Who addresses funding?

• How do we effectively communicate?

• How will this be funded?

OT Role (not the ADP Authorizor)• Explain the prescription process (roles, risks and benefits, release of

information, vendor involvement, funding options)• Risks include falls, injuries to client or caregiver if equipment used

incorrectly due to lack of training (CCAC loaner equipment or equipment not set up properly)

• Education of current and future safety needs• To prioritize and set goals with the client and family (for interventions

and equipment)• Assess client and family to establish equipment parameters to meet

needs • To liaise with authorizing therapist to determine trial equipment• To liaise with preferred vendor to arrange equipment trials• To provide letters and forms for funding not covered by ADP• To work with family and community agencies to negotiate the health

care system including access to funding and in-home service providers

• To identify when external resources are required (e.g. ADP Authorizer, Universal Design Consultant, contractor, vendor, social worker, case manager, physiotherapists etc.)

ADP Authorizer Role• Connect with therapist to collect pertinent information (i.e.

pediatric safety and equipment assessment)• Meet with client, family, primary therapist and preferred vendor to

perform physical and environmental assessment and determine trial equipment

• To explain the role of ADP and to provide a list of vendors• To act as a resource during equipment trials• To finalize the prescription of the equipment• To complete ADP prescription form, submit for funding, and

photocopy ADP form and place on client record• To provide follow up once final equipment is dispensed (visit,

phone call, fitting with vendor as appropriate)• To ensure COTA consultation note is completed and placed on

client’s health record

Vendor Role

• To match identified client parameters with available equipment

• To support the therapist and family in the equipment prescription process (education, equipment trials, equipment choices etc.)

• To provide accurate and timely quotations• To notify prescribing therapist when equipment

dispensed or service has been completed in the home

• To bill appropriate funding agency (e.g. ADP) only for equipment dispensed

• To provide manufacturers with feedback regarding equipment uses and unmet needs

• To provide ongoing technical service to families as requested

Shared responsibilities• Education on safety• Communication between partners • Share appropriate information with partners• Training on specific equipment to all caregivers• Identify need for team lead to coordinate a meeting

(for services outside of CCAC)

Best Practices• Identified the pathway in best practice to address

equipment and safety issues in the home.• Identified key pieces of information for the

following groupings:• General Child Proofing a home• Pre-Discharge assessment• Rehab equipment needs

• Home accessibility (minor and major)

Equipment and Safety Assessment Provides all forms needed for any area of safety and

accessibility Is modeled on the ADP form, to increase comfort Has information included that is needed for the ADP

authorizer Cues the OT to consent, release and to give out the

ADP vendor list when required Identifies appropriate safety mobility and accessibility

goals Identifies options and priorities needed in home

accessibility

Decision Trees

• Were put together by the Task force and experts (Educators from Vendors, Contractors and Consultants)

• Clearly defines the roles of the therapists, vendors, CCAC and Family

• Were to guide a therapist in helping the family make decisions

Our Partners

• Motion Specialties, Toronto

• EZ Access Design Consultants

• Shopper’s Home Health Care, Home Renovation Division

Questions?