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4.1.4 Children's Occupational Therapy - Referrals and Assessment


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


Chronically Sick and Disabled Persons Act 1970

Disabled Persons Act 1986

National Health Service & Community Care Act 1990

The Children Act 1989

Carers and Disabled Children Act 2000

The Disability Discrimination Act 2005

Pan-Dorset Multi-Agency Safeguarding Policies and Procedures Manual, Children who are Disabled Procedure

Housing Grants, Construction and Regeneration Act 1996


In July 2017 this chapter was significantly updated to reflect local practice and should be re-read in full.


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

1. Introduction

1.1 The purpose of this document is to set out the procedure that should be followed when receiving referrals and undertaking assessments in relation to the Children's Occupational Therapy Service. Its aim is to ensure that responses given are consistent across the service.
1.2 All work undertaken should be compliant with relevant legislation issued in relation to Children's OT Services (see Nottinghamshire Children's Social Care Services Procedures Manual, Children’s Occupational Therapy – Legal Framework Guidance).
1.3 The procedure complements Bournemouth Safeguarding Children Policy and Procedures. Staff should be familiar with these documents and ensure they are complied with at all times.

2. Role of the Local Authority Occupational Therapy Service

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

OT equipment and adaptation can not be prescribed:

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

3. Thresholds and Eligibility for Assessment


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

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

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

  • Short Break in a specialist placement (i.e. Wessex Autistic Society, Diverse Abilities Plus etc);
  • Education at a Special School for Autism.

4. Referral and Assessment Process

4.1 Child Contacts


All requests for an OT assessment are received through 2 possible routes:

  • Referral professionals via the completion of a Children’s OT referral form;
  • Telephone referral to the OT service. Hours: 8.30am – 5.15pm Monday to Thursday and 8.30am – 4.45pm Fridays.
4.1.2 A Contact record will be completed on all enquiries to the OT service.
4.1.3 The response to a Contact may be that no further action will be taken, but that in itself is a decision and should therefore be recorded. If this is the outcome a letter should be sent to the referrer confirming the outcome of the contact.

4.2 Referral and Decision Making

4.2.1 When a referral is received a decision whether to progress to an OT initial assessment will be made by the Practice Manager Occupational Therapist in line with the threshold criteria described in paragraph 3.1.
4.2.2 If the decision is made to progress to an OT initial assessment a letter will be sent to the referrer and child, parent, carer, informing them of when the OT service would aim to initiate the OT assessment. This letter to the family will also include an OT Triage assessment form to be completed and returned. This allows the referrals to be prioritised more effectively.
4.2.3 Where it is felt that other statutory services may be needed to promote the development and welfare of the child (Section 17, CA 1989) or where there is reason to suspect the child is suffering or likely to suffer harm (Section 47, CA, 1989) a referral will be made to Multi Agency Safeguarding Hub (MASH).
4.2.4 Where it is felt that a child has additional needs that can be met by universal and targeted services, the professional referrer or most involved professional will be advised to undertake a CAF to consider the child's need for early preventative and targeted provision.
4.2.5 All NFA's resulting from an OT referral will be recorded on RAISE. A letter is sent out to the referrer and the family advising them of the outcome of the initial referral and any signposting that may be appropriate.

4.3 Prioritisation

4.3.1 If the threshold for an initial OT Assessment is met, the OT Practice Manager 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 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 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 2. Children who have complex needs, but are not considered being at risk if OT assessments/provision is not immediate i.e. they do not fit into the priority 1 category and therefore immediate intervention is not a necessity to their current health and social wellbeing.

The budget for major house adaptations is held by local authorities. This is a central budget shared by adult and children's services. Ordinarily the authorities progress major adaptations in date order. The Children's OT service and the authority 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 council will manage all priority requests (both children and adults cases) in date order.

5. Levels of Assessment and Timescales

5.1 OT Initial Assessment


An OT initial assessment will be carried out by an allocated OT. An OT Initial Assessment is an evaluation of the child's needs and should look at the whole of the child’s situation rather than just a single functional aspect. If an initial assessment has been completed recently e.g. last 12 months, it will be at the discretion of the OT Practice Manager as to whether an updated initial assessment is required. The purpose of an OT Initial Assessment is to ascertain:

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

An OT Initial Assessment may include information from:

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

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

  • Signposting on to universal, targeted or other specialist services (complete CAF referral if required) or advice the professional referrer or most involved professional to undertake a CAF;
  • Referral to MASH;
  • Assessment and provision of specialist equipment;
  • Assessment and recommendation for provision of minor or major adaptions;
  • Advice to parent/carer regarding equipment and/or adaptation available for purchase from high street retailers;
  • A recommendation that an application is made for charity funding or equipment.
5.1.5 Following completion of the assessment the parent/carer will be provided with a copy of the OT Initial Assessment form signed and dated by the worker and OT Practice Manager, detailing the outcome of the assessment and the recommendations made.
5.1.6 In instances where the parent/carer does not agree with the recommendations made, or where the parent/carer is unhappy with the assessment process, the OT Practice Manager will make contact with the family in an attempt to agree a way forward. If this is unsuccessful a copy of the complaints leaflet will be provided.

6. Reviews

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

  • All children modular/specialist seating needs;
  • All children who have a hoist and sling in situ. Review of moving and handling care plans are required.
6.1 All other cases will routinely be closed to the OT service with a letter detailing how a new referral can be made to the service should circumstances alter in the future and an OT evaluation form.

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

A review may result in the following outcomes:

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