1. Children’s Safety Best Practices in Risk Reduction Catherine O’Leary, OT Reg. (Ont.) COTA Health SYMPOSIUM 2008 Working Together for Kids & Teens with Disabilities

2. What is Risk?

3. 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

4. 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

5. 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.

6. 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.

7. Balloon Play You be the Therapist, understanding the role of the therapist and how the system currently works. Lets Play with Risk

8. What Safety Concerns? Where? Who’s concerns?

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

10. Children with developmental and/or sensory issues are at higher risk in the home…. So are their parents!

11. Discharge or Pre- Discharge visits HOME.

12. Families living with a disability Caregiver Stress High Fall Risk Back problems

13. Increasing Safety & Quality of Life

14. End of Life Comfort Care

15. 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?)

16. Identifying Roles Who is responsible for what? Who supports whom? Who addresses funding? How do we effectively communicate? How will this be funded?

17. 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.)

18. 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

19. 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

20. 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)

21. 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)

22. 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

23. 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

24. Our Partners Motion Specialties, Toronto EZ Access Design Consultants Shopper’s Home Health Care, Home Renovation Division

25. Questions?