4.3.7 Lambeth Occupational Therapy Framework

1. What is Occupational Therapy (OT)?

Occupational Therapy focuses on the wellbeing and strengths of the person to promote independence with daily living tasks. In addition, there is a preventative ethos to provide advice, information and interventions (i.e. equipment, adaptations) which help to prevent, reduce or delay the development of the adult’s need for care and support, and enable them to remain in their own home as long as possible.

In Lambeth, occupational therapy is embedded throughout our work in adult social care. It aims to provide a holistic, strengths-based approach for adults who appear to have care and support needs due to a physical or mental health impairment or illness.

Anyone can contact Adult Social Care to request an assessment for OT services for an adult who appears to have care and support needs. This includes the individual themselves, their carer or representative, their GP, their housing association, or any other person or professional involved in their care.

2. Service Description

Lambeth Occupational Therapy Service comprises Occupational Therapists and Occupational Therapy Assistants based within all the Adult Social Care Assessment Teams. In addition, we have a Trusted Assessor approach so some of Assessors and Social Workers have had additional training to be able to assess and provide low level equipment.

Occupational Therapy Assistants and Trusted Assessors complete functional assessments and order simple standard equipment and adaptations to meet assessed needs.

Occupational Therapists complete occupational therapy assessments and reviews, and provide standard and specialist equipment, and/or minor and major adaptations.

3. Key Considerations

For occupational therapy assessment, intervention and outcomes:

• Wellbeing and promoting independence;
• Right support, Right place / Right time;
• Information and advice, and Advocacy;
• Reablement;
• Mental Capacity Act principles;
• Prevent/ Reduce / Delay care and support needs;
• Safety and Safeguarding.

4. Children’s Occupational Therapy

Lambeth Social Care Children’s Occupational Therapy sits within the 0-25 service and linked to the Adult Occupational Therapy. Children Occupational Therapists (COTs) work to support children with disabilities and their families within their home.

Social Care has a duty to assess the needs of disabled children and families under The Children Act 1989/2004 and The Chronically Sick and Disabled Persons Act.

Lambeth Children’s OT Team define disability as given by the Equality Act 2010 – ‘a physical or mental impairment that has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities’.

Appropriate areas for Children’s OT assessment:

• the child or young person is not independent with or has significant difficulties with age-appropriate activities of daily living;
• requires postural management to access daily living activities/occupations and meet their care needs;
• carers are having significant difficulties maintaining safe moving and handling or care for the child or young person;
• is unable to access essential facilities within their home.

Referrals are screened by the Children’s Occupational Therapy Practitioner Manager and prioritised according to need. Requests for non-complex equipment or adaptations may be passed to the Children’s OT Assistant.

5. Prioritisation and Response Times

New referrals to Occupational Therapy (OT) are screened collectively by OT Practitioner Managers in a weekly meeting. Urgent referrals can be screened by OT managers outside of these meetings as required.

Screened referrals are risk assessed (i.e. safety and support in place, carer breakdown, chronic long-term conditions etc.) and given a priority level.

Priority	Details	Response
Priority 1 – High Need	Severe difficulty with transferring on/off toilet, chair or bed (an essential need for moving and handling equipment) Mobility problems where there is a high risk of injury – for example, from falls Provision of an essential piece of equipment to facilitate discharge from, for example, out-of-borough or private hospital	Within 1 week
Priority 2 – Moderate Need	Difficulties with stairs, or difficulties with transfers to bed / chair / toilet, where the support being provided is not sustainable Difficulties with access to essential rooms within the home Difficulties with external and community access (wheelchair/ may include scooter access)	Within 2 months
Priority 3 – Low Need	Without support the person’s situation is likely to deteriorate which may result in increased risks Some difficulty with mobility including on steps and stairs Difficulties with access to washing facilities but managing with support Re-housing reports Difficulties with garden access	Within 3 months

Referrals which do not require assessment (e.g. equipment repairs, adaptation repairs requests) are managed by ICAS or Community Duty to be actioned by a Duty Worker.

Referrals classed as “urgent” (for same day allocation) where the person is at immediate risk and lack of input may result in hospital admission should be directed/ redirected to the At Home Team where applicable.

6. Process

Occupational Therapists will:

• visit the person at home to complete an occupational therapy (OT) assessment of need;
• consider whether further rehabilitation and reablement is required to promote the person’s skill and independence with completing daily living tasks and accessing their home;
• where needs identified, take photographs and measurements of areas identified for proposed intervention (i.e. equipment and adaptations);
• request the adult’s permission to obtain medical information i.e. from GP if needed to inform the proposed interventions/outcomes. Note information may be available via Local Care Records (LCR);
• discuss proposed recommendations to meet assessed needs;
• explain next steps i.e. ordering of equipment, equipment delivery times and follow-up;
• if required, obtain the resident’s consent to share information with relevant departments and organisations subject to data protection (complete the consent to share form);
• following the assessment visit, order any equipment or refer for installation of adaptations, and complete OT assessment on Mosaic;
• arrange a follow-up visit to check that the adult is safe and independent with using the equipment;
• make necessary changes as required to ensure needs are met if outstanding issues remain after review.
• complete and send a closing letter with details of work completed, onward referrals, and with a copy of the OT assessment and support plan, if no outstanding issues after review.
• make sure all case work is completed on Mosaic, documentation uploaded and

7. Occupational Therapy Reviews

• Most adults assessed by the Occupational Therapist will not require ongoing review once recommendations and interventions are completed. However, under certain circumstances a Review within a year period may be required i.e. management of adults at high risk with bed rails, moving and handling high risk or unusual risk management, fluctuating or fast changing deteriorating conditions etc.). In these cases, the OT will include details of ongoing review period in their closing letter.

There are additional sections with further information on Equipment and Minor Adaptations, and Major Adaptations.

8. Components of the Occupational Therapy (OT) Assessment

The OT assessment can cover any of the following:

• getting in and out of the home or accessing the essential rooms within the home including getting up and down stairs;
• managing personal care activities, such as eating, washing, feeding, dressing and toileting;
• transfers on / off the chair, toilet or bed;
• managing essential daily domestic tasks, such as preparing and consuming a hot drink and a snack, using taps, carrying food;
• requests for rehousing assessments;
• moving and handling risk assessments;
• support for carers, and carers assessments when these are alongside assessments of adults with care and support needs.