Adaptations for young people with physical disabilities in Sheffield Mainstream Schools

This is an information document for special educational needs co-ordinator’s (SENCo’s) provided by the community therapy team occupational therapists, Sheffield Children’s NHS Foundation Trust.

If you are not sure of the name of the occupational therapist working with a child or young person in your school please contact Ryegate Children’s Centre on 0114 271 7610. You will need the name, date of birth and address for the child or young person.

The occupational therapist will advocate for the needs of the young person and will give advice on the most appropriate facilities needed to meet the child or young persons needs both now and into the future.

Funding

If your school is a local authority school, you are responsible for funding minor adaptations. The local authority will fund major adaptations. See below for further details.

If your school is an academy it is your responsibility to fund all adaptations using the money provided to you from the government.

Adaptations process for local authority maintained schools (major adaptations)

Major adaptations needed to make sure a school can meet the needs of a young person should be raised with the local authority and the schools adaptations consultation group. These adaptations include adapting toilets, building accessibility, internal platform lifts, external platform lifts and hoisting facilities.

Schools will need to liaise with the local authority and the young person’s NHS occupational therapist to make sure that their needs are met within the school building. If they are not sure what is needed the occupational therapist will be able to make initial recommendations to meet the child or young person’s needs.

The local authority will support with contacting architects, contractors and suppliers for the recommended facilities. The local authority will liaise with the occupational therapist as well as the school’s site or facilities manager.

This process takes a long time so it is advisable that adaptations are raised as early as possible in liaison with the occupational therapist. If adaptations are identified during the school place consultation process, do liaise with the occupational therapist. Needs should be identified during an access visit led by the occupational therapist if not previously raised in the consultation period.

If a child or young person’s needs change during their time in school meaning they require adaptations they should be raised as soon as they are identified with the local authority to start the process.

Adaptation process for academies

Adaptation needs should be identified by both school and the occupational therapist who will complete an access visit if adaptations are needed.

It is then the academy’s responsibility to fund the adaptations. It is also the academy’s responsibility to contact and liaise with the relevant agencies (for example architects, engineers, contractors and equipment companies) to identify what work needs to be done.

If the academy is having any extension or expansion work completed in liaison with the local authority they can raise any adaptation needs as part of these adaptations to discuss if the adaptations can be built into the process to future proof the school for other young people.

Evacuation and safety

Please see our resource has been created to help schools make sure the safety of young people when considering fire evacuations.

Please note it is the school’s responsibility to identify evacuation equipment and to make sure there is a procedure in place for evacuating anybody in their care safely from the school building. The child or young person’s occupational therapist can support with making sure transfers are safe once the school has an identified system in place, or prior to them identifying the system to make sure that the child is safe in the evacuation process. School will also need to be trained in how to use the evacuation equipment. This training will be provided by the company you purchase equipment from, not the occupational therapist.

Transfers, moving and handling

Moving and handling

Schools are responsible for making sure that their staff have appropriate moving and handling training to support the physical needs of children in their school. For staff to be trained in generic manual handling they need to contact manual handling trainers. School can source their own if they are aware of specific companies or they can contact Fusion who are based at Talbot Secondary School for manual handling training.

Once staff have had manual handling training, the occupational therapist for the child or young person in your school, will then be able to provide specific training for their transfers. If the child or young person uses specific equipment such as a hoist, standing transfer aid or transfer board, the occupational therapist will provide the training in how to use this once staff have completed their moving and handling training.

The occupational therapist will also provide this equipment to support these transfers and talk through how to complete them safely with the young person.

Ceiling track hoist

There are different versions of hoisting systems available. There are multiple things to consider when thinking about hoisting.

Single track hoist on a straight track. This allows movement between 2 positions but always placed directly under the tracking.

Closomat.co.uk

Molifthoistsandparts.co.uk

‘H’ frame hoist allows movement any way with the frame of the hoist, allowing flexibility of positioning and staffing.

Closomat.co.uk

Lifeontheslowlane.co.uk

Ceiling mounted fixes into joists in the ceiling (dependent on type and structure of ceiling).

Alinemobility.co.uk

Opemed.net

Closomat.co.uk

Wall mounted is used when there are very tall ceilings or if there is a suspended ceiling.

Dolphinlifts.co.uk

Taylordolman.com

You will need to liaise with your site or facilities manager to consider the type of hoist fixing required depending on your buildings structure.  There are various companies who provide all the types of hoisting mentioned above. You can find a full range online by searching for ceiling track hoists.

These are some of the companies:

• Etac Molift
• Guldmann
• Prism Medical
• Simply Moving and Sleeping

Hoist funding

If you are a local authority maintained school, the local authority will fund, contact relevant companies, arrange assessment, fitting and liaise with your site manager.

If you are an academy, it will be the academies’ responsibility to contact the companies to ensure the layout, design and fit of the hoist will meet the young persons need and the school’s responsibility to provide the funding for this.

Mobile hoists

Mobile hoists are provided by the occupational therapist in school if there is a need. School need to consider where they will store this safely and where it will be used.  Mobile hoists require their batteries to be on charge when they are not in use, this should be considered when thinking about storage of the hoist. Mobile hoists cannot be provided for fire evacuation only.

Slings

Slings that are used for hoisting a child or young person will be provided by the occupational therapist. They may have different styles of slings, the occupational therapist will explain how and when to use the slings.

Personal care and hygiene

Accessible toilets

Consider the size and space needed in an accessible toilet. If you are needing to support with transfers and personal care then you will need space for the child or young person, 2 members of staff and possibly other equipment. A small space can make the transfers more challenging and more time consuming.

Toilets

Consider the placement of toilets within your accessible hygiene room. The toilet should not be close to 2 walls as it is essential to be able to access both sides for transfers and safety. Make sure that the sink is a reasonable distance from the toilet to enable the young person to move between the toilet and the sink and so the sink does not get in the way of a transfer. Toilet chairs will be provided by the occupational therapist involved with the young person if they are needed.

The occupational therapist will also be able to provide step platforms or toilet frames if appropriate to make sure the child or young person’s safety.

Wash dry toilets

Consider wash dry toilets for young people that are unable to clean themselves after toileting. This should be discussed with the occupational therapist prior to planning. The toilets need to be placed away from the sides of the room to enable people to be able to get round both sides of the toilet. Make sure that if you use a wash or dry toilet you position it so that all the pipes and boxing are behind the back of the toilet to enable a toilet chair to be placed over the toilet if needed.

You can find a full range online by searching for wash dry toilets. There are various companies that provided wash dry toilet including:

• Closomat
• Geberit

Schools can speak to companies for advice. If the young person requires a toilet chair to fit to this toilet the occupational therapist will provide the toilet chair.

Changing plinths

Depending on the size of your accessible toilet area this will impact on what facilities are available for changing plinths. If you are a local authority maintained school the local authority will support with considering options, contacting companies and funding equipment. If you are an academy then you will need to consider the options, contact companies and fund the equipment yourself.

If a mobile changing plinth is needed to be used by one child or young person only, the occupational therapist may be able to provide a changing plinth. However, if a mobile plinth is used by multiple young people in school it will be for school to source an appropriate plinth that meets all their needs.

Things to consider for changing plinths:

• Length: make sure it is long enough for your child or young person to access for the duration of their time in school.
• Width: make sure it is wide enough for the young person to comfortably lie on and roll onto their sides, if needed for transfers.
• Height range: make sure it goes low enough to support a child or young person who can transfer onto it from standing or a wheelchair and high enough to make sure staff are not bending over when supporting them.
• Mobile: if the room is large, then a mobile plinth allows flexibility of position and use for staffing and transfers.
• Fixed (wall mounted): is useful in small spaces where a plinth can be flipped up against the wall to save space. These may impact on transfers depending on space.
• Sides: help to make sure a child or young person is always safe when on the changing plinth if you need to move away or reach for something so that the child will not roll off and injure themselves.
• Hydraulic: requires adult to adjust the height manually using a foot pump.
• Electric: height is adjusted using a hand control. This will also require a power supply in the room is it used in.
• Flat: the whole changing plinth is flat for lying on.
• Head raise: the head end of the changing plinth can be adjusted to provide some support if the young person will be sitting for example.

You can find a full range online by searching for changing plinths. There are various companies that provide changing plinths including:

• Care and Independence
• Medi-Plinth
• Osprey
• Smirthwaite

If you need support from a moving and handling perspective around transfers using the changing plinth, please contact the child or young person’s occupational therapist.

School building accessibility

Ramp access

Threshold ramps will be schools’ responsibility to purchase. However, for external ramps or significant areas that need ramping, school needs to follow the school’s adaptation process depending on if you are local authority maintained or an academy. There are legal restrictions regarding gradients of ramps which need to be adhered to.

Automatic doors

Automatic doors should also be considered in school if there are children or young people who are wheelchair users or walk using a walking aid as they are unable to reach to open doors or push doors. Consider push button doors or sensor opening doors as a way for children or young people to be more independent. If possible, having doors open all the time will enable children or young people to access all the school independently. These can also be set to close in the event of a fire drill or a fire alarm going off.  This should also be considered in the Personal Emergency Evacuation Plan (PEEP) for the child.

Classroom or lesson facilities

Height adjustable tables

Height adjustable tables may be recommended if the child or young person uses a wheelchair and they cannot fit under the height of the standard tables in order to complete their school work.

Consider the number of tables that may be required, for primary schools you may only need one table in their main classroom. However, in secondary schools you may need one in all subject areas unless you can move the timetable to allow them to be in the same classroom for multiple subjects.

Schools can also consider table raises for some tables. However, these are not as stable as height adjustable tables. Table raisers also require staff to lift tables which is not practical between lessons if using multiple classrooms and relies on an adult always being present. They may be suitable if just one table needs raising in one room. These come in set heights and it may not be appropriate for the young person that needs them.

Things to consider for height adjustable tables:

• Height range: consider the height range to make sure the young person can sit up to the table in their wheelchair with their knees under the table. They will also still need to access their wheelchair controls if using a powered wheelchair.
• Width: consider the implications of a higher table for someone sat next to them. It may be they have an adult with them or it may be a free space, a peer may not be able to sit at the same table. If you need it for multiple young people at the same time it will need to be wider to make sure adequate width for both wheelchairs.
• Depth: some tables are standard desk depth and others are larger, this can prevent young people reaching things and will take up more space in the room.
• Manual adjustment: is controlled with a handle that is turned to adjust the height, this would be suitable if it is only used by one young person and left at a set height.
• Electric adjustment: allows flexibility for the young person to be specific with where they want the table, or for it to be adjusted between multiple users.
• Placement in the classroom: consider the most appropriate place in each classroom for the young person’s needs, maybe near the door for easy access or ease of arriving or leaving. Consider space around the table for wheelchair mobility and obstacles for peers.

Height adjustable tables can be purchased from lots of companies. In the first instance liaise with the companies your school usually purchases school furniture from, or you can search online for height adjustable tables, there are multiple companies and tables available.

Schools, both local authority maintained and academies, are responsible for funding height adjustable tables.

Kitchen accessories

If the child or young person will be accessing cooking lessons in school, then the occupational therapist may recommend some different equipment to help facilitate participation and independence in these lessons.

Please liaise with the occupational therapist prior to ordering any equipment to make sure it will meet the needs of the child or young person. If the occupational therapist recommends equipment and you need some support with how to use them with the child or young person, then please liaise with the child or young person’s occupational therapist.

It is school’s responsibility to order and fund any kitchen aids.

Below are some of the typically recommended equipment:

Kitchen workstation

Completecareshop.co.uk

Kettle tippers

Make sure you get the correct style of kettle tipper for the kettle you have.

Mobilitysmart.co.uk

Pan stands

Pan stands can be fitted to electric or gas hobs.

Livingmadeeasy.org.uk

Cooking baskets

Essentialaids.com

Angled sharp knives

Essentialaids.com

Dycem

Dycem is a material to place under objects to stabilise it and prevent it moving when being used (useful for bowls, chopping boards and trays).

Activemobility.co.uk

The equipment is available from a wide range of places, you can search for specific items online and choose a company to order from.

If the child or young person’s occupational therapist recommends these, schools can order them here:

• Living Made Easy
• Performance Health
• Essential Aids

Bathroom accessories

Grab rails and drop down rails

Grab rails are often recommended to enable a child young person to be safe, often in toilet cubicles, on stairs or in corridors. Liaise with the young person’s occupational therapist to make sure that appropriate rails are placed in the correct position (height, angle and length) for the young person to enable as much independence as possible. It is schools’ responsibility to purchase and fit any grab rails recommended by the occupational therapist.

When seeking to fit drop down rails in an accessible toilet, liaise with the occupational therapist regarding appropriate height for the rail both for now and future use for the young person. Also consider how far away they are from the toilet to make sure they have enough space around them but they are close enough for them to reach and feel safe. Liaise with the school premises manager to make sure that the wall they are being fixed to is suitable to maintain the rail and the pressure applied through it. The type of fixing may differ depending on the type of wall, such as solid brick walls or stud walls.

Taps, paper towel dispensers and soap dispensers

Consider the height and placement of taps, paper towel dispensers and soap dispensers for children or young people. Position them in a place where the child or young person can reach and access them either from their wheelchair or without stretching far.

Consider the style of taps if you are changing them. The twist top taps can be difficult for young people to use. Lever taps would be more beneficial to enable independence.

Documenting learning

Information technology (I.T.)

If the young person is accessing I.T. to document their learning, it is school’s responsibility to provide appropriate hardware and software. This includes laptops or tablets, software such as Clicker or DocsPlus and or or keyboards and mice if appropriate.

Liaise with the child or young person’s occupational therapist regarding what is most appropriate for them.

School curriculum

School trips and residentials

Consider the physical abilities of the young person prior to arranging trips and residentials. Consider what facilities they might need during those visits. For example, level access, toileting facilities or transfer aids or facilities (if a hoist or transfer aid is used in school).

Consider how you will complete the transfers that you usually do in school out on your trip to make sure they can participate, are safe and they can have their personal care needs met alongside accessing all the activities.

Consider your transport for these trips. If the young person is a wheelchair user you will need to have access to a wheelchair accessible bus or minibus.

If you are considering a residential with lots of different physical activities and you are not sure of what the young person can safely access, then please liaise with the child or young person’s occupational therapist or physiotherapist.