This document discusses the importance of occupational therapists who specialize in working with children assessing and providing services to children, rather than these services being provided by occupational therapists in adult social care. It states that occupational therapists in children's services are better able to meet children's unique needs, comply with child-focused laws and policies, and develop expertise in working with children. The document urges recognizing the value of children's occupational therapy and ensuring these specialists are employed to serve children.

1. © 2010 College of Occupational Therapists
106-114 Borough High Street, Southwark, London SE1 1LB
www.cot.org.uk Page 1
Disabled children, young people and their families who require assessments and advice
on equipment, or major structural alterations for independence, safety or ease of care
have the right to expect this from occupational therapists who have the expertise and
specialist knowledge in working with children.
The principles and recommendations within Getting it right for children and young
people (Kennedy 2010), Getting it right for every child (Scottish Government 2008), and
Achieving equity and excellence for children (DH 2010a) support the development and
use of a specialist workforce who will deliver high quality services for children, young
adults and their families.
The College is aware that within the UK, there continue to be a number of adult social
care services that provide occupational therapy assessments and arrange for support and
provision of services for children, young people and their families.
The College believes that the continuation of occupational therapists assessing children
within adult social care services is unacceptable and compromises the quality and
effectiveness of occupational therapy provision for the following reasons:
1. It does not always ensure equity of access to services. Fair Access to Care
Services (FACS) criteria is used within adult services (in England and Wales).
There is a risk that FACS can be used for children accessing occupational
therapists within adult services, which is inappropriate and as a result children
may be excluded from receiving services that they need.
2. Children’s services have to comply with legislation, national and local policy that
specifically targets the needs and protection of children and young people. High
quality services that are safe and meet these requirements should be provided by
informed occupational therapists working under a framework of relevant policy
and legislation.
3. Training related to child-specific national guidelines and safeguarding is difficult
to access from services that focus on adult social care. Occupational therapists
working within children’s services have easier access to appropriate training and
information about legislation, policy and child protection.
4. Occupational therapists working in children’s services develop specific expertise
and skills. They have access to professional and management supervision that is
Social Care Occupational Therapy
for
Children, Young People and Families

2. © 2010 College of Occupational Therapists
106-114 Borough High Street, Southwark, London SE1 1LB
www.cot.org.uk Page 2
child-focussed and ensures high quality services are available. Occupational
therapists develop effective links with other children’s services in health,
education, and social care, including early years, short-term breaks, and schools,
in order to provide high quality support to children, young people and their
families. This is more difficult if occupational therapists assessing children are
provided from adult social care services.
5. Workforce planning is compromised as workforce numbers in adult social care
services do not take account of the work occupational therapists undertake
assessing children’s needs. The long-term implications lead to difficulties for
maintaining and sustaining the numbers of occupational therapists needed for
assessing children.
6. Maintaining a sustainable workforce will be difficult. Recruitment difficulties in
2008 were highlighted at a 23.3% vacancy rate for occupational therapists
working within children’s social care in England (Children’s Workforce
Development Council 2008). This is much higher than vacancy rates in the NHS.
7. In areas where children’s occupational therapists are working in isolation, there is
no other cover when the therapist is on leave, and professional supervision is
minimal. This does not provide continuity, it presents a risk in terms of quality of
service delivery, and staff often do not feel supported and valued.
8. Integrating health and social care services would further improve services for
children. Integration is fully supported by the College (COT 2002) and is in
accordance with UK policies such as Liberating the NHS (DH 2010b).
Cost Benefit Evidence
! Housing adaptations reduce the need for daily visits and reduce or remove costs
for care (savings range from £1,200 to £29,000 a year) (Heywood et al 2007).
! One study has shown that through occupational therapy intervention for
adolescents with emotional and behavioural disorders a positive financial cost
benefit realised per teenager was £100 (Ikiugu and Anderson 2007).
! Assessment, follow-up and support to use equipment makes a positive difference
for 80% to 91% of equipment users, with regard to feeling safer, to their
independence, wellbeing and ability to do things (Sainty et al 2009).
! A study that explored the relationship between provision of equipment and
reduction on care package costs and residential care found that over an eight
week period cost savings to care packages through provision of equipment were
over £60,000 (Hill 2007).
The College urges children’s social care services to fully recognise the value of
children’s social care occupational therapy and ensure that occupational
therapists are employed within children’s services if they are assessing children.
The College would welcome the opportunity to collaborate with others to work
towards improving services for children, young people and their families.

3. © 2010 College of Occupational Therapists
106-114 Borough High Street, Southwark, London SE1 1LB
www.cot.org.uk Page 3
References
! Children’s Workforce Development Council (2008) The state of the children’s social
care workforce: a statistical overview of the workforce providing children’s and
families social care in England. London: CWDC.
! College of Occupational Therapists (2002) From interface to integration: a strategy
for modernising occupational therapy services in local health and social care
communities. London: COT.
! Creek J (2003) Occupational therapy defined as a complex intervention. London:
College of Occupational Therapists.
! Department of Health (2010a) Achieving equity and excellence for children. London:
The Stationery Office.
! Department of Health (2010b) Equity and excellence: liberating the NHS. London:
The Stationary Office.
! Heywood F, Turner L (2007) Better outcomes, lower costs: implications for health and social
care budgets of investment in housing adaptations, improvements and equipment: a review
of the evidence. London: Office for Disability Issues, Department for Work and Pensions.
! Hill S (2007) Independent living: equipment cost savings. (Extract taken from the
COT in house Killer Facts database).
! Ikiugu MN, Anderson L (2007) Cost effectiveness of the instrumentalism in
occupational therapy (IOT) conceptual model as a guide for intervention with
adolescents with emotional and behavioral disorders (EBD). International Journal of
Behavioral and Consultation Therapy, 3(1), 53-76.
! Kennedy I (2010) Getting it right for children and young people; Overcoming cultural
barriers in the NHS so as to meet their needs. London: The Stationary Office.
! Sainty M, Lambkin C, Maile L 2009 ‘I feel so much safer’: unravelling community
equipment outcomes. British Journal of Occupational Therapy, 72(11), 499-506.
! Scottish Government (2008) A guide to getting it right for every child. Edinburgh:
Scottish Government. Available at:
http://www.scotland.gov.uk/Publications/2008/09/22091734/0 Accessed on
12.10.10.
Background Information
Social care occupational therapists usually offer occupational therapy services to children
and young people with permanent physical disability or challenging behaviour caused by
Autistic Spectrum Disorder or a learning disability.
Occupational therapy helps people of all ages to lead healthy and fulfilling lives through
improving their ability to carry out the activities they need to do or choose to do in their
daily lives. Occupational therapists work with children and young people with poor
physical or mental health, disabilities, social limitations or learning difficulties. The
problems that they might help them with are, for example, in the areas of development,
personal, social, educational, economic or cultural functioning (Creek 2003).
November 2010
Director of Professional Operations
November 2012
Country Relevance:
Publication date:
Lead group:
Review date:
UK