Priority Score Guidelines Children's Equipment

Eligibility for DCSI funding:Background information

• The equipment programprovides only disability-specific equipment, not standard household items.
• The equipment will generally be provided for the client’s primary residence only
• Short-term loan of equipment is provided where it meets the criteria below and is available from existing equipment items in store.
• The equipment item needs to be used frequently i.e. at least 3 – 4 times/ week (see frequency guidelines below).
• Clients are ineligible to receive DCSIequipment if they are eligible to receive it from another funding source including compensation payments. Refer to DCSI Strategic Policy on Equipment for details.
• Equipment for use solely at school or work is not provided via DCSI

Tasks of Daily Living refers to: eating, dressing and grooming, preparing meals, mobility within the home and the community, bathing, toileting (including continence management), transfers and bed mobility, seating and postural needs (including night time posture) and functional communication and related technologies for eligible items only. Functional Communication need – broadly relates to language as used “to establish interpersonal relationships, regulate the behaviour of others, satisfy material needs or desires, explore and organize environments and exchange messages and information” This does not include transport or medication management.

Fast track funding / Delegate Approval of Equipment:

Provisional delegates for children’s equipment are Novita Equipment Service NAH 2 therapists. The final delegate for children’s equipment is the Manager Equipment Service, Novita Children’s Service (see “Seeking delegate approval for an equipment prescription”). Fast-track funding for urgent items must be approved by the final delegate.

The following situations prompt possibility for fast tracking, which is approved by Manager.

•Children under the Guardianship of the Minister (GOM)

•Items with an “Extreme” risk rating and additional individual supporting information emailed to the Team Leader /External Liaison Clinician who will liaise with the Manager

•Urgent equipment for non metropolitan clients who only travel to Adelaide occasionally, are dependent on a clinically informed judgment of urgency and require equipment which needs assessment / fitting / custom modification which can be most efficiently managed in Adelaide

•Top-up funding for prescriptions already approved where an increase or variation in costs has occurred

•Replacement item when no suitable refurbished item is available. A clinically informed determination of urgency of provision and/or the need for reassessment will also be considered

For further details see EP documents on the DES website.

Useful docuemnts:

• Key Approval Criteria:

Key Approval Criteria for Equipment

Key Approval Criteria for Home Modifications

• Specific Eligibility Criteria:

Specific eligiblity criteria Scooters

Specific eligiblitycriteria Powered Wheelchairs

Specific eligiblity criteria Manual Wheelchairs

Specific eligiblity criteria Provision of a Powered Mobility Aid and a Manual Wheelchair or non-standard Stroller

Specific eligiblity criteria Electric Beds

Specific eligiblity criteria Electric Riser Recliner Chairs

Specific eligiblity criteria Ceiling Hoists,

Specific eligiblity criteria Roof Mounted Wheelchair Carriers

Specific eligiblity criteria Towbar Mounted Wheelchair Carriers,

Specific eligiblity criteriaCar Hoist (person lift only),

Specific eligiblity criteria Modified Driving Controls

Medical grade footwear clinical criteria

Foot ankle orthoses clinical criteria

Specific eligibility criteria Speech Generating Devices

Specific eligibilty criteria Posture Chairs

Specific eligibiltycriteria Technology

Specific eligibility criteria Technology (Environmental Control Systems)

Specific eligibility criteria Strollers

• Funding:

Funding of additional features to equipment by client

Priority scoring:

A priority score is required for all children’s equipment prescriptions.

Scoring is based on the expected outcome of provision of the requested item as compared to the current situation.

The maximum priority score is 12 points. Items scoring at this level require immediately sending a brief explanation of the extreme risk caused as a consequence of non provision justifying the high priority to the Novita Equipment Service Manager / Team Leaderusing “Urgent” in the email subject header

For example, the very unsafe condition of a client’s situation or current equipment or home modification may lead to a likely or almost certain probability of a major or catastrophic consequence. Such as exposure to an immediate hazard that may result in an injury requiring significant medical treatment, hospitalisation, long term dependency or death. The provision of the prescribed equipment or home modification will mitigate this extreme risk.

The following are examples of situations that may need to be assessed for the probability of leading to a major or catastrophic consequence as above:

• Need for post operative equipment if urgent.
• Imminent hospital discharge (new or existing clients).
• Wheelchair can no longer be repaired as is declared unusable by repairers and client is left without equipment and equipment is essential for daily living needs.
• The current device has broken and repair is not an option and equipment is essential for daily communication development and participation needs.
• Client has pressure areas which threaten to require hospitalisation.

Different forms are used to assess priority for the following item groups:

Mobility, positioning, ADL equipment, home modifications and switches / mounts for Powered Mobility Devices usethe “Risk rating and priority scoring form”to rate the risk of not supplying the equipment and score the associated priority.

See the form for instructions on how to calculate the risk of a significant consequence occurring to the client carer without the requested equipment / home modification.

Communication / assistive technology / Non Powered Mobility Device switches / mountings use the “Priority scoring communication and assistive technology”form.

See the form for instructions on how to calculate impact on communicative success and / or assistive technology.

The examples below are for Columns 2, 3 and 4 which are completed on either form (Mobility and ADL = Blue, Communication equipment = Pink, All types of equipment = Black)

How to scoreColumn 2: Independence and Function for the client and / or carer:

Without the requested equipment the client is:

• is able to walk with assistance but is very slow, cannot walk far, and is unreliable with weight bearing and direction etc.
• is unable to learn independent self-propulsion due to lack of a suitable manual wheelchair.
• has seating which is inadequate to enable use of hands for activities.
• is unable to be independent in toileting without suitable commode.
• has shower chair but would be more independent with self propelling chair
• will be unable to learn to walk without the walker.
• will fall sometimes without the AFO.
• can communicate, socialize or participate but requires assistance to be successful. Requested equipment would reduce the need for assistance.
• uses a low tech system well, but requires the communication partner or helper to interpret the message. A voice output device would mean this assistance was not required
• requires the communication device to be positioned correctly on the tray each time, and needs to ask for it when needed. A mount system on the wheelchair would mean that the device is then available most of the time and does not require a carer to set up each time when moving from activity to activity.
• is reliant on carer / assistant when low tech auditory scanning is being used- ie. communication partner required to offer verbal choices while child indicates choice

• is unable to move the client in or outside but could carry a small child a short distance.
• has indicated that client is motivated to interact with peers but often gets left behind. Equipment will assist with inclusion.

• is unable to move independently due to lack of equipment, therefore requiring assistance. Eg. Client is pushed in a manual chair instead of using a powered wheelchair independently.
• is unable to shower, having to use bath instead.
• Is able to mobilise independently with the provision of a walker (as demonstrated by trial at walker clinic or in-home trial)
• is unable to vocalize and a device is required to call for attention/help.
• has the ability, but cannot communicate messages in any other way. Eg. The client has gesture and eye gaze methods, but unable to convey specific information or messages out of context.
• cannot communicate with peers as they don’t understand signing or low tech picture set.
• uses another system but this equipment is an essential adjunct to that system to allow for independent community access and communication with people in the community. (eg. Joystick so that access to device is reliable, or a mounting system so that device is available to the client at all times)
• has a voice which is difficult to hear and a speech amplification device is being requested so they can be heard in class without having to get up and walk over to the teacher.
• can communicate messages with low tech set up but turning pages or access is difficult. Client may be able to access more messages per page with equipment (this includes key guard/access device).
• needs a more portable device which can be carried with them, rather than requiring a carer to move it for them.
• would potentially develop communicative competence to the level of an independent user if provided with this device.
• would have the opportunity to participate to a similar level to their peers in some activities with this device. Eg. Step by Step to give morning news or Show and Tell, etc. (ie. Intentional communicators)
• uses another system but this equipment is an adjunct to that system to allow for improved community access. Eg. Talk Trak for playground use.
• could use the equipment quite independently in a supported environment.
• shows interest and potential to interact with peers but is unable to do so with current means of communication.
• is at risk for social isolation or has behaviour problems result in social exclusion.

• requires the equipment to provide opportunities to learn that they can exert control over the environment, or participate. (ie. Preintentional)

How to scoreColumn 3: Frequency

Equipment will be used:

• Not eligible for DCSI provision

• Equipment is used during occasional shopping or outings in the evening more than 3 times per week, but less than daily.

• uses wheelchair every time they go outside and from one room to another
• uses equipment for a specific activity every day eg standing frame, walker if in a wheelchair more often, wheelchair if only for longer distances
• requires the shower chair for daily hygiene (though carer access may dictate whether this is actually occurring on a daily basis).
• uses the device most of the time during the day but has other methods at certain times of day
• requires the device for participation during more than one activity during the day, but at other times low tech or gestural communication is used.
• The device is predominantly used for participation in a once daily routine such as circle time, during lunchtime, or at mealtimes.

• is dependent on wheelchair for seating and mobility throughout the day at school / work and home
• requires the communication device full time for all activities, including incidental communication.
• requires equipment in order to be able to fall asleep independently
• requires equipment to be able to get in/ out of bed independently
• requires equipment to be safe in bed unsupervised

How to scoreColumn 4: Timing/Deterioration/Growth

The following describes the client:

• Increasing calf tightness or foot deformity without a new splint
• Increasing hamstring tightness in a wheelchair that is too small
• The child’s condition is slowly deteriorating and speech is less intelligible. Future AAC needs will likely increase.
• Child’s development of more intelligible, specific, efficient, effective, independent and socially appropriate communication will be limited without provision of equipment/SGD
• Slow deterioration in physical status so that alternate access to device will be required and some time to train will be necessary before skills are lost.
• Client has visible signs that they are outgrowing their wheelchair ie seat depth or width too small, and final growth adjustments have already been made)

• Development of or participation using more intelligible, specific, efficient, effective, independent and socially appropriate communication is being limited by lack of access to equipment/SGD
• Child is transitioning to school and needs a manual wheelchair to self propel when travelling long distances or on excursion.

• is moving from an environment where communication attempts are predictable and most often understood, to one where context and message may be less obvious. The device is required now so that training can occur in time for successful integration into new environment.
• requires voice output in new environment for purposes of socialization or participation
• is in a very supportive situation for the introduction of the device (e.g, very motivated parent, kindergarten/school have been trained and eager to incorporate device)
• has successfully trialled the equipment and shows skills that suggest introduction of equipment will be successful however trial equipment not available.

• has a rapidly deteriorating condition declines rapidly and needs wheelchair/seating
• has deteriorated and speech is no longer intelligible.
• has had deterioration in physical status so that alternate access to device is required.