Assessor education webinars

Kia ora Koutou, Welcome to this assessor education session on Sleep Positioning Systems. I'm going to start the session with an opening karakia

My name is Dana and I'm a clinical services advisor working for enable New Zealand. I'm an occupational therapist and a member of the Imries ACC advisory team with me today I have Jane Hammer. Jane is a paediatric physiotherapist with a special interest in postural care. She completed her master's thesis in 2022.
On caregivers, experience of implementing sleep positioning systems for children with complex neuro disability, she is the clinical leader for paediatric physiotherapy in Waitemata and has a wealth of knowledge in this area and we're so grateful you're here today to share your knowledge with us, Jane.
This education session is primarily targeted towards a CC assessors. However, Vikaha assessors are also welcome to listen in.
The objectives, sorry, the objectives for the session today are for, for assessors to understand the importance of sleep positioning systems.
For assistance to understand the complexities and barriers for using sleep positioning systems.
And for scissors to have tools and their kitted to support clients and caregivers, implement sleep positioning systems.
Now you may have heard of a few different terms to describe lying positioning equipment such as night time, postural management equipment, sleep systems and sleep positioning systems or SPS. In our conversation today, we will be referring to them as sleep positioning systems just to be using consistent language.
Sleep positioning systems can be low tech supports, such as using standard bidding such as pillows or rolled up towels, or high tech options which include commercially available products specifically designed to support the body and neutral and symmetrical positions.
Firstly, when considering sleep positioning systems, I want us to touch on the importance of the International classification of Functioning, Disability and Health ICF framework. I'm sure that there will be a lot of assessors with an understanding of this framework. However, for those who aren't as familiar with it, Jane, are you able to give a quick reminder or overview of the framework?

Jane 3:11
Sure.
And so the International Classification of Functioning Disability and Health is a framework for describing and organising information on functioning and disability, and it defines disability not as an individual's intrinsic feature but as a result of the interaction in an environment, and it graphically depicts the domains of body structure and function, and this encompasses both the physiological functions of body systems and body structures.
Including the organs and limbs, and for people with complex neuro disability. This may include difficulties with movement, respiration, digestion, hearing, envision, sleep disorders, pain and other challenges such as seizures and the activities domain involves.
Execution of a task or action by an individual and includes activities such as mobility, play and self-care tasks, and includes sleep, communication, cognition and learning. Whilst sleep is a neurological and biological function and it is classified under the body structure and function, domain, sleep disorders and sleep itself is also recognised within the activity domain and then the participation domain.
And this encompasses the individuals involvement and life situations and interactions with others such as family and friends.
For individuals with complex neuro disability, the physical and health challenges such as experiencing pain or not getting a good night's sleep often limit opportunities for wider social participation, resulting in greater dependence on key givers and family members.
Supporting health to sustain activity in participation in the activities of both individual and their families, those that they enjoy and prioritise across the life span also needs to be considered when we in the care we provide.
And I see if excuse me and the ICF also considers the R environmental and personal factors that impact on how a person expresses experiences and manages the health and or disability consumes.

Dana Walsh 5:36
Thanks for that overview Jane. Now I wondered if you can share why it is important to consider the ICF when thinking about sleep positioning systems.

Jane 5:47
Yeah. Well, I think what's important to note on the ICF are that the arrows that connect each of the domains and factors are bidirectional. So everything is interconnected and no one domain is acting alone, which means you must consider that the impact of our intervention on one domain will impact another. And I personally think that the magic or impact of therapy happens in the spaces between the domains.
In those arrows, and I think that often as therapist, depending on our professional training and perhaps our perspective or view all ends of disability, we can tend to focus on one domain more than the others like I'm a physio. So you may think I'm I might focus more on the body structure and function domain, but if we are going to really support and understand the context of a person's life, we need to understand, explore and appreciate all the domains and factors.
Much 24 hour postural management research focuses on the body structure and function domain, which is has resulted in a prominent intervention message or focus on body structure and function. So mostly on hips and spine is what the researchers mostly focused on, with less focus on the activities and in particular, sleep and activities domains and less consideration and exploration of the personal and earned.
Army two factors in which a person lives and where we undertake our support. Look, I'm definitely not saying that we don't consider body structure and function promoting postural alignment and protection of the body. What I am saying is that it's equally as important for us to constantly remind ourselves of all the ICF domains when considering 24 hour postural care and sleep positioning system is in particular.
What is the person and the caregiver's activity?
Food for sleep systems, it's mostly sleep.
And what do they want to be able to do to participate in? Maybe if they have good sleep as a family, they're going to be able to go out and go to the mall or enjoy an activity because they've had good sleep. And what limits this? Maybe it's pain, maybe it's lack of sleep. And what are their goals and priorities? What are their values, what's supports do they have? What's the capacity to understand, undertake the work that we are, the intervention that we suggesting and all of these need to be considered.
If together we're going to be successful in implementing 24 hour postural care.

Dana Walsh 8:34
Hmm. Thanks, Jane. Yeah, I can really see how the ICF provides a great framework for us to be considering when looking at sleep positioning systems and intervention.
To in preparing for our chat today, I have reviewed some journal journal articles in this area and from the articles that I reviewed, the appears to be a lack of high level evidence in the field of night time positioning. So a systematic review by Humphries and all published in 2019 on Sleep Positioning Systems for children and adults with neuro disabilities found that although sleep positioning systems are often prescribed by OTS and physios, evidence for them is currently poor.

Jane 8:58
Hmm.

Dana Walsh 9:16
Blake and Owen, 2015. Looks specifically at sleep positioning systems for children with CP, and they found that insufficient. They found insufficient high quality evidence to address the objectives of their review. They reported no robust evidence to inform clinical decision making regarding the prescription of sleep positioning systems to reduce or prevent hip migration for children with CP.
And then the study by Stinson, Crawford and Madden in 2021, they found that OT skills in 24 hour postural care improves with frequency of use.
They also found that reliance on postural care equipment leads to service user and caregiver frustration that also needs to be addressed, and this also ties into your research, Jane, which we will touch on a little bit later. I do want to acknowledge that most of the research in this area is related to children with cerebral palsy.
Jane, do you have anything to add about the research in this area?

Jane 10:21
I should do first, and there's quite a bit of research into the effectiveness of sleep positioning systems, which is identified that sleep positioning systems may prevent or reduce deformity.
My enhanced or impaired respiratory function may improve sleep quality, may improve pain levels, and that we should commence coastal management programmes early. That postural management programmes improve patient and caregiver quality of life, that specific cultural management pathways improve clinician skill but can also have negative effects because of an increase in workload and lack of time to support the project, with the risk that the service or training.
It's not sustainable. Additionally, limited time may impact on outcomes of information given without ongoing support, without ongoing support of families, however.
I think what's important of what I've said is that may, but because what's?
As you say, it is insufficient high level evidence and the regular of some of that researchers low. For example, many studies don't identify gmfcs level. That's gross motor function, classification, scale. That's how you lose to identify levels of cerebral palsy. And without these descriptors, clinical relevance from research can't be accurately drawn across populations.
The Blake Cochrane Review is an example of a real focus on one particular criteria that were looking at migration and determining whether sleep positioning systems affected that one area.
And, but Cochrane reviews only recognise RCT, and it's really hard to undertake high level research for such a heterogeneous group of people with complex disability. The mix of sensory, motor and cognitive systems means it's really ethically not possible to do an OCD. That's why the hell freeze it all group then undertook the air literature review to capture evidence from a wider source of studies. There are some areas in our wheeled mobility.
The postal management practise that are well supported by research such as the biomechanics of propulsion, of wheelchairs and pressure injury management and wheelchair training, skill wheelchair skills training, but there are also pockets of practise where evidence is still building, such as night time positioning. What I think is important to consider with the current research is where that high level evidence such as our CTS should be the only basis for considering intervention.
Whilst caution must be used when interpreting in using the findings from the current research to inform clinical decision making, we must also consider evidence and formed principles which guide us to use the best available research evidence in literature.
Clinical experience of self and peers, the client's values and preferences in data from measuring outcomes of our individual interventions with individual clients.
A recent scoping review.
Published by the British Journal of Occupational Therapy in 2023 by Osborne, Casey and Carl Gowan, I wrote on the evidence of 24 hour postural management that research in this field is challenging and subsequently greater credibility should be attributed to specialist expertise.

Dana Walsh 14:04
Hmm, yes, it is hard for clinicians to be guided by research if it is not conclusive. But as you say, there is stronger evidence in other areas of 24 hour postural care, such as seating and standing.
But yeah, I think it's also important to recognise the clinical expertise that assesses bring and the values and beliefs of the clients that we also that we work with that also guide us.

Jane 14:29
It's true.

Dana Walsh 14:30
So so want to now move on to highlight the importance of sleep positioning systems and why we need to be considering them.

Jane 14:39
Yeah, well, as I've already said, research and evidence in this area is tricky. But what we do know is that for people with complex physical and sensory disabilities who are unable to independently change their body position posture.
Posture and 24 hour positioning becomes a really important issue. Their body structures are influenced by both postural alignment and the forces of gravity, which in turn affect body functions and the ability to participate in everyday activities. The international mckeith consensus statement for postural management for children with CP defines it as a planned approach encompassing all activities and interventions which impact an individual's posture.
The function and fairly at all in 2003 to find 24 hour postural management as utilisation of a range of interventions to reduce postural asymmetry and improve function, and includes all line sitting and standing positions that occur within 20 any 24 hour period.
I think sleep systems sleep positioning systems are important because the amount of time people with complex disabilities spend and lying.
Michelin Owl and Lungi in 2018, in their book seating and wheeled mobility, advised that clients would humans.
Support links at least 40% of the year are spent in bid for rest and sleep, and research has identified that whilst typically developing children spend approximately 1/3 of their time in bed, children with cerebral palsy can spend up to send off their day and lying.
Researchers showed that sustained asymmetry and has it habitual postures and supine, have been linked to the development of progressive, non reducible deformities such as hip dislocation, pelvic obliquity, wind sweeping and scoliosis, and people with cerebral palsy. And there's growing evidence that positioning in living has a direct relationship on the success of postural alignment and and so really given the significant amount of time.
Line often in unsupported and asymmetrical positions, we gravity is impacting negatively on bodies. It's so important for us to consider equipment that supports a symmetrical or asymmetrical possible position in lying.

Dana Walsh 17:13
Yeah. The amount of time that people with complex disability spend and lying is really sobering. It's such a large portion of the 24 hour period given that what's the positive impact, 24 hour positioning can have on the individual.

Jane 17:19
Yeah.
Well, as I hope I've already made clear, 24 hour positioning is needed to protect body structure and that's because if an individual adopts an asymmetrical composition and is not able to independently change their position and is supported to submitted to the forces of gravity, the body structures distort and compress and restrict the functional, the internal organs, and they can develop secondary complications such as tissue damage.
Still, contractors and further health and participation complications such as pain and discomfort, skin breakdown, pressure areas, respiratory difficulties, poor sleep.
Constipation and infections and for a lot of people with complex disability, premature death. So it's important to remember that equipment.
And sleep system positioning systems in particular is just one part of 24 hour postural care.
And whilst there's researchers and conclusive, if we take a family centred and whole person approach that supports both the mental and physical health and wellbeing to enable individuals the opportunity to achieve their full potential, we must consider all ICF domains of both the person and their key giver, and across both day and night. And if we implement it consistently and early enough, we can suppose or hope that we will improve posture.
Symmetry. Well, at least maintain it. But there is evidence to show that we might be able to improve postural symmetry and integrity, improve or sustain good sleep for both the individual and their caregivers.
Reduce the risk of pain, respiratory difficulties, skin and pressure and injuries, gastrointestinal issues and reflux and address comfort for both the individual and their child. But we've also got to remember that there are negative effects and primarily my research found that these were mostly in relation to the burden of care on key givers.

Dana Walsh 19:43
Hmm, I can see we need to think about positive impacts across the ICF domains for the individual and their caregivers. So to help us as clinicians, when should we be considering sleep positioning systems? What are the indicators that tell us we should be considering their use?

Jane 20:04
Well, from a wider body structure and function and care perspective, we can consider sleep positioning systems as an intervention. If an individual has habitual postures that asymmetry and with immobility and lying frequently repositioning due to pain, pressure concerns and safety such as breathing and swallowing or aspiration. But there are other checklists or guidelines.
Bit help conversions to consider sleep positioning systems, such as the Mansfield checklist that was developed by Goldsmith in 2000, and that poses some body structure and function questions for the clinicians. So these questions.
And help her clinician to think, should I be considering sleep systems for this person? And those questions in the Mansfield checklist are does the body stay in a limited number of positions?
Do the knees seem to be drawn usually to one side or inwards or outwards into a frog position?
And as the heed seem to turn mainly to one side.
There's also the international mckeith consensus statement for children with CP, developed by Garrick in 2006.
And obviously this is more focused on the child versus the adult client, but this recommends that children with gmfcs levels four and five should begin 24 hour postural management programmes. Since lying as soon as possible after birth and sitting from six months in standing from 12 months, there's two other guidelines up here as well. So the consensus statement on heaps, surveillance for children with cerebral palsy, whilst it doesn't give a clear indication of when you should be introducing sleep systems.
This guideline does talk about equipment that supports the hips of children and the same with the Nice guidelines of spasticity, which talks about a range of interventions which includes surgery and Botox and Baclofen and orthotics and a postural management equipment. So there's no really.
Um, one sort of guideline, but people listening to this or other conditions might find one of them is more of this useful thing for them to have in their head like the the Garrick statement or the Mansfield checklist, just to be thinking, ohh I should be considering lying supports.

Dana Walsh 22:31
Hmm. Thanks, Jane. So as you said, there's no one definitive guideline for for the people that we may support, but these are helpful for us to use when considering implementing sleep positioning systems.

Jane 22:41
Yeah.

Dana Walsh 22:44
And so in your research, the first thing you explored was the concept of it's a complex night. You suggest that multiple factors contribute towards the complexities and barriers for using sleep systems. Can you delve into what some of those are?

Jane 23:02
Yes. Well, theme one, it's a complex, pretty obvious. It's talking about night time complexity. So Kia givers the in my research caregivers described always prioritising their child's health needs first to keep them well and out of hospital. They described the heath health challenges primarily as managing overnight seizures and their respiratory needs often caused by an increased oral secretions.
Or choking and aspiration. Maybe they already had chronic lung disease, like bronchitis, and those often led to frequent and prolonged hospital admissions.
Many also described the impact of pain on the child's poor sleep at night and often didn't know where the pain was coming from. But they prioritised comfort and sleep of off the both the child and consequently themselves above sleep system use and postural care.
They described night time as complex because of wrestling with this dilemma of balancing the needs of the child and all their priorities at night with the guilt of maybe not meeting some needs that such as using sleep positioning systems. Additionally, they also spoke with therapists recommending that they implement sleep positioning systems without really understanding the complexity, the complexity of the child, and the caregivers at night.
And my experience is that attention and knowledge of caregivers concerns in particular regarding their health needs, such as respiratory issues, pain and sleep. It doesn't appear to be addressed within the usual care that therapists provide families.
And based on that caregivers narratives, I suggest that our focusing on body structure and function, which seems to be the primary focus within our within our Sleep Positioning System interview and it doesn't fully account for this complexity of night time challenges and it we don't we're not addressing their priorities of sleep, health and comfort.

Dana Walsh 25:20
Hmm. Thanks, Jane. It's it's so valuable to have some insight into the complexities that caregivers are faced with during night times. It does sound really challenging. Are you able to share what Kivers reported as being most important to them?

Jane 25:37
Well, I found it quite hard to summarise because.
As I said, three things developed and from you know from my research, it's a complex night. This is what I know and support me to support my child and I think all three things speak to what key givers described as being important to them.
So theme one speaks to the health complexity overnight, trying to manage all those competing demands and clinicians not really understanding it and not addressing it.
And thing two, this is what I know. Caregivers spoke about their knowledge, beliefs, and values about their child's health and sleep, and they all spoke, also spoke of their understanding of sleep systems, what they did, or more importantly, what they didn't know. And they wanted better understanding of the purpose of sleep positioning systems.
They spoke about the unknown future for the child and the our future prevention method, or what they described it. Connections often came in and said that using this equipment would prevent problems on the future. They found that message unhelpful and actually quite frightening.
And the preference was for us to speak perhaps rather than about prevention, but about protection. So giving some hope for the future.
And then in theme 3 support me to support my child and here King of us spoke about the way they wanted support from clinicians, so they wanted timely support. They often spoke about the frustration that we all have with the delay of assessing and then trialling equipment and how long it takes before they get a piece of equipment.
They wanted their knowledge about their child, family and goals respected. They wanted information and support, provided a collaborative coaching way and they wanted clinicians to communicate openly and with no judgement, with active listening so that they were building a relationship of trust and partnership, encouraging hope and optimism for the future.

Dana Walsh 27:59
Hmm, yeah, it's so crucial to recognise that whilst we may be focusing on providing sleep positioning systems for the child or the adult, the involvement of caregivers really is key for successful implementation and they really do play a pivotal role in this process. It seems that there needs to be a greater emphasis on nurturing those relationships with caregivers. If sleep positioning systems are to be effective.

Jane 28:12
Absolutely.

Dana Walsh 28:25
How can we? Sorry, how can assessors be best supporting clients and caregivers on this journey?

Jane 28:34
Well, first, I'm gonna bang on about it, but we've got to consider all the ICF demains and remember that 24 hour postural care, and especially night time postural care, is so much more than body structure and function. We also need to consider both activity and participation domains for the child and the caregivers. And we need to consider the environmental and personal factors, which means we need to consider the quality of life and priority as priorities.
Of both the person and their keepers. If we think that we are going to be providing 24 hour postural care and lying in at night, we need to think about their bodies, sleep, health needs and the needs of their caregivers and understand their complexity at night.
We need to undertake a full assessment and undertake people's lives across 24 hours with this understanding and by being curious, listening and nonjudgmental, and trying to understand people's lives, priorities and goals together we can Co create a plan. First, we have to acknowledge that the person and all caregivers are the experts in their care, not just you. As the clinician, we have to put the person family.
And cute divers, knowledge and priorities. First in doing this, builds trust in partnership.
Of course we will be doing a physical assessment to determine any to determine the parameters of any equipment, but by building trust and partnership through this process of gathering information together, we can then decide what we're going to resist, what the priorities might be, what the plan might then be, and what we're going to do together, how we will measure success and therefore what outcomes we will need to use to measure the success or change.

Dana Walsh 30:31
Hmm. Yeah, it really is clear that the importance of building strong partnerships and a high level of trust with the clients and their caregivers is such a critical piece to this and the effectiveness of sleep positioning systems.
And there were a couple of key points that you would like people to take away from today's conversation.

Jane 30:52
Yeah. Yep.
Is a short summary. I hope you've seen from our presentation today that I think we really need to broaden our approach to 24 hour postural care to could consider and address all aspects of the ICU.
To do this, I think we need to we, as clinicians need to uncrease our knowledge of the health complexity, Keegan, as speaker of in particular, we need to increase our knowledge of sleep, pain, respiratory issues and seizures. And we need to know how to support caregivers with these challenges before we start adding another burden on of implementing sleep systems at night. And we need to make sure our intervention adopts person or family centred.
Clear principles and particularly partnership relationships through adopting coaching models of care, we need to address key givers, priorities and goals, and Co create a plan and we need to reframe our messaging around postural care. So postural care versus postural management and protection of the body versus prevention of problems.
And if we can achieve all these things I like, I guess language. What I'm saying is language really matters, and if we can achieve all all the these things and work together in partnership with caregivers and the wider MDT, then perhaps juggling this complexity becomes something that's both shared and also looks pretty amazing for everyone.

Dana Walsh 32:29
Thanks, Jane. Yeah, I do want to acknowledge that this is a really complex area and it's clear that there's much more that we could delve into today. However, for the sake of time, we must begin to wrap up. So for the listeners who are eager to learn more, we would you suggest they go to for further information in this area.

Jane 32:50
Well, absolutely. I would encourage them to undertake the whimper. One we will, mobility postural management level one and the lying training workshops with seeking to go. They are the national trainers and they are the absolute experts in this work. And there's also a great website born at the right time. It's a UK based website and team and they provide online courses for clinicians and parents. However, it is UK based and not everything is applicable.
That the New Zealand context, and if you're really interested, I'd suggest people read the articles that have been suggested in the reference list.

Dana Walsh 33:31
Thank you so much Jane for sharing your knowledge and your research with us today. I'm sure this will be really helpful and valuable information to assessors.
And so now you will see the reference list here, which I look will get uploaded to the website as well and you can refer back to as always please feel free to contact our clinical services advisory team at enable New Zealand. You can find our contact details on the enable New Zealand website.
I'm going to end the session with the closing karakia.

Christa Roessler
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Christa Roessler 0 minutes 5 seconds
I'm just going to give it a minute to wait for everybody to link in.
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Excuse me.
Christa Roessler 0 minutes 16 seconds
We had quite a high number of registrations for this webinar, so we're not sure how many people are actually going to join.
Christa Roessler 0 minutes 26 seconds
So it just give it another half a minute.
Christa Roessler 0 minutes 32 seconds
I did put in the chat.
Christa Roessler 0 minutes 34 seconds
Of course, if you can't hear us, you won't hear me saying in the chat that if you're having trouble with the sound, make sure your speakers are turned on.
Christa Roessler 0 minutes 46 seconds
Just give everybody another couple of seconds to join in.
Christa Roessler 0 minutes 53 seconds
And then we'll start with some introductions and a Charak here.
Christa Roessler 1 minute
OK, we might get started.
Christa Roessler 1 minute 4 seconds
So thank you for joining us today.

Christa Roessler
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Christa Roessler 50 minutes 36 seconds
Yes, that's right.

Jolene Young
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Jolene Young 50 minutes 37 seconds
I understand.
Jolene Young 50 minutes 38 seconds
Umm but yeah, please do let us know if it does end up being any issues with that.

Christa Roessler
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Christa Roessler 50 minutes 43 seconds
But it will take a week or so to have all that of sent out and the recording put up on the website.
Christa Roessler 50 minutes 48 seconds
So that doesn't happen immediately, yeah.

Jolene Young
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Jolene Young 50 minutes 52 seconds
Which companies will make custom bariatric equipment?
Jolene Young 50 minutes 55 seconds
I know Cubro is really good at being able to customize equipment.
Jolene Young 50 minutes 59 seconds
There is some other suppliers.
Jolene Young 51 minutes 3 seconds
Also.
Jolene Young 51 minutes 4 seconds
Umm.

Christa Roessler
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Christa Roessler 51 minutes 7 seconds
Good question, though I don't think we've got a list of companies that, yeah.

Jolene Young
51 minutes 8 seconds51:08
Jolene Young 51 minutes 8 seconds
Yeah, we might need to.
Jolene Young 51 minutes 10 seconds
Umm make sure we have a more and that's something we could also add to the comparison chart as sort of indication on if they can customize.
Jolene Young 51 minutes 19 seconds
It's there as actually a really good point that we can tie in.

Christa Roessler
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Christa Roessler 51 minutes 20 seconds
Umm.
Christa Roessler 51 minutes 24 seconds
Yep.
Christa Roessler 51 minutes 28 seconds
Any.

Jolene Young
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Jolene Young 51 minutes 28 seconds
A question around options for bariatric heavy duty commodes.

Christa Roessler
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Christa Roessler 51 minutes 34 seconds
Yep.
Christa Roessler 51 minutes 35 seconds
So that's definitely on the comparison chart that we have for shower and Arthur equipment.

Jolene Young
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Jolene Young 51 minutes 40 seconds
Yeah.

Christa Roessler
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Christa Roessler 51 minutes 40 seconds
So there's some a couple of really high safe workload shower commodes available which I can look up while you're talking.

Jolene Young
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Jolene Young 51 minutes 50 seconds
And there's a question around moving bariatric equipment to band One for the whaikaha list.
Jolene Young 51 minutes 55 seconds
That's a great, great point and that's something we can feed back up to the likes of procurement and talk about that with them.
Jolene Young 52 minutes 4 seconds
We personally don't have the power to do that.

Christa Roessler
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Christa Roessler 52 minutes 9 seconds
I'm just going to have a quick look if.

Jolene Young
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Jolene Young 52 minutes 10 seconds
Ah, sorry.

Christa Roessler
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Christa Roessler 52 minutes 16 seconds
If I can find it quickly on the website.
Christa Roessler 52 minutes 17 seconds
If you want to keep talking.

Jolene Young
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Jolene Young 52 minutes 19 seconds
I don't know if I do.
Jolene Young 52 minutes 21 seconds
I'm just trying meeting.
Jolene Young 52 minutes 24 seconds
Yeah, we've had someone say that medifab also do customized options so.

Christa Roessler
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Christa Roessler 52 minutes 30 seconds
I think most suppliers have capacity to do some level of customization, but it's definitely something that we could provide better indication around.

Jolene Young
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Jolene Young 52 minutes 45 seconds
Alright.

Christa Roessler
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Christa Roessler 52 minutes 47 seconds
No, I've just.

Jolene Young
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Jolene Young 52 minutes 48 seconds
The questions seemed to have like that.

Christa Roessler
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Christa Roessler 52 minutes 49 seconds
Ohh Yep.

Jolene Young
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Jolene Young 52 minutes 50 seconds
No, you you too.

Christa Roessler
52 minutes 51 seconds52:51
Christa Roessler 52 minutes 51 seconds
No, no, you're right.
Christa Roessler 52 minutes 52 seconds
I've just downloaded our comparison chart to have it look and in terms of bariatric shower commodes, there is a Kobe rehab XXL provided by Cubro that's got a safe workload of 325 kilos.
Christa Roessler 53 minutes 10 seconds
There's a Raz heavy duty also from Cubro, which has a safe workload of 275 and this even a they both non tilting and there is a Raz tilting heavy duty shower commode to 72 safe workload and even the multi Chairs have 180 safe workload and there's three or four more active healthcare have a spy about bariatric shower commodes got a 400 KG safe workload Joe have a Carey Carmina 320.
Christa Roessler 53 minutes 42 seconds
The brothers got 363.
Christa Roessler 53 minutes 44 seconds
That's active healthcare.
Christa Roessler 53 minutes 45 seconds
There's actually quite a few options in a very high safe workload for shower commodes, so that's where that comparison chart can be quite useful.

Jolene Young
53 minutes 53 seconds53:53
Jolene Young 53 minutes 53 seconds
Yeah.
Jolene Young 53 minutes 53 seconds
And as mentioned, feel free to contact us if you wanted to talk about possible options before submitting your order or the advice request and we can help look at what options are out there.
Jolene Young 54 minutes 11 seconds
Ohh it was got some more questions about products being added to band One so we can take that away or for consideration.
Jolene Young 54 minutes 19 seconds
I'm just mindful of time, so if if there's any questions we haven't been able to get back to you, we'll do our best to try and answer these unanswered questions.
Jolene Young 54 minutes 30 seconds
We want to thank you for your time with us today.
Jolene Young 54 minutes 33 seconds
We'll now close today's session with a karakia Kia Ficaria tapu Kiwi, Tio tiara, Kia Turuki fattahi Kia Turuki, whakataha AI Homier, Hoyer Tahir.

Christa Roessler
54 minutes 49 seconds54:49
Christa Roessler 54 minutes 49 seconds
Great.
Christa Roessler 54 minutes 50 seconds
Thanks everybody.
Christa Roessler 54 minutes 51 seconds
Have a great day.
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Ailsa Lucking stopped transcription

So if it's alright, I think that I will start.
Ailsa Lucking 1 minute 32 seconds
So cure dokoto and welcome everyone.
Ailsa Lucking 1 minute 35 seconds
Thank you for coming today.
Ailsa Lucking 1 minute 37 seconds
We're really, really pleased with the numbers.
Ailsa Lucking 1 minute 39 seconds
It's brilliant.
Ailsa Lucking 1 minute 40 seconds
So thinking that we'll start today with a Cachia.
Ailsa Lucking 1 minute 44 seconds
So Toya Karonga tuya.
Ailsa Lucking 1 minute 46 seconds
Kirara, Toyokawa, Aho, Toyohiro, Tuiaki, Taheri tangata, corona, topo corona, Tau homie, huyer tikia.

Christa Roessler
1 minute 58 seconds1:58
Christa Roessler 1 minute 58 seconds
OK.

Ailsa Lucking
2 minutes2:00
Ailsa Lucking 2 minutes
OK, so welcome to our session.
Ailsa Lucking 2 minutes 1 second
And as I mentioned, I'm also and with me as Christa.

Christa Roessler
2 minutes 5 seconds2:05
Christa Roessler 2 minutes 5 seconds
Morning.

Ailsa Lucking
2 minutes 6 seconds2:06
Ailsa Lucking 2 minutes 6 seconds
Wait.
Ailsa Lucking 2 minutes 6 seconds
Clinical Service advisors who work within the ACC contract at enable New Zealand and our colleague Jolene has also present and she'll be helping us to drive the slide show.
Ailsa Lucking 2 minutes 17 seconds
So we're presenting today for two reasons.
Ailsa Lucking 2 minutes 20 seconds
We've had feedback from assessors about the need to raise awareness of the clinical service advisors and what our role is and how we can support and assist you.
Ailsa Lucking 2 minutes 29 seconds
And we have noticed there are quite a few of you who are new to imerys.
Ailsa Lucking 2 minutes 33 seconds
That's the managed rehab equipment service.
Ailsa Lucking 2 minutes 36 seconds
So just for our interest in understanding, could you please answer the question in the poll, which I'm hoping is popped up on the screen.
Ailsa Lucking 2 minutes 44 seconds
So are you a new grid or perhaps just new to imerys?
Ailsa Lucking 2 minutes 47 seconds
Or perhaps returning to Emrys after some time?
Ailsa Lucking 2 minutes 50 seconds
Or maybe you're just using today as a refresher, so it would be awesome if you'd be happy to answer that polls.
Ailsa Lucking 2 minutes 56 seconds
They think you very much for that brilliant and now the key focus for today is to demonstrate how we can support you as a scissors to get your orders through the system as quickly and efficiently as possible.
Ailsa Lucking 3 minutes 11 seconds
Cool.
Ailsa Lucking 3 minutes 12 seconds
And we'd like you to understand what is expected and to learn who we are and how we can assist you to reach the outcomes you need for your clients.
Ailsa Lucking 3 minutes 20 seconds
So enable New Zealand has held the Emrys contract for two years now, and there are continuous improvements happening and the more you know about these, the easier it is for you to get your orders through the system smoothly and as a thesis, it's worthwhile being familiar with the Emrys operational guidelines, which you can find on the enable New Zealand website in the ACC website.
Ailsa Lucking 3 minutes 42 seconds
And these are the guidelines that also inform the role of enable New Zealand and as as clinical advisors.
Ailsa Lucking 3 minutes 49 seconds
So just a few formalities and housekeeping before we kick off.
Ailsa Lucking 3 minutes 54 seconds
Umm.
Ailsa Lucking 3 minutes 54 seconds
If you could use the chat function for questions and there'll be 10 to 15 minutes at the end to answer these.
Ailsa Lucking 4 minutes
As we said, there are quite a few people registered for this session, so if we can't get your questions during the session, we will do it afterwards.
Ailsa Lucking 4 minutes 8 seconds
It would be out of scope to discuss any individual clients situation today, so please feel free to call or email an advisor if you'd like to have this type of discussion and we will put a copy of this presentation in the chat at the end of the session.
Ailsa Lucking 4 minutes 23 seconds
Although it's worth noting it might contain all the information we discuss, and we're also hoping to have a recording available on the Enable website in the near future.
Ailsa Lucking 4 minutes 33 seconds
OK, brilliant.
Ailsa Lucking 4 minutes 35 seconds
So moving on to our session plan.
Ailsa Lucking 4 minutes 40 seconds
The next slide.
Ailsa Lucking 4 minutes 45 seconds
Brilliant.
Ailsa Lucking 4 minutes 46 seconds
This is so this is a plan of our session.
Ailsa Lucking 4 minutes 51 seconds
We're hoping it will be relatively short, maybe about 20 minutes, leaving us plenty of time to answer any questions you might have.
Ailsa Lucking 4 minutes 58 seconds
We appreciate your time as precious and we're hoping that that kind of timing will work for you.
Ailsa Lucking 5 minutes 4 seconds
OK, lovely.
Ailsa Lucking 5 minutes 5 seconds
So moving next slide.

Jolene Young
5 minutes 9 seconds5:09
Jolene Young 5 minutes 9 seconds
I'll just pop in for a moment.
Jolene Young 5 minutes 11 seconds
I asked the Sams to be some people not able to hear, but I'm not sure why.
Jolene Young 5 minutes 17 seconds
We've got some people who can and some people who can't.

Christa Roessler
5 minutes 21 seconds5:21
Christa Roessler 5 minutes 21 seconds
I've just noticed that as well, Jolene.

Ailsa Lucking
5 minutes 21 seconds5:21
Ailsa Lucking 5 minutes 21 seconds
Hmm.

Christa Roessler
5 minutes 23 seconds5:23
Christa Roessler 5 minutes 23 seconds
So I've just, it may mean that people need to leave the meeting and rejoin.
Christa Roessler 5 minutes 28 seconds
So I'm not sure what the technical issue is there and also in the invitation there should be another option to join into the meeting.
Christa Roessler 5 minutes 37 seconds
As well.

Ailsa Lucking
5 minutes 41 seconds5:41
Ailsa Lucking 5 minutes 41 seconds
Ohh so if I give it a minute just to see if it's worked for anyone coming out in rejoining.

Christa Roessler
5 minutes 53 seconds5:53
Christa Roessler 5 minutes 53 seconds
Sorry everyone.

Ailsa Lucking
5 minutes 55 seconds5:55
Ailsa Lucking 5 minutes 55 seconds
Apologies and what we might do is we might just press on because there will be a recording and you will be able to get the PowerPoint.

Christa Roessler
6 minutes 5 seconds6:05
Christa Roessler 6 minutes 5 seconds
Hmm.

Ailsa Lucking
6 minutes 5 seconds6:05
Ailsa Lucking 6 minutes 5 seconds
So I'm hoping it's resolved itself and I'm hoping the vast majority of you can hear it.

Jolene Young
6 minutes 8 seconds6:08
Jolene Young 6 minutes 8 seconds
Yeah, I'll just.
Jolene Young 6 minutes 10 seconds
I've had a tip come through from someone saying that maybe make sure they're computer speaker isn't muted, so it's just the the microphone muted which the the that's the presentation has done.
Jolene Young 6 minutes 22 seconds
So make sure your computer speaker is on.

Christa Roessler
6 minutes 25 seconds6:25
Christa Roessler 6 minutes 25 seconds
OK.
Ailsa Lucking 32 minutes 16 seconds
If you could overlook that, that would be awesome.

Christa Roessler
32 minutes 20 seconds32:20
Christa Roessler 32 minutes 20 seconds
Well, picked up.

Ailsa Lucking
32 minutes 24 seconds32:24
Ailsa Lucking 32 minutes 24 seconds
And we have had some brilliant questions in the chat as we've been going along and I've been having an awesome time answering them.
Ailsa Lucking 32 minutes 31 seconds
So thank you very much for that.
Ailsa Lucking 32 minutes 32 seconds
Everything you can tell us is just really, really useful to us

Sarah Boyt 1:26
We're just gonna give it to 902903 to give everybody an opportunity to get here and then we'll begin our presentation for today.
Sarah Boyt 3:30
OK, welcome.
Welcome to our presentation today on restraint minimisation and thank you so much for taking the time to join us.

Sarah Boyt 3:39
We just like to begin this morning with an opening karakia.

Sarah Boyt 4:18
My name is Sarah and Pauline and I are clinical service advisors for enable New Zealand.

Sarah Boyt 4:23
Our colleague Shania is joining us today and as kindly running in supporting all IT aspects for us.

Sarah Boyt 4:30
Thank you, Shania and our colleague Krista, who was also a clinical services advisor, is going to help manage the Q&A.

Sarah Boyt 4:37
Thank you, Krista.
During our session today, you are invited to pop any questions or comments into the Q&A.

Sarah Boyt 4:46
We have allocated time to address these near the end of the presentation.

Sarah Boyt 4:50
Please note there are quite a few people tuning in today, so we will endeavour to get to all your questions.
However, if that's not possible, we will respond to as many as possible post our webinar today.

Sarah Boyt 5:04
Also, just to let you know, we are recording today's session.

Sarah Boyt 5:08
You hopefully all have our resource accessible to you.
If not, you will see an attachment in your chat section.

Sarah Boyt 5:15
To access this, we will be referencing the flow chart throughout the second half of this presentation.

Sarah Boyt 5:21
So please do have this handy to refer to.

Sarah Boyt 5:27
Pauline and I are part of a team of experienced occupational therapists and physiotherapists.

Sarah Boyt 5:32
Our mission is to support disabled people and their far no to live everyday lives in their communities and homes.

Sarah Boyt 5:40
We aim to do this by effectively managing access to the equipment and modification services on behalf of Icahn, Ministry of Disabled People and also ACC

Sarah Boyt 5:52
So just a little bit about our backgrounds.

Sarah Boyt 5:56
Umm I am a physiotherapist and have a background in Pediatrics working in special schools and the wider Auckland area.

Sarah Boyt 6:03
Over the past 15 years, I recently relocated to the South Island and have been employed as a member of the Fire Kaha advisory Team with enable New Zealand for almost two years, Pauline.

Pauline Lazarus - NZPT 6:16
And I'm also a physiotherapist with a fairly generalist adult background.
I'm a member of the AC equipment team and have worked at enable New Zealand for four years.

Pauline Lazarus - NZPT 6:29
Thanks Sarah.

Sarah Boyt 6:31
Lovely.
Next slide, please.
OK, the intent of this presentation will be to help establish a consistent approach to providing safe and quality care in relation to tailored solutions that may limit a person's normal freedom of movement and to highlight the parts of the current standard

Sarah Boyt 6:50
We expect a relevant to our practice.
The objectives for today include to be aware of the most recent New Zealand standard concerning restraint, provide you with and highlight relevant resources.

Sarah Boyt 7:05
Highlight that some of our commonly prescribed equipment could be at times limiting a person's normal freedom of movement and the consideration that needs to be given to this.

Sarah Boyt 7:17
We started looking into this area.
As we noted, inconsistencies when reviewing situations potentially involving restraint, this has led to us researching the current standards and considering how we apply them to our work.

Sarah Boyt 7:34
Next slide please.

Sarah Boyt 7:38
So solutions that could be a restraint, I'm sure you have all have examples of equipment solutions that you have come across where you considered if the solution could be a restraint.

Sarah Boyt 7:51
As an example, adding a tray to a seating solution with the intent to provide additional positioning support or to enhance the use of a person's functional skills can be a great solution for some people.

Sarah Boyt 8:05
But if that person can normally sit to stand independently and they are not able to release and remove that tray on their own, the question posed is have I now in fact restrained them?

Sarah Boyt 8:18
Keep this example in mind whilst we move through our slides.
We hope to highlight ways to clinically reason through proposed solutions with direction from the current standards and potentially flag things we may not be currently considering when it comes to restraint.
Next slide please, Pauline.

Pauline Lazarus - NZPT 8:39
Not pitaya health and disability services Standard was published in 2021 and came into effect in February 2022 on Manatu Holder Ministry of Health website and a video by Doctor Ashley Bloomfield.

Pauline Lazarus - NZPT 8:56
He quotes this standard, outlines what we can expect in New Zealand to ensure we provide high quality and safe health and disability services.
The standard is applicable for a wide range of providers, and certain providers are required to comply with the standard and are audited against relevant sections of the standard.
For example, providers of overnight hospital inpatient services and age related residential care and disability services, to name a couple.

Pauline Lazarus - NZPT 9:28
It also notes it is also fit for use by home and Community support services.
Pauline Lazarus - NZPT 9:35
Thus, I expect the standard relates to all of our work.

Pauline Lazarus - NZPT 9:38
Next slide please. Chennai.
On the slide, you can see the principles of the standard and there are further details in the document itself if you want to explore.

Pauline Lazarus - NZPT 9:56
Next slide please. Chennai.
Additionally, the principles of Tetris TO White Hungy have been formative in developing this standard.
Tino Rangatiratanga can be translated as the right to self determination.

Pauline Lazarus - NZPT 10:20
Next slide please.

Pauline Lazarus - NZPT 10:21
Can I?

Pauline Lazarus - NZPT 10:27
Outcome 6 in the standard refers to restraint and seclusion, and as per the slide, services shall aim for a restraint and seclusion free environment in which people's dignity and mana are maintained.

Pauline Lazarus - NZPT 10:42
Next slide please, shanya.

Pauline Lazarus - NZPT 10:48
The outcome statements in the next three slides are formatted in three columns which talk to from left to right.

Pauline Lazarus - NZPT 10:55
What all people can expect from the services and support they receive?
What mildy can expect from the services and support they receive and the commitment of service providers doing their part to deliver the best quality care and services?
And this outcome 6.1 Hector Kounga heady.
I have highlighted the following, ensuring the person is free from restrictions TE T partnership to gain mana enhancing and least restrictive practices that we demonstrate the rationale for the use of restraint and the aim being elimination.

Pauline Lazarus - NZPT 11:36
Next slide please, shanya.

Pauline Lazarus - NZPT 11:42
Outcome 6.2 heading yard haumaru I have highlighted the need to adapt when things change for that person, for example via a review or reassessment.

Pauline Lazarus - NZPT 11:54
The at least restrictive options are used.
First partnership.

Pauline Lazarus - NZPT 12:00
Restraint being a last resort and consideration of alternatives.
Next slide please.
Outcome 6.3 arotake going now or to hedya.

Pauline Lazarus - NZPT 12:17
I have highlighted sharing of restraint, experiences and monitoring and review to influence, inform and improve practice.
Of note, we haven't talked to Outcome 6.4 on seclusion, as this did not appear relevant over to you, Sarah.

Pauline Lazarus - NZPT 12:33
And next slide please.

Sarah Boyt 12:37
Thank you, Pauline.
We would like to highlight the following definitions from this current standard restraint when assessing a person for a solution, we must always consider does this limit the persons normal freedom of movement in all clinical reasoning?

Sarah Boyt 12:55
Restraint elimination.

Sarah Boyt 12:57
Thorough assessment is key to restraint elimination, and I'll talk to this in a later slide.
Restraint Episode elimination is the goal as per the current standards.

Sarah Boyt 13:09
However, it is acknowledged that this will not always be possible if elimination is not possible.
Consideration and documentation of all other considered options is essential to ensure the solution in place is the least restrictive option and the restraint episode has a clear planned purpose.

Sarah Boyt 13:30
Next slide please.
So what is normal freedom of movement?
A pelvic positioning belt on a person who is unable to sit to stand independently without it does not limit their normal freedom of movement.

Sarah Boyt 13:48
This same solution on a person who normally can sit to stand independently and does not have the fine motor skills to release the bout does have their normal freedom of movement limited by the solution.

Sarah Boyt 14:01
It is not the equipment, but the individual persons functional ability that determines if a piece of equipment often intended for safety, support or function has also become a restraint to that person.

Sarah Boyt 14:15
We will work through some other examples together shortly.
Next slide please.
So how do we incorporate these current standards into our everyday clinical reasoning?
This is a resource we have developed to help us work through individual cases, ensuring the current standards are considered and the least restrictive option is being used.

Sarah Boyt 14:43
There is a copy on the resource and a copy in your chat.
We would like to take a couple of minutes to talk through this and then work through some examples.
Thorough assessment is key to restraint elimination.
So what does this look like?
It needs to be person centred, open quote it all with the person, family and Fano, other specialists and with those involved in supporting that person.

Sarah Boyt 15:11
Functional abilities need to be assessed.
What can the person do independently?
What can they achieve with assistance?
Has the bigger picture been taken into account, including cultural considerations and both social and environmental factors such as medications, mental health or emotional state, or the general physical setup of that person's living space?

Sarah Boyt 15:36
Once we have all of that information and a solution in mind, we now ask the question, does the proposed solution have the potential to limit this person's normal freedom of movement?
If no, run with it and document as per normal.
If yes, the following then needs to be considered.
What is that person's normal functional ability?
Could another option meet the need that doesn't limit normal freedom of movement?

Sarah Boyt 16:04
What else has been considered?

Sarah Boyt 16:06
Sometimes equipment solutions may not actually be needed.
What has been discounted and why remember least restrictive options are to be used in the first instance.
Who else may need to be involved?
Have you peer reviewed your case with a colleague or a clinical advisor?

Sarah Boyt 16:26
Elimination is the goal as per current standards.
However, it is acknowledged that this will not always be possible, so at this point, if a solution that does limit a person's normal freedom of movement is deemed essential after thorough assessment and all other options considered and discounted, then that is called a restraint episode.
Node if a restraint episode is indicated.
There must be clear documentation to support the clinical reasoning around this decision and a review date scheduled so that our solutions adapt and change as people and their situations adapt and change.

Sarah Boyt 17:09
Sometimes restraint episodes are needed.
That is OK, our job is to keep people safe.
However, safety is not the only consideration.

Sarah Boyt 17:20
Next slide please.
These are some examples of equipment that are often used to keep a person safe, aligned or well positioned.

Sarah Boyt 17:32
However, it needs to be considered if they may also contribute to a restraint episode.
This is where the flow chart can be a helpful resource in guiding our thinking around this with the first thought being will the addition of this solution limit this person's normal freedom of movement as highlighted earlier?
The answer to this question is dependent on that particular person's normal independent functional ability.
Whether something does limit someone's normal freedom of movement is not always obvious at first glance, and this is where peer review alongside your clinical analysis is really helpful and potentially the use of the flow chart we just shared.

Sarah Boyt 18:17
Next slide please.
OK.
So we're gonna look at a scenario using the flow chart.
I'll give you a break from my voice and a minute just to read the slide on the screen.

Christa Roessler 18:38
While that happening, Sarah, I think a lot of people haven't been able to open the flow chart in the attachment.
So we'll definitely email that out to everyone.

Sarah Boyt 18:48
Lovely.
Thank you.
Christa, our IT support will get on to that for you all, apologies.
Lovely.
So with keeping that and that information in the in the case study in mind, we will work through it together.

Sarah Boyt 19:06
So after a thorough assessment of the solution of sorry, after a thorough assessment, the solution of a safety sleep Rep was proposed, and if we reference the flow chart, we ask the question, does this solution limit this person's normal freedom of movement?

Sarah Boyt 19:23
What is this child's normal functional ability?
Can they normally transfer in and out of beard?
Do they normally have independent bed mobility?
The answer in this case was no, so the addition of the safety sleep wrap does not limit them from doing something they would normally be able to do.
Least restrictions up least restrictive options.
First, padded bed sides were considered and trialled in this instance.
However, they were not successful in resolving the presenting issues, who to involve?
This solution has not come about as a result of challenging behaviour.
Therefore, NESC needs assessment services coordinator and explore behavioural support services.
Input is not required if you are working within the fire.
Ha ha.
Criteria.
It was indicated that a peer review took place and that the child's family and wider therapy team were involved.
In this case, the solution proposed was deemed the most successful, least restrictive option, allowing for some movement but not extreme ranges to support safe positioning and the essential function of sleep.

Sarah Boyt 20:39
In this case, the main question does the solution limit the persons normal freedom of movement made us think of movement in two different ways, posing the following questions for our further thinking.
Is involuntary movement considered normal and is it normal for that person?
As you know, these questions can only be considered on an individualized case by case basis for the person in question, no two people and their situation are the same.

Sarah Boyt 21:13
Next slide, please.
Tania in over to you, Pauline.

Pauline Lazarus - NZPT 21:17
Thank you, Sarah.
I will use the flowchart to talk through assessment and solution considerations for this scenario.
I'll give you a minute just to have a read.

Pauline Lazarus - NZPT 21:41
So the assessment likely needs to involve Fano carers and wider the wider interdisciplinary team, as well as the person themselves.

Pauline Lazarus - NZPT 21:53
Umm and to include understanding of the recent history and why this person is now wanting bed rails, has something changed for them?
For example, a change in medication environment or carers.
We also need to know if the person has episodes of confusion or memory loss to consider whether they may attempt to climb over the rails and risk falling from a greater height.
And assessment of their bed mobility and their ability to transfer out of bed if they can transfer independently, rails would limit their normal freedom of movement and would be considered a restraint.
For potential solutions to consider least restrictive options, first we need to ask ourselves, is an equipment solution needed at all?
Or may the issue be resolved with a non equipment approach, for example a medication review or carer training at the least restrictive options first could include call bells or intercoms to call for assistance side support rails wider.
Sorry, wider beds, ultra low beds.
Floor fall mattresses and sensor pads.

Pauline Lazarus - NZPT 23:11
It is essential you note the options considered and discounted in your report.
In this case, in this scenario, we did support the bed rails.
The falls for the cupboard injury, where from falling out of bed, so it linked to that and this person wasn't able to transfer independently and didn't look like they were going to get that ability back.
Thanks, Sarah.
Over to you and next slide.

Sarah Boyt 23:46
Thank you, Pauline.
So assessors will be working in either the fire car, HA or ACC funding spaces.
I'm just going to note some ficar specific points.
Firstly, we acknowledge the language in EMS and NASC documents hasn't been updated to reflect the current language being used in the current standards.

Sarah Boyt 24:09
You will see the you will still see the word enabler which is not referenced in the current standards.
There is a table as part of the 2015 NASC interface document that clearly states what solutions are considered restraint and which pathway must be followed when challenging behaviour has been identified as an EMS assessor, working with people with challenging behaviour, you will need to be aware of this.

Sarah Boyt 24:39
If a solution has been identified as a restraint and challenging behaviour is in play, then consultation with the NASC is mandatory.
The NASC will determine if a referral to explore behavioural support services is appropriate at the yes box at the end of the flow chart.

Sarah Boyt 25:00
If accessing the fire haha.
Funding stream and challenging behaviour has been identified.
You will need to consult with the nest at this point.
Consultation must take place before funding can be approved for any solution.
I'm just going to hand over to Pauline to go over some ACC specific points.

Pauline Lazarus - NZPT 25:22
So for ACC assessors, if the proposed equipment is to help manage challenging behaviour.
Consultation with ACC Behavioural Support Services is recommended to consider the least restrictive options first.
For example, a behaviour strategy rather than an equipment solution.
And the behavioural support services will indicate the solutions that they support.

Pauline Lazarus - NZPT 25:47
Next slide please.
So take home points from this presentation.
Here are the main points we expect will be useful whether an intervention limits a person's normal freedom of movement is pivotal when considering whether the intervention could be a restraint.

Pauline Lazarus - NZPT 26:12
It is a situation and scenario.
Sorry, it is the situation in scenario that needs taking into account and no two people's situations are the same.
Hence whole of life and person centered assessment are crucial.
Peer review could be with a colleague or a clinical advisor.
If a person's normal freedom of movement is likely to be restricted, your documentation needs to include the options considered and discounted.
The relevant parties involved and the outcome of their input.
Elimination is the goal.
However, some situations, sorry.
In some situations, a solution that is a restraint may be required.
If this is the case, plan a review for that person at a later date, as people's needs do change.
Next slide.
So Christa may have already answered some of your questions.
I'm and if, as noted by Sarah, if we're unable to get to your questions and time we in the time we have, please go back to your question and add your email address.

Christa Roessler 27:17
It.

Pauline Lazarus - NZPT 27:26
So we can email you a response.
So what questions do you have for us?

Christa Roessler 27:29
So at the moment there's there's no questions in the Q&A at the moment.
Margaret just commented in the chat about limiting freedom of movement can easily become seclusion.

Christa Roessler 27:42
So I don't know if you want to comment on that at all.
Umm, that's just a statement I think.

Pauline Lazarus - NZPT 27:50
Yeah, I agree, Sarah.

Sarah Boyt 27:51
Agreed.
Agreed.
And yet well noted.

Christa Roessler 27:56
Yep, and.
That's there isn't any other specific questions.
A couple of people have asked about whether we can send the slides.
We can definitely send the flow chart.
We're sending the slides out as well, Sarah and Pauline.

Pauline Lazarus - NZPT 28:10
I I think we can.

Christa Roessler 28:13
Yep.
Umm.
So Abby is just asked about housing mods about the use of housing mods, gates that prevent an individual from leaving spaces, example children running out on the road.

Christa Roessler 28:26
Is this a restraint?
Is that something you want to talk about, Sarah or Pauline or is?

Sarah Boyt 28:33
That's so I can address that from the fight.
Haha.
Space.
So yes, as we noted with the the documents, the nest interface documents and the pathways, yeah, there are clear a few reference those documents.

Christa Roessler 28:36
Mm-hmm.

Sarah Boyt 28:47
It clearly states their what they consider a restraint and whatnot, and often those are solutions required when challenging behaviour is involved.
So just.
Differentiating those two pathways?
I guess so.
When challenging behaviour is in play, the is on the five haha side a a process to follow and I am pulling.

Sarah Boyt 29:11
Would you like to comment for the ACC funding channel?

Pauline Lazarus - NZPT 29:15
Umm, I don't believe there's a particular process to follow for the, but just as I said, you'd be liaising with them behavioural support services.

Christa Roessler 29:28
OK.
Thanks for that.
Hopefully that's answered your question.
Abby Jasper is interested about a definition for a restraint episode.
Bit more specific detail I guess than what was discussed in the presentation.

Sarah Boyt 29:46
So I guess historically we may have said that if we are.
Restricting someones movement to enable them to better function.
We would have maybe just said this as an enabler and carried on.
So I guess what we're making very clear is that wording is no longer in the current standards and we're calling a restraint episode as a restraint episode.
So if what you are doing is limiting someone's normal freedom of movement, it is a restraint episode.
And what I guess we are sharing is when you're coming for funding for these solutions, we need it clearly documented.
Umm that you've gone through the steps to consider why this is?
It's not that.
Like we said, elimination is the goal, but we acknowledge in the standards acknowledge it's not always possible.

Sarah Boyt 30:37
So yes, if you have limited someones normal freedom of movement, it is a restraint episode.
Yep, and an episode will.

Christa Roessler 30:43
I think just no. Sorry.

Sarah Boyt 30:45
Sorry, Christa, I just give for a specific purpose for a start and a finish time.

Christa Roessler 30:45
No, no, you're right.
I was just about to say I think it's the that there's an end point to.
It is probably why it's called an episode more specifically now because it is not an ongoing situation, isn't it?
That's it's not something that should be in place forever.
It needs to be reviewed.

Sarah Boyt 31:08
Clear documentation of when and why.
Yes, absolutely.
Thank you, Christa.

Christa Roessler 31:14
So somebody also asking whether a cost to set a cost effective solution would win over the solution being less restrictive?
Does a cost effective solution win over the solution being less restrictive?

Pauline Lazarus - NZPT 31:27
I from ACC perspective, would say the least restrictive option trumps everything.

Sarah Boyt 31:36
And on the whaikaha side, we would 100% agree if the least restrictive option is going to cost more money, we would say overall that was a bit of value for money where our first and foremost consideration is to the guidelines and the standard.
Regarding restraint, we would not want you to feel like you had to propose a solution for at least a cost if it had greater restrictive qualities to it.

Christa Roessler 32:01
Umm.

Sarah Boyt 32:02
If there was a least restrictive option that would meet the need, that was more expensive, least restrictive.
Would Trump every time.

Christa Roessler 32:12
Umm.
Somebody Jordan is asking if somebody is asking to be restrained.

Christa Roessler 32:16
Is that a restraint?
So person requesting to be restrained.

Pauline Lazarus - NZPT 32:24
I believe so, yes.

Sarah Boyt 32:24
If it.

Pauline Lazarus - NZPT 32:26
And the reading that I've done.
Umm.
And also I think it quite clearly states that or somewhere I've read might be in the document itself or it might be have been mentioned in the cubro webinar, can't remember and it also.
If a founder member is asking for a particular piece of equipment that will restrain the person that is also deemed a restraint.

Christa Roessler 32:53
So it's back down to the documentation, isn't it?
And just being clear that even if a person's asked to be restraint, that the whole process has been followed.
So that's reasonable.

Sarah Boyt 33:05
Correct restraint is restraint, even if the person has asked for it.

Christa Roessler 33:09
Yep.

Sarah Boyt 33:10
Yeah, and.

Christa Roessler 33:12
Yep, no, I think that's right.

Sarah Boyt 33:13
Yep.

Christa Roessler 33:14
So somebody else is asking whether we can use this justification in rest homes, and I'm not sure what they mean by this justification specifically, and I don't have a name on that question.

Christa Roessler 33:26
So I think Sarah and Pauline, you'd probably repeat the same message that a restraint is a restraint and the process needs to be followed. Umm.

Pauline Lazarus - NZPT 33:36
They may still be referring to the cost effective versus the.
Least restrictive.

Christa Roessler 33:44
I'm not sure can't.
Can't clarify that, sorry, yes.

Pauline Lazarus - NZPT 33:45
Maybe, and that would be a conversation.
Depends whose funding would be a conversation to have with the whoever the funder is of the equipment.

Christa Roessler 33:54
But don't rest homes also have a responsibility to follow the standards.

Pauline Lazarus - NZPT 33:59
Absolutely, absolutely.

Christa Roessler 34:00
Yep.
OK.
Yep.
So somebody else also doesn't have a name against it, would what would count as evidence of consultation with nascent in the NASC ENT is an email enough.
In terms of a consultation.

Sarah Boyt 34:21
Consultation with the nest.

Christa Roessler 34:24
I maybe that's what is intended.
It just says NASC ENT NASC int.

Sarah Boyt 34:31
At apps absolutely.
Look, it's a case by case scenario.
If we needed more information at the point when you're, umm, either way, if you're request gets picked up through the advice channel or at service request stage, it may get picked up for review.
Sometimes a phone call is sufficient.
Sometimes an email is sufficient, and then sometimes if it's a more complex situation we we will require more documentation.

Sarah Boyt 35:00
But initially, if you've had a concern, if you've had a chat to the nest and you can confirm that you've spoken to them and they do not require a referral to behaviour support services, stick with that with the first instance and we'll work from there.

Sarah Boyt 35:16
We are never wanting to ask you to do more paperwork than as absolutely necessary.

Sarah Boyt 35:23
We will.
We are conscious of that and to work with you throughout the process and not be sending you an every which way direction and to grab paperwork if we can use what you've already provided in that initial advice request.

Christa Roessler 35:39
And it was meant to be NASC.

Sarah Boyt 35:41
Yeah, no problem, no problem.

Christa Roessler 35:41
That's been clarified.
UM.
Kate has asked if there is no longer restraint in enablers and I think you might just wanna repeat the point around the new standard.

Sarah Boyt 35:55
Yeah.
So we're just like to point out that we know if you've been around for a while, the term enabler is widely used when considering restraint.
So I guess we'd just like to point out in these current standards that definition and that word has been completely eliminated.
It is no longer there, so restraint is restraint.

Sarah Boyt 36:16
It's not an enabler.
It is a restraint and then the reasons around it are to be clearly documented and like we said, it's a restraint episode.
It's for a purposeful meaning at a time and a place with a start and a finish.
So if we are restricting someones normal freedom of movement, we acknowledge that's what we're doing and we know why we're doing it.

Christa Roessler 36:39
I'm just.
I'm just going through.
We've still got a few minutes.
The person who had asked about somebody asking to be restrained.
The specific example was somebody who is of sound mind asking to be tied to her commode at night time.
All day you've offered other options, so I think just you'd reiterate that you would still want to make sure everything's well documented and the process has been followed.

Sarah Boyt 37:08
Absolutely.
And the fact that person can give their own verbal consent and of a sound mind as as a great addition to your documentation.

Sarah Boyt 37:16
And we of course always consider what the person wants and the first and foremost.

Christa Roessler 37:22
Right.
I will just go through and maybe pick out a few key things, and this is probably a good one.
The wait list for explorers so long that children are really delayed in receiving services, are we able to apply for equipment that could be considered restraint while the children are on the wait list?
That's you, Sarah.

Sarah Boyt 37:40
Yeah.
Look, we we are aware and we have made five car hire aware and I knew this would come up.
What I will endeavour to do is get some updated comms on that so we are aware of the issues.
If you would like to feed that back officially through the enable channels, that can always be something to do to help get that heard, but I can acknowledge that the clinical service advisory team have flagged this with WHAIKAHA and at present the comms are keep you you know, no, we can't take shortcuts.

Sarah Boyt 38:22
And we do understand it's frustrating and it's putting some families and children and really unsafe situations.
We are aware of it and we are asking for direction from whaikaha, how we can address this.

Sarah Boyt 38:38
We do acknowledge that the number of families and children accessing that service has grown significantly and the idea of that service initially just to give you some background, was to ensure that restraint solutions couldn't be put in place without a collaborative approach.
So again, it's one of those systems where the intention was really, really good.
But as the number of people requiring access to the surface has grown, the surface hasn't growing with the population, so we are aware of it.
We have flagged it with them and we will continue to do that on your behalf and we we acknowledge how hard it is.
I'm sorry we can't be of more assistance with that one.

Christa Roessler 39:19
There's a couple of questions about buckle guards, harnesses, seat belts, mostly in car, travelling in a car and challenging behaviour as well and so anti escape buckles.

Sarah Boyt 39:30
Yeah.

Christa Roessler 39:35
Are they a restraint?

Sarah Boyt 39:38
Uh.
The on the fire car has side restraint in a vehicle is 100%.
A OK restraint is restraint.
It's how it's supposed to be.
You do not need to go down the nest behavioural support service for that restraint in a vehicle is how it is supposed to be and we support that without the need for further consultation.

Christa Roessler 40:01
I think again, if anybody's unsure about something, definitely ring to discuss it.
Sarah, would you say on case by case basis?

Sarah Boyt 40:09
100% you do not need to wait in line for a process.
All the professional advisor contact details for both ACC and WHAIKAHA can be found on the website and we do really welcome phone calls or emails to talk through specific scenarios to assist you in guide, make sure you're doing the minimal paperwork possible for each person you're trying to support.

Sarah Boyt 40:34
Yes, thank you, Christa.

Pauline Lazarus - NZPT 40:36
Alright.
Shall we wrap it up?

Christa Roessler 40:39
Yep, there is some further questions, but I think we might see if we can email responses to those.

Pauline Lazarus - NZPT 40:39
Thank.
Yeah.

Pauline Lazarus - NZPT 40:45
Thanks, Christa.

Sarah Boyt 40:45
And we would definitely endeavour to do that.
Thank you everybody for your questions.

Christa Roessler 40:47
Uh-huh.

Sarah Boyt 40:49
It's really appreciated.

Pauline Lazarus - NZPT 40:51
Next slide please, should I?
So this as a replication of what is on the information sheet.
Once we can get that to you, it includes links for nipah.
Sorry, not paerewa, I'm link for a cubro webinar which talks more so to restraint and care facilities.

Pauline Lazarus - NZPT 41:15
And even if you're not working care facility, I found it really helpful for my understanding of the standard and some of the case studies are applicable outside the, you know, in other situations as well and and for the EMS assessors, we have the links for the NASC document and EMS manuals.

Pauline Lazarus - NZPT 41:35
I'm clinical advice wise for gaining clinical advice.
We've included Accessibles email addresses for the Auckland area for Whaikaha and our teams email addresses.

Pauline Lazarus - NZPT 41:50
Our Enable 800 number and webpage links with our direct dials for both our ACC team, ACC Advisors and EMS Advisors.

Pauline Lazarus - NZPT 42:02
Next slide please.

Pauline Lazarus - NZPT 42:06
So we hope this information has been helpful and thought provoking and we are keen to hear feedback for the session and ideas for further webinars.
Please use the contact details on the resources or the attached document to provide this feedback or ideas.
I will close with a karakia.

Transcript coming soon.