Supporting Pupils Within Early Years and Mainstream Settings - Continence

Introduction

The Disability Discrimination Act requires schools to re-examine policies and practices to ensure that they are not discriminating against a person who has a disability.

The DDA provides protection for anyone who has a physical, sensory or mental impairment that has an adverse effect on his/her ability to carry out normal day-to-day activities. The effect must be substantial and long-term.

It is clear therefore that anyone with a disability that affects aspects of personal development must not be discriminated against.

Achieving continence is usually a developmental milestone that is reached before a pupil enters a learning setting. However for some pupils this may not be the case and the reason for the delay may be unclear. It is therefore appropriate for schools to meet the needs of a pupil with delayed personal development in the same way as they would meet the individual needs of a pupil with a diagnosed disability.

The admission policy of a school therefore cannot set a blanket standard for continence, or any other aspect of development, for all children as it is discriminatory and therefore unlawful under the Act. All issues have to be dealt with on an individual basis and schools need to make reasonable adjustments to meet the needs of each individual.

Incontinence may create a lot of embarrassment for the pupil, as they get older. The school needs to put procedures into place to ensure that the pupil’s dignity, independence, privacy and self esteem is respected at all times. It also should give a commitment to ensuring that the pupil is included in all activities.

Issues Schools Need To Consider

Health and Safety

Schools are required to implement precautions laid down in their Hygiene/Infection Control Policy. The main considerations being that:

staff should wear disposable gloves and apron while dealing with an incident;
soiled nappies should be double wrapped and placed in an appropriate bin;
soiled clothing should be placed in appropriate bag for the pupil to take home- the school is not required to launder soiled clothing;
changing area to be cleaned after use;
hot water and liquid soap is required for washing hands after the task is completed; and
paper towels or hand driers available for drying hands.
Asking parents/carers of a child to come and change a child is likely to be a direct contravention of the DDA, and leaving a child in a soiled nappy for any length of time pending the return of the parent/carer is a form of abuse.

Facilities

As already stated incontinence may create a lot of embarrassment for the pupil, especially as they get older. It is therefore important for schools to look at the toilet facilities they offer and ensure that privacy and dignity for the pupil is respected. Schools therefore should assess whether there is an appropriate place for a pupil to be changed. If there is no such place it is important that the school looks forward and highlights it as a priority on their access plan. If there is not a purpose built changing area the school has to consider how they can provide privacy- this may mean placing a “Do not enter” sign on the toilet door whilst the pupil is changed and to purchasing a changing mat, and change the child on the floor or on another suitable surface.

Generally schools should see that the facilities are: -

safe, pleasant and warm;
accessible at all times and easy to reach;
able to provide privacy;
cleaned regularly;
provided with toilet paper, soap and paper towels; and
clean, fresh drinking water should be available at all times.
Pupil Protection
All staff within a school will have had a CRB check to ensure that they have no record preventing them from working with pupils. It is appropriate to ensure that two or three members of the teaching assistant staff are willing to undertake supporting the personal care of a pupil. If this responsibility is not written into the job description it will be necessary to ask for volunteers to take this responsibility on. To develop good practice a school should place this specification in any new job description.
When a pupil requires support for personal care the parents should be informed as to who will do this task. If there are concerns that the pupil or parent may make false allegations against a teaching assistant then it is advisable that the school ensures that the assistant is supported.

Other Factors to Consider

If a pupil comes into school with a continence delay it is likely that a planned programme worked out in partnership with the parent/carer will have a positive impact on the pupil. The parent/carer is more likely to discuss their concerns if they feel they are not being judged.

The school nurse should be able to give support to the school and if necessary sign post to other professional.

Guidance Notes for Schools

Once a continence problem with a pupil is highlighted the following action need to be taken to support the pupil:

A meeting needs to be arranged with the Headteacher, class teacher, parent/carer and relevant health professional involved. The pupil should be included if old enough to contribute.
A full assessment of the pupil’s difficulties should be undertaken and some form of monitoring system put in place.
An assessment of the facilities available in school and of the pupils daily toileting routine should be included as part of this process. It is important to ensure that the pupil has free access to the toilet when s/he feels the need to go or, when training the pupil supported access is given at set times of the day.
It may be appropriate to develop a Continence Management Plan. This needs to be agreed by all parties, targets need to be set and reviewed. It should also include advice and guidance on managing the pupil’s toileting needs on school trips and other visits away from the school premises. A copy should be kept in school and a copy be given to parent/carer.
The carer(s) in the school should be given guidance and training on the relevant issues by the health professional responsible for the pupil (this may be the school nurse). The parent/carer and the pupil should be included if appropriate.
Consideration needs to be given to what the parent/carer needs to provide and how the soiled waste is going to be collected or disposed of.
Members of staff who are involved in changing and/or cleaning the pupil should adhere to the Infection Control Policy.

Further Information/Guidance

There are other professionals who can help with advice and support. The School Nurse or Family Health Visitors have expertise in this area and can support parents to implement toilet training programmes in the home. Health care professionals can also carry out a full health assessment in order to rule out any medical cause of continence problems

Enquiries Resource & Information Centre (ERIC), 34 Old School House, Britannia Road, Kinswood, Bristol, BS15 8BD. Telephone: 0117 960 3060