Bathroom Toolkit. Here is rationale for inclusion of the following items in the toolbox:

Transcription

1 Bathroom Toolkit More students with hygiene goals are being educated in their neighborhood schools. This requires staff to increase their skill sets to include instruction in toileting and hygiene. Our goal is to provide members with tools that can support staff, students and IEP Teams. Here is rationale for inclusion of the following items in the toolbox: A. School Bathroom Checklist: Information is important in the development of any plan or the transition of any student from one classroom or building to another. The checklist is a means of getting information from staff and parents who know the student. With this information plans can be developed and strategies for implementation can be considered. B. School Bathroom Activity List: Once you determine the present functioning level of the student the IEP Team and/or staff can consider how to implement goals. The goals could relate to the skills needed to successfully complete the process or the goals could relate to mobility, identification of bathroom by gender (male or female), or positive behavior supports. Strategies would be determined to support the student s growth. The IEP team would then consider if accommodations and modifications need to be incorporated to support the instructional strategies. Commonly asked questions: Q: Who is responsible for implementing the bathroom schedule and hygiene components of the plan? A: The simple answer is the LEA is responsible for implementing the IEP. To get clarification on individual staff members responsible for implementation we would recommend that the IEP team discuss assignments. Issues such as staffing patterns, availability of bathrooms and changing tables, privacy, data collection, continuity, and schedules also should be addressed by the Team. Q: What can I do if I am not allowed to attend the IEP meeting because I am a paraprofessional and the decisions are made at the meeting without me? A: First, suggest to the staff attending that they use an action plan as they discuss this topic. Action plans cover the who, what, when, how, and why which should help to clarify roles and give more details. Second, I would submit recommendations and data to the IEP team members so your information and suggestions can be shared with and considered by the Team. Q: Do I have any say about whether the district can assign me responsibility for taking the child to the bathroom and implement the plan? A: There are several considerations which are relevant in answering this question. As a threshold matter, it is important that you understand that under the PARC Decree of the rights to an education in Pennsylvania were more clearly spelled out. Students with disabilities and students with health issues were no longer excluded from receiving a public education. Subsequently enacted federal law ( and now IDEA) reinforces the expectation that all students with disabilities have a right to FAPE (free and appropriate public education) which may include assistance with hygiene and toileting where necessary and appropriate..

2 School Bathroom Checklist This document can be used to establish present functioning levels for the IEP, needs statements or as a helpful tool to support the transition of the student from one educational team to another. a. Can student identify a bathroom? b. Can the student identify a bathroom by gender? c. Can the student identify bathroom by their gender? d. Does student use acceptable request/technique to access bathroom? (hall pass, raise hand, etc.) e. Does the student time the request to allow for enough time to reach the bathroom? f. Does the student have medical issues that impact his/her abilities to bathroom independently? g. Can student locate student bathrooms in the building? h. Can student enter bathroom independently? (push/pull, turn knob, etc.) i. Can student enter stall? j. Can student lock stall? k. Can student unlock stall? l. Can the student identify hot and cold water faucets? m. Can student use sink for proper hygiene? n. Does the child use the hand dryers? o. Does the student dry his/her hands with paper towels? p. Does student place towels in trash receptacles? q. Can student find way back to classroom or point of origin? r. Can the student undo belt? s. Can the student remove pants/shorts, under garments? t. Can the student dress after using the facilities? u. Can the male student use the urinal? v. Can the student use toilet? w. Does the student use toilet tissue appropriately? a. Does the student flush urinal or toilet without prompts? b. Can the female student handle hygiene related issues with menstrual cycle? c. Does the student demonstrate appropriate behaviors in bathroom? d. Does the student use the appropriate voice volume in bathroom? Answer Key Independent= I Verbal Prompts= VP Physical Prompts= PP Picture Exchange Required= PE Not Applicable= NA

3 -2- Do not be insubordinate to an administrator if directed to implement a hygiene or bathroom plan. You can, however, share your concerns and ask questions to clarify roles and responsibilities. Request instruction/demonstration/ directions when given a new assignment. Request staff support from the nurse, physical therapist, occupational therapist and speech therapist. These staff can be a resource in toilet techniques, equipment use, dressing skills, transfers from wheelchairs to toilets, and communication techniques. Request supplies to implement universal precautions. Universal precautions are measures to keep you safe from bodily fluids including disposable gloves, wipes, and trash bags. Exercising care to avoid insubordination, you can when appropriate, suggest alternatives. You should request that in designing a program, the IEP Team consider the age of student and the gender of the individual who will be supporting the student. When using the opposite gender consideration should be given to staffing patterns. Location becomes an issue in some schools. Will the student bathroom meet the requirements? Will the nurse s office be used? What privacy issues have been considered? Does the student give enough notice requesting a bathroom to be able to reach the designated location? You should also request that the team consider the location of services. Will the student bathroom meet the requirements? Will the nurse s office be used? What privacy issues have been considered? Does the student give enough notice requesting a bathroom to be able to reach the designated location? You should request that the IEP team discuss and identify necessary equipment such as changing tables, transfer boards, lifts, and ensure that the equipment is available for the safe movement and positioning of students. The team should ensure that equipment needed to protect the safety of staff is also available. You should request that the team consider whether staff members need to collect data (e.g. number of times a student uses the facilities, number of accidents, growth in independence, and behavior during toileting and hygiene activities). Q: The child comes back from winter recess or spring break and has regressed in skills. I am frustrated. What can be done? A: Keep data on the student s skills. The student is showing signs of regression during breaks in service. This could entitle the student to Extended School Year (ESY). IEP teams must consider eligibility for ESY by February 28 th of any school year. The goal of ESY is to maintain and enhance skills so regression does not occur. It is critical that the IEP for ESY include a goal related to toileting skills. Other issues for the school team to consider when students regress over breaks include parental communication and skill sets. In this regard, to the extent possible, the school team will want to coordinate with the parents so that the program can be followed through at home.

4 -3- Q: What do I do when the student exhibits behavior such as smearing feces on the bathroom stall walls? A: Notify the case manager/special education teacher immediately. Keep a log of incidents including what happened prior to the incident, the time of day, any change in behavior, health of student, etc. This is a behavior that needs to be addressed by the Team. Members of the IEP Team should consider how to address the behavior with positive behavior supports. If the team is at a loss for ideas, team members should request the district bring in a behavior specialist to consult on the matter. Revisions may have to be made to the behavior plan or goals in the IEP. Communication with the parents should be made. In some cases the student is not exhibiting the behavior to act out but for self stimulation, out of boredom, or lack of materials to keep him/her occupied. You should review the following: level of supervision while in the bathroom, amount of time the student is left on the toilet, reinforcement schedule for the appropriate behaviors, verbal and non-verbal cues and directions. Q: I have a male student with disabilities that knows how to use the urinal but drops his drawers to use the bathroom which causes the general education students to laugh or act up. What can I do in this situation? A: Consider the facts in the case. Does the child know how to use the urinal without pulling down his pants? Does he wear clothing with zippers? Can he perform the same task but use the stalls? Has anyone instructed the student about appropriate procedures? Has anyone communicated with the parents to see what they have taught the child? In some cases the student wears elastic waist pants or sweat pants and zippers are not an option. Here the stall or having the student use the bathroom several minutes before or after the group of students would eliminate the reaction of the classmates. Q: How do I train a student to become independent in the use of the toilet? A: In general, you should develop a task analysis of the skills needed. A task analysis is the breakdown of all of the steps it takes to complete the task. Strategies and accommodations are used to teach specific parts of the task. Data is collected to measure progress. Student exhibiting appropriate behaviors and progress are given positive reinforcement. The data collection will let you know when the child has mastered a specific skill or set of skills and when it is time to move to the next skill.

5 -4- Q: What if there are no expectations that the child can be potty trained? Is there anything I can do to make this part of my job easier? A: Some students can be habit trained. Habit training is when the staff targets specific times of the day to take the student to the bathroom. Some recommend that 20 minutes after drinking a cup of water or X number of minutes after eating lunch, the student should be taken to the lavatory. Some student s bodies function on a specific schedule and by keeping data on bowel movements and urinations you can establish the timelines and work a schedule that matches their schedule. Other considerations that work include running water at the time the student is sitting on the toilet to increase the likelihood that the student will urinate. Staff members can use verbal, sign language and non verbal measures to convey to the student that they have a function to perform when placed on the toilet. Always reinforce the student when the student is successful. Q: Are there some common strategies to support independence? A: Here are some ideas to consider: Lacks dexterity to hold zipper Lacks verbal skills to communicate Can t unbuckle belt Doesn t want to leave bathroom Doesn t want to leave bathroom Forgets steps in process Acts confused with directions Not invested in process Not invested in process Not invested in process add shortened pipe cleaner to zipper use picture exchange symbols use elastic waist pants and sweatpants might like echo so change bathroom location likes individualized attention, fade support use picture exchange teach body part and function vocabulary find interest or positive reinforcements self monitoring chart communications to parents to reinforce

6 Identifying bathroom: Picture/photo/word on bathroom door Guided practice to the bathroom Footprint path to follow Gesture/sign language SCHOOL BATHROOM ACTIVITY LIST Identifying gender of bathroom: Matching male and female international symbols to symbol on the door Photo of child on door Hall pass with international symbol attached Color code Requesting technique: Picture exchange Verbal Hall pass Designated symbol (picture paddle- place international symbols on two sides of a board) Sign language Assistive technology (switch, communication device) Independent door operation techniques: Put rubber gripping on knob or lever Color code direction (push/pull, lift/lower, turn) Arrows for direction Discuss with Occupational Therapist assigned to program Reinforcement Survey student s interests Stickers Self monitoring checklist in bar graph format or sticker format Adult praise Music Time to play with toy or educational manipulative at completion of task Communicate with parent and they reinforce at home also