Occupational Therapy News OTnews February 2020 | Page 49

MOBILITY ASSESSMENT REPORT
Real life examples
Domenica and Nick then described SHA’s new assessment tool
specifically for hidden disabilities, which can be used face to face,
desk based, or for telephone based approaches, and links directly
to the DfT guidance with a simple scoring system that supports
appeals by clearly identifying any DfT criteria not met.
The tool been road tested by SHA clinicians across several local
authorities, with excellent feedback.
Three case studies (two children and an adult) from existing SHA
IMA clients were then presented and discussed in relation to the
new guidance and eligibility criteria.
In the case of one child with autism, there was clear evidence
that the child was eligible for a blue badge due to availability of
very comprehensive assessments about the child’s cognition,
behaviours, predictability and risks provided by an integrated
neurodevelopment team. 
In the case of the other child, a seven-year old who also has
autism, the decision-making process has not been as clear cut.
The family and social worker described the extent of challenging
behaviours, experiences of sensory overload, and behavioural
challenges, such as sudden dropping to the floor and not be able to
be moved or running away.
However, a wheelchair with a harness was an effective
coping strategy to allow the child to be quite happy sitting in the
wheelchair, including on the school bus and public transport.
In the case of an adult with bipolar disorder and suicidal
intentions, medical evidence was provided from a psychiatrist/
clinical psychologist, however, the SHA assessor’s outcome for this
case was that the person was not eligible for a Blue Badge, as the
person goes out independently several times each week and walks
to and from school to collect their grandchildren.
The person’s mental health is being monitored and treated by
specialists and the bipolar/suicidal intentions would be present
regardless of being parked close to a destination or not.
Domenica explained how SHA has been supporting its clients
with professional advice on borderline eligible applicants, training
and trialling the new SHA assessment tool.
The final session of the event was given over to participant
discussion and information sharing on experiences to date of
implementing the new DfT eligibility criteria on hidden disabilities to
the assessment process and new established best practice.
All authorities in attendance reported a substantial initial increase
in Blue Badge applications after the implementation of the new Dft
guidance.
Examples of key experiences from different local authorities
included:
• 12 hours additional occupational therapy support provided to
process new applications under the hidden disabilities category;
five to 10 extra assessments per week;
• an initial spurt in new applications needing assessments,
resulting in 10 hidden disabilities applicants per week;
• one authority has seen an increase of seven applications per
week; assessments for hidden disabilities are taking longer – on
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average twice as much time as those for physical and sensory
disabilities requiring assessment – and typical conditions
referred now under the new eligibility criteria are dementia,
epilepsy, children with autism;
another reported that an initial influx of applications under the
new criteria, which caused a seven to eight week backlog
of IMAs, is now clearing; 15 to 20 per cent of all Blue Badge
applications are now hidden disabilities;
a further authority received 120 initial applications under the
hidden disabilities criteria, which caused a waiting list for
assessment and processing. This has levelled out to 12 to 15
more applications per week, which make up 15 per cent of
all applications received. It states that assessment of hidden
disabilities take twice as long as for physical and sensory
disabilities, and new conditions presenting are Irritable Bowel
Syndrome, agoraphobia and claustrophobia; and
one local authority reported that it received 400 initial hidden
disability applications, which has led to a 10 per cent overall
increase and 10 to 12 additional assessments are required each
week.
Local authority experience
The discussions indicated that after an initial, in many cases,
substantial influx of new applications under the new hidden disability
criteria, most local authorities have seen and sustained an overall
level of increase in new assessments of between eight and 10 per
cent.
Hidden disability assessments take twice as long to complete
as other IMAs, whether desk based or face to face. A desk-based
approach is the deemed the most apt and favoured.
One authority utilises a weekly all-day assessment panel, which
includes an occupational therapist, to process new applications that
do not fit automatic criteria.
Most authorities are processing these new hidden disabilities
applications as desk-based assessments/reviews, based on
paper evidence from ‘other’ (that is, than occupational therapy or
physiotherapy) experts.
Some authorities are giving the responsibility of expert assessor to
their existing IMA clinicians, who process desk-based assessments
within face-to-face clinic slots using ‘other’ expert evidence.
Three or four of those local authorities in attendance said that they
are using or plan to use an adapted assessment scoring tool, which
incorporates hidden disabilities. Others are thinking about doing this.
There was a consensus for clear demarcation and differentiation
between desk-based, versus face-to-face assessment, versus
appeal/review, versus complaints. Although one authority uses
exclusively trained non-health professional officers, the majority of
authorities said they use occupational therapists or physiotherapists
to assess or review IMA assessments, including hidden disabilities.
Much of this work is completed in a clinic setting.
Nick Stone, director, SHA Disability Consultancy Ltd. Visit: www.
shadisability.com
OTnews February 2020 49