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Continence

Information on how education and care services provide proactive and reactive management for children and young people with continence care needs.

The continence in education and care procedure (under development) will describe how to support children and young people with continence needs.

Care plans

A continence care plan HSP230 (DOC 215KB) can be completed by a health professional in consultation with parents or legal guardians for children requiring support with continence care education and care services. 

A continence care plan is required where a child requires care that is not routinely provided by the education and care service.  A care plan is not required for a child in childcare services unless they have a special need related to their continence. Preschool and school aged children only require a care plan where continence needs is different to what is developmentally expected and requires additional individualised support. 

The care plan includes recommendations for:

  • the nature and extend of support required
  • management of unplanned events
  • catheter management (if relevant).

Where a child or young person has transfer and positioning requirements in addition to the continence care plan a transfer and positioning care plan HSP220 (DOC 432KB) must also be completed by a health professional.

Additional care plans

Additional care plans that may be completed to describe the support needs of the child may include:

Health support agreement

Where a child or young person has a care plan and requires additional supports and assistance a  health support agreement HSP120 (DOC 243KB) and safety and risk management plan HSP121 (DOC 147KB) should be completed.  These are completed by the parent and education or care service to document specific risk minimisation strategies, individualised management and treatment for the child in the context of the education or care service. 

The Health Support Agreement should clearly identify cultural, spiritual and language needs.

Medication agreement

Where medication is prescribed and required to be administered during attendance in an education or care service a medication agreement HSP151 (DOC 142KB) must be completed by a health professional. 

Refer to medication management for further information.

Continence management in education and care

The education or care service leader must ensure appropriate support to enable all children and young people to participate in and benefit from their educational experience, as per requirements of the Disability Discrimination Act 1992 (DDA) and Disability Standards for Education 2005 (DSE).  This includes the allocation of staff that are appropriately trained and able to provide the required level of support and supervision. For example, a child or young person cannot be excluded from an education or care service because they require continence assistance and staff are uncomfortable or unqualified to provide assistance. 

Where a child or young person has predictable health support needs this must be planned for and addressed by the education and care service. 

Allocation of resources

Allocation of additional resources to support child with continence support needs is based on a reasonable assessment of the hours of work required to undertake the additional tasks.  This is difficult with toileting as this does not generally happen at routine times. 

Education and care services may allocate additional hours to an SSO who can be called away from other duties when required or add to a number of SSO’s duties to share the responsibility. An SSO can either undertake the continence support or observe the class while the teacher assists the child. Education and care services may choose to ‘buy-in’ a service to support the child’s continence needs however due to the unpredictability of the work on-site staffing is a more practical option.

Refer to the student toileting allowance (requires staff login) for further information about staff allowances and eligibility for toileting allowance.

Special schools and units

Special schools and units often have a large proportion of children and young people requiring continence support.  These services may choose to develop a continence care site policy detailing:

  • management of support roles and responsibilities, with a standard change of 3 per day
  • provision of aids and equipment
  • safe work practices.

Where a child in a special school or unit has different support needs to the site policy they will require a continence care plan and health support agreement.

Safe practices

Education and care services should follow first aid and standard precaution procedures to ensure safe and prompt support is provided. 

Education and care services should keep a change of clothes and bathroom items.  

Children who soil rarely and unexpectedly

When a child who is usually continent has an ‘accident’ an education or care staff should be delegated to assist.  This is treated as standard first aid.  It is the duty of care of education and care service leaders and staff to ensure this occurs.

Changing a child

Education and care staff can change children and young people discreetly and hygienically in facilities in line with their training.

Education and care services require the appropriate space and equipment to follow the agreed care plan and support agreement.  For example, a service may require a space where a child can be changed with privacy and dignity including washing, access to a change of clothing and storage for soiled clothing. 

Provision of items and continence aids

It is the parent’s responsibility for the provision of items needed to deliver routine health support for their child including:

  • change of clothes
  • nappies
  • wipes
  • flannels.

Education and care staff are not expected to use ‘sharps’ including nappy pins where a safer alternative of comparable cost is available.  Sites should keep a supply of alternatives for unexpected incidents. 

Soiled clothing and cloth nappies should be stored discreetly in a secure plastic bad and returned home for cleaning.

The requirement for continence aids will be documented in the care plan or support agreement.  Any decision about changing continence aids must be negotiated with parents. Continence aids are determined by factors including:

  • safety and dignity of the child
  • hygiene
  • cost
  • ease and safety for staff (this does not override other issues to the detriment of the child).

Toilet training

Enrolment in preschool cannot be refused if a child is not toilet trained. Many preschool children are not developmentally ready to be continent. Exclusion for this reason is discriminatory.

Conversations at the time of enrolment for a child that is not toilet trained should include the nature of support required and how this can be managed in the education service. This may determine the requirement for a continence care plan HSP230 (DOC 215KB) and Toileting care and learning plan HSP233 (DOC 233KB) completed by a health professional.  

Where staff agree to provide individualised continence care support this can be documented in a health support agreement HSP120 (DOC 243KB) consultation with parents, without a continence care plan. For example, staff may agree to support a toilet training program for a limited time. Education and care staff cannot take full responsibility for toilet training. This is a parent responsibility.

Women’s and Children’s Health Network have further information on toilet training.

Toilet tactics

Toilet tactics is a fun, user friendly resource designed to help promote health bladder and bowel habits in primary schools and to improve or maintain the standards of school toilets.

The resource is divided into sections for schools and teachers and can be integrated into classroom activities for health education. 

For more information visit the Continence Foundation of Australia website

To gain access to the toilet tactics resources complete the online registration form.

Child wellbeing

Education and care staff providing personal care are not required to be the same gender as the child or young person. Any personal or cultural needs defining gender of support staff should be documented in the health support agreement.  Education and care services should allocate support staff that the child feels comfortable with.  

It is advisable to have two people present when changing a child.  A second staff member should be within line of sight or hearing to observe and confirm that child protection issues have been met. As this can be intrusive for a child this must be negotiated with the child and family.

Education and care staff, the child or young person and their family should have clear conversations describing roles, responsibilities, expectations and processes; including the grievance process.

Training and education

All education and care services should have at least one trained support worker with personal care support in their job description.  Services should anticipate support of this nature will be required before the situation arises and plan accordingly. 

Where an education or care service does not have a trained support worker the service leader can: 

  • employ someone else
  • engage an outside service provider
  • allow a teacher to do this work
  • undertake the work themselves.

Staff supporting children with continence needs should be trained to the specific requirements documented in the care plan and/or support agreements for that child.

The Royal District Nursing Service (RDNS) provide basic continence support training. For training enquiries contact RNDS:

Novita may be able to provide training or consultancy to support children requiring continence support. Contact Central Intake Novita:

The Continence Resource Centre (CRC) is a state-wide continence information and advisory service. For further information contact CRC:

The Health Objective can be contacted to provide continence training to education and care services. For further information contact Allison Willis:

Resources 

Care plans

Health support agreement

Planning and management tools

Contact

Disability and complex needs team

Phone: 8226 3620
Email: education.health [at] sa.gov.au