Child Disability Payment decision making guide

Relevant considerations for setting a review period

A review date should be set based on when the individual’s circumstances are likely to have changed. The case manager should take a holistic, person-centred approach to determine when this is the case for the individual in question. This means that they should not set a review period based only on when, generally, individuals with a certain condition may experience changes. Rather, the case manager should also consider:

to determine when the individual’s needs will likely change in the future.

Although some conditions might suggest a longer review period (or none at all), case managers should make a decision based on the information available to them relating to the individual and the holistic picture they’ve established based on that information.

Where there is more than one condition, the case manager should take into account the effects of all of the conditions. This should also involve considering how those conditions interact with each other and what their overall impact on the individual is.

If the information available on the individual does not provide a case manager with this level of detail, it may be appropriate to consider seeking a case discussion with a practitioner.

The following factors are all relevant in setting an award review date:

  • the age and developmental stage of the individual
  • whether it would be appropriate for the individual’s entitlement to continue to their 18th birthday without being reviewed as their needs are highly unlikely to change, by which time they will have been invited to apply to ADP
  • whether the individual has a single condition or multiple conditions
  • how long the individual has had their condition
  • whether there is any ongoing, current or future treatment or surgery and how this might be expected to impact the individual’s level of needs
  • the type and anticipated progress of the underlying condition
  • relevant life events

Establishing how these factors interact with one another and, based on them, what review period (if any) will be appropriate, can be complex. Case managers should request a clinical case discussion if they need support to select an appropriate review period.

Age

The individual’s age and developmental stage can impact on the likelihood of their needs changing over time. For example:

  • the age at which an individual first develops or experiences their condition may impact their ability to adapt to that condition
  • depending on their age, individuals might have different support available: a younger child may have parental or family support to manage a condition and an older child may require less to help manage their condition, both may impact how they deal with their condition
  • a child might have a condition that is highly unlikely to change (which would indicate a long review period) but due to them gaining more independence with age, they might be expected to be able to manage their condition independently in 3 or so years, which would be a significant decrease in needs (which would indicate a short review period)

This list is not exhaustive.

It is impossible to be prescriptive about the effects of age in all cases. However, consideration of both the individuals age and stage of development in conjunction with their condition(s) and impact on functioning/needs is important. If in doubt, refer for case discussion with a practitioner.

It could be reasonable to expect that a 3-year old child born with vision loss, could likely adapt to their condition as they grow and develop, depending on their individual needs.

However, a 10-year-old child who experiences a sudden loss of vision would likely require more intensive support to manage their day-to-day needs in the shorter and possibly longer-term. If in doubt, a referral for case discussion with a practitioner could be requested.

If a case manager is unsure about whether the individual’s age is more likely to give rise to longer-term needs, they should:

Individuals entitled to CDP and who are aged between 16 to 18 years of age, will not have a scheduled review of their entitlement.

When setting a review period for an individual under 16 the case manager should consider whether it is appropriate:

  • to set a review before the individual turns 16 or
  • to not set a review date so that the individuals award will end at their 18th birthday, by which time they will have been invited to apply to ADP.

If it is appropriate to set a review before the individual turns 16, the case manager should set the review with enough time for the review to be completed by the time they turn 16.

If a case manager is unsure about whether to set a review before the individual turns 16 or not set a review date so that the individuals award will end at their 18th birthday they should request a case discussion with a practitioner.

Level of award

If an individual is only entitled to the mobility component of CDP and under the age of 16, a review should be scheduled to occur before their 16th birthday. As Individuals aged 16 and over could be entitled to the lowest rate of the care component of CDP if due to their condition and needs they are unable to prepare a cooked main meal for themselves. Link to Care component criteria – preparation of a cooked main meal.

If an individual is entitled to the higher rates of both components of CDP and it is highly likely their needs will either:

  • not change or
  • increase

The case manager should consider setting a review date so that the individuals entitlement to CDP will end at their 18th birthday, by which time they will have been invited to apply to ADP.

Depending on the age of the individual this could mean setting a review period of longer than 10 years. This may be appropriate for an individual who is already entitled to the highest level of award and whose needs are only likely to increase. This is because their award would not be able to be increased any further.

Apart from individuals who are terminally ill, there is no automatic process to not set a review period for an individual who is already entitled to the highest rate of the care and mobility components.

Case managers should consider all of the information available from the application or review form and supporting information in deciding whether or not to set an award review period.

Single or multiple awards

In the case of a single condition, it may be relatively easy to understand if the individual’s condition is unlikely to change.

Where the individual has multiple conditions, it may be much more challenging to assess the likelihood of a change in their level of need.

Where the individual has multiple conditions, it is likely that planned treatment or surgery may not improve their overall level of need. Case managers should therefore consider carefully the extent to which any treatment or surgery will likely change the individual’s overall level of need.

Even if one or several conditions an individual has are likely to change over time, it might still be appropriate to set a longer review period if their overall level of need is highly unlikely to change over time.

Length of time individual has had the condition

Individuals who only recently acquired a new condition might still be adjusting to their disability. For example, they might still be learning how to use aides enabling them to walk. This might impact the likelihood of their needs changing in the future.

Case managers must not set a review period solely based on the duration the individual has had their condition. Case managers should consider all other factors discussed in this section and how they apply to the individual in question when setting a review period

In all cases, the age and stage of development of the individual should be considered in line with their condition(s). For example, a 10 year old child with newly diagnosed diabetes might require more support for a longer term due to having less insight into the impact of this condition on their needs whereas a 10 year old child who has had their condition for a number of years could be expected to require less support.

The length of time an individual has had a condition is not the same as the recency of a diagnosis of a condition. An individual may have had their condition for a long period of time and may have learned to adapt (e.g. by avoiding certain environments or movements, relying on support from others, or using aids) before they get diagnosed.

Due to waiting lists for assessment and intervention, particularly for mental health conditions, behavioural issues and neurodevelopmental disorders, children often present with symptoms and needs prior to receiving a diagnosis. However, a recent diagnosis can lead to new and potentially more appropriate treatment or support becoming available, which the individual will then need time to adapt to. This is likely to impact on their level of needs. If a case manager is in any doubt they should consider requesting a clinical case discussion.

Ongoing, current or planned treatment or surgery

If the supporting information suggests that the individual is either

  • currently undergoing
  • likely to soon undergo

a planned course of treatment or surgery that is expected to improve their overall condition or level of need, case managers should schedule a review after this, taking into consideration the recovery period and possible rehabilitation.

Not all treatment or surgery will lead to a change in needs. Individuals might also receive treatment or undergo surgery to maintain their current level of needs. This could be the case, for example, if they have a degenerative condition. If unsure whether a scheduled review would be necessary after an upcoming course of treatment or a planned surgery, case managers should request a clinical case discussion.

Where the individual has multiple conditions, it is likely that planned treatment or surgery may not improve their overall level of need. Case managers should therefore consider carefully the extent to which any treatment or surgery will likely change the individual’s overall level of need.

In the case of planned treatment, this may take place over a period of days, weeks or months. The review date should be a reasonable time after the planned treatment ends.

In the case of surgery, the review date should be a reasonable time after the surgery is due to take place. This should include time for any recovery.

What is reasonable will vary in every case, depending on the complexity of the treatment or surgery. It will also depend on whether the individual has any other health conditions, as well as whether any complications are common for a time after either.

If the case manager needs guidance on likely recovery times, they should request a case discussion with a practitioner.

Many individuals will be receiving ongoing or regular treatment, or take medication, to manage their conditions or disability. Medication can have side effects that can impact on an individual's overall level of need.

The likelihood of the individual’s needs changing might also be impacted by the amount of time they have been taking their medication.

For example, due to drug resistance and increased tolerance over time, it is possible that the impact of an individual's medication on their level of need will change over the course of their prescription. For more information on medications refer to BNFC (British National Formulary for Children) | NICE.

Similarly, it can take time and multiple trials for an individual to receive medication that is effective and manageable for them.

For example, an individual who is newly diagnosed with ADHD may just have begun their first trial of medication, and have yet to receive any support to allow them to self-manage their condition. Based on their condition and information on the medication, it can be expected that they may require a couple of ADHD reviews and medication changes to find a medication that works well for them, and to learn how best to manage their condition. Here, a shorter review period may be reasonable.

In contrast, an individual with ADHD who:

  • has tried numerous medications over the past 8 years
  • is aware of self-management techniques may have more stable needs. Here, a longer review period may be appropriate.

Condition

Case managers should take into account the prognosis of the individual’s condition.

It is important to remember that the typical features of a health condition might not apply to every individual. The presence or absence of these features may still be relevant to the award review date, as a case manager should set the review date when needs are likely to change

If it is unclear what the natural progress of a health condition may be, and how the typical progression of a condition applies to the individual in question, the case managers should:

Relevant life events

The level of needs an individual has might change due to upcoming life events. If, based on the information the case manager has on the individual, a future life event is expected to change the individual’s level of needs, the case manager should set a review for after that event. If it can be expected that the individual will require time to adjust to their new circumstances following that event, the case manager should take this adjustment period into consideration.

For example, a child with autism starting primary school may require enhanced transition or additional support, which may change their level of need. Similarly, a further relevant life event could include their transition to secondary school.

This may change the level of care, support, or treatment they receive and therefore could change their ability to manage their condition. If in any doubt, please refer for practitioner case discussion.

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