Guiding Principles

• Bathroom independence is a fundamental skill for independent living and dignity. We want each student to be as independent as possible in the bathroom.
• Assume that students are capable of learning new skills and routines.
• Adults should model boundaries by telling students when and why they are touching the student’s private areas.
• Assume the student is listening to everything you say.
• Students who are not yet independent in the bathroom may be vulnerable. Safety and Dignity are two of our highest priorities.
• For the protection of both students and staff, two adults must be present if adults will be in the bathroom assisting the student with clothing removal, changing, or wiping.
• Other students should never be involved in the changing routine.
• Staff should protect themselves by using appropriate Personal Protective Equipment.

Procedural Guidance

• Updated Guidance 2023-2024 SY
• Consider the Environment
• Student bathroom is more typical/less restrictive than staff bathroom
• If physical transfer of student is necessary, ensure that staff doing transfer have been trained by the Physical Therapist on appropriate procedure
• Basic procedure for full change (Remember, the goal is for the student to take over steps as they are able):

1. Inspect the designated changing area and make sure that all of the necessary equipment and supplies are available in the area (i.e. gloves, wipes, etc.)
2. Bring student to changing area
3. Prepare table/surface where student will be changed by wiping with a sanitized cloth and/or by placing protective paper on the table surface
4. Wear appropriate Personal Protective Equipment — gloves (sleeves and apron if necessary).
5. Talk to student about what you are doing and why (i.e. “I’m going to use the wipes to clean your buttocks now.”)
6. Transfer student to changing table (per PT training) or standing position if able
7. Remove soiled diaper and place in a covered waste receptacle
8. Clean student using wipes
9. Dispose of soiled gloves and put on clean pair of gloves
10. Place clean diaper on student
11. Transfer student from changing area
12. Remove paper and clean surface with wipe

• Have clean clothes available and a bag for wet/soiled clothes
• Waste disposal:
• Disposal should be in a covered can and appropriate bagging that minimizes odor.
• Work with your building custodial engineer to ensure that appropriate waste can and bags are accessible and being removed from the building on a daily basis.
• Personal Care Routine to be developed by a team, may be facilitated by OT or PT
• Training on Personal Care Routine provided and documented by OT or PT if there are significant motor or sensory concerns

Building independence:

• The FACTER assessment has a bathroom routine task analysis that helps to focus instruction – allowing the student become more independent in some or all components of the routine.
• Data tracking can help the team see incremental progress on each step in the routine
• Depending on the needs of the student, consider the following in building independence
• Adaptive equipment (see PT or OT)
• Visuals or social stories to teach steps in the routine
• Reinforcers (food, star chart, screen time, adult attention) can help students with the motivation to persist in learning bathroom skills
• However, reinforcers can also become a barrier to future independence (if the student thrives on adult attention, they may have an incentive to extend the time they spend in the bathroom with two adults)
• Consider how to fade prompts & reinforcers

Resources

• Toilet Training for Children with Developmental Delays
• Seven Toilet Training Tips That Help Nonverbal Kids With Autism

FAQ’s

I have a student who wears pull-ups and they don’t seem to notice (or don’t seem to mind) when they have urinated in their pull up. How do we encourage them to use the bathroom instead?

Pull-ups are effective at wicking the wetness away from the skin. Some students say they actually like the warm feeling from a wet pull-up. The team may encourage the parents to dress the student with underwear under the pull-up. This may provide an incentive for the student to recognize when they need to go to the bathroom.

Keeping data about when and how often the student’s pull-up is wet can help the team recognize patterns. Creating a routine where the student goes to the bathroom before they urinate in their pull-up can help them develop the skill and expectation of going to the bathroom.

Can we use peers to help students learn bathroom routines?

Peer influence can be very strong for helping students develop new habits and routines. However, safety and dignity are two of our highest priorities. A peer should never be involved in a changing routine (for a student who uses a pull-up or diaper).

It is not unusual for students to go to the bathroom in groups of 2 or 3. For a student who is nearly independent, the teacher could encourage peers to help each other with reminders of the bathroom routine (“remind each other to close the door when you use the stall” “remind each other to flush and wash your hands”).

Video Modeling can be a powerful technique to help students learn new routines. Can we use Video Modeling for bathroom routines?

No. Safety and Dignity are our two highest priorities. Staff should never take photographs or videos of students using the bathroom. Parents may choose to use Video Modeling for their own instruction at home, but we will not use Video Modeling in the bathroom.

Stick figure icons can be helpful (SymbolStix, Board Maker, etc.) as a visual guide for some students.

Video Modeling may be used to teach some elements of the routine outside of the bathroom, but with these restrictions:

1. Staff should not take pictures or videos in the bathroom. Any photos or videos for these routines should be taken outside of the bathroom (ex. using the classroom sink to film handwashing routines).
2. Students should always be fully clothed in any photos or videos.
3. Do not use a student’s actual clothing. If you are using Video Modeling to help a student learn to use a zipper or a button, have the student use a separate piece of clothing that they are not wearing (maybe a jacket or backpack).
4. Staff should get parent permission before filming a child for Video Modeling.