Transitions to adult care Dawn O’Neill

www.talkinglife.co.uk

Transitions to adult care

Dawn O’Neill


Learning outcomesLinks between The Children and Families Act and The Care Act

Assessing a child's need for care and support

Planning for children who may need care and support at 18

Meeting a child's carer's needs for support

Continuity of care around transition

Continuing care assessments


“ Optimal care is achieved when every person at every age receives care that is medically and developmentally appropriate.”

A Consensus Statement on Health Care Transitions for Young Adults With Special Health Care Needs. Pediatrics 2002; 110;1304


Transition Definition

“The purposeful, planned and timely transition from child and family-centered pediatric health care to patient-centered adult-oriented health care.”

Society for Adolescent Medicine, 1993


“Planning for transition necessitates young people being encouraged to have high aspirations, offered

accurate information on the options available to them, and invited to say what other options they

would like considered.

Positive planning by schools, LEAs, health, youth services and other relevant professionals will

maximise the contribution of parents and young people.”

(Special Educational Needs Code of Practice, WAG 2002)


Cross cutting themes in transition

Becoming an adult and achieving independence

Changes in the actual services used

Explicit duties in relation to the care act 2014 and the children and families act 2014


Personal Perspective Think back to a time in your life when you went

through a transitional period.

1. What was the goal of transition?

2. What types of things did you do to accomplish the goal?

3. Who helped you during this period of transition?

4. Did certain tasks have to be completed in a timeframe?


Why Transition is Important

Failure to recognise and plan transition may result in young people dropping out of care

Poor transition processes are recognised to have a significant negative effect on morbidity and mortality in young adults with chronic health needs


Elements of Care Transition

1. Policies, Procedures and Legislation

2. Preparation

3. Planning

4. Transfer of care

5. Transition Completion


Goal of Transition:Maximise lifelong functioning and potential through the provision of high-quality, developmentally appropriate care services that continue uninterrupted as the individual moves from adolescence to adulthood


Children and Families Act 2014 : Overview• New requirement for LAs, health and social care services to

commission services jointly for SEN and disability

• LAs to publish a clear, transparent ‘local offer’ of services

• More streamlined assessment process, co-ordinated across education, health and care

• New 0-25 Education, Health and Care (EHC) Plans for those with more complex needs

• New statutory protections for young people aged 16-25 in FE

• A new duty on health commissioners to deliver the agreed health elements of EHC plans

• The option of a personal budget for families and young people with an EHC plan


Local councils have to provide support to enable individuals and families to plan ahead so that there are no gaps in services when a person becomes 18. An assessment helps identify services that may be required during the

transition to adulthood.

An assessment must be carried out by your local council where it considers that:

the young carer, child or carer of a disabled child is likely to have care and support needs after the child becomes 18 and there is ‘significant benefit’ to the young carer, child or adult carer if an assessment is made


Children and Families Act 2014

Whether or not the person being assessed (or their carer) have eligible needs after they turn 18 will ultimately depend on whether or not they meet the eligibility criteria appropriate to them as either a carer or disabled person.

The Care Act introduces a new duty on local councils to carry out assessments for the following individuals:

Children receiving care and support who are approaching their 18th birthday. This is called a Child’s Needs Assessments (CNA) ‘in transition’

Carers of disabled children who are approaching their 18th birthday. This is called a Child’s Carer’s Assessment (CCA) ‘in transition’

Young carers who are approaching their 18th birthday – this is called a Young Carer’s assessment (YCA) ‘in transition’


We want children and young people with special needs and disabilities to:

• Have high aspirations & a focus on outcomes• Achieve well in their early years, at school and college,

and transition smoothly into adult life; • Find meaningful employment; • Lead happy and fulfilled lives; • Have choice and control over the support they receive.

What we want to achieve


What are the challenges?


Care Act 2014Services at transition should be aimed at moving a person into work/adult life in such a way as to PROMOTE their independence and so reduce their long term needs for care and support

The Act says that if a child, young carer or an adult caring for a child (a “child’s carer”) is likely to have needs when they, or the child they care for, turns 18, the local authority must assess them if it considers there is “significant benefit” to the individual in doing so. This is regardless of whether the child or individual currently receives any services.


Transfer To Adult Services

Key findings

Most people told us that they’d had a negative experience of the transition phase

Shortage of appropriate short break facilities for young people after transitions

There was no evaluation or quality checking of the outcome of transition planning for individual young people and their parents

From the pond into the sea : childrens transition to health services


Whether or not the person being assessed (or their carer) have eligible needs after they turn 18 will ultimately depend on whether or not they meet the eligibility criteria appropriate to them as either a carer or disabled person.

The Care Act introduces a new duty on local councils to carry out assessments for the following individuals:

Children receiving care and support who are approaching their 18th birthday. This is called a Child’s Needs Assessments (CNA) ‘in transition’

Carers of disabled children who are approaching their 18th birthday. This is called a Child’s Carer’s Assessment (CCA) ‘in transition’

Young carers who are approaching their 18th birthday – this is called a Young Carer’s assessment (YCA) ‘in transition’


Different Types Of Transitions

From adolescence to adulthood developmental considerations

From school to training, employment or further education

From child centred service provision to person centred planning

Assessment of young people leaving care

Young people who are carers needs

Assessment for young people with mental health needs


Young people’s Challenges

Many transitions at once:

Graduate, move away, new job

New relationships, new opinions about politics and religion

Choices about alcohol, tobacco, drugs, sexual activity

Focus on independence


Family Challenges

Close ties with pediatric caregivers

Considered an adult at 18 privacy becomes an issue

Lack of confidence in:

Young adult’s ability to adequately provide self-care

Adult medical team

Adult care services


Child Care Team Challenges

Strong relationship with young person and family

Limited contact with adult providers and services

Lack of trust in adult care system/providers

Lack of training on how or when to start transitions


Adult Care Team Challenges


Transition Concerns multi-agency

Systems issues

Young person’s

psychosocial needs

Young person’smaturity

Family involveme

nt

Transition coordinatio

nCompetency


Parents said: Young people said:

• Listen to the needs and aspirations of young people

• Young people should be allowed to meet without parents so they can talk without being influenced

What young people want:

• Engage with us every step of the way

• Be honest, even with the difficult bits

• Be clear this isn’t an excuse for cutting services

• Ask for our help • Help us understand the cultural

change


Transfer of Care – What age?

What does the Law say?

Children Act 1989

Children and Families Act 2014

Care Act 2014


Working with children and young people and their parents and carers

Section 19 of the Children and Families Act lays the foundation for working in partnership with children and young people and their parents and carers.

It states that local authorities must have regard to:

• The views, wishes and feelings of the child, young person and their parents;

• The importance of allowing them to participate in decisions relating to themselves (or their child);

• The importance of providing information to enable active participation in decision-making;

• The need to support the child, young person and their parents to facilitate development and enable the best possible outcomes, educational or otherwise.


Preparing for Adulthood

A single system from 0-25 for EHC plans, removing the current ‘cliff edge’ at 16;

Focus on outcomes and preparing for adulthood – employment, health, independent living and community inclusion.

Local authorities to involve training providers when reviewing their special educational provision and developing their local offer;

Role for local authorities in commissioning post-16 provision, to deliver outcomes for young people, including supported internships, study programmes and specialist provision;

Young people with EHC plans can remain in the SEN system between age 19 and 25, where the extra time will allow them to consolidate their learning.


EHC Plan: Eligibility Criteria

From 1st September ‘14 under the SEND Reforms, the definition of SEN has not changed

Education is the key driver for an EHC Plan

An EHC needs assessment may be triggered if a child or young person has learning difficulty or disability which requires special educational provision to be made for them

A young person has a learning difficulty or disability if they:

• Have a significantly greater difficulty in learning than the majority of others of the same age, or

• Have a disability which prevents or hinders them from making use of facilities of a kind generally provided for others of the same age in mainstream schools or mainstream post-16 settings


Post-16 settings

• Further Education colleges, Sixth Form colleges and approved Independent Specialist Providers will be under new legal duties from September 2014

• Extends comparable rights and protections for young people aged 16-25 in further education as to those found for children/their parents in school

• Should use ‘best endeavours’ for all young people (up to the age of 25) with SEND, regardless of whether or not they have an EHC plan


Preparing for Adulthood

• A single system from 0-25 for EHC plans, removing the current ‘cliff edge’ at 16;

• Focus on outcomes and preparing for adulthood – employment, health, independent living and community inclusion

• Local authorities to involve training providers when reviewing their special educational provision and developing their local offer

• Role for local authorities in commissioning post-16 provision, to deliver outcomes for young people, including supported internships, study programmes and specialist provision

• Young people with EHC plans can remain in the SEN system between age 19 and 25, where the extra time will allow them to consolidate their learning


Social CareThe SEND Reforms will allow a more joined up assessment

process for children and young people with SEND, across education, health and social care

The majority of young people’s needs will still be met by:Commissioned services Occupational Therapy servicesShort BreaksAccess to information via Charities

Children’s Social Care will still undertake single assessments

EHC Plan reviews should be synchronised with social care statutory reviews and must always meet the needs of the individual child


So what is Changing?


What does this mean to you?

Listening to young people and their families

Ensuring effective, regular communication with young people and their families through the transition phase

Following existing good practice guidance

Recognition of adolescence and young adulthood as an important developmental phase

Readily accessible information for young people and their families

Professionals clear about process (following and knowing local policies and protocols

Effective collaborative working with other services (co-ordinating and involving all those involved in the young persons plan for transition


What are the future needs?


Assessing and addressing the needs of parent as carers

Parents experiences

“We have to fight for everything”

“From the pond, your are picked up and thrown into the sea”

“No one seems to work together”

“why cant people talk to each other better?”


Transition assessment: key expectations

They should

take place at the right time for the young person

support the young person and their family to plan for the future

be proportionate to a person’s needs

consider short-term outcomes as well as medium and longer-

term aspirations

build on existing information

be carried out in a reasonable timescales


The Assessment and Planning Process should:

Focus on the or young person as an individual

Enable young people and their parents to express their views, wishes and feelings

Be easy for, young people and their parents or carers to understand, and use clear ordinary language and images, rather than professional jargon

Highlight the young person’s strengths and capabilities


What should a transition plan look like?

TRANSITION


Preparing For Adulthood

Personal budgets

Mental capacity act and decision making

Person centred practice in converting statements and LDAs to EHC plans


Guiding Questions for the Assessment Process

Transition assessment is an individualised

process designed to answer three broad

Questions:

1. Where is the young person presently?

2. Where are they going going?

3. How do we get them there?


Transition Assessment Can Answer Many Questions

What are the young person’s preferences, interests, needs, strengths, needs, capabilities and aptitudes?

Where does the young person want to work, live and go to school?

What courses do they need to take in school to achieve their post-school goals?

What skills does the young person need in order to be independent?

What post secondary education/training programs best match their interests and needs?



Education, Health and Care Plans

EHC plans should:

Establish and record the views, interests and aspirations of the parents and child or young person

Provide a full description of the child or young person’s special educational needs and any health and social care needs

Establish outcomes across education, health and social care based on the young person’s needs and aspirations

Specify the provision required and how education, health and care services will work together to meet the young person’s needs and support the achievement of the agreed outcomes


Other factors to consider:

Is the young person medically stable?

Has transition readiness been assessed?

Does the young person have competency to make decisions

What are the young person and families expectations

What skills are needed to make a successful transition?

Documents

Transitions to adult care Dawn O’Neill