3.1.4 Transition from Young People Focussed to Adult Oriented Services

1. Introduction

Young people with long term needs may require a move from young people focussed to adult orientated services. This is known as transition. The process of transition to adulthood involves changes in service provision and the law for disabled young people.

Young people with long term needs may need to move from young people focussed to adult oriented services. This is known as transition. There are two key issues in transition. Firstly, it is about legally becoming an adult and achieving independence, to an appropriate degree. Secondly, it is about changes in the actual services used.

During adolescence, young people may experience change in a number of areas: from paediatric to adult health services, school to higher education or work and childhood dependence to adult autonomy. For young people receiving services as children, both the planning process and the actual move to adult services can be complicated and stressful.

The age at which transition may take place can vary between services, for example some changes in health provision may take place at 16 but a young person may remain at school until they are 19. Other issues include social isolation, difficulty finding work and problems with their parent / carer relationships, such as over-protectiveness or low parental expectations.

Transition from young people focussed to adult oriented services can cause considerable stress for families and carers. In order to reduce the stress it is vital that transition planning is started early, at about 14 years, and is central to any work that is undertaken with the young person and their family. It should centre on the views, wishes and aspirations for the future of the young person and their parents / carers. It is also essential that the services and support provided at the time of transition are seamless, but also enable the young person to achieve greater independence.

The transition from children's to adult's care and support can cause stress for families. Families often feel the services and support they have falls away and adult services are not ready to step in. In order to reduce the stress effectively early preparation for transition to adulthood is essential.

The planning process for Year 9 in school focuses on Preparation for Adulthood. Education should generally take the lead in transition planning unless there has been significant health or social care involvement. A duty placed on education is to produce a transition plan from the age of 14. The Care Act 2014 places a duty on Local Authorities to conduct a transition assessment "where there is a likely need for care and support after the child in question turns 18 and a transition assessment "would be of significant benefit".

Good transition involves effective planning which should centre on the views, wishes and aspirations for the future of the young person (and their parents/carers). It is also essential that the services and support provided at the time of transition are seamless. Effective transition planning enables a young person to achieve greater independence.

Effective planning, that starts well before the transition period, will help to keep young people engaged and accessing service that will enhance independence and meet support needs. This should be a person centred approach and include adult services from the beginning.

Good practice for transition planning should be based on the principles of self-directed support, and specific service provision which is multi-disciplinary, holistic, planned and provides an element of continuity. Staff in all agencies must be mindful of the implications of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) when supporting young people, but especially those in transition. Training for staff in both children and adult services in relation to issues of transition will be of benefit to both service users and their families. The goal of transition planning should be to provide high quality services, offer choice and control to young people / young adults and maximise their education, training, employment and social opportunities (SCIE, 2005). Young people who are in transition should be referred to adult services if there are safeguarding concerns.

2. Adult Guardianship

There may be times when a young person, who is subject to a Care Order, requires guardianship when they reach adulthood. In such circumstances the Local Authority is responsible for identifying this need and ensuring it happens. If guardianship is deemed necessary, it should be addressed as early as possible and reviewed regularly as part of the young person's pathway planning process.

3. Disabled Young People Making the Transition to Adult Services

3.1 Introduction

Disabled young people will face many of the same experiences and challenges as other care leavers. However, the transition to adulthood for disabled young people who are looked after may be particularly challenging. They will often experience different practitioner languages, styles, expectations and cultures as they make the transition from support by children's services to support from adult health and social care services. Disabled young people also have needs relating to their health, social care and education, and these may vary widely depending on the nature of their conditions.

The definitions in the 1989 Act and legislation governing provision for disabled adults often differ and have differing thresholds for eligibility for services.

Care leavers with complex needs, including those with disabilities, may transfer direct to adult services and the pathway plan will need to ensure that this transition is seamless and supported. Local authority responsibilities towards disabled care leavers are the same as for all other care leavers.

Each disabled young person will have their own individual aspirations, hopes, needs and wants. Whilst different services will have their own eligibility and access criteria, they must work together to adopt a holistic approach based on assessment of individual needs informed by each young person's wishes and feelings.

Person centred planning will ensure that planning for disabled young people to make the transition to adulthood is focused on what is important to the young person for the future and what needs to be in place to ensure that they receive the support to achieve their goals. The young person must be kept at the centre with family members, carers and friends being partners in supporting the young person to achieve their potential. A shared commitment should be established to ensure that the young person's views are listened to and ways are found to remove any organisational barriers that might limit personal development and choices. Young disabled people leaving care should not simply be placed in pre-existing services and expected to adjust.

Services should, in particular, be responsive to the needs and preferences of a disabled young person in relation to such issues as housing, social networks and isolation, education, employment and leisure.

PAs and others working with disabled care leavers should be given training to ensure that they are equipped to communicate effectively with them, including those with high communication needs. Trained advocates should also be available to ensure that young people's views are heard and taken into account.

3.2 Joint Protocols

For transition to become a positive experience for young people and their families, it is necessary for all agencies to work together and understand each other's roles, responsibilities, practitioner frame of reference and legal duties within the transition process. To ensure that this happens for disabled care leavers it is essential that specific protocols and agreements are drawn up in each local authority area, with the participation of all agencies. This will include children's and adult social care, children's and adult health, education, housing, youth offending, information, advice and guidance services, supported employment services and leisure services.

Strategic planning approaches will need to be reflected at an operational level through protocols. These should identify the timing and mechanisms by which key practitioners come together with young people to help to identify their needs and to plan individualised support packages. In order to avoid duplication, wherever possible, protocols will need to identify how the pathway planning process relates to other frameworks for planning the transition to adulthood for young disabled care leavers, such as those for special educational needs.

Young people generally transfer from child to adult health services at 16, from child to adult social care services at 18, from school-based education to further education between 16 and 19, and to higher education from 18.

However, there may be exceptions to these general arrangements. Children and Young People’s Mental Health Services (CYPMHS) usually provide services up to age 18, and young people with Education, Health and Care Plans may not transfer to support from adult social care services until the end of school year 13, at age 19. Joint protocols must reflect the fact that age-related policies of different agencies do not fit easily with the realities of the transition process for young people leaving care, and should allow for a flexible approach which recognises the corporate responsibility towards them. Where it is likely that a care leaver will require continuing support from adult services, it will be good practice to make a formal referral as early as possible from age 16, so that eligibility for this support is established in time for their 18th birthday.

Protocols should clarify roles and funding responsibilities of different agencies. The use of pooled budgets across agencies may help remove some of the barriers arising from potential differences in eligibility criteria of different services provided under different legislation.

Tracking systems based on the transition arrangements associated with a young person's Education, Health and Care Plan should be in place to ensure that social care, health, education and other relevant agencies are aware of who are the potential users of adult services from age 14 upwards.