Transitioning into Adulthood Workshop: Challenges & Recommendations

1. Working With Young People Transitioning Into Adulthood Greg Anstead - Head of Operations London Care Partnership 15th October 2018

2. Workshop overview • LCP Overview • Where am I going? • Be prepared • Challenges for providers • CQC Transition Message • Transition Flowchart • Transition Plan • Conclusions and Recommendations • Q&A

3. LCP Overview • 9 services in South West London, within 7 mile radius of head office allowing daily oversight and support. • 90% clients are transition age: 18-25yrs old. Compatibility due to similar diagnosis, interests and life interests. • Predominantly residential schools and colleges. Minority of placements from hospital discharges, family homes or failed placements. • Over 250 assessments leading to 80 successful transitions in 9 years. • Specialist team of PBS behaviour specialist, Quality of Life Manager and SALT. • Recognition: 4 overall outstanding ratings by CQC, all other services outstanding in one KLOE.

4. What is transition and where am I going? • What is the preferred future provision? • How do we know what the young person really wants? • How has the person been prepared for transition or adult life? • How and when do we get the transition process started?

5. Be prepared • Be as prepared as possible for adult life. • Who is leading this process? • Start formulating a future plan: What, when, how and by whom? • Have clearly defined goals of what is to be achieved for this young person. • Do the research: Preference - choice between the various options thought to be available.

6. Challenges for Providers • Last minute referrals and delayed agreements from budget holders. • Difficult parental relationships. • Lack of support for new services. • School adult provision making the assessment difficult, causing delays. • Colleges being cancelled a year or 2 early and late notice for placement requested. • Poor documentation from existing services, especially if an adult provision or family home. • Disjointed schools – educational psychology but no behavioural support in school residential care facilities.

7. CQC Transition Message CQC – have set four priorities. More health focused but same principles. 1) Commissioners and providers must listen to, involve, and learn from young people and their families, and understand what they want from their care. 2) Existing national guidance must be followed so that young people are appropriately supported through their transition. 3) GPs should be more involved at an earlier stage in planning for transition. 4) Services must be tailored to meet the needs of young people transferring from children’s health services and include extra training for health care staff in caring for young people. Reference CQC: From the Pond to the Sea 2014

8. Transition Flowchart Expression of Interest and visits – Families, LA’s, CCG’s, Schools Referral – yes/no Assessment – Greg, QofL, PBS, HM’s Interact with the client if appropriate Interview relvant people Review records Visit client in at least 2 settings Debrief – yes/no Further visits if required in LCP with family or to client Transition meeting and plan devised Transition client to new home Develop transition plan Client visit new service or not Staff to visit client's home Development of Support Plans

9. Transition Plan The following plan represents an intensive period of working with x throughout his transition period. This plan has been developed to support x to take small incremental steps (within the given timescale) towards moving to x, hopefully without experiencing challenging behaviour along the way. Please note: Initially the plan will focus on rapport building within x. Then accessing x and then rapport building within the family home. Staff are available and committed to this plan from LCP. There is the opportunity to review this plan’s outcomes weekly to make an objective evaluation of x progress. At such point the plan may need to be reviewed. The plan is outlined below, along with the opportunity to record the successes or difficulties at each visit. Week ?: Informal rapport building with x

10. Example Plan • John Smith Transition Plan • The following plan represents an intensive period of working with John throughout his transition period. This plan has been developed to support John to take small incremental steps (within the given timescale) towards moving to 185 Arabella Drive, hopefully without experiencing challenging behaviour along the way. • Please note: • At no time should his current staff, LCP staff or family tell John he is moving to a ‘new home’. ‘Home’ is clearly John’s parental home and 185 Arabella Drive should be referred to as “Arabella Activity Drive”. • All staff should also be aware that John knows the Wandsworth area very well and may get confused that he is near his family home but not staying/living there. It is therefore advisable that John is supported to access the community within other local boroughs e.g. Kingston, Richmond, Surrey for his initial transition period. • LCP staff do not want John to associate any current challenging behavioural patterns with them. Therefore, if John is displaying any challenging behaviour during transitional visits they are not to engage, to ignore and passively observe from a safe distance leaving his current staff to manage him. • Mr & Mrs Smith to organise with Jessica a mutually convenient time to tour/risk assess the house, choose, and personalise a bedroom for John (This can take place while John is at his school or respite service) ready for his first night on X.

11. Example cont: • Initially the plan will focus on rapport building within his school and respite. • Then accessing 185 Arabella Drive and then a further rapport building phase will start within the family home. Staff are available and committed to this plan from LCP. • There is the opportunity to review this plan’s outcomes weekly to make an objective evaluation of John’s progress. At such point the plan may need to be reviewed and can be adapted to ensure the best outcomes for John, all opinions are welcome and encouraged. • The plan is outlined below, along with the opportunity to record the success or failure at each visit. • Week 1: Informal rapport building with John at school

12. Example Cont: Week 2: Other LCP staff (Potential new keyworker) and visit to 185 Arabella Drive with school support staff

13. Example Cont: Week 3: John moves to 185 Arabella Drive

14. Conclusions and Recommendations • Only agree to support those you are able to. • Providers must lead the coordination of the plan and communicate it effectively throughout the process. • Work in partnership at all times. • Ensure you have the right team to do the job. • Socks and pants.

15. Helpful Resources • bild: Transition toolkit • CQC: From the pond into the sea Children’s transition to adult health services. • NAS: About Autism – Transition - Leaving School • Nice/SICE: Transition planning for young people moving from children's to adult. • SICE: Building independence through planning for transition

16. Questions please….

17. References • CQC: https://www.cqc.org.uk/publications/themes-care/transition-arrangements-young-people-complex-health-needs-children%E2%80%99s-adult • CQC: https://www.cqc.org.uk/publications/themes-care/infographic-transition-arrangements-young-people-complex-health-needs • https://www.cqc.org.uk/sites/default/files/CQC_Transition%20Report.pdf • https://www.nhs.uk/news/pregnancy-and-child/parent-training-may-benefit-children-with-severe-autism/ • LCP: http://www.lcpcare.com/assessment-a-admissions.php • NAS: https://www.autism.org.uk/about/transition/leaving-school.aspx • NHS: https://digital.nhs.uk/data-and-information/publications/statistical/health-and-care-of-people-with-learning-disabilities/health-and-care-of-people-with-learning-disabilities-experimental-statistics-2016-to-2017 • https://www.nice.org.uk/guidance/ng43/chapter/recommendations#developmentally-appropriate