Skip to main content

 

CAPTION: LCP Procedures
   
View LCP Procedures View LCP Procedures

CAPTION: workingtogether
   
View workingtogether View workingtogether

4.1.6 Transition Protocol - Young People With Disabilities

This chapter was added to the manual in July 2014.


Contents

  1. Introduction
  2. Definition
  3. Purpose of the Protocol
  4. Good Practice
  5. Procedure
  6. Transition Pathway
  7. Young People with Statements and/or Disability year 9 (age 14 years)
  8. Young People with Statements and/or Disability year 10 (age15 years)
  9. Young People with Statements and/or Disability year 11 (age 16 years)
  10. Young People with Statements and/or Disability year 12 (age 17 years)
  11. Young People with Statements and/or Disability year 13 (age 18 years)


1. Introduction

The purpose of this protocol is to set out the agreed responsibilities of each group of professionals involved in the transition to adulthood process for young disabled people 14+ and to ensure involvement of all relevant agencies including the local authority, health, further education sector, and voluntary sector.


2. Definition

Transition to adulthood is the process by which young disabled people aged 14-25 years receive the support they need to lead the life they outlined in their person centred plan.

The SEN Code of Practice describes this as the process which:

“draws together information from a range of individuals within and beyond the school in order to plan coherently with the young person for their transition to adult life”

The SEN Code of Practice states that a “transition plan must be prepared for all young people with a statement of special educational needs following the year 9 annual review. The aim of transition planning is to help the young person prepare for a successful transition to adult life”
(SEN Code of Practice - SEN toolkit Section 10)


3. Purpose of the Protocol

This protocol is written for all Waltham Forest professionals working with 14-25 year olds who have a learning disability, physical and/or sensory impairment and/or an associated mental health need.

This protocol is intended to be a working document, which will inform the practice of those working with disabled young people going through the transition process. It highlights areas of good practice in line with current legislation.

The protocol will be of most interest / relevance to professionals working in the following services:

  • Social care including children with disabilities and leaving care and adult social care services;
  • SEN / LDD Services;
  • Children’s and adults finance;
  • Learning Disability Services;
  • Teachers working with disabled young people in schools;
  • Waltham Forest Careers Service;
  • Health services professionals, including mental health;
  • College staff;
  • Staff working in related areas within the voluntary sector.


4. Good Practice

There are six established key prerequisites for successful transition planning:

1.

There is a commitment

  Children and young people with complex needs are given explicit priority by senior managers in children’s, and adult’s health and social care services and council members. This means priority for care management, service delivery and for capacity to ensure that services are provided in time.
Commissioning, housing, schools, colleges and other services are required to prioritise their involvement in transition planning.


2.

Young People and Families are fully involved in the process

  Young people and their families are fully engaged in transition planning from Year 9.
Young people and their families are also involved in strategic planning for transition.


3.

Effective Strategic Planning and Commissioning

  The planning and commissioning of Adult Social Services are informed by an analysis of transition needs of the cohort of young people from 14 onwards receiving support from Children’s Service and who will be requiring services from Adult Health and Social Care within five years.
Strategies are underpinned by good financial planning.
The range and quality of services commissioned and outcomes for young people are systematically monitored.


4.

There is a multi-agency approach with good protocol systems and processes

  All relevant transition services are actively engaged and giving support from 14 years onwards to young people and their families that focuses on transition planning.


5.

There is a co-ordinated person-centred planning process

  Person centred planning methods and processes are used to create integrated transition plans. Direct payments are promoted.
The focus is on achieving outcomes, improving and supporting independence, and providing normal life opportunities.


6.

Monitoring

  There is regular follow-up to see that the plan remains appropriate and is delivering outcomes the person sought.


5. Procedure

This good practice procedure:

  • Demonstrates a commitment to joint working for children with complex needs;
  • Supports strategic planning and commissioning;
  • Is an incremental approach to multi-agency working/helping to understand the complexities of the transition processes.

The day-to-day operational practices are described within this policy to minimise communication breakdown. Any difficulties arising will be discussed at the quarterly transition strategy meetings.

In addition monthly meetings have been identified with managers from children’s and adult services to ensure that there is close monitoring of individuals going through the transition process, this is the purpose of the individual tracking meeting.

This agreement applies to:

  • Social workers within children’s social care teams;
  • Social worker within adult’s social care teams;
  • Professionals in the transition team;
  • Workers in SEN Team;
  • Health staff in children and adult services - e.g. therapy services, nursing and mental health.


6. Transition Pathway

The transition pathway maps the journey for young people with statements of special educational needs and disabilities aged 14 to 18 years who will need a transition plan to support them in to adulthood.

The information collated during this period will be shared with the all professionals in the transition team to ensure that the projection of future needs, market stimulation and commissioning begins in preparation for transfer in to the adult services.

The transition team is multi professional, therefore the appropriate professional will take a lead role at different times, for example the careers PAs will take the lead role in the year 9 transition reviews, in the majority of cases the social workers and health professional will take a more significant role from year 12. However this will not apply to young people with the most complex needs and/or those in residential placements. In these cases transition social work involvement will begin much earlier.

Young people remain the responsibility of the children’s health and social care services with respect to on-going care management through years 9 to 13, (ages 14 to 18years).


7. Young People with Statements and/or Disability year 9 (age 14 years)

Each July / Sept SEN Team send a list to schools of the young people who are due to have a transition review. This list is also sent to the transition team, the careers PA will contact each school and arrange the dates for the year 9 person centred transition reviews. The careers PA will then have all the dates in the diary for the year. There should be approx. 120 young people requiring a review, PA.s should arrange 2 to 3 reviews in one day at the same school, (there are 190 school days in a year). Pupils in residential schools can have their review outside of the school term. This will be monitored by the transition team manager. The Team Manager will ensure through supervision that the PAs will transfer the information from reviews on to the data tracking spread-sheet for each young person, including all current and predicted costs. This will enable forward commissioning of local services based on data. The careers PA will ensure that the schools send them a copy of the final transition review document.


8. Young People with Statements and/or Disability year 10 (age15 years)

Each July / Sept SEN Team send a list to schools of the young people who are due to have a year 10 transition review. This list is also sent to the transition team, the careers PA will contact each school and arrange the dates for the year 10 person centred transition reviews. The careers PA will then have all the dates in the diary for the year, however they will make it clear to schools that they will only attend a limited number. Although there will be approx. 120 young people requiring a review, the careers PA will only attend the year 10 reviews for young people where their year 9 review indicated significant support needs, and those young people in mainstream schools who have no clear pathway and have complex needs which will require significant multi-disciplinary input.

The careers PA will ensure that the schools send them a copy of the final transition review document, even if they have not attended. The Transition Team Manager will ensure through supervision that the PAs will transfer any new information from reviews on to the data tracking spread-sheet for each young person, including all current and predicted costs.


9. Young People with Statements and/or Disability year 11 (age 16 years)

Each July / Sept SEN Team send a list to schools of the young people who are due to have a transition review. This list is also sent to the transition team, the careers PA will contact each school and arrange the dates for the year 11 person centred transition reviews. The careers PA will then have all the dates in the diary for the year. There should be approx. 120 young people requiring a review, however the PA will prioritise young people who will be leaving their school at the end of year 11 to ensure they have a clear supported transition plan that is shared with their college/employer. PA.s should arrange 2 to 3 reviews in one day at the same school, (there are 190 school days in a year).

Pupils in residential schools can have their review outside of the school term, it may be appropriate that the transition social worker attends these reviews. This will be monitored by the transition team manager. The Team Manager will ensure through supervision that the Pas or social worker will transfer the information from reviews on to the data tracking spread-sheet for each young person, including all current and predicted costs. This will enable forward commissioning of local services based on data. The careers PA will ensure that the schools send them a copy of the final transition review document.


10. Young People with Statements and/or Disability year 12 (age 17 years)

Each July / Sept SEN Team send a list to schools of the young people who are due to have a year 12 transition review. This list is also sent to the transition team, the careers PA will contact each school and arrange the dates for the year 12 person centred transition reviews. The careers PA will then have all the dates in the diary for the year. The transition team will allocate the work to the most appropriate professional who will attend the review and pull the transition plan together.

The Team Manager will ensure through supervision that the allocated worker will transfer any new information from reviews on to the data tracking spread-sheet for each young person.

The adult assessment, (FACE and RAS), will be completed for young people approx. 6 months before their 18th birthday, this will be based on the on-going transition planning started in year 9. Priority will be given to children in residential or independent schools to prepare them for moving back in to the borough.

The health facilitator will check if any young people are health funded, have large community health packages, or have complex health needs which are likely to meet the adult continuing care criteria. They will work with the children health service to ensure that an adult continuing health care screening tool and if appropriate full continuing health care assessment is completed. It will be the responsibility of the health facilitator to link with the lead health manager and present the case to the continuing health care panel.

The continuing care management remains the responsibility of the children service with the transition team professional jointly working with the appropriate children team.


11. Young People with Statements and/or Disability year 13 (age 18 years)

Each July / Sept SEN Team send a list to schools of the young people who are due to have a year 13 transition review. This list is also sent to the transition team, the allocated worker in the transition team will contact each school and arrange the dates for the year 13 transition reviews. The allocated worker will then have all the dates in their diary for their allocated young people.

The Team Manager will ensure through supervision that the allocated worker will transfer any new information from reviews on to the data tracking spread-sheet for each young person. This includes the final support plan, the amount of I.B and the actual cost of the support package.

Where this didn’t happen in year 12 the adult assessment, (FACE and RAS), will be completed for young people approx. 6 months before their 18th birthday, this will be based on the on-going transition planning started in year 9.

The continuing care management becomes the responsibility of the transition team on the young person’s 18th birthday, as long as there has been an appropriate transfer of the case from the responsible children’s team, until this happens the responsibility remains with children’s services. On transfer the allocated worker will then ensure that the support plan is approved, in place and working for the young person. The young person will transfer to other adult social teams if and when appropriate to their needs and support plan.

The young person will meet with the professional in the transition team on a regular basis to discuss what’s working well and to review the support plan. There will be at least an annual review.

Some young people will need:

  • On-going support from the team up to the age of 25 years, this may be because of the complexity of needs;
  • Joint working with the leaving care team;
  • A referral on to an adult team for long term on-going, once the transition plan and support plan are established and working well;
  • May be held by the team but with minimal input once the transition/support plan is in place, this would relate to young people who may be in residential college and need support during the holidays or their support plan is likely to significantly change once they leave full time education;
  • Young people in full time education will continue to have their placement monitored by careers PAs.

The transition service will have limited resources and will prioritise the work of the team based on complexity of needs. The team are responsible for establishing a robust transition and support plan which may require short term or longer term support but the goal should be to minimise the long term support a person may need, making the person as independent as possible. Transition/support plans will be reviewed at 6 weeks and three months. If long term support from a team is required then the person will be transferred to a long term adult team. The team will aim to transfer people to other team within a year. This will stop a back log of cases which would impact on the ability to complete the new young people coming through the system each year.

There will be a very small number of people placed in residential colleges, these placements will be robustly monitored to ensure there is an appropriate support plan in place prior to them leaving. This will be the responsibility of their allocated worker and will form part of the individual tracking meetings.

 

End