SH CP 181 Transition for Children to Adult Services Policy Version: 3 Summary: Keywords: Target Audience: This Policy outlines the process contributing to the movement of adolescents and young adults with chronic physical, mental, emotional health conditions or Learning Disabilities and Children in Care from child centred care to adult orientated services and encouraging self-management of ongoing health into Adulthood. Due to the diversity of in-patient and community services this is the overarching policy. Specific procedures and processes have been developed for relevant services that deliver care to children. Transition. Long term conditions, Complex health needs, children with additional needs, mental health, emotional health, learning disability, All staff who work with children in Southern Health NHS Foundation Trust. Next Review Date: April 2020 Approved & Ratified by: Clinical Effectiveness Group Date of meeting: 27 April 2017 Date issued: Author: Director: Liz Taylor, Associate Director of Nursing AHP Children s Fiona Butt, Supervisor for Family Nurse Partnership Gethin Hughes, Director ISD 1
Version Control Change Record Date Author Version Page Reason for Change March 2016 March 2017 Fiona Butt 2 Updated to processes and scope 3 Policy review Reviewers/contributors Name Position Version Reviewed & Date Ollie White Named Doctor safeguarding Children Feb 2017 Kerry Elliott Team Leader- CMHT Feb 2017 Margaret Martin Learning Disability Service Team Manager (West Feb 2017 Hants) Carol Adcock Associate Director of Nursing, Adult mental Health Feb 2017 Laura Pemberton Practice Development and training nurse Feb 2017 Liz Gremond Community Treatment Team manager Havant Feb 2017 Nicky Macdonald Head of Learning Disability Service (Hampshire) Feb 2017 Rachel Marsh Feb 2017 Maya Deshpande Consultant Psychiatrist V3 March 2017 Liz Taylor Associate Director Children s Division V3 March 2017 Fiona Butt FNP supervisor V3 March 2017 Ginny Taylor Head of Service Children and Families. V3 March 2017 Alison Morton Head of Nursing Children s Division V3 March 2017 Jane Levers Professional lead for school Nursing V3 March 2017 2
Quick Reference Guide For quick reference, this page summarises the actions required by this policy. This does not negate the need to be aware of and to follow the further detail provided in this policy. Transition from childrens to adults services for young people accessing health services. Overarching principles: planning, timing, involvement of child or young person, named worker, building independence. Involvement of parents/carers Support before transfer Support after transfer Ref: NICE 2016 3
Contents Section Title Page 1. Introduction 5 2. Who does this policy apply to? 5 3. Definitions 5 4. Duties and responsibilities 6 5. Overarching Principles 7 6. Main policy content 7 7. Training requirements 8 8. Monitoring compliance 8 9. Policy review 9 10. Associated trust documents 9 11. Supporting references 9 Appendix 1 Training needs analysis 10 Appendix 2 Equality Impact Assessment Tool 11 4
Transition of children to adult services policy 1. Introduction 1.1 This policy outlines the process for transition to adult services; the purposeful planned movement of adolescents and young adults with chronic physical, emotional and medical conditions from child centred care to adult orientated health systems (Blum et al, 1993). This includes children and Young people with Learning Disabilities or Children in Care who will need support to manage their own health. 1.2 Children and young people experience many significant transition points between health care services as well as between educational settings. All the transitional phases can have an impact on adherence to therapeutic regimes and retention by supportive health care services (RCN 2013) 1.3 The National Service Framework (NSF) for Children and Young People (DH 2003; DH/DfES 2006) recognises that transition should be a guided, educational, therapeutic process, rather than an administrative event. Effective transition must also allow for the fact that adolescents are undergoing developmental changes far broader than just their clinical needs. 1.4 It is recognised that transition plans may be led by another agency such as Local Authority and in these circumstances health providers may form part of a comprehensive, strategic plan of care. 2. Who does this policy apply to? 2.1 The contents of this document apply to all members of Southern Health NHS Foundation Trust (The Trust) 3. Definitions 3.1 Healthy Child Programme 0-19 (HCP) (Southern Health Foundation Trust) 3.2 Health Visiting and School Nursing Teams A team of practitioners who work with a defined population to deliver services that promote the health and well-being of children, young people and their families. Team members will include all or some of the following practitioners: Health Visitor (HV) School Nurse (SN) Special School Nurse (SSN) Community Staff Nurse (CSN) Community Nursery Nurse (CNN) Health Care Support Worker / School Nurse Assistant (HCSW / SNA) Clerical Support Worker Student Health Visitor Student School Nurse 3.3 Children in Care teams A team of Children in Care Nurses who work with Looked After Children placed in and who live in Hampshire to deliver services that promote the health and well-being of children, young people and their families. 5
3.4 Family Nurse Partnership A team of Family Nurses who work with mothers and their families, aged 19 and under having their first baby. This is an intensive, voluntary programme which starts in early pregnancy and aims to promote the health and well-being of children, young people and their families. It is delivered in specific areas of Southern Health Foundation Trust. Team members will include all or some of the following practitioners: Family Nurse Supervisor Quality Support Officer 3.5 Bluebird House Bluebird House is a Medium Secure Forensic Adolescent Psychiatric Unit that provides inpatient care for 12 to 18 year olds who present with a significant mental health difficulties and risk of harm to others. Bluebird House is part of a national network of medium secure adolescent units and therefore patients originate from throughout the country. All patients at Bluebird House are detained under the Mental Health Act. 3.6 Leigh House: Leigh House is a Tier 4 Adolescent Psychiatric Unit that provides inpatient care to 12 to 18 year olds who present with significant mental health difficulties. The majority of patients originate from Hampshire and the Isle of Wight. Some of the patients will be at Leigh House on an informal (voluntary) basis, and some will be detained under the Mental Health Act. (1983) 4. Duties and responsibilities 4.1 Clinical Directors / Divisional Directors / Area Managers / Matrons / Ward & Unit Managers 4.1.1 Must actively manage staff to ensure that they understand and comply with this policy and procedural guidance. 4.1.2 Must ensure that resources are available in order for staff to work to the policy and procedural guidance detail. 4.1.3 Ensure that staff receive appropriate training in accordance with the identified training needs analysis. 4.1.4 Monitor staff compliance with each section of this policy and identify any concerns arising and take action appropriately. 4.2 All Clinical Staff: 4.2.1 Must work to and comply with this policy and its associated procedures. 4.2.2 Must ensure that they receive appropriate training and are competent to undertake the procedures as detailed 4.2.3 Identify any issues of concern in relation to the use of the policy and bring this to the attention of their line manager in a timely way. 6
5. Overarching Principles 5.1 Transition should be planned in advance of a young person s 18 th birthday. There should be support before transfer, support after transfer and training and development for staff as well as infrastructure to support transition. This will vary between agencies and in mental health be through a CPA coordinator. 5.2 Children and Young People themselves should be involved in the planning and delivery of health services or have support from an advocate. 5.3 Identified agencies involved should work together to share expertise, complete joint assessments and, where appropriate, pool resources. 5.4 Timing of transition Although transition is governed by the child s age at 18 from CAMHS to Adult Mental health it is recognised that not all young people will be ready to make the transfer to adult services at the same time; this will depend on their cognitive and physical development, emotional maturity and state of health. Transition should be developmentally appropriate. 5.5 Transition should be encompassed into service specifications and commissioning arrangements. 5.6 Transferring Care a named worker should be identified from the lead agency with responsibility for monitoring the child or young person s health, social, psychological, educational and employment needs. It is the responsibility of all agencies to ensure thorough information sharing about a Young person s needs and to prioritise attendance at Transition meetings. If there is a CPA care coordinator they would take this role. 5.7 There should be a plan of the young person s involvement and evidence of responsibility given for decision making wherever possible and documented accordingly. Where the young person has complex needs and with their consent, it is particularly valuable to involve their family / carers too, so that they can agree to and support the proposed plan of care in the best interests of the young person. 5.8 Where there is concern about the capacity of the young person to give consent then use of the Fraser guidelines or MCA should be considered as part of an assessment. 5.9 The Health Care Professional involved in the Child or Young Person s care should, with input from the young person, their family and the wider professional network, develop an individualised transition care plan to support the transition in a timely and effective manner, building on a young person s strength. 5.10 For Children in Care, transition planning starts when the child or young person first comes into care and is supported with the use of the Health App CIC Mobile. 6. Main policy content 6.1 The following should be considered when planning a child or young person s transition to adult services: 6.1.1 The importance of children and young people having autonomy and involvement in decision making. 6.1.2 Providing support for parents / carers whilst empowering the young person with advocacy to ensure their needs are met. 7
6.1.3 Professionals need to engage with the young person and ensure that they have a good understanding of their needs. They also need to build relationships and involve other professionals, working across professional boundaries. 6.1.4 The availability or lack of specific service provision for young people. 6.1.5 The level of understanding and appreciation of young people s needs and issues in both children and adult health sectors and the opportunity to influence. 6.1.6 The need to challenge low expectations from professionals and agencies in order that the young person achieves their potential 6.1.7 The level of self-advocacy skills and potential to support young people s development and practise of these skills for young people 6.1.8 The need to acknowledge differing views of personal independence and success but to aim for independence for a Young Person. 6.1.9 Boundary issues may impact on transition arrangements in certain geographical areas. For example differing transition arrangements in different authorities and these would need to be assessed on an individual basis. 6.2 Factors thought to enhance transition between services Leadership Successful collaboration and cross-boundary working Resources Acquisition of skills and knowledge Robust documentation and appropriate administration Understanding the implications of the Mental Capacity Act (2005) Understanding of the Children Act (1989) Encouraging the commissioning of a seamless service for children and young people that meets their needs. 7. Training requirements 7.1 All clinical staff involved in the transition of children to adult services should receive training through their induction processes on commencing work and through the Trust Induction process. 7.2 All clinical staff involved in the transition of children to adult services should receive training related to the management of Care plans through their induction processes on commencing work and through the Trust Induction process 7.3 All clinical staff involved in the admission, discharge and transfer of patients should receive training related to compliance in this policy 8. Monitoring compliance Element to be monitored Lead Tool Frequency Reporting arrangements A named worker should be identified from the lead agency with responsibility for monitoring the child or young person s Matron/ senior nurse Discharge check list /transition care plan Monthly Divisional Q&S meetings 8
health, social, psychological, educational and employment need There should be a plan of the young person s involvement and evidence of responsibility given for decision making wherever possible and documented accordingly Matron/ senior nurse Audit/Tableau report Discharge check list /transition care plan Audit/Tableau report Monthly Divisional Q&S meetings 9. Policy review This Policy will be reviewed in 3 years or sooner if national guidance or legislation require. 10. Associated trust documents SH CP 72 Children s Community Public Health 0-19 Overarching policy SH CP 56 Safeguarding Children s Policy SH CP 69 Transfer in and out process aged 0-19 SH CP 181Transition for children to adult services guideline Hampshire Mental Health Transition Care Protocol 11. Supporting references Department of Health (2003) Getting the right start: the National Service Framework for children, young people and maternity services. Part 1: Standard for hospital services. Department of Health (2005) Mental Health Capacity Act Department of Health / Department of Education and Skills (2006) Transition: getting it right for young people. Available from: http://webarchive.nationalarchives.gov.uk (accessed 11/4/15) Department of Health (2015) Promoting the health and wellbeing of Looked after Children Mental Health Act (2007) HMSO. NICE Guidance (2016) Transition from Children s to Adult s Services Royal College of Nursing (2011) Learning from the past setting out the future, RCN, London. Available at www.rcn.org.uk/publications (accessed 29 September 2013) Royal College of Nursing (2013) Adolescent Transition Care A guide for nursing staff. Royal College of Nursing, 20 Cavendish Square, London, W1G 0RN Royal College of Paediatrics and Child Health (2010) Not just a phase, RSPCH: London Royal College of Paediatrics and Child Health (2003) Bridging the gaps: health care for adolescents. Available from: www.rcph.ac.uk (29 September 2013) https://www.uhs.nhs.uk/ourservices/childhealth/transitiontoadultcarereadysteadygo%2ftrans itiontoadultcare.aspx 9
Appendix 1: Training Needs Analysis If there are any training implications in your policy, please make an appointment with the LEaD department (Louise Hartland, Quality, Governance and Compliance Manager on 02380 874091) to complete the TNA before the policy goes through the Trust policy approval process. Training Programme Local induction Frequency Course Length Delivery Method Facilitators Recording Attendance Once Appropriate to each service Face to face training within appropriate venues in the Trust Various registered staff Directorate Service Target Audience Attendance is recorded on each person s local induction list Strategic & Operational Responsibility Director of nursing and Allied Health Professionals MH/LD/TQ21 Adult Mental Health Specialised Services Learning Disabilities TQtwentyone Clinical staff engaged in the transition of children to adult services Clinical staff engaged in the transition of children to adult services Clinical staff engaged in the transition of children to adult services Clinical staff engaged in the transition of children to adult services ISD s Older Persons Mental Health N/A ISD s Adults Clinical staff engaged in the transition of children to adult services ISD s Childrens Services Clinical staff engaged in the transition of children to adult services Corporate All N/A 10
Appendix 2: Equality Impact Assessment The Equality Analysis is a written record that demonstrates that you have shown due regard to the need to eliminate unlawful discrimination, advance equality of opportunity and foster good relations with respect to the characteristics protected by the Equality Act 2010. Stage 1: Screening Date of assessment: February 2017 Name of person completing the assessment: Ricky Somal Job title: Equality and Diversity Lead Responsible department: Intended equality outcomes: This Policy outlines the process contributing to the movement of adolescents and young adults with chronic physical, mental, emotional health conditions or Learning Disabilities and Children in Care from child centred care to adult orientated services and encouraging self-management of ongoing health into Adulthood. Due to the diversity of in-patient and community services this is the overarching policy. Specific procedures and processes have been developed for relevant services that deliver care to children. Who was involved in the consultation of this document? See list of reviewers/contributors page 2 Please describe the positive and any potential negative impact of the policy on service users or staff. In the case of negative impact, please indicate any measures planned to mitigate against this by completing stage 2. Supporting Information can be found be following the link: www.legislation.gov.uk/ukpga/2010/15/contents Protected Characteristic Positive impact Negative impact Age The transition from child to adult services can be a difficult time for young people. During this time there may be a number of changes a young person experiences such as education and relationships that may impact from the shift from Disability Gender reassignment Accessible Information Standard; Provision of reasonable adjustments; person centred approach and individualised care plans; childhood to adulthood. The impact of physical and mental health may impact on access to health care services is accessible information is not available. No negative impacts have been identified at this stage of screening 11
Marriage & civil partnership Pregnancy & maternity Race Religion Sex Sexual orientation Accessible Information Standard; Interpreting and translation support. No negative impacts have been identified at this stage of screening No negative impacts have been identified at this stage of screening Young people from whose first language is not English may potentially have less access to information which may impact on access to services and more likely to drop out of services during transition. No negative impacts have been identified at this stage of screening No negative impacts have been identified at this stage of screening No negative impacts have been identified at this stage of screening Stage 2: Full impact assessment What is the impact? Mitigating actions Monitoring of actions Transition from child to adult services can be a difficult time for children and young people. The additional effects on communication due to race,, ethnicity, nationality and culture are relevant where they affect language and communication: Poor communication may impact on a young person and their parents understanding of the issues around transition and their care. Every effort should be made to obtain the child s view or an understanding of their situation and to ensure that this is done in the child s first language or other relevant format if the child has a disability. Access to communications and interpreting services. Language line for emergencies Regular peer reviews to monitor use of interpreters for eligible groups. 12