Unlocking the Path to Adulthood for Young Individuals - A Comprehensive Workshop Insight

Working With Young People Transitioning Into Adulthood Greg Anstead - Head of Operations London Care Partnership 15thOctober 2018

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

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.

What is transition and where am I going? Residential care What is the preferred future provision? Fear of the unknown Family How do we know what the young person really wants? Young person Local Authority CCG Supported living How has the person been prepared for transition or adult life? Anxiety Education How and when do we get the transition process started?

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.

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.

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

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

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 Date Aim Achieved? Yes/No If not why not? Materials Absence of challenging behaviour 1 hour before, during or 1 hour after visit. Review

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.

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 Date Aim Achieved? Yes/No If not why not? Materials Not applicable as JS not present Jessica to meet with Sarah Green at school and see John s current residential setting. Jessica to visit school. Meet with Lisa, Peter and any other key individuals in John s life. John to be introduced to Jessica and tolerate Jessica s presence with a low stimulus task. On x Lisa to advise when Jessica can visit John again for a second visit within this week. Lisa to advise Jessica on an appropriate time to deliver and share his social story with his class mates. On this second visit Jessica to finish at school and then visit residential service, spend further time with John and speak to all staff involved with John s care e.g. Steve. X Absence of challenging behaviour 1 hour before, during or 1 hour after visit. JT to bring photos and Arabella word search folder. X TBC JT to bring any additional photos for John s social story and word searches. TBC JT to prepare a photographic document to support John s tour of 185 Arabella Drive TBC School to inform Jessica when they can bring John for a tour of 185 Arabella Drive. Review

Example Cont: Week 2: Other LCP staff (Potential new keyworker) and visit to 185 Arabella Drive with school support staff Date Aim Achieved? Yes/No If not why not? Materials School to inform Jessica when a member of her staff team can come into school & respite. (This should be earlier in the week e.g. 25th, 26th (Not good for respite) or 27th July). A second visit to school to engage in an activity that John likes e.g. PE, Playground, Cycling etc. LCP Staff member to visit the family home from 10:00am 16:00 engage and interact with John and the family initially. Then JS, LCP staff member and dad to visit the South African sausage shop and take them to 185 Arabella Drive to cook and eat lunch in the house. TBC Absence of challenging behaviour 1 hour before, during or 1 hour after visit. TBC X LCP Staff member to visit the family home from 10:00am 16:00. Staff to try and work independently with John (mood depending) on an activity that he likes e.g. word searches, McDonald s etc. X Review

Example Cont: Week 3: John moves to 185 Arabella Drive Date Aim Achieved? Yes/No If not why not? Materials Mr and Mrs Smith and LCP Staff member to move John into 185 Arabella Drive. John to experience his first night at 185 Arabella Drive. X Absence of challenging behaviour 1 hour before, during or 1 hour after visit. John to stay at 185 Arabella Drive and supported by x having built rapport. X John to stay at the family home but be supported by 185 Arabella Drive staff 10:00 16:00 both days and parents to return John on Monday 8th. X Review

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.

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

Questions please.

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