Managing the transition from child to adult services

Children and Young People Care Services

The repercussions of the Covid-19 pandemic continue to be felt across health and care services, with the unprecedented demand on already stretched resources having an inevitable impact on the availability and quality of resources.

Although less likely to be hospitalised due to infection, children and young people with care needs have not been immune from the challenges created by the pandemic. Access to care services has been severely disrupted and recent research from the Care Quality Commission (CQC) suggests there have been gaps in the support received by children and young people when transitioning to adult care services .

There is a higher likelihood that healthy children will become healthy adults, so quality care services for children and young people are crucial in creating and maintaining a healthy society.

The transition to adult health services

Until the age of 18, children and young people with health conditions receive treatment from child health and social care services and in most cases, the transfer to adult services takes place once an individual is 18 and critical to a successful transition is early planning. The NHS recommends planning should begin when the child is aged 13 or 14, but the earlier discussions take place, the better.

Supporting claimant and defendant parties, Children and Young People case managers at Bush & Co work closely with clients from as early as the age of 12 to prepare them and their families for the transition to adult health services, providing the psychological support needed and engaging the appropriate professionals to proactively initiate and organise transition plans.

Early planning is key

Debbie Edler, Case Manager at Bush & Co, underlines the importance of early planning when saying “Early planning allows the child and their family to get a deep understanding of what will change and the opportunity to fully discuss any concerns and digest as much information as possible. Advanced preparation is key to minimising anxiety and ensuring a holistic person-centred plan is in place for when the child turns 18.”

Moving from child health services to adult health services is likely to mean care will be given by a new team and the prospect of working with unfamiliar people can be scary for young people and their families. All parties should feel supported and prepared in advance, with detailed exchanges of information occurring regularly between care providers to ensure any changes are captured and all needs continue to be met.

Support and equipment provided by adult health services will be determined via an assessment and funded from different budgets, so planning ahead gives the best possible chance of securing the necessary financial provision for the established level of care to continue.

Differences in operating procedures between child and adult health services and across individual NHS trusts may cause delays in support being made available, so planning early will mitigate these delays and ensure they do not impact support services.

Managing the transition

The National Institute for Health and Care Excellence (NICE) publish guidelines for practitioners supporting children and young people to help manage the transition, stressing the importance of having the correct information available and putting together a transition plan that is reviewed and updated regularly.

Perhaps the biggest adjustment resulting from the transition is the transfer of legal responsibility; adult services focus on the young person as an independent adult and once a child reaches 16 or 18, their ability to exert control over the support they receive increases and if they are deemed to have sufficient capacity to make decisions themselves, their parents can no longer make them on their behalf.

If capacity is not established, responsibility passes to the local Integrated Care Body (ICB) and an advocate appointed who may make choices in conflict with the wishes of the parents. This area requires great sensitivity and a significant change in mentality by all parties and having time to prepare is essential in making the transition a success.

Expertise from Bush & Co

Our team of specialist Children and Young People case managers are experienced in providing support in a number of crucial areas and coordinating resources to ensure optimum care continues post-transition.

• Mental Health

Statistics from the Royal College of Psychiatrists from 2021 indicate record numbers of children were referred to mental health services at the height of the pandemic. Compared to data from 2020, referrals increased by 134% and 80% more children and young people accessed urgent or emergency crisis care[1]. The Child and Adolescent Mental Health Service (CAMHS) team needs to coordinate closely with adult mental health services to support the transition.

• Education

As they get older, children may want greater involvement in the support they receive for their special educational needs and disabilities (SEND). Ensuring they engage with the educational establishment, local authority, and other care providers is critical in safeguarding appropriate ongoing support. If specialist help is needed, an Education, Health, and Care (EHC) plan can be considered which could provide support until a young person reaches the age of 25.

• Financial support

Parent carers can claim benefits to help care for children and young people with complex needs until they are 16 or they remain in full-time education. Beyond this they may be able to claim support on their own, but if no longer classed as a dependant, some benefits will reduce and there will be an impact to household income.

• Housing

Leaving home is never an easy decision, but supported housing allows vulnerable young people or those with a disability to lead independent lives whilst continuing to receive the support they need. Local authorities can provide information on the supported housing options available, and your case manager can help organise advanced visits to check suitability.

• Work

Should a child or young person decide to leave education to work, our case managers can introduce a Disability Employment Advisor for specialist advice on work and disability and schemes designed to provide additional support in the workplace.

[1] Royal College of Psychiatrists