Health / Transitions Group

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The Health/Transitions Group was formed to ensure that our Transitions Protocol and Pathway provides the framework for how services in Gateshead will work together to ensure the best outcomes for all young people with disabilities as they move into adult life. It sits alongside Gateshead Council’s SEND Multi Agency Transitions Protocol. The Health/Transitions Group meet on a three-monthly basis to identify and discuss referrals into the Gateshead Adult Community Learning Disability Team when the young person is 17.
Following a young person’s seventeenth birthday they will be discussed at each meeting (with their consent or in their best interests) to raise awareness of their needs. They will be discussed at each meeting thereafter until the referral is activated if required.

If the Health and Local Authority Transition Group agree the criteria for referral to an adult service or services are met and the young person has consented or there is a best interest consent decision, then that young person at 17 ½ will be referred to the appropriate Adult Community service/s.

The Gateshead Adult Community Learning Disability Team are based in Bensham Hospital, Gateshead.
The team provides specialist assessment and treatment to people aged 17 ½ and onwards with learning disabilities and additional health needs, where their needs are complex and require a specialist and or integrated approach to care and treatment and cannot be met through mainstream services. The teams are staffed by a range of specialist learning disability health professionals Psychiatry, Psychology, Nursing, Speech Language Therapy, Occupational Therapy, Physiotherapy, Health Care Support Workers and Admin, all with training and experience of working with individuals and their families, carers and supporters. The community team offers a range of service functions including specialist interventions in Positive Behavioural Support (PBS) mental health and physical health.

17 ½ – 18yrs Next Steps

As per Cumbria, Northumberland Tyne and Wear Transition Policy the following steps will take place once a referral is made to adult services.

  1. At 17 ½ yrs. where CYPS believe a person under their care with a learning disability will require support at 18yrs and they meet the criteria set by other stakeholders for access to their services, a referral will be made to that adult service.
  2. The allocated adult and CYPS practitioner to then meet within 1 month to discuss case further and then arrange two further visits before young person is 18yrs to do joint visit to introduce adult services to the family/carer/service user and to then complete a transition plan.
  3. Psychiatry Medics will refer to each other by letter and CYPS medic will ensure that adult psychiatry are informed of persons medical history and ongoing concerns that will need treatment /review in adulthood when the young person is 17 and 9 months. This allow adult psychiatry time to arrange appointment for when the young person is 18yrs.
  4. The following information is to be handed to young person/ carer/ family. Adult team leaflet
    Information on adult social services
    Local Authority transitions leaflet
  5. CYPS have primary responsibility for the service user until the user is 18yrs old.
  6. Before transfer/transition to adult service, CYPS case holder, will ensure all core documentation and other relevant documentation is completed prior to handover.

What are the benefits for family/young person?

By following the steps 1- 6 outlined above the young person will have.

• Integrated holistic care.
• Smooth transition from young people to adult services.
• Time to form and build new relationships with other professionals.
• The young person and family/carer/s will know who is coordinating the young person’s care.
• Help to alleviate anxieties around transition for the young person and their family/carer/s.

When the young person requires crisis support when in transitions

The care of the young person remains the responsibility of CYPS until the person is 18yrs old, therefore any crisis support required whilst the young person is in transition, will be supported by CYPS services and outreach team.

Learning Disability Screening

For many young people their Education, Health and Care Plan refers to their ‘Intellectual difficulties’, this is terminology generally used by Schools and Educational Psychologists who do not provide a diagnostic service.

For those whom it is unclear whether they have a Learning Disability, and uncertainty whether they can access Adult Learning Disability Services, the team can offer a Learning Disability screening. If appropriate they can be added to the Referral list through the group meeting though the young person must also have an associated health need, such as mental health, physical health or behavioural need that cannot be met through enhancement of social care provision or within primary care services.

Phone 0191 478 0650 for more information about the service