Children’s ASD and LD Partnership
Initial Meeting Notes and Workplan – June 2017

Background

The Transforming Care Programme places a clear mandate on local areas to review the support provided to people with learning disabilities and ASD of all ages to enable them to remain in their communities, and avoid long-term placements in residential institutions. The publication of the Lenehan Review in January 2017 has added a further policy focus on children and young people:

“These are our children and they are known. They occur in every area and they often follow a well-trodden pathway out of their local authority area, never to come back. Our group of children cry out for a cross-government, cross-system approach. They are small in number, easily identifiable and very expensive. They should sit at the heart of joint commissioning and yet they don’t. Why not? The small number in each area means that they never reach a critical mass for commissioning and they are dealt with on an individual basis and placed into a system which has patchy provision, usually a long way from home.”(These are our children: A review by Dame Christine Lenehan, CDC, 2017)

The guidance acknowledges that there is a lack of organisational ownership and that these children often fall through the gaps between health, education and social care, due to not meeting thresholds, lack of skills, or the fact that challenging behaviour is not the specific remit of any one agency. A multi-agency approach is therefore considered to be crucial, with lead professionals in each case to coordinate the system.

Within Hounslow, there is growing evidence of the need for a new approach. The assessment pathway is disjointed with ever increasing waiting times; significant numbers of families are being referred to social care family support services for help managing behaviour due to gaps in support provided pre- and post-diagnosis; and an increasing number of young people are emerging in crisis requiring bespoke packages of support as an alternative to residential or inpatient care. Residential school placements can each cost the local authority £200,000 per year (the Lenehan review quotes a cost of £1million per child every 3 years), and the fact that they are frequently at a distance from the child’s home, and with limited therapeutic support available, means that they can impact negatively on the child’s outcomes.

Furthermore, the ongoing use of out of borough residential care for these young people can impact on their outcomes long into adulthood. The 131 Project within adult social care, which is focussed on supporting adults with learning disabilities to return to the community setting, has highlighted the importance of intervening early to support behavioural change in adolescence and enable the young person to remain in the community, as it is often very difficult to support a return to their community as adults.

Initial Meeting 30.06.17

An initial meeting of partner agencies took place in June 2017 to identify the key issues and the work required across the partnership.

Present: Susie O’Neill (Joint Commissioning – Chair), Jennifer Hopper (LBH Families First & Intensive Interventions), Elaine Morgan (LBH Families First & Intensive Interventions), Martin Forshaw (LBH Safeguarding), Annita Cornish (LBH SEND), Liz Fellow-Smith (WLMHT CAMHS), Lisa Burrage (WLMHT CAMHS), Julie Hale (HRCH Paediatrics), Nimmi Sellathurai (HRCH Paediatrics), Natasha Patten (CCG).Apologies: Phil Hopkins (LBH 0-25 Service)

Key issues discussed:

  • There are 2 vulnerable cohorts – those with LD known to the social care disabilities team at risk of residential school placement, and those with ASD at risk of residential school and/or hospital admission, usually known to Intake/Safeguarding only which has challenges in terms of capacity and expertise. MF and AC will consider whether the second cohort would be better located with the disabilities team, with reference to ‘disability’ criteria in other areas, the projected numbers, and the service thresholds.
  • There are numerous meeting structures – CIN and Section 117 led by social care, the EHCP review process led by SEN, and the CETR process led by health. All agreed that the CETR process should continue to be embedded as the mechanism for coordinating bespoke packages in crisis, when the EHCP process would be too slow.
  • Developing bespoke packages of care is challenging within current systems, although all agree it is a good idea in terms of both costs and outcomes. Relies on someone to hold case responsibility to coordinate the package, and mechanisms to be in place to agree flow of funding between budgets (e.g. spend in Safeguarding saves money in Placements).
  • Funding has been identified to commission an intensive community LD and ASD service for 2 years based on the evidence-based Ealing ITSBS model which works to this approach i.e. case coordination, PBS assessment and plan, oversight of a bespoke multi-agency care package. SO will be working with WLMHT and the independent PBS provider to mobilise this as soon as possible.
  • Frequently referrals are coming to early help via the front door, of young people with ASD or waiting for diagnosis presenting with disruptive behaviour at school and/or home. The family support workers do not have the expertise to manage these cases and they are not within the remit of the service as they do not meet Troubled Families criteria. They need family support at home e.g. parenting strategies and behavioural support in school – potentially a specialist family support post/s. We need to map the available resources within the borough, consider how to build capacity within universal settings, and highlight the gap to the Early Intervention SMOG.
  • The waiting time for an ASD assessment is currently 18 months following a 200% increase in demand, and there are challenges in the pathway including those with LD, and the need for screening in schools prior to referral. A separate task and finish group is needed.

The actions/next steps are captured in the draft action plan below. A follow-up meeting will be scheduled for