Multi-Agency Transition Protocol for Children and Young People with Learning Difficulties

Multi-Agency Transition – Protocol for Children and Young People with Learning Difficulties and Disabilities

Contents

1.IntroductionPage 3

2. Background & PurposePage 4-5

3.Legal ContextPage 6

4.Person Centred Plan & TransitionPage 7

5.Contributions to Transition Planning

(i)Young PeoplePage 8

(ii)Parents / CarersPage 9

(iii)The SEN ServicePage 10

(iv)LSCPage 11

(v)SchoolsPage 12-13

(vi)Connexions Cumbria Page 14-15

(vii)HealthPage 16

(viii)Adult Social Care DirectoratePage 17-18

(ix)Children’s Social Care Page 19

6.Transition Planning by AgePage 20-27

(i)Year 8 – 12/13 years

(ii)Year 9 – 13/14 years

(iii)Year 10 – 14/15 years

(iv)Year 11 – 15/16 years

(v)Year 12 – 16/17 years

(vi)Year 13 – 17/18 years

(vii)Year 14 – 18/19 years

7.Financial Planning in Adult Social Care DirectoratePage 28

8.Dispute Resolution between PartnersPage 29

9.ComplaintsPage 30–31

10.Monitoring Performance and OutcomesPage 32

Appendix 1 - SafeguardingPage 33

1 Introduction

This protocol is intended to ensure that all agencies that have a role in supporting young people, as they move into adulthood, are able to make an effective contribution to the transition planning process. The protocol aims to ensure that relevant agencies are involved at the start of the process so that the young person, their parents / carers and the agencies themselves are clear what the specific responsibilities of each agency will be at each stage of the process and to ensure that the young person is actively involved in planning their future and that any transition is a smooth one.

The protocol explains the roles of Schools, Connexions Cumbria, Cumbria PCT, Children’s Services and the Adult Social Care Directorate in working together to support young people with special educational or complex health needs in the transition to adulthood, this includes those with statements of special educational needs and others who will need support in reaching independence. The process of transition planning should start when the Young Person is in Year 9, approximately age 14.

The annual review of the statement in year 9 must also include the completion of a transition plan and it is this part of the meeting that is the focus of this protocol. The transition planning process involves the development of a multi-agency transition plan, which helps the young person to prepare to move on to the next phase of their life after school. The transition plan identifies: -

the young person’s aims and aspirations for the future;
the options which are available to the young person after leaving school;
the support the young person may need as they prepare to leave school and when they have left.

The aim is to ensure that the young person and their parents/carers have a central role in this process.

This protocol has been produced in partnership with the following organisations:

Connexions Cumbria
Learning Skills Council
Cumbria Health Organisations
Cumbria County Council – Children’s Services – Cumbria Adult Social Care
School partners
Parents/carers of children with Learning Difficulties and or Disabilities
Children with Learning Difficulties and or Disabilities

A glossary of key terminology used in the document is available as an appendix.

2Background

The need for a multi agency Transition Protocol was highlighted in “Valuing People: A New Strategy for Learning Disability for the 21st Century”, the “National Service Framework for Children, Young People and Maternity Services – Transition: getting it right for young people”, and in the “Inspection of Social Care Services for people with learning disabilities, Cumbria County Council, September 2001 by the Inspectorate”.

The legislation referred to within this document primarily relates to England and Wales.

The need for a multi-agency Transitional protocol has been identified for people with disabilities, during the consultation process which is informing the development of Commissioning Strategies for Physical Disability and Sensory Impairment across Cumbria.

Improving the Life Chances of Disabled People – Analytical Report by the Strategy Unit Disability Project 16 June 2004 clearly identifies key barriers and potential solutions in regard to the transition into adulthood.

The Children Act 2005 and the Every Child Matters agenda highlight multi-agency partnership and co-ordination as a key to providing services to children & young people. Transition is identified as a key area for service development.

Progress So Far

Cumbria County Council and partners introduced a Transitions Protocol in 2004. This has been piloted since September 2005.

Children and Adult Social Care have jointly funded 3 Transition Coordinators since Autumn 2005 to work with young people in transition to adult learning disability services and to signpost other young people in need of assessment to appropriate services.

A transitions steering group was formed in March 2005.

A CAMHS transition policy is in place for young people with mental health needs.

Adult Social Care is piloting “In Control” with young people in transition.

Transition Coordinators and Connexions Personal Advisers are taking part in the National programme around developing person centred approaches to transition.

Continuing Challenges

Disabled young people and their families experience multiple assessments and their involvement in making decisions about their future is still inconsistent in terms of the standard of involvement.

Universal or mainstream support is not always designed or resourced to meet additional needs.

Potential Solutions

Improve integrated working at all levels, including between departments, in planning, commissioning, and delivery of services.

To equip Connexions Cumbria to identify and meet the needs of all disabled young people.

Provide young disabled people with appropriate work experience, training, apprenticeships, and further and higher education, to develop valid and valued activities for those where paid work is not an option.

Empower young people and their parents to participate in planning, make decisions, and feel informed about choices and in control.

Once implemented consistently in Cumbria, to use the Common Assessment Framework and Single Assessment Process as tools to enable the process.

The protocol developed will assist in removing some of these challenges and utilise some of the above potential solutions.

Purpose

This Protocol explains what must happen, when it must happen and who will enable this to happen from each organisation.

For the purpose of this protocol a young person with a disability includes a person with learning and/or physical disability and/or a sensory impairment / people with autistic spectrum disorders.

The Protocol starts in year 9 when a young person is approximately 14 years of age and can continue until a person reaches their 25th birthday.

It is vital that young people and their families plan for their transition as early as possible. It is equally vital that Health, Adult Social Care Directorate, Children’s Services and Connexions Cumbria fully support them in the work that is required.

An accessible guide for young people and their families is available.

3 Legal Context

The Special Educational Needs Code of Practice (2001) has led to a substantial change in the way the Transition process is carried out and who is involved.

A representative of the Adult Social Care Directorate must attend the review meetings to ensure that the parallel assessments under the Disabled Persons Act 1986, the NHS and Community Care Act 1990 and the Chronically Sick and Disabled Persons Act 1970, take place.

The law states under section 5/6 Disabled Persons Act 1986 a young person in Looked After Care Services has a right for a pathway plan under the Leaving Care Act. This act also gives the right to a school leaver assessment and says the education department should inform social services of young people with statements as decisions have to be taken to decide if a young person is disabled.

The Leaving Care Act 2000 gives the right to a Pathways Plan.

Other key legislation/guidance is contained in: -

Education Act 1996
Disability Discrimination Act 1999
Transition: getting it right for young people (NSF for Children, Young People & Maternity Services), Department of Health March 2006
‘Our health, our care, our say: a new direction for community services’, Department of Health January 2006

The following legislation, among others, has influenced how this protocol has been adapted.

National Service Framework 2004
Removing Barriers to Achievement, 2003 (DfES)
The Children Act 2005 – Every Child Matters 2004
The Disability Discrimination Act 2005
The SEN Code of Practice 2001
Mental Capacity Act 2007

4Person Centred Planning and Transition

At a child’s review from year 9 (13-14 yrs), there will be a discussion about whether a person centred plan (PCP) is needed/wanted/appropriate and who will make contact with the transition worker to identify a PCP facilitator.

The term ‘Person Centred’ has been defined by Cumbria’s Learning Disability Partnership Board as

“activities which are based upon what is important to a person from their own perspective and which contribute to their full inclusion in society”.

‘Person Centred Planning’ is an on going process and not a one off approach. It is defined as,

“a process for continual listening and learning, focussed on what is important to someone now and for the future, and acting upon this in alliance with family and friends”.

The listening and learning is used to understand a person’s capabilities and choices. Person Centred Planning is a basis for problem solving and negotiation to mobilise the resources necessary to pursue the person’s aspirations. These resources may be obtained from service agencies or from a range of non-specialist and non-service sources’.

There are a number of methods that can be used to support the Person Centred planning process for an individual. These include tools like Essential Lifestyle Planning, PATHS and MAPS.

There are some fundamental principles behind the process of Person Centred Planning. The most important of these is that the person remains in control of and at the centre of the process at all times. They should also choose how the person centred plan is to be developed, who will be involved, where people should meet, how things will be recorded etc.

The transition process is to support individuals through a period of significant change. This may include changes in, where a person lives, what they do in the day, their social and support networks and the services that they receive. Person Centred planning can provide a useful tool to start this planning process. Person Centred Planning is an on going process, not a one off process. Therefore planning through the transition period can form the basis for future planning that may go on throughout an individual’s life. It should therefore not be seen as something that has an end, rather something that will continue beyond the transition period. In the future other people may be involved and it will be necessary to revisit some areas of the plan as the person’s life and aspirations change.

5Contributions to the Transition Plan

In the next section there are various people who, depending on particular circumstance, will need to be invited to the Transition meetings. The school is responsible for the coordination and invitations to transition meetings. They will include:

Young People

It is very important that the young person has a chance to share their concerns and ideas – both inside and outside the family. Every effort must be made to ensure that the young person attends and participates in the Transition planning meetings.

‘Person Centred Planning’ is an on going process and not a one off approach. It is defined as,

“a process for continual listening and learning, focussed on what is important to someone now and for the future, and acting upon this in alliance with family and friends”.

There are a number of methods that can be used to support the Person Centred planning process for an individual. These include tools like Essential Lifestyle Planning, PATHS and MAPS.

Information for young people and advice on who can support the young person through the process is available in the Accessible Guide to Transition.

Parents/Carers or other family Members

Parents have a vital role in collecting relevant information because they know all the important people and activities in their child’s life. They also know what they may be able to do to help in the future and to understand some of the choices available.

It is essential that we find out who is important to the parent/carer so we can ensure they are invited to the transition review and planning meetings. It is helpful if the parents are asked, prior to the transition meeting, to make a checklist of everyone who has been working with the young person.

Information on who can support parents and carers through this process is available in the Accessible Guide to Transition.

Responsibilities of the SEN Service and/or schools

It is the responsibility of the SEN Service and school to:-

ensure that the correct procedures are followed;
ensure that other agencies contribute to the review where appropriate;
ensure there is consistency in terms of the standard and quality of service families receive;
identify unmet need to inform strategic planning.

The School will ensure a representative from the school attends all transition planning meetings.

Action to be taken by the SEN Service

Children’s Services will arrange to notify other agencies of young people starting the transition planning process. This includes all young people in year 8 with a statement of SEN. This list will be sent to Transition Coordinators in Adult Social Care and the Inclusion Co-ordinator in Connexions Cumbria.

In addition, in order to comply with the requirements of the Disabled Persons Act 1986 Children’s Services need to maintain a record of children and young people aged 14 and over who are physical or learning disabled. A separate list will be sent to the Adult Social Care Directorate Transition Coordinators and Connexions Cumbria Inclusion Co-ordinator for LDD each term.

ensure that the year 9 review meeting focuses on establishing a transition plan
make provision to meet the young person’s special educational needs whilst the young person remains in statutory education

For young people educated outside of the area, the SEN Service will fulfill any functions that cannot be delegated to the school.

Responsibilities of LSC

It would be helpful to make clear the LSC's legal responsibilities for young people at age 16, 17 and 18 - i.e. to consider the needs of young people with learning difficulties and/or disabilities and, in the discharge of its duties, to secure a residential placement at a specialist college for a young person of up to 19 years only if it cannot secure the provision of facilities for education or training that are sufficient in quantity and adequate in quality unless it also secures the provision of boarding accommodation for him or her. In considering requests for such placements the LSC expects that agencies involved with the young person will, with the young person and his or her family or carers, have considered all appropriate options for his or her post-16 education during transition planning and through 140 assessments.

It is important to stress that it is likely that for the majority of learners with learning difficulties and/or disabilities who do not stay at school, their learning and support needs could be met by general post-16 provision.

Generally, where a learner is under the age of 19, has a statement of special educational needs and the most appropriate placement is within a special school, the learner remains the funding responsibility of the LA. All other children are the financial responsibility of LSC.

Responsibilities of Schools

(including Pupil Referral Units, Special Schools etc)

The following actions should be delegated to schools

Arranging the year 9 review meeting and subsequent annual review meetings

The school should check with the parents/carers whether there are any other agencies or individuals who they feel it would be helpful to involve in the review. The school will arrange the review meeting in consultation with the young person and will invite:-

the young person and their parent(s)/carers;
a SEN Children’s Services representative;
other agencies as indicated by Children’s Services and the school’s knowledge of the young person’s needs and circumstances;
the young person’s advocate and the independent parental support as appropriate;

Transition Co-ordinator;
Voluntary Organisation involved in supporting the family/child in connection with their disability (e.g. Cumbria Deaf Association);
Connexions;
Health Service practitioner (where involved with the child/young person);

local advocacy scheme representative if appropriate;

arrange the year 9 review meeting and invite other agencies where appropriate;
produce and update the Transition Plan in consultation with the young person, their family and other agencies where appropriate.

The school should organise the meetings with sufficient notice to facilitate interagency planning.

Following the year 9 review meeting and subsequent annual review meetings, the School will circulate a copy of the latest Transition Plan to all agencies involved with the young person and those who attended the meeting.