The aim of Transforming Care is to improve the lives of children, young people and adults with learning disabilities and/or autism who display behaviours that challenge, including those with a mental health condition.
The programme has three key aims:
- To improve the quality of care for people with a learning disability and/or autism
- To improve the quality of life for people with a learning disability and/or autism
- To enhance community capacity, thereby reducing inappropriate hospital admissions and length of stay
The Transforming Care Lead for Children and Young People in Islington is Sheron Hosking (email@example.com).
The original Care and Treatment Review (CTR) policy was published by NHS England in 2015, as part of the wider Transforming Care work.
This was updated in 2017 to include a section specifically for children, and the introduction of Care, Education and Treatment Reviews (CETRs), recognising the importance of the role of education within a child’s life.
CETRs are specifically for children and young people up to the age of 18 who are facing potential admission to, or are patients in, a specialist learning disability or mental health hospital and who are the commissioning responsibility of NHS England or Islington CCG (i.e. they fund the placement).
After 18, the young person will come under the adults’ policy and process; this is very similar to the children’s process in many respects. These reviews are called CTRs.
Anyone, including the child or young person, or their family, can request a CETR. However, CETRs cannot take place without the consent of the child or young person, or where this is not possible (either because of their age or they have been assessed as lacking capacity) their parent/guardian or carer.
If you are a young person or a parent/carer and want to request a CETR, you need to speak to your social worker, the health professional leading on your or your child’s care, or your or your child’s SEN Keyworker. They will discuss the request with you, and can escalate the request to the responsible commissioner.
The Admission Avoidance Register is a register of children and young people for who there are concerns that they are at risk of being admitted to a specialist learning disability or mental health hospital. This will mainly be for children and young people who have a learning disability or autism or both who display, or are at risk of developing, behaviour that challenges or mental health conditions who were most likely to be at risk of admission.
Potential relevant risk factors include (but are not exclusive)
- Already in a residential 52 or 38-week placement but providers are raising concern at their ability to be able to meet their ongoing needs
- Is in a JAP placement which is consider to be unstable
- Is displaying significant challenging behaviours that providers are raising as being of significant concern
- Has previously had a CAMHS T4 admission and there remain concerns
- Is known to the criminal justice system / Youth Offending Service and there are concerns about mental health / challenging behaviour
- Is presenting significant challenging behaviours at the Integrated Learning Space (ILS) and there is concern about their ability to meet their ongoing needs.
A child or young person can only be included on the register if they (or their parent/guardian or carer) have given their consent. There is a form that needs to be completed and signed, and this can be requested from your social worker, SEN key worker or health professional who leads on your or your child’s care.
Many of the children and young people who are on the Admission Avoidance Register will be known to existing services such as SEN, Disabled Children’s services, or Children Looked After.
If a child or young person is placed on the Admission Avoidance Register, this means that we can ensure that they are receiving support to enable them to stay in the community, and that their needs are less likely to escalate to the point of needing a CETR and are at risk of being admitted to hospital. A child or young person will only require a CETR at the point of which all current community services have been exhausted.
The aim of a CETR is to facilitate a process of exploring alternatives to hospital admission. If this is not possible, it will continue whilst the child or young person is an inpatient, through their assessment and treatment, and their discharge.
There are three different types of CETR
- Community CETR - takes place when the child or young person is living in the community (this could also include if they live in a residential placement)
- Post-admission CETR
- Inpatient CETR - takes place when the child or young person is in a specialist learning disability or mental health hospital
A community CETR will take place when it is highlighted that the child or young person is at risk of being admitted to hospital. The aim of this CETR is to seek alternatives to hospital admission, exploring what other services or options are available to keep the child or young person in the community; this will include exploring the option of a Personal Budget.
Sometimes in an emergency situation it is not possible for a community CETR to take place. A community CETR should not be used to hold up the process of admitting someone to hospital if this is needed.
A post-admission CETR will only take place if no community CETR took place. It will take place within 2 weeks of admission.
An Inpatient CETR will take place every 3 months whilst the child or young person is in hospital. The CETR will be solution-focussed, looking at ways to overcome any barriers to the child or young person being discharged, and will agree any actions and timelines for this happening, as well as making it clear who is responsible for those actions taking place.
There are principles which sit at the heart of CETRs which the CETR Panel should always uphold. These are:
- Person-centred and family-centred
- Evidence based
- Rights led
- Seeing the whole person
- Open, independent and challenging
- Nothing about us without us
- Action focussed
- Living life in the community
The CETR must include:
- The child or young person (if they choose to attend)
- Family members (if the young person wants them to be there)
- The responsible commissioner (usually the local CCG if a community CETR, or NHS England if a post-admission or Inpatient CETR)
- Responsible Clinician or Senior Nurse
Other people or services who may be helpful/appropriate:
- Social Worker
- SEND key worker
- School representative
- Youth Offending Team
- VCSE organisations who the young person is known to/involved with
- Virtual School
- Adult social care/Transitions team (if young person is over 14 years old)
The process uses ‘Key Lines of Enquiry’ (KLOE) which helps to put together a summary and feedback for the child or young person which says:
- Am I safe?
- What is my current care like?
- Is there a plan in place for my future?
- Do I need to be in hospital for my care and treatment?
The CETR itself will not decide whether the child or young person is discharged. What it should do is ensure that there are clear plans in place for when the child or young person is discharged, and that the right support is in place to make the discharge a success.
NHS England have developed ‘Discharge Steps and Standards’ to support those involved in the CETR process plan for when someone is leaving hospital. This includes ensuring there are follow up meetings, and plans to ‘check-in’ with the family to ensure that things are working well.
Islington CCG and London Borough of Islington are currently in the process of commissioning a Positive Behaviour Support service to work with children and young people who are likely to be part of the Transforming Care Group.
This services will provide intensive behavioural analysis and therapeutic intervention for CYP with a learning disability/ ASC who display behaviour described as challenging and who are potentially at risk of family breakdown and residential or hospital placement.
The service will enable a detailed assessment and analysis of a child or young person’s behaviours which will inform the development of a positive behaviour support plan that parents and carers and other professionals working with the young person will be supported to implement in a consistent and effective way, intensively over an agreed period of time. The service will work intensively with identified CYP and their parents and carers.
It is anticipated this service will be established by July 2018 and once it is we will provide more details to the service and how to access it on the local offer.
NHS England are working nationally to develop local Community Forensic CAMHS services. These services, will be based in the community and will work with local services to support the assessment, planning and where necessary risk management of CYP with complex mental health needs who may be a risk to themselves or others.
It is anticipated this service will be fully established by September 2018. As the service develops we will update this section of the local offer.