Children and young people are fulfilling their potential and achieving their goals by being prepared for adulthood early

Introduction

Planning for adulthood begins early and is based on young people’s individual needs, interests, and circumstances.

We are committed to ensuring young people with SEND can have choice and control over where to live and that wherever possible young people are supported to live independently.  We will work with families and young people to support independence from as early an age as possible. We recognise the importance of continuity of support where needed as critical to the positive experience of becoming an adult. This commissioning priority sits alongside priorities for the operational delivery of statutory services such as Preparing for Adulthood Team, Adult Social Care and adult Health Services.

Local needs

The 18-21-year-old cohort of young people with SEND who transition to Adult Social Care (ASC) in any given year is variable. The mean averages each year is 156, which ranges from between 133 and 189. There is a general upward trend over the last three years. During this period, an increasing proportion of young people with identified SEND meeting Care Act eligibility but who do not have an EHCP (rising from 27% in 2018-19 to 36% in 2020-21) Further analysis on the needs of young people is underway to ensure the right service responses are in place.

Of young people transitioning to Adult Social Care who have an ECHP, the proportion with a primary need of autism has remained consistent over the last three years.  However, the proportion with any learning disability has steadily dropped from 20% in 2018-19 to 15% in 2020-21. SLCN, SEMH and sensory impairments needs have remained relatively consistent over the last three years, while the proportion of young people with physical disabilities requiring ASC support has dropped to 2018-19 levels following a spike in 2019-20.

Where we are now

The joint strategy between Devon County Council and Devon Clinical Commissioning Group Healthy Lives, Vibrant Communities, Housing Choices 2020-2025 outlines the shared strategic intentions to provide sufficient accommodation and support options to enable those approaching adulthood, who receive health and care support, to maximise their capability to live independently in the community as adults.

From the age of 14 or year 10/11 young people with SEND are offered support from the Preparing for Adulthood team. This is to support effective transition to adult services where young people are eligible for ongoing care and support. The offer from this team can be found here. 

There continue to be challenges to meet the accommodation needs of young people, who are becoming adults, with barriers around providers needing to comply with dual regulatory frameworks of Ofsted and CQC. This can cause significant disruption at a critical point in the lives of those young people. In addition, to minimise any disruption, we will focus on improving appropriate matching for accommodation to ensure young people are not living in adult settings which are not able to meet their individual needs. We are committed to do this through creative joint commissioning and market development.

Devon Partnership Trust are commissioned to provide Adult Mental Health and Autism[32] diagnostic and assessment and treatment services. With the Council providing an Autism community support team of Social Workers. Under the Sustainability and Transformation Plan (STP) a programme of change was underway in 2019 to further develop multidisciplinary support teams for adults with autism. This was paused, during 2020, due to COVID-19 but it remains a key part of the restoration plans. The programme of change included the development of pre and post diagnostic services including assertive outreach.

The Designated Medical Officer and Designated Clinical Officers have identified that for some young adults with SEND their transition and access to specialist therapy services such as physiotherapy, occupational therapy and speech and language therapies has been difficult due to the differences in the services being offered. Sensory processing differences, augmented communication needs and other therapies may be specified in the provision in a young adult’s EHCP, however due to the differences in paediatric and adult services being offered there can be delays whilst the provision is put in place. In addition, we have identified that we are not meeting the complex needs of some care leavers and it is a priority to improve this support up to the age of 25 so that they can live happy and fulfilled lives as adults.

We are committed to resolving the limitations to the community therapy provision post 18 set out here:

• SALT is accessible for young adults only with a diagnosis of learning disability meaning very few children are eligible for the offer in adulthood,
• OT if provided through transition by the Preparing for Adulthood Team OT. CFHD refer to Care direct Adult services for statutory provision usually at the latest by 17 ½ years and joint work until 18 years to ensure good transition
• CFHD are building stronger links with Improving Access to Psychological Therapies (Talk Works) regarding our sensory pathway
• Young People with severe or profound learning disability and ongoing physiotherapy needs have a clear transition to the adult Learning Disability service
• Young people without a Learning Disability have access to general community physiotherapy whose priorities are intermediate care. This is a gap as there are not expertise or services available to meet the needs of children with severe cerebral palsy, spinal and head injury, muscular dystrophy for example.  There is a gap in expertise in neuro-disability related to childhood.  Awareness of the responsibilities post 18 in line with SEND reforms requires improvement
• Children with pure rheumatology, orthopaedic, musculoskeletal conditions transition to specialist services acute consultant led care earlier at 12-14 years
• We have in place a CAMHS to Adult Mental Health transition protocol however a review of this in 2020 determined improvements are needed. This is a priority under the NHS Long Term Plan Mental Health work stream. In addition, the development of a bespoke young adult mental health service will be scoped, designed, and implemented.

During 2020 we reviewed the transition to adult care for young people with complex medical conditions involving physical and severe learning disabilities.

A focus group with parents of young people with complex health conditions attending a Devon special school confirmed that transitions from paediatric to adult health services was not smooth.  A pilot project funded by Together for Short Lives provided the resources for a trial of a multi-disciplinary Pathway Clinic; service evaluation confirmed the positive impact on parent/carer and their young adult- aged children, thereby securing future NHS funding. The result has been the creation of an expert multi-disciplinary team within secondary care combining skills from community child health, transition, palliative medicine, general medicine, and movement disorders. The clinics are enhanced by multi-agency involvement with education and social care colleagues.

[32] Devon Adult Autism and ADHD Service (DAANA) | DPT

What we will do

In response to the needs analysis data above and feedback from young adults, children, young people, parents and carers we have set the priorities below:

• We have in place a CAMHS to Adult Mental Health transition protocol however a review of this in 2020 determined improvements are needed. This is a priority under the NHS Long Term Plan Mental Health work stream.  In addition, the development of a bespoke young adult mental health service will be scoped, designed, and implemented. Review the number of 18-25-year olds accessing Talkworks, Kooth and EH4MH and evaluate outcomes to inform future commissioning.
• Due to the limited progress in determining the community therapies offer 18-25to meet the SEND needs of children under the SEND Improvement Plan we will undertake a rapid improvement task and finish group between May and July 2021. This will conduct an analysis of the demand and provision for this age group to inform the improvement and commissioning of local services to meet these identified needs. Including resolving the pathway for SALT, OT and Physiotherapy post 18. By September 21 we will have an agreed system plan in place that will set out how we will address the identified needs and gaps and implement the necessary changes to meet these needs  To enable provision to meet need to at last 25 in line with requirements.
• The new service delivery model for community mental health services will align support through primary care networks and ensure that young people with SEND, up to the age of 25 will have access to holistic, multi-disciplinary and consistent mental health support.
• Deliver the outcomes of the Adult autism and learning disability STP business case to develop pre and post diagnostic support and review impact
• Increasing the capacity of all providers to focus on the independent living skills for children with SEND throughout their life, ensuring EHCPs are clearly specifying independent living outcomes and conducting joint reviews to assess the young person’s transition to adulthood.
• The Councils adult enabling offer (Reaching for Independence) has changed in early 2021 to begin from age 17, instead of age 18 this will work to develop great independence skills for young people earlier and enable young people to confidently thrive as young adults.  Review the impact of this Winter 2021.
• To support the development of Reaching for Independence the short breaks project will focus a workstream on jointly commissioning and developing with the voluntary and community sector to improve access to community-based activities for young people moving through transitions and into adulthood
• Through Preparing for Adulthood team put in place earlier and more effective working with disabled young people, who meet threshold to transition to Adult Social Care, to understand their needs and jointly-commission housing within their community. This will be done with the aim of enabling the young adult to thrive, become independent and avoid the need for residential care.
• As set out in the Healthy Lives, Vibrant Communities, Housing Choices 2020-2025 work with District Councils and providers to ensure they are developing the types of homes we need in Devon for young people with SEND as they become adults.
• Improve information about housing options so that young people can make informed plans about how and where they would like to live throughout their lives, and they know how to access.
• Continue to work closely with all Devon, Plymouth and Torbay local authorities, and the CCG, to develop community-based housing for people with complex needs. We will co-ordinate and share knowledge on housing, health, and care widely across the county.
• Develop a range of accommodation and support options from 16+ years of age that are based in communities. This includes improved access to Shared Lives schemes, Supported Living options, general housing and increasing the availability of accommodation options around education establishments to support the move into independent living.
• Develop CQC registered short-term crisis support for young adults with complex needs, based in local communities.
• During Summer 2021, the CCG and Devon Children’s and Adults’ services will review transition processes, producing recommendations for improvements. The review will be conducted alongside young people and families and include a consideration of the joint funding and decision-making for accommodation and placement choices.
• In addition, we will also increase and improve the understanding of SEND among adult workforce and senior managers through training and development of staff. As part of the SEND Transformation this will include identifying ‘SEND champions’ who will work with colleagues to embed change and enable robust and effective multi-disciplinary and collaborative working to support and provide high-quality and outcomes-focused support to young people with SEND as they become adults.

How we will know we are making a difference

Outcomes for children and young people

•  Increased number of young people 18-25 have their health needs met in the community.
• There are more young people with SEND who are satisfied that they have a clear plan for transition to adulthood.
• Young people feed-back more positively about agreed outcomes being achieved and improved trust and confidence in the support they receive and the services that deliver them
• Families and carers express a high level of satisfaction with the outcomes for their young people and improved trust and confidence in the services that support them.
• An increased proportion of young adults with SEND are living independently (either in housing with care or mainstream housing)
• Fewer young people are transitioning to residential care at age 18. Or are accommodated in unsuitable accommodation if Care Leavers with SEND needs.
• Young people are supported to have choice and control about how they can live independently.

Outcomes for services

• Services are aware of their responsibilities to meet the needs of young adults with an EHCP up to 25 and have clear transition arrangements in place for continuity of care
• We have expanded the access to accommodation and support within the community, including in the event of a crisis, for young people with SEND, with a focus on care-experienced young people
• Housing options for young adults are better informed by local needs, interests, and circumstances
• There are clear and effective transition processes and pathways in place across services for young people with SEND to continue to receive the help and support they need when they turn 18
• Frontline professionals, managers, commissioners, and strategic leaders across services will have an improved knowledge of local housing, health and care needs and provision.