The Hesley Group guide to transition planning


Published on

Published in: Health & Medicine, Education
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

The Hesley Group guide to transition planning

  1. 1. The process described applies in England and Wales. In Scotland the lawsays the young person must have a “Record of Future Needs” but theprinciples are the same. Becoming an adult,experiencing life changes, planning for thefuture and managing to acquire skillsand knowledge for independence isan important time in any youngperson’s life. When that personalso has complex needs andreceives support from social care,education and health servicesit becomes a time of complexplanning, exploration andagreeing future directionsand pathways.
  2. 2. A transition plan should bea document that addressesfuture needs of the personand how these are to be achievedand accessed. The plan shouldaddress where the person willlive and how they wish/needto be supported, in areas suchas finances, further education,health, housing, transport,work, relationships and hobbies.The transition document isessential during the last twoyears of statutory education,and should aid a smoothtransition by ensuring all theneeds of the young personare being properly met bythe right agencies.
  3. 3. The transition plan is a continuous and evolving process and therefore canchange and grow over time. The plan should draw together information froma range of individuals in the young person’s life – family and carers, staffwithin provider services, people involved externally in education, social careand health services and others and result in a plan that is effective, realisticand achievable to support the young person’s transition to adult life.Transition planning requires a lot of inter-agency working, and this is oftenwhere difficulties arise. From the start it needs to be clear what people’s rolesand responsibilities are, not only during the process, but also in the future.The involvement of a number of agencies means clear communicationchannels and agreed methods of working need to be in place in order totransfer information correctly and successfully.The people who are involved and their roles, may change during thetransition years for a range of reasons. This can be frustrating but isgenerally unavoidable. Some professionals will step in and out when needed,sometimes people move on and are replaced.However all professionals who take part need to have a clear understandingand awareness of the unique needs of the young person concerned.Of course, you can always talk to us. As an independent specialist with over35 years’ experience we have a wealth of knowledge ready to share.Call us free on 0800 055 6789 or visit
  4. 4. Involving everyoneGood inter-agency practice andsupport for young people withspecial needs is fundamental toa good transition. Recent historyand people’s stories tell us thattransition is often neglected andcommunication difficult.We know parents have to exertpressure on local authorities toachieve what they would like fortheir sons and daughters in adult life.We hope this booklet will at least help tobriefly explain how the process should work andgive a little bit of help towards achieving a smooth transition.Responsive to transition issuesAt Hesley Group we have supported the move into adult services for a greatmany young people. Some people come into our own adult residential careor supported living services and some move into accommodation elsewhere.Wherever the young people go, we always try our best to support the move ina positive way and do what we can to make the process as smooth as possible.
  5. 5. The young personIn the centre of the transition should be the child/young person. Supportingthe young person to take part in decision making can be difficult dependingon their capacity. However the young person has to be informed andconsulted. At Hesley Group our clinicians will support young people in decisionmaking. If the young person is deemed not to have capacity then a decisionwill ultimately be made in his or her ‘best interests’. How the information is tobe presented to the young person also needs to be well planned and agreed.Stepping from children’s to adult services for young people with complex needsand their families requires careful work and planning to make sure the youngpersons voice is heard, to take account of everyone’s views, to help prepareyoung people and their families and to work well across agencies.
  6. 6. Parents and carersParents and carers need to decide how they may wish to be involved with thefuture care of their son or daughter. Be prepared and have access to the rightinformation in readiness. Some actions to take:• Ask to see local guidance/policy relating to transition plan• Ask who the named school contact is• Get to know the names, job titles and responsibilities of all professionalsinvolved including the named careers advisor• Find out about target dates and deadline• Think about what is available and what choices there might be – what youwould prefer – then you are in a good position to influence the outcomeand achieve a plan that is most suitableDuring the production of the transition plan discussion should not only begeared to services and support available but should also focus on other‘ideal’ services which may not be available at the present time.It’s hard for parents to realise that at the age of 18 their son or daughterbecomes an adult and legally (no matter how they feel) they no longer haveparental responsibility. Decisions may have to be made in the young person’s‘best interests’ – please see paragraph on Mental Capacity Act 2005.Where the MCA applies to people aged 16 and over.
  7. 7. Every aspect of the young person’s life needs to be considered and takeninto account. The plan should address areas such as support needed withpersonal health and social care, further education, health, housing, transport,work, relationships, interests and hobbies.It is also important that the plan looks at what would be the ‘ideal’ provision,even if it does not exist as yet, rather than become a process of fitting intoexisting services.ProfessionalsHead TeacherHeads are responsible for starting the transition review process, inviting therelevant parties to the review meeting and ensuring that a transition planis produced.TeachersThey provide information about a young person’s interests, likes and dislikes,current and future needs. They are involved in developments and changes tothe plan that have been highlighted in earlier annual reviews.Connexions Service (only in England)Young people with complex needs and learning difficulties can havethe support of a Connexions Personal Advisor up to the age of 24.The Connexions Personal Advisor can be contacted through the school.
  8. 8. Careers Wales/Careers ScotlandThey will be involved if the young person lives in Wales or Scotland respectively.They are only responsible for further learning and employment.Local Education Authority (LEA)LEAs are responsible for carrying out statutory assessments for young peoplewith Special Educational Needs (SEN) and issuing statements.They notify the relevant representative for Connexions (in England), CareersWales or Careers Scotland of all the young people who will require a Year 9review. This happens no later than two weeks before the start of schoolYear 9. They must also tell the Social Services Department (SSD) about all theyoung people who have special educational needs who are due to leave fulltime education at the end of Year 11 or the age of 16.The LEA also offers:The Educational Psychology Servicewhich carries out specialised assessments.The Educational Welfare Servicewhich advises upon and resolves attendance issues.The Behaviour and Social Support Teamwhich can provide advice and practical support on behavioural problems.The Learning Support Servicewhich assists with hearing and visually impaired pupils.The Parent Partnershipwhich advises parents and carers about the SEN process.
  9. 9. Current Provision/Placement ProviderThe school or care provider can supply information on the current levels ofeducation or care being provided, as well as progress and achievements.Housing optionsLiving arrangements can vary considerably dependent on the level of needof the individual. Some may wish to remain in the family home or choose tolive independently. Others may require different levels of supported living,ranging from a home-helper to full time residential placements.The type of housing provision andsupport should be establishedthrough the community careassessment and detailedin their care plan.Local housingdepartments shouldwork alongside socialservices helping toidentify possiblehousing optionsavailable to theyoung person.
  10. 10. Getting the right informationSupport staff, teachers and clinicians where appropriate should be able to provideinformation that builds a picture of the young person’s strengths and areas of needs,they should also actively be involved in any development and adaptations during thechild’s remaining school years, which are recognised in the early transition reviews.A representative from adults’ social services should attend the Year 9 review.They should have been alerted by the young person’s education authority.Their duties are outlined in section 11 of the Special Educational Needs Toolkit.The transfer of responsibility from child to adult social work teams can be a confusingtime. The reviews provide the ideal opportunity for multi- agency focus andagreement.Some transition plans may require the input and advice of health representatives.For example continued psychology, speech and language therapy and/oroccupational therapy.Don’t be. Give us a call and we’ll talk you through every stage.Call us free on 0800 055 6789 or visit
  11. 11. Health and social careSocial Services Departments (SSD)SSD are responsible for community care assessments and services to whicha young person may be entitled. These can include social and leisureopportunities, respite care, supported living, Social Services Day Services,direct payments and residential care.They make the LEA aware of what services are available to families ofchildren with special needs.They carry out a multi-agency community care assessment which shouldhappen no later than three months before the young person leaves school.Some areas have specialist transition workers who provide support andadvice for parents. They help maintain good, clear communication betweenthe young person and all those involved in the transition planning process.SSD must be contacted if a young person is not already getting support sothat they can receive the appropriate assessments and services, particularlyif they will have continuing care needs after leaving school.We have a team of multi-disciplined experts we can tap into.Call us free on 0800 055 6789 or visit
  12. 12. Learning Disability Partnership BoardIn 2001, the Government produced a report called ‘Valuing People’. It is theGovernment’s plan for making the lives of adults with learning disabilities andtheir families easier.The Board is part of the local authority and sets up groups to discussadvocacy, family carers, education, health services, health care action plans,transport and person-centred planning.Health ServiceA representative from the health service may attend a transition reviewif their advice is needed on health issues. These may range from speechtherapy, occupational therapy or significant health needs, such as paediatrics,clinical psychologist (behavioural) and psychiatry. The health service oftenjointly or solely funds future placements where health needs have beenidentified.Educational Psychologists and TherapistsThese provide an educational evaluation of the current needs and anassessment of future requirements, based upon cognitive ability andbehavioural traits.Commissioner of ServicesA Commissioner of Services co-ordinates the placing of services for eithersocial services, health services or, in some cases, both.
  13. 13. If things aren’t moving in the right direction, there are plenty oforganisations out there ready to help, including us.We’re just a call away 0800 055 6789 or visit
  14. 14. What happens if transition planning does not start in Year 9?Immediately contact The School and check their responsibilitiesstated in section 9 in the SEN Code of Practice (2001). Also contact theConnexions Service (England), Careers Wales or Careers Scotland todiscuss what is involved and how a transition plan can be started.Social Services Department – if they have failed to carry out assessmentsor offer the right services to the young person, or their parents and carers,when they have identified a need then a complaint can be made. There is aformal complaints procedure and it is advisable to seek legal advice.Who can offer advice and support to protect the youngperson’s rights?Connexions Personal Advisor (CPA) – every young person between theages of 13–19 has a right to a CPA, who can be contacted through the school.For young people with complex needs and learning difficulties the support ofthe CPA is available up to the age of 24.Independent Advocate – promotes the wishes of an individual.The parents and carers of a young person will naturally act as theiradvocates. However, they may not always be aware of the opportunitiesthat are available and there may be a conflict of interests. By using anindependent advocate to assist a young person they can be assured of anindependent voice.
  15. 15. Independent Mental Capacity Advocate (IMCA) – if a young personreceives care or health services but does not have relatives or friends to helpwith decision making, then they will be entitled to an Independent MentalCapacity Advocate (IMCA).IMCAs are appointed by the Court of Protection to help support the youngperson in making decisions about serious medical treatment or a change inwhere they live, but they are not involved in day to day decision making. Thisresponsibility remains with carers or advocates.The IMCA does not make decisions for the young person but providessupport and represents their views and wishes to the Court AppointedDeputy who acts as the decision maker.Court of Protection – established by the Mental Capacity Act 2005 to dealwith decision making for adults and, in certain cases, persons under the ageof 16 who lack mental capacity. The Court will be the final arbiter for capacitymatters. It will have its own procedures and nominated judges.The Public Guardian Office – is the administrator of the court of protection andprovides financial protection services for people who are not able to manage theirfinancial affairs because of mental incapacity. The Public Guardian and his/herstaff are the registering authority for deputies.A deputy is a person appointed by The Court to manage someone’s affairs.They will also work together with agencies such as the police and social servicesto respond to any concerns raised about the way in which an attorneyor deputy is operating.
  16. 16. SEN Tribunal – parents and carers can challenge a local authority’s decisionabout a young person’s placement via the SEN tribunal process.It is advisable to seek legal advice. Unfortunately, legal aid does not cover theSEN tribunal process. SEN Tribunals are only applicable if the young person isunder the age of 19.Judicial Review Process – once the young person is 19 years or older localauthorities can be challenged through a judicial review process.Out of area placementSometimes it is very difficult to identify how a person’s needs can be metlocally, especially when the person has particularly complex support needs.If parents and carers feel that the best interests of the young person can onlybe met by an ‘out of area placement’, they have a right to request one.An ‘out of area placement’ means the young person can be placed furtherthan the current requirement of within a 30 mile radius of homeHow are a young person’s rights protected?Policies and proceduresService providers have different ways of supporting people with severelearning disabilities and complex needs. It is essential that the reason for theyoung person’s behaviour and communication needs are fully understoodand the management of their support is dealt with in a person-centred way.Parents and carers should always have the opportunity to obtain a copyof the provider’s policies and procedures which should include informationon child/adult protection, behaviour support, physical intervention, riskassessments and complaints.
  17. 17. How are the young person’s rights monitored?All service providers are monitored and inspected to make sure that they areproviding a secure environment for the individuals in their care, and that thefacilities and the opportunities that they offer meet the standards set by theinspection agencies. The main inspection agencies are:Care Quality Commission (CQC)The CQC inspects all adults health and social care services and grants thema licence to operate.The Office for Standards in Education (Ofsted)Ofsted inspects all children’s residential services and schools. Residentialservices are inspected twice a year and schools every three years.How are the people who work with children and adultsat risk monitored?People applying for jobs in social care and education are checked by the Policeand the Independent Safeguarding Authority by the Criminal Records Bureau(CRB) before they can start work.However, the best way of ensuring day to day good standards is to haveeffective quality assurance and governance systems internally, good qualitytraining and supervision of staff and effective multi-disciplinary working.We have a team of multi-disciplined experts we can tap into.Call us free on 0800 055 6789 or visit
  18. 18. The checklists provide a framework and guide to the sort of questionsthat should be considered during the transition process.If the young person lacks capacity then the parents/carers/IMCAshould ensure that decisions being made on the young person’s behalfare in his/her best interests. For you reference, please seeThe Mental Capacity Act 2005 opposite.
  19. 19. The Mental Capacity Act 2005The Act’s starting point is to confirm in legislation that it should be assumedthat an adult (aged 16 or over) has full legal capacity to make decisions forthemselves (the right to autonomy) unless it can be shown that they lackcapacity to make a decision for themselves at the time the decision needs tobe made. This is known as the presumption of capacity.The Act also states that people must be given all appropriate help andsupport to enable them to make their own decisions or to maximise theirparticipation in any decision-making process.The Act sets out a legal framework of how to act and make decisions onbehalf of people who lack capacity to make specific decisions for themselves.It sets out some core principles and methods for making decisions andcarrying out actions in relation to personal welfare, health care and financialmatters affecting people who may lack capacity, to make specific decisionsabout these issues for themselves.Any decisions or acts undertaken on behalf of a person who lacks capacitymust be taken in their best interests.For more information go to and type in mental capacity act.If you’re unsure of anything, call us on 0800 055 6789or visit
  20. 20. Young people with special needs mayneed support to ask questions. Somequestions may be:What are my options when I reach16 or 19 – stay at school/college/specialist residential college/work ortraining?What targets do I want to worktowards during the remainderof my time at school?How long can I stay at school?Where would I like to go whenI leave school?What would I like to do?
  21. 21. What support do I feel I will need ifI go to college or go to work?Who do I want to support me whenI leave school?What will my school do to helpprepare me for leaving school?Where do I want to live?Can I work?Who can I talk to if I’m worried?What interests or hobbiescan I follow?When will I see family and friends?
  22. 22. Obtain the local guidance or policyon transition planning either fromthe SEN representative at school orthe Learning Disability PartnershipBoard if represented locally.Name and contact details ofschool contact and who leadsthe transition team.Names, contact details, roles andresponsibilities of all involvedin the review.Names and contact details ofthe careers advisor, ConnexionsAdvisor, or Careers Wales orCareers Scotland.Name and contact details of theperson responsible fora person-centred plan.
  23. 23. Know the timescalesand deadlines involved.Ensure everyone involvedunderstands/has knowledgeof the child’s special needs.Be informed – find out whatoptions are available for yourchild in further education/health/housing/work/hobbies/benefitsand funding.Find out what otherfamilies have done.Contact relevant networks/groups/voluntary organisations.Find out the point in the transitionprocess at which Adult Servicesbecome involved.
  24. 24. Name and role of person who ischairing or running the meeting.Who is going to be present,what do they do, what are theyresponsible for?Time and place of meeting andtravel plans in order to arrive at themeeting on time.Agenda – a list of what is going tobe discussed.Has everyone involved received upto date information on your child?List your objectives for the meeting– what do you want to achieve?
  25. 25. Further EducationDoes the young person want tocontinue with further education?If YES what are the practical andrealistic options available?If NO what would they like to doinstead that is a practical andrealistic option?What types of colleges areavailable? (eg local or specialistresidential) Some specialistlearning disability colleges provideservices up to 25 years of age.What subjects are on offer andwhat vocational courses areavailable?
  26. 26. What activities and learningopportunities are available otherthan formal education?Health NeedsHow are the person’s health careneeds going to be met?Accommodation, Housingand Support NeedsWhere would the young person liketo live and if sharing, with whom?Is supported living an option?Does the person need to besupported in a residential setting?What would they like to do?Checklist 4 - continued
  27. 27. Checklist 4 - continuedWould the young personlike to work?What would they like to do?What type of work is availableand realistic?How can this goal be achieved?Will the right level of support be inplace before the young person entersthe workplace?Does the local area have a supportedemployment scheme which offersfull time or occasional support?HobbiesWhat opportunities are there forthe young person to continue theirhobbies and interests?Are there opportunities to developnew ones?
  28. 28. BenefitsWhat changes will there be to existingbenefits that the young personcurrently receives?What benefits and funding will theybe entitled to in the future?AspirationsWhat are the young person’s hopes,dreams, fears and worries?Is there a particular goal they wouldlike to achieve, place they would liketo visit, lifestyle they would like toachieve, etc?Inhibiting factorsAre there any factors that wouldinhibit or prevent any of the abovetaking place?How could these be overcome?
  29. 29. How will the college meet the person’s specific needs?Where is the college and is it accessible to family and friends?What facilities does it have?How many people live there?How is it staffed?This checklist provides the opportunity to directly compare anumber of different residential FE colleges at a glance.Always try to identify a residential college that can meet the youngperson’s particular learning and support needs. Things to consider are:
  30. 30. College name: College name: College name:
  31. 31. Checklist 5 - continuedHow are student groups/classes organised?What teaching and learning is provided?What specialist support and equipment is available?What is there to do outside college time?How are family and friends supported to spend time with the person?How do they manage the quality of their service?
  32. 32. College name: College name: College name:
  33. 33. This checklist provides the opportunity to directly compare anumber of different specialist care providers at a glance.Always try to identify a specialist care provider that can meet the youngperson’s particular daily life and support needs. Things to consider are:How will the specialist care provider meet the young person’s specific needs?Where is the specialist care provider and is it accessible to family and friends?What facilities does it have?Is it accessible to people with a physical disability?
  34. 34. Specialist CareProvider 1Specialist CareProvider 2Specialist CareProvider 3
  35. 35. Checklist 6 - continuedHow many people live there?How is it staffed?What specialist support is available?What is the housing or residential accommodation like?What activities can the person take part in? For example, can the person accesswork, leisure and vocational activities as well as accessing the local community?How are family and friends supported to spend time with the person?How do they manage the quality of their service?
  36. 36. Specialist CareProvider 1Specialist CareProvider 2Specialist CareProvider 3
  37. 37. Year 9 reviewHead Teachers are responsible forstarting the transition review process,inviting the relevant parties to the Year9 review meeting and ensuring thata transition plan is produced. The LEA,Connexions (England only), Children’s Servicesand the Health Service are involved in this process.Every young person has the right to a Connexions PersonalAdvisor between the ages of 13 and 19. In some casesthis can be extended up to the age of 24.Careers Wales or Careers Scotland willbe involved if the young person lives inWales or Scotland respectively. They areonly responsible for further learning andemployment.We know you’ve got enough to think about,so we’ve summed it all up for you.
  38. 38. Year 9 (age 14) to Year 10 (age 15)The person’s needs are identified and assessed. A person-centred plan andhealth needs action plan are created and subsequently reviewed annually.Amendments are made as appropriate to identify and take into accountwhat the person will require when they reach the school leaving age.Year 11 (age 16)A multi-disciplinary team (Transition Social Worker, Education andHealth professionals) annually re-assess the young person’s needs andchanging requirements.The Transition Social Worker and Manager carry out a core care assessmentand identify education, care and health needs of the young person.Age 19Parents/carers/members of the multi-disciplinary team check on and visitproviders that can meet the person’s assessed care and support needs.If a place is found – The transition from one provider to another takes place.• The provider will spend time with the person and their family.• If the provider is suitable a place will be offered.• A contract will be signed by the provider and the placing authority.• A transition meeting will take place with the provider and a plan agreedfor moving.• The person will move to the new service.
  39. 39. General adviceBritish Association for SupportedEmployment:www.base-uk.orgCitizen’s Advice 0800 988 7554Directgov - Young Wales:www.careerswales.comCareers 0845 8502 502Health 020 7210 4850Social Services Departments (SSD):Contact your local council who willadvise you on the best person tocontactCourt of 0300 456 4600HousingHousing 0845 456 1497Association for Supported Living:www.associationsupportedliving.orgTel: 01993 772885EducationSkills Funding Person’s Learning Association of 0121 428 5050
  40. 40. SKILL – National Bureau forStudents with Disabilities:www.skill.orgTel: 0207 450 0620British Institution of LearningDisability (BILD) and financeBenefits Enquiry Line:0800 882200 (freephone) Completion Service:0800 441144 (freephone)Family Fund:Tel: 0845 130 45 42Direct Payments: A parent’s guideto direct payments (Departmentfor Education) Social Care Institute forExcellence (SCIE) 0207 089 6840Direct Payments - Frequently AskedQuestions. Tel: 020 7089 6840 forthis free publicationSocietiesNational Autistic 0207 833 22 0207 454 0207 619 7100The Challenging 01634 838739
  41. 41. Advocate – a person who intercedesor speaks on behalf of another.Applied Behaviour Analysis –analysis of functions and developingstrategies for changing negativebehaviour.ASC – Autistic Spectrum Condition.ASD – Autistic Spectrum Disorder.AtW – Access to Work.Care plan/support plan – a plandeveloped for an individual’s careand support.Clinical assessment – anassessment by medical professionals.Cognitive theory – an approachin psychology that tries to interpretbehaviour, emotions etc in terms ofthe knowledge or image of reality.Complaint – the act of complaining;an expression of grievance.CQC - Care Quality Commission –register and inspect hospitals, GPsurgeries, dentists, clinics and carehomes for adults and supportedliving home care.CRB – Criminal Records Bureau.DH – Department of Health.Domiciliary Care Organisation –an organisation which provides careworkers to work within the home ofa person to give support and care.ILF – Independent Living Fund.ISA – Independent SafeguardingAuthority.LEA – Local Education Authority.MCA – Mental Capacity Act.Mental Health Assessment –an assessment of the mental/emotional wellbeing.
  42. 42. Mental Health Act Assessment –assessment under the 1983 Act todetermine whether psychiatric inpatient care is required.Ofsted – Office for Standards inEducation, Children’s Services andSkills. Inspects and regulates carefor children and young people, andinspects education and training forlearners of all ages.PCP – Person-Centred Planning.Person-centred plan – a planbased on individual needs andpreferences.Psychiatry – branch of medicineconcerned with the diagnosis andtreatment of mental disorders.Psychology – the scientific studyof all forms of the function ofbehaviour, sometimes concernedwith how behaviour can be modified.SEBD – social, emotionalbehavioural difficulties.SEN – Special Educational Needs.Speech and Language Therapy –support with communication,also with swallowing difficulties(dysphagia).SSD – Social Services Department.Statement of SpecialEducational Needs (SEN) –a document the LEA putstogether after a series of statutoryassessments of the child’s specialneeds. A child may be assessedand issued a SEN from as early as 4years, and the SEN normally finisheson the child’s 19th birthday whenthe person-centred plan/transitionplan takes effect.Tribunal – Court of justice or anyplace where justice is administered.
  43. 43. Call us on 0800 055
  44. 44. Call us on 0800 055
  45. 45. Call us on 0800 055
  46. 46. Call us on 0800 055
  47. 47. Call us on 0800 055
  48. 48. Call us on 0800 055
  49. 49. Call us on 0800 055
  50. 50. Call us on 0800 055
  51. 51. We hope you found our transition guide helpful. We want it to be as useful aspossible. So if you think we’ve missed something please let us know and we’lldo what we can to include it in our next edition.Email: ServicesHesley HallTickhillDoncasterDN11 9HHFreephone: 0800 055 6789Facsimile: 01302 861661Email: