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Transition from children's to adults' services

About

What is covered

This interactive flowchart covers the transition from children's to adults' services for young people using health or social care services. It aims to improve the planning and delivery of care, and young people's experience as they move from children's to adults' services. It focuses on all young people aged up to 25 years old who are going through a planned transition, including those who have mental health problems, are disabled or who are looked after.

Updates

Updates to this interactive flowchart

20 December 2016 Transition from children's to adults' services (NICE quality standard 140) added.

Your responsibility

Guidelines

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this interactive flowchart is not mandatory and does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the interactive flowchart to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Short Text

Everything NICE has said on transition from children's to adults' services for young people using health or social care services in an interactive flowchart

What is covered

This interactive flowchart covers the transition from children's to adults' services for young people using health or social care services. It aims to improve the planning and delivery of care, and young people's experience as they move from children's to adults' services. It focuses on all young people aged up to 25 years old who are going through a planned transition, including those who have mental health problems, are disabled or who are looked after.

Updates

Updates to this interactive flowchart

20 December 2016 Transition from children's to adults' services (NICE quality standard 140) added.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Transition from children's to adults' services (2016) NICE quality standard 140

Quality standards

Transition from children's to adults' services

These quality statements are taken from the transition from children's to adults' services quality standard. The quality standard defines best practice in transition from children's to adults' services and should be read in full.

Quality statements

Planning transition

This quality statement is taken from the transition from children’s to adults’ services quality standard. The quality standard defines best practice in the transition from children’s to adults’ services and should be read in full.

Quality statement

Young people who will move from children’s to adults’ services start planning their transition with health and social care practitioners by school year 9 (aged 13 to 14 years), or immediately if they enter children’s services after school year 9.

Rationale

Starting to plan their transition as early as possible can lead to a better experience for young people moving from children’s to adults’ services. Early planning allows a more gradual process. A sudden move to adults’ services with no time for preparation or support can lead to young people and their families losing confidence and disengaging with services. Early planning, led by the health and social care practitioners but with full involvement from the young person, allows young people more time to be involved in decisions and to adjust to changes to their future care. It is recognised that for some young people, those covered by health and social care or education legislation, early transition planning is already a legal requirement.

Quality measures

Structure
Evidence of local arrangements to ensure that young people who will move from children’s to adults’ services start planning their transition with health and social care practitioners by school year 9 (aged 13 to 14 years), or immediately if they enter children’s services after school year 9.
Data source: Local data collection.
Process
a) Proportion of young people in school year 9 (aged 13 to 14 years) who will move from children’s to adults’ services who have started planning their transition.
Numerator – the number in the denominator who have started planning their transition.
Denominator – the number of young people in school year 9 (aged 13 to 14 years) who will move from children’s to adults’ services.
Data source: Local data collection.
b) Proportion of young people entering children’s services after school year 9 and who will move to adults’ services who started planning their transition immediately.
Numerator – the number in the denominator who started planning their transition immediately.
Denominator – the number of young people entering children’s services after school year 9 and who will move to adults’ services.
Outcome
a) Satisfaction with planning for transition and transfer as reported by young people and their carers.
Data source: Local data collection.
b) Proportion of young people attending adults’ services after transfer from children’s services who continue to engage with services (for measurement purposes this could be engagement at 1-year after transfer).
Data source: Local data collection.
c) Proportion of young people who have transferred from children’s services, who do not attend their first meeting or appointment with each adults’ service.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (children’s and adults’ health, mental health and social care providers) ensure that systems are in place to identify young people who will move from children’s to adults’ services and to start planning their transition by school year 9 (aged 13 to 14 years), or immediately if they enter children’s services after school year 9.
Health and social care practitioners (such as hospital consultants, nurses, social workers and mental health workers) involve children and young people in planning their transition from children’s to adults’ services by school year 9 (aged 13 to 14 years), or immediately if they enter children’s services after school year 9.
Commissioners (clinical commissioning groups, local authorities and NHS England) ensure that they commission services that identify young people who will move from children’s to adults’ services and start planning their transition by school year 9 (aged 13 to 14 years), or immediately if they enter children’s services after school year 9. Commissioners should ensure that the planning involves the young person and their parents and carers, as well as the practitioner.
Young people who will move from children’s to adults’ services work with their health or social care practitioners to start planning for the move by school year 9. For young people who enter children’s services after year 9, planning for the move should start immediately. Early planning gives young people time to be involved in decisions and to understand and adapt to changes in their future care.
Parents and carers of young people who will move from children’s to adults’ services are involved from the start in planning for the move. This gives them time to understand and to adapt to changes in the young person’s future care. Their level of involvement will depend on the needs and preferences of the young person.

Source guidance

Annual meeting

This quality statement is taken from the transition from children’s to adults’ services quality standard. The quality standard defines best practice in the transition from children’s to adults’ services and should be read in full.

Quality statement

Young people who will move from children’s to adults’ services have an annual meeting to review transition planning.

Rationale

Transition is a lengthy process that starts early, by school year 9 (aged 13 to 14 years), and continues past the point of transfer. Regular review of transition planning ensures that a young person’s changing needs are taken into account. Transition planning should be reviewed at least annually, but for some young people the meetings may need to be more frequent, depending on their individual needs.

Quality measures

Structure
Evidence of local arrangements to ensure that young people who will move from children’s to adults’ services have an annual meeting to review transition planning.
Data source: Local data collection.
Process
Proportion of young people, older than school year 9, who will move from children’s to adults’ services who have had a meeting in the previous 12 months to review transition planning.
Numerator – the number in the denominator who have had a meeting in the previous 12 months to review transition planning.
Denominator – the number of young people older than school year 9 who will move from children’s to adults’ services.
Data source: Local data collection.
Outcome
a) Satisfaction with planning for transition and transfer as reported by young people and their carers.
Data source: Local data collection.
b) Proportion of young people attending adults’ services after transfer from children’s services who continue to engage with services (for measurement purposes this could be engagement at 1-year after transfer).
Data source: Local data collection.
c) Proportion of young people who have transferred from children’s services, who do not attend their first meeting or appointment with each adults’ service.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (children’s and adults’ health, mental health and social care providers) ensure that systems are in place for young people who will move from children’s to adults’ services to have an annual meeting to review transition planning.
Health and social care practitioners supporting transition (such as the lead clinician, care coordinator or named worker) take part in an annual meeting to review transition planning for young people who will move from children’s to adults’ services.
Commissioners (clinical commissioning groups, local authorities and NHS England) ensure that they commission services that arrange an annual meeting to review transition planning for young people who will move from children’s to adults’ services.
Young people who will move from children’s to adults’ services have a meeting each year to talk about planning for the move and check that the plans are still suitable for them. The meeting should involve practitioners supporting the young person, and parents and carers.
Parents and carers of young people who will move from children’s to adults’ services are involved in a meeting each year to review planning for the move. The meeting ensures that parents and carers feel involved and know about future changes to services and care that the young person will receive.

Source guidance

Definitions of terms used in this quality statement

Annual meeting
The annual meeting should involve the young person, their parents or carers and input from the lead practitioners providing support.
The meeting can take place either in person or via teleconferencing or video.
The meeting should identify what is working well in the transition planning and what can be improved. The young person should be treated as an equal partner and their views taken into account. At the meeting there should be a review of the young person’s current:
  • clinical needs
  • psychological status
  • social and personal circumstances
  • caring responsibilities
  • educational and vocational needs
  • cognitive abilities, and
  • communication needs.
[NICE’s guideline on transition from children’s to adults’ services for young people using health or social care services, recommendations 1.1.2, 1.1.4, 1.2.4 and expert opinion]

Named worker

This quality statement is taken from the transition from children’s to adults’ services quality standard. The quality standard defines best practice in the transition from children’s to adults’ services and should be read in full.

Quality statement

Young people who are moving from children’s to adults’ services have a named worker to coordinate care and support before, during and after transfer.

Rationale

Transition can be a difficult time for young people and their families, because it is a lengthy process and involves various professionals and services. A single point of contact – preferably a person that the young person knows and trusts – can coordinate care and signpost to appropriate support. This can increase attendance in adult services and lead to a better experience of care and better outcomes.

Quality measures

Structure
Evidence of local arrangements to ensure that all young people who are moving from children’s to adults’ services have a named worker to coordinate care and support before, during and after transfer.
Data source: Local data collection.
Process
Proportion of young people who are moving from children’s to adults’ services who have a named worker to coordinate care and support before, during and after transfer.
Numerator – the number in the denominator who have a named worker to coordinate care and support before, during and after transfer.
Denominator – the number of young people who are moving from children’s to adults’ services.
Data source: Local data collection.
Outcome
a) Satisfaction with planning for transition and transfer as reported by young people and their carers.
Data source: Local data collection.
b) Proportion of young people attending adults’ services after transfer from children’s services who continue to engage with services (for measurement purposes this could be engagement at 1-year after transfer).
Data source: Local data collection.
c) Proportion of young people who have transferred from children’s services, who do not attend their first meeting or appointment with each adults’ service.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (children’s and adults’ health, mental health and social care providers) ensure that systems are in place for young people who are moving from children’s to adults’ services to have a named worker to coordinate care and support before, during and after transfer.
Health and social care practitioners (such as hospital consultants, nurses, youth workers, social workers, mental health workers and transition workers) work with the young person who is moving from children’s to adults’ services to identify a named worker and then work with this practitioner to coordinate care and support before, during and after transfer.
Commissioners (clinical commissioning groups, local authorities and NHS England) ensure that they commission services that work with young people who are moving from children’s to adults’ services to identify a named worker to coordinate care and support before, during and after transfer.
Young people who are moving from children’s to adults’ services should be helped to choose a single worker – preferably someone that they know and trust – to act as a named worker who coordinates care before, during and after transfer. The named worker acts as a link with staff providing support, including the young person’s GP. The named worker should arrange appointments, as well as providing support to the young person and their family.
Parents and carers of young people who are moving from children’s to adults’ services can contact the named worker for information and support for themselves. If appropriate, they can also ask the named worker for extra support for the young person to help with the move.

Source guidance

Definitions of terms used in this quality statement

Named worker
The named worker is a role rather than a job title. This should be one of the people from among the group of workers providing care and support to the young person, who has been designated to take a coordinating role. The young person should help decide who this person should be. It could be, for example, a support planner, a nurse, a youth worker, an allied health professional or another health or social care practitioner. It could also be someone who already has the title keyworker, transition worker or personal adviser. The transition process is lengthy and it would be expected that the named worker may change over time.
A named worker should oversee, coordinate and deliver transition support. They should be the main link with other practitioners, particularly if a young person receives care from more than one service. They should arrange appointments for the young person, act as their representative, direct them to other services and sources of support, and support the young person’s family if appropriate.
The named worker should be involved throughout transition, supporting the young person before and after transfer until a time agreed with the young person and their family. The named worker should hand over responsibilities to a practitioner in adults’ services (if they are based in children’s services).
[NICE’s guideline on transition from children’s to adults’ services for young people using health or social care services, recommendations 1.2.5, 1.2.6, 1.2.7 and 1.2.9]

Introduction to adults’ services

This quality statement is taken from the transition from children’s to adults’ services quality standard. The quality standard defines best practice in the transition from children’s to adults’ services and should be read in full.

Quality statement

Young people who will move from children’s to adults’ services meet a practitioner from each adults’ service they will move to before they transfer.

Rationale

Young people may feel unsure about moving to adults’ services, especially if they have been with children’s services for a while. Meeting a practitioner who will take a lead role in their future care, at least once, from each of the adults’ services they will move to can help build a young person’s confidence, reduce their concerns and increase their willingness to have new practitioners involved in their care. This can lead to a smoother transition for the young person and more regular attendance at appointments in adults’ services, with better outcomes.

Quality measures

Structure
Evidence of local arrangements to ensure that young people who will move from children’s to adults’ services meet a practitioner from each adults’ service they will move to before they transfer.
Data source: Local data collection.
Process
Proportion of young people who moved from children’s to adults’ services who met a practitioner from each adults’ service they moved to before they transferred.
Numerator – the number in the denominator who met a practitioner from each adults’ service they moved to before they transferred.
Denominator – the number of young people who moved from children’s to adults’ services.
Data source: Local data collection.
Outcome
a) Satisfaction with planning for transition and transfer as reported by young people and their carers.
Data source: Local data collection.
b) Proportion of young people attending adults’ services after transfer from children’s services who continue to engage with services (for measurement purposes this could be engagement at 1-year after transfer).
Data source: Local data collection.
c) Proportion of young people who have transferred from children’s services, who do not attend their first meeting or appointment with each adults’ service.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (children’s and adults’ service managers) ensure there are systems in place for young people to meet a practitioner from each adults’ service they will move to before they transfer from children’s to adults’ services. These may include joint appointments, joint clinics, and pairing of a practitioner from adults’ services with one from children’s services.
Health and social care practitioners from adults’ services (such as hospital consultants, nurses, social workers and mental health workers) meet the young people who will move into their service before they transfer.
Commissioners (clinical commissioning groups, local authorities and NHS England) ensure that they commission adults’ services in which practitioners meet young people before they transfer from children’s services.
Young people who will move from children’s to adults’ services meet someone from each of their new adults’ services before they transfer, to help them feel more confident about the move.

Source guidance

Missed first appointments after transfer to adults’ services

This quality statement is taken from the transition from children’s to adults’ services quality standard. The quality standard defines best practice in the transition from children’s to adults’ services and should be read in full.

Quality statement

Young people who have moved from children’s to adults’ services but do not attend their first meeting or appointment are contacted by adults’ services and given further opportunities to engage.

Rationale

Young people need to engage with adults’ services so that they continue to receive the care and support they need. When young people disengage from services during transition it can affect their future health, mental health and social care needs.

Quality measures

Structure
Evidence of local protocols in adults’ services about follow-up arrangements for young people who have moved from children’s to adults’ services but do not attend their first meeting or appointment.
Data source: Local data collection.
Process
Proportion of young people who have moved from children’s to adults’ services but did not attend their first meeting or appointment who were contacted by adults’ services and given further opportunities to engage.
Numerator – the number in the denominator who were contacted by adults’ services and given further opportunities to engage.
Denominator – the number of young people who have moved from children’s to adults’ services but did not attend their first meeting or appointment.
Data source: Local data collection.
Outcome
Proportion of young people who have transferred from children’s services, who are discharged from each adults’ services without attending a meeting or appointment.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (adult health, mental health and social care services) ensure that systems are in place so they know who is transferring from children’s services, and that a young person is contacted and given further opportunities to engage if they do not attend their first meeting or appointment in adults’ services.
Health and social care practitioners from adults’ services (such as hospital consultants, social workers, mental health workers) ensure that they work with children's services to identify young people who have moved to adults’ services but did not attend their first meeting or appointment. They ensure that the young people are contacted and given further opportunities to engage.
Commissioners (clinical commissioning groups, local authorities and NHS England) ensure that they commission adults’ services that contact young people who have moved to their services but do not attend the first meeting or appointment and give them further opportunities to engage (for example, other appointments).
Young people who have moved from children’s to adults’ services but do not attend their first meeting or appointment are contacted by someone from adults’ services. They will check if the young person’s care and support plan is still right and whether they need any other help to get back in touch with the service.
Parents and carers of young people who have moved from children’s to adults’ services but do not attend their first meeting or appointment are contacted by someone from adults’ services to try to help the young person keep in touch with adults’ services.

Source guidance

Definitions of terms used in this quality statement

Opportunities to engage
If a young person does not attend meetings and appointments in adults’ services the adults’ service should try to contact them and their family and follow up with the young person, then involve other relevant professionals (including children’s services and their GP) if need be. If there is still no contact then the relevant provider should refer back to the named worker with clear guidance on re-referral, if applicable. If the young person does not want to engage in services they should be offered alternative ways to meet their support needs.

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Implementation

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

Your responsibility

Guidelines

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this interactive flowchart is not mandatory and does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the interactive flowchart to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Supporting information

Glossary

This describes an approach to supporting young people that recognises them as a distinct group, subject to constantly changing circumstances. Developmentally appropriate care and support considers the young person as a whole, addressing their biological, psychological and social development in the broadest terms. This approach will need joined-up service provision, and for the young person to be informed about, and supported to play an active role in, their care and support (Farre et al. Developmentally appropriate healthcare for young people: a scoping study 2015).
An exercise carried out to understand the difference between the amount and type of services needed and the amount and type of services available. This could also be extended to understand the difference between the services people expect and those that are available.
The named worker is a role rather than a job title. This should be one of the people from among the group of workers providing care and support to the young person, who has been designated to take a coordinating role. It could be, for example, a nurse, youth worker, an allied health professional or another health and social care practitioner. It could also be someone who already has the title keyworker, transition worker or personal adviser.
this means seeing the person using care and support as an individual and an equal partner who can make choices about their own care and support. The recommendations in this pathway seek to ensure that all of a young person's needs are supported, including those related to their wider context (for example, education and employment, community inclusion, health and wellbeing including emotional health, and independent living and housing options)
a type of partnership arrangement whereby NHS organisations and local authorities contribute an agreed level of resource into a single 'pot' that is then used to commission or deliver health and social care services
Strengths-based practice involves the person who uses services and the practitioners who support them working together to achieve the person's intended outcomes, in a way that draws on the person's strengths. The quality of the relationship between those providing support and those being supported is particularly important, as are the skills and experience that the person using support brings to the process (Strengths-based approaches Social Care Institute for Excellence).
the actual point at which the responsibility for providing care and support to a person moves from a children's to an adults' provider
the process of moving from children's to adults' services. It refers to the full process including initial planning, the actual transfer between services, and support throughout

Paths in this pathway

Pathway created: February 2016 Last updated: April 2017

© NICE 2017

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