1. family and parenting
2. children

PRINCIPLES OF
GOOD TRANSITIONS 2
Scottish Transitions Forum
2014
PRINCIPLES OF GOOD TRANSITIONS 2
Scottish Transitions Forum
2014
i
Scottish Transitions Forum. 2014
Compiled on behalf of
Scottish Transitions Forum
Members by ARC Scotland
[email protected]
www.arcuk.org.uk/scotland
www.scottishtransitions.org.uk
0131-663 4444
May 2014
© ARC Scotland 2014
Association for Real Change is a registered charity:
Registered Charity No. 285575, Scottish Charity No. SCO39129
Design by Bold
www.bold-marketing.co.uk
ii
PRINCIPLES OF GOOD TRANSITIONS. 2
Foreword
{{
I welcome the publication of TPrinciples of Transition 2V and the work
of the Scottish Transitions Forum to highlight the important issues
surrounding transitions, and to bring them to the forefront of policy
and practice relating to children and young people. This document
outlines the ways in which we can all work jointly together to ensure
that transitions are as smooth as possible and that the voices of children
and young people are at the centre of decisions made about their
future. Transition should be a time when children and young people feel
empowered and excited about their options, not concerned about what
lies ahead. Given the recent adoption of the Children and Young People
(Scotland) Act 2014, this document serves as a timely reminder of how
we can Get It Right For Every Child by ensuring that the rights enshrined
within the United Nations Convention on the Rights of the Child (UNCRC)
are upheld as children and young people experience transition.
Transitions are important in the lives of all children and young people.
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starting to use adult health and social care services or starting a new job
or placement, transitions can be both an exciting and a worrying time.
For children and young people with additional support needs these
rites of passage can become particularly concerning due to an
often-complex health and social care landscape and a multitude
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I look forward to a future where all decisions about a child or young
person are made in their best interests, their views are heard and
respected and their rights are embedded within transitions practice.
This document is a welcome step towards making this a reality.
Tam Baillie
ScotlandVs Commissioner for Children and Young People
iii
PRINCIPLES OF GOOD TRANSITIONS. 2
Contents
Foreword by Tam Baillie, ScotlandVs Commissioner
for Children and Young People
iii
The purpose of TPrinciples of Good Transitions 2V
2
What we mean by TtransitionsV
5
Scottish Transitions Forum
8
The seven principles of good transition
15
1. All plans and assessments should be made in a
person-centred way
16
2. Support should be co-ordinated across all services
24
3. Planning should start early and continue up to age 25
32
4. Young people should get the support they need
38
5. Young people, parents and carers must have
access to the information they need
46
6. Families and carers need support
52
7. Legislation and policy should be co-ordinated and
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54
Principles into practice
58
How to support TPrinciples of Good Transitions 2V
62
1
Scottish Transitions Forum. 2014
The purpose of 1Principles
of Good Transitions 29
Members of the Scottish Transitions Forum
have prepared TPrinciples of Good Transitions
2V with support from ARC Scotland. Our
objective is to improve the quality of care
and support for young people with additional
support needs who are making the transition
to young adult life. We aim to achieve this
by providing clear guidance to supporting
smooth transitions that are shared by all
professionals. Without a positive transition
process, children and young peopleVs lives
can be negatively impacted, leading to lost
RSSRUWXQLWLHVDQGXQIXOƬOOHGSRWHQWLDO
2
PRINCIPLES OF GOOD TRANSITIONS. 2
This document follows the publication of
TPrinciples of Good Transitions 1V in 2013.
There is a need to fundamentally change
the way we support young people with
additional support needs to make the
transition into young adulthood. This
change is needed in legislation, policy and
practice across all professional sectors.
To help achieve this change,
TPrinciples of Good Transitions 2V
provides a framework of principles
that can be used by the Scottish
Government and civil service teams
and professionals. This includes people
who are responsible for planning and
delivering support for children and young
people with additional support needs in:
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(such as housing and welfare)
3
Scottish Transitions Forum. 2014
We set out seven clear principles to
getting transitions right. These should
be adopted by all professional sectors.
Throughout this document we have
indicated several areas that align with
the United Nations Convention on
the Rights of the Child (UNCRC) and
further information is highlighted.
We also list actions that will help put
these principles into practice, along
with a brief summary of the relevant
Scottish legislation and policy that
underpins each of the seven principles.
Owing to the rapidly changing
legislative and policy framework
that impacts on transition, including
self-directed support, the Children
and Young People Act and Health
and Social Care integration, we plan
to update and issue the TPrinciples of
Good TransitionsV each year until 2017.
We focus on the transition to
young adulthood since the challenges
4
associated with it are widely recognised
as being often poorly supported. We
recognise that all people make important
transitions throughout their lives and we
hope that the seven principles will be
helpful to those who support people who
are experiencing other life transitions.
Further information is available on
the Scottish Transitions Forum website
(www.scottishtransitions.org.uk). This
provides more detailed information
concerning legislation, policy, practice
H[DPSOHVUHVHDUFKHYLGHQFHƬOPVRI
young people telling their transition
stories and other key matters of concern
(eg, transport, challenges in urban/
remote areas and data/IT systems).
We hope that this document will
also be useful to young people and
their carers. We will be working with
others to provide this information in
accessible formats, which again will be
available from the above website.
PRINCIPLES OF GOOD TRANSITIONS. 2
What we mean by
1transitions9
For the purpose of this document,
TtransitionV is the period when young
people with additional support needs
(such as a learning disability, autism,
sensory impairments, mental health,
emotional and behavioural issues,
exceptional health care needs and young
people in care, among many others) grow
from children to young adults. Professionals
often associate it with the move from school
or college or the Tcase transferV from child
to adult services. Professionals refer
to this as the Ttransitions processV.
Young people moving through transitions
come from a wide range of circumstances.
Some may live in families, with foster carers,
kinship carers or in residential or community
settings. No matter their circumstances,
all young people with additional support
needs have a right to individualised support,
to express their views and be part of
deciding their own future and the support
and care they may need.
5
Scottish Transitions Forum. 2014
Reasons for support for pupils with Additional Support Needs
[Rates per 1000 pupils]
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Achieving a Tpositive destinationV in
education, training, health provision
or employment is often regarded as
success in the transition process. This
should not be the whole story. To fully
appreciate what transitions are, we must
move to a more holistic model where
HƪHFWLYHO\VXSSRUWLQJWUDQVLWLRQVLV
viewed as part of fundamental rights and
the overall well-being of a young person.
It is important to stress that transition
is an active process that unfolds over a
number of years and not a single event
(such as leaving school). It is equally
important to plan and support later
transitions (such as leaving college).
Transitions for children with additional
support needs happen concurrently
across a range of services, including
health, education, housing, welfare
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of a smooth transitions process
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organisations involved having a shared
understanding of how the support
they provide contributes to the overall
well-being of the young person.
7
Scottish Transitions Forum. 2014
Scottish Transitions Forum
The Scottish Transitions Forum aims to improve the experience of
people with additional support needs, particularly those with high
support needs, as they go through life transitions. The Forum focuses
on the transition of young people from school or college to adult life.
We seek to achieve our aim by:
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people with additional support needs. At the start of 2014
the Forum had over 300 members from across Scotland
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f as highlighted here and at Forum meetings
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and improving our work practice
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additional support needs at a local and national level.
8
PRINCIPLES OF GOOD TRANSITIONS. 2
The Scottish Transitions Forum began in 2008. Membership is
open to anyone who is committed to improving the transitions
for young people with additional support needs.
The Scottish Transitions Forum is engaged in Scottish Government
initiatives such as the Autism Strategy, the Keys to Life, the Advisory
Group for Additional Support for Learning Act and Self-directed
Support capacity-building initiatives. Other areas of engagement
include Partnership Matters, More Choices More Chances,
Opportunities for All and Education Scotland. The Scottish
Government is also exploring how transitions can be improved
within legislation and policy relating to health care. This is an agenda
in which the Scottish Transitions Forum is increasingly engaged.
Challenges associated with transitions have been the subject
of recent reviews and research including the Doran Review,
research undertaken by ScotlandVs Commissioner for Children
and Young People, and the National Deaf Children Society.
9
Scottish Transitions Forum. 2014
To LEARN MORE ABOUT US and join the Scottish Transitions Forum
PLEASE VISIT OUR WEBSITE AT WWW.SCOTTISHTRANSITIONS.ORG.UK
Or contact [email protected]
Telephone: 0131-663 4444
PRINCIPLES OF GOOD TRANSITIONS. 2
The Scottish Transitions Forum is supported by ARC Scotland.
ARC Scotland promotes the development of high quality, person-centred
support for people with a learning disability or other support need. We
SULGHRXUVHOYHVLQRXUHƪHFWLYHDQGH[WHQVLYHSDUWQHUVKLSVZLWKSURYLGHU
organisations, local authorities, people who use services and their
carers across Scotland.
Scottish Transitions Forum. 2014
Colin Young is the Senior Policy and Outcomes
2ƯFHUIRUWKH$//,$1&(+LVUROHLVWRH[WHQG
the principles of self-directed support into a
person-centred health system.
Colin has a background in policy having worked
for Mencap as the Children and Young PeopleVs
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full-time roles, Colin has held positions on the
Equality 2025 board and currently sits on the Scotland
committee of the European Human Rights Council.
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health intervention on children with cerebral palsy.
In his spare time Colin pursues acting
for TV and on stage.
12
PRINCIPLES OF GOOD TRANSITIONS. 2
1I met with Scott from ARC Scotland in 2012 to talk about my
H[SHULHQFHVVLQFHOHDYLQJVFKRRO7DONLQJDERXWWKLQJVLVQRW
always easy for me, I have worried a lot and learned to cope
with change. Some things have worked out great and some
things not. I still have lots of things I would love to do and look
forward to living more independently in the future.9
I love Xbox, DVDs, graphic novels and super-heroes. One of the
things I enjoy most about being an adult is having independence
and going to meet my friends, travelling independently. I need
some support initially but once I get going there is no holding me
back. I left school in 2011. School wasnVt always easy for me but I
had some great times and met some good friends I was ready to
leave but it was a worrying time, you never really know what is
going to happen until the last minute and that is not good for
anyone. I enjoyed college however things didnVt work out too well. I
loved making friends but college is too busy and unpredictable. I have
had some amazing experiences since leaving and was really lucky to be
part of a project with Artlink starting in 2011 where I met Alan Grant
a Graphic Novelist from the 2000AD and Marvel fame. We wrote a
story based on my interest in super-heroes and zombies. I have had
lots of celebrity moments; it has been a life changing experience.
13
PRINCIPLES OF GOOD TRANSITIONS. 2
The Seven
Principles of
Good Transitions
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seven principles to improve transitions:
Principle 1
All plans and assessments should
be made in a person-centred way
16
Principle 2
Support should be co-ordinated
across all services
24
Principle 3
Planning should start early
and continue up to age 25
32
Principle 4
Young people should get
the support they need
38
Principle 5
Young people, parents and carers must
have access to the information they need
46
Principle 6
Families and carers need support
52
Principle 7
Legislation and policy should be
FRRUGLQDWHGDQGVLPSOLƬHG
54
15
Scottish Transitions Forum. 2014
This means:
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of their transition planning
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access to a personal outcomes
approach and person-centred planning
in its truest sense
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commitment to person-centred approaches
across all services
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16
This principle is supported by the
following legislation and policy:
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on the Rights of the Child (UNCRC)
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in the Children and Young
People (Scotland) Act 2014
and associated policy
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Support) (Scotland) Act 2013
options and principles
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planning practices and philosophies
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as detailed in the Children and
Young People (Scotland) Act 2014
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Act (2000). Guardianship
and power of attorney
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(Scotland) Act (2007)
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of which person-centred
is a quality ambition
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Care Health Policy
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17
Scottish Transitions Forum. 2014
Young people should be at the
centre of their transition planning
The Scottish Government and
professionals have made clear, in current
legislation and practice documents, that
the voices of children, young people,
their families and carers should be
listened to and their opinions taken
into account in matters or procedures
DƪHFWLQJWKHP7KLVLVLQOLQHZLWKDUWLFOH
12 of the UNCRC (respect for the views
of the child). Despite this, many people
report that they are not fully involved
or consulted in processes surrounding
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Young people and their families and
carers are best placed to know what
they need to make things work for
them, provided they have access to
the right information and support.
Ensuring their right to say what they
think should happen, to be in control of
their own lives and to make their own
decisions and have their opinions taken
into account leads to informed choice
and better outcomes. This should still
be considered when there are issues
concerning guardianship and capacity.
All actions concerning the child should
take full account of his or her best
interests and this should be a primary
consideration in making decisions that
PD\DƪHFWWKHP81&5&DUWLFOH
18
Young people should be given every
opportunity to make independent
and informed decisions about their
future. Direction and guidance should
be provided to young people in
exercising their rights as enshrined in
the UNCRC, in a manner consistent
with the evolving capacities of the
young person (UNCRC article 5).
This should lead to their having as much
say as they wish in how their parents
are involved in transitions planning.
This has to be balanced with the needs
and wishes of parents and carers.
Young people should be given every
opportunity to make independent
and informed decisions about their
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the evolving capacities of the child in
the UNCRC, which means that children
and young people gradually assume
greater autonomy and independence,
with the appropriate support and
guidance of their parents and carers.
Consideration must be given to the
GLƪHULQJIRUPVRIFRPPXQLFDWLRQ
and communication styles of young
people. All professionals will need to
ensure the full involvement of young
people in the planning process, and
this means being able to communicate
with and understand the child or young
person. Parents and carers are usually
the most appropriate source of advice
PRINCIPLES OF GOOD TRANSITIONS. 2
_At one point social work was all about keeping people safe and now it is
keeping people safe while enabling them to lead a life that they always
wanted to lead.`
- Social worker, Putting People First
on a young personVs communication
style. More information can be
found in the Scottish GovernmentVs
TA right to speakV document.
Young people should have access
to a personal outcomes approach
and person-centred planning in its
truest sense
Person-centred planning is well
evidenced as a successful way to
improve outcomes for young people in
transition and has been used to great
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the voluntary sector. Despite this,
these approaches are not routinely
used in transition planning.
A trained planner who operates
externally to health, education and
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should facilitate person-centred plans,
in their fullest sense. If the Transitions
Co-ordinator (see Principle2) were trained
in these methods it would be ideal
for them to facilitate this process.
Not all young people may want a
person-centred plan in its fullest sense.
However they must have their rights
respected and should be provided with
the relevant information they need and
be supported to choose what is right
for them. A choice of other planning
approaches should be available. This
applies to the Additional Support for
Learning planning and its associated
methods. Independence, choice and
control and outcomes should be central
to planning processes, whatever their
nature, in line with the Social Care (Selfdirected Support) (Scotland) Act 2013.
There should be a shared
understanding and commitment to
person-centred approaches across
all services
All assessments and plans for those
in transition should follow the core
person-centred principles described on
page 20. Currently, there is no agreed
GHƬQLWLRQEHWZHHQSURIHVVLRQDOJURXSV
about what Tperson-centredV actually
means, and interpretation can vary. To
further complicate this, other terms
such as Toutcomes-based assessmentV
(such as TTalking PointsV), Tco-productionV,
Tco-designV and TpersonalisationV are all
used to describe similar approaches.
Outcomes based on self-directed
support principles and guidance
should form the basis of the young
personVs transitions (UNCRC article
3). Too frequently, assessment
decisions are based on resource or
needs-led statutory concerns rather
than individual outcomes. Outcomes
and needs, even though linked,
DUHYHU\GLƪHUHQWSKLORVRSKLHVZKHUH
need represents the barriers that have
to be overcome to reach outcomes.
19
Scottish Transitions Forum. 2014
Person-centred planning, in its truest sense, is not the same as need led or client
centred assessment. Needs in assessment are associated with what people are
eligible for funding for via interpretation of policy and resources of the Local
Authority. Person-centred planning, in its truest sense goes beyond this and
explores peopleVs aspirations, and is not limited to entitlement of services.
Person-centred planning is:
Person-centred planning is not:
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respond to people
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commitment
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communities
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of paper work
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assessment
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service packages
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Person-centred planning
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picture of what matters for Lucy.
Though several people at the meeting were really enthusiastic about the plan and
said how helpful it was for them as professionals to think about their contributions to
LucyVs future, the social worker was apologetic. She said, l IVm sorry we donVt recognise
Essential Lifestyle Planning. We donVt have the resources to implement it. We can only
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The social worker was confusing assessment for council services and broader life
SODQQLQJ-HDQDQG/XF\GLGQRWH[SHFWVRFLDOVHUYLFHVWRGHOLYHUHYHU\WKLQJLQWKH
plan. They wanted the professionals to listen to what was important to Lucy and her
family and work out what they could do to contribute towards achieving these things.
They also wanted help with problem solving other sources of support and resources.
Taken from Helen Sanderson f What is Person Centred Planning
20
Scottish Transitions Forum. 2014
_I hated reviews a I came out more upset than I went
in. I felt that people were talking over me a there was
no eye contact. I felt like a shadow.`
- School leaver, Enquire
Young people should have a single
plan
The lack of a shared planning
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PDNLQJWKHLURZQSODQVIRUGLƪHUHQW
but overlapping aspects of the young
personVs life. Each time, a young person,
their parent or carer has to tell their
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This is frustrating for those involved, a
duplication of work and not consistent
with person-centred approaches.
The ChildVs plan detailed in the
Children and Young People (Scotland)
Act 2014 seeks to remedy this.
The ChildVs plan should include all
plans relevant to the planning process,
including the co-ordinated support
plan, and should remain the property
of the child or young person for whom
it has been prepared. It should be
a Tcare passportT that accompanies
them whenever and wherever they
contact health or social care services.
Professionals in these areas, especially
at transition, should refer to it to
provide seamless assessments.
22
In addition to availability of
person-centred processes, young
people should therefore have one
ChildVs plan as laid out in the 2014 Act.
The ChildVs plan should also include any
person-centred planning input that has
gone on outside of statute led planning.
More information on this will be available
in the guidance being issued in 2016
to support these duties in the Children
and Young People (Scotland) Act 2014.
The Getting it Right for Every Child
(GIRFEC) assessment (which is included
as part of the ChildVs plan) in childrenVs
services currently has no counterpart
in adult services. Outcomes-based
assessment tools, used by adult health
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from those used in childrenVs services.
If GIRFEC principles could be applied to
adult services it would provide a basis
for early indicative budgets (as set out
in the Social Care (Self-directed Support)
(Scotland) Act 2013, and lead to less
duplication of assessment. In addition,
parents, carers and young people will
already be familiar with this assessment
procedure from childhood, and therefore
adoption of its principles in adult services
will provide a smoother pathway.
6RPHJXLGLQJGHƬQLWLRQV
GIRFEC
TGIRFECV stands for TGetting It Right
For Every ChildV and is the legislated
approach within the Children and Young
People (Scotland) Act 2014. It provides a
consistent way for people to work with
all children and young people. It is the
bedrock for all childrenVs services and
can also be used by practitioners in adult
services who work with parents or carers.
The GIRFEC approach helps practitioners
IRFXVRQZKDWPDNHVDSRVLWLYHGLƪHUHQFH
for children and young people f and
how they can act to deliver these
improvements. GIRFEC is being
threaded through all existing policy,
practice, strategy and legislation
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people and their families.
Childs Plan
The Children and Young People
(Scotland) Act 2014 requires a ChildVs
plan to be developed for an individual
child if they have a Twell-being needV that
requires a targeted intervention (s.31).
A targeted intervention is one that is
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children generally by health boards, local
authorities, managers of grant aided
schools or proprietors of independent
schools (s.31 (4) read with s.41).
The duty to prepare the ChildVs plan
lies with the responsible authority
(ie, the health board for pre-school
children, the local authority, and
grant-aided or independent school
for ages 5 to 18). Existing statutory
requirements remain and will become
part of the wider ChildVs plan.
These are:
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the Looked After Children (Scotland)
Regulations 2009
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the Education (Additional Support
for Learning) (Scotland) Act 2004.
The education authority prepares this
when a child or young person requires
VLJQLƬFDQWDGGLWLRQDOVXSSRUWIURPWKH
education authority and from at least
one other agency from outwith
HGXFDWLRQLQRUGHUWREHQHƬWIURP
VFKRROHGXFDWLRQ7KHUHDUHVSHFLƬF
rights of appeal in relation to this plan.
Scottish Transitions Forum. 2014
This means:
r (GXFDWLRQPXVWWDNHWKHOHDGLQ
co-ordinating transition services
r 7KHUHVKRXOGEHDFRRUGLQDWHDSSURDFK
to transitions in each local authority area
r $WUDQVLWLRQVFRRUGLQDWHUVKRXOG
be available throughout the transitions
period to all young people who
need them
r 7UDQVLWLRQVSURFHVVHVVKRXOGEHHYDOXDWHG
r 6WDƪWUDLQLQJVKRXOGLQFOXGH
an understanding of all aspects
of transition
24
PRINCIPLES OF GOOD TRANSITIONS. 2
Professionals need to be aware of:
r 1DPHG3HUVRQDQG/HDG3URIHVVLRQDODVGHWDLOHGLQ
the Children and Young People (Scotland) Act 2014
r 3XEOLF%RGLHV-RLQW:RUNLQJ6FRWODQG$FW
r 5ROHVRIHGXFDWLRQDQGRWKHUVWDWXWRU\DQGWKLUGVHFWRUSURIHVVLRQDOV
r 7UDQVLWLRQV&RRUGLQDWRUZKHUHWKH\H[LVW
r 7UDQVLWLRQVWHDPVZKHUHWKH\H[LVW
r 7UDQVLWLRQV)RUXPVZKHUHWKH\H[LVW
r &RQWLQXHG3URIHVVLRQDO'HYHORSPHQWRSSRUWXQLWLHVDQG
other post registration learning requirements.
Education must take the lead in co-ordinating
transition services
It is suggested in recent legislation and policy
consultation that a schoolVs named person or lead
professional will be responsible for the co-ordination
of young peopleVs transition under the terms of the
Education (Additional Support for Learning) (Scotland)
Act 2004, as amended, and in line with the Children
DQG<RXQJ3HRSOH6FRWODQG$FWGHƬQLWLRQRID
named personVs duties. Up until this point statutory
responsibility for co-ordination has been unclear, even
though it is the duty of education to carry out transitions
planning under the 2004 Act. The named person is
responsible for the ChildVs plan and these new duties
should strengthen this responsibility and accountability.
The named personVs duties are ambiguous if a young
person is in a residential school setting. It would make
sense for the named person from that setting to lead
the transitions planning, however this is currently
under discussion (see CELCIS for more information).
The ChildVs plan and other assessments should
extend into adult services to help ensure continuity
through the transitions period (see Principle 3).
These roles are aspirational and each local authority
ZLOOEHLQWHUSUHWLQJWKHGHWDLOVGLƪHUHQWO\
and in line with their individual plans.
25
Scottish Transitions Forum. 2014
There should be a co-ordinated
approach to transitions in
each local authority area
Young people with additional
support needs may come into contact
with numerous practitioners in the
ƬHOGVRIKHDOWKHGXFDWLRQDQGVRFLDO
FDUH(ƪHFWLYHFRRUGLQDWLRQRI
transitional care and support at a local
level is therefore critical, particularly
for those with learning disabilities
or multiple and complex needs.
Cross-professional partnership
working does exist. However, in many
cases organisations can be unsure of each
otherVs roles and often do not engage
with one another. A local transitions
forum will help to co-ordinate support
IRUWUDQVLWLRQVDFURVVGLƪHUHQWVHUYLFHV
and address the support needed
for future transitions. The local
transitions forum should consist
of, but not be limited to:
r &KLOGUHQDQG\RXQJSHRSOH
(UNCRC article 12)
r 3DUHQWVDQGFDUHUV
r +HDOWKDQGDOOLHGKHDOWK
professionals from paediatric
and adult health settings
26
r 6NLOOV'HYHORSPHQW6FRWODQG
/careers advice
r 2SSRUWXQLW\IRU$OOORFDO
authority representatives
r 6RFLDOZRUNsFKLOGDQGDGXOWVHUYLFHV
r 7KLUGVHFWRUVHUYLFHVVXFKDV
support, advice and advocacy
r (GXFDWLRQSURIHVVLRQDOVSUH
and post-16 education
r /RFDODUHDFRRUGLQDWRUV
r 3ULPDU\DQGVHFRQGDU\
care representatives
r (OHFWHGPHPEHUV
Other services or individuals that
are key to commissioning, workforce
GHYHORSPHQWRUFDQRƪHUFRRUGLQDWHG
DQGUHVSRQVLYHVXSSRUWVSHFLƬFWRDORFDO
authority should also be included.
Where transition processes have
been explored in a local authority (via
a transitions forum, for example), it has
led to improvement in local practice.
However, how this will work across the
whole of Scotland is still in its infancy.
What are transitions teams,
forums and co-ordinators?
Transitions Forums at local
authority level provide a way for
all those working in the area of
transition to explore challenges and
solutions that will help to improve
practice. A good example of how
this is being developed is by NDCS
and Audiology in pan-Ayrshire local
authorities. They are currently
establishing a forum that explores
transitions for deaf young people.
Transitions Teams (such as in the
City of Edinburgh Council) is a team
within the local authority created to
support transitions independently
from children and adult services. Each
ORFDODXWKRULW\KDVGLƪHUHQWSULRULWLHV
and processes and therefore the
way these teams are organised can
vary greatly across Scotland. However
this is done, they must be tailored to
meet the needs of children and young
people rather than led by other drivers.
Transitions Co-ordinators Transitions
Co-ordinators (such as in the Highlands
and the Islands) are individuals that
support transitions across education,
health and social work. Their role is
described below. They work where
their expertise is needed due to the
particular needs of the child or
young person. Because they are
DZDUHRIGLƪHUHQWGULYHUVWKH\FDQ
help to smooth transitions across
GLƪHUHQWSURIHVVLRQDOVHFWRUV7KH\
may also be trained in advocacy and
person-centred planning approaches.
27
Scottish Transitions Forum. 2014
Case Study
Transitions Teams a how
do they work?
Hamish left special school in Edinburgh
in the summer of 2011. Prior to this
he had had annual transition meetings
at his school. In attendance at these
meetings was Hamish, his parent/
guardian, ASL teacher (and head
teacher), Skills Development Scotland
representative (careers service) and duty
(un-allocated) social worker. Everyone
present was responsible for developing
a plan for HamishVs transition.
Hamish wanted to go to college when
he left school, so his Skills Development
Scotland worker supported him to apply
for appropriate courses, and to make
his own choices. The school supported
Hamish to attend various taster sessions
at the college so that he could feel more
secure and familiar with the environment
once he had left school. The social worker
ensured the plan was appropriate and
28
all agencies involved were meeting
their obligations whilst gathering various
pieces of information to ensure the
correct supports could be put in place.
Hamish was allocated a social worker
from EdinburghVs 7UDQVLWLRQ7HDP.
They were responsible for supporting his
whole transition by ensuring that the
transitions plan was put into place
and continuing to be available
after this had happened.
HamishVs social worker completed
the adult assessment and secured
the funding for transport to and from
college. Since he was attending a
supported course he did not require
any other support at this time.
Hamish started college with no
problems and remained there for two
years. After this Hamish wanted to leave
college and move on to day support.
His social worker was again allocated
PRINCIPLES OF GOOD TRANSITIONS. 2
to update the previous assessment
and seek the funds for day support.
Hamish was assessed as having a critical
level of need, meaning he could have
some funded support. The next step
was to discuss how this funding would
be provided. His mum decided that she
would like to manage a direct payment
on her sonVs behalf under the principles
of Self-directed Support. This means
that money is put into a bank account
to allow someone to buy their own
services instead of the council arranging
services for them. HamishVs mum
decided it would be best for him to use
a local provider for half of his week.
This approach enabled Hamish to have
a good level of independence and
meant he would remain in touch with
people he knew who also attended this
service. The other half of his week went
WRDQRWKHUSURYLGHUZKRRƪHUHGKLP
more variety and options to develop his
interests in art. The direct payment also
included respite provision for 30 nights
per year. Hamish and his family decided
to use 15 nights as respite and this
was included in their direct payment.
The provider invoiced Hamish for
the costs of the service and his mum
ZRXOGFDOOWKHLUƬQDQFHGHSDUWPHQW
and use the DP card to pay them.
HamishVs mum said:
lThe process took longer than
expected but the end result was the
best for Hamish. The social worker
was there to assist with ideas on
where and who could help to get
Hamish what he required, which is
helpful and important for parents.m
29
Scottish Transitions Forum. 2014
A transitions co-ordinator should
be available throughout the
transitions period to all young
people who need them
Transitions processes should be
evaluated
Transitions co-ordinators should be
available to all young people who need
them. This role is distinct from the named
person. An example of this approach
can be found in the Highlands region.
Young people should be consulted and
their wishes taken into account when
choosing their transitions co-ordinator.
There should be a clear understanding
amongst all professionals, the young
person and their family of what the
role of the transitions co-ordinator is.
To ensure smoother transition, they
should remain involved until the young
person is settled in the adult system
of health and social work. For more
information on this, see our website.
It is not possible to know if transitions
experiences are improving and young
peopleVs outcomes are being met
without evaluating what is happening.
Partner agencies and all key individuals
in the transitions process should meet
and agree a Ttransitions pathwayV in
WKHLUORFDODXWKRULW\DUHD-RLQWZRUNLQJ
should be built into national and local
authority considerations and workforces,
including the work of the third sector,
LQWKHVHDUHDV7KH3XEOLF%RGLHV-RLQW
Working) (Scotland) Act 2014 is making
it easier for local authorities to do
this. The transitions pathway should
be evaluated on a regular basis and be
clearly available and understandable.
The evaluation and pathway may be
VSHFLƬFWRRQHDUHDRIDGGLWLRQDOVXSSRUW
need or involve more than one area.
Health and social care partnerships
should actively consider the need for
an adolescent nurse specialist/transition
co-ordinator and, where these
professionals are already in post,
their skills should be fully used
in the co-ordination and delivery
of the transition process.
30
PRINCIPLES OF GOOD TRANSITIONS. 2
_In the end we couldn9t have managed without the Local Area
Coordinator… they helped us understand everything from directing our
RZQVXSSRUWWRZKDWEHQHƬWVZHQHHGHGWRRDQGDGYRFDWHGRQRXUEHKDOI
we know its not what they are meant to do but without them. We would
have been lost.`
a Parent discussing their son9s transition
6WDƪWUDLQLQJVKRXOGLQFOXGHDQXQGHUVWDQGLQJRI
all aspects of transition
High quality training should include an understanding
RIWKHHƪHFWWKDWOHJLVODWLRQDQGSROLF\KDYHRQDOODUHDV
of transition and should not be limited to professional
silos. Along with this, there should be information
DERXWWKHGLƪHUHQFHVLQSURIHVVLRQDOFXOWXUHV7KLV
will help to tackle the lack of understanding amongst
professionals and agencies of each otherVs roles.
Everyone working in transitions should have access to
innovative and aspirational learning as part of their initial
training and continuing professional development.
31
Scottish Transitions Forum. 2014
This means:
r 3ODQQLQJPXVWEHDYDLODEOHIURPDJH
14 and be proportionate to need
r 3ODQVPXVWEHƮH[LEOHDQG
accommodate change
r &KLOGUHQoVSODQVDQGDVVHVVPHQWV
should be adopted by adult services
r 7UDQVLWLRQSODQQLQJDQGVXSSRUWVKRXOG
be legislated to continue to age 25
32
PRINCIPLES OF GOOD TRANSITIONS. 2
The Education (Additional Support
for Learning) Act 2004 amended
and its associated Codes of Practice
place a duty on schools to start
transitions planning at least a
year before leaving school.
Professionals need to be aware of:
r The Childs Plan as detailed
in the Children and Young
People (Scotland) Act (2014)
r 7KH(GXFDWLRQ$GGLWLRQDO
Support for Learning) Act 2004
r 7KHDPRXQWRIELRSV\FKRVRFLDO
changes that occur at this time
r (DUO\,QGLFDWLYHEXGJHWVDVODLG
out in the Social Care (Self-directed
Support) (Scotland) Act 2013
r 6HOIHƯFDF\DQGUHVLOLHQFH
r 2SSRUWXQLWLHVIRU$OO
r 0RUH&KRLFHV0RUHFKDQFHV
r 3RVW3ROLF\DQG
Practice framework
r 3DUWQHUVKLS0DWWHUV
33
Scottish Transitions Forum. 2014
Planning must be available from
Age 14 and proportionate to need
There is substantial evidence to
demonstrate that early intervention
KDVDSURIRXQGHƪHFWRQIXWXUHOLIH
planning (UNCRC articles 2,3,12 and 28).
This approach has been put into local
authority policy in Highland and Islands.
Unfortunately, for many young people
it does not happen. To help make sure
that it does, Education Scotland, National
Health Care Standards and Social Care
inspectorate bodies should review the
provision of transitions planning for 14
year olds in their inspection criteria.
An early start to transition planning
can support the beginning of
low-level interventions around
transitions. This could include the
beginning of planning about:
r %HQHƬWFKDQJHV
r Empowerment of parents
and young people
r -RLQHGXSSODQQLQJ
r Managing the reality of adult
health and social care services
r Potential person-centred
planning opportunities
34
r Explaining outcome-led assessments
r 6SHFLƬFKHDOWKSUREOHPV
and self-management
r Employment and training
needs and opportunities
r Discussing what choices and
resources are available as the
transition process continues.
This is also the time to establish
an early indicative budget. Parents,
carers and young people need to be
made aware of this at an early age to
help inform the planning process.
The experience of many young people
leaving care, however, is that early
planning leads to an expectation of
leaving and inadvertently causes anxiety
that their transition is imminent. This
should not be the case. Early planning
does not mean an early leaving date
and anxiety about this should be
taken into account in the early stages.
What early planning means needs to
be clearly understood and practised
by schools, and shared by them
with parents and young people.
PRINCIPLES OF GOOD TRANSITIONS. 2
p3HRSOHDURXQG\RXPLJKWJHWKXƪ\DQGDQJU\EXW\RXKDYHWR
remember that you are in control and you can say no you want things
to be this way… ultimately you are in control and there are people to
help you stay in control.`
a Young person at college
3ODQVPXVWEHƮH[LEOHDQG
accommodate change
Young peopleVs needs and wishes
will evolve over the transitions period,
so plans begun at an earlier date should
be regularly checked and updated
by the named person or lead
professional in partnership with the
young person, their parents and carers
and the team around them. Reviews
should be held when necessary.
Children9s plans and assessments
should be adopted by adult
services
Adult services should use the ChildVs
plan as an integral part of adult service
outcome-based assessment at transition.
The plan should be the starting point for
adult social work and health servicesV
outcome-focused assessment. This plan
should help provide an early indicative
budget to help achieve continuity as
the young person moves to adult
services in line with the Social Care
(Self-directed support) (Scotland) Act
2013 and the joint provision of budgets.
It is important early on to establish the
supports that will not change, which
can help to address anxieties and fears
that are associated with this time. This
helps to provide not only indicative
budgets but also outcome-based
assessments that lead from one
service area to the next.
The GIRFEC assessment framework,
which aligns with the Curriculum for
Excellence, should be extended to adult
services by health and social care. The
Curriculum for Excellence allows for
development of skills that directly relate
to transitions processes and should be
followed up by Community Learning and
Development, colleges and schools. An
example of how transition education
can be incorporated into the curriculum
is demonstrated by the work carried
out on transitions by Playback plc.
35
Scottish Transitions Forum. 2014
_One of the hardest things is understanding the processes when
you change services... it ends up being the small ones [processes]
that cause the biggest delay.`
a Young person discussing their transition
Transition planning and support
should be legislated to continue to
age 25
Post-16 transitions are often treated
as a leaving school TeventV rather than
an on-going process lasting several
years. Too often TtransferV (of case)
or leaving school is seen as the
transition rather than a process that
evolves over several years. As a result,
support for subsequent transitions
is often lacking.
All young people with additional
support needs should have support to
plan transitions up to their 26th birthday.
(This is legislated for looked-after
children in the Children and Young
People (Scotland) Act 2014). Support
systems provided by Skills Development
Scotland and Opportunities for All
enable local authorities to provide
VXSSRUWLQƬQGLQJZRUNHGXFDWLRQ
36
and training. However, these should
not be the only focus for transitions.
Well-being outcomes (as indicated
by GIRFEC and Self-directed Support)
should be at the heart of this process.
Support with care needs, short breaks,
health services, leisure and social
DFWLYLWLHVEHQHƬWVDQGLQFRPHSRVW
guardianship and powers of attorney
may need to be a part of this process.
These avenues of continued support
should be explored in greater detail to
HQDEOHWKHPWRSURYLGHPRUHHƪHFWLYH
opportunities for young people with
additional support needs. While
Opportunities for All and Skills
Development Scotland have limited
capacity in these areas and do not
have the remit to focus outwith
employment concerns and embrace
well-being, local area co-ordinators
provide a mechanism by which young
people can access support.
Scottish Transitions Forum. 2014
Principle 4
Young people should get the
support they need
This means:
r (OLJLELOLW\FULWHULDVKRXOGQRWEHWKHRQO\
measure of entitlement to support
r 6HUYLFHVVKRXOGEHDOORFDWHGWR
support outcomes, not needs
r 0RUHVXSSRUWVKRXOGEHPDGHDYDLODEOHIRU
those who do not meet eligibility criteria
r )XUWKHUHGXFDWLRQSURYLVLRQVKRXOGQRW
be a substitute for lack of services
r 3ODQQLQJDQGFRPPLVVLRQLQJVHUYLFHVVKRXOG
be done in partnership with young people
r $GYRFDF\VKRXOGEHDYDLODEOHDWWKH
start of the transitions process
Professionals need to be aware of:
r Social work (Scotland) Act 1968 f the right to an
assessment, the right to a carerVs assessment
r Children (Scotland) Act 1995 f right to an
assessment of a childVs need
r Chronically Sick and Disabled Persons (Scotland) Act 1972
r Social Care (Self-directed Support) (Scotland) Act 2013
r Human Rights Act 1998
r Equality Act 2010
r Children (Leaving Care) Act 2000
r Children and Young People (Scotland) Act 2014.
38
PRINCIPLES OF GOOD TRANSITIONS. 2
Eligibility criteria should not be the only measure
of entitlement to support
Eligibility criteria set the standard by which needs are
eligible for state funded support. Under the Social Care
(Self-directed Support) (Scotland) Act 2013, the way
eligibility criteria operate in local authorities should
change to mirror what has been termed the Resource
Allocation System (RAS), which represents the philosophy
of an equal share of money to help support outcomes.
How local authorities work out their individual RAS is
down to their own preference but, as matters stand, access
to state funded support is provided only if individuals meet
what is termed TsubstantialV or TcriticalV need. In some
local authorities it is limited to critical need only.
There are concerns about inequities and inconsistencies
in the application of eligibility criteria across and between
local authorities. There is also concern that owing to
the inequity of resources between children and adult
services, the resources available pre-transition can be
much greater than those available post-transition. If you
combine this with the ending of school support, many
children and young people will receive greatly reduced
services as they make the transition from school (UNCRC
articles 2,3,4,25,27 and 28). This situation, coupled with
FRPSOLFDWHGZHOIDUHEHQHƬWVUHDVVHVVPHQWRIWHQOHDYHV
young people with additional support needs substantially
ZRUVHRƪWKDQZKHQWKH\ZHUHFKLOGUHQ:KHUHHOLJLELOLW\
criteria are in place, they should be implemented
consistently and fairly, and the reasons for decisions either
way should be clearly communicated (UNCRC article 2).
39
Scottish Transitions Forum. 2014
_When I have a care assessment I have to be careful how I talk about
VWXƪf\RXGRQoWJHWDQ\VHUYLFHXQOHVV\RXDUHGHHPHGDWULVNDQGVRFLDO
services put something in to stop you being at risk, that9s the only basis
on which you get a service. You have to play it carefully. You don9t want
to be so at risk that you get put in residential care or not allowed out or
something but you need to be enough at risk to get a service.`
a Young person talking about services in transition
Services should be allocated to
support outcomes, not needs
Outcomes should not just be about
mitigating risk, but about enabling
people to have control and choice and
to live as independent a life as possible.
The Self-directed Support legislation
and other agendas, such as the Autism
Strategy, Keys to Life, Personalisation
and Reshaping Care, agree that there is a
considerable value in pursuing alternative
supports to publicly delivered services in
WKHLUWUDGLWLRQDOIRUP2ƪHULQJVXSSRUW
to enable people to be more connected
in their local communities will help to
enhance and nurture both individual
and community health and well-being.
It has been suggested that the
RAS should mirror the well-being
indicators (termed SHANARRI) that
are applied via the GIRFEC policy, as
every outcome should align to these
areas and therefore merit funding.
However, when a young person moves
into adult services this is no longer
40
the case and resources are once more
allocated according to adult service
criteria based on need (risk prevention)
rather than enablement (outcomes).
This can lead to families putting
themselves at risk to get the funded
services they need just to maintain
their way of life. It can mean painting
a worse case scenario to those who
are assessing them, because they are
aware that only the most negative
of situations are eligible for support
(UNCRC articles 2,3,24 and 27).
Portioning resources within a
risk-management model prevents
childrenVs and young peopleVs outcomes
being the focus of resource allocation.
Rather, it looks at critical and substantial
needs (ie, risk-reducing measures).
7KXVWKRVHZKRPD\EHQHƬWJUHDWO\
from preventative services are
denied access to them unless third
sector services provide them through
initiatives funded from other sources.
:KDWLV6+$1$55,"
6+$1$55, is an acronym that represents the areas of a childVs
wellbeing at various stages of their lives. It is used with the
Getting It Right For Every Child assessment framework.
It stands for:
Safe
Protected from abuse, neglect or harm
+ealthy
High standards of physical and mental health;
support to make healthy, safe choices
Achieving
Support and guidance in learning - boosting
VNLOOVFRQƬGHQFHVHOIHVWHHP
Nurtured
Having a nurturing and stimulating place to live and grow
Active
Opportunities to take part in a wide range of activities
Respected
Given a voice, and involved in the decisions
WKDWDƪHFWWKHLUZHOOEHLQJ
Responsible Taking an active role within their
schools and communities
,ncluded
Getting help and guidance to overcome inequalities; full
members of the communities in which they live and learn.
Scottish Transitions Forum. 2014
_Ultimately it9s the man in the counting house who makes the decision
about what [package of care] you should get… and the social worker has
to just get on with it, its not the social workers fault there isn9t enough for
everyone.`
a Parent talking about package of care for his sons
More support should be made
available for those who do not
meet eligibility criteria
Further education provision should
not be a substitute for lack of
services
Without some support (even a little)
many young people with additional
support needs fail to achieve as
much as they are capable of. There are
VHUYLFHVWKDWKHOSWRƬQGHPSOR\PHQW
RSSRUWXQLWLHVIRUH[DPSOH5HDO-REV
and Project SEARCH. Support is also
available through Skills Development
Scotland and Opportunities for All, but
they come with their own eligibility
criteria for support. Opportunities for All
can work with young people up to age
19 (or 21 in exceptional circumstances).
Further education plays an important
role in supporting many young peopleVs
personal and career development.
However, some young people with
additional support needs, particularly
those with learning disabilities, are
referred to college courses as a substitute
for the universal services they had when
they were children (UNCRC article 28)
and because it is perceived that there
is nowhere else for them to go.
However, this does not address the
full issue, as not all young people with
additional support needs are able to
achieve open employment. They should
have opportunities to engage with their
community in ways that best helps them
to be included and valued. Community
advocacy, citizenship and engagement
projects can help people achieve this. A
spend-to-prevent approach should
be investigated to look at the
FRVWYVEHQHƬWWRORFDODXWKRULWLHV
of working in this way.
42
7RWUXO\VXSSRUW\RXQJSHRSOHZLWK
DGGLWLRQDOVXSSRUWQHHGVZHPXVW
WKLQNDERXWKRZHOLJLELOLW\FULWHULDDQG
IXQGLQJIRUVHUYLFHVVXFKDVFROOHJH
6NLOOV'HYHORSPHQW6FRWODQGDQGRWKHUV
FDQEHSHUVRQDOLVHGLQFRQMXQFWLRQZLWK
KHDOWKDQGVRFLDOFDUHEXGJHWVWRDOORZ
IRUGLƪHULQJPRGHOVRIVXSSRUWLQWKH
FRPPXQLW\7KLVZRXOGOHDGWRPRUH
SRVLWLYHRXWFRPHVDQGRSSRUWXQLWLHV
WKDWDUHQRWFXUUHQWO\DYDLODEOH
PRINCIPLES OF GOOD TRANSITIONS. 2
_Leaving child and adolescent mental health services felt like I was falling
RƪDFOLƪ,ORVWWKHVXSSRUWDQGIHOOWKURXJKWKHJDSVf2QFH\RXDUH
they treat you like you are responsible, but overnight that doesn9t change,
we still need that support.`
a Young person from Young Minds focus group
Planning and commissioning
services should be done in
partnership with young people
Research and project work demonstrate
that young people and their families
often feel alienated and disconnected
from the planning and commissioning
SURFHVVHVWKDWDƪHFWWKHP
Young people should be encouraged,
DQGJLYHQWKHRSSRUWXQLW\WRLQƮXHQFH
and inform the commissioning processes
of local authorities (UNCRC article
3). Where these opportunities do
QRWH[LVWHƪRUWVVKRXOGEHPDGHWR
develop them. The co-production of
services will have a positive impact
on commissioning the most
needed and appropriate services.
A useful forum for engagement
can also be found in Tage-bandedV or
Tage-dedicatedV adolescent clinics.
These clinics can help health and
social care work with young people
to explore opportunities needed
in the local authority, community
and in services provided to enable
DUHDOGLƪHUHQFHWREHPDGH
Initiatives such as the National
Standards for Community Engagement
and Charter for Involvement provide
useful frameworks to help structure and
support involvement of this nature.
43
Scottish Transitions Forum. 2014
Advocacy should be available from the start of the transitions process
Advocacy should be available to all who need it, particularly if there are
concerns from families and young people about having their wishes heard.
7KHRƪHURIDGYRFDF\VKRXOGEHPDGHDWWKHVWDUWRIWKHWUDQVLWLRQVSURFHVV
and be available throughout. This is especially relevant for those involved
with looked-after children and young people or guardianship.
Case Study
&RPSOH[KHDOWKFDUHQHHGV
and transition:
Sam is a 20-year-old man who has
RYHUFRPHPDQ\GLƯFXOWLHVWKURXJKRXW
his life. He has a condition known as
Duchenne Muscular Dystrophy, severe
scoliosis, is wheelchair dependent and
is ventilated 24 hours per day. Sam has
been looked after by the local authority
and was in a residential school for a
QXPEHURI\HDUV6DPKDVEHQHƬWWHG
from regular respite visits to both
Rachel and Robin House ChildrenVs
Hospices for paediatric palliative care.
This case study will share the pathway
experience that led to Sam receiving the
keys to his own tenancy- as opposed to
the other option, which was long term
adult/older people residential care. Sam
has a future he has chosen. His transition
44
was not a simple process but led to a very
positive outcome. It involved a childrenVs
rights worker, two local authorities, two
health boards, two private providers
and the Children Hospice Association
Scotland from the voluntary sector.
Sam participated in a person-centred
SODQQLQJPHHWLQJZLWKVWDƪIURP
Capability Scotland where he was
supported to identify his needs, hopes,
dreams and wishes. He was resident in
one local authority, came from another
local authority area and wanted to live
in a third local authority area. During
this process he was also required to
transfer from paediatric health care to
adult health care and move from one
health board locality to another. There
were numerous looked-after childrenVs
reviews and planning meetings in which
he received support and encouragement
to participate. Those involved
included a social worker, who took the
lead role, education, advocacy, solicitor
(recommended by his advocate), child
and family support worker from CHAS,
third sector providers, paediatric and
adult ventilation service, SamVs brother
DQGPRWKHUDFRQVXOWDQWDQGEHQHƬWV
advice from his through-care worker.
Unfortunately, his accommodation was
chosen for him; this was necessary to
ensure it met his physical needs. He
ZDVYHU\KDSS\ZLWKWKHƮDW+LVVRFLDO
worker commissioned services from
Sense Scotland to provide the support
he needed. Sam did however interview
DQGDSSRLQWWKHVWDƪIRUKLVRZQWHDP
SamVs transition process took several
years. He left school when 16
years old and did not move into his
own accommodation until he was
approaching his twentieth birthday.
Often, Sam did not feel in control of
this process. The goalposts moved
frequently and he became quite
withdrawn and low at times.
+HKDVQRZEHHQOLYLQJLQKLVRZQƮDWIRU
one year. Small issues still arise for him,
however he has grown and developed
into an autonomous young man with
WKHFRQƬGHQFHWRPDNHFKRLFHVDQG
decisions. He is living a full and active
life, although like many other young
people who have a disability, he can feel
socially isolated from his peers at times.
Advocacy is important for everyone, and
Sam believes that all young people have
a right to be represented by an advocate.
45
Scottish Transitions Forum. 2014
This means:
r ,QIRUPDWLRQVKRXOGFOHDUO\VWDWH
what they are entitled to during
the transitions process
r ,QIRUPDWLRQVKRXOGVKRZZKDW
support is available
r ,QIRUPDWLRQVKRXOGEHLQFOXVLYHRI
GLƪHUHQWFRPPXQLFDWLRQQHHGV
r ,QIRUPDWLRQVKRXOGFRYHUDOODUHDVRI
education, health and social care
r &RPPRQDQGDJUHHGODQJXDJHVKRXOG
be used in the transitions process
46
PRINCIPLES OF GOOD TRANSITIONS. 2
Information should clearly state what they are
entitled to during the transitions process
Young people, their parents and carers should have access
WRLQIRUPDWLRQWKDWFODULƬHVZKDWVXSSRUWWKH\DUHHQWLWOHG
to and should expect in the transition period.
This should include clear information about their statutory
rights, including but not limited to:
r 7KH&KLOGUHQDQG<RXQJ3HRSOH6FRWODQG$FW
r (GXFDWLRQ$GGLWLRQDO6XSSRUWIRU
Learning) (Scotland) Act 2004
r &KLOGUHQoV6FRWODQG$FW
r 'XWLHVIRULQIRUPDWLRQXQGHUWKH(TXDOLW\$FW
r 1+64XDOLW\,PSURYHPHQW6WUDWHJ\
r %HWWHU+HDOWK%HWWHU&DUH+HDOWK3ROLF\
r $)DLUHUDQG+HDOWKLHU6FRWODQG
r 3URWHFWLRQRI9XOQHUDEOH*URXSV6FRWODQG$FW
r $GXOWVZLWK,QFDSDFLW\6FRWODQG$FW
r *XDUGLDQVKLS
r 6RFLDO&DUH6HOI'LUHFWHG6XSSRUW6FRWODQG$FW
r +XPDQ5LJKWV$FWDQGLWVDVVRFLDWHGDUWLFOHV
r 5LJKWWRDSSHDOYLDWKH$GGLWLRQDO6XSSRUW
Needs Tribunal for Scotland
r 5LJKWWRFRPSODLQ
r 'XWLHVIRU6FRWODQGoV&RPPLVVLRQHUIRU&KLOGUHQ
and Young People, as laid out in the Commissioner for
Children and Young People (Scotland) Act 2003 and the
Children and Young People (Scotland) Act 2014. The
&RPPLVVLRQHUoVRƯFHUXQVDQHQTXLULHVVHUYLFH
47
Scottish Transitions Forum. 2014
p,DPDSDUHQWNQRZOHGJHLVSRZHULWJLYHV\RXDQHYHQSOD\LQJƬHOGq
The information should be accessible and relevant
to carerVs and young peopleVs individual needs,
rather than being solely aimed at meeting statute
led priorities and legislation (UNCRC article 4).
Good sources of information are available. These
include Enquire, Autism Tool Box, Moving on Transitions
Workbook, English as a second language resources,
LEAD Scotland (Linking Education and Disability) and
Contact a Family. These resources should be continually
developed to their fullest potential. Children, young
people, their parents and carers should be made
fully aware of the information available to them.
The information also needs to take into account the
redress that young people, their parents or carers
may wish to take if things go wrong. This may be
access to a tribunal through education processes, or
complaints procedures relating to social care services.
There should also be information about the
judicial process if these avenues do not produce
HƪHFWLYHRXWFRPHV$GYRFDF\VKRXOGEHRƪHUHG
to help achieve this.
48
PRINCIPLES OF GOOD TRANSITIONS. 2
Children9s rights and transitions
7UDQVLWLRQVVKRXOGEHƬUPO\URRWHG
in childrenVs rights, by placing the
child at the centre, recognising
them as rights-holders and acting
in their best interests while taking
their views into account.
In Scotland there is a growing
awareness of childrenVs rights across
public policy, public services and
society as a whole. This is indicated
by the recent inclusion of a range of
duties on Scottish Ministers relating
to the United Nations Convention
on the Rights of the Child (UNCRC),
ZKLFKZDVUDWLƬHGE\WKH8.LQ
The principles outlined in TPrinciples
of Good Transitions 2V clearly align
with the articles contained within
the UNCRC, in particular articles:
rQRQGLVFULPLQDWLRQ
rEHVWLQWHUHVWVRIWKHFKLOG
rSURWHFWLRQRIULJKWV
rYLHZVRIWKHFKLOG
rFKLOGUHQZLWKGLVDELOLWLHV
rULJKWWRKHDOWK
rUHYLHZRIWUHDWPHQWLQFDUH
rDGHTXDWHVWDQGDUGRIOLYLQJ
rULJKWWRHGXFDWLRQ
rULJKWWRSOD\
Additionally, the United Nations
Convention on the Rights of
Persons with Disabilities (UNRPD)
UHDƯUPVWKDWDOOSHUVRQVZLWK
disabilities must enjoy all human
rights and fundamental freedoms,
DQGLQFOXGHVVSHFLƬFSURWHFWLRQV
for the rights of disabled people.
Policies, programmes and
interventions relating to transitions
should be framed around the rights
enshrined within these conventions.
This means taking a holistic approach
to transitions and placing a focus
RQULJKWVLQRUGHUWRƬUPO\HVWDEOLVK
the principle of best interests of
the child. The UNCRC also contains
the key concept of Tevolving
capacities,V whereby with increasing
age, maturity, understanding and
experience, children can progressively
assume greater autonomy.
49
Scottish Transitions Forum. 2014
_Health care information should support young people from paediatrics
into adult health care, for instance, at the time of transfer a young person
with additional support needs can receive paper work detailing current
diagnosis without any information about adult services. This can be further
compounded when there is one area of engagement in paediatrics that
WKHQPRYHVWRƬYHRUPRUHLQDGXOWVHUYLFHVq
a Nurse RCH
Information should show what support
is available
To enable young people with additional support needs
to have control of their lives they should be able to
make informed choices about which services they would
like to support them. Currently there is no national
database or provision of information that would help
them. A national resource database should be compiled
using open source software such as ALISS.Org. This
should be done in partnership with support agencies,
local and national government and other statutory
services to ensure that all options are included.
In Fife, a wide range of organisations
and groups help young people
make the transition into adulthood.
These include Fife Council, NHS Fife,
charities and voluntary organisations.
To guide their work and ensure a
consistent standard of service is
provided a TCharter for TransitionV
and a website with information
to help in the decision-making
process have been produced.
The four standards set out in the
Charter for Transition are:
r 7KHVXSSRUWWKH\RXQJSHUVRQ
gets meets their particular needs.
Parents, carers and the young
person, will be involved in
50
deciding what these are.
r 3DUHQWVDQGFDUHUVKDYHWKH
information they need to make
decisions as their son or daughter
moves from school and childrenVs
services to adult services.
r (YHU\RQHZKRoVLQYROYHGLQWKH
young personVs care will help plan
what will work best for them.
r 7KH\RXQJSHUVRQZLOOJHW
the right support at the right
time as they move from
one service to another.
A copy of the charter can
be downloaded from the
Moving On website at
ZZZƬIHGLUHFWRUJXNPRYLQJRQ
PRINCIPLES OF GOOD TRANSITIONS. 2
_You need to instil in the person a sense of their own achievement and
the fact that they can do it. Once somebody starts to write their own job
description for a personal assistant the psychological change in them is
massive.`
Community assets should also
EHLGHQWLƬHGDQGPDGHDYDLODEOH
Again, ALISS could provide a way of
doing this. This information should
help the young person and their
family to be aware of the full range
of options available to them.
Local transitions fairs have been held
to provide parents with information
about services in their local area.
Examples of this are the Futures Fair
in East Lothian, exploring local options
for support post-transition, and TYoung
Scots Got TalentV (Values into Action
Scotland). Such initiatives should
be the norm, not the exception.
Information should be inclusive of
GLƪHUHQWFRPPXQLFDWLRQQHHGV
Information should be provided in ways
that are inclusive of young peopleVs,
SDUHQWVoDQGFDUHUVoGLƪHUHQWQHHGVVXFK
as audio/video, assistive technologies,
board maker, talking mats, etc).
Information should cover all areas
of education, health and social care
Information should be developed
across disciplines in one easy-to-use
IRUPDWUDWKHUWKDQGULYHQE\GLƪHUHQW
legislative and policy concerns.
Young people, their parents and carers
should be able speak to supportive
individuals in advocacy or information
services about any social and health
care concerns that they may have.
Advocacy and information providers
should consider broadening their scope
WRFRYHUDOODUHDVWKDWPD\DƪHFWSHRSOH
in transitions, rather than being limited
WRDGGUHVVLQJVSHFLƬFDUHDVRIQHHG
Common and agreed language
should be used in the transitions
process
$WHUPFDQPHDQGLƪHUHQWWKLQJV
depending on who is using it. For
example, the terms Tkey workerV,
Ttransitions co-ordinatorV, Tlearning
GLVDELOLW\onGLVDELOLW\onOHDUQLQJGLƯFXOW\o
ToutcomeV, Tpositive destinationV and
Tperson-centred planV, amongst many
RWKHUVFDQKDYHGLƪHUHQWPHDQLQJV
depending on the professional
background of the person using it. This
leads to confusion amongst children,
young people, their parents and carers,
and the professionals themselves.
Information should, as far as possible, be
free from professional jargon. Where it is
QHHGHGWKHUHVKRXOGEHFOHDUGHƬQLWLRQV
of the terms that are shared and agreed
across all professional sectors.
51
Scottish Transitions Forum. 2014
This means:
Family well-being needs to be supported
Professionals need to be aware of:
r Parental support groups,
such as VOCAL
r Advocacy
r Carers assessments
r Respite and short Breaks.
52
PRINCIPLES OF GOOD TRANSITIONS. 2
Transition services must address the needs of family members and other carers
ZKRVHUROHVZLOODOVREHFKDQJLQJ0DQ\SDUHQWVDQGFDUHUVKDYHKDGWRƬJKWIRU
services and support. At the time of transition parents can face Tburn outV as they
deal with the challenges of arranging new services, complex assessment
procedures and lack of resources.
A number of strategies have been developed that recognise the context and
impact of stress on families and carers, and the burn out experienced by some.
The strategies include:
r (QFRXUDJLQJSRVLWLYHH[SHFWDWLRQV
and working with doubts around
community and social life post-16.
Supporting parents to look at how
this can be maintained or built upon
where it does not already exist
r $VVLVWLQJSDUHQWVLQUHFRJQLVLQJWKH
importance of their contributions by
providing early information sessions
at age 14 to help them plan and adjust
to changes. If information is timely
and accurate, parents and carers
will have a chance to acclimatise
to the transitions process
r 6XSSRUWLQJSDUHQWVVRWKH\XQGHUVWDQG
and acknowledge that their young
person can make informed choices
r ,QFUHDVLQJWKHUROHRIVRFLDO
support networks
r $GGUHVVLQJSDUHQWFRQFHUQVUHJDUGLQJ
the future by accurate and timely
information from relevant sources
r 7HFKQLTXHVVXFKDVUHOD[DWLRQDQG
meditation that can help to deal with
the physical symptoms of stress.
r 8VLQJDSSURSULDWHVKRUWEUHDNDQG
respite services. This can allow for
carer respite as well as the young
person having a break from their
current situation
r /RRNLQJDWLPSURYLQJUHVLOLHQFH7KLV
can be achieved through practices
based on the principles of resilience,
VHOIHƯFDF\DQGVHOIHVWHHPEXLOGLQJ
r (QVXULQJWKDWSDUHQWVKDYHFRQWLQXHG
access to a named person and have
their role in the childVs life validated
r (QVXUHWKDWSDUHQWVUHFHLYH
information and are supported to
complete carer assessments and
consider other forms of legal
processes such as guardianship
and incapacity
r %HJLQQLQJWRHQFRXUDJHFRQYHUVDWLRQV
about transition in clear, simple
language at an early stage
r 7DONLQJDERXWWUDQVLWLRQLQSRVLWLYH
and creative ways and seeing this
as a time to celebrate moving
into young adulthood.
53
Scottish Transitions Forum. 2014
This means:
r 7KHUHVKRXOGEHZRUNDWQDWLRQDOOHYHOWR
review how legislation and policy interlink
r 7KH6FRWWLVK*RYHUQPHQWVKRXOG
SURYLGHLQIRUPDWLRQWKDWFODULƬHVWKH
links between legislation and policy
54
There should be work at a national
level to review how legislation and
policy interlink
The current legislation and policy
VXUURXQGLQJWUDQVLWLRQVRƪHUVDSRVLWLYH
framework to improve young peopleVs
experience. However, new initiatives
sit on top of older legislation and
policy without clarity about how they
interlink. Older legislation and policy
ZHUHFUHDWHGZKHQWKHUHZHUHGLƪHUHQW
social drivers and often do not focus
on the right to an independent life. As
a result, out-dated work practices and
values continue to apply. These stand
in the way of young people achieving
choice, independence and control.
55
Scottish Transitions Forum. 2014
A team or an individual should be appointed to work
between government and other stakeholders to review
how current legislation and policy interlink to support
clearer transitions pathways, especially between children
and families and adult health and social care services.
Looking at both of these areas over the transitions
period has been outside the scope of any review in
recent times and it would help the Scottish Government
achieve its 20/20 vision for health and social care.
Scottish Government committees should improve their
HƪHFWLYHQHVVLQVFUXWLQLVLQJKRZZHOOOHJLVODWLRQDQGSROLF\
are applied in practice. Consideration should be given to
the appointment of permanent specialist advisers to the
committees. Their roles would be to explore the impact of
legislation and policy across all areas, and how outmoded
values and work practices can be challenged and improved.
56
PRINCIPLES OF GOOD TRANSITIONS. 2
The Scottish Government should
SURYLGHLQIRUPDWLRQWKDWFODULƬHVWKH
link between legislation and policy
7KH6FRWWLVK*RYHUQPHQWVKRXOGSURYLGHEULHƬQJVWKDW
clearly identify the links throughout the broad legislative
and policy environment that impact on transitions. The
EULHƬQJVVKRXOGEHVLPSOHWRXQGHUVWDQGLQFOXGLQJE\
those undergoing the transitions process, and relevant
WRDOOSURIHVVLRQDOVHFWRUV%ULHƬQJVVKRXOGGHWDLOKRZ
health, education, social care and other areas interlink
through legislation and policy and clarify the values,
principles and recommendations that underpin these.
A working group of cross-professionals is already looking at
mapping the multi-sector legislative and policy framework
in Scotland as it applies to children and adults. More
information as this develops will be available on our website.
57
Scottish Transitions Forum. 2014
Principles into practice
The following organisations have endorsed
TPrinciples of Good Transitions 2V and have committed to
putting the principles into practice whenever possible.
58
PRINCIPLES OF GOOD TRANSITIONS. 2
59
Scottish Transitions Forum. 2014
60
PRINCIPLES OF GOOD TRANSITIONS. 2
61
Scottish Transitions Forum. 2014
How to support *Principles of
Good Transitions 27
There are lots of ways you can support
2Principles of Good Transitions 28 and the
work of the Scottish Transitions Forum:
r %HFRPHDPHPEHURIWKH)RUXPLWLVIUHHWRMRLQ
at www.scottishtransitions.org.uk
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r $SSO\WKHVHYHQSULQFLSOHVLQ\RXURZQ
ZRUNSUDFWLFHZKHQHYHU\RXFDQ/HWXVNQRZ
if you would like us to help you do this
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principles and encourage them to apply them
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KDYHDOUHDG\FRPPLWWHGWRSXWWLQJWKHSULQFLSOHV
into practice
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happening in your local area that is helping
WRLPSURYHWUDQVLWLRQV:HZRXOGEHYHU\
KDSS\WRKHDUDERXWWKLVDQGWROHWRWKHUV
NQRZDERXWLWRQ\RXUEHKDOI
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help us to write 2Principles of Good Transitions 38.
62
PRINCIPLES OF GOOD TRANSITIONS. 2
However you choose to get involved
we would like to hear from you:
Scottish Transitions Forum a ARC Scotland
Unit 12
Hardengreen Business Centre
Eskbank
Dalkeith
EH22 3NX
Email: [email protected]
Tel: 0131 663 4444
63
Price: £10
Scottish Transitions Forum
2014