Transitions assessments and care planning: a gap that needs a better bridge.
There is an increasingly apparent tension between the eligibility criteria and the ‘wellbeing principle’ in the Care Act Guidance.
No council is resourced to deliver the preventative aims of the wellbeing principle: essentially the freedom to do anything that might prevent, delay or reduce an eligible need.
Many young people who have autism, or have been looked after children, or have an emerging mental health diagnosis may not meet the strict definitions of the eligibility criteria-they may not need help with personal care-the ambition to prevent, reduce or delay an emergent need arising from trauma; exploitation; harmful behaviours or isolation may be a legitimate one.
The ‘transition’ from being supported by children’s social care to needing the support of adult social care is one element of the Care Act that merits review and reflection. The guidance in chapter 16 to carry out a ‘transitions assessment’ reads as particularly open and generic in the post COVID-19 world of increasing volume and complexity in regard to the mental health of young people and the accumulating caselaw around mental capacity.
The long-established pressures of the Ofsted inspection regime for social work and care provision for the under eighteens, and the emerging CQC assurance framework for adults is also likely to heighten scrutiny of transition arrangements, with the CQC’s report on the pilot assurance sites noting a significant variation in practice in regard to this area.
When the Care Act was drafted, ‘transitions’ work in most council areas largely related to young people with a learning disability or a physical disability, but ten years on increasing numbers of young people are now experiencing significant mental health problems and a growing body of knowledge about the effects of trauma and the fact that young people’s brains are still in formation, arguably make the age of 18 probably not the optimum time to take a fixed view of someone’s needs.
Increases in diagnoses of autism without a learning disability and more recently increased diagnoses of attention deficit hyperactivity disorder (ADHD), mean that demand is widening and the challenges of assessing and planning for adulthood for those young people who may have been on very restrictive care plans and have had little opportunity to develop experiential learning is becoming increasingly difficult. Family courts are also becoming much more interested in what the plan is for a child post-18, meaning that longer term planning is required. Taking an ‘eligibility criteria only’ based approach to assessing young people under the Care Act seems likely to be increasingly ineffective.
In 2021 Research in Practice produced ‘Bridging the Gap’: policy guidance on managing ‘Transitional Safeguarding’, and while it promoted better mutual understanding of children’s and adult’s social care, its focus on abuse and exploitation the post-coronavirus challenge for transitions looks much broader than safeguarding. Reviews like Feather et al (2023) of the actual evidence for effective care intervention to support young people suggest a framework that takes into account a range of elements including: access to therapy; education and life skills and-critically-offering services when they are needed and wanted by the young person (which may not be when the state agencies are configured to offer them: for example Child and Adolescent Mental Health Services (CAMHS) age criteria and variable waiting lists may restrict therapeutic offers).
A particular challenge for social workers trying to work for young people moving between the children’s and adult’s legal worlds is that the Care Act (quite rightly) prohibits adult social care from paying for services that should be commissioned or provided by the NHS, like talking therapy, while family court timescales and demands mean that councils often have to provide this.
This is a significant challenge, as young people approach 18 and are perhaps mid-way through a course of treatment but also a challenge for council commissioners in buying interventions for young people engaged in sexually inappropriate behaviour. A strategic aim of keeping young people in borough, although very challenging to deliver, would focus attention and could support invest-to-save business cases if supported by effective analysis and modelling.
Strengths-based practice in social work with adults focuses on outcomes, promoting autonomy and recognising that people’s wishes and feeling are paramount even when they are unlikely to optimise their wellbeing. Additional and very real challenges come when young people present with forensic needs and do things that are likely to cause themselves and others harm, especially when those risks have been previously managed by controlling access to communications technology, but there is no actual criminal justice sanction or control in place once they are 18. We are also seeing increasingly complex and sometimes contradictory mental capacity assessments on sex and relationships, which providers find hard to deliver.
Young people are also seeking and experiencing new definitions around gender and sexuality and changing attitudes to race, identity, ethnicity and culture, and there are significant opportunities to respond to these changes with innovation rather than traditional care models, through the use of direct payments; personal assistants; new technology and other forms of self-directed support.
Many councils have ‘Directions panel’ type arrangements (derived from Barnsley in ‘Bridging the Gap’) to try and bring a range of agencies together to manage these transitions more effectively, but further work is needed to look at how social workers can lead on more effective assessment, care planning and commissioning across 16–25-year-olds. In looking at people’s experiences of transition between services including children's social care and adult social care, the Care Quality Commission (CQC) have found that policy and practice appear to vary significantly across councils, with some reporting significant challenges in working between ages 16 and 25, and others reporting a smoother, more harmonious transition.
A proportionate approach to this dynamic area of practice would be for the LGA, ADASS, care-experienced and other young adults, the children's and adult's social care principal social worker networks, Ofsted and CQC to establish a working group to review the challenges, identify the more effective practice that is obviously out there, and draft a revision to the Care Act guidance that supports better, more person-centred outcomes for young adults.
This could be done without establishing uniform assessment models but could support clarity in a number of areas-for example, setting out more clearly what being a ‘corporate parent’ means, that is, what a reasonable and effective parent should be expected to consider and provide, perhaps through supporting care-experienced lay advisers to Directions-panel type arrangements.
References
Feather, J., Allen, D., Crompton, R., Jones, Z., Christiansen, A., and Butler, G. (2023). Transitional support interventions for care leavers: A scoping review. Children and Society, 00, 1–23.
Bridging the gap: Transitional Safeguarding and the role of social work with adults
