Transitioning from child to adult care services

Legislation states that preparing for adulthood, including assessing a child’s likely care and support needs as an adult, should begin way before they reach 18. The SEND regulations 2014 and the Code of Practice state that for children with and without EHCPs, preparing for adulthood should begin from year 9 onwards. This preparation includes discussions regarding future employment, accommodation and participation of the child (future adult) in society.

A transitional assessment is a document created by the local authority which takes into consideration all of your child’s current needs for care and support and their likely needs after they reach 18. This assessment begins around age 14 (year 9) and The Care Act 2014 states the local authorities must assess if it is likely that a disabled child will have care and support needs after transitioning to adulthood and must complete an assessment if it will be of ‘significant benefit’ to the child and their carer.

A transitional assessment can then be used as a ‘needs assessment’ when the child reaches 18 to establish which needs the person has, and how these will be met. A care and support plan and personal budget can then be created by the local authority.

The transitional assessment often takes place from year 9 (age 14) onwards, but the Care Act 2014 states that the timing of the transition assessment should be when there is a ‘significant benefit’ to the child and their carer.

Local authorities may have policies which indicate when they usually assess, but the process should be tailored to your child in terms of when it is most beneficial to assess and when it is most appropriate to predict future needs. Factors such as the child’s care leavers status, their medical treatments, and family circumstances can all affect this timing.

Once a Care Act assessment has taken place, a person is deemed to have eligible needs if they have a physical or mental impairment or illness which is likely to prevent them from meeting two or more specified outcomes as an adult. These outcomes are: 

1. Managing and maintaining nutrition;
2. Maintaining personal hygiene;
3. Managing toilet needs;
4. Being appropriately clothed;
5. Being able to make use of the home safely;
6. Maintaining a habitable home environment;
7. Developing and maintaining family or other personal relationships;
8. Accessing and engaging in work, training, education or volunteering;
9. Making use of necessary facilities or services in the local community, including public transport, and recreational facilities or services;
10. Carrying out any caring responsibilities an adult has for a child;

To have ‘eligible’ care and support needs, there would need to be significant impact on the child’s wellbeing to them not being able to achieve these outcomes. 

The Care Act 2014 states that a local authority must assess needs if it is ‘likely’ that the disabled child will have care and support needs after they transition to adulthood. They must also assess if it will be of ‘significant benefit’ to the child and/or the carer. The threshold for assessing a child’s needs is therefore low.

The fact that the child may not require adult services is not a reason on its own for the local authority to refuse to assess your child. Your child may already have needs or have the likely appearance of needs. Some of these needs may be met by yourself currently, but you may not be able or willing to continue to meet these needs. If the local authority is refusing to assess, there are requirements on the local authority to give written reasons of their refusal.

The care and support statutory guidance states that even if the child does not likely require adult services, the local authority must still provide signposting to prevent or delay the development of needs.

If the local authority has refused to assess your child’s needs, it must give written reasons of the refusal, provide information and guidance to prevent or delay the development of needs, and if they say it is purely the wrong time, they must contact you when the right time will be.

If you feel your local authority is not correctly following the legislation, you can challenge this by following the complaints process, under extended appeal or under judicial review.

If your child has eligible care and support needs, a care and support plan should be in place which states what these needs are and how they should be met. Regardless of financial responsibility, local authorities should provide you with information on the available care and support in your area. Unless the needs are being met by a carer, the local authority has a duty to arrange care where the adult lacks capacity and there is no one else authorised to arrange this. Local authorities can charge for putting these arrangements in place, depending on the adult's income. 

Your child may be eligible for NHS continuing healthcare (CHC) funding if they have long-term complex health needs depending on what help they need, how intense their needs are, how unpredictable they can be, and how complex they can be. There is a National Framework for Children and Young People’s Continuing Care 2016 which sets out the process for assessing whether a child is eligible for CHC funding. After a child is referred to the CCG (Clinical Commissioning Group) to assess for a primary health need, the assessor will send their recommendation to a multi-agency forum who then decide if the child has a continuing care need. The decision can be appealed if you disagree with the outcome, and any care package commissioned will be subject to regular reviews. 

Future CHC eligibility should be assessed as early as possible in the transition process. At around 16 to 17 years of age, the adult screening tool should be used to assess and ascertain whether the child is likely to need NHS Continuing Healthcare as an adult.

If your child had eligible care and support needs before 18, it is likely they will continue to have care and support needs as an adult. For children with an EHCP, children’s services can continue to support the child until the EHCP ceases. The legislation is worded so that this ‘black hole’ or ‘cliff edge’ where care ceases should not occur. The SEND code of practice states “under no circumstances should young people find themselves suddenly without support and care as they transition”.

To challenge the failings in the transition process, you should contact the local authority for them to confirm in writing why this has happened. If you are still unsatisfied with the response, there are options to challenge via extended appeal, by following the complaints process, or under judicial review.

Decisions about where your child will live when they turn 18 should be made with regards to the views and wishes of the child/young adult, the willingness/ability of their parent/carer to continue to care for them and house them, the mental capacity of the young adult. The local authority has to take into account the human rights of the young adult and the process of determining where their needs should be met should be person-centred. The focus should be on what accommodation is required to meet the needs of the young adult and where the young adult wishes to live.