National Framework for Children and Young People’s Continuing Care

Aims of the Session. To consider the component parts of the CCF.To consider the component parts of the CCF. To work through the DSTTo work through the DST To share project on CCNTo share project on CCN To consider partner agency working.To consider partner agency working. To consider the transition phase for young people.To consider the transition phase for young people. This is an interactive event. This is an interactive event.

Exercise. National Framework for Children and Young People's Continuing Care Myth Busters!

Continuing Care. A continuing care package will be required when a child or young person has needs arising from disability, accident or illness that cannot be met by existing universal or specialist services alone.

The framework provides a systematic approach to assessing the ongoing health needs of children & young people through : Joined up services & commissioning.Joined up services & commissioning. Building on existing assessments.Building on existing assessments. A process that is transparent & includes participation from the family & young person.A process that is transparent & includes participation from the family & young person. National Framework for Children & Young People’s Continuing Care.

Decision Making Phase Arrangement of Provision Phase 1) Identify 2) Assess 3) Recommend 4) Decision 5) Inform Stage of Continuing Care Pathway 1 working day 8 working days 14 working days 5 working days Timescales Cumulative Timescales 9 working days 23 working days 28 working days Child or Young Person with possible continuing care needs identified through effective referral. Fast track if necessary Nominated children and young people’s health assessor completes four areas of assessment Nominated children and young people’s health assessor prepares recommendations and costed options Multi-Agency Forum considers recommendations, costed options and decides upon package of continuing care for child or young person where continuing care need is established Child or Young Person and family, referrer and relevant organisations informed of decision Summary of key actions 6) Deliver 7) ReviewRe-assessment of child or young person’s continuing care needs and appropriateness of package of continuing care should occur 3 months after initial assessment, then annually as a minimum or sooner as appropriate Identify provider(s) for package of continuing care / Commissioning and Implementation of package of continuing care / Ongoing Training, Support and Monitoring Dependent on complexity, commissioning, Disability Grant Funding processes and/or national exemplars 3 months / Annually / as appropriate Phases of the Continuing Care Process 1 working days Assessment Phase

Core Elements of the National Framework for Children and Young People's Continuing Care. Principles.Principles. Timelines.Timelines. Assessment phase.Assessment phase. Decision-making phase.Decision-making phase. Arrangement of provision phase.Arrangement of provision phase. Transition from child to adult services.Transition from child to adult services.

Fast Track Pathway. Only for those children where their condition is deteriorating rapidly characterised by an increasing level of dependency and ‘where lifespan is thought to be days or weeks rather than months or years’. The need immediate decision on eligibility to be made so that their immediate needs can be met.

Nominated Children and Young People’s Health Assessor. Key requirements: Health practitioner experienced in children and young people’s health.Health practitioner experienced in children and young people’s health. Has experience and expertise in health assessment.Has experience and expertise in health assessment. A thorough working knowledge of the policy on the Framework.A thorough working knowledge of the policy on the Framework. Well-developed leadership qualities.Well-developed leadership qualities.

Assessment. The child and family centred assessment process must be at the very heart of a children’s continuing care assessment process. All other aspects of the assessment process must be seen in the context of this assessment.The child and family centred assessment process must be at the very heart of a children’s continuing care assessment process. All other aspects of the assessment process must be seen in the context of this assessment.

Assessment. There are three key considerations which are paramount in children’s continuing care:- Parents - experts in their child or young person’s care and as primary carers.Parents - experts in their child or young person’s care and as primary carers. Home is the centre of caring.Home is the centre of caring. A child's right to education.A child's right to education.

Key Factors in Assessment. Timing of assessment.Timing of assessment. Location of assessment.Location of assessment. Communication skillsCommunication skills Skilled interpreters.Skilled interpreters. Parents with learning or communication difficulties. Communication aids. Advanced planning techniques.

How do you build up a holistic child and family centred assessment without repeating assessments, reports and risk assessments already undertaken? Discuss.

Possible Assessments and Reports. Multidisciplinary reports.Multidisciplinary reports. Multi-agency reports.Multi-agency reports. Records.Records. Independent reports.Independent reports.

Key Areas for Risk Assessment. Clinical risk.Clinical risk. Staffing levels.Staffing levels. Moving and handling.Moving and handling. Environment of care.Environment of care. Equipment.Equipment.

The Elements in Risk Management. Risk refers to the possibility of a situation occurring which would involve exposure to danger or a hazard, that is, the possibility of something harmful happening.Risk refers to the possibility of a situation occurring which would involve exposure to danger or a hazard, that is, the possibility of something harmful happening. Risk is a combination of the likelihood of something harmful happening and the seriousness of the potential injury.Risk is a combination of the likelihood of something harmful happening and the seriousness of the potential injury.

The Elements in Risk Management. A hazard is less likely to cause harm if certain controls are in place.A hazard is less likely to cause harm if certain controls are in place. Controls are the steps taken to either eliminate the hazard or reduce the associated risk to an acceptably low level.Controls are the steps taken to either eliminate the hazard or reduce the associated risk to an acceptably low level.

The Elements in Risk Management. Risk is managed by assessing it, avoiding it if it is unnecessary or reducing it to a level which is ‘reasonably practicable’.Risk is managed by assessing it, avoiding it if it is unnecessary or reducing it to a level which is ‘reasonably practicable’. When considering what is ‘reasonably practicable’ the needs of both the child and staff should be taken into account.When considering what is ‘reasonably practicable’ the needs of both the child and staff should be taken into account.

Reasonably Practicable - As defined by the Health and Safety Executive (HSE), means ‘an employee has satisfied his/her duty if he/she can show that any further preventative steps would be grossly disproportionate to the further benefit which would accrue from their introduction’ (HSE 1992,p8).

DST – What is it? The decision support tool enables practitioners to: Inform consistent decision making.Inform consistent decision making. Requires practitioners to use their professional judgement to justify how and why a recommendation is made.Requires practitioners to use their professional judgement to justify how and why a recommendation is made. Clarifies the evidence used to make the decision.Clarifies the evidence used to make the decision. A stage of the assessment process.A stage of the assessment process.

DST – What it’s not. An assessment tool.An assessment tool. A decision MAKING tool.A decision MAKING tool. Suitable for every individual’s situation.Suitable for every individual’s situation. A substitute for professional judgement.A substitute for professional judgement.

How Does it Work – Care Domains. BehaviourBehaviour Psychological & emotional needsPsychological & emotional needs CommunicationCommunication MobilityMobility NutritionNutrition Continence Skin & tissue Viability Breathing Drug therapies & medication: symptom control Seizures

Levels. Each domain is divided into levels describing a hierarchy of need.Each domain is divided into levels describing a hierarchy of need. Each level is given a weighting (not score) no needs, low, moderate, high, severe, priority.Each level is given a weighting (not score) no needs, low, moderate, high, severe, priority. Not all domains have the same weighting – based on principle that some domains reflect health needs more than others.Not all domains have the same weighting – based on principle that some domains reflect health needs more than others.

1. Child or Young Person and family preferences or views 3. Reports and Risk Assessments from Multi- Disciplinary Team 2. Holistic Child or Young Person & Family centred assessment and carer assessment Health – Carry Out Social – Collate existing report / Commission / Carry Out Joint Assessment / Education – Collate existing report / Commission 4. Decision Support Tool

Exercise – National Framework for Children and Young People's Continuing Care (2010) - Using the Decision Support Tool (DST). Go through each domain and consider the following:- How do you apply professional judgement to the child / young person’s domains?How do you apply professional judgement to the child / young person’s domains? How does normal child development impact on the scoring of each domain?How does normal child development impact on the scoring of each domain? What risks could / should be considered in each domain?What risks could / should be considered in each domain?

Key Requisites of a Multi-Agency Decision Making Forum. The multi-agency decision-making forum is made up of key PCT and local authority professionals, including commissioners and clinical advisers.

Discuss how existing/ or new panels or processes can be used for making decisions on Children’s continuing Care Assessments in your area.

Record Keeping. Clear record of multi-agency inputs.Clear record of multi-agency inputs. Record rational behind decisions and recommendations.Record rational behind decisions and recommendations. Evidence based decisions.Evidence based decisions. Scoring of DST or rational for professional judgement based decisions.Scoring of DST or rational for professional judgement based decisions.

Communicating the Decision. Within 5 working days – How?Within 5 working days – How? Clear rational.Clear rational. Care options.Care options. Time frame.Time frame. Appeal process.Appeal process.

Delivery. Care packages should be sustainable and integrated with existing universal and specialist provision, provided in a timely manner and adaptable to future care needs.

Delivery Goals. Integration with existing universal and specialist services is a key requisite, which should enhance sustainability and reduce fragmentation of service delivery.Integration with existing universal and specialist services is a key requisite, which should enhance sustainability and reduce fragmentation of service delivery. Sustainability of services should be constantly considered and reviewed. Early indications from work being undertaken by DH on community children’s nursing has demonstrated the advantages of large, multifaceted children’s teams in delivering sustainable services.Sustainability of services should be constantly considered and reviewed. Early indications from work being undertaken by DH on community children’s nursing has demonstrated the advantages of large, multifaceted children’s teams in delivering sustainable services.

Care management should be integral to care packages. National Framework for Children and Young People’s Continuing Care (DH 2010 Pg 64).Care management should be integral to care packages. National Framework for Children and Young People’s Continuing Care (DH 2010 Pg 64). Training of parents, staff and foster carers should be considered as appropriate.Training of parents, staff and foster carers should be considered as appropriate.

Review. Initially at 3 months.Initially at 3 months. As required.As required. Minimum of yearly.Minimum of yearly. Clear expectation of all involved that care will be reviewed.Clear expectation of all involved that care will be reviewed. Open and transparent process.Open and transparent process.

Auditing & Monitoring. PCTs are responsible for:PCTs are responsible for: –Ensuring consistency in the application of the national policy on eligibility for Children’s Continuing Healthcare, –Promoting awareness of Children’s Continuing Healthcare, –Implementing and maintaining good practice, –Ensuring quality standards are met and sustained, –Providing training and development opportunities for practitioners, –Identifying and acting on issues arising in the provision of Children’s Continuing Healthcare, and; –Informing commissioning arrangements, both on a strategic and individual basis. –Monitoring the number of appeals and their outcomes.

Dispute Prevention. How can you avoid disputes? a.Process. b.Implementation.

Co-ordinating the Process. Ownership of process beginning to end: Identify children / young people who should be assessed.Identify children / young people who should be assessed. Identify if a child / young person needs to be “fast-tracked”.Identify if a child / young person needs to be “fast-tracked”. Identify all professionals involved in the care of the child / young person who may contribute to the assessment.Identify all professionals involved in the care of the child / young person who may contribute to the assessment. Complete documentation accurately, clearly and comprehensively.Complete documentation accurately, clearly and comprehensively. Ensure appropriate care plan put in place.Ensure appropriate care plan put in place. A Care Coordinator can help this process run smoothly.

Review Panel. Neighbouring PCTNeighbouring PCT PCTPCT Senior officer reviewSenior officer review

PCT Complaints Procedure.

Dispute Resolution Good Practice Principles – Handout.