Introduction ‘Transition’ is the purposeful, planned process that addresses medical, psychosocial and educational needs of Young people with long-term conditions as they move from child-centred to adult-oriented healthcare systems. The importance and challenges of healthcare transition are recognised in UK National Institute for Health and Clinical Excellence (NICE) Guideline and Quality Standard (2016). A new dedicated transition clinic for Young people with neuro-developmental problems was initiated in Carmarthenshire in September 2016
Aims To demonstrate the provision of transition services for children with neuro-developmental conditions; benchmark services against NICE standards and illustrate areas for improvement.
Methods Young people aged 16-19 years who were seen in a transition clinic with diagnosis of neuro-developmental problems in Carmarthenshire. 50 Young people from September 2016 to July 2018 were reviewed.
Results 38 were male and 12 were female. Diagnosis were ADHD 40%, Learning difficulties 34%, ASD 24%, Developmental coordination disorder 16%, Physical disability 14%. Co-occurrence of ADHD, ASD and/or learning difficulties was prevalent in 74% of cases. Age at first appointment was 16 years 10 months to 18 years 8 months. The only NICE quality standard met was discussion of transition care ideas with cares/parents. Majority had one appointment only. Repeat appointment was given to 5 patients. Outcome from clinic included discharge to GP (64%), referral to adult mental health services (16%), referral to Adult LD team (12%), and review by behavioural team (8%). Social worker involvement was recommended for all cases. All of them were seen in age banded clinic. Written transition plan was provided to all. 24% saw adult team before transfer, 14% had a key worker. 6% had a co-ordinated team. Holistic life skills training were discussed with all those who attended.
Conclusion Start of new transition clinic has facilitated transfer of Young people with neuro-developmental conditions. NICE quality standards were not met in many cases. ‘Proposed beneficial features’ are suggested in literature to improve outcomes; which we aspire to implement. We aim to start by providing a meeting with the adult team before transfer and providing a key worker/transition manager for all patients to achieve optimum transition.
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