Objectives To assess current transition practice in a London foundation Trust delivering secondary, tertiary and quaternary care to young people(YP) 13–18 years, with> 43,000 outpatient episodes/year. To determine whether the services meet quality standards for care of YP.
Methods A retrospective review of developmentally appropriate healthcare (DAH) and transition process was performed against the DoH ‘You’re Welcome’ quality criteria(1) and NICE guideline ‘Transition from children’s to adults’. A questionnaire was co-designed by a YP steering group; a multidisciplinary team across paediatric, adolescent, and adult services, which was circulated and completed electronically.
Results 56 services across the Trust responded. 68% of respondents reported that they provided a Transition service, 35% of services had a transition lead (consultant 48% ; CNS 35%),with 57% running multidisciplinary team (MDT) clinics for YP.
The average age for transition process to start was 13 years (13–20) into adolescent services, 17 years into adult services.
Transfer to adolescent service mean age 17 years ( 13–17), and to adult services 18 years ( 16–24yrs).
Despite transition clinics being held, 8/25 services describe only 10% will go into the pathway and 90% will be transferred with letter only.
Table 3 describes issues identified with the transition process.
Table 4 describes adherence to You’re welcome criteria (young person’s centred approach)
No service had a clear idea of how to support YP with learning difficulties. There was no common trust policy regarding adolescents DNAs. 21% had involved YP in designing their process and 18% had asked for feedback on their services.
Conclusion Many services reported offering a transition service, and there were areas of excellent practice in dedicated young people’s services, including developmentally appropriate healthcare practices.
However transfer into adult services is often occurring without adequate transition., DAH is not universal. Engagement with YP is low.
Going forwards the following work streams were identified:
Develop YP steering board
Creation of policy and guidelines with regular audit and PPIE review
Identify transition leads and key workers to support each service
Recognise where specialist support from psychology, social work and learning disability teams required
Develop and improve use of resources to engage and prepare YP
Develop staff training and education programme
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