Orkney Transition Planning Guidance [PDF]

Orkney Transition Planning Guidance and Procedures Transition to Post-School Services

Version 2: September 2011

Founding Members of The Orkney Transitions Strategy Group Cathy Lyner

(Chair) Principal Educational Psychologist

Derek Aiken

Service Improvement Manager, All Age Disabilities Service

Linda Russell

Head of Division (Care and Support), Orkney College

Joe Horrocks

Team Manager, All Age Disabilities Service

Kirstie White

Team Manager, All Age Disabilities Service

Paul O’Loughlin

Social Worker, Learning Disabilities Social Work Team

Beth MacKinnon

Social Worker, Learning Disabilities Social Work Team

Rosemary Ramsay

Social Worker, Learning Disabilities Social Work Team

Hilda Learmonth

Head Teacher, Stromness Academy

Marlyn Firth

Guidance Manager, Stromness Academy

Chris Burton

Depute Head, Kirkwall Grammar School

Laura Ballantyne

16+ Learning Choices Development Co-ordinator

Karen Foubister

Skills Development Scotland

Alastair Tait

Principal Teacher (Pupil Support)

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Contents 

Introduction

4

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Level 1 – Universal Planning

7

− 16+ Learning Choices

8

− Orkney Transition Pathway

9

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Level 2 – Additional Support Needs/Barriers to Employment

11

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Level 3 – Significant and Complex Additional Support Needs

13

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Role of Orkney Health & Care Services in Transitional Planning to Post School Services

15

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Joint Working and Planning Themes

16

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ASL Act: Post School Transition – Level 3

18

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Transition and Throughcare Planning for Looked After Children

19

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Other Transitions − Additional Support Needs/Extended Learning Support: : Post College Transition

21

Appendices 

Appendix 1

Four Learning Areas for Career Management Skills

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Appendix 2

Suggested Agendas for Transition Planning meetings

25

23

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Appendix 3

Moving on Passport

29

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Appendix 4

What constitutes an ‘Offer’

61

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Appendix 5

Activity Agreement

63

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Appendix 6

Transitions Bridge Pathway

65

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Transition to Post-School Services Introduction The Orkney Transition Planning Guidance embraces principles of the Additional Support for Learning Act (2009) and also covers children and young people in the context of developing Curriculum for Excellence and 16+ Learning Choices. It also provides specific guidance concerning transitions for Looked After Children, including those in out of area placements and incorporates key elements of Getting It Right For Every Child – Orkney’s guidance is entitled Getting It Right For Orkney’s Children. Three levels of transition planning are identified and these correspond to the three levels of planning set out in the new Code of Practice: Level 1 – Universal transition planning for all young people (young people with no additional support needs). Level 2 – Transition planning for children and young people with additional support needs who require specific guided support to achieve a positive post-school destination, for example pupils with mild Autistic Spectrum Disorder and pupils requiring Additional Assessment Arrangements (e.g. scribe, extra time, digital papers). Additional Assessment Arrangements require to be identified and conveyed to and accepted by the Support for Learning Teacher. Level 3 – Transition planning for children and young people with significant and complex additional support needs which require a high level of planning, often with multi-agency input, for example moderate or severe learning difficulty or physical disability, Autistic Spectrum Disorder, and emotional behavioural difficulties. In the case of Looked After Children, careful and explicit consideration must be given to whether level 3 transition support is required.

These principles will apply in Orkney The general principles identified for all transitions at each of the above levels apply to post-school transitions and build on the identifiable strengths of all our pupils in the lead up to that transition. In addition it has been agreed with key adult service providers that a detailed plan for post-school provision should be in place at least 6 months before the expected school leaving date. For young people with additional support needs (estimated at 20 per cent of the school population at any given time) the following general code of practice will apply: 

Transition planning should be embedded within the education authority's policies and procedures for additional support needs.

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Other agencies, such as health and social care services, Skills Development Scotland, Further Education Colleges and Institutions of Higher Education should also be involved in transition planning where required and within timescales that enable positive transitional planning outcomes.

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The child's or young person's views will be paramount within the process.

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Parents should be part of the planning process, their views should be sought and taken account of, and they should receive support as required, during the transition process.

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Early consultation should take place between the school and the postschool provision which the child or young person will be attending.

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Schools should plan to ensure that the necessary support is in place for children who have additional support needs to help them through the transition phase to their new learning environment.

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Professionals from all agencies working with the child and family should plan in good time for transition to future services.

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Transition should be co-ordinated by a relevant person known to the child or young person and their family.

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Where a child or young person has a co-ordinated support plan, any anticipated change in the statutory co-ordinator should be discussed with the child or young person, and parents, as far in advance of the change as possible.

In addition, the following good practice will apply in Orkney 

The young person is the most important person in the planning process and he or she should be empowered and enabled to participate as fully as possible in this process. In order to achieve the above; −

Support should be person-centred, and specifically tailored to the needs of each individual young person. For example, a key adult such as a support teacher should enable a young person to contribute to their Moving On Passport in a constructive and meaningful way.

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Person centred planning meetings should be run in such a way as to enable the young person to contribute their own passport information into the person centred planning process.

−

Passports* and person centred plans are tools for engagement and participation. The Co-ordinated Support Plan (CSP) remains the main strategic document until the age of 18.

− There should be a clear link between transition planning and the effective development of career management skills in all of our pupils. The four learning areas for career management skills are shown in Appendix 1.

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All relevant services for children, young people and adults should give a high priority to transition planning. See Appendix 2 for suggested agendas for transition planning meetings.

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Individual contacts within each agency should be identified as part of the plan, e.g. contact person in the Secondary School.

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Transition reports should include a profile of the competencies of the child or young person.

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A settling-in (post-placement) review will be held during the first 3 months of the new placement. In most cases this will be a short meeting/interview to check how the young person is settling in. The frequency of future review and planning meetings will be agreed. There should be at least one annual review of the Transition Plan.

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All transition planning meetings must follow Orkney’s guidelines for planning and review meetings. In particular, they should be personcentred and solution-oriented, sharing the same principles and values as ‘Getting It Right’. Children and young people should always attend, or at least be given the opportunity to attend, and should be consulted over who will attend their meetings. The record of the meeting should be in the form of an action plan which states clearly WHO is responsible for WHAT action within a clear TIMESCALE. Transition plans need to reflect the aspirations as well as the needs of a child or young person and should be presented in an accessible way to the child or young person.

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The minutes should also update the list of professionals who are currently involved and who will be involved following the transition.

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A passport is a collation of information provided by those who know the young person and the young person themselves detailing strengths, support needs, preferences, aspirations, etc. (See Appendix 3)

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Level 1 – Universal Planning The Curriculum for Excellence provides an entitlement to an appropriate curriculum from 3 to 18 years, which includes a senior phase from S4 to S6 or 16 to 18 years. All young people are entitled to receive ‘an offer’ (see Appendix 4 for details of what constitutes an offer) of post-16 learning before they leave school, and the provisional timescales, roles and responsibilities are set out below: 

Schools to identify all of those from S3, S4 and possibly S5 who are potentially in the 16+ Learning Choices cohort, i.e. those first eligible to leave school at Christmas or at the end of May.

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From those, schools to identify who is intending to remain at school for a further year and confirm to Skills Development Scotland a formal offer of a place in learning post-16.

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From the 16+ cohort, schools to identify pupils who are considering leaving school at Christmas or at the end of May.

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Ensure all of those pupils are notified to Skills Development Scotland.

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Skills Development Scotland to ensure all of those pupils are updated on Insight (the Skills Development Scotland client management system), with their intended leaving date and, where relevant, their offer of a place in post16 learning.

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Schools to keep Skills Development Scotland apprised of all senior pupils moving on or off their rolls.

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Skills Development Scotland to ensure that all potential statutory leavers have definite plans in place for their transition from school, ideally before the October or Easter breaks; and that their career intentions are recorded on Insight. The young person’s occupational choice should be recorded where available, along with their preferred route of FE, HE, work, Get Ready for Work, etc.

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Schools to supply intended career choice information for any pupil failing to attend their interview appointment with Skills Development Scotland prior to leaving school.

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Schools, Skills Development Scotland and partners to work with pupils who do not yet have an offer of a place in 16+ learning, training or employment, to endeavour to secure them an offer prior to their school leaving date.

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Schools and partners to notify Skills Development Scotland of offers made. 7

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Skills Development Scotland to record this information on Insight. Skills Development Scotland to liaise with partners and work actively with leavers who are not in education, employment or training to secure them a suitable offer of learning, training or work.

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Skills Development Scotland to track leavers’ progress through the School Leaver Destination Return and record this on Insight.

16+ Learning Choices 16+ Learning Choices is the Scottish Government’s model for helping young people stay in learning post-16, since this is the best way to ensure their long-term employability. It will help build capacity in individuals, families and communities, and will support economic growth in Scotland. Critically, it will help prevent and reduce youth unemployment. For young people, 16+ Learning Choices will translate into an offer of post-16 learning well in advance of their school leaving date, and before leaving any subsequent episode of learning during the senior phase. In line with Curriculum for Excellence, the offer of learning will focus on personalisation and choice, reflecting individuals’ needs and aspirations. Importantly, it will encompass relevant supports to help young people make effective learning choices; and to progress on the path of lifelong learning. The model includes the following 3 critical elements:  The right learning – with a range of options on personalisation and choice. This may include staying on at school, entering further or higher education, taking up employment, participating in a National Training Programme, or taking part in personal skills development in a community learning and development setting or a third sector organisation;  The right support – to remove barriers that might restrict young people’s learning choices and provide information, advice and guidance to help young people take up and sustain their offer; and  The right financial support – to help young people take up the offer which is right for them and not the choice which pays best or offers the most generous support. Examples of 16+ Learning Choices ‘offers’ can be found in Appendix 4.

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Orkney Transition Pathways There are several transition routes for young people which include: − Activity Agreements (See Appendix 5 for a full description of Activity Agreements). In summary, Activity Agreements constitute a ‘non-formal’ offer of a programme, and through the involvement of other agencies working with schools can provide for the most vulnerable/disengaged young people pre- and post-16. They are prepared for and implemented around the time of leaving school or in some cases before this time, and may last for 6 to 9 months after this transition point. They can prepare the young person for a ‘formal offer’ after this time. − For a small group of young people an activity agreement may involve input from the Joint Additional Support Project (JASP). JASP is a joint Education and Leisure Services and Health and Care Services project. It is aimed at a highly targeted group of young people with closely assessed needs (JASP Manual). − A referral from Skills Development Scotland to Get Ready for Work at either Orkney College or Lifeskills Central Ltd. − Referrals from Skills Development Scotland to the Connect Project run through Voluntary Action Orkney. Connect Project is a project set up for young people between 16 and 19 who are unsure of what steps to take next, or who do not feel quite ready to move on to employment or further training. Involvement with Connect gives access to a personal and flexible programme to meet individual needs in order to develop skills and confidence to move on to the next step of further education/training or employment. Once registered with Voluntary Action Orkney, any young person aged 16+ can undertake volunteering opportunities through Voluntary Action Orkney and Employability Orkney. − Employability Orkney offer a range of supported employment and job coaching programmes which build confidence and skills ready for employment. − Young people with Additional Support Needs can enrol on the Preparation for Progression* programmes as well as ‘mainstream’ courses run by Orkney College which can lead on to further education, training or employment. Role of Skills Development Scotland In March 2011 the Scottish Government published its strategy for Career Information, Advice and Guidance – A Framework for Service Redesign and Improvement. The strategy underlines the significant contribution CIAG makes to sustainable economic growth. CIAG helps people to make informed decisions about their learning, job opportunities and career development with the ultimate goal of helping them to get, stay and progress in work. Through the CIAG strategy, Scottish Government has charged Skills Development Scotland to establish a framework to help people develop career management skills. This framework should exploit new interactive technologies and so be delivered through web-based, telephone and face to face services.

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The development of web-based services will allow Skills Development Scotland staff to ensure that intensive face to face support is targeted at those who needs are the greatest. With the introduction of the first ( and subsequent) phases of My World of Work (MWOW), Skills Development Scotland can begin to increase the proportion of time spent delivering services to school pupils who have been identified as requiring targeted support. In addition Skills Development Scotland will continue to provide a differentiated service for those out with the targeted group.

Targeted Group S4 to S6 The targeted group consists of all those pupils S4 to S6 who have been identified by the school and partner agencies as being “at risk” of not moving to a positive destination after leaving school. The following indicators will assist in identifying those pupils S4 to S6 who should be given the highest priority for face to face services:     

Health or other additional support needs –e.g. there may be a coordinated support plan or other individual learning plan in place Interrupted learning, part-time timetable, in FE provision pre 16, excluded from school, attending non formal learning Care leavers, Looked After Children at home or away, pupils with known offending behaviour, pupils with drug/alcohol abuse problems, pupils with caring responsibilities Pupils identified and referred by partners – e.g. receiving multi-agency support or has an Activity Agreement Other groups – e.g. Gypsy traveller; Asylum Seeker

This is not an exhaustive list and it is not expected that Skills Development Scotland staff will see all the above cases as they may not be in their last year of school or require their specific help.

Other work in School The focus for face to face services is clearly on S4 to S6 but there may occasions when it is appropriate for Skills Development Scotland to see a pupil from S3 – e.g. date of birth may show eligibility to leave school or they can make a significant input to an ASN review meeting. Other work pre S4 will normally be focused on promoting to school staff Skills Development Scotland’s universal services on the web, through the contact centre and local career centres. The aim is to build the capacity of school staff and other agencies working in schools to use and refer pupils (and their parents/carers) to their full range of services.

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For the purposes of clarity, staff are invited to note that Skills Development Scotland Key Workers help vulnerable 16-24 year olds as identified in levels 2 and 3 of this document, i.e. those with additional support needs and/or those who need additional assistance to improve their chances of development to further education, training or employment. Working in partnership, the Key Worker service aims to support the young person whilst easing the transition from school to further education, training or employment. It is essential for training, employment and education providers to inform the individual Key Workers if any young person ‘drops out’ of their learning opportunity, as this will allow the Key Worker to re-engage with the young person and hopefully support them to move on to another learning opportunity.

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Preparation for Progression is an alternative to fifth year which aims to give students the qualifications and opportunities to access other Orkney College courses at National Certificate level.

Level 2 – Additional Support Needs/Barriers to Employment All the steps set out at level one apply to all children and young people. In addition, for those who need additional support and/or those likely to face barriers to employment, the following additional measures apply. 

Schools and other key partners to ensure Skills Development Scotland are aware of any additional support needs and specific barriers to employability these pupils might face.

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Schools to inform Skills Development Scotland and other post-school providers using information within the transition passport or other relevant assessment/planning documents.

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Skills Development Scotland to record these individual circumstances on Insight.

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For most young people with additional support needs, it is helpful to identify a lead professional to co-ordinate the transition process. This will usually be a member of school staff, but it could also be a Careers Adviser, Key Worker, social worker, or another professional, depending on the individual circumstances.

The draft revision of the Supporting Children’s Learning Code of Practice recognises that it is not necessary to apply all the duties under the Additional Support for Learning Act (2009) to every child who has additional support needs, and that a degree of flexibility is required. Level 2 planning is designed to provide that flexibility which should be applied by those working with the child taking into account the views of parents.

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Level 3 – Significant and Complex Additional Support Needs All the steps set out at Level 1 apply to all children and young people. In addition for those who need additional support and/or those likely to face barriers to employment, the additional measures set out in Level 2 also apply. In addition, for those children and young people with severe and complex needs (e.g. those with an Additional Support Needs file or Co-ordinated Support Plan), the following transitional planning procedures will apply: 

The transition planning process will be incorporated into the school’s annual review and planning process, co-ordinated with any other formal planning process.

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At the start of the school session, the school’s Additional Support for Learning coordinator should be confirmed. The coordinator should then call a professionals’ meeting with the representatives of other agencies to plan the review meetings, with the explicit aims of avoiding duplication and facilitating joint working.

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At the S2 annual review and planning meeting, a major issue is to plan the pupil’s education in S3 and S4. Possible post-school needs will be included on the agenda, and relevant agencies which will need to become involved will be identified and contacted, with the consent of parents and the pupil. The minutes will include an outline transition plan and a record of parent and pupil consent.

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All the agencies relevant to the post-school transition will be invited to the S3 review called by the school. Consent to share information with postschool providers should be obtained if this has not already been done at the time of the S2 review. Following this review, a more detailed plan will be drawn up for the next 12 months. This will specify the actions required from each agency, together with the timescale. At this stage, Orkney Health and Care services may wish to conduct more elaborate planning arrangements e.g. person centred planning. The transition plan should cover the following (see Transition Planning Template in Appendix 6):

− education programme for the remaining years at schools (including work experience) − details of additional support provided in school − relevant medical/health factors (including disability status) − first possible school leaving date/target school leaving date − external support services involved and contact details − views of the pupil and their contribution to the plan − views of the parents and their contribution to the plan − outcome of risk assessments or need for new risk assessment − details of possible post-school services with named contacts − name of the person who is coordinating the plan − date and time of the next review The minute of the review meeting, including the transition plan, will be sent to all the identified agencies and services. 13

NB The above review should be held at least 12 months before the statutory school leaving date, and, if possible, correspond to the school reporting timetable and the timescale recommended in 16+ Learning Choices. For a small number of pupils this may mean holding the meeting in S2 – the school Additional Support for Learning Co-ordinator should monitor this. 

The plan will be refined at subsequent annual review meetings called by the school.

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The availability of Education Maintenance Allowances will be explained where appropriate.

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A medical report will only be required if there are significant health or medical issues which must be taken into account in the transition plan.

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A risk assessment should be undertaken following the S3 Review by the appropriate Adult Service provider in collaboration with the school if safety factors are likely to be an issue following transition. School risk assessments are not transferable.

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Where Orkney College is an option a representative should be invited to the S3 review. Specific guidance regarding school-college transition planning is provided below. Schools should ensure that written information, including reports and transition planning forms are forwarded to Orkney College and also to post-school providers such as the Orkney Health & Care Learning Disability Social Work Team.

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A post-placement review should be convened by the post-school provider within 3 months of the placement, involving key staff, the young person and parents where appropriate. Only when there are significant difficulties would a full review and planning meeting need to be convened.

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Role of Orkney Health and Care Services in Transition Planning to PostSchool Services Current Services 1.

The Learning Disabilities Social Work Team The Learning Disabilities Social Work Service supports children, young people and adults who are diagnosed with one or more of the following:  learning disability;  autism spectrum disorder with an associated diagnosis of learning disability;  primary learning disability with associated physical or sensory impairment;  primary learning disability with a secondary mental health dual diagnosis.

2.

Child and Adolescent Mental Health Services (CAMHS) Orkney CAMHS works with 0-18 year-olds with, or at risk of developing, significant mental health problems, and their families. The service operates an open access referral process, which means that anyone can refer to the service.

3.

Other Children and Families Social Work Services The C&F Social Work Team provides assessment and a range of supports to vulnerable families and children in need, including looked after children and children in need of protection. Through Care Services are provided by the Children’s Resources Team. Transition to Through Care Services normally occurs prior to a young person’s 16th birthday. Advice, guidance and assistance can continue to be accessed up to age 18.

4.

Community Occupational Therapy Services Community Occupational Therapy services are provided by of Occupational Therapists (OTs) and a Rehabilitation Officer - for people with Sensory Impairments (RO).

5.

Other Children’s Health Services There are a range of specialist health support services for children with additional support needs and their families. These include: School Health Nursing, Paediatric Occupational Therapy, Physiotherapy and Speech and Language Therapy.

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Joint Working and Planning Themes 

For a number of children additional support is not obvious or indeed required when making the transition from primary to secondary education. Early preventative referrals are to be promoted wherever possible. However, transitional planning issues may only manifest and require intervention in times of crisis. Ill-health, mental health issues, etc, can affect whether or not additional support for transition is required. In these circumstances a referral can be made at any time to the most appropriate Orkney Health and Care service detailed above.

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A named Service Improvement Manager or Team Manager, Orkney Health and Care, will be identified to attend the annual professional’s meeting called by the school’s Additional Support for Learning coordinator(see page 12).

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Where a child makes the transition from primary to secondary education and it is evident that the child’s support needs meets any of the above teams’ criteria, the transitional planning processes need to be identified during S1 or S2. Where this is the case the school’s Additional Support for Learning coordinator will seek parental consent in order to inform or make a referral to the most appropriate Orkney Health and Care service.

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At this stage, the designated Orkney Health and Care Service can discuss with the school, child and their respective family whether initial representation at the child’s initial S1 and/or S2 school review(s) is required. If not, the school, with the consent of the parents, should forward information from the child’s S1 and/or S2 annual school/coordinated support plan review minute to the designated Team Manager.

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From S3 onwards (including 16+ learning choices), if a referral has been made which meets the respective team’s eligibility criteria, and parental consent has been given, a social worker/allied health professional from the respective team will be allocated to attend the young person’s annual school/coordinated support plan review. Wherever possible, the same social worker/allied health professional should be involved throughout the transitional planning processes.

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From S3/S4 onwards, if a young person has an integrated assessment and plan, the social worker will complete a Transitional Bridge Pathway between this plan and the Adult Services Single Shared Assessment. See Appendix 6.

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Under the Adults with Incapacity (Scotland) 2000, if a child/young person is under the age of 16, the consent of the parents to share information should be recorded in all school review minutes. From S3 onwards, if applicable, there must be a focus within the annual school/coordinated support plan review on addressing the legal status of the young person as they turn 16. This will include identifying any action that may need to be taken, either by 16

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ASL ACT: POST-SCHOOL TRANSITION - LEVEL 3 At all stages

Skills Development Scotland, Community Learning Development Team, Orkney Health & Care should be kept informed at all stages of the Transition Process from S1 to age 19

S2 review

S2 Annual School Review – S3 subject choices and post-school transition on agenda – views of parents and pupil sought – Co-ordinator named - 1st possible leaving date confirmed - agencies to be involved in transition planning identified and referrals made.

S3 review

S3 Annual School Review and Transition Planning

To be held at least one year before the expected school leaving date

Present: Essential – Parents, young person, relevant school staff, co-ordinator, identified post-school service providers. As appropriate –Allied Health Professionals (e.g. Paediatric Occupational Therapy/Physiotherapy, Speech & Language Therapy), Orkney Health & Care Services, Education Specialists, Educational Psychology, Skills Development Scotland, supporter for parent/young person, other agencies. Action - Detailed transition plan drawn up by school and adult service providers involving parents, young person together with other agencies as appropriate. Named contacts identified - timescales and responsibilities clearly stated – target leaving date set minutes circulated – consent obtained and information sent as needed to post-school providers. School programme to support the transition agreed.

S4 onwards

6 months before leaving date

3 months into new placement

Transition plan implemented and reviewed at least annually at the time of the school review. Post-school providers actively involved as required. Detailed plan for post-school services in place with identified funding where necessary. School sends further information to provider as needed. Post-placement review including young person, carers and key professionals. 18

Transition and Throughcare Planning for Looked After Children Future planning for all looked after children will be consistent with the Looked After Children (Scotland) Regulations 2009 and linked to the transition planning model set out above. The existing procedures are set out below, together with proposals as to how this can link in with the educational planning process and timescale. Home Supervision Children looked after at home have no less than 6-monthly formal reviews of their progress, together with Core Group Planning meetings as required. This includes transition and ongoing support plans before the supervision requirement comes to an end.    

An initial transition strategy should be considered at the first S1/2 review. At this stage Skills Development Scotland should be informed together with relevant post-school agencies or providers. A detailed plan should be in place 6 months before the first statutory school leaving date. This plan must be incorporated into the transition planning process led by the school. It is presumed that all looked after children will have additional support needs unless this is demonstrated not to be the case, through assessment. It is also presumed that the school-led transition planning will be at level 2 or level 3.

Looked After and Accommodated Children Looked after and accommodated children (LAAC) are subject to 6-monthly (or more frequent as required) statutory reviews. At the age of 14 years, the Throughcare and Aftercare team is notified in writing by a Team Manager. Thereafter, the Throughcare and Aftercare team will work jointly with the young person’s Social Worker to plan for the future. Various assessment tools are available to assist the future planning process. Where necessary, the Housing section is also informed. The Throughcare and Aftercare team continues as an entitlement until the age of 19 yrs and can continue to age 21 yrs, with funding to age 25 available in some specific circumstances. 

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An initial/transition plan must be considered at the first review following the child’s 14th birthday. At this stage Skills Development Scotland should be informed ,in addition to the Throughcare and Aftercare team, together with relevant post-school agencies or providers. A detailed plan must be in place one year before the first statutory school leaving date. The transition planning for LAAC children and young people is led by the LAC reviewing officer. The planning process is incorporated into the 6monthly LAC reviews by means of adding the transition planning agenda to the LAC review agenda. This will avoid two parallel transition planning

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It is presumed that all looked after and accommodated children will have additional support needs this is demonstrated not to be the case through assessment. It is also presumed that the school-led transition planning will be at level 2 or level 3. It is essential that all the key agencies are able to attend the 14+ review (within education this would usually be the S3 review). Review dates should therefore be set well in advance, avoiding school holiday periods. All concerned in planning for the child should take responsibility for ensuring that dates set are appropriate.

Out of Area Arrangements All children and young people placed in residential schools or foster placements outwith Orkney are Looked After and Accommodated and the same LAAC transition planning arrangements will therefore apply. Those enrolled at a school at the time of their statutory school leaving date are entitled to support from the Throughcare and Aftercare service. Children and young people placed in medium- to long-term hospital provision outwith Orkney may not be looked after. However, the same transition planning arrangements should also be provided for them. Throughcare and Aftercare services are only provided for those who have been looked after..

Home educated children Children who are home educated are entitled to an offer of continuing education post-16 and to support from Skills Development Scotland. The Education Authority (with parental permission) will notify Skills Development Scotland when a home educated child reaches the age of 14 years.

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Other Transitions

ADDITIONAL SUPPORT NEEDS/EXTENDED LEARNING SUPPORT: POST-COLLEGE TRANSITION August/ September

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Personal Support and Learning Plans compiled

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September/ October

January/ February

January onwards March

Information on students with additional support needs/Personal Programmes to Skills Development Scotland and other post-school/college support services as appropriate (if not already in place)  Initial Review Meeting held where appropriate, for all students with additional support needs/Personal Programmes. Present: Student, College Support Staff, Skills Development Scotland Adviser/Key Worker, Parents/carers (as appropriate), other support workers as appropriate   

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Liaise with Skills Development Scotland and other Support Services (as above) as appropriate

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ASN – End of Year College Review Meeting to follow the same format as Initial Review Meeting Update PSLP – Transition plan compiled and responsible people identified

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April/June

Skills Development Scotland to visit College and meet with students as identified above Liaise with other support services (as above) Skills Development Scotland staff to hold information sessions with Non Advanced Further Education students to advise of services available

ASN  Student to visit post-College provision and attend tasters arranged as appropriate  Students meet with SDS staff and other transition support workers as appropriate  Information transferred as requested and agreed with students

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APPENDICES Appendix 1

Four Learning Areas of Career Management Skills

Appendix 2

Suggested Agendas for Transition Planning meetings

Appendix 3

Moving on Passport

Appendix 4

16+ Learning Choices: What constitutes an ‘Offer’

Appendix 5

Activity Agreement

Appendix 6

Transitional Bridge Pathway

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APPENDIX 1 Four Learning Areas for Career Management Skills 

Self: understanding and growing self-awareness and confidence – link to SQA Personal Development

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Strengths: building on personal strengths, competencies and preferences – link to SQA personal development

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Horizons: widening work and learning horizons and exploring greater personal potential – link to community volunteering

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Networks: finding out and connecting into new and wider networks – link to SQA Employability Award

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APPENDIX 2 S2 Review and Planning Meeting Name…………………………………. Date……………………… AGENDA Welcome and Introductions 1

Summary of reports a. School b. Other (i.e. Medical, Allied Health Professionals, Social Work) c. Parents’ views d. Young person’s views

2

Action points – what, by whom and when a. School b. Other

3

Choice of course

4

Contact post-school agencies – who, by whom, and when

5

First possible school leaving date and provisional schedule for transition

6

Co-ordinated Support Plan/Individual Support Plan

7

Date of S3 Review

25

S3 – S6 Review and Planning Meeting Name…………………………………. Date……………………… AGENDA Welcome and Introductions 1

Brief summary of reports a. School b. Other (i.e. Medical, AHPs, Social Work) c. Parents’ views/issues/reports d. Young person’s views/issues/reports

2

Programme for the remaining years in compulsory education - details of courses to be followed - details of additional support provided by the education establishment/provider

3

Post-school needs and possible options - additional support required - details of relevant health and medical factors - possible post-school agencies

4

Transition plan – what, by whom and when? - target school leaving date and timescales - involvement of other services – adult services, Skills Development Scotland, respite, college, CLD, (Activity Agreement required) - skills development - transfer of information - risk assessments - other e.g. housing needs, transport needs

5

CSP/IEP

6

Key Contacts - school - Skills Development Scotland - Social Work - Adult Services - Appointed Transition Co-ordinator

7

Date of S4, 5 or 6 Review

26

Draft Transition Planning Form Pupil Name

Date of Birth

Transition from

To

Date of Planning Meeting

Present -

Apologies –

POST-SCHOOL TRANSITION ACTION PLAN First Possible School Leaving Date Target School Leaving Date Involvement of other services (Adult services, Skills Development Scotland, respite, College)

Who

When

Skills Development (e.g. independent living, travel)

Transfer of Information to Post-School Provider

Outcome of Risk Assessment/Need for New Risk Assessment

Other e.g. apply for benefits, Guardianship, etc

Key Contacts Currently Involved 27

Name

Role

Involvement/Context Phone Number

Appointed Transition Co-ordinator

Date and Time of Next Review

Please attach copies of relevant reports and a copy of the CSP/IEP A minute of the review meeting, including this transition plan, will be sent to all the identified agencies and services Consent to share information Parent’s Signature Young Person’s Signature

Date Date

28

APPENDIX 3

A Passport Workbook for Young People moving on from school

Name

Post-school placement

You will find this transition passport useful if you are moving from school to university, college or other post-school training. It has been designed for young people with autism spectrum disorders (ASDs) but could be useful for anybody with additional support needs. The passport aims to provide essential information which will ease transition between school and the next step. It contains two sections: Section 1:

All about school and your learning needs in school

Section 2:

Post-school provision – what you need to know about the provision and how your changing needs can be met

The following timescale is suggested: 

Before the beginning of the final year at school (or earlier) You start work on the passport, supported by parents/carers and school staff such as your guidance teacher (PTG) or key support staff.



PTG contacts post-school coordinator to tell them about your transfer. If you are going to college this will be the Support Needs Coordinator. If university, it will be the Disability Advisor. PTG also contacts Careers Scotland. The post-school coordinator visits school to share information with you and key adults and to make a transition plan.



January - Starting PTG begins the process of transferring relevant information to help your post-school provision prepare for you starting in the autumn.



May – Induction process begins Meeting between you and all relevant people, e.g. parents; PTG; support staff; post-school coordinator; social worker if appropriate.



The post-school coordinator makes a plan with you for supporting induction which may involve familiarisation over the summer break.

Responsibility for supporting you with the passport transfers from school to postschool coordinator. You have ownership of the passport at all times. You can complete what is relevant to you, miss out what isn’t relevant and add anything else you want. Please note there are guidelines to support you in working on the passport.

30

Date of Birth Tel. No. Home

Name Address

Mobile

Email Contact Person

At home At School

School details Primary school attended Secondary School attended Leaving date Attendance record Issues which affect attendance Transport requirements Medical issues

Qualifications achieved before leaving school Subjects taken in final year Courses being followed at post school provision

LIFE EXPERIENCES

e.g. work experience; part-time jobs; Enterprise; colleg e experience

31

Health and safety issues

e.g. medication; concentration levels; exercise requirements; mental health

Do you have any medical diagnosis?

Reaction to stress

e.g. Do you get stressed? How severe is it? How do you show you are stressed?

What helps to keep you calm? What helps to reduce stress?

Sensory issues

e.g. Sensitivity to certain smells; dislike of loud noises

Any issue of particular importance can have its own section 32

Name

1

Address Telephone Email Name

2

Address Telephone Email Name

3

Address Telephone Email Name

4

Address Telephone

Other Key People

Email Name Address Telephone Email Name Address Telephone Email 33

Learning / Working What helps learning?

e..g. distraction-free space; visual timetable; IT provision; when one-to-one support is needed e

What hinders learning?

e.g. noise; smells; poor IT provision; no visual instructions

When you are coping, people will know because….

If you are not coping you show it by doing the following….

Strategies that help you

You can explain your support needs more fully in the Additional Support Needs section 34

Communication What works?

e.g. providing visual timetable

What doesn’t work

e.g. giving instructions without writing them down

How can people tell when you do not understand?

Things that are important

e.g. time to process information; short instructions

35

Skills

Strengths

e..g. Personal attributes – such as being reliable; areas of competence e

Interests

e.g. Hobbies; special interests

Attainments and Achievements?

e.g. exam outcomes; modules; certificates; sporting achievements; driving test; promoted position (such as prefect); other achievements

36

Problems

Worries

Difficulties

Key areas for support

Areas for development

Areas/activities to be avoided

37

In School What supports currently work for you in school?

NB N B these will change over time and can be altered to address changing need.

Tick Type of support your needs

Comments Where? When?

One-to-one support IT support

Please specify what is needed

Visual Aids, etc Special examination arrangements

Please specify e.g. extra time, scribe

Help with finding your way around a new situation Buddy or support person for the first few weeks (where possible) Personal class arrangements and/or Personalised timetable

e.g. arrive/leave late

Contact person for organising support

Communication supports Other appropriate support arrangements including equipment needs (e.g. wheelchair/access) 38

Please specify

How many marks out of 10 would you give yourself on the following? (1 very poor; 10 excellent) How good are you at revising on your own? (Please choose )

1

2

3

4

5

6

7

8

9

10

7

8

9

10

7

8

9

10

What are your reasons for rating yourself in this way? What would help you move up the scale?

How good are you at getting homework in on time? (Please choose )

1

2

3

4

5

6

What are your reasons for rating yourself in this way? What would help you move up the scale?

How good are you at using the library? (Please choose )

1

2

3

4

5

6

What are your reasons for rating yourself in this way? What would help you move up the scale?

39

How do you cope with factual assignments, e.g. writing up a science experiment? (Please choose )

1

2

3

4

5

6

7

8

9

10

What are your reasons for rating yourself in this way? What would help you move up the scale?

How do you cope with imaginative assignments, e.g. describing the content of a poem? (Please choose )

1

2

3

4

5

6

7

8

9

10

9

10

What are your reasons for rating yourself in this way? What would help you move up the scale?

How do you cope with working out of school, e.g. at home? (Please choose )

1

2

3

4

5

6

What are your reasons for rating yourself in this way? What would help you move up the scale?

40

7

8

How do you manage giving a talk? (Please choose )

1

2

3

4

5

6

7

8

9

10

7

8

9

10

9

10

What are your reasons for rating yourself in this way? What would help you move up the scale?

How do you cope with instructions spoken to you? (Please choose )

1

2

3

4

5

6

What are your reasons for rating yourself in this way? What would help you move up the scale? e.g. a written checklist

How do you cope when asked to work with a partner or group? (Please choose )

1

2

3

4

5

6

7

8

What are your reasons for rating yourself in this way? What would help you move up the scale? e.g. clear instructions of who does what

41

Relaxing/Having Friends

Favourite Activities

Group Activities

e.g. are you a member of any clubs – is there anything you would like to do?

What support is needed?

42

Who are they?

Who is the best person to contact?

How can they be contacted?

When should they be contacted?

Will this be the same when you leave school and move on?

yes

Any other relevant information?

43

no (Please choose )

Goals for next year

What do you need to help you get there?

Goals for 5 years time

What do you need to help you get there?

How can that happen?

NB It is important your post-school coordinator checks with you that your goals are still realistic 44

The Surroundings When you move on from school you might want to find out about the following: The Campus layout – Key areas: Where can you find? Eating places / refectory / café Library Lecture / class rooms Tutorial room Health centre Sports centre Chaplaincy centre Support staff / advisor Social areas Counselling Other 46

The Surroundings When you move on from school you might want to find out about the following: The Campus layout – Key areas: Where can you find? Eating places / refectory / café Library Lecture / class rooms Tutorial room Health centre Sports centre Chaplaincy centre Support staff / advisor Social areas Counselling Other 47

The Surroundings When you move on from school you might want to find out about the following:

Where can you find?

48

The Surroundings When you move on from school you might want to find out about the following:

Where can you find?

49

Details of college courses applied for

Induction arrangements

Details of courses applied for

Do you understand how courses link together?

Are your subject choices confirmed?

yes

Induction arrangements

50

no (Please choose)

Places in post-school life

51

52

Is support required? If so, how?

e.g. Money, cooking; finding your way about; timekeeping; joining in social activities

Is support for managing money required? Is transport / funding required e.g. Student loans; allowances; benefits; contact person

53

Health and safety issues

e.g. Medication; concentration levels; exercise requirements; mental health

Do you have any medical diagnosis?

Reaction to stress

e.g. Do you get stressed? How severe is it? How do you show you are stressed?

What helps to keep you calm? What helps to reduce stress?

Sensory issues

e.g. Sensitivity to certain smells; dislike of loud noises

Any issue of particular importance can have its own section I have had a letter from my GP/Educational Support Team within the yes no (Please tick ) last 2 years supporting a diagnosis of autism spectrum disorder/dyslexia (necessary for university) 54

Relaxing/Having Friends

Favourite Activities

Group Activities

e.g. are you a member of any clubs – is there anything you would like to do?

What support is needed?

55

Make a plan for structuring each day. Remember to include:

   

Getting up and ready for lecture s lectures Mealtime arrangement s arrangements Study time Leisure activitie s activities

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

7.00 – 9.00 9.00 – 12.30 Lunchtime 12.30 – 1.30 1.30 – 5.00 Suppertime Evening study 7.00 – 9.00 9.00 – 12.30 Lunchtime 12.30 – 1.30 1.30 – 5.00 Suppertime Evening study 7.00 – 9.00 9.00 – 12.30 Lunchtime 12.30 – 1.30 1.30 – 5.00 Suppertime Evening study 7.00 – 9.00 9.00 – 12.30 Lunchtime 12.30 – 1.30 1.30 – 5.00 Suppertime Evening study 7.00 – 9.00 9.00 – 12.30 Lunchtime 12.30 – 1.30 1.30 – 5.00 Suppertime Evening study 7.00 – 9.00 9.00 – 12.30 Lunchtime 12.30 – 1.30 1.30 – 5.00 Suppertime Evening activities 7.00 – 9.00 9.00 – 12.30 Lunchtime 12.30 – 1.30 1.30 – 5.00 Suppertime Evening activities

56

  

Travel to lectures Lectures / classes Shopping

Subject

Where

When

57

Support Needs

Further information you might find useful The National Autistic Society Scotland (NAS)

NAS Scotland Central Chambers 1st Floor 109 Hope Street Glasgow G2 6LL Tel: 0141 221 8090 Fax: 0141 221 8118 Email: [email protected] www.autism.org.uk

Useful Telephone Numbers:

Autism Helpline Provides impartial, confidential information, advice and support for people with autism spectrum disorders Tel: 0845 070 4004 Education Advice Line Advice on educational provision for parents and carers in Scotland whose children have autism or Asperger syndrome Tel: 0845 070 4002 Capability Scotland Scotland's leading disability organisation provides flexible services which support disabled people, their families and carers. Westerlea 11 Ellersly Road Edinburgh EH12 6HY Telephone: 0131 337 9876 ENABLE Scotland ENABLE Scotland is a dynamic charity run by its members. It campaigns for a better life for children and adults with learning disabilities and support them and their families to live, work and take part in their communities. 2nd Floor 146 Argyle Street Glasgow G2 8BL Telephone: 0141 226 4541

58

RNID Scotland RNID Scotland offers a wide range of services for those who are deaf or hard of hearing, as well as their families and others who work with them or for their benefit. Empire House 131 West Nile Street Glasgow G1 2RX Telephone: 0141 341 5330 Email: [email protected] RNIB Scotland RNIB Scotland is the leading charity working with blind and partially sighted people in Scotland. 12-14 Hillside Crescent Edinburgh EH7 5EA Telephone: 0131 652 3140 For general email enquiries contact [email protected]

I agree that the information contained in this passport is accurate I understand that it will only be shared with relevant post-school staff who understand my need for a balance between confidentiality and appropriate support. The people I would like it shared with are: ……………………………. ………..………………………………………………………………………………… Signature: Signature:

Young Person Date Parent/carer (if Young Person under 16 years)

Date Signature:

School Keyworker Designation Date

59

60

APPENDIX 4 16+ Learning Choices: What constitutes an ‘Offer’ The ‘offer’ “All children and young people are entitled to opportunities for developing skills for learning, life and work. The skills are relevant from the early years right through to the senior phase of learning and beyond.” (p.10, 16+ Learning Choices, Policy and Practice Framework) This following section has been slightly amended but comes from 16+ Learning Choices Policy and Practice Framework pps.21-22 What constitutes an ‘offer’?  Education in school Attending school for all or part of the curriculum, in S4, S5 and S6. It might include a wholly school-based curriculum or a curriculum delivered by a range of providers, including schools, further and higher education, employers, community learning and development and third sector providers. The school should retain overall responsibility for planning the most appropriate educational provision for the young person.  Full- or part-time further education Attending college and studying either National Qualifications, Access courses, portfolio courses, portfolio preparation, pre-vocational courses, S/NVQs, Highers/A Levels.  Full- or part-time higher education Including study at university to study degree level, or an FE/HE college to study at HNC/HND level  National training programmes This includes participating in a National Training Programme (NTP). A young person may be a trainee and in receipt of a training allowance, or an employee receiving a wage. NTPs include: - Get Ready for Work - Skillseeker – employed or non-employed trainee status - Modern Apprenticeships – employed and undertaking a vocational qualification  Employment (where this is not a national training programme) Employment, whether with or without structured training, will involve learning and should generally be considered a positive post-16 learning choice. Broadly, employment covers: - All young people who consider themselves to be employed in full- or parttime employment (with a minimum of 16 hours per week) - All young people who consider themselves to be self-employed and earning a living by working independently of an employer either freelance or by running their own business. Where a young person takes up an offer of employment that does not include training, SDS will engage both the young person and employer in negotiating appropriate training for the young person. 61

 Personal/Skills Development Some young people are not yet ready for, or in the position (for any number of valid reasons) to participate in any of the foregoing opportunities. Where this is the case, individuals should be able to engage in Personal/Skills Development. This is often, but not exclusively, delivered by a community learning and development or a third sector organisation, as a stepping-stone to a positive destination. Included in this category is a wide range of and development opportunities (often short-term ones) combined with appropriate personalised support, such as: - Get Ready for Work Lifeskills - Short-term training programmes (less than 16 hours) including either jobrelated training or Personal/Skills Development - Personalised programmes of support aimed at supporting progression into positive and sustained learning destinations - Activity Agreement, currently only delivered in 10 local authority pilot areas  Volunteering Undertaking volunteering, which will involve a young person giving of his/her time and energy through a third party. It will benefit both the young person and others, including individuals, groups and organisations, communities, the environment and society at large. A young person will get involved in volunteering through choice, and should not be motivated primarily by financial gain or by a wage or salary. Some volunteering includes a financial allowance.

62

APPENDIX 5 Activity Agreement The scheme which describes Activity Agreements arises from recent Scottish Government guidance (July 2010) on good practice relating to 16+ entitlements. This scheme is developing across local authority areas. Four Pathfinder Areas have been identified. The results of their pilots will inform further planning. It is expected that Activity Agreements will arise naturally out of good practice linked to Getting it Right for Every Child and the review system which that entails. Using the level 1, 2 and 3 model, for instance, most young people (whose needs and entitlements are met by “universal service”/ Level 1) will embark on agreed activities in school or other educational establishments; in employment; or in some other freely chosen, positive destination. A proportion who need or request additional support (at Level 1/2) will be known to school and other agency staff. Activity Agreements will be explicit and geared to meet individual needs. A much smaller proportion (at Level 2/3) may need complex and significant support. Activity Agreements will reflect this, usually involving more agencies, more staff, more coordinators and more resources. It is clear that the Review System and Activity Agreements need to be part of a coherent approach, just as they need to articulate clearly with Co-ordinated Support Plans, Integrated Assessment planning, Looked After Children planning and actions arising from the Children’s Panel. Thus, just as young people prepare to make decisions about leaving or staying on at school, where the school has already established a spectrum of support, which involves Pupil Teaching; Career Management Skills; Review meetings with other agencies; and Tasters and other induction experiences, then Activity Agreements become part of a whole school approach to support provision. They will become part of the Review Meeting agendas (described in Appendix 2). Examples of what an Activity Agreement might contain are listed below. Local contexts will provide a wide variety of options. Examples of content:  Team building/working in a group  Work experience  Literacy/numeracy skills relevant to …(particular interests)  Computing/IT  Community learning & development  Self-efficacy/PSE Possible providers/agencies that may contribute to an Activity Agreement programme may include:  Orkney College 63

   

Voluntary Action Orkney (volunteering) Employability Orkney Connect Community Learning and Development

Key worker role: The key worker role can be adopted by staff from a variety of backgrounds and services provided they have the necessary skills and resources:      

Rapport with the young person Communication skills appropriate to the young person’s needs Time for a series of 1:1 meetings Understanding and experience of solution-oriented working Links with partner agencies and providers in local 16+ arena Supervision/line-management within 16+ Learning Choices arrangements

Summary Activity Agreements improve the support and recognition of young people learning in a community learning and development or a third sector setting. There are two priority groups for Activity Agreements:  

Young people identified as vulnerable to disengagement prior to leaving compulsory education Young people who initially move into a positive post-school destination but who do not sustain it.

Schools are strongly advised that Activity Agreements should be integrated into existing models of delivery, as a starting point. Just as the Review system (based on SHANARRI principles) needs creative and solution-based approaches, so the identification of Activity Agreements will require interagency partnership and responsibility.

Financial Support Education Maintenance Allowance (EMAs) have undergone considerable changes during May 2010, with no commitment from December 2010. Further details are awaited from government. Implicit in the Activity Agreement scheme is the expectation that EMAs (or any successor) will encourage and allow for financial support for young people who are no longer exclusively in a school setting at 16+.

64

APPENDIX 6 TRANSITION BRIDGE PATHWAY BETWEEN

‘GETTING IT RIGHT’ CHILD’S PLAN & ADULT CARE AND SUPPORT PLAN (SINGLE SHARED ASSESSMENT)

CONTENTS Page Guidelines for Using the Transition Bridge

63

Proportionate Tools for Transition Planning

65

My World Assessment Tool

66

Précis Guidelines on Capacity, Welfare and Financial Guardianship

67

Guidelines on the Assessment of Capacity

68

Parts One and Two - The Transition Bridge Part One Checklist/Tools

72

How I Grow and Develop

73

What I Need from the People Who Look After Me

74

My Wider World

75

Part Two Capacity

76

Consent to Sharing Information Form

78

65

THE TRANSITION BRIDGE PART ONE A tool for use in the transition process to support an information bridge between the ‘Getting It Right’ Child’s Plan and the Adult Care and Support Plan (Single Shared Assessment)

Guidelines for Using the Transition Bridge What is the Transitions Bridge for? 

To help service providers and managers by providing: o An electronic bridge between the ‘Getting It Right’ Child’s Plan and the Adult Care and Support Plan (Single Shared Assessment) o A straightforward, standardised and easy way to highlight the information about a young person that is contained in their ‘Getting It Right’ Child’s Plan. This would inform, but not replace, assessments done by adult services. o A record of highlighted issues that need to be considered in complex cases. o A tool to help multi-agency planning to be forward-looking towards post-school transition at an early stage and to incorporate this into the ‘Getting It Right’ Child’s Plan. o The information required to help General Practitioners and others make assessments for Disability Living Allowance, Financial and/or Welfare Guardianship and Capacity. o Information for relevant partner agencies, well in advance of transition, to help with planning services.



To help young people and families by: o Providing reassurance that transition planning is starting early and has a robust process. o Giving a checklist that supports young people or their families to be involved in planning in a person-centred way, and to ensure that plans are followed through by agencies. o Enabling young people or families to concentrate agencies’ attention onto aspects that are important to them. o Introducing potentially complex issues, such as guardianship, early enough to allow reassurance and preparation with the core team available.

66

Who might use the Transitions Bridge? The diagram on page 64 shows how the various planning tools in Orkney could be used for different young people. There are aspects of the Transitions Bridge (TB) that might be helpful for any young person. However, its use is particularly indicated where in the future there is likely to be: 

An Adult Care and Support Plan (Single Shared Assessment)



A need to consider questions of Capacity and Financial and/or Welfare Guardianship or Disability Living Allowance.

When and how should it be used? Orkney’s Transitional Planning Guidelines: Transitions to Post-School Services calls for transition planning to begin at least two years before an expected school leaving date. As part of the ‘Getting It Right’ Child’s Plan meetings, from this two year point onwards, partners to the Plan are asked to consider the questions in Part One of the Transitions Bridge (pages 72-78 ). Where there is knowledge or evidence of any issue, this should be documented in the ‘Getting It Right’ Child’s Plan. Where there is not enough information to answer a question as either YES or NO, then the TBC (To Be Confirmed) column should be ticked. The TBC issues could be a focus for future work with and for the child, family and partners to the ‘Getting It Right’ Child’s Plan. TBC can also be ticked if there is a lack of consensus, as this would also indicate an area for further work or discussion. The Transitions Bridge is not a stand-alone assessment. Its purpose is to highlight issues where there is relevant information available, or where further work needs to be done. The completed Transitions Bridge should, with appropriate consent, be sent to relevant adult or young adult services, including the young person’s General Practitioner, using the pre-existing referral process, to assist with planning and any future assessment. Copies of the Transitions Bridge should also be given to the individual young person and his/her parents and/or carers.

67

Proportionate Tools for Transition Planning

Transitions Bridge Young people who may need an Adult Care and Support Plan (SSA), DLA, or consideration of Guardianship or Capacity

My Transition Guide

Young people who may need support & preparation for postschool transition

Universal guidance All young people

Key:

Recommended tools

May also be useful

68

Every day care and help Being independent, looking after myself Enjoying family & friends Is there a carer’s plan in place for me? Do I need resources or equipment to help with What are my key relationships? Are there health or social care issues that might prevent me seeking or keeping hearing or vision? Do I have issues with respect to employment or further education? Do I need places to be made more accessible intimate or key relationships? Being there for me Do I have any life long or life limiting conditions? for me? Are the people I need Do I need help with behaviour? Does any equipment I use need regular always there for me? How well do I sleep? maintenance or updating? How do I know they are Are there any Health and Safety issues for my care? Learning to be responsible Will any current equipment follow me into there for me? Have I been involved in the adulthood? Keeping me safe Understanding my family’s planning process? If so is there a plan in place for this? What do I need to help me background and beliefs What kinds of decisions am I able Is religion important to me? keep safe? Learning and achieving to make? What helps me? If so, what do I need to be able to take Have I ever been harmed or How is my long-term and short-term How well can I understand what part in my religious activities? neglected? memory? is happening and what I need to Are there issues of diet and/or culture Would I be a vulnerable What are my achievements in do? that need to be considered? adult? learning? How aware of safety and danger What gender of carer is right for me? Do I need help with verbal or What am I going to be learning am I? physical aggressions? next? How well do I co-operate Do I enjoy learning? If not, what Knowing what is going to happen & when with others? might help? Have I been involved in the planning Confidence in who I am Is there any risk of harm to process? How I do best learn new things? How do I communicate me or to others? What supports do I need in order to Have my family or carers been involved? with others? learn? Do I use equipment to Play, encouragement & fun Being healthy help this? Do I have a medical history that adult Do I have satisfying personal relationships? Do I need help with services need to know about? How do I express my preferences and choices for reading or writing? Am I taking medication? leisure? How do I deal with Do I have support for personal care What social activities suit me? numbers and money? needs? Do I have enough opportunities for social activity? Have I had opportunities Are there issues about mobility and How can I develop my interests and hobbies? to explore issues of exercise? sexuality? Guidance, helping me to make the right choices Do I have any allergies? Am I able to give consent to medical treatment? What support do I need to prepare food Am I able to give consent for dental treatment? or to eat and drink? How is my mental health? Have I Enough money experienced any difficult events? Belonging Am I getting help with income Do I get anxious or depressed? Places to learn Am I satisfied with my opportunities for social interaction? maximisation/benefits? Where might my future employment or life long learning Am I seeking Am I getting Disability Living Allowance? Support from family, friends and other people learning continue opportunities? Do I get Independent Living Allowance? Have I been receiving regular respite/short breaks? after school? Am I in receipt of self directed payments? Are anticipatory care arrangements in place for me? Comfortable and safe housing Do I have some Housing support? Do they need to be considered? How about my immediate environment? alternatives for if of the building OK? Is the fabric that doesn’t work Work opportunities for me Local resources Is it secure? Are there safety hazards? out? Are you getting the help you need to find information Do I have a single point of contact for the Do I need equipment or adaptations? about work opportunities? transition process? How do I get help? 69 Have you been able to access work experience? Do my family/carers have a single point of Is the heating satisfactory? contact?

TRANSITION BRIDGE P A R T TW O CAPACITY AND FINANCIAL and/or WELFARE GUARDIANSHIP PRECIS Adults with Incapacity (Scotland) Act 2000 Issues of capacity will need to be considered when making the transition from children’s to adult services. Measures under the Adults with Incapacity (Scotland) Act 2000 may also need to be considered. 1. Adult means a person who has attained the age of 16 years. 2. “Incapacity means incapable of:  Acting; or  Making decisions; or  Communicating decisions; or  Understanding decisions; or  Retaining the memory of decisions”; but also  Inability to communicate because of physical disability; or  by reason of mental disorder. General Principles and Fundamental Definition of the Act     

Encourage the adult to exercise and develop their skill in decisionmaking; and There shall be no intervention unless that intervention will benefit the adult The least restrictive option should be taken in relation to the adult’s freedoms The present and past wishes and feelings of the adult must be taken into account The views of the nearest relative and primary carer of the adult where reasonable and practical to do so must be taken into account.

To assist robust and appropriate decision-making at the time of transition; and in preparation for transition; and under terms of the Adults with Incapacity (Scotland) Act 2000; those partners to the ‘Getting It Right’ Child’s Plan should consider the following questions during Child’s Plan Meetings for young persons aged from 14 years. Issues arising should be documented in the ‘Getting It Right’ Child’s Plan. Where the young person’s lack of capacity is as a result of a mental disorder, however caused or manifested, consideration should be given to involving a Mental Health Officer in planning discussions.

A Guardianship application must be accompanied by a report from a Mental Health Officer and two medical reports, at least one of which must be by a doctor approved under the Mental Health Act; the other can be by the General Practitioner. The application then requires approval by the Sheriff.

Guidelines on the Assessment of Capacity 1. Who these Guidelines are for 



 

Staff in the community, hospitals and care homes, who may make an informal assessment of capacity for the people with whom they are working. Staff in such settings may well be the first to become aware that a person may be losing their capacity or lacks capacity. Doctors, including GPs and Consultants, who will make a formal assessment which may result in a Certificate or Report of Incapacity. Such assessments may be informed by the assessments mentioned above and below. Clinical Psychologists who may carry out psychometric assessments. Such assessments will use formal methods, and may be relied upon when Certificates or Reports of Incapacity are being completed. Relatives and carers of people who lack capacity may find these guidelines helpful, either to assist in deciding whether or not to ask for further help, or as an aid to understanding how decisions about incapacity are reached.

2. The Adults with Incapacity Act gives the following definition of incapacity: An adult over the age of 16 incapable of 1. Acting; or 2. Making decisions; or 3. Communicating decisions; or 4. Understanding decisions; or 5. Retaining the memory of decisions by reason of mental disorder or inability to communicate because of physical disability, may be deemed to lack capacity, even if only one of the above applies. Any assessment of capacity must take the above definition into account and, in addition, the Principles must be adhered to:  Any action should be of benefit to the adult  Least restrictive intervention  Take account of the adult’s wishes and feelings  Take account of the views of relevant others  Encourage independence 3. Decision-Making Capacity should be assessed for major decisions that affect peoples’ lives, including the following:

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Finance / Property

Welfare

Day-to-day finances

Residence

Income and expenditure

Medical Treatment

Assets

Safety / Risk-taking

More than one assessment may be required when separate decisions have to be made, e.g. a young person aged 16 with a mild learning disability may be able to give informed consent to treatment for an underlying health condition, but may not be able to manage their financial affairs. As a result, different approaches may have to be taken when assessing for the capacity to make different types of decisions. Someone with impaired abilities can be assisted in the making of a decision by following a sequence of steps, and looking at the pros and cons at each stage.

4. Communication Being able to communicate is clearly essential when decisions have to be made. Where the communication difficulty is because of physical reasons such as stroke or head injury, every effort should be made using aids to facilitate communication such as alphabet boards, visual aids, etc. Speech and language therapists may also be of assistance. Only when this has clearly failed should the person be deemed to lack capacity. Where the adult has a mental disorder such as dementia or learning disability, such aids may also help. However, the mental disorder itself may prove to be the main barrier to communication, and in such cases aids are unlikely to be successful. There are two main areas of communication to consider: (a) Receiving information Some people with impaired capacity may have difficulty processing incoming information. In such cases, assistance should be given to help the person understand the information better (see above and Section 5 below). If the adult is still unable to process the information needed to make an informed decision, they may be deemed to lack the capacity to make that decision. (b) Communicating information and decisions 72

Others may be able to process information, but have difficulty in expressing themselves. Again, every effort should be made to assist communication, and only if such efforts have failed should a decision about incapacity be made. 5. Understanding Being able to understand the need for decisions to be made, and the nature of decisions, can be problematic when capacity is impaired. Some people may be able to make decisions, but be unable to understand the consequences, e.g. during an acute episode of mania, decisions may be made regarding finances that the person would not make normally. Every effort should be made to assist the person in their understanding of any decision which needs to be made. The following advice may be helpful:  Try to speak at the level and pace of the person’s understanding, and ‘processing’ speed;  Repeat information, clarify further, and repeat again if necessary;  Ask the person to repeat information in their own words;  Be careful in the use of language – no jargon;  Try to ensure that the person is not overwhelmed by choices;  Use family and friends to assist in providing information about whether the person can make a decision, and what their wishes might be;  Take literacy into account;  Assess the ability to weigh up the advantages and disadvantages of a decision, and the alternatives;  Use ‘open’ questions, not ‘closed’ ones to which the answer will be “yes” or “no”;  The body language of both interviewer and interviewee may be crucial in helping understanding. 6. Memory Some people may be able to make decisions quite adequately, but be unable to recall them soon afterwards. Others may be unable to recall the initial information which would enable them to make the decision. For others, memory may be patchy and variable – very good some days, but poor otherwise.  If a person is able to make a decision, but is unable to recall it, an attempt should be made to enable the decision to be made again, using the same information. If the same decision is again reached, it can be argued that capacity may be present. Consistency in decision-making is more likely to mean capacity, despite a lack of retention, but the person may still be deemed incapable because of other factors.  In assessing capacity, there is a distinction to be drawn between short- and long-term memory loss. Short-term memory loss is more likely to lead to incapacity because of the nature of the decisionmaking process. However, an assumption should not automatically 73

 

Tests, such as the ‘Mini Mental State Examination’, are available to test memory. These are useful as a guide, but they are not tests for capacity. An in-depth assessment may be required in assessing memory impairment and its effect on decision-making, particularly when crucial decisions are being considered.

7. Duration Incapacity can be temporary, indefinite, fluctuating or permanent. Its duration and strength will depend on the individual and the reason for the incapacity. For example, during episodes of mental illness, capacity may be impaired for a few weeks, before being fully restored. Head injury may result in a period of years before capacity returns, whilst dementia is likely to see a gradual decline from full capacity to being unable to make simple decisions. The duration and nature of the incapacity may give a clue to the best type of intervention. Reference should be made to the Act itself, the Codes of Practice and other guidance. Incapacity is not ‘all-or-nothing’, and will vary from decision to decision. 8. Diagnosis A learning disability is a key cause of incapacity followed by physical causes such as head injury. A small but significant number will have a severe and enduring mental illness such as schizophrenia or manic depressive illness. Diagnosis may be a guide to potential incapacity, and to its duration, but assumptions should not be made. For example, someone with a learning disability is not automatically unable to make decisions, and may be very capable in some areas whilst having difficulty in others. 9. Conclusion The assessment of capacity relating to decision-making is an art still in its infancy. There are no tests as such. These guidelines should provide some assistance, but assessments will always depend on professional judgement and consultation. The information provided by relatives, carers, professionals, and others is also vital. Previous beliefs, culture and behaviour should also be taken into account. It should be stressed that a person deemed incapable of making decisions still has the right of refusal, for example to medical treatment. Finally, assumptions are often made about incapacity based on diagnosis and initial observation. In many cases people who at first sight appear to lack capacity can be helped to make informed decisions with encouragement and the right approach.

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P A R TS O N E AND TWO THE TRANSITION BRIDGE PART ONE CHECKLIST/TOOLS A link from the ‘Getting It Right’ Child’s Plan to the Adult Care and Support Plan (Single Shared Assessment) ‘Are there any barriers/issues relating to each item below?’ HOW I GROW AND DEVELOP Relationships  key relationships  intimate relationships  key / intimate relationships

YES NO

Hearing & Vision  resources  accessibility  equipment Communication  speech  language  understanding  reading  writing  numeracy  communication equipment Does this person use any equipment that requires regular maintenance / updating? Will the equipment follow the person into adulthood - and if so:  is there a plan in place that includes adult services? 

Is a plan being considered?

Personal Care and Wellbeing Relevant medical history: learning and / or physical disability requiring  ongoing care?  prescribed medication? Personal Care  washing  dressing  oral hygiene  foot care  skin care (please circle)  bathing/showering  continence 75

TBC

HOW I GROW AND DEVELOP / cont’d Mobility  balance  exercise tolerance  transfers  equipment  level of independence  wheelchair user

YES NO

Food Preparation  eating  drinking  nutrition  allergies Mental Health & Capacity  cognition  capacity  concentration  memory  orientation  wandering  safety awareness Emotional Wellbeing  emotional difficulties triggered by a life event  general mood  anxiety  motivation Social and Cultural Life  personal relationships  ability to express preference / choice  social activities  opportunities for social activity  behaviour  interests / hobbies Employment / education / life long learning Health or Social Care issues that inhibit seeking or retaining:  employment  

life long learning opportunities work experience

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TBC

WHAT I NEED FROM THE PEOPLE WHO LOOK AFTER ME Consultation

YES

Has the young person been involved in this process? Has the primary carer been involved in this process? Is this person a young carer? Has a carer’s assessment been offered?  In place? 

Being considered

Life limiting / or life long condition 

alcohol misuse



substance misuse

Mental Health & Capacity 

behaviour



prompting



agitation



restlessness



sleep disturbance



verbal aggression



resistive / or lack of cooperation towards others



risk of harm to self



risk of harm to others

Social & Cultural Life 

religious matters



arrangements for provision of gender carer



spiritual



cultural spiritual



cultural

Care & Protection Previous or current child protection issues. Will these child protection issues transition into adult protection issues? If so, are plans in place with adult support and protection services for this? History of health & safety at work relating to anyone in direct contact through care and support?

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NO

TBC

MY WIDER WORLD Management of Finances / Income Is this person receiving help with income maximisation / benefits? In receipt of *Disability Living Allowance? In receipt of Independent Living Allowance? In receipt of a **Direct Payment? *NB Disability Living Allowance regulation states that when applying for Disability Living Allowance “needs must have been identified for at least 3 months”. **NB A Direct Payment for a person who lacks capacity and is 16 years or over requires to be managed by a person with a financial legal authority to do so, i.e. Power of Attorney or Financial Guardian; therefore forward planning must be considered

Immediate environment & resources Accommodation Concerns with fabric of the building Security Safety hazards Equipment including telehealthcare and other assistive equipment Adaptations Heating Summoning help Housing support Social & cultural life Is the person satisfied with their opportunities for social interaction? Does this person have the opportunity to explore issues of sexuality? Is this person receiving regular respite / short breaks? Life long / or life limiting condition Anticipatory care arrangements:  in place?  to be considered? Has the subject of NHS Continuing Health Care been prompted for and/or discussed. Single point of contact Is the single point of contact during this process known to  the person? 

the family / carer?

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YES NO

TBC

PART TWO CAPACITY: CHECKLIST/TOOL: KEY QUESTIONS Does this person have a mental disorder? (Diagnosed with a Learning Disability, Mental Illness or Personality Disorder)

YES

NO

Does this person have an acquired brain injury? Is this person able to communicate by any known means? Does this person lack capacity? (Ability to give informed consent) Does this person require to give consent for medical or dental care? Is this person approaching 16 years of age? Is financial guardianship being considered? Is welfare guardianship being considered? Has this person reached full capacity for further development? Is this person vulnerable and in need of protection? Do decisions have to be made which could not be made without Guardianship? (If yes, detail in the ‘Getting It Right’ Child’s Plan) Would the person be at risk without Guardianship? (If yes, detail in the ‘Getting It Right’ Child’s Plan) Prompts about Capacity 1. How confident is the young person in making decisions for themselves, for example what clothes to wear? 2. Is the person more confident in some situations and not others? 3. Does the person understand the value of money – for example would they know how much a bar of chocolate was and how much change they would get? 4. Does the person understand the consequences of their actions regarding personal safety, for example would they know that if they cross the road without looking they might be run over? 5. Does the person look to others to make decisions for them? 6. Is the person able to make informed choices/decisions based on retained information? 7. Could the person give informed consent to medical treatment – for example, would they understand the need to take medication for a medical condition such as diabetes? 8. How good is the person at understanding of straightforward instructions based on information given in an individual format?

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TBC

9. Can the person communicate their needs adequately e.g.  Verbally  Picture format:  Specialist equipment:  British Sign Language or  Other? 10. Can the person dress themselves without supervision? 11. Can the person find their way around their environment without prompting, e.g.  At home? At school/college? In the community? In a variety of settings?  Only in rehearsed places and settings know to the person? 12. Can the person use skills learned in one place in a different place?

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Consent to Share Information Young person (Y/N)

Parent/Carer Notes (Y/N) (e.g., exceptions)

General Practitioner Partners to Child’s Plan Team Manager, All Age Disabilities Service Other (1) Other (2)

Signature

Date

Young person

Parent/Carer

Lead Professional

This document should be kept as a whole unless otherwise specified

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