Transcript Slide 1

National Framework for
Children and Young
People’s
Continuing Care
Aims of the Session.
• To consider the component parts of the CCF.
• To work through the DST
• To share project on CCN
• To consider partner agency working.
• To consider the transition phase for young
people.
This is an interactive event.
Exercise.
National Framework for Children and
Young People's Continuing Care
Myth Busters!
Continuing Care.
A continuing care package will be
required when a child or young person
has needs arising from disability,
accident or illness that cannot be met
by existing universal or specialist
services alone.
National Framework for Children &
Young People’s Continuing Care.
The framework provides a systematic approach to
assessing the ongoing health needs of children &
young people through:
• Joined up services & commissioning.
• Building on existing assessments.
• A process that is transparent & includes
participation from the family & young person.
Phases of the Continuing
Care Process
Assessment
Phase
Decision
Making
Phase
Arrangement
of
Provision
Phase
Stage of Continuing Care
Pathway
Summary of key actions
Timescales
Cumulative
Timescales
1) Identify
Child or Young Person with possible continuing care
needs identified through effective referral. Fast track
if necessary
1 working
day
1 working
days
2) Assess
Nominated children and young people’s health
assessor completes four areas of assessment
3) Recommend
Nominated children and young people’s health
assessor prepares recommendations and costed
options
8 working
days
9 working
days
4) Decision
Multi-Agency Forum considers recommendations,
costed options and decides upon package of
continuing care for child or young person where
continuing care need is established
14 working
days
23 working
days
5) Inform
Child or Young Person and family, referrer and
relevant organisations informed of decision
5 working
days
28 working
days
6) Deliver
Identify provider(s) for package of continuing care /
Commissioning and Implementation of package of
continuing care / Ongoing Training, Support and
Monitoring
Dependent on complexity,
commissioning, Disability
Grant Funding processes
and/or national exemplars
7) Review
Re-assessment of child or young person’s continuing
care needs and appropriateness of package of
continuing care
should occur 3 months after initial assessment, then
annually as a minimum or sooner as appropriate
3 months / Annually / as
appropriate
Core Elements of the National Framework
for Children and Young People's
Continuing Care.
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•
•
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Principles.
Timelines.
Assessment phase.
Decision-making phase.
Arrangement of provision phase.
Transition from child to adult services.
Fast Track Pathway.
Only for those children where their condition is
deteriorating rapidly characterised by an
increasing level of dependency and ‘where
lifespan is thought to be days or weeks rather
than months or years’.
The need immediate decision on eligibility to
be made so that their immediate needs can be
met.
Nominated Children and Young
People’s Health Assessor.
Key requirements:
• Health practitioner experienced in children and
young people’s health.
• Has experience and expertise in health assessment.
• A thorough working knowledge of the policy on the
Framework.
• Well-developed leadership qualities.
Assessment.
• The child and family centred assessment
process must be at the very heart of a
children’s continuing care assessment
process. All other aspects of the assessment
process must be seen in the context of this
assessment.
Assessment.
There are three key considerations which are
paramount in children’s continuing care:• Parents - experts in their child or young
person’s care and as primary carers.
• Home is the centre of caring.
• A child's right to education.
Key Factors in Assessment.
• Timing of assessment. • Parents with learning
or communication
• Location of
difficulties.
assessment.
• Communication skills • Communication aids.
• Advanced planning
• Skilled interpreters.
techniques.
How do you build up a holistic
child and family centred
assessment without repeating
assessments, reports and risk
assessments already undertaken?
Discuss.
Possible Assessments and Reports.
• Multidisciplinary reports.
• Multi-agency reports.
• Records.
• Independent reports.
Key Areas for Risk Assessment.
• Clinical risk.
• Staffing levels.
• Moving and handling.
• Environment of care.
• Equipment.
The Elements in Risk Management.
• Risk refers to the possibility of a situation
occurring which would involve exposure to
danger or a hazard, that is, the possibility of
something harmful happening.
• Risk is a combination of the likelihood of
something harmful happening and the
seriousness of the potential injury.
The Elements in Risk Management.
• A hazard is less likely to cause harm if
certain controls are in place.
• Controls are the steps taken to either
eliminate the hazard or reduce the
associated risk to an acceptably low level.
The Elements in Risk Management.
• Risk is managed by assessing it, avoiding it if
it is unnecessary or reducing it to a level
which is ‘reasonably practicable’.
• When considering what is ‘reasonably
practicable’ the needs of both the child and
staff should be taken into account.
Reasonably Practicable As defined by the Health and Safety
Executive (HSE), means ‘an employee has
satisfied his/her duty if he/she can show that
any further preventative steps would be
grossly disproportionate to the further
benefit which would accrue from their
introduction’ (HSE 1992,p8).
DST – What is it?
The decision support tool enables practitioners to:
•Inform consistent decision making.
•Requires practitioners to use their professional
judgement to justify how and why a
recommendation is made.
•Clarifies the evidence used to make the decision.
•A stage of the assessment process.
DST – What it’s not.
• An assessment tool.
• A decision MAKING tool.
• Suitable for every individual’s situation.
• A substitute for professional judgement.
How Does it Work – Care Domains.
• Behaviour
• Psychological &
emotional needs
• Communication
• Mobility
• Nutrition
•
•
•
•
Continence
Skin & tissue Viability
Breathing
Drug therapies &
medication: symptom
control
• Seizures
Levels.
• Each domain is divided into levels describing
a hierarchy of need.
• Each level is given a weighting (not score) no
needs, low, moderate, high, severe, priority.
• Not all domains have the same weighting –
based on principle that some domains reflect
health needs more than others.
1. Child or Young Person and family preferences or
views
2. Holistic Child or
Young Person &
Family centred
Social – Collate existing
assessment and
report / Commission / Carry
carer assessment
Out Joint Assessment /
Health – Carry Out
Education – Collate existing
report / Commission
3. Reports and Risk Assessments from MultiDisciplinary Team
4. Decision
Support
Tool
Exercise – National Framework for Children
and Young People's Continuing Care (2010) Using the Decision Support Tool (DST).
Go through each domain and consider the following:• How do you apply professional judgement to the
child / young person’s domains?
• How does normal child development impact on the
scoring of each domain?
• What risks could / should be considered in each
domain?
Key Requisites of a Multi-Agency
Decision Making Forum.
The multi-agency decision-making
forum is made up of key PCT and
local authority professionals,
including commissioners and clinical
advisers.
Discuss how existing/ or new panels
or processes can be used for
making decisions on Children’s
continuing Care Assessments in
your area.
Record Keeping.
• Clear record of multi-agency inputs.
• Record rational behind decisions and
recommendations.
• Evidence based decisions.
• Scoring of DST or rational for professional
judgement based decisions.
Communicating the Decision.
• Within 5 working days – How?
• Clear rational.
• Care options.
• Time frame.
• Appeal process.
Delivery.
Care packages should be sustainable
and integrated with existing
universal and specialist provision,
provided in a timely manner and
adaptable to future care needs.
Delivery Goals.
• Integration with existing universal and specialist
services is a key requisite, which should enhance
sustainability and reduce fragmentation of service
delivery.
• Sustainability of services should be constantly
considered and reviewed. Early indications from
work being undertaken by DH on community
children’s nursing has demonstrated the advantages
of large, multifaceted children’s teams in delivering
sustainable services.
• Care management should be integral to
care packages. National Framework for
Children and Young People’s Continuing
Care (DH 2010 Pg 64).
• Training of parents, staff and foster carers
should be considered as appropriate.
Review.
• Initially at 3 months.
• As required.
• Minimum of yearly.
• Clear expectation of all involved that care
will be reviewed.
• Open and transparent process.
Auditing & Monitoring.
• PCTs are responsible for:
– Ensuring consistency in the application of the national policy
on eligibility for Children’s Continuing Healthcare,
– Promoting awareness of Children’s Continuing Healthcare,
– Implementing and maintaining good practice,
– Ensuring quality standards are met and sustained,
– Providing training and development opportunities for
practitioners,
– Identifying and acting on issues arising in the provision of
Children’s Continuing Healthcare, and;
– Informing commissioning arrangements, both on a strategic
and individual basis.
– Monitoring the number of appeals and their outcomes.
Dispute Prevention.
How can you avoid disputes?
a. Process.
b. Implementation.
Co-ordinating the Process.
Ownership of process beginning to end:
• Identify children / young people who should be assessed.
• Identify if a child / young person needs to be “fast-tracked”.
• Identify all professionals involved in the care of the child /
young person who may contribute to the assessment.
• Complete documentation accurately, clearly and
comprehensively.
• Ensure appropriate care plan put in place.
A Care Coordinator can help this process run smoothly.
Review Panel.
• Neighbouring PCT
• PCT
• Senior officer review
PCT Complaints Procedure.
Dispute Resolution
Good Practice Principles – Handout.