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3.1.5 Care, Education & Treatment Reviews

The national Transforming Care programme is concerned with preventing admission to Tier 4 hospital provision and/or 52-week residential placements for children and young people with autism and/or a learning disability, behaviour that challenges and/or mental health issues. As a response to national concerns about the care of young people in long term hospital placements, it promotes a multi-disciplinary, preventive approach to addressing challenging behaviour. Click here for more details of the national programme.

This procedure outlines the social work responsibilities in working with partners to ensure that children, young people and their families receive timely support, both to prevent admission and facilitate discharge.

This chapter was added to the manual in April 2019.


Contents

  1. Introduction
  2. Care Education and Treatment Reviews (CETR)
  3. Role of the Social Worker
  4. The Transforming Care Register
  5. Other Responsibilities


1. Introduction

The aim of Transforming Care is to improve the lives of children, young people and adults with learning disabilities and/or autism who present with behaviours that challenge, including those with a mental health condition.

The programme has three key aims:

  • To improve the quality of care for people with a learning disability and/or autism;
  • To improve the quality of life for people with a learning disability and/or autism;
  • To enhance community capacity, thereby reducing inappropriate hospital admissions and length of stay.

In Cambridgeshire this approach is also used to reduce the need for 52 week residential school placements.

There is a Transforming Care Partnership in Cambridge and Peterborough that includes representatives of all agencies and coordinates this work.

More details can be found on the Local Offer.

See also: A Family Survival Guide – Care and Treatment Reviews (CTRs) written by Bringing Us Together.

The original Care and Treatment Review policy was published in October 2015 by NHS England, alongside 'Building the Right Support' and the 'New Service Model' as part of Transforming Care and a new policy and guidance document was issued in March 2017. For the first time, this included a section for children and young people, and the explicit naming of education as a key part of this work. This led to Care, Education and Treatment Reviews (CETRs) for children and young people.


2. Care Education and Treatment Reviews (CETR)

If a child or young person is in hospital or anyone is worried that they may have to go into hospital, or there is a possibility of admission to a 52-week residential placement, they will have a Care, Education and Treatment Review (CETR) or, if they are over 18, a Care and Treatment Review (CTR).

This review ensures that the child or young person, their family and those professionals supporting them, all have a say in how they can be supported in their community. Health, education and social care all have to be involved in the CETR.

The purpose of a CETR is to jointly develop an Action Plan about what needs to be done to support the child or young person in their community and avoid them going into hospital or what needs to be done to make their stay in hospital as short as possible.

A Community CETR will be held as soon as it is known that there is a risk that a child may be admitted to hospital or 52 week provision and, following that, every 3 months. It will be chaired by the Cambridgeshire and Peterborough CCG Transforming Care Lead Commissioner.

A Hospital CETR will be held within 5 days of a child being admitted to hospital and then every 3 months. It will be chaired by an NHS England representative and the Chair of the Community CETR will be included in this CETR.

A social worker must always be part of a CETR and is responsible for assessing and planning to meet the child and family's social care needs generally but in particular to prevent admission or plan for discharge in conjunction with other services and the family.

If the child already has a social worker that social worker must attend the CETR.

  • The request may come direct from the inpatient setting or via the Cambridgeshire and Peterborough Transforming Care Lead Commissioner;
  • The Cambridgeshire and Peterborough Transforming Care Lead Commissioner, if they do not know who the social worker is, may go through the Customer Service Centre or one of the CCC Transforming Care Champions;
  • Attendance must be prioritised and arrangements made for someone else to attend if the social worker is unavailable.

If the child does not already have a social worker the Cambridgeshire and Peterborough Transforming Care Coordinator will request social care involvement via the Customer Service Centre.

  • A social worker from the Disabled Children's Social Care Service will be allocated;
  • They must attend the CETR;
  • If, following assessment, the child does not meet the eligibility criteria for a disability social work service the child will, with parental permission as appropriate, be transferred to the most appropriate children's social work or early help team.


3. Role of the Social Worker

Within the CETR process, the social worker will:

  • Work with others to develop an education, health and social care package of support to prevent hospital admission, 52 week residential placement or to plan for hospital discharge;
  • Carry out social care single assessment where required;
  • Arrange for social care support as needed following the usual process;
  • Undertake actions as agreed within the CETR process;
  • Ensure that their manager is aware of the issues and potential needs so that they can support as needed.

However, as speed will often be essential, Social Workers will need to prioritise this work and may need to provide support before the assessment is complete.


4. The Transforming Care Register

The CCG and the local authority are required to jointly maintain a register of all children and young people with autism and/or learning disability, behaviour that challenges and/or mental health issues who are in Tier 4 hospital beds, are at risk of being admitted or having a 52 week residential placement.

Anyone who is concerned about this in relation to a child or young person they are aware of can make a request for the child to have a CETR and be included in the register.

Workers can request inclusion but must obtain consent from the young person or their family first. Referral and consent forms can be requested from: capccg.childrenstransformingcare@nhs.net.

The register is coordinated by the Cambridgeshire and Peterborough Transforming Care Lead Commissioner.

Every child on the register must have CETRs within the timescales outlined in section 2, above, and a clear plan in place to prevent hospital admission or in preparation for discharge or prevent 52 week placement.

Children and young people should only be included on the register if there is a risk of hospital admission, they have already been admitted or there is a risk of 52 week placement. They should be removed from the register at the earliest appropriate opportunity. This will be a joint decision of all involved, coordinated by the Cambridgeshire and Peterborough Transforming Care Coordinator.


5. Other Responsibilities

The Transforming Care/CETR process has a high profile, both locally and nationally. The local authority and the CCG service directors have to report monthly to NHS England on the plans and situation for every child, young person and adult on the Transforming Care Register.

Social Workers must ensure that their manager has up to date information to enable them to do this effectivly.

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