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Standard 4: Growing Up into Adulthood

The National Service Framework for Children, Young People and Maternity Services establishes clear standards for promoting the health and well-being of children and young people and for providing high quality services which meet their needs.

Vision

We want to see:

  • Young people supported to make the transition to adulthood and to achieve their maximum potential in terms of education, health, development and well-being.
  • Young people taking responsibility for their own health and making informed choices and decisions regarding their emotional and social development, and health and well-being both now and in the future.
  • Services and staff who are able to respond in a sensitive way which encourages engagement and provides high quality support for young people.

Standard:

All young people have access to age-appropriate services which are responsive to their specific needs as they grow into adulthood.

Markers of good practice

1. All services working with young people have policies and procedures which ensure that their confidentiality and rights are respected.

2. Young people are consulted in the planning and development of local services.

3. Services address targets for the reduction of teenage pregnancy, smoking, substance misuse, sexually transmitted infections and suicide through the provision of targeted and/or specialist services which are sensitive to young peoples' needs.

4. Young people in special circumstances receive targeted and/or specialist services to meet their needs which are easily accessible and of the same standard in all settings.

5. All transition processes are planned in partnership and focussed around the preparation of the young person.

6. Young people up to eighteen years of age with mental health problems have access to age-appropriate services.

7. All services for young people contribute towards assisting young people to take on increasing responsibility for their own lives.

8. Services seek to support parents, in particular providing information and advice on how they can appropriately support their child's transition to adulthood.

2. Rationale

2.1 Supporting young people and encouraging them to make their own way in life and take responsibility for their own actions and decisions is essential if they are to grow up into independent adults. Moving to adolescence brings with it challenges for all families.

2.2 Adolescence is a time when patterns of behaviour and use of services are developed and these tend to be continued during adult life making it an important time to promote engagement with advice and services. Young people want services which are flexible in approach and are responsive to their needs.

2.3 In contrast to all other age groups, mortality in this age group did not fall significantly in the second half of the twentieth century. The main causes of mortality in young people are accidents and self-harm, and there has been a record rise in suicides in young men. Morbidity in young people is commonly caused by chronic illness and mental health problems, with the risk of long term adverse consequences. There is a strong relationship between physical, mental health and good social functioning.

2.4 Young people with additional, and sometimes complex, needs such as mental health problems or disabilities may find it more difficult to make these transitions successfully and they and their families may require additional support. However, these young people often have experiences of poor support during their transition to adulthood. They need high quality, multiagency support allowing them to have choice and control over life decisions and, in particular, to maximise education, training and employment and leisure opportunities with a view to living independently. High quality transition services should be delivered in a multi-agency context.

2.5 Parents often find the transition of their children towards greater independence difficult to manage effectively, and often feel it is the time when they are most isolated and are least supported in their parenting roles. Yet young people who have positive relationships with their parents, and whose parents are well informed about issues such as sexual health, drugs etc, are less likely to engage in risky behaviour, and are more likely to navigate the transition to adulthood more successfully. Services should seek to support parents more actively, particularly by providing information and advice.

Interventions: 3. Respecting and Involving Young People in Their Care

3.1 Until young people reach adolescence, they are normally presented to health services by their parents and have not had to access these services themselves. By the age of fifteen, half of young people want to see the doctor or nurse alone, just under a quarter with their parents, and just over a quarter with a friend. Young people need to be supported by professionals in learning to exercise autonomy and developing confidence in using services.

When requested, professionals enable young people to attend part of a consultation without their parents present, and offer encouragement to discuss lifestyle and psychological issues. Wherever practicable, young people are offered choice regarding the gender of the professional that they see.

Confidentiality & Rights

3.2 Confidentiality is one of the key issues that young people report influences their use of health services.

3.3 Concerns about the confidentiality of information held by their primary health care provider, together with lack of immediate access to primary health care services for those at school, college or work, may lead young people to use a range of other primary care providers (e.g. walk-in centres, school nurses, sexual health services, family planning services, community clinics etc.). Putting systems in place to ensure continuity of care is therefore particularly important when providing effective services for young people.

3.4 Young people of sixteen years or over are competent to consent to treatment even though they are under the legal age of majority (eighteen years) and may need to be assured of confidentiality in clinical consultations. Under this age, young people can consent to treatment if the health professional is satisfied the young person is competent to understand fully the implications of treatment options.

All health services develop policies which take account of the needs of young people, and include addressing issues of confidentiality, copying young people in to clinical correspondence or writing to the young person; and wherever possible, by the holding of personal health records by young people. See Standard 3

Health, education, social care and other services develop policies and good practice guidelines to be followed by all practitioners, on young people's rights and professionals' responsibilities for consent and confidentiality. These include:

  • Issues for confidentiality arising in relation to safeguarding/child welfare concerns;
  • The UN Convention on the Rights of the Child (1);
  • The need young people may have for privacy from their parents as they get older;
  • UK legislation in relation to sharing of information about children and young people between agencies, and person-held records. See Standard 3

Health, education, social care and other services for young people produce, and clearly display, a confidentiality policy which makes clear the duty of confidentiality and care to young people, including those under 16, as set out in the Royal College of General Practitioners' Confidentiality and Young People Toolkit (2). Staff are able to explain the implications of these policies to young people.

Information for Young People

3.5 Young people need access to information on healthy living, health services and other support services, to enable them to make informed decisions regarding their choice of lifestyle and to access appropriate services. See Standards 1 and 3 and 6 to 11

3.6 Duties under the Disability Discrimination Act need to be taken into account when considering the provision of information in appropriate formats and language.

Primary Care Trusts, Local Authorities and Connexions services ensure that young people have access to service directories providing comprehensive information about how to access health and social care services and education services and this is available in a range of settings used by young people. This information is produced in consultation with young people to ensure that the language, format and medium used are relevant and accessible to young people.

All staff working with young people are able to refer and support young people in accessing services.

Looked after children receive a copy of the Staying Healthy, Feeling Good (3) guide on what support is available from health and social care staff.

4. Health Promotion for Young People

4.1 Five key health issues have been highlighted as particularly important for young people (aged 12 - 19 years). These are:

  • nutrition
  • sexual and reproductive health
  • mental health
  • injury
  • substance misuse.

4.2 Approaches to health promotion for young people may need to be different to those provided for adults and be appropriate for their stage of cognitive and social development. They may not appreciate the long term health consequences of lifestyle choices. Young people need to be engaged in developing a range of life skills and be supported to make informed choices, to minimise risks to themselves and to take responsibility regarding their health and well-being. See Standard 1

Primary Care Trusts working with partner agencies ensure that health promotion strategies in each locality address the particular needs of young people.

Young people are actively involved in planning and implementing health promotion services and initiatives.

Promoting Healthy Eating and Healthy Lifestyles

4.3 Young people can sometimes develop poor eating habits and find it difficult to make healthy choices in relation to food. From the age of 16, participation in physical activity and sport falls dramatically for both boys and girls. If lifelong benefits of an active lifestyle are to be maintained, it is important that young people do not stop doing exercise. See Standard 1

Primary Care Trusts and Local Authorities ensure that young people are provided with ongoing information and support to enable them to make healthy choices and instigate a 'culture' change in the way they think about and approach issues in relation to health and food.

Professionals caring for young people are able to recognise inappropriate eating habits such as the development of anorexia nervosa or bulimia and are able to make appropriate referrals if specialist help is required.

Local Authorities ensure that services implement an inclusive approach to physical activity that offers high quality experiences across a range of activities, reflecting the interests of teenage girls, as well as boys.

Sexual and Reproduction Health

4.4 The UK has the highest rate of teenage births in Western Europe. 70% of teenage pregnancies are unplanned with almost 50% of conceptions in under-eighteen year olds ending in abortion. Although parenthood can be a positive experience for some young people, it may also bring a number of negative consequences for young parents and their children. Morbidity and mortality are significantly higher than for babies of older women; for example, infant mortality in this group is 60% higher than for babies of older women.

4.5 The Government is committed to reducing the rate of teenage pregnancies and this is reflected in the PSA target as set out in National Standards, Local Action (4) which sets out priorities for the NHS. The Department of Health national target on improving the health of the population sets out some of the current challenges which need to be addressed in this area. The sexual health areas which will be particularly relevant for Primary Care Trusts and their Local Authority partners to cover in their plans are: STI and HIV rates, holistic access times (covering both STI and reproductive health), and contraceptive and sexual health services provision.

4.6 There is also a strong association between deprivation and conception rates in young people. Teenage mothers are less likely to finish their education, less likely to find a good job, and more likely to bring up their child alone and in poverty. There has been a general decrease in conception rates among most age groups. The exception, however, has been among girls aged 13-15 years; rates of conception in this group have remained static between 8-10 per thousand females, from 1990 to 2000. Looked after children and care leavers are also at higher risk of early pregnancy - 17% of young women leaving care are pregnant or are already mothers. Daughters of teenage mothers are more likely to become teenage mothers themselves (5).

4.7 There is an increasing and disproportionate burden of sexually transmitted infections among young people. There is a ten year programme for investment and reform in sexual health services, published as the Government National Strategy for Sexual Health and HIV (6) in 2001. This strategy specifically identifies young people as a priority group for interventions. Between 1991 and 2001, the number of new episodes of sexually transmitted infections (STIs) among those aged under 20 in England, Wales and Northern Ireland doubled to 1.3 million. (7)

4.8 It is known that young people who are able to discuss sexual and reproductive health issues openly with their parents are less likely to engage in risky behaviour, are less likely to engage in sexual activity at a young age, and are less likely to conceive a teenage pregnancy. However, parents often find talking about these issues difficult. Parents need to be offered information and advice so that they can support their children most effectively in this area.

Primary Care Trusts and Local Authorities ensure that interventions to improve sexual health and reduce unwanted teenage pregnancies are identified in health promotion strategies, and informed by Government strategy.

Primary Care Trusts and Local Authorities reduce the under-18 conception rate by 50% by 2010 (from the 1998 baseline) as part of a broader strategy to improve sexual health (a joint DH/DfES PSA target).

Young people are informed of the risks of unprotected sexual activity, and of sexually transmitted infections and the potential consequences of teenage pregnancy.

Young people have access to confidential contraceptive and sexual health advice services which are tailored to meet their needs. These can be provided in a range of settings, including extended schools. For the provision of contraception to under sixteens, health professionals follow revised guidance (8) (2004). This includes rapid access to testing and treatment for sexually transmitted infections including blood borne viruses.

Young people have rapid access to emergency contraception, for example, through community pharmacy schemes, and walk-in centres.

Young women have early and easy access to free pregnancy testing, unbiased advice and speedy referral for NHS funded abortion or ante-natal care.

Primary care services, particularly general practice, deliver a comprehensive sexual health programme.(9)

Primary Care Trusts and local Authorites, in partnership with others, implement targeted approaches to reach specific groups of vulnerable or disadvantaged young people who are often excluded from mainstream services e.g. disabled young people and looked after children.

Primary Care Trusts and local Authorities provide advice and information to parents on sexual health so that they can support their children most effectively.

Young People's Mental Health

4.9 The prevalence of mental health problems during adolescence is higher than in childhood and some, such as psychoses, anorexia nervosa and self-harm, are more likely to emerge during teenage years.

4.10 Between 1985 and 1995, there was an overall increase of 28.1% in teenage deliberate self-harm. Young people who are at risk of deliberate self-harm are often not identified and, as a result, their psychological problems may not be treated. Up to half the children and young people presenting with deliberate self-harm may suffer from a major depressive disorder. There is an increased risk of repetition and completed suicide following deliberate self-harm. Suicide is now the most frequent cause of death amongst men and the third most frequent cause of death among women aged 15 to 24 years. See Standard 9

4.11 Young people in special circumstances, such as those who are looked after by a local authority, in young offenders institutions, those with a learning disability, and unaccompanied refugees and asylum seekers, have much higher rates of mental health problems than young people in the general population.ealth so that they can support their children most effectively.

Primary Care Trusts and Local Authorities ensure that interventions to improve sexual health and reduce unwanted teenage pregnancies are identified in health promotion strategies, and informed by Government strategy.

Primary Care Trusts and Local Authorities reduce the under-18 conception rate by 50% by 2010 (from the 1998 baseline) as part of a broader strategy to improve sexual health (a joint DH/DfES PSA target).

Young people are informed of the risks of unprotected sexual activity, and of sexually transmitted infections and the potential consequences of teenage pregnancy.

Young people have access to confidential contraceptive and sexual health advice services which are tailored to meet their needs. These can be provided in a range of settings, including extended schools. For the provision of contraception to under sixteens, health professionals follow revised guidance (8) (2004). This includes rapid access to testing and treatment for sexually transmitted infections including blood borne viruses.

Young people have rapid access to emergency contraception, for example, through community pharmacy schemes, and walk-in centres.

Young women have early and easy access to free pregnancy testing, unbiased advice and speedy referral for NHS funded abortion or ante-natal care.

Primary care services, particularly general practice, deliver a comprehensive sexual health programme.

Primary Care Trusts and local Authorites, in partnership with others, implement targeted approaches to reach specific groups of vulnerable or disadvantaged young people who are often excluded from mainstream services e.g. disabled young people and looked after children.

Primary Care Trusts and local Authorities provide advice and information to parents on sexual health so that they can support their children most effectively.

Young People's Mental Health

4.9 The prevalence of mental health problems during adolescence is higher than in childhood and some, such as psychoses, anorexia nervosa and self-harm, are more likely to emerge during teenage years.

4.10 Between 1985 and 1995, there was an overall increase of 28.1% in teenage deliberate self-harm. Young people who are at risk of deliberate self-harm are often not identified and, as a result, their psychological problems may not be treated. Up to half the children and young people presenting with deliberate self-harm may suffer from a major depressive disorder. There is an increased risk of repetition and completed suicide following deliberate self-harm. Suicide is now the most frequent cause of death amongst men and the third most frequent cause of death among women aged 15 to 24 years. See Standard 9

4.11 Young people in special circumstances, such as those who are looked after by a local authority, in young offenders institutions, those with a learning disability, and unaccompanied refugees and asylum seekers, have much higher rates of mental health problems than young people in the general population.

Primary Care Trusts and Local Authorities ensure that planning addresses the needs of young people who self-harm. Services are available to help young people in crisis, provide follow-up support, and work in partnership with the family, the community and other service providers in order to address any underlying mental health problems.

There is a programme of mental health promotion in schools, Connexions services and other community settings through the provision of information, advice, counselling services and evidence-based interventions.

Young people with specific learning disabilities and mental health problems are identified and supported. See Standards 8 and 9

Staff in all agencies recognise the early signs and symptoms of distress which could lead to mental health problems in a young person and are competent to support and refer them.

Primary Care Trusts and Local Authorities ensure local systems are in place for referral to, and assessment by, child and adolescent mental health services for young people who are experiencing mental health problems.

Accident and emergency departments monitor the provision of specialist assessments for young people who present with self-harm.

Preventing Injury

4.12 Risk-taking is part of how young people work out their place in the world and develop their identity, and should be considered within the broad health and social context of young people's lives. Addressing risk-taking is particularly important for young people who are marginalised or vulnerable, particulary in the area of unintentional injury. For example, in England and Wales between 1989 and 1992, the accidental injury death rate for children in social class V was five times higher than for those in social class I. Between 1997 and 1999, 1,071 children aged 0-14 died of an unintentional injury in England and Wales, the majority of them - 66% - were boys. Road traffic accidents and drowning are the two most common forms of accidental death in this age group (10).

Schools with support from other agencies support young people in exploring and managing risk and encourage less harmful behaviours through personal, social and health education (PSHE) and citizenship programmes as part of a 'whole school approach'. See Standard 1

Local Authorities reduce injuries to, and deaths of, young people through local initiatives such as action to reduce drowning, and traffic calming and careful siting of public play areas. See Standard 1

Reducing Smoking and Substance and Alcohol Misuse

4.13 A national survey of young people published in March 2003 showed that:

  • 21 per cent of pupils had taken drugs in the last year, compared with 20 per cent in 2002 and 2001;
  • 9 per cent of pupils aged 11-15 years were regular smokers, a decrease from 10 per cent in 2002; and
  • 21 per cent of 11-15 year olds drink twice a week, an increase of 4 per cent on 1994; and those who are drinking are consuming almost 10 units per week, compared with 5.3 units in 1990.

4.14 Drugs use has become increasingly common with many young people taking illegal drugs from an early age. The National Drugs Strategy (11) provides some key principles for substance misuse education and support. Working towards this NSF standard will help to meet the national target set by the Home Office to reduce the harm caused by illegal drugs (as measured by the Drug Harm Index encompassing measures of availability of Class A drugs and drug-related crime) including substantially increasing the number of drugmisusing offenders entering treatment through the criminal justice system.

4.15 Parents often do not know how best to help their children avoid misuse of drugs. Services should seek to inform and engage parents as well as young people in drugs education and information strategies.

Box 1. Principles for substance misuse education and support

Key principles for substance misuse education and support:

  • Drugs cannot be dealt with in isolation but addressed within the context of other issues that affect young people's lives;
  • Most young people's needs in relation to drugs and related issues should be met through mainstream children and young people's services;
  • Specialist support should be provided to vulnerable young people who have complex needs;
  • Young people are entitled to accurate and credible education, information and support, and
  • Adult treatment services do not work for young people. Young people need tailor-made support fully integrated within the wider provision of children and young people's services.

4.16 Many children and young people use and experiment with alcohol, frequently from early adolescence. This may lead to young people taking unnecessary risks, leading to trouble and injury or death. The Alcohol Harm Reduction Strategy for England12 sets out a range of measures needed for children and young people. These include:

  • Improvements to school-based alcohol education - to ensure that it addresses attitudes and behaviours as well as providing information;
  • Developing health promotion messages for young people whose misuse of alcohol may lead to risk-taking activities.

Primary Care Trusts and Local Authorities ensure that smoke-free policies are developed and implemented in settings for young people. All Young people in school, including those in pupil referral units and alternative education, have access to education, informed by Department for Education and Skills guidance, covering all substances such as alcohol, tobacco, volatile substances and other drugs. See Standard 1

Primary Care Trusts ensure that information and advice helplines and services are provided for young people and their parents. This may include the national 'Frank' drugs information campaign (see www.talktofrank.com) which provides web-based information and a helpline.

Primary Care Trusts and Local Authorities ensure that information about local and national support services is clearly displayed and accessible to young people in a range of settings including young people who do not attend school. For example, leaflets are available at local leisure facilities highlighting the risks in taking recreational drugs or of drinks being spiked (and the subsequent risk of 'date rape').

A range of accessible services (including access to an NHS Stop Smoking Service, advice on the use of Nicotine Replacement Therapy (NRT) and supply of NRT if agreed with a health professional) is available in each locality to actively encourage young people not to smoke and to support them to stop smoking. Information is available to direct young people to local services, as well as the NHS Smoking Helpline and www.givingupsmoking.co.uk

Staff from all agencies are able to recognise young people who are misusing substances or alcohol or who are at risk of doing so. Children and young people have access to a range of local prevention andtreatment programmes delivered by appropriately trained and skilled practitioners and are provided with information about drugs (including volatile substances and excessive consumption of alcohol).

5. Access to Services

5.1 Young people need services which are age-appropriate and accessible. Issues such as the provision of confidential services (see sections 3.2 to 3.4), the location of services, and minimal waiting times are particularly important to this age group.

5.2 There are situations where providing specialist services/clinics for young people outside general practice may be advantageous. Achieving access to services with a low visibility to parents and the community as a whole - which young people say they want - often poses unique problems for young people, particularly those in rural areas or disabled young people who are reliant on school or parental transport.

Local Authorities and Primary Care Trusts ensure that appropriate services for young people are co-located with other services which are focussed on or relevant to young people, for example, holding a young people's drop-in health surgery in a leisure centre one afternoon per week, providing a 'One-Stop-Shop' or providing some services in schools.

Primary Care Trusts ensure that services are planned to assist access by young people often excluded from services by disability, poverty, ethnicity or sexual orientation.

Staff working directly with young people in all agencies are competent to identify those who are at risk of not achieving their full potential; agencies have locally agreed systems in place for assessing young people's needs, referring them for services and checking that the treatment or services they receive has a positive impact on their lives.

Young people in rural communities and those with particular needs are able to independently access services, for example, through satellite services and/or outreach professionals - e.g. sexual health nurses - who can link into other services such as youth projects. The provision of such services is guided by a needs assessment of local populations and links to rural transport plans.

Young people are consulted in planning about the appropriate location of services. See Standard 3

Primary Care Services

5.3 The needs of young pople in primary care are not always addressed specifically. There is much that practices can do to meet their additional needs in terms of confidentiality (See 3.2 to 3.4 above), reassurance and support during adolescence, as well as the health promotion activities appropriate for adolescents. The issues for primary care document sets out what action by primary care providers is needed to meet the standards in this national service framework.

5.4 The Royal College of General Practitioners (RCGP) and the Royal College of Nursing (RCN) have developed an initiative to help improve young people's uptake of advice and support from general practice. Getting it Right for Teenagers in Your Practice (13) aims to help general practices review their service to young people and plan and implement improvements; it provides a checklist for practice audit and suggestions for action.

Primary care trusts have a lead professional to take responsibility for the development of services, joint working between agencies, and the maintenance of standards in the care of young people.

 Primary care services for young people are informed by Getting it Right for Teenagers in Your Practice.

Young People in Special Circumstances

5.5 For some young people such as young offenders, those who are homeless, drug users, care leavers and others who may be marginalised, accessing services can be a problem. Young people who are looked after by a local authority may need to access services repeatedly in new locations. Following the Promoting the Health of Looked After Children (14) (DH 2002) guidance, the DfES funded Healthy Care Programme (15) (NCB 2002), will ensure that the healthcare needs of looked after children and young people are assessed and plans are implemented.

Primary Care Trusts and Local Authorities, working with others, ensure that the provision of health, social care and education services which young people in special circumstances access, is of the same high standard across the full spectrum of settings and circumstances in which young people find themselves such as, young offender institutions, prisons, hospitals, supported housing, psychiatric units, residential units and community services.

Arrangements are in place to engage with young people in special circumstances, including refugee and asylum-seeking young people, who are not registered with the NHS including general practice and dentist. These arrangements reflect strategies for providing continuity of care for all young people in special circumstances near to where they are living, including where this is a temporary arrangement.

Where young people in special circumstances need to register with a new healthcare provider, Primary Care Trusts work with other agencies to ensure that systems are in place so that important clinical information accompanies the child or young person and that there is continuity of health assessment and planning processes. See Standard 3

Educational Settings

5.6 Educational settings provide good opportunities to promote access to health and well-being services. School staff and health professionals can often directly reach young people and provide details on services and access to them, which support and address young people with health-related problems.

5.7 Pupils, students and parents value health information which is given by health professionals in educational settings, as their special knowledge and skills gives them additional credibility. Teachers also value their support, particularly with young people who have emotional, psychological or mental health problems.

5.8 Young people who have left school and moved on to other educational establishments will also need support services. Young people in this age group have a range of health needs and may not access local health services.

See Standard 1, Healthy School Settings

Young people in school and further education have opportunities to discuss and learn about health and well-being issues through personal, social and health education (PSHE) and Citizenship in the curriculum, individual and group tutoring and targeted sessions delivered outside the classroom.

Every young person has access to a Connexions Personal Adviser, and confidential counselling if they want it.

Where colleges have students from more than one locality, Primary Care Trusts and Local Authorities develop a service level agreement to meet the needs of all the young people attending the college.

6. Transition to Adult Services

6.1 The transition from child to adult services can be a difficult time for young people. During this time there may be many changes in a young person's life. These include changes from child to adult services, from school to further and higher education, and from childhood dependency to adult responsibility.

Ensuring that the transition process and the change in services run smoothly is important for all concerned. Currently when a young person is transferred from children's services, support and care can be poorly co-ordinated and patchy. Multi-agency transition planning for young people is key to providing high quality transition services. The Royal College have produced a report on healthcare for adolescents Bridging the Gaps: Healthcare for Adolescents (2003), which may be a useful resource. See also the British Medical Association Report, Adolescent Health (2003).

6.2 This is particularly important for disabled young people or those with a chronic illness including those requiring palliative care. See Standards 6, 8. and 9

6.3 Health and Social Services need to work closely with the Connexions service, which provide information and support for 13 - 19 year olds and helps them access and stay engaged with education, training and employment.

6.4 Connexions is able to offer both simple advice and guidance on options available and intensive support from a personal adviser to help them identify aspirations and barriers and broker a package of specialist support.

6.5 Youth Services provide informal personal and social education for young people. This helps young people to achieve their full potential by acquiring social skills, helping them to become responsible citizens and preparing them for the world of work. Youth Services also work with young people with particular issues to overcome such as alcohol and drug misuse, through individual and outreach work. A joint DH/DfES pilot Young People's Development Programme is showing how vulnerable young people can be engaged in health issues. See www.dh.gov.uk

6.6 There are particular issues for young people with serious long-term medical conditions when:

  • Their condition has stabilised and they no longer have regular contact with a specialist, resulting in no planned handover; and when
  • Appropriate services cannot be identified for them and they are transferred to an inappropriate service.

6.7 There are many possible models for organising transitions to adult health services which include jointly-staffed, dedicated adolescent clinics or parallel and joint clinics so that the young person does not have a sudden change in staff and the pattern of care delivery. See the Royal College of Nursing guidance, Adolescent Transition Care: Guidance for Nursing Staff.

6.8 Ensuring that relevant up-to-date clinical information is made available in the adult health service is key. The paediatric record will form an integral part of the NHS Care Record Service which will provide a summary of the child's clinical data and will follow them into adulthood See standard 3

6.9 The National Service Framework for Mental Health16 recognised the importance of ensuring the smooth transition of care for young people from child and adolescent mental health services to services for adults. When the mental health care of a young person is transferred to services for working age adults, a joint review of the young person's needs must be undertaken to ensure that effective handover of care takes place. This should be incorporated into a care plan under the Care Planning Approach arrangements for adult services. See Standard 9

6.10 Current gaps in adult health services need to be addressed to make the transition to adult services easier for young people at risk from, or who have genetic diseases. Paediatric services for rare conditions are frequently more highly developed than adult services, making transition particularly problematic in areas where little adult expertise exists. There are two main reasons why these gaps exist:

a) New treatments mean that for the first time, children and young people are surviving into adulthood where there is often an absence of, or limited services.

b) Young people will normally have experienced a more comprehensive approach to their problems through paediatric care, whereas adult services are frequently organ or system-specific. As many genetic diseases affect several organ systems, the co-ordination of adult medical care can be problematic.

Primary Care Trusts, Local Authorities and Connexions have agreed protocols detailing roles and responsibilities for co-ordinating transition process including schools, children and adults social services and health teams. This includes addressing their social and emotional needs as well as assisting with their educational career development. See www.connexions-direct.com

All transition processes are planned and focussed around preparation of the young person rather than the service organisation. Young People and their families are actively involved in transition planning

Where relevant, Connexions Personal Advisers or Leaving Care Personal Advisers liaise with children's and other services to prepare the young person for transition to adult services. All paediatric clinics have a written policy on transition to adult services which is the responsibility of a named person. See Standard 7

Policies on health services for young people are developed between agencies as appropriate, and ensure that:

  • Young people are not transferred fully to adult services until the supports are in place to enable them to function in an adult service;
  • Individual disciplines have clear good practice protocols for the management of young people's health during transfer to adult care;
  • General Practitioners are fully involved; and
  • Joint audit of local transitional arrangements is undertaken.

Young people in the 16-18 age group with mental health problems can access specific services including adolescent mental health services, linking to specialist drug and alcohol services, early intervention (in psychosis) teams and Youth Offending Teams.

Young people with complex health needs and/or long term conditions, such as sickle cell disease or cystic fibrosis, or disabilities, have access to expert, coordinated care planning which may involve clinicians from several specialties. See Standards 6 and 8

Young people with, or at risk of genetically determined disease have access to genetic counselling before they start a family and they are offered repeat or further counselling whenever necessary, according to individual circumstances.

Supporting Looked After Young People Leaving Care

6.11 Young people who have been looked after by a local authority often have to leave care and live independently at a much earlier age than other young people leave home; just over half move regularly after leaving care; and 20% experience homelessness in the two years after they leave care. Care leavers have lower levels of educational attainment and lower post-16 further education participation rates. They have higher unemployment rates, less stable career patterns and higher levels of dependency on welfare benefits; they enter parenthood earlier and they experience more mental health problems.

Primary Care Trusts and Local Authorities ensure that care leavers are supported to make successful transitions into young adulthood by:

  • Providing support appropriate to the care leaver's new, young adult status;
  • Making services flexible and tailored to the young person's needs;
  • Ensuring support is provided by a few professionals who are a consistent presence in the young person's life;
  • Ensuring that the support offered by employment and Connexions services meets the particular needs of care leavers;
  • Minimising barriers to accessing services by integration and co-location of services;
  • Facilitating the development of young people's informal support networks;
  • Helping young people to be informed about, and to access the range of benefits and support available to them on leaving care;
  • Helping young people to manage their finances;
  • Helping young people to take responsibility for their own physical, mental and emotional well-being, enabling young people to build on their resilience and selfdetermination; and
  • Continue to support young people in education or training after they have left care.

7. Training & Development

All staff who work with or come into contact with children, young people and their families in all agencies have the basic competencies outlined in Standard 3.

All professionals working with young people are confident in discussing sexual health and relationships issues, substance and alcohol misuse, adolescent mental health problems and signposting young people to relevant services.

All personal advisers, such as Connexions and leaving care advisers, are trained and supported to be able to provide young people with good quality advice on health and social care issues and make effective referrals to other, or more specialist, services for young people throughout school, sixth form/further education and into higher education or employment.

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References

1 United Nations Convention for the Rights of the Child 1989 [Ratified by the UK government in 1991]

2 Royal College of General Practitioners Confidentiality and Young People Toolkit London: Royal College of General Practitioners and Brook 2000

3 Department for Education and Skills Staying Healthy, Feeling Good 2004 www.dfes.gov.uk/qualityprotects/docs/SHFGsanspics.pdf

4 Department of Health National Standards, Local Action: Health and Social Care Standards and Planning Framework 2005/06 - 2007/08 2004

5 Office of National Statistics Census 2001 May 2003 www.ons.gov.uk

6 Department of Health National strategy for sexual health and HIV 2001

7 Office of National Statistics The Health of Children and Young People March 2004 www.ons.gov.uk

8 Department of Health Best Practice Guidance for Doctors and other Health Professionals on the Provision of Advice and Treatment to Young People under 16 on Contraception, Sexual and Reproductive Health 2004

9 Medical Foundation for Sexual Health and Department of Health Consultation on draft national Recommended standards for sexual health services 13 August - 8 October 2004 Medical Foundation for Sexual Health 2004 www.medfash.org.uk

10 Office of National Statistics Office for National Statistics mortality data

11 Home Office Updated Drug Strategy 2002
www.drugs.gov.uk/NationalStrategy

12 Prime Minister's Strategy Unit Alcohol Harm Reduction Strategy for England 2004 www.strategy.gov.uk/output/page3669.asp

13 Royal College of General Practitioners and Royal College of Nursing Getting it Right for Teenagers in Your Practice Royal College of General Practitioners March 2002 www.rcn.org.uk/members/downloads/getting_it_right.pdf

14 Department of Health Promoting the Health of Looked After Children London: The Stationery Office 2002 www.dh.gov.uk

15 Chambers H, Howell S, Madge N. and Ollie H. Healthy Care Building an Evidence Base for Promoting Health and Well-being of Looked After Children and Young People National Children's Bureau 2002 www.ncb.org.uk

16 Department of Health National Service Framework for Mental Health The Stationery Office September 1999 www.dh.gov.uk

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