Posted 14th January 2009
Case Management and Transition
Transition is the process of moving from childhood to adulthood. This is not always a smooth process and can be fraught with difficulties. Transition Awareness was the topic of the dissertation for my Masters Degree and whilst working at the Royal National Orthopaedic Hospital in Stanmore I led a project which resulted in the publication of "Wha'ever", a handbook for young people with spinal cord injuries, after discovering that there was limited information available for that age group.
I have been considering how Case Managers could respond to the challenges presented by transition, particularly as Local Authorities, Local Education Authorities and Health have differing approaches to transition. In my opinion, it is important to consider the issues and to include a statement around transition in any Case Management Reports, and other documents, wherever relevant to the current or future needs of the client. I hope that these ideas will generate some discussion around this important time for young people.
Transition is a process which starts at different ages for different people. The core age will be in the teenage years, when young people start to think about leaving home, going onto higher education, starting a career, developing relationships, etc.
However, if dealing with a client with a long term condition, it maybe appropriate to comment on transition issues when the client is much younger, as case management input will be needed at the appropriate age, and there will be associated costs.
At the other end of the scale, there may be older clients, perhaps well into their 20s, who have not yet left home or developed independent living skills, or who may have regressed in their behaviour since injury.
There are no hard and fast rules in transition. Different Local Education Authorities, Social Services Department and Primary Care Trusts will have different processes and age criteria, and these may also change over time. Some handle transition well and have strategies in place. Others are just starting to develop strategies. So it is difficult to predict how smooth or challenging the process will be for the young person, their family or the Case Manager to negotiate. However, it is important to highlight that there are likely to be issues.
If the young person is approaching 16 - 18 years of age, it is vital that a change from Children's to Adults' Services is negotiated. Whether this is a change of Social Worker, a change from Paediatric to Adult Community Nursing, a change of hospital Consultant, or a change from Children's to Adults' care for frequent hospital admissions.
Normal development processes will also need to considered, including leaving home, developing personal and sexual relationships, ongoing education and employment. Advice and support may be needed in negotiating these.
Whilst all of this can be difficult, particularly for parents who have had to take on the role of carers, it is important that the issues are raised as early as possible in order to engender the expectation of as normal a life as possible for the young person. This could be ensuring that they develop skills in directing their own care, or that their privacy and dignity as a young adult are respected, by introducing carers so that parents can start to withdraw. It could be talking about when would be the right time for the young person to speak for themselves, perhaps with an advocate, in hospital appointments or discussions with their solicitor - or meetings with their Case Manager.
I hope that this is helpful. I am very happy to be contacted if you would like to discuss this further. Kim Russell Sept 2008