BRIEFING NOTE FOR CCGS FOR THE ATTENTION OF CHILDRENS AND
ADULT COMMISSIONERS RESPOSIBLE FOR COMMISSIONING OF SERVICES
FOR CHILDREN AND YOUNG PEOPLE WITH LEARNING DISABILITIES
AND/OR AUTISM
This is a briefing note to inform about the NHS England Transforming Care
Programme for children and young people with learning disabilities and / or autism
who have a mental health condition or display behaviour that challenges and to set
out the requirements of Clinical Commissioning Groups as we progress this agenda.
You can find a link to the work being carried out under Transforming Care here
including the national plan for “Building the Right Support.” This project with children
and young people will support Transforming Care Partnerships to achieve their local
targets and improve outcomes for children, young people and their families, by
preventing unnecessary admissions to hospital, avoiding lengthy stays, and
supporting people to get the right support in their local communities and close to
their families.
The information in this letter is for both children’s and adult Learning Disability
Commissioners with transition being a critical time spanning both.
There are four key things that I want to bring your attention to and where you need to
take action working in your local Transforming Care Partnerships.

The continuing roll- out of Care and Treatment Reviews (CTR) for children
and young people either admitted or at risk of being admitted to hospital
(includes Assessment and Treatment Units, CAMHS and secure services)
It is a key priority to ensure that young people who are at risk of admission
have a CTR prior to admission, or for those who have been admitted in an
emergency to have a CTR within two weeks of their admission in line with the
policy. In line with the CTR Policy requirements on the At Risk of Admission
Register please ensure that you have clear processes for identifying any
young people who are at risk of or who have been admitted to hospital and for
initiating the Care and Treatment Review.

The need to (a) identify young people who have a learning disability and / or
autism who have a mental health condition or display behaviour that
challenges who are currently in residential special schools; and (b) to ensure
there is appropriate health engagement in their preparing for adulthood
transition reviews. This is in line with the Special Educational Needs and
Disability (SEND) code of practice, (2015) which states details of legal
requirements that you must follow without exception and is statutory guidance
that you must follow by law unless there’s a good reason not to.Currently no
national data-set exists to identify these young people. NHS England will be
in touch with each area to seek your support in identifying these young people
who are in Year 9 and above. You will need to have some discussion with
your local authority to ensure that you are fully aware of all young people who
fall into this category, and who you will want to consider for the local “At Risk
of Admission Register” ( ref CTR Policy). Working with others in your local
Transforming Care Partnerships will support this work. I am asking that you
identify who will lead on this for your area – this may be an appropriate role
for your Designated Medical/ Clinical Officer. Ref SEND code of practice
(2015)
(NB For context there are currently around 1400 children in this target cohort
in 52 week residential schools, in England, across all ages. Focusing on
school leavers therefore the number per CCG is likely to be in single figures)

In addition to above, note that all those in residential schools with a statement
of SEN who are expected to leave at the end of this academic year are
subject to a Transition Review under the Children and Families Act 2014. You
are required to work with the local authority in undertaking this process in a
timely and efficient manner. (Articles 12-17 of the Transitional and Saving
Provisions Order 2014)

The opportunity for local VCS or not-for-profit organisations to bid for a small
grant to support effective implementation of the programme of work that may
prevent children and young people being admitted to hospital, or that may
speed their discharge. We are looking for innovative and visionary projects
that will be willing to disseminate and share their learning. We would
welcome you sharing this opportunity with your local partners and you can
find out more information here…( link to be inserted in Monday)
We have recruited regional delivery leads for this programme of work who will be
able to support your region. The details of the regional points of contact once
people are in post, from January 2016 will also be found on the NHS England
website page on the CAMHS LD project. Here (link)
The support of all partners is essential to enable us to transform care for our most
vulnerable children and young people and we look forwards to working together to
achieve this outcome.
Appendix 1
Definition of children and young people with learning disabilities and / or autism who
have a mental health condition or display behaviour that challenges.
Children or young people with a learning disability and / or autism who have a
mental health problem, such as severe anxiety, depression or a psychotic illness
which may result in them displaying behaviours that challenge.
Children or young people with an (often severe) learning disability and / or autism
who display self-injurious or aggressive behaviour, not related to severe mental illhealth, some of whom will have a specific neurodevelopmental syndrome with
often complex life-long health needs and where there may be an increased
likelihood of behaviour that challenges.
Children or young people with a learning disability and / or autism who display
‘risky’ behaviours which may put themselves or others at risk (this could include
fire-setting, abusive, aggressive or sexually inappropriate behaviour) and which
could lead to contact with the criminal justice system.
Children or young people with a learning disability and / or autism, often with lower
level health or social care needs and disadvantaged backgrounds (e.g. social
disadvantage, substance abuse, troubled family background), who display
behaviour that challenges, including behaviours which may lead to contact with the
criminal justice system.