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Learning Disability and Autism: admission avoidance and discharge (DRAFT)

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Any child or young person with a diagnosed learning disability and/or autism, who also has serious mental health needs, can be referred for support. If their condition requires help from health professionals and puts them at high risk of being admitted to specialist mental health in-patient services, referrals can be made. These referrals can come from health, education, or social services. The Learning Disability and/or Autism Admission Avoidance and Discharge team (LDA-AAD team) also accepts self-referrals.

Access the Dynamic Support Pathway (DSP)

The Dynamic Support Pathway (DSP) is designed to monitor and track those individuals known to the NHS Herefordshire and Worcestershire Integrated Care Board (ICB), and who are at the highest risk of admission to specialist in patient – locked, secure and Tier 4 hospitals.

The DSP aims to ensure that:

all appropriate Health, Education and Social Care services are working together
people receive the right care and treatment, when they need it
crisis is prevented
risk factors are managed to prevent admissions to Tier 4 in-patient services, locked and secure services

To access the admission avoidance pathways, consent is required. If the child or young person is capable of understanding of what is involved they may give their own consent (Gillick competence). If they are not, someone with parental responsibility must provide consent on their behalf. If this is not possible then the person making the referral must complete and submit the 'best interest decision documentation', following on from a Mental Capacity Assessment.

All documents must be submitted to the LDA-AAD team and follow along with the referral process.

Once the person is confirmed as eligible for the service, they will be added to the Dynamic Support Pathway (DSP). Information about them will be shared with relevant system partners. The child or young person will then receive a RAG (Red, Amber, Green) rating, which reflects the level of risk of being admitted to specialist mental health in-patient services.

Dynamic Support Pathway Self Referral Form

Consent is reviewed annually according to the Care, Education and Treatment Reviews (CETR)/ Dynamic Support Register (DSR) Policy.

Being on the DSP also means that LDA-AAD team oversees the challenges, bringing our Health, Education and Social Care systems together to make sure the child or young person has the right support when they need it.

More information about the DSP can be found here: H&W ICS Dynamic Support Pathway.

Care, Education and Treatment Reviews (CETRs)

The LDA-AAD team facilitates and chairs the Care, Education and Treatment Reviews (CETRs) for those known to Herefordshire and Worcestershire pathways.

A CETR is a person-centred review of care, education and treatment plans to make sure that the child or young person's and their family’s needs are met and to overcome or challenge any barriers for progress and/or discharge.

It's important to know that the CETR does not decide whether a person should be admitted to or discharged from hospital. This remains the responsibility of clinicians (or the courts/Ministry of Justice (MoJ) under Part 3 of the Mental Health Act 1983).

Everyone has the right to request the CETR. It is not a mandatory requirement for someone to be on the DSP to be able to have a CETR. However, it may take longer to process CETR referrals for anyone not known to the DSP.

The LDA-AAD team will work with partners from Health, Education and Care systems to address the concerns that led to the CETR request in order to reduce the risks of admission to specialist locked Mental Health hospital.

More information about Care, Education and Treatment Review can be found here: Care, (Education) and Treatment Reviews C(E)TRs :: Herefordshire and Worcestershire Integrated Care System.

System Navigator (formally Key Workers)

The System Navigators work with those children and young people known to the Dynamic Support Pathway. System Navigators are allocated to children and young people with a DSP RAG rating status of Red or Amber, and who are at risk of admission to or are detained in CAMHS T4, locked and Secure in-patient services.

System Navigators will:

work closely with the child, young person and their families to listen to them and gain an understanding of their health, education and social care needs
help to guide local Health, Education and Social Care systems to make sure that everyone is working together so that child or young person have the right support when they need it
make sure that a child or young person’s voice is heard across local Health, Education and Social care systems to develop and plan their next steps

Once the child or young person comes off the DSP, they are offered on-going support and guidance from the Link System Navigator who can continue to follow up on any outstanding recommendations. The team will “move the person over” with their agreement.