Developed establishment with diverse skill mix to enable a core team plus mitigation for staff burnout/turnover. Ratio of support most likely to be 2:1 as the smallest, with 3:1 support in the community post-discharge. Graded packages with high staff ratio, with flex in response to risk management. Highly skilled/experienced staff in ASD, LD, behavioural issues, MH risk, trauma, attachment, safeguarding.
Market Context
The Transforming Care Programme (TCP) for children and young people (CYP) operates across the Southend, Essex and Thurrock (SET) footprint. The programme is responsible for delivering change for CYP who are autistic and/or have a Learning Disability who are at risk of an admission to tier 4 mental health services as a result of challenging behaviour and/or their mental health. The team is responsible for managing a Dynamic Support Register, which identifies those most at risk of admission, and will expand to include those CYP at risk of other forms of institutionalisation, such as becoming looked after or being placed in residential schools.
Recently the majority of the CYP known to transforming care have been female (or navigating transitions of their gender identity) with complex familial dynamics. They are often cared for by a relative and/or with significant experience of placement breakdowns. These children and young people often present across service at different times. This may include struggles with engagement/attendance at educational provisions, contact with the police, attendance at A&E / admission to General Adolescent Units, etc. Children and young people are often known to Social Care or CAMHS, but not always both.
Clinical presentation can include behaviours which put the individual and/or others in positions of risk. For example aggression/self harm/suicidal ideation with intent, absconding, attachment/trauma related issues, sensory processing problems, sleep difficulties, eating difficulties, reduced capacity for self-care, depression and anxiety. The majority of CYP are autistic without a learning disability, and there has been a growing rate of post-admission diagnosis of ASD. This suggests there are children and young people in the community who are undiagnosed, presenting with high risk in parts of the system which are unknown.
Current Market Status
Transforming Care commission PA Support on a spot purchase basis. When there is a one-off need for support to aid admission avoidance, expedition of discharge from Tier 4 hospital, or sustainability of community placement (post-discharge or to prevent readmission). Care packages range between 1:1 – 3:1 support for most 6 weeks. Demand is influenced by the number of children and young people on the Dynamic Support Register. This can average between 80-110 children and young people. Transforming Care currently support around a tenth of this population.
There is no dedicated Framework for providers supporting the Transforming Care population. Packages are commissioned based on existing relationships with providers in the area, or via PIN to the market when requiring larger packages.
| Market Quality | Market Supply | Market Demand |
|---|---|---|
| Moderate | Low | High/Very High |
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| Market Workface | Market Ambition | Market Maturity |
| Low | Increase Supply | Established |
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Total Number of Providers: |
2 |
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ECC Funded Placements: |
1 |
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Average Accommodation Placement Size: |
1 |
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Framework/spot Placement Ratio: |
0%/100% |
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Expected future Capacity Required: |
8-10 CYP |
Current resource is 2 providers. 1 for exclusive provision of PA support (no CQC registration or capital assets). The other for Individual Resettlement Project (with appetite for expansion into the Essex arena). Transforming Care are looking to develop the market to support this cohort of children and young people.
High cost packages of care as a result of high clinical risk. This requires a strong recruitment and retention approach, staff wellbeing offer, and business continuity planning.
Risk of readmission/high risk of placement breakdowns. This needs solid engagement and shared risk planning/management with the system/statutory partners.
Risk for the rising 18 cohort and work with ASC colleagues to build sustainability for packages post-18.
Considerations in train around capital asset development and of costs to providers/Local Authority for associated rent/utilities for Individual Resettlement Projects/Move on Projects.
- PA Support for those with LD/ASD
- PA Support for ASD children and young people only
- Individual Resettlement Projects / Move on Projects (Solo)
- Short Term Intervention Residential support