Transition planning - health

As young people grow up, their needs and preferences can change. Some may require health support from children's health teams, who also collaborate with their parents or caregivers. As they age, the ways in which young people receive healthcare may shift, which can be a confusing and stressful experience for both the young individuals and their families. To ease this transition, it is crucial to start planning early, ideally before they turn 14.

Young people and their parents or caregivers should receive information and support throughout the transition process, allowing them to ask questions, share their thoughts, and make informed decisions. Open discussions about the transition can help everyone understand the options available and ensure a successful transition. Health services should have a clear transition process designed specifically for young people moving from children to adult services. This process should focus on the individual needs of each young person, be suitable for their stage of development, and actively involve them and their families in making decisions.

Health pathway information

Wheelchair and posture service

When you turn 18 years old, the same service rolls forward and into adulthood. You will likely have the same team of clinicians and have the same contacts, and access/changes of equipment will be dealt with as required.

Children’s therapy services

Shropshire Community Health Trust’s Paediatric Speech and Language Therapy, Occupational Therapy, Physiotherapy teams provide services for Children and Young People (CYP) up to 19 years old.

Exceptions:

• Muscular Skeletal Physiotherapy – up to 16 years old
  
• Services may extend to 19/20 years old for Children and Young People with Learning Disabilities in
• Specialist Provision
  

Paediatric physiotherapy

Some children and young adults may still need physiotherapy as they transition into adulthood. The Paediatric Physiotherapy service offers physiotherapy care for individuals up to the summer after they turn 18 years old or until they finish specialist education. If ongoing physiotherapy is required after leaving the service, your physiotherapist will discuss and arrange a referral to the appropriate adult physiotherapy team. If you require a referral after discharge, you can ask your GP or consultant to refer you to adult services for a new assessment.

Diabetes

Children and young people with type 1 and 2 diabetes may remain on the paediatric team's caseload until their 19th birthday. Young people will then be referred to the most appropriate adult diabetes service, whether that be a GP, community diabetes nurse, or a hospital diabetes nurse depending on their diabetes type, diagnosis, and treatment plan (e.g. insulin injections/insulin pumps).

Epilepsy services

As young people with epilepsy transition to adult services, it is important for both the paediatric and adult healthcare teams to work together. They should review the young person's diagnosis and care plan while focusing on the individual’s needs. This process should include the young person and their family or caregivers in discussions about their treatment. The consultant will share this information with the adult nursing staff, and it will be discussed with the young person and their family during appointments. Joint transition clinics, where young people can meet with adult specialist nurses, are also available, and parents often choose to attend these sessions with their children.

Children’s Community Nursing Team (CCNT)

For most children attending our specialist schools, the actual transition to adult services takes place between the ages of 17 and 19, depending on their school leaving date. At this stage, enteral feeding care is transferred to the adult dietetics team at The Shrewsbury and Telford Hospital NHS Trust, who continue to provide support with feeding management and coordinate community-based supplies, including gastrostomy care. Where equipment is required, responsibility is passed to the district nursing team.

Transition clinics are available within certain specialties where the CCNT is actively involved, such as rheumatology and neuropathic bladder and bowel care. For children and young people accessing Hope House Hospice, particularly those under the care of CCNT or attending specialist schools, palliative care planning can be carried out in partnership with Hope House community nurses to ensure a smooth and well-supported transition to adult hospice services.

Annual Health Checks with GP – anyone over the age of 14 years with a diagnosed learning disability can have an annual health check with their GP.