Integration and Transitions: What can the research tell us?

Fraser Mitchellf.mitchell57@btinternet.com

What do we know about transitions?

•Transitions from childhood to adulthood are problematic.

•Transitions from child to adult services are also problematic.

•Lack of involvement of young people in transitions planning.

Life Transitions are difficult...

Transitions between child and adult services: •Priorities•Eligibility criteria: age, needs, etc.•Budgets•Ethos/culture•Legal status of young person•Services•Staff

Involvement of young people

•Disability, not strengths focus.•Communication aids not widely used.•Lack of professional continuity.•Views of professionals and parents

dominate.

What do we know about integration?•It is coming to Scotland!•Ill defined concept....•Challenges posed by differences in power

and culture between organisations and professions.

Integration: Scotland style Public Bodies (Joint Working)

(Scotland) BillIntroduced to Parliament on May 28,

2013. The aims of the Bill are focussed on improving outcomes for people by providing consistency in the quality of services, ensuring people are not unnecessarily delayed in hospital and maintaining independence by creating services that allow people to stay safely at home for longer.

Scottish Government proposals

•Initial focus on older people.•Integrated budgets.•Least disruption to staff and public.•Locality service planning groups

(“All integration is local...” Leutz’s 6th law of integration).

Highland: an early adopter“We can see improvements on some of our

performance measures but I feel the real success is that we are changing the culture. What I am seeing is really close working, better communications, reduced duplication and a much more supportive environment for everyone. All of this is leading to better and more flexible use of resources enabling more people to access services quicker”.District Manager in Inverness

And another thing...

•Self-directed Support (not to mention co-production, etc.)

•How does this fit into the mix of integration and transitions?

•Will it encourage individual consumerist approaches or genuine collaboration and supportive networks?

Integration and the individual

•If integration is local (Leutz, 2005) then the next level of integration is with the individual (Gleave et al, 2010).

•Integrated approaches need to be with individuals and communities as well as between agencies.

Concerns re SDS

•Professionals concerned about potential for misuse of public funds.

•Parents concerned about shrinking resources.

•Young people concerned about bureaucracy.

Integration for transitionsIntegration: one more barrier to collaborative

services and positive outcomes for young people?

(“You can integrate all of the services for some of the people, some of the services for all of the people, but you can’t integrate all of the services for all of the people.” Leutz’s 1st law of integration).

“There is not a clear pathway for people with learning disabilities. NHS and Social Work integration has not solved this. We are further away from children’s services which remain with the Council.”(Practitioner)

SDS working...

•“When I am really unsure about something I will ask people. I surround myself with people who know me. I am going to make the decision, but other people may be able to see aspects that I may not have thought of.” (Disabled young person describing how she makes informed choices re supports?)

Conclusions

•There are no conclusions...but some guiding principles:

•Be aware of what is and is not being integrated. (“Your integration is my fragmentation.” Leutz’s 3rd law of integration).

•Keep it local.• Involve young people and parents.• Integration is wider than health and social

work.

References• Gleave R, Wong I, Porteus J & Harding E (2010) What is ‘more

integration’ between health and social care? Results of a survey of primary care trusts and directors of adult social care in England. Journal of Integrated Care 18(5) 29-44

• Leutz W (2005) Reflections on integrating medical and social care: five laws revisited. Journal of Integrated Care 13(5) 3-12

• Mitchell F (2012) Self-directed support and disabled young people in transition (part 1). Journal of Integrated Care 20(1): 51-61

• Mitchell F (2012b) Self-directed support and disabled young people in transition (part 2). Journal of Integrated Care 20 (4) 223-230