Transitions Programme: Phase 2 NEW

Customer Pathway: Key outcomes

18/04/23

Helping you to help yourself

Helping you when you can’t help yourself

Being a trusted advocate

Live your life

At any point you may feel able to manage more by yourself

Child Protection & Safeguarding, children in care / leaving care

including Referral &

Signposting

Transitions: Key outcomes

Information, Advice & Support:

including Referral & Signposting

Improved comms. with internal/external

stakeholders

Timely & accurate info to support transition

planning

Growing great people

Short term support

Immediate Response & safeguarding

Re-ablement

Strengthened Community Support

Longer term support

Supported independent living

Help provided when you can’t help

yourself

Self-directed support

Is it working & what next?

Partner Representatives

Child Protection & Safeguarding, children in care / leaving care

Will ColesKerry Bishop

Ann McGaleStephen Harley

Ann McGaleC O’Rourke /J Cattermole

Nita MistryJill Buchanan-Huck?

Better understanding of what works by

listening

Using review & feedback for continuous

improvement

Joint commissioning

Children’s MASH & early help / targeted prevention

Information, Advice & support

Short term support

Longer term support

Is it working & what next?

Partner Representatives

Self-management / prevention services

Annual Big Event

EET

Care

Health

Other / Joint working

Web-sites

E-newsletter

Children's MASH

Local area coordination

Continuing (Health) Care

EHC

Different models for care

Multi-disciplinary teams

Develop local market

Links and dependencies

Joint Commissioning

Healthier Northants

Locality platform model

Personalisation

RAS

Disabled Children & Young People’s partnerships

This page may require further development

Children’s Services Improvement Programme

Public Health Promotion

Targeted Prevention (from mental health)

Information, Advice & support: with Referral & Signposting (Summary)

Links to: Children’s MASH, early help, targeted preventionLed by: Rachael Tootell, Kerry Bishop (OWD)

Improved communications with internal stakeholders

NCC website Easy read website E-newsletters Local Offer portal

Transitions Service marketing materials

Named link workers in schools &

collegesAnnual Big Event Young Person

Champion (LD)

Timely & accurate information supports transition planning

Performance & finance data Processes & protocols

People & communities are effectively supported so that they can make more informed life choices

Developing People Developing communities to meet needs

Bespoke training plan for staff

Development activity with YP &

families

Review current community activity

Work on improvement with

local groups

Information, Advice & support - 1Led by: Rachael Tootell, Kerry Bishop (OWD)

Information, Advice & support - 2Led by: Rachael Tootell, Kerry Bishop (OWD)

Information, Advice & support -3

What Detail Who When

People & communities are effectively supported so that they can make more informed life choices

Developing People

Bespoke training plan for Transitions Team

Well-trained staff will have the skills & knowledge to empower YP. Implementation will be business as usual

Amy BrockAutumn 2013 & ongoing

Development activity with young people and their families

Work with shooting stars group to understand need then scope outcomes

Kerry Bishop Feb – June 2014

Developing Communities

Developing communities to meet the needs of young people & their families

1. Review current situation2. Work with local groups to

encourage & improve provision

Kerry Bishop with Maria FallerAnn McGale

Jill Buchanan-Huck

Jun – Aug 2014

Work on community improvement with local groups

Kerry Bishop Sept – Dec 2014

Led by: Will Coles (Connexions), Kerry Bishop (OWD)

Short term support (summary)

Child Protection & Safeguarding, children in care / leaving careLed by: Ann McGale, Children’s social care rep (TBC)

Children with disabilities who need of protection receive effective support through immediate response & safeguarding

Formal agreement on working with children’s social care for Initial & core

assessments Agreed protocols with children’s MASH

Service users have the confidence & skills to carry out activities themselves and continue to live at home through re-ablement.

Autism outreach workers in Transitions & YA

Commissioning Strategies: short-term support

Strengthened Community Support

Community connecting programme Improve social networking for YP (18+) with learning disabilities

What Detail Who When

Children in need of protection receive effective support through immediate response & safeguarding

Children’s social care & Transitions

Formal agreement on co-working with children’s social workers on assessments to meet statutory obligation

Ann McGaleStephen Harley Sept-14

Agreed protocols with children’s MASH With implementation Ann McGale

Julie MacFarlane Sept-14

Service users have the confidence & skills to carry out activities themselvesand continue to live at home through re-ablement

Autism outreach workers Pilot of 2 workers (North/South) for YP aged 18-25 where short-term response is required, with analysis

Karen SexonLiam Spalding

Initially for 12m

Commissioning Strategies For short-term support only Ann McGaleNicola Hobbs

Strengthened Community Support Community connecting programme

Pilot with DELOS, will look at quantitative & qualitative data to report to DMT

Karen SexonLiam Spalding

Social networking “Mates & Dates” for young people (18+) with learning disabilities Jun-14

Short term supportLed by: Ann McGale + TBC

Longer term support (summary)

Child Protection & Safeguarding, children in care / leaving careLed by: Ann McGale, Catherine O’Rourke / Judith Cattermole

People are supported to live as independently as possible

Transitions post in Health Connexions & Transitions Service

Health and the Transitions Service

Multi-agency service for autism / learning

disabilities

Commissioning strategies: long-term support

Self-directed support enables people to keep control of their lives

Aspergers pathway EHC Implementation & Plans Housing & accommodation

Help is provided when you can’t help yourself

Improve understanding of the Continuing Care process

What Detail Who When

People are supported to live as independently as possible

Health: Transitions post New fixed term post (2 yr) in NHfT Sharon Robson From Jan-14

Health & Transitions Service Understand impact of health recommissioning Carolyn Kus April-14

Multi-agency service for autism & learning disabilities

Commission health provider to work with AFAT as a multi—agency service (0-25)

C O’RourkeJudith Cattermole

Commissioning Strategies For long-term support only Ann McGaleNicola Hobbs

Self-directed support enables people to keep control of their lives

Aspergers pathway New pathway for YP with Aspergers Sue Pepper (CCG) April 2014

EHC Plans - Single assessment tool

Multi-agency outcome-focused plans for all disabled children in education. Will build on CAFs and link to personal budgets.

Gwyn BotterillJill Buchanan-Huck

All - from Sept-14

Housing & accommodation Link with boroughs & districts; co-location of care managers/housing; Npton one-stop shop Ann McGale 2014

Help is provided when you can’t help yourself

Continuing Care process To make it more effective for young people supported by Transitions

Karen BurrowsMaria Faller Mar-14

Longer term support

Led by: Ann McGale, Catherine O’Rourke / Judith Cattermole

Is it working & what next? (summary)

Better understanding of what works by listening

Gain customer feedback through:

Surveys of YP & families Surveys of staff POET Making it real

Improve process for customer feedback Storybooks

Continuous improvement is achieved through review & feedback

Improve processes for all Review activities

Led by: Karen Sexon and Jill Buchanan-Huck

Advice & support

What Detail Who When

Better understanding of what works by listening

Gain customer feedback:

Survey of young peopleCarry out surveys and analyse to inform the way forward & understand impact of programme

Karen SexonSurvey of families

Survey of staff

POET Personal Outcomes Evaluation tool Jill Buchanan-Huck From Jan-14

Making it real Workshops to look at full customer journey & identify priorities Jill Buchanan-Huck TBA

Improve process for customer feedback

Develop more effective mechanism for young people to provide feedback Maria Faller

StorybooksPull together “real life stories” (case studies) which demonstrate personal impact of Transitions

Maria Faller

Is it working & what next? 1Led by: Karen Sexon and Jill Buchanan-Huck

Advice & support

What Detail Who When

Continuous improvement is achieved through review & feedback

Improve processes for all Review activities

The range of reviews includes looked after children, short breaks, school, respite, care package, Y9 in school, e

Ann McGaleUzma Moody

Jill Buchanan-Huck

May - Jun-14

Is it working & what next? 2

Led by: Karen Sexon and Jill Buchanan-Huck

Theme What Detail Who When

Care Personalisation Personalised budgets for the Transitions cohort Jill Buchanan-Huck

Care RASResource Allocation System ( see longer-term support for Transitions cohort)

Jill Buchanan-Huck

Care MASH Multi-agency safeguarding hub for children – currently being embedded Satinder Gautam

Care Children’s Services Improvement Programme

Set up to improve local services for children and implement Ofsted recommendations

Satinder Gautam Three year programme

Care / Health Different care models Developing the integration model Senior Managers in

health & social care Phase 3

Health Continuing (Health) CareImprove & manage pathway (CC for CYP, CHC for adults) – different assessment models, criteria, funding

Mary ChapmanSharon RobsonMarianne Spencer / Katie Warren (Health)

Health Healthier Northants

Health Targeted prevention services ...from mental health, (currently being re-tendered)

Sharon RobsonOct-14

Links and dependencies 1

This section requires further development

Theme What Detail Who When

Other / Joint working

Joint Commissioning

Other / Joint working

Disabled Children & Young People’s Partnerships

Other / Joint working

Build on locality platform model

a revolutionary approach to supporting vulnerable people in our communities. (“Support Wellingborough” portal) Not just Transitions

Tony Meadows?Andy Horwood?

ongoing

Other / Joint working

Local Area Co-ordination

...working with local people to promote opportunities to people who may be vulnerable due to ages, disability or mental health needs. Not just Transitions

Kelvin Linnett In development

Other / Joint working

Multi-disciplinary teams

Commission multi-disciplinary teams for children as part of Healthier Northants agenda (link to Different Care models)

Judith CattermoleAD: Learning, Skills and Education

By Oct-14

Links and dependencies 2

Outcome Leads: Responsibilities

•Managing the production of required deliverables

•Planning and monitoring the work

•Manage risks & issues; escalate as appropriate

•Keep in touch with programme manager and related projects to ensure that work isn’t overlooked or duplicated

•Reporting on progress through highlight reports as agreed

•Identify & obtain support and advice for management, planning & control of work

•Manage administration of work

Task & Finish Leads: Responsibilities

•Delivery of activities to agreed timescales

•Report progress and escalate issues to the “box” lead

•Involve other people – including operational staff – as appropriate , with advice from the Business Change Manager

Business Change Manager: Responsibilities

•Facilitating change management, through involvement with key stakeholders (understanding aims, managing expectations, enabling involvement etc.)

•Working closely with the Programme/Project Manager to ensure that the work of the project(s), including the scope, covers the necessary aspects required to deliver the products or services that will lead to operational benefits;

•Identifying, defining and tracking the benefits and outcomes required of the project(s);

•Leading the activities associated with benefits realisation and ensuring that continued accrual of benefits can be achieved and measured after the project has been completed;

•Establishing and implementing the mechanisms by which benefits can be delivered and measured.