Neurodisability transition plan

What happens at your clinic appointment?

Your clinician will:

• Discuss your condition with you and your family
• Signpost to websites or give you written information
• Ask for your or your parent’s consent to refer to any other services
• They may refer to Sheffield Children’s Hospital complex transition team if there are lots of medical professionals supporting you
• They will start a Transition Plan on their electronic records

What you can do

• Fill in a Communication and Health Passport – this will help staff in medical places to help you.
• You can start the Ready, Steady, Go questionnaires – these help to think about getting ready for adult services.
• You can discuss either form with your health professional. They can print it out for you.  You can also discuss with your school and SENCO.
• If you have a Learning Disability – ask your GP for your Annual Health Check. More information is available at the Sheffield Directory.org.uk

What happens at your clinic appointment?

• The doctor or nurse will discuss the transition process with you and your family. You can ask any questions about the services you can move on to and where to get support. This is likely to be with your General Practitioner (GP).
• The doctor or nurse will update the live transition plan in electronic notes so your records are up to date.
• This might be the stage where your care is moved from the Children’s Neurodisability Service to your GP. The doctor or nurse will confirm this at the appointment. This would be followed by a letter to confirm that you have been discharged from the service.

What’s next?

Some young people may benefit from an assessment with SAANS (Sheffield Adult Autism and Neurodevelopmental Service), the Neurological Enablement Service or the Community Learning Disability Team. The service will link with Sheffield Adult Hospital services if you need their support, such as Neurology, and the Transitions Service. This may be done as a discussion with the health professionals from these services to agree the best place for your care. You may be invited to a joint clinic with you, the children’s neurodisability nurses and adult services. It can also be an appointment with the adult service once you are 18. The doctor or nurse will give you more information.

Your doctor or nurse may make a referral to the social care team at Sheffield City Council.

What you can do

• Review your hospital passport regularly in case your needs, preferences, or contacts have changed.
• Complete the Steady questionnaire. You can talk about it at your clinic appointment.

What happens now

• Your doctor or nurse will offer you a final appointment.
• Complete the Go questionnaire to discuss at the appointment.
• A letter will be sent to the young person, the GP, and other involved professionals.

What’s next?

If you have been accepted into an adult service you will be offered an appointment. This may take place in clinic, at home or on a phone or video call. Where you have not been accepted into an adult service at this time, your GP provide any follow up support and advice.