skip to main content

When childhood services are ending, planning matters

Written by Fiona Kenny

For many families, a child’s 18th birthday is viewed as a significant milestone. However, for young people living with a serious injury, disability or complex health need, turning 18 often represents much more than a legal transition into adulthood. It can trigger changes to healthcare provision, social care support, funding arrangements, legal-decision making and possible changes to the wider network of professionals involved in their care.

For case managers, a clear understanding of these changes is essential to ensuring continuity of support and service delivery, and to help families prepare for and navigate what can be a complex and unsettling period.

The continuity of case management into adulthood and key considerations

The transition to adulthood should provide an opportunity to review whether the existing case management support remains appropriate rather than assuming that services should continue unchanged.

In many cases, a young person who is receiving case management as part of a personal injury or clinical negligence claim will often remain with the same case manager after turning 18. This is provided the arrangement continues to meet their needs and the client and their family wishes for case management to continue.

Maintaining continuity can be particularly helpful where a strong therapeutic relationship has been established and the case manager has detailed knowledge of the client’s rehabilitation goals, care packages and family circumstances.

However there are some situations in where a change is considered appropriate, such as:

  • The clients needs becoming significantly more adult focused, and a change to an adult case manager would be appropriate
  • A transition from paediatric to adult rehabilitation services
  • The clients preference
  • Changes in funding arrangements or case management providers.

The shift from children’s services to adult services

Within this process one of the most significant change occurs in statutory services.

Children’s health and social care services generally cease at age 18, with support then transferring to adult services. This is not intended to happen suddenly on the young person’s 18th birthday. Whilst it doesn’t often happen, transition planning should begin well in advance, often from ages 14-16 in order to give the young person a voice, ensure everyone involved in supporting the young person is aware of their needs (including health, education and social care) and help families prepare for significant change. Guidance from the NHS describes transition as a planned process rather than a single event.

Despite this guidance, many families report gaps in service provision during the transition period, making proactive planning and implementation essential.

Areas commonly affected include:

  • Community paediatric services
  • Children’s therapies
  • Child and Adolescent Mental Health Services (CAMHS)
  • Specialist nursing teams
  • Children’s social care
  • Short break and respite services
  • Educational provision

The impact of the transition to adulthood on funding arrangements

Funding arrangements frequently undergo a review when a young person reaches adulthood, meaning that funding may change. NHS Continuing Care, social care funding and education support are funding arrangements that are most likely to change during this transitional period:

NHS Continuing Care and Continuing Healthcare

Children with highly complex health needs may receive Children’s Continuing Care funding, however this eligibility does not automatically transfer into adulthood.

Young people instead are assessed for NHS Continuing Healthcare (CHC), the adult funding framework. A young person who qualified for Children’s Continuing Care may not necessarily meet the criteria for adult CHC funding, meaning some funding arrangements can change significantly.

Where a young person is eligible for adult CHC, responsibility for funding transfers at age 18 and the packages is reviewed under adult criteria.

Social Care Funding

Adult social care assessments focus on different legal principles and eligibility thresholds compared to children’s services.

Families are sometimes surprised to discover that support packages available during adulthood may be reduced, reconfigured or delivered differently once the young person becomes an adult. Adult service play greater emphasis on promoting independence, personal outcomes and extended participation in the wider community.

Education Support

Where a young person has an Education, Health and Care Plan (EHCP), support may continue up to the age of 25 if educational outcomes are still in place. However support arrangements often change when a young person leave school, enters further education, employment or supported living.

Injury specific considerations in case management during transition

A significant legal change at 18, is that parents no longer have automatic authority to make decisions on their child’s behalf. A client’s mental capacity will therefore become a key consideration within transitioning into adult services and the transitions that becoming an adult can bring including higher education/ employment and independent living, This means that the nature of a clients’ injury or condition can have a substantial impact on what changes in case management will be required at 18.

Acquired brain injury:

Young people with an acquired brain injury often face challenges relating to executive functioning, decision making, emotional regulation and insight into risk.

While their physical recovery may appear stable, adulthood introduces new demands involving education, employment, finances, relationships and independent living. Case management remains crucial in coordinating support through these life transitions.

Cerebral Palsy and Development Conditions:

Young people with cerebral palsy, genetic conditions or lifelong disabilities may experience relatively predictable transitions into adult services, although funding and eligibility issues remain common.

Planning often focuses on:

  • Education and vocational pathways
  • Independent or supporting living
  • Long-term therapy provision
  • Equipment and accommodation needs

Complex orthopaedic injuries:

Young people with predominantly physical injuries may encounter fewer changes in cognitive or decision making support but still require ongoing coordination around vocational rehabilitation, higher education, employment and independent living.

Psychological Injury and Mental Health Needs:

Transition for these young people can be particularly challenging for clients receiving support through CAMHS. Adult mental health service often operate differently and may apply different referral thresholds. Early planning for these client is therefore critical.

Mental Capacity becomes a key consideration:

One of the most important legal changes at age 18 concerns decision making.

Under the Mental Capacity Act 2005, adults are presumed to have capacity unless proven otherwise. Once a young person turns 18, parents no longer have automatic authority to make decisions on their behalf.

For clients with significant cognitive impairment consideration may need to be given to:

  • Mental capacity assessments
  • Best-interests decision-making processes
  • Court of Protection applications
  • Deputyship arrangements for property and affairs
  • Deputyship arrangements for health and welfare (where appropriate)

These issues should ideally be explored well before the client’s 18th birthday to avoid delays and uncertainty.

Financial Management and Litigation Considerations during key milestones

For clients involved in personal injury or clinical negligence turning 18 can create additional considerations in relation to their legal case, these may include:

  • Will the client receive direct access to compensation funds?
  • Is a personal injury trust required?
  • Does the client have capacity to manage a substantial settlement?
  • Is deputyship necessary?
  • Should professional financial management be introduced?

If a client lacks capacity, arrangement may need to be established through the Court of Protection before funds can be managed on their behalf.

Case managers are often well placed to identify potential concerns and ensure that the client and family seek appropriate legal support.

Independence as a key consideration during the transition of case management at 18

Perhaps the biggest shift between children’s and adults services and support is the emphasis on independence.

Adults services generally expect young people to take a more active role in managing and making decisions about their health, care, finances and also their education and employment choices.

For some clients and families this transition is empowering, for others the increased expectations can feel overwhelming, and for families the gradual release of parental decision making can be unnerving and feel like a loss of control.

As the client approaches 18 the case manager should be considering:

  • Beginning transition planning well before age 18
  • Reviewing statutory service involvement
  • Identifying changes to healthcare provision
  • Clarifying funding arrangements
  • Exploring capacity and legal decision making issues
  • Reviewing education, employment and vocational goals
  • Assessing accommodation and independent living needs
  • Supporting families to understand changing roles and responsibilities
  • Ensuring continuity wherever possible

      • Turning 18 is rarely a simple administrative milestone for young people with complex needs and disabilities. It represents a major transition across healthcare, social care, funding, legal status and personal independence.

      While some clients will experience relatively smooth progression into adult services, others may face significant changes in eligibility, funding and support arrangements. The type of injury, the individuals level of independence and their capacity to make decisions all influence the nature of the transition.

      For case managers working with Bush & Co, early planning, proactive coordination and a thorough understanding of adult service pathways are essential to ensuring that young people continue to receive the support they need as they move into adulthood.