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Pathway into adulthood (Transitions)

Transitions image
What Transition is

Transition is the process by which young disabled people receive the support they need to move into adulthood. The transition process should be led by the wishes and needs of the young person as identified in their person-centred care and support plan.

The Transitions team

The Transitions Team work with young people and their carers who have received support from children's services and/or are likely to need social care support after the young person reaches 18. There can be many changes in how services are provided when the young person reaches 18, so the Transitions Team works closely with other professionals and services; such as Children's Services (Disabled Children's Team and Children in Our Care Team), the Early Help Team, SEND Team, CYPS, Adult Community Learning Disabilities Team, and schools and colleges.

To be eligible for a referral you need to have an identified need for care and support under the Care Act (2014) due to either a Physical Disability, Mental Impairment, Learning Disability/and or Autism. As part of the screening process we may also request information about your diagnosis from the other professionals working with you for example your G.P, Nurse or Psychologist/Consultant.

For those young people who are already receiving children's services, their social worker will make a referral to the Transitions Team following their 16th birthday. Alternatively, those young
people who are not receiving Children's Services can make a self-referral online by visiting our care assessments page.

Other professionals may also refer a young person for an assessment with the young person's consent by contacting 0191 4337033 or online by visiting our care assessments page.

If a young person is not eligible for referral to the Transitions team

If the young person does not meet the eligibility criteria for a referral into the Transitions team but is likely to have care and support needs as an adult, they or their carer can request an assessment through Adult Social Care Direct after their 18th birthday.

However, it is recognised that young people do not always receive a diagnosis of a Learning Disability as a child. If there is a strong likelihood that a young person may have a Learning Disability (LD), they can be referred by the Transitions Team to the Health/Transitions Group for a full health assessment before their 18th birthday for an LD screening to
be considered.

Health / Transitions Group

The Health/Transitions Group was formed to ensure that our Transitions Protocol and Pathway (PDF) [226KB] (opens new window) provides the framework for how services in Gateshead will work together to ensure the best outcomes for all young people with disabilities as they move into adult life. It sits alongside Gateshead Council's SEND Multi Agency Transitions Protocol. The Health/Transitions Group meet on a three monthly basis to identify and discuss referrals into the Gateshead Adult Community Learning Disability Team when the young person is 17 years and 9 months old.

Referrals are made to the group via the Transitions Team, Children in Our Care Team and the Children's Young People's Service.

After a health assessment has been completed the nurse will agree with the young person and their primary carer what the next steps will be. This may include referrals to other services such as Occupational Therapy, Psychology, Physiotherapy, or Psychiatry.

Education, Health and Care Plan (EHCP) Reviews

As part of the Transitions Team, a transitions team rep currently attends Year 9 and Year 12 EHCP reviews where they can provide information and advice regarding preventative, universal
and specialist services. They attend information events at special schools, signpost to health colleagues and offer information around self-referrals for a transitions assessment (initial care
assessment) to those who may have eligible, adult care and support needs, but who are not currently open to Children's Services.

What happens after a referral is made 

If the young person meets the criteria for adult services, then from 16+ years old the Transitions Team will be available to provide the young person and their parents/carers with general information and advice about adult services. They will work in partnership with the young person's children's social worker to ensure that the young person has a smooth, well managed transition into adult services.

Where it appears that a young person is likely to have a need for care and support post 18 but that it is not yet of significant benefit to undertake the transitions assessment, the transitions team will agree the timing of completing the initial care assessment with the care team and/or the young person and/or their carer.

The children's social worker will remain the young person's allocated social worker until they turn 18 years old (i.e. they will continue to monitor, update and review their children's support package and support plan). From 18 the Transitions worker will be their allocated worker. The team will work with you until your transition to adult services is completed. This can be up to 25 although for many young adults this is achieved much earlier.

Assessment eligibility

The Transitions Team will use guidelines to determine if someone is eligible for adult services using the eligibility threshold in the Care and Support (Eligibility Criteria) Regulations 2014. To be eligible an adult's needs must arise from or are related to a physical or mental impairment or illness; and as a result, are unable to achieve two or more of the specified outcomes without
assistance as listed below:

  • managing and maintaining nutrition
  • maintaining personal hygiene
  • managing toilet needs
  • being appropriately clothed
  • being able to make use of the adult's home safely
  • developing and maintaining family or other personal relationships
  • accessing and engaging in work, training, education or volunteering
  • making use of facilities or services in the local community including public transport and recreational facilities or services 
  • carrying out any caring responsibilities the adult has for a child

We will only provide adult services to people who are assessed as being unable to achieve two or more of the specified outcomes and therefore there is, or is likely to be, a significant impact on the adult's wellbeing without the implementation of services. The local authority has a duty to provide after-care services to a young person as defined by s.117 Mental Health Act 1983 (as amended 2007) and where a young person is in receipt of such services.

As part of completing an initial care assessment, the transitions team will adopt a strengths based approach which will focus on what a young person can do, rather than what they can't do. The team will look to explore ways to support a young person's well-being, resilience, psychological and emotional needs whilst considering how to support and promote independence and positive risk taking.


The young person may have to pay for some of the services they receive as an adult. This will depend on their income and how much help they need. They will be asked to complete a financial assessment. Their transition worker can give them advice and support with this.

If a young person is not eligible for referral following a Care Act Assessment

If the young person's needs are assessed and it is determined that they do not meet the eligibility threshold to be able to receive adult social care services, then we will be able to give
them advice and information about other services and organisations which may be able to help them.


Contact Adult Social Care

There are many ways to contact the adult social care team, both online and over the phone.

We encourage people who can contact us online to do so, as it helps to free up phone lines for emergencies or for those who don't have access to or the skills to use computers.

Contact Adult Social Care