Supporting transitions to adult hearing services

Your service should have a policy that outlines how it will support deaf young people to transition from paediatric to adult services. The policy should cover the following:

• Designated responsible person: A person should be assigned to create, maintain and review the policy regularly.
• Review timescales: Set specific timescales for reviewing and updating the policy.
• Stakeholders: Identify key stakeholders, including deaf young people and their families, and describe how they will be involved.
• Flexibility: The policy should be adaptable to meet the individual needs of each young person.
• Multi-agency collaboration: Outline processes for working with other services, such as education and social care, to provide coordinated support.
• Transition coordinator: Designate a key worker or transition worker to manage the young person's transition and provide an overview of their needs across services. This person should be chosen with input from the young person.
• Referral system: Include a process for referring young people to other services and sharing relevant information.
• Confidentiality, consent, safeguarding and equality: Address policies for handling confidentiality, consent, safeguarding and equality throughout the transition process.
• Staff training: Ensure a system is in place to identify and provide relevant training, including areas like deaf awareness and transition support.

For more detailed guidance, see the NICE quality standards for transitions from children's to adult's services. Also, check your NHS trust's broader transition policy for additional context.

When creating or updating your transition policy and processes, you should regularly consult deaf young people and their families. They know their needs best and should be actively involved in shaping services.

Relying on questionnaires alone is not enough. Ask deaf young people how they prefer to engage and use formats that are comfortable and familiar to them. For example, consider:

• focus groups held at convenient times and in spaces where young people feel at ease (such as a weekend afternoon at a quite social venue with pizza provided, or during school time in a hearing resource provision)
• a choice of online or paper surveys
• feedback boxes for anonymous suggestions

To encourage meaningful participation, make sure engagements:

• cover communication support costs and reimburse young people for their time and travel expenses
• are accessible (for example, organising a British Sign Language interpreter for face-to-face engagements or a translation for text surveys)
• are well-planned and resourced
• are clear about how feedback will be reviewed and acted upon
• are relevant to young people and their families

Make sure young people and their families feel comfortable approaching your service at any time with their concerns and views, not just during formal consultations. Also, aim for a representative sample of feedback that reflects the local community in terms of ethnicity, gender, and disability.

Working in partnership with other services supporting the deaf young person is crucial during the transition process. Collaborating with other agencies like education, social care, and voluntary services helps meet the young person’s holistic needs and ensures timely support. While most deaf young people will move into adult services at 18 years old, other services may work with them into young adulthood.

Strong relationships between paediatric and adult services, along with other relevant services, is key to providing seamless care. This collaboration:

• avoids duplication
• improves communication
• ensures timely interventions
• enhances decision-making through shared learning

A good service will:

• share information with other organisations, following confidentiality and data protection policies
• provide clear referral pathways for young people with emotional and mental health concerns, including referrals to Child and Adolescent Mental Health Services (CAMHS) where appropriate
• involve other agencies in transition meetings

While challenges like funding, resources, and time are common in multi-agency work, the long-term benefits – such as improved coordination and more efficient services – make the effort worthwhile.

Deaf young people will be ready to transition to adult hearing services at different ages, with some starting as early as 14. The length and nature of transition support will vary, particularly for those with additional or complex needs. Therefore, it's important your service is flexible to meet the needs of individuals.

Introduce the young person to the adult services

Paediatric and adult services should work together to introduce young people to adult services before they transition out of paediatric care. The introduction process will depend on:

• whether the child and adult services are in the same location or separate
• the individual needs of the young person and their family

Ways to introduce young people to adult services include:

• groups with other young people transitioning at the same time
• one-to-one appointments with the adult service
• joint clinics with both paediatric and adult audiologists or other professionals present
• open days where paediatric patients can visit adult hearing service departments

Create a transition plan with the young person

Collaborate with the young person to develop a personalised transition plan that addresses their needs for moving to adult services. This plan should include:

• a designated key worker or transition worker who will ensure continuity throughout the transition process
• information on upcoming appointments for hearing devices, like fitting new hearing aids or scheduling implant surgery
• a clear timeline for when the transition will take place, such as once secondary school is finished or once they've consulted with other medical professionals
• how the young person feels about transition and whether they need more support or prefer a gradual transition
• the most appropriate introduction to adult services, such as a one-to-one appointment or through a small group or larger event
• details on who to contact for hearing aid repairs and batteries during the transition period

Plan for young people with additional needs

Some deaf young people will have additional needs that require extra care and planning. They may or may not need ongoing support from their families. When preparing these young people for the transition to adult services, it’s important to consider their unique requirements and offer tailored support.

Key strategies include:

• Familiarise the young person with new environments and professionals: Organise joint clinics where young people can meet their new hearing care professionals in person. This provides a smoother transition and reduces anxiety about unfamiliar faces and settings.
• Use visual support tools: Social stories can be effective in helping young people understand what to expect during the transition to their new hearing service.
• Plan for extra appointments: Ensure there are additional appointments scheduled for things like hearing aid maintenance or adjustments, allowing the young person to feel more confident in using their devices.
• Allow extra time during appointments: Plan for additional time in appointments to address any specific needs, ensuring there’s ample opportunity for questions, adjustments, or concerns to be discussed.
• Avoid assumptions: Be mindful not to make assumptions about the young person’s needs or preferences. Always check in with them and, when possible, include them in decisions about their care, even if they are non-verbal.
• Engage with the young person directly: Make a conscious effort to involve the young person in their own care process. While parents play an important role, always engage directly with the young person as much as possible. Their input, however small, can make a big difference in how they feel during the transition.

By focusing on these strategies, you can provide a more personalized and supportive transition for young people with additional needs, helping them feel more confident and comfortable in the adult hearing care environment.

Refer the young person to the National Deaf Children's Society

If they haven’t already, encourage the young person to get in touch with the National Deaf Children’s Society.

Our advice and guidance officers are here to support them and, with their permission, can attend appointments alongside them. We provide tailored advice and information to help young people as they transition into adulthood, including:

• financial and disability benefits they may be entitled to
• other useful benefits, such as free bus passes and cinema tickets
• signposting to other organisations that can help
• guidance on further and higher education options
• support and advice around technology

Young people can contact our free Helpline directly, or – with their permission – you can refer them to us.

Deaf young people need clear information to understand what happens during the transition process, how to participate and how to make informed decisions about their future.

Information should be provided throughout the transition process covering:

• what transition involves and what to expect
• contact details for the new service
• how to access the service (referral process, clinic hours and so on)
• differences between child and adult services (location, appointment frequency, types of support, technology and so on)
• what to expect during appointments
• entitlements (such as access to an interpreter)
• any costs they will need to cover, such as charges for lost hearing aids or speech processors
• new hearing devices and assistive technology and decisions to be made
• a personal portfolio of their deafness and hearing needs (which will be particularly useful for those moving to higher education)
• local and national support services such as careers services, support groups and voluntary groups
• where to find up-to-date information online (for example, about the latest assistive technology)
• how their information will be shared or disclosed
• who to contact if they have a complaint about the adult service
• the young person's responsibilities when transitioning (for example, making their own appointments)
• who to contact for hearing aid repairs, earmoulds and batteries during and after the transition process
• how to access hearing services while away from home (for example, if in further or higher education)

Information must be accessible, understandable and available in a range of formats. It should be in the young person's preferred language and include interpreters or translations when needed. Formats might include:

• website information (with subtitles, sign language and/or translations as needed)
• leaflets or factsheets
• videos (with subtitles, sign language and/or translations as needed)
• written reports
• online forums
• individual support
• face-to-face discussions

Here are two examples of providing online information about transitioning:

• Imperial College Healthcare: Transitioning to adult audiology services (online PDF)
• Kingston and Richmond NHS Foundation Trust: Moving from children's audiology services to adult audiology services