Pathway Modules

Discharge Planning
A series of discharge planning meetings are needed to assess the child/young person's needs. The meetings should be child & family centred. The aim should be to have the first discharge meeting as soon as possible to plan for the child's discharge from hospital.
Assessment and Planning
Anticipatory planning for acute readmission to hospital should take place in case the child needs to go into hospital unexpectedly. This should be included in the initial discharge plan.
Transition
Transition is a challenging process because of the different methods of delivery of service in the paediatric and adult services. Parents and the young person can find the moving to different services and the building of new relationships with a range of different professionals daunting.
Communicating with children with complex and exceptional healthcare needs
The importance of communication when meeting a child or young person with complex or exceptional healthcare needs.
Identification of Children with Exceptional Healthcare Needs
The Pathway is developed for the use for children meeting the assessment criteria as described below, however our aim is to evolve the document into a Pathway that can support the wider group of children with complex needs.
Support for Parents/Carers
It is recognised that parents and siblings require appropriate emotional support at the time that the complexity and vulnerability of their child's situation is recognised. Both parents should be involved, if possible, in discussions and decision making. Appropriate verbal and written information should be provided. Access to a source of information for further questions should be available.
Continuing Care Packages
Deciding on how best to meet the needs of children with exceptional healthcare needs and who should provide the necessary services and funding requires effective integrated working based around a robust joint assessment process.
Breaking News
Breaking difficult news is an essential part of the pathway for the children with exceptional healthcare needs because it is often a recurrent feature in the lives of these children and their families and this process might be revisited at a number of stages in their lives.
Financial Support
There are many different sources of financial support available to children with exceptional healthcare needs and their families. Perhaps most important is Disability Living Allowance (DLA) as a lot of other funding is dependent on this benefit.
Recording on NHS Scotland Support Needs System (or a local equivalent database)
Registration on SNS will allow identification and mapping of children meeting the CEN criteria. This will improve service planning and the audit of services.
Training Parents/Carers and Health Care Support Staff
Training parents and carers to feel confident in dealing with the technical aspects of the care for their child is an essential step in preparing the home support plan. Healthcare support staff need to be appropriately trained to allow timely discharge of children with exceptional healthcare needs.
Equipment Provision/Housing Adaptations
To support timely discharge of a child with exceptional healthcare needs, any equipment needed for the child needs to be ordered well in advance. Waiting for the child to be fit for discharge before ordering equipment will cause delay in the discharge from hospital.