Transitional Service

The focus within the Transition Service is to strengthen and maintain previously established routines and to continue to develop self-management strategies. The activities within the Transition Service are designed to reinforce social skills and further develop emotional management, already established within the secure services or at other hospitals. Individuals are encouraged to plan their activities and outings and in doing so, further increase problem solving skills, organisation and initiation.

The transitional service provides either the final stage of the Care pathway to the community for service users moving from other services within St Mary's or a short term rehabilitation programme for people struggling in the community or other hospital placements. There is an emphasis on enabling and encouraging people to arrange and organise their own programmes and activities particularly those tasks vital to a successful return to community living.

The focus within the Transitional Service is to strengthen and maintain previously established routines and to continue to develop self-management strategies. Many of our individuals within the Transition Service are transitioning from more structured activities and tasks, to initiating and organising their own plans. Programmes are designed and delivered to help service users take more responsibility for planning their own futures with a range of planned activities targeted to increase coping strategies and enhance daily living skills. Some service users require considerable support in this area, particularly if they have had limited social or community contacts and may be institutionalised.

Social and psychological support and therapies take a higher priority in preparing service users to transition to a safe and more independent life. Essentially, the service aims to improve the quality of life of service users by maximising their level of functional independence in an appropriate risk managed environment. The service recognises that not all people will be able to achieve full community independence and may require ongoing support in a less restrictive environment.

Vocational and basic daily living skills form the core of daily activities and these are delivered through trained occupational therapy staff and rehabilitation co-therapists. Wherever possible families and carers are involved to support and reinforce the programmes to ensure the best possible outcome for the service user. Referrals from the community or other hospitals are accepted subject a pre admission assessment undertaken by the multi disciplinary team.

Dalston - Transitional Service Criteria for Admission

• Male 18-65
• ABI
• Section or informal
• There is no evidence of current physically aggressive or threatening behaviour there may be history of offending behaviour.
• There is a low risk of absconding.
• The patient is assessed as a low risk of self-harm.
• The patient is assessed as stable in terms of their mental state.
• The patient is co-operative with treatment and attempts at rehabilitation.
• The patient is willing to comply with a contract specifying the requirements of living in the Transitional Service.
• The patient may be moving from secure care.