What is a CETR?
The policy and guidance for Care, Education & Treatment Reviews (CETRs) comes from the Transforming Care programme. Transforming care is all about improving health and care services so that more people with a learning disability and/or autistic people can live in the community, with the right support, and close to home.
This means that fewer people will need to go into hospital for their care.
A CETR is a meeting. It is organised when a child or young person who has a learning disability or autism is considered to be at risk of a mental health inpatient hospital admission.
The CETR brings together those responsible for commissioning and those providing services alongside the young person and their family or carers. They seek the views and experience of the family and carers and the young person themselves to ascertain whether or not all system resources have been maximised to support the young person to remain in their local community. They also seek to understand how local services are able to support the young person and identify and barriers to accessing that provision. They make suggestions as to any other options or opportunities which could help the young person live and thrive in the community.
CETRs have a set of principles that should always be upheld. These are:
Person centred and family centred
Seeing the whole person
Open, independent and challenging
Nothing about us without us
Living life in the community
Consent MUST be given to hold a CETR by the young person or responsible adult or organisation with parental responsibility if the young person is not competent to give consent.
Types of CETR
An urgent CETR is called if a young person is at imminent risk of an admission. In order to facilitate this at short notice these are often teleconferences. These are sometimes called ‘blue light’ CETR’s.
If a young person is admitted to hospital, an inpatient CETR must be held within 10 days.
A community CETR is held for a young person who is considered to be at significant risk of requiring an inpatient admission, or where there is a significant risk of a family or placement breaking down.
How can it help?
The aim of the CETR is to bring a person-centred and individualised approach to ensuring that the care and treatment and differing support needs of the person and their families are met and that barriers to progress are challenged and overcome so that the child/young person avoids admittance to mental health inpatient hospital.
CETR’s are driven by the NHS, but the involvement of local authority and education services in the CETR process and its outcomes is integral to improving care, education and treatment of children and young people with learning disabilities, autism or both and their families.
At the CETR a key lines of enquiry form is completed. This is anonymised and sent to NHS England for monitoring. An action plan with timescales is produced to support the young person and their family.
How do I request a CETR?
Anyone can request a CETR, including the young person and the family or carers of that young person and professionals working with the young person. Although it is most likely that the young person will already be known to services and be on the Transforming Care draft Dynamic Risk Register this is not always the case.
Where can I go for more information?
A family Survival Guide to CETR’s:
A Family Survival Guide – Care and Treatment Reviews (CTRs) – Bringing Us Together
What does a CETR report look like:
What is the Dynamic Support Register?
Many children and young people known to the Special Educational Needs Disabled Children’s services will not require Care, Educational and Treatment Reviews (CETRs) and will live full and active lives in the community and/or in residential settings without being at risk of admittance to a learning disability or mental health hospital bed.
Once identified and placed on the Dynamic Support Register (DSR), each child is ‘RAG’ rated according to their current risk. The criteria used are as follows:
Imminent risk of being admitted to hospital; displaying signs of challenging behaviour that are significantly challenging family and existing support services
Young person is placing themselves or others at serious and/or significant risk of harm
Young person has had an unplanned hospital admission in the last year (excluding admission for physical health)
They have been managed by a crisis team or similar to avoid a hospital admission in the last year
All possible options to support in the community have been exhausted
Child or young person is starting to display challenging behaviour which existing services are struggling to manage; these behaviours are at such a stage that a multidisciplinary team meeting, or a review of their current services, they are likely to be able to be managed OR
The child or young person is living in the community (either at home or in a foster placement) but they are displaying challenging behaviours which may lead to a residential placement being sought, and there are concerns that there may not be a suitable residential placement available
The child or young person is in receipt of/has received all possible service options available in the community.
The child or young person has previously been in a learning disability or mental health inpatient setting but is currently in the community or a residential placement and there are no concerns.
The DSR is a ‘live’ document and updated in real time, but also reviewed as a whole document on a regular basis by a team of relevant professionals.
For a child or young person to be included on the DSR, they, or their parent/carer/guardian (either because of their age or because they have been assessed as lacking capacity) have to have given their consent to be placed on the register which is held securely by the CCG Commissioner. This consent must be updated annually. The Lead Professional involved in the case is best placed to seek consent from the parent / carer or from a young person themselves if they are over 16 and deemed to have capacity.
How can it help?
It is important that local services including the NHS, understand the needs of people with a learning disability, autism or both in their area, so that they can make sure people receive the right support in order to avoid being admitted to mental health or learning disability hospitals unnecessarily.
By holding the register and reviewing it regularly to keep it live, key professionals continually evaluate the risk(s) and also progress of the CYP on the register. It also enables the relevant professionals/teams to plan for transition to adult services (if required) in a timely way.
How can it be accessed?
Any professional can bring a child or young person directly to the attention of the Transforming Care/CETR Holder if they are concerned that a young person is potentially at risk of admission.
Where to go for more information?
For Easy Read Guides visit this website: