Keyworking service

The Surrey Keyworking Service is a newly formed team who are passionate about listening to children, young people and their families living in Surrey, and we aim to ensure local health, education and social care teams work together in a holistic and joined-up way to put the right support in place at the right time. By working in partnership with other agencies to offer a joined-up approach to supporting families, the Keyworking Service helps services to work more closely together to manage a person's support needs effectively and ensure positive outcomes in the community.

What is the keyworking service?

The NHS Long Term Plan includes a commitment to provide a designated keyworker for every child or young person with learning disability, autism, or both, with the most complex needs.

Autism and learning disability keyworkers support children, young people and families to help avoid unnecessary admissions to mental health hospitals. They work with children or young people who are at risk of mental health hospital admission or are in inpatient settings. Keyworkers make sure that these children, young people, and families get the right support at the right time.

You can find out more about keyworking services nationally on the NHS England webpage Children and young people keyworkers (NHS England).

Who is the keyworking service for?

Surrey's Keyworking Service will be working with children and young people aged 5 to 25 years old with a learning disability and/ or autism who are Surrey residents and are on the Dynamic Support Register (DSR).

A Dynamic Support Register (DSR) is a list of people with a learning disability and/ or autistic people who need support. People on the Dynamic Support Register are at risk of going into hospital if they do not get the right care and treatment in the community. It helps health and care staff understand the type of support a person with a learning disability and/ or an autistic person needs to stay well at home. Surrey Heartlands Integrated Care Board manages the Dynamic Support Register for those living in Surrey.

Priority referrals to the service for Keyworker support will be provided to children and young people who are already inpatients or are at risk of being admitted to a Mental Health setting. Keyworkers will work closely with the child, young person and family alongside other agencies involved to try and prevent this happening or will remain involved to try to make any hospital stay as short as possible and endeavour to facilitate a smooth as possible discharge whilst ensuring the right support is available in the community.

Who can have a keyworker?

You can have a keyworker if you meet all following criteria.

  • You have a diagnosis of autism, learning disability or both.
  • You are 5 to 25 years old.
  • You are at risk of hospital admission or currently in hospital.
  • You are on the Dynamic Support Register. Priority referrals are those who are at an immediate risk of admission to a mental health hospital and those who are currently in inpatient services.
  • You live in the geographical area of Surrey.

How can a keyworker help?

A keyworker can help in many ways, including:

  • Acting as the main point of contact for children, young people and their families.
  • Building and maintaining positive relationships with the child, young person and their family/carers during the supportive period, with the aim of avoiding admission or facilitating discharge and strengthening links with relevant services.
  • Working on behalf of the child, young person and their family/carers towards unblocking challenges and barriers.
  • Ensuring the child/young person has a clear, personalised plan to promote their development.
  • Providing continuity of care for the child/young person, working across systems and services to ensure they respond and react to their needs as required.
  • Ensuring recommendations from Care (Education) and Treatment Reviews are completed in a timely manner

Feedback about Surrey keyworkers

We have been receiving lovely feedback from the young people, families and professionals we are working with about the ways in which keyworkers have been able to help.

"[Young person] seemed really positive and reassured. She particularly commented on how neuro-affirming your approach was."

"I wanted to share how pleased [mother] is with how you are working with [young person] and how quickly you've built a secure relationship with them and that they trust you. [Mother] also said that communication has been great, and they have confidence in our service."

"I wanted to highlight the incredible work [Keyworker] is doing with [young person]. [Keyworker] has built such a secure relationship and been really creative with community visits and this has enabled [young person] to open up... [Keyworker] has been so responsive and curious around the challenges [young person] has raised which has helped create this safe space for them to begin to explore her concerns on discharge."

Referrals

All referrals to the Keyworking Service must be made via the Dynamic Support Register (DSR). For more information, contact Surrey Keyworking Service at keyworkingservice@surreycc.gov.uk