CETRs and the Dynamic Support Register

There are three types of CETR for different situations.

• Community CETRs for children and young people at significant risk of admission to in-patient care. These look at what can be done to meet their needs in the community so admission to hospital is prevented.
• Urgent CETRs, also called Blue light or Local Area Emergency Protocol (LAEP) pre-admission CETRs for children and young people who are at the point of admission to in-patient hospital care. These look at whether admission is really necessary, and if anything could be done to meet needs safely in the community instead.
• In-patient CETRs for children and young people who are in hospital. If they were admitted without a CETR beforehand, there must be one held within two weeks. If they stay in hospital longer, a meeting should happen every 3 months or sooner if something changes. These should look at whether they still need to be there and plan for a successful discharge. Some young people may be admitted to a mental health hospital and diagnosed as autistic whilst they are there. They should have a CETR once this has happened.

CETRs are focused on children and young people who have learning disabilities or are autistic or both, whose behaviour challenges those around them and creates a risk that they will end up as an in-patient in hospital, for example in an assessment and treatment unit (ATU). They may:

• be seeing or waiting to be seen by specialist behaviour services
• have had hospital services in relation to their mental health
• be in a 52-week school
• be involved with youth offending services

But they can also be children and young people who look like they are heading in that direction if things are not put in place to prevent this.

These children and young people should be on the local Dynamic Support Register.

Anyone closely involved with a child or young person can request a CETR and it should happen if the risk level is high enough. If the young person is over 18 and no longer in education, it would be a CTR (Care Treatment Review). If they should be in education, but perhaps the placement has broken down, it can still be a CETR and this can be one of the issues that is covered.

The commissioner has to get consent before a CETR can go ahead. For children this is from the parent. For young people aged 16 and over, this will be from them. If the young person does not have capacity to consent, then a Best Interests decision must be made about the CETR taking place in line with the Mental Capacity Act.

The meeting is led by a panel comprised of:

• A chairperson, a commissioner who is responsible for relevant services but who is not involved in the child or young person’s everyday care
• A clinical (medical) expert
• An expert by experience – someone who has lived experience of people and families with learning disabilities, autism or both

Apart from the panel, the meeting should also include:

• the child or young person themselves
• parents/family members
• people involved in the child’s education, treatment and care e.g., head teacher, social worker, psychiatrist, mental health nurse.

Arrangements should start at least two weeks before the meeting. This gives time to get consent, for the panel to learn about the child, check their medical history and current support and education plans, make contact with the family and send them information explaining what is happening. The child or young person should be sent a booklet to explain CETRs and a planner to fill in to give their views, with support to capture this if they need that. See Further information below to download copies of these.

The commissioner who convenes the meeting should also think in advance about how the child or young person can be supported to take part positively and comfortably on the day.  This could include thinking if they may need an advocate.

The meeting is usually in person, but attending via a video call should be possible. The commissioner should finalise the agenda (what will be talked about and in what order) so everyone can contribute. The panel will make time available to meet the child or young person and their parent carers separately from the people invited because they provide the child’s care, treatment and education. The panel will invite people in to talk about the care the child is getting and answer questions. They will be looking at whether the child or young person is getting the right care, education and treatment. They will look at:

• Is the person safe?
• Are they getting good care now?
• What are their care plans for the future?
• Can care and treatment be provided in the community?

They have a list to help prompt them to cover everything. This is called the Key Lines of Enquiry or KLOE. See ‘Find out more’ below for a link to read the guides for panels at each sort of CTR/CETR if you want to know more about what the panel should be asking.

The commissioner and the independent experts discuss what they have heard and think about their recommendations before the meeting ends. CETR meetings can be quite long, possibly most of a day. The child or young person and their parent don’t have to sit through all of it. The panel should speak to the child or young person and family at the end to give them some verbal feedback about what they have heard, what recommendations they expect to make and what happens next.

The panel use what they have heard to write up a report with recommendations and an action plan.

This report should be sent to the family and everyone who took part within two weeks. The recommendations and actions should go on the child or young person’s medical record.

There must be a plan to review what happens as a result and check recommendations are followed up and actions are carried out.

Currently the recommendations don’t have legal force but there are proposals for change to the Mental Health Act to put CTR/CETRs on a statutory footing soon.