The Long Handover

A family can spend fifteen years inside children's services. There are appointments, reviews, a school that knows the child, therapists who have watched them grow, equipment that arrives when it is outgrown. It is not perfect and it is often stretched, but it is a structure, and families learn how to work it.

Then the young person turns eighteen, or leaves school, and most of it stops. The paediatric team discharges. The school ends. Adult services operate to different thresholds, with different eligibility criteria, and frequently decide that a young person who has received support throughout their childhood does not meet them. Families who spent a decade becoming expert navigators find the map no longer applies.

Transition is widely acknowledged to be the weakest point in the whole system, and it has been for a long time. Which means the work has to start much earlier than it feels necessary.

Beginning at fourteen

Good transition planning starts around fourteen, which routinely surprises families who feel they are still dealing with a child. The reason is arithmetic: the things that need to be in place by eighteen — a place at a TVET college or university, a housing plan, funding through a medical aid or a disability grant, adult equipment, a driving assessment, care arrangements — each take months, and several of them depend on each other.

What occupational therapy contributes here is a shift in the question. Throughout childhood it has been developmental: what skills are emerging, what support does this child need. From about fourteen it becomes the adult version — what does this young person want their life to look like, and what has to be true for that to be possible?

That means assessing quite different things. Not fine motor skills but whether they can manage money, get themselves across town by taxi, prepare a meal, order a prescription, keep themselves safe online, direct a support worker, or explain their own condition to a stranger. These are learnable, and they take years, which is why fourteen is not early.

Handing over the controls

The hardest part of this period is rarely technical. It is the renegotiation of a relationship between a young person and the parents who have spoken for them, advocated for them and organised their care for eighteen years, often at enormous personal cost.

Those parents have usually had to be formidable, and the habits that got a child what they needed — speaking first, chasing everything, knowing the whole history — become an obstacle at exactly the point the young person needs to start doing it themselves. Nobody is at fault, and telling a parent to step back without acknowledging what they have carried is both unfair and ineffective.

The practical work is gradual transfer. A young person who has never spoken in their own appointment might begin by saying one prepared thing. Then ten minutes alone with the clinician. Then a phone call with a parent in the room, then without. Each step is small, each is uncomfortable, and the sequence needs a couple of years.

It also requires clinicians to change who they address. A great many appointments are conducted over a young person's head, with the adult who is easier to talk to. That habit is hard to break and it teaches a lasting lesson about whose life is being discussed.

Dignity, risk and privacy

Adolescence brings territory that childhood services often handle poorly, largely from discomfort.

Young disabled people have the same interest in relationships and intimacy as everyone else, and markedly less access to information, privacy and opportunity. They are also at higher risk of exploitation, and the protection that works is not restriction but knowledge — accurate, unembarrassed information about bodies, consent, boundaries and how to say no. A young person given no vocabulary for any of it is far less safe, not more.

There is also the matter of risk. Childhood support is protective by design, and it should be. Adulthood involves the right to make choices other people consider unwise, and a young person who has never been permitted an ordinary mistake arrives at eighteen without the experience to judge anything. Building in some real, proportionate risk during adolescence is part of the preparation.

Capacity deserves care here too. Under the Children's Act a child of twelve or older may consent to their own medical treatment where they are mature enough to understand what it involves, and majority arrives at eighteen. The principle worth carrying beyond the law is that capacity is judged decision by decision rather than delivered as a single global verdict. A young person may need considerable help with a housing decision and none whatever about what they wear or who they see.

What childhood was for

It is worth ending a series about children by looking at where all of it points. Everything in the preceding essays — the milestones, the pencil, the mealtimes, the seating, the playground — is in service of a person who will spend most of their life as an adult.

That reframes some familiar decisions. Whether a child writes by hand matters less than whether they can express what they know. Whether they eat a wide range matters less than whether they can manage a meal away from home. Whether they walk matters less than whether they can get where they want to go. Skills are worth teaching when they open something, and worth setting down when they have become an obstacle to the life underneath.

The measure of a childhood well supported is not a young person without difficulties. It is one who reaches adulthood knowing what they are good at, what they find hard, what helps, and how to ask for it — and who has some say in what happens next. Everything else was scaffolding, and scaffolding is supposed to come down.