Support for young people with complex autism and/or learning difficulties

NHS Key Worker Service

A new Key Worker Pilot Service is being developed as a response to the NHS England learning disability and autism long-term plan commitment that by 2023/24, children and young people with a learning disability, who are autistic, or both, with the most complex needs will have a designated key worker.

Watch the video to find out more about the Key Worker Service in Herefordshire and Worcestershire, what it does, who is eligible and how a key worker can help and support. You can also read the Key Worker Service NHS leaflet.

The key working function is an important response to ensuring children, young people and families get the right support at the right time, from local systems that are responsive to meeting their needs in a holistic and joined up way.

The initial phase of this work (2021-2023) in Herefordshire and Worcestershire is focused on children and young people who are inpatients or at risk of being admitted to hospital.

These young people will be on the Dynamic Support Register (DSR) and at high risk of admission to tier 4 inpatient services or already admitted.

Dynamic Support Register (DSR)

A Dynamic Support Register is sometimes called a DSR. A DSR is a list of people with a learning disability and/or autistic people who need support.

People on the DSR are at risk of going into hospital if they do not get the right care and treatment in the community.

The list tells health and care staff about the type of support a person with a learning disability or an autistic person needs to stay well at home.

Once identified and placed on the DSR, each child or young person is rated according to their current risk. The criteria used is as follows:


  • The child or young person would have a red status on the DSR if they are in crisis and are at immediate risk of being admitted to hospital
  • A keyworker would work with the child or young person and community professionals to avoid this
  • A keyworker would attend the Care (Education) and Treatment Review
  • The actions from this meeting will be followed up by the keyworker and support will be focused on discharge to the community


  • The child or young person would have an amber status on the DSR if they are facing significant deterioration in the community and their risk of hospital admission has increased due to:
    • Changes in behaviour
    • Recent significant incidents
    • Escalation of concerns or
    • Breakdown of placement
  • The keyworker will focus on support to avoid hospital admission and/or stepping down to green with community services support


  • The child or young person would have a green status on the DSR if they have reached a time of stability and are out of crisis
  • They are not at risk of hospital admission
  • The keyworker will monitor the wellbeing of the child or young person for three to six months and then potentially remove them from the DSR and/or step down to SENDIASS services

You can find out more about Dynamic Support Registers on the NHS website.

Care (Education) and Treatment Reviews (CTR)

A Care and Treatment Review:

  • Makes sure adults (18+) get the right care and treatment
  • Looks at how to make care and treatment better for adults

Sometimes a Care and Treatment Review is called a CTR.

A CTR is for people who are at risk of going into hospital or who are already in hospital, which includes:

  • Children
  • Young people
  • Adults with a learning disability or autism

A Care (Education) and Treatment Review is different to a Care and Treatment Review because it is for children and young people (under 18) and includes their education needs.

Sometimes a Care (Education) and Treatment Review is called a C(E)TR. This is a meeting to check the person's care and treatment is meeting their needs.

A CETR can be held for anyone with learning disabilities, autism or both who may be at risk of admission to, or already in, a specialist learning disability or mental health hospital.

People invited to a CETR/CTR include the person, their advocate (if appointed), a family member (if consented to) and the professionals responsible for providing the person's care.

The review is chaired by the responsible commissioner with support from independent expert advisors whose role is to bring additional challenges and an alternative perspective.

The review team makes recommendations to improve the person's care with follow up checks to ensure this is happening.

You can download an easy read guide to C(E)TRs at NHS England - My Care and Treatment Review