scholarly journals Who is in the transition gap? Transition from CAMHS to AMHS in the Republic of Ireland

2015 ◽  
Vol 32 (1) ◽  
pp. 61-69 ◽  
Author(s):  
F. McNicholas ◽  
M. Adamson ◽  
N. McNamara ◽  
B. Gavin ◽  
M. Paul ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Young People ◽  
Health Service ◽  
Health Services ◽  
Young Person ◽  
Republic Of Ireland ◽  
Transition Boundary ◽  
The Republic ◽  
Service Need

ObjectiveThe ITRACK study explored the process and predictors of transition between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) in the Republic of Ireland.MethodFollowing ethical approval, clinicians in each of Ireland’s four Health Service Executive (HSE) areas were contacted, informed about the study and were invited to participate. Clinicians identified all cases who had reached the transition boundary (i.e. upper age limit for that CAMHS team) between January and December 2010. Data were collected on clinical and socio-demographic details and factors that informed the decision to refer or not refer to the AMHS, and case notes were scrutinised to ascertain the extent of information exchanged between services during transition.ResultsA total of 62 service users were identified as having crossed the transition boundary from nine CAMHS [HSE Dublin Mid-Leinster (n=40, 66%), HSE South (n=18, 30%), HSE West (n=2, 3%), HSE Dublin North (n=1, 2%)]. The most common diagnoses were attention deficit hyperactivity disorder (ADHD; n=19, 32%), mood disorders (n=16, 27%), psychosis (n=6, 10%) and eating disorders (n=5, 8%). Forty-seven (76%) of those identified were perceived by the CAMHS clinician to have an ‘on-going mental health service need’, and of these 15 (32%) were referred, 11 (23%) young people refused and 21 (45%) were not referred, with the majority (12, 57%) continuing with the CAMHS for more than a year beyond the transition boundary. Young people with psychosis were more likely to be referred [χ2 (2, 46)=8.96, p=0.02], and those with ADHD were less likely to be referred [χ2 (2, 45)=8.89, p=0.01]. Being prescribed medication was not associated with referral [χ2 (2, 45)=4.515, p=0.11]. In referred cases (n=15), there was documented evidence of consent in two cases (13.3%), inferred in another four (26.7%) and documented preparation for transition in eight (53.3%). Excellent written communication (100%) was not supported by face-to-face planning meetings (n=2, 13.3%), joint appointments (n=1, 6.7%) or telephone conversations (n=1, 6.7%) between corresponding clinicians.ConclusionsDespite perceived on-going mental health (MH) service need, many young people are not being referred or are refusing referral to the AMHS, with those with ADHD being the most affected. CAMHS continue to offer on-going care past the transition boundary, which has resource implications. Further qualitative research is warranted to understand, in spite of perceived MH service need, the reason for non-referral by the CAMHS clinicians and refusal by the young person.

A systematic review of service transitions in people with ADHD

2016 ◽  
Vol 33 (S1) ◽  
pp. S58-S58
Author(s):  
F. McNicholas ◽  
M. Tatlow-Golden ◽  
B. Gavin ◽  
S. Singh
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Grey Literature ◽  
Young Person ◽  
Service Development ◽  
Transition Boundary ◽  
Low Rate

BackgroundYoung people (YP) with attention deficit hyperactivity disorder (ADHD) are recognized to be a group who are particularly vulnerable to falling through the gap regarding transitioning from Child and Adolescent Mental health Services (CAMHS) to Adult Mental Health Services (AMHS). This presentation will combine a systematic review of the literature with some clinical examples of the pathway for a number of YP with ADHD who reach the transition boundary (TB).Method(1) Databases (e.g., PubMed, PsycINFO, AMED, CINAHL, EMBASE, Web of Knowledge), and grey literature, were searched systematically with database-specific key words, variants and truncations, to cover six subject areas: ADHD; transition or transfer; age; experiences or views; service development; and policies or protocols. Hand searching of key journals, ancestry and forward searches of references, and expert consultation were conducted. Two reviewers critically evaluated studies using a validated appraisal tool for mixed methodologies and findings were synthesized. (2) Following ethical approval, CAMHS clinicians from 9 clinics in Republic of Ireland identified all cases where a YP with ADHD had reached the TB, and identified referral/service outcomes (n = 20).ResultsThe search yielded 27 studies, covering areas of service review and recommendations (7), guidelines (3), medication (5), case note audit (3), professional's views (5), pilot transition clinics (2). A further set of papers covered the perspective of the young person (4) and parent (2). Overall these highlighted the less than optimum experience by both clinicians and service users of the experience with suggestions for future developments. These findings were mirrored in the review of clinical notes and individual interviews of YP identified through their CAMHS. Of the 20 young people identified, only 1 was directly transferred to AMHS. Eight were retained in CAMHS, on average for over a year. A significant number (7) refused onward referral. A perception from CAMHS clinicians, that AMHS did not accept such cases or lacked relevant service/expertise, may have contributed to the low rate of referral.ConclusionBoth the extant literature and the specific study presented highlight the lack of clear cut consensus about the appropriate management of young people with ADHD have who reach the transition boundary. Low rates of AMHS transfer may come from CAMHS clinicians’ perceptions of AMHS, and preferences of young people and families. Before assuming the very low rate of referral by CAMHS clinicians is poor practice, clinical outcomes need to be identified, young people's reasons for refusing transfer explored and service options identified.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Transition from child and adolescent mental health services to adult mental health services

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S347-S348
Author(s):  
Tania Saour
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Clinical Information ◽  
Young Person ◽  
Timely Manner ◽  
Team Meetings ◽  
Significant Barrier ◽  
Transition Plan

BackgroundThe prevalence and recognition of mental health conditions in young people is growing. Around 50% of lifetime mental illness (except dementia) begins by the age of 14. Around 75% of adults requiring secondary mental health services developed problems prior to 18.The TRACK study of young people's transitions from CAMHS to AMHS has found that up to a third of teenagers are lost from care during transition and a further third experience an interruption in their care.A CQUIN for Transition has concluded that young children should have a transition plan 6 months before they turn 18.MethodAll young people aged 17 and a half years old were included in the data collection for this audit. Clinical information was reviewed using the West London RIO computer system. While reviewing the clinical documentation I was recording whether:Transitional plans had been discussed with the young person.If yes, what were they?Had a referral been made to the appropriate service?ResultThere were 180 open cases to the Hounslow Adolescent Team. 35 cases were over 18:At least 16 of these cases needed to be closed as no intervention was being provided.14 cases had an unclear plan.Of the 25 cases aged between 17.5 and 18 years of age transitional plans were:Transition was discussed in 11 cases (44%). This meant that transitional plans were not discussed in 56% of young people.Of these 11 cases 7 referrals were completed. (28%)ConclusionThe lack of consistent protocols for transition remains a significant barrier to health care provided to young people.Transitional planning needs to take place in an effective and timely manner to ensure continued patient centred care.Transitional discussions to be made a regular agenda item at team meetings.Care co-ordinator to be informed and reminded that transitional plans need to be explored with young people.Following a re-audit of this data 6 months on 100% of cases over the age of 18 were closed and transition was discussed in the remaining 56%.

scholarly journals Using Digital Technologies to Facilitate Care Coordination Between Youth Mental Health Services: A Guide for Implementation

2021 ◽  
Vol 1 ◽  
Author(s):  
Frank Iorfino ◽  
Sarah E. Piper ◽  
Ante Prodan ◽  
Haley M. LaMonica ◽  
Tracey A. Davenport ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Young People ◽  
Health Service ◽  
Health Services ◽  
Dynamic Simulation ◽  
Care Coordination ◽  
Youth Mental Health ◽  
Simulation Modelling ◽  
Dynamic Simulation Modelling

Enhanced care coordination is essential to improving access to and navigation between youth mental health services. By facilitating better communication and coordination within and between youth mental health services, the goal is to guide young people quickly to the level of care they need and reduce instances of those receiving inappropriate care (too much or too little), or no care at all. Yet, it is often unclear how this goal can be achieved in a scalable way in local regions. We recommend using technology-enabled care coordination to facilitate streamlined transitions for young people across primary, secondary, more specialised or hospital-based care. First, we describe how technology-enabled care coordination could be achieved through two fundamental shifts in current service provisions; a model of care which puts the person at the centre of their care; and a technology infrastructure that facilitates this model. Second, we detail how dynamic simulation modelling can be used to rapidly test the operational features of implementation and the likely impacts of technology-enabled care coordination in a local service environment. Combined with traditional implementation research, dynamic simulation modelling can facilitate the transformation of real-world services. This work demonstrates the benefits of creating a smart health service infrastructure with embedded dynamic simulation modelling to improve operational efficiency and clinical outcomes through participatory and data driven health service planning.

scholarly journals The impact of digital communication on adolescent to adult mental health service transitions

2020 ◽  
Vol 25 (3) ◽  
pp. 277-288
Author(s):  
Rosie Martin ◽  
Jackie Sturt ◽  
Frances Griffiths
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Young People ◽  
Health Service ◽  
Health Services ◽  
Safety Net ◽  
Long Term Conditions ◽  
Adult Mental Health ◽  
The Impact

Background Inaccessible services and poor communication are barriers to successful transitions between adolescent and adult mental health services, for which digital communications (DC) offer a possible solution. Aims To investigate the role of DC, including smartphone apps, email and text, given the known barriers and facilitators of mental health service transitions reported in the literature. Methods Use of Neale’s (2016) iterative categorisation technique to undertake a secondary analysis of qualitative data collected for the Long-term conditions Young people Networked Communication (LYNC) study. Results DC were used successfully by young people and staff in ways that ameliorated known barriers to service transitions. They engendered responsibility in young people, promoted service access and contributed to client safety, particularly in times of crisis. DC risks included over-familiarity between young people and staff, and the possibility that messages could go unread. Conclusions DC have the potential to facilitate trust and familiarity during and after transition to adult mental health services. They can strengthen young people’s perceptions of adult services as supportive, empowering and available. DC can be used for frequent ‘check-ins’ and remote digital support for social and personal problems. They provide an additional safety net for at-risk individuals, but require careful boundary setting.

Jigsaw: Engaging communities in the development and implementation of youth mental health services and supports in the Republic of Ireland

2010 ◽  
Vol 19 (5) ◽  
pp. 422-435 ◽  
Author(s):  
Robert J. Illback ◽  
Tony Bates ◽  
Craig Hodges ◽  
Karen Galligan ◽  
Patrick Smith ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Youth Mental Health ◽  
Republic Of Ireland ◽  
The Republic ◽  
Services And Supports

scholarly journals The effect of a youth mental health service model on access to secondary mental healthcare for young people aged 14–25 years

2018 ◽  
Vol 43 (1) ◽  
pp. 27-31 ◽  
Author(s):  
Sarah Maxwell ◽  
Obianuju Ugochukwu ◽  
Tim Clarke ◽  
Brioney Gee ◽  
Emmet Clarke ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Young People ◽  
Health Service ◽  
Health Services ◽  
Mental Healthcare ◽  
Youth Mental Health ◽  
Service Model ◽  
Youth Service

Aims and methodThe Norfolk Youth Service was created in 2012 in response to calls to redesign mental health services to better meet the needs of young people. The new service model transcends traditional boundaries by creating a single, ‘youth friendly’ service for young people aged 14–25 years. The aim of this study was to investigate the effect of the transition to this new model on patterns of referral, acceptance and service use. We analysed routinely collected data on young people aged 14–25 years referred for secondary mental healthcare in Norfolk before and after implementation of the youth mental health service. The number of referrals, their age and gender, proportion of referrals accepted and average number of service contacts per referral by age pre- and post-implementation were compared.ResultsReferrals increased by 68% following implementation of the new service model, but the proportion of referrals accepted fell by 27 percentage points. Before implementation of the youth service, there was a clear discrepancy between the peak age of referral and the age of those seen by services. Following implementation, service contacts were more equitable across ages, with no marked discontinuity at age 18 years.Clinical implicationsOur findings suggest that the transformation of services may have succeeded in reducing the ‘cliff edge’ in access to mental health services at the transition to adulthood. However, the sharp rise in referrals and reduction in the proportion of referrals accepted highlights the importance of considering possible unintended consequences of new service models.Declaration of interestsNone.

scholarly journals Cohort profile: demographic and clinical characteristics of the MILESTONE longitudinal cohort of young people approaching the upper age limit of their child mental health care service in Europe

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e053373
Author(s):  
Suzanne E Gerritsen ◽  
Athanasios Maras ◽  
Larissa S van Bodegom ◽  
Mathilde M Overbeek ◽  
Frank C Verhulst ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Clinical Characteristics ◽  
Service Use ◽  
Care Service ◽  
Health Care Service ◽  
Young Person ◽  
Age Limit

PurposeThe presence of distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) impacts continuity of mental health treatment for young people. However, we do not know the extent of discontinuity of care in Europe nor the effects of discontinuity on the mental health of young people. Current research is limited, as the majority of existing studies are retrospective, based on small samples or used non-standardised information from medical records. The MILESTONE prospective cohort study aims to examine associations between service use, mental health and other outcomes over 24 months, using information from self, parent and clinician reports.ParticipantsSeven hundred sixty-three young people from 39 CAMHS in 8 European countries, their parents and CAMHS clinicians who completed interviews and online questionnaires and were followed up for 2 years after reaching the upper age limit of the CAMHS they receive treatment at.Findings to dateThis cohort profile describes the baseline characteristics of the MILESTONE cohort. The mental health of young people reaching the upper age limit of their CAMHS varied greatly in type and severity: 32.8% of young people reported clinical levels of self-reported problems and 18.6% were rated to be ‘markedly ill’, ‘severely ill’ or ‘among the most extremely ill’ by their clinician. Fifty-seven per cent of young people reported psychotropic medication use in the previous half year.Future plansAnalysis of longitudinal data from the MILESTONE cohort will be used to assess relationships between the demographic and clinical characteristics of young people reaching the upper age limit of their CAMHS and the type of care the young person uses over the next 2 years, such as whether the young person transitions to AMHS. At 2 years follow-up, the mental health outcomes of young people following different care pathways will be compared.Trial registration numberNCT03013595.

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