Challenges and Facilitators During Transitions from Adolescent Medium Secure Units to Adult Services in England: Interviews with Mental Healthcare Professionals

Abstract

Young people moving from child and adolescent secure hospitals present with complex needs and vulnerabilities and are more likely to experience poor transition outcomes. Previous research has indicated the presence of several risk factors in periods of transition, such as poor liaison among services, lack of proper planning, shortage of beds in adult services, multiple transitions and lack of emotional readiness. However, little evidence exists about the processes and outcomes of transitions from adolescent secure services to adult settings. This study aims to bridge the gap in the existing literature by exploring the views and experiences of key professionals involved in the transition process from six adolescent medium secure units to nine adult secure and community services in England. Thirty-four key workers from 15 child and adolescent (N = 21) and adult (N = 13) forensic hospitals were interviewed to provide information about potential barriers and facilitators to transitions. Face-to-face semi-structured interviews were conducted between January 2016 and December 2017. Thematic analysis was used to identify challenges and facilitators to transitions. Three primary themes were identified: (1) transition processes and preparation; (2) transition barriers and challenges; (3) success factors to transition. Key differences in adult and adolescent service care-models and lack of emotional and developmental readiness to moving onto adult-oriented settings constitute major barriers to positive transition outcomes. Practice and policy implications are considered to address the need for service transformations.

Models of care in forensic psychiatry

“…Secure hospital provision for forensic child and adolescent patients necessitates further modifications. Special attention is required to ensure appropriate transitions from forensic child and adolescent to adult forensic psychiatry services, including processes, experience and outcomes (Livanou 2021).…”

Co‐producing a complex psychosocial intervention during COVID‐19 with young people transitioning from adolescent secure hospitals to adult services in England: Moving Forward intervention (MFi)

“…We identified four papers about young people moving from adolescent secure hospitals to adult care in the UK based on first author's (ML) previous work in the area including two qualitative studies with young people, carers and mental health professionals, a case note review audit and a service scoping exercise (Livanou, Bull, et al., 2021; Livanou, D'Souza, et al., 2021; Livanou, Lane, et al., 2020; Livanou, Singh, et al., 2020). These papers were extracted based on sample selection which includes young people moving from MSUs to adult settings and is one of our subgroups of interest for the MFi.…”

“…We discussed and reflected on predetermined themes for the MFi based on previous findings (Livanou, Bull, et al., 2021). We identified only four papers in this area due to the lack of research about young people discharged from MSUs to adult care in the UK (Livanou, Bull, et al., 2021; Livanou, D'Souza, et al., 2021; Livanou, Lane, et al., 2020; Livanou, Singh, et al., 2020). There is only one national study (Livanou, 2018) as part of a doctorate thesis which followed up young people in adult services and community settings postdischarge from all national medium secure services for adolescents.…”

“…In addition, we aimed to trial co‐production with young people within secure hospitals in the context of COVID‐19, identifying challenges and facilitators to co‐producing research at this time. The themes discussed in the Advisory Groups were based on previous research conducted with young people moving from adolescent secure services to adult provision, parents and transition keyworkers (Livanou, Bull, et al., 2021; Livanou, D'Souza, Lane, La Plante, & Singh, 2021). The present paper describes the collaborative steps of the MFi co‐production and development.…”

Assessing the Feasibility of a Multicenter Transition Intervention Model Across Adolescent Secure Services in England (MOVING FORWARD): Protocol for a Feasibility Cluster Randomized Controlled Trial

“…Effective and supportive transitions foster independence in young people and facilitate confidence in their treatment. The National Institute for Health and Care Excellence (NICE) 2016 guidelines explicitly state that self-efficacy (managing one’s own health) is a key priority for service commissioners and policy makers, and recommend evidence-based research in the form of cluster randomized controlled trials (cRCTs) in self-management training to improve transition preparation for special groups [ 7 ]. This study aims to address this gap and improve current processes for young people transitioning from adolescent secure services to adult-oriented care by (1) developing a psychosocial transition intervention with a developmental focus and (2) assessing the feasibility of undertaking a future trial of its clinical and cost-effectiveness.…”