Lost in transition or translation? Care philosophies and transitions between child and youth and adult mental health services: a systematic review

Mulvale, Gillian; Nguyen, Tram; Miatello, Ashleigh; Embrett, Mark; Wakefield, Patricia A.; Randall, Glen E.

doi:10.3109/09638237.2015.1124389

Cited by 46 publications

(59 citation statements)

References 38 publications

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“…Parental views are not homogenous, and involvement should be managed on a case‐by‐case basis. Our findings reinforce distinct service cultures as a key aspect of transition experience (Mulvale et al., ) and an area of priority when improving transition experiences of all stakeholders.…”

Section: Discussionsupporting

confidence: 83%

“…Research on CAMHS‐AMHS transition has been previously reviewed (Broad, Sandhu, Sunderji, & Charach, ; Mulvale et al., ; Paul et al., ; Reale & Bonati, ). Transitions have been shown to be problematic, with the reasons varying across settings and countries (Reale & Bonati, ) but including policy‐practice gaps such as commissioning issues, a lack of leadership and not prioritising transition‐aged adolescents (Paul et al., ).…”

Section: Introductionmentioning

confidence: 99%

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Review: Transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS): a meta‐synthesis of parental and professional perspectives

Hill

Wilde

Tickle

2019

Child Adoles Ment Health

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Background Transition between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) can be stressful for the young person and family alike. Previous reviews have focused on specific aspects of transition or perspectives of young people, or have not used systematic approaches to data identification and analysis. The objective of this review was to develop the understanding of the transition between CAMHS and AMHS by systematically identifying and synthesising evidence regarding professionals’ and parents/carers’ perspectives. Method A systematic search in July 2018 was conducted on Medline, PsycINFO and CINAHL. Google Scholar and references of selected articles were also searched. Papers were included if they presented empirical qualitative research in peer‐reviewed journals with a primary focus on experiences of parents/carers and/or mental health professionals in relation to adolescents making the CAMHS‐AMHS transition. Data were extracted from each full‐text paper. The quality of included studies was appraised using an expanded Critical Appraisal Skills Programme (2018) tool, and studies’ results were synthesised using meta‐ethnography. Results Fourteen studies of variable quality were identified. Four main third‐order constructs were developed through synthesis: (a) Service cultures; (b) Service resources and gaps; (c) Working relationships between the services; and (d) Leaving secure relationships for new ones. Conclusions Professionals and parents experience adolescents’ transition from nurturing and comprehensive CAMHS to more individualistic AMHS as having many barriers. There is desire for better preparation for transition between services and relationships, more joint working and better CAMHS‐AMHS communication. AMHS service gaps exist, for example for those with neurodevelopmental conditions.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Review: Transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS): a meta‐synthesis of parental and professional perspectives

Hill

Wilde

Tickle

2019

Child Adoles Ment Health

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“…Previously described differences between care philosophies of children's services (emphasising family) and adult's services (focussing on autonomy) (Mulvale et al., ) explain the importance of preparation and the provision of information about adult services to facilitate transition. These cultural differences may also explain why parents report lack of involvement in adult services as a barrier to continuity of care.…”

Section: Discussionmentioning

confidence: 99%

“…Existing literature on healthcare transitions for young people with mental health disorders includes three recent systematic reviews (Embrett, Randall, Longo, Nguyen, & Mulvale, ; Mulvale et al., ; Paul et al., ). Conclusions are limited by scarcity of data but indicate patchy provision, a need for accessible and age‐appropriate services, a need to tackle stigma, unhelpful cultural differences between CAMHS and AMHS, and parents wanting more involvement (Mulvale et al., ; Paul et al., ). Literature specific to ADHD healthcare transition is even more limited.…”

Section: Introductionmentioning

confidence: 99%

Review: Experiences of healthcare transitions for young people with attention deficit hyperactivity disorder: a systematic review of qualitative research

Price

Janssens

Woodley

et al. 2018

Child Adoles Ment Health

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Background Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by hyperactivity, inattention and impulsivity. Up to two thirds of young people with ADHD may experience symptoms into adulthood, yet the limited literature available suggests that many young people with ongoing needs do not transfer from child to adult healthcare services. Although worldwide and NICE guidelines recognise the importance of supported transition, evidence suggests for ADHD that this is poorly managed and variable. Little is known about how transition is experienced by those involved. We aimed to synthesise existing peer‐reviewed literature to understand views and experiences of young people, carers and clinicians on transitioning between child and adult ADHD services. Method Five databases were searched and all articles published between 2000 and up until January 2017 considered. Four key search areas were targeted; ADHD, Transition, Age and Qualitative Research. Quality appraisal was conducted using Wallace criteria. Findings from included studies were synthesised using thematic analysis. Results Eight papers, six from the UK and one each from Hong Kong and Italy, were included. Emerging themes centred on difficulties transitioning; hurdles that had to be negotiated, limitations of adult mental health services, inadequate care and the impact of transition difficulties. Conclusions Healthcare transition for this group is difficult in the United Kingdom because of multiple challenges in service provision. In addition to recommendations in NICE guidelines, respondents identified a need for better provision of information to young people about adult services and what to expect, greater flexibility around age boundaries and the value of support from specialist adult ADHD services. More research is needed into ADHD healthcare transition experiences, especially in countries outside the United Kingdom, including accounts from carers and clinicians.

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“…Only through use will we be able to start to describe patient benefit, often not assessed or measured in benchmarking initiatives (41), but essential if we are to capture experiences of care to inform change that is centered on the receivers of our care. We know from our initial pilot that these benchmarks need adapting to specific populations, such as those with complex needs/disabilities (42), and mental health needs (43), and we would encourage readers to do that to ensure that care philosophies, service delivery, and transitions are a good fit with the population, particularly for those who require services from multiple agencies (44). …”

Section: Discussionmentioning

confidence: 99%

“We Sometimes Hold on to Ours” – Professionals’ Views on Factors that both Delay and Facilitate Transition to Adult Care

et al. 2016

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BackgroundThe transition from child to adult services is a crucial time in the health of young people who may potentially fall into a poorly managed “care gap.” Health service provision, which fails to meet the needs of young people and families at this time of significant change, may result in deterioration in health or disengagement with services, which can have negative long-term consequences. Developing transitional care packages has become a focus of activity in the United Kingdom and elsewhere. Indeed, policy documents have been trying to guide practice for many years, with some variable success. There is much work still to be done, particularly around how guidance and the sharing of best practice, when combined can result in a change in practice.ObjectiveThis study aimed to explore the views of professionals involved in transitional care, the process of transition in their services, and the barriers and facilitators to transition.MethodsThis was a qualitative study using focus group methodology. Four focus groups were carried out, attended by 36 health professionals across child and adult services. They had expertise in working with young people with various health conditions and disabilities. Transcripts were analyzed using qualitative content analysis.ResultsEight key factors that impact on transition emerged from the data. These included factors associated with the patient group (such as age, health condition, having complex needs) as well as factors associated with services (such as the availability of equivalent services within adult care and the links between child and adult team).ConclusionIt is imperative that health professionals consider the population they are working with when planning transitional care and take into account the factors which can lead to delayed transition, so that this can be avoided if possible. Numerous examples of initiatives to facilitate more timely transition were shared: these have been reflected in our “Benchmarks for Transition from Child to Adult Health Services.” We offer these benchmarks to inform and guide the practice of others and illustrate their potential for use in the context of the findings shared here.

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Lost in transition or translation? Care philosophies and transitions between child and youth and adult mental health services: a systematic review

Abstract: Better understanding of philosophical differences and collaborative planning and service delivery may foster shared approaches in CAMHS and AMHS to better meet the needs of transitioning youth.

Cited by 46 publications

References 38 publications

Review: Transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS): a meta‐synthesis of parental and professional perspectives

Review: Transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS): a meta‐synthesis of parental and professional perspectives

Review: Experiences of healthcare transitions for young people with attention deficit hyperactivity disorder: a systematic review of qualitative research

“We Sometimes Hold on to Ours” – Professionals’ Views on Factors that both Delay and Facilitate Transition to Adult Care

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