Outcomes of young people who reach the transition boundary of child and adolescent mental health services: a systematic review

Appleton, Rebecca; Connell, Catriona; Fairclough, Emma; Tuomainen, Helena; Singh, Swaran P.

doi:10.1007/s00787-019-01307-7

Cited by 53 publications

(57 citation statements)

References 25 publications

(88 reference statements)

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“…Service pathways out of CAMHS at age 18 are diverse, as highlighted by Munson and Colleagues in their mental health services utilization framework [25]. Research has consistently shown that less than 50% of youth transitioning directly from CAMHS to AMHS [5,6,26]. Transition experiences of youth may be different based on their service pathway when they leave CAMHS care at age 18 [12].…”

Section: Introductionmentioning

confidence: 99%

“Objectively terrifying”: a qualitative study of youth’s experiences of transitions out of child and adolescent mental health services at age 18

2020

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Background: Mental health issues presenting in childhood often persist into adulthood, usually requiring youth to transition from child and adolescent mental health services to adult mental health services at 18 years. Discontinuity of care during this transition period is well-documented and can leave youth vulnerable to adverse mental health outcomes. There is growing recognition of the need to improve transition-related care for youth leaving the child and adolescent mental health system. However, the perspectives and experiences of youth have not always been forefront in these discussions, and in particular, the perspectives of youth in the pre-transition period. This study qualitatively explores transition-related knowledge and experiences of youth both prior-to and after transition. Methods: A purposive sample of youth aged 16-19 years was recruited from two child and adolescent mental health programs. Youth were enrolled as part of a longitudinal follow-up study and had the opportunity to opt into this study. Interviews were transcribed and coded using NVivo11 software. Main themes were distilled through descriptive analysis following the principles of directed content analysis. The study followed the principles of participatory action research, engaging youth with lived experience navigating transitions in each stage of the study. Results: In-depth, semi-structured interviews were conducted with 14 pre-transition and 8 post-transition youth. All youth reported having either a mood and/or anxiety disorder for which the majority were receiving treatment at the time of the interview. The participants' experiences were distilled into six major themes. Youth advocated for being considered partners in transition planning and to have increased control over transition-related decisions. Youth also made specific recommendations on how to improve continuity of care during the transition process.

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Section: Introductionmentioning

confidence: 99%

“Objectively terrifying”: a qualitative study of youth’s experiences of transitions out of child and adolescent mental health services at age 18

2020

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“…It has been well-documented that transition from CAMHS to AMHS rarely goes smoothly, with young people experiencing distress, uncertainty, and discontinuity as they cross the service transition boundary (3)(4)(5). This is often due to young people experiencing disruption to their care, sometimes having several moves between services and/or clinicians during this time (6,7) and struggling to develop new therapeutic relationships (8). The transition from CAMHS can also be a difficult time for their parents, especially if they are excluded from decisions around their child's care once the young person is legally an adult (9).…”

Section: Introductionmentioning

confidence: 99%

“I’m just a long history of people rejecting referrals” experiences of young people who fell through the gap between child and adult mental health services

Appleton

Elahi

Tuomainen

et al. 2020

Eur Child Adolesc Psychiatry

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The paediatric-adult split in mental health care necessitates young people to make a transition between services when they reach the upper end of child and adolescent mental health services (CAMHS). However, we know that this transition is often poor, and not all young people who require ongoing support are able to continue care in adult mental health services (AMHS). These young people are said to have fallen through the gap between services. This research aimed to explore the reasons why young people fall through the gap between CAMHS and AMHS, and what effect this has had on them and their families. Narrative interviews were conducted with 15 young people and 15 parents, representing 19 unique transition stories. Themes were identified collaboratively using thematic analysis. Reasons for falling through the gap were grouped into systemic problems and problems with the quality of care received. Effects of falling through the gap were grouped into separate themes for young people (feeling abandoned; struggling to manage without continued care; problems with medication) and parents (emotional impact of care ending; parents taking an active role in the young person's care). To our knowledge, this is the first qualitative study that has focused only on the experiences of young people who have fallen through the gap between services. This research adds novel findings to existing literature regarding barriers to transition and the effects of discontinuity of care.

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“…Transitions from adolescent medium secure units in the UK are channelled by medicolegal processes, which further complicate transitions. However, most research studies have focused on transitions of care from mainstream CAMHS rather than forensic services (Appleton et al, 2019). Liddiard and colleagues (2019) highlight that poorly planned and executed transitions may lead to increasing rates of self-harming, readmission and relapse, yet few studies have included child and adolescent and adult secure services (Wheatley et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

A retrospective case note review of young people in transition from adolescent medium secure units to adult services

Livanou

Lane

D’Souza

et al. 2020

JFP

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Purpose There is substantial evidence that young people moving from child and adolescent mental health services to adult services are more likely to experience poor transitions. However, little is known about the care pathways of young people transitioning from forensic services. This retrospective case note review sought to examine the clinical characteristics, transition pathways and psychosocial indicators of transition outcomes amongst young people in forensic medium secure services discharged to adult services. Design/methodology/approach The electronic records of 32 young people, who transitioned from six adolescent medium secure units in England to adult services between May 2015 and June 2016, were examined. Findings Approximately 65% of young people were between 18 and 19 years at the time of transition and the average waiting time from referral to discharge was six months. A total of 63% young people transitioned to community placements and adult medium secure services. Four pathways describing the journey into and out of adolescent medium secure services were identified in a subsample of 12 young people. A total of 25% young people with neurodevelopmental problems moved to specialist services. Practical implications The results suggest that diagnosis, severity of offence and clinical background are associated with transition pathway. Promoting a person-centred approach and gradual independence of the young person may improve current practice. Originality/value These results inform existing policy and clinical practice in an effort to reform transition guidelines around young people’s needs during transition times. Further studies in adolescent forensic services are needed to understand complex neurodevelopmental problems and comorbidities.

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Outcomes of young people who reach the transition boundary of child and adolescent mental health services: a systematic review

Cited by 53 publications

References 25 publications

“Objectively terrifying”: a qualitative study of youth’s experiences of transitions out of child and adolescent mental health services at age 18

“Objectively terrifying”: a qualitative study of youth’s experiences of transitions out of child and adolescent mental health services at age 18

“I’m just a long history of people rejecting referrals” experiences of young people who fell through the gap between child and adult mental health services

A retrospective case note review of young people in transition from adolescent medium secure units to adult services

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