‘Talking a different language’: an exploration of the influence of organizational cultures and working practices on transition from child to adult mental health services

Abstract

BackgroundOrganizational culture is manifest in patterns of behaviour underpinned by beliefs, values, attitudes and assumptions, which can influence working practices. Cultural factors and working practices have been suggested to influence the transition of young people moving from child to adult mental health services. Failure to manage and integrate transitional care effectively can lead to young people losing contact with health and social care systems, resulting in adverse effects on health, well-being and potential.MethodsThe study aim was to identify the organisational factors which facilitate or impede transition of young people from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) from the perspective of health professionals and representatives of voluntary organisations. Specific objectives were (i) to explore organizational cultures, structures, processes and resources which influence transition from child to adult mental health services; (ii) identify factors which constitute barriers and facilitators to transition and continuity of care and (iii) make recommendations for service improvements. Within an exploratory, qualitative design thirty four semi-structured interviews were conducted with health and social care professionals working in CAMHS and AMHS in four NHS Mental Health Trusts and four voluntary organizations, in England.ResultsA cultural divide appears to exist between CAMHS and AMHS, characterized by different beliefs, attitudes, mutual misperceptions and a lack of understanding of different service structures. This is exacerbated by working practices relating to communication and information transfer which could impact negatively on transition, relational, informational and cross boundary continuity of care. There is also evidence of a cultural shift, with some positive approaches to collaborative working across services and agencies, involving joint posts, parallel working, shared clinics and joint meetings.ConclusionsCultural factors embodied in mutual misperceptions, attitudes, beliefs exist between CAMHS and AMHS. Working practices can exert either positive or negative effects on transition and continuity of care. Implementation of shared education and training, standardised approaches to record keeping and information transfer, supported by compatible IT resources are recommended, alongside management strategies which evaluate the achievement of outcomes related to transition and continuity of care.

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

“…Professionals should aim to network, making communication easier, joint working more possible and also enable professionals to better prepare families and adolescents for AMHS. AMHS professionals should also receive training on working with adolescents (McLaren et al, 2013), developmental theories (Richards & Vostanis, 2004) and specific disorders (Kuhlthau, Warfield, Hurson, Delahaye, & Crossman, 2015).…”

Determinants of Transition From Child and Adolescent to Adult Mental Health Services: A Western Australian Pilot Study

“…High demand upon and limited resources of AMHS are suggested as among the leading organisational constraints, which forces a rigid intake criterion of only the most serious and severe cases (Cosgrave et al., ; Singh et al., ). A number of studies have also pointed out that rigid cut‐off boundaries, poorly designed transition protocols, and a lack of communication and collaboration between adult and child/adolescent services are all barriers to successful transition of clients (Davis & Sondheimer, ; Lindgren, Soderberg, & Skar, ; McLaren et al., ; McNamara et al., ; Richards & Vostanis, ; Singh, Evans, Sireling, & Stuart, ; Singh, Paul, Ford, Kramer, & Weaver, ). Even for those accepted into AMHS, disengagement can occur due to a combination of personal factors, such as resistance to leave an established clinical relationship, anxieties of working with a new case manager in a new area, and limited social support to cushion the transition to adulthood and AMHS (Hovish, Weaver, Islam, Paul, & Singh, ; Jivanjee, Kruzich, & Gordon, ; Soderberg, Skar, & Lindgren, ; Vanheusden et al., ; Yu, Adams, Burns, Brindis, & Irwin Jr., ).…”

Evaluating Perceptions of the Healthcare Providers Concerning Accreditation in Healthcare Organizations in the R. Macedonia

“…Information transfer, standardized, and computerized ways of record keeping, supported by compatible IT resources are recommended to help standardize work with patients as well as evaluate outcomes and continuity of care (McLaren et al, 2013). The majority of the respondents had a positive attitude regarding introducing a new IT system adapted to the needs of accreditation, which shows that they perceive this important link for interconnecting and fast and effective sharing information at all levels in the organization.…”