Transitions of Care from Child and Adolescent Mental Health Services to Adult Mental Health Services (TRACK Study): A study of protocols in Greater London

Abstract

BackgroundAlthough young people's transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) in England is a significant health issue for service users, commissioners and providers, there is little evidence available to guide service development. The TRACK study aims to identify factors which facilitate or impede effective transition from CAHMS to AMHS. This paper presents findings from a survey of transition protocols in Greater London.MethodsA questionnaire survey (Jan-April 2005) of Greater London CAMHS to identify transition protocols and collect data on team size, structure, transition protocols, population served and referral rates to AMHS. Identified transition protocols were subjected to content analysis.ResultsForty two of the 65 teams contacted (65%) responded to the survey. Teams varied in type (generic/targeted/in-patient), catchment area (locality-based, wider or national) and transition boundaries with AMHS. Estimated annual average number of cases considered suitable for transfer to AMHS, per CAMHS team (mean 12.3, range 0–70, SD 14.5, n = 37) was greater than the annual average number of cases actually accepted by AMHS (mean 8.3, range 0–50, SD 9.5, n = 33).In April 2005, there were 13 active and 2 draft protocols in Greater London. Protocols were largely similar in stated aims and policies, but differed in key procedural details, such as joint working between CAHMS and AMHS and whether protocols were shared at Trust or locality level. While the centrality of service users' involvement in the transition process was identified, no protocol specified how users should be prepared for transition. A major omission from protocols was procedures to ensure continuity of care for patients not accepted by AMHS.ConclusionAt least 13 transition protocols were in operation in Greater London in April 2005. Not all protocols meet all requirements set by government policy. Variation in protocol-sharing organisational units and transition process suggest that practice may vary. There is discontinuity of care provision for some patients who 'graduate' from CAMHS services but are not accepted by adult services.

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“…Findings from TRACK study (above) [18] have sharply focused the attention of policy makers and service providers on the need for improving transition and several policy documents have been launched such as New Horizons [28], No Health without Mental Health [29], Royal College of Psychiatrists Briefing paper (2011) [30], the charity Youngminds' report on transitions [31] and Social Care Institute for Excellence report on transitions [32]. In the UK, all major political parties have included youth mental health 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 Response from the Republic of Ireland:…”

“…The current service configuration of Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) is increasingly regarded as an impediment to holistic and comprehensive care for young people, especially those who make a transition from one model to another [18][19][20][21]. Disruption of care during transition adversely affects the health, wellbeing and potential of this vulnerable group.…”

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“…[42] This does not address the large conceptual differences in provision of preventive services and thresholds for access (e.g. people with neurodevelopmental difficulties [43] ), which requires more of a national policy discussion to effect meaningful change.…”

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“…By failing to adequately furnish our future adult psychiatrists with skills in child and adolescent mental health, we are reinforcing a culture whereby young people are potentially falling through the care gap between CAMHS and adult mental health services. 2,3 Indeed, this very issue is highlighted in a joint paper from the inter-faculty group of the child and adolescent psychiatry and the general and community psychiatry faculties which presents recommendations for the provision of psychiatric services to adolescents and young adults. 4 Furthermore, by restricting the level of exposure to child psychiatry, we are doing little to encourage core trainees to perceive the specialty as a future career option.…”

“…This high-risk period could be an opportunity to monitor imminent behaviours through routine enhanced nursing observations, allowing a proactive rather than reactive response style bearing the brunt of staff/patient interactions. 3,4 The observations of week-on-week reduction in serious violence could be explored further with a case-control study. Although resource intensive, ultimately any procedure that is likely to reduce violence to staff and patients is worth pursuing.…”