Still Lost in Transition?

Numerous policy directives highlight the need for planned and well-coordinated support to enable young people with long-term conditions and disabilities to negotiate the transition to adulthood, including making the leap from children-oriented to adult- centered health services. The journey is complex and multi-dimensional. For young people with a disability, long-term condition, or mental health problem there are additional challenges when transitioning between services with differences in expectations, delivery, and culture. This article explores findings from 6 case studies of young people who have recently experienced transition to adult health and care services, triangulating inter-related perspectives: those of young people, parents, and carers, and where possible the professionals involved. One of the case studies illustrates how the challenges are actually experienced. Analysis of emerging themes across the case studies leads to key messages from families to inform strategic development of services and practice

Found in Transition.

The journey to adulthood is complex and multi-dimensional. Young people may be independent in some spheres of their lives, but dependent in others. For young people with a disability, long-term condition, or mental health problem there are additional hurdles. As they move between health and social care services, they will find significant differences in expectations, delivery, and culture. At the same time, their own needs will be evolving. Despite a great deal of guidance on effective transition support, in 2014, England's Care Quality Commission highlighted a shortfall between policy and practice. The result is confusion and frustration for young people, their families, and the staff caring for them. Seamless transition to adult services is by no means a universal experience. Here the authors offer two case studies that triangulate inter-related perspectives: those of young people, parents and carers, and the professionals involved in successful models of transition support. The case studies illustrate how the challenge of transitioning to adult services is actually experienced and how, despite some concerns held by young people, parents, and carers, well-planned and coordinated transitions can have positive outcomes for the families involved

A critical analysis of Child and Adolescent Mental Health Services policy in England

Policy in Child and Adolescent Mental Health (CAMH) in England has undergone radical changes in the last 15 years, with far reaching implications for funding models, access to services and service delivery. Using corpus analysis and critical discourse analysis, we explore how childhood, mental health, and CAMHS are constituted in 15 policy documents, 9 pre-2010, and 6 post 2010. We trace how these constructions have changed over time, and consider the practice implications of these changes. We identify how children’s distress is individualised, through medicalising discourses and shifting understandings of the relationship between socioeconomic context and mental health. This is evidenced in a shift from seeing children’s mental health challenges as produced by social and economic inequities, to a view that children’s mental health must be addressed early to prevent future socio-economic burden. We consider the implications CAMHS policies for the relationship between children, families, mental health services and the state. The paper concludes by exploring how concepts of ‘parity of esteem’ and ‘stigma reduction’ may inadvertently exacerbate the individualisation of children’s mental health

Transition from children's to adult services for adolescents/young adults with life-limiting conditions : developing realist programme theory through an international comparison

Abstract Background Managing transition of adolescents/young adults with life-limiting conditions from children’s to adult services has become a global health and social care issue. Suboptimal transitions from children’s to adult services can lead to measurable adverse outcomes. Interventions are emerging but there is little theory to guide service developments aimed at improving transition. The Transition to Adult Services for Young Adults with Life-limiting conditions (TAYSL study) included development of the TASYL Transition Theory, which describes eight interventions which can help prepare services and adolescents/young adults with life-limiting conditions for a successful transition. We aimed to assess the usefulness of the TASYL Transition Theory in a Canadian context to identify interventions, mechanisms and contextual factors associated with a successful transition from children’s to adult services for adolescents/young adults; and to discover new theoretical elements that might modify the TASYL Theory. Methods A cross-sectional survey focused on organisational approaches to transition was distributed to three organisations providing services to adolescents with life-limiting conditions in Toronto, Canada. This data was mapped to the TASYL Transition Theory to identify corresponding and new theoretical elements. Results Invitations were sent to 411 potentially eligible health care professionals with 56 responses from across the three participating sites. The results validated three of the eight interventions: early start to the transition process; developing adolescent/young adult autonomy; and the role of parents/carers; with partial support for the remaining five. One new intervention was identified: effective communication between healthcare professionals and the adolescent/young adult and their parents/carers. There was also support for contextual factors including those related to staff knowledge and attitudes, and a lack of time to provide transition services centred on the adolescent/young adult. Some mechanisms were supported, including the adolescent/young adult gaining confidence in relationships with service providers and in decision-making. Conclusions The Transition Theory travelled well between Ireland and Toronto, indicating its potential to guide both service development and research in different contexts. Future research could include studies with adult service providers; qualitative work to further explicate mechanisms and contextual factors; and use the theory prospectively to develop and test new or modified interventions to improve transition

Children and Young People’s Health Outcomes Forum—Report of The Public Health and Prevention Sub-Group.

The Public Health Group of the Children and Young People’s Health Outcomes Forum focused on developing suggestions and recommendations for how the new health system could improve the life chances of children and young people by promoting good health and acting early where problems are developing. Our aspiration is that the new system supports all infants, children, and young people; helped by their families, to lead healthy lives as they grow and develop into adults. Throughout our work, we have been guided by the Faculty of Public Health’s definition of public health: ‘The science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society.