Process, outcome and experience of transition from child to adult mental healthcare : multiperspective study

Background Many adolescents with mental health problems experience transition of care from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). Aims As part of the TRACK study we evaluated the process, outcomes and user and carer experience of transition from CAMHS to AMHS. Method We identified a cohort of service users crossing the CAMHS/AMHS boundary over 1 year across six mental health trusts in England. We tracked their journey to determine predictors of optimal transition and conducted qualitative interviews with a subsample of users, their carers and clinicians on how transition was experienced. Results Of 154 individuals who crossed the transition boundary in 1 year, 90 were actual referrals (i.e. they made a transition to AMHS), and 64 were potential referrals (i.e. were either not referred to AMHS or not accepted by AMHS). Individuals with a history of severe mental illness, being on medication or having been admitted were more likely to make a transition than those with neurodevelopmental disorders, emotional/neurotic disorders and emerging personality disorder. Optimal transition, defined as adequate transition planning, good information transfer across teams, joint working between teams and continuity of care following transition, was experienced by less than 5% of those who made a transition. Following transition, most service users stayed engaged with AMHS and reported improvement in their mental health. Conclusions For the vast majority of service users, transition from CAMHS to AMHS is poorly planned, poorly executed and poorly experienced. The transition process accentuates pre-existing barriers between CAMHS and AMH

Back to the workplace: How organisations can improve their support for management learning and development

This paper explores how organisations can become more sophisticated at supporting transfer of learning, by identifying the perceived barriers and facilitators to transfer of learning, by examining a range of individual characteristics and workplace features associated with these barriers and facilitators and then relating these to the type of programme that managers undertake. The longitudinal survey methodology and programme typology used in the research are described. Findings highlight 26 perceived barriers and 17 facilitators to the transfer of learning, significant associations are shown with particular features such as mentoring and personal values. The paper goes on to identify the characteristics associated with a lack of transfer and suggests a tentative model of perceived influences on transfer of learning. Based on this research, it is concluded that it is important to take programme learning design into account when considering support for transfer of learning from management development programmes back to the workplace

Transferring managerial learning back to the workplace : the influence of personality and the workplace environment

This thesis identifies the influences of individual characteristics, particularly psychological type preferences, and workplace environment features, on managers’ perceptions of the barriers and facilitators to transferring their learning from management development programmes. In doing so, it provides information and insights to help increase understanding of the transfer of learning process through the building of a model of transfer. Guided by a Realist perspective, this research was conducted using longitudinal survey methodology, incorporating both questionnaires and interviews. The survey gathered data at three time points, establishing a chronological ‘Base Map’ representing programme participants’ journeys through four kinds of learning event/experience, their expectations of those programmes, resulting learning outcomes and applications of learning back in their workplaces. This research identified 26 perceived barriers and 17 perceived facilitators to transfer of learning from 17 organisations, incorporating a wide range of workplace environments, described how these barriers and facilitators operate and identified the need to take the nature of the learning event/experience into account to provide a meaningful context for the transfer of learning outcomes. This research presents a series of ‘Route Maps’, highlighting the significant associations between individual characteristics, workplace features and elements of the learning and transfer processes, based on programme type. Psychological type was found to influence perceptions of barriers and facilitators to transfer and is associated with critical elements in the transfer process. This thesis contributes to theory and practice about transfer of learning from management development programmes and has implications for organisations, programme designers and future participants on such programmes

Transition from CAMHS to adult mental health services (TRACK) : a study of policies, process and user and carer perspective (TRACK)

Adolescents with mental health problems are poorly served by mental health services, even though this is an age when serious mental disorders such as schizophrenia occur. Some CAMHS services only take those 16-years or older cases who are in full time education, while many adult services set a minimum age criteria of 18 for access to adult services. Young people between 16-18 years, who are not in full time education or employment, get excluded by both services. Service providers are well aware of barriers at services interface which can cause vulnerable young people to slip through the care net at a time when they most need health and social care. Yet there is no research on the size of the problem, the organisational structures and processes that impact upon and influence transition, the experiences of those undergoing transition or how to ensure a smooth transition across services. The TRACK study aims to identify what factors facilitate or impede effective transition of patients from CAMHS to adult services; what barriers exist at the interface of these services; what are the outcomes of those who make a transition and those who need transition but fall through the care net; and how users, carers, and care co-ordinators experience transition. We will achieve this by conducting an audit of transition policies and procedures within six mental health trusts in London, Coventry and Warwickshire. Young people under the care of CAMHS who reach the transition age will be identified and their progress through the health care system evaluated over one year by a case note survey. Semi-structured interviews will be conducted with a representative sample of professional staff working in CAHMS, adult services, social services and voluntary organisations to explore factors which influence organisational boundaries, cultures, processes and resources which influence transition of care. In-depth interviews will be conducted with a group of users who underwent transition, their carers and care co-ordinators. The study steering group will involve service users, carers, voluntary organisations and relevant charities, along with clinicians and academics. The findings from the study will determine what facilitates and impedes transition, help services ensure that effective intervention continues to be available to vulnerable children at risk of falling through the care net during transition across services, and improve communication between users, clinicians and healthcare agencies. The study will help understand the crucial and as yet unexplored impact of organisational structures and culture at the interface of adolescent and adult services on organisational performance, quality and continuity of care, and patient and carer experiences

Pan-London tuberculosis services: a service evaluation

<p>Abstract</p> <p>Background</p> <p>London has the largest proportion of tuberculosis (TB) cases of any western European capital, with almost half of new cases drug-resistant. Prevalence varies considerably between and within boroughs with research suggesting inadequate control of TB transmission in London. Economic pressures may exacerbate the already considerable challenges for service organisation and delivery within this context. This paper presents selected findings from an evaluation of London’s TB services’ organisation, delivery, professional workforce and skill mix, intended to support development of a strategic framework for a pan-London TB service. These may also interest health service professionals and managers in TB services in the UK, other European cities and countries and in services currently delivered by multiple providers operating independently.</p> <p>Methods</p> <p>Objectives were: 1) To establish how London’s TB services are structured and delivered in relation to leadership, management, organisation and delivery, coordination, staffing and support; 2) To identify tools/models for calculating skill mix as a basis for identifying skill mix requirements in delivering TB services across London; 3) To inform a strategic framework for the delivery of a pan-London TB service, which may be applicable to other European cities. The multi-method service audit evaluation comprised documentary analysis, semi-structured interviews with TB service users (n = 10), lead TB health professionals and managers (n = 13) representing London’s five sectors and focus groups with TB nurses (n = 8) and non-London network professionals (n = 2).</p> <p>Results</p> <p>Findings showed TB services to be mainly hospital-based, with fewer community-based services. Documentary analysis and professionals’ interviews suggested difficulties with early access to services, low suspicion index amongst some GPs and restricted referral routes. Interviews indicated lack of managed accommodation for difficult to treat patients, professional workforce shortages, a need for strategic leadership, nurse-led clinics and structured career paths for TB nurses and few social care/outreach workers to support patients with complex needs.</p> <p>Conclusions</p> <p>This paper has identified key issues relating to London’s TB services’ organisation, delivery, professional workforce and skill mix. The majority of these present challenges which need to be addressed as part of the future development of a strategic framework for a pan-London TB service. More consistent strategic planning/co-ordination and sharing of best practice is needed, together with a review of pan-London TB workforce development strategy, encompassing changing professional roles, skills development needs and patient pathways. These findings may be relevant with the development of TB services in other European cities.</p