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

Abstract

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