Objective: The ITRACK study explored the process and predictors of transition between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) in the Republic of Ireland. Method: Following ethical approval, clinicians in each of Ireland's four Health Service Executive (HSE) areas were contacted, informed about the study and invited to participate. Clinicians identified all cases who had reached the transition boundary (i.e. upper age limit for that CAMHS team ) between January and December 2010. Data were collected on clinical and socio-demographic details and factors that informed the decision to refer or not refer to AMHS and case notes were scrutinised to ascertain the extent of information exchanged between services during transition

Adamson, M

Barry, S

Coyne, I

Cullen, W

Dooley, B

Ford, T

Gavin, B

McNamara, N

McNicholas, F

Paul, M

Singh, SP

English

ObjectiveThe ITRACK study explored the process and predictors of transition between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) in the Republic of Ireland.MethodFollowing ethical approval, clinicians in each of Ireland’s four Health Service Executive (HSE) areas were contacted, informed about the study and were invited to participate. Clinicians identified all cases who had reached the transition boundary (i.e. upper age limit for that CAMHS team) between January and December 2010. Data were collected on clinical and socio-demographic details and factors that informed the decision to refer or not refer to the AMHS, and case notes were scrutinised to ascertain the extent of information exchanged between services during transition.ResultsA total of 62 service users were identified as having crossed the transition boundary from nine CAMHS [HSE Dublin Mid-Leinster (n=40, 66%), HSE South (n=18, 30%), HSE West (n=2, 3%), HSE Dublin North (n=1, 2%)]. The most common diagnoses were attention deficit hyperactivity disorder (ADHD;n=19, 32%), mood disorders (n=16, 27%), psychosis (n=6, 10%) and eating disorders (n=5, 8%). Forty-seven (76%) of those identified were perceived by the CAMHS clinician to have an ‘on-going mental health service need’, and of these 15 (32%) were referred, 11 (23%) young people refused and 21 (45%) were not referred, with the majority (12, 57%) continuing with the CAMHS for more than a year beyond the transition boundary. Young people with psychosis were more likely to be referred [χ2(2, 46)=8.96,p=0.02], and those with ADHD were less likely to be referred [χ2(2, 45)=8.89,p=0.01]. Being prescribed medication was not associated with referral [χ2(2, 45)=4.515,p=0.11]. In referred cases (n=15), there was documented evidence of consent in two cases (13.3%), inferred in another four (26.7%) and documented preparation for transition in eight (53.3%). Excellent written communication (100%) was not supported by face-to-face planning meetings (n=2, 13.3%), joint appointments (n=1, 6.7%) or telephone conversations (n=1, 6.7%) between corresponding clinicians.ConclusionsDespite perceived on-going mental health (MH) service need, many young people are not being referred or are refusing referral to the AMHS, with those with ADHD being the most affected. CAMHS continue to offer on-going care past the transition boundary, which has resource implications. Further qualitative research is warranted to understand, in spite of perceived MH service need, the reason for non-referral by the CAMHS clinicians and refusal by the young person.</jats:sec

F. McNicholas

M. Adamson

N. McNamara

B. Gavin

M. Paul

T. Ford

S. Barry

B. Dooley

I. Coyne

W. Cullen

S. P. Singh

Crossref

Irish Journal of Psychological Medicine

Who is in the transition gap? Transition from CAMHS to AMHS in the Republic of Ireland

Nottingham Trent Institutional Repository (IRep)

A Call to Action: Commissioning Mental Health Services for 16-25 yearolds. Stressed Out and Struggling Project.

Adult ADHD patient experiences of impairment, service provision and clinical management in England: a qualitative study. BMC health services research,

Avoiding the 'twilight zone': recommendations for the transition of services from adolescence to adulthood for young people with ADHD.

Estimating the prevalence of adult ADHD in the psychiatric clinic: a cross-sectional study using the adult ADHD self-report scale.

et al (2010). European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD.

Health of the world's adolsecents: a synthesis of internationally comparable data.

Management of adult attention deficit hyperactivity disorder in UK primary care: a survey of general practitioners.

Pathways into adult care.

The Challenge of Managing Severely Ill Patients with Anorexia Nervosa in Ireland.

TRACK: Transfers and transitions between child and adolescent and adult mental health services.

Transition from child and adolescent to adult mental health services in the Republic of Ireland: An investigation of process and operational practice. Early Intervention in Psychiatry. doi: 10.1111/eip.12073

Transition from paediatric to adult care. Bridging the gaps or passing the buck?

Transition to adult care: experiences and expectations of adolescents with a chronic illness.

Transition to adult mental health services for young people with Attention Deficit/Hyperactivity Disorder (ADHD): a qualitative analysis of their experiences.

Turned upside down: developing community-based crisis services for 16-25 years olds experiencing a mental health crisis. Mental Health Foundation.

Young adults with ADHD: an analysis of their service needs on transfer to adult services.

Objective The ITRACK study explored the process and predictors of transition between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) in the Republic of Ireland.

Method Following ethical approval, clinicians in each of Ireland’s four Health Service Executive (HSE) areas were contacted, informed about the study and were invited to participate. Clinicians identified all cases who had reached the transition boundary (i.e. upper age limit for that CAMHS team) between January and December 2010. Data were collected on clinical and socio-demographic details and factors that informed the decision to refer or not refer to the AMHS, and case notes were scrutinised to ascertain the extent of information exchanged between services during transition.

Results A total of 62 service users were identified as having crossed the transition boundary from nine CAMHS [HSE Dublin Mid-Leinster (n=40, 66%), HSE South (n=18, 30%), HSE West (n=2, 3%), HSE Dublin North (n=1, 2%)]. The most common diagnoses were attention deficit hyperactivity disorder (ADHD; n=19, 32%), mood disorders (n=16, 27%), psychosis (n=6, 10%) and eating disorders (n=5, 8%). Forty-seven (76%) of those identified were perceived by the CAMHS clinician to have an ‘on-going mental health service need’, and of these 15 (32%) were referred, 11 (23%) young people refused and 21 (45%) were not referred, with the majority (12, 57%) continuing with the CAMHS for more than a year beyond the transition boundary. Young people with psychosis were more likely to be referred [χ2 (2, 46)=8.96, p=0.02], and those with ADHD were less likely to be referred [χ2 (2, 45)=8.89, p=0.01]. Being prescribed medication was not associated with referral [χ2 (2, 45)=4.515, p=0.11]. In referred cases (n=15), there was documented evidence of consent in two cases (13.3%), inferred in another four (26.7%) and documented preparation for transition in eight (53.3%). Excellent written communication (100%) was not supported by face-to-face planning meetings (n=2, 13.3%), joint appointments (n=1, 6.7%) or telephone conversations (n=1, 6.7%) between corresponding clinicians.

Conclusions Despite perceived on-going mental health (MH) service need, many young people are not being referred or are refusing referral to the AMHS, with those with ADHD being the most affected. CAMHS continue to offer on-going care past the transition boundary, which has resource implications. Further qualitative research is warranted to understand, in spite of perceived MH service need, the reason for non-referral by the CAMHS clinicians and refusal by the young person

Who is in the transition gap? Transition from CAMHS to AMHS in the Republic of Ireland

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