Effect of managed transition on mental health outcomes for young people at the child–adult mental health service boundary: a randomised clinical trial

Abstract

Background Poor transition planning contributes to discontinuity of care at the child–adult mental health service boundary (SB), adversely affecting mental health outcomes in young people (YP). The aim of the study was to determine whether managed transition (MT) improves mental health outcomes of YP reaching the child/adolescent mental health service (CAMHS) boundary compared with usual care (UC). Methods A two-arm cluster-randomised trial (ISRCTN83240263 and NCT03013595) with clusters allocated 1:2 between MT and UC. Recruitment took place in 40 CAMHS (eight European countries) between October 2015 and December 2016. Eligible participants were CAMHS service users who were receiving treatment or had a diagnosed mental disorder, had an IQ ⩾ 70 and were within 1 year of reaching the SB. MT was a multi-component intervention that included CAMHS training, systematic identification of YP approaching SB, a structured assessment (Transition Readiness and Appropriateness Measure) and sharing of information between CAMHS and adult mental health services. The primary outcome was HoNOSCA (Health of the Nation Outcome Scale for Children and Adolescents) score 15-months post-entry to the trial. Results The mean difference in HoNOSCA scores between the MT and UC arms at 15 months was −1.11 points (95% confidence interval −2.07 to −0.14, p = 0.03). The cost of delivering the intervention was relatively modest (€17–€65 per service user). Conclusions MT led to improved mental health of YP after the SB but the magnitude of the effect was small. The intervention can be implemented at low cost and form part of planned and purposeful transitional care.

Annual Research Review: A systematic review of mental health services for emerging adults – moulding a precipice into a smooth passage

“…Most were conducted in the past 5‐year period ( n = 30), based in the United Kingdom ( n = 29) and either did not differentiate between types of mental health conditions ( n = 24) or focused on attention deficit hyperactivity disorder (ADHD) ( n = 16), see Table 1. The most commonly applied methodology was retrospective case note review ( n = 25), and notably we only retrieved one randomised controlled trial (Singh et al., 2021).…”

“…Only four studies evaluated interventions designed to facilitate transition and ensure continuity of care for young people transitioning from CAMHS to AMHS (Cappelli et al., 2016; Maslow, 2016; Moosa & Sandhu, 2015; Singh et al., 2021). These included an evaluation of a quality improvement project focused on transition and continuity of care for young people with ADHD (Moosa & Sandhu, 2015), and an assessment of the utility of a transition clinic established to keep young people with psychiatric conditions in contact with services while awaiting intake into AMHS (Maslow, 2016).…”

“…Young people and families participating in the programme received support from a transition coordinator who helped prepare them for transition and ensured continuity of care (Cappelli et al, 2016). The recently completed cluster randomised controlled trial, the MILESTONE study, tested the effectiveness of a complex managed transition process in eight European countries (Singh et al, 2021). The intervention involved the systematic identification of those approaching the transition age boundary, with a structured assessment of needs to facilitate transition planning and information transfer, if required.…”

“…In addition, Appleton (2021) in a secondary analysis of data from the MILESTONE study (Singh et al, 2021) selected a cohort of a young people with anxiety, depression, neurodevelopmental and emerging personality disorders as prior work suggested that such young people were particularly likely to drop through gaps in services (Appleton, 2021). The wider MILE-STONE cohort study included young people with any diagnosis (Singh et al, 2021). There were several studies of transition among young people with neurodevelopmental conditions, particularly ADHD, which are therefore grouped and discussed separately below.…”

“…We identified 24 papers describing 19 unique studies that focused on the transition of young people to AMHS regardless of their specific mental health condition (see Table ). Twelve studies included participants with any MH diagnoses without further specification (Adamopoulos & Samuel, 2021; Cohen, Klodnick, Kramer, Strakowski, & Baker, 2020; Garcia, Boix, Vegue, & De Angel, 2019; Islam et al., 2016; Leeb et al., 2020; Livanou et al., 2020; McNicholas et al., 2015; Paul et al., 2013; Pottick, Bilder, Vander Stoep, Warner, & Alvarez, 2008; Reneses et al., 2018; Saour, 2021; Singh et al., 2010, 2021; Stagi, Galeotti, Mimmi, Starace, & Castagnini, 2015). One study focused on ‘serious’ mental health disorders and provided the following example: schizophrenia spectrum, bipolar and major depressive disorders (Cohen et al., 2020).…”