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

Singh, Swaran P.; Paul, Moli; Ford, Tamsin; Kramer, Tami; Weaver, Tim; McLaren, Susan; Hovish, Kimberly; Islam, Zoebia; Belling, Ruth; White, Sarah

doi:10.1192/bjp.bp.109.075135

Cited by 322 publications

(528 citation statements)

References 14 publications

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“…This may not regularly occur because young adults with chronic medical and mental health conditions are particularly vulnerable to disrupted medical care during the years of transition from pediatric to adult care (39,40). This study suggests that mental health and eating disturbances in particular should be an important clinical focus of effective transition and continuity of care for young women with type 1 diabetes.…”

Section: Discussionmentioning

confidence: 99%

Eating Disorders in Girls and Women With Type 1 Diabetes: A Longitudinal Study of Prevalence, Onset, Remission, and Recurrence

et al. 2015

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OBJECTIVEGirls and women with type 1 diabetes are at increased risk for developing eating disorders (EDs), and these disorders are associated with serious diabetes-related medical complications. This study describes the longitudinal course of disturbed eating behavior (DEB) and EDs in a cohort with type 1 diabetes. RESEARCH DESIGN AND METHODSA total of 126 girls with type 1 diabetes receiving care for diabetes at The Hospital for Sick Children in Toronto participated in a series of seven interview-based assessments of ED behavior and psychopathology over a 14-year period, beginning in late childhood. Survival analysis was used. RESULTSMean age was 11.8 6 1.5 years at time 1 and 23.7 6 2.1 years at time 7. At time 7, 32.4% (23/71) met the criteria for a current ED, and an additional 8.5% (6/71) had a subthreshold ED. Mean age at ED onset (full syndrome or below the threshold) was 22.6 years (95% CI 21.6-23.5), and the cumulative probability of onset was 60% by age 25 years. The average time between onset of ED and subsequent ED remission was 4.3 years (95% CI 3.1-5.5), and the cumulative probability of remission was 79% by 6 years after onset. The average time between remission of ED and subsequent recurrence was 6.5 years (95% CI 4.4-8.6), and the cumulative probability of recurrence was 53% by 6 years after remission. CONCLUSIONSIn this longitudinal study, EDs were common and persistent, and new onset of ED was documented well into adulthood. Further research regarding prevention and treatment for this vulnerable group is urgently needed.The prevalence, clinical characteristics, and medical consequences of disturbed eating behavior (DEB) and eating disorders (EDs) in individuals with type 1 diabetes has received increasing attention since case reports of this dangerous combination were first published in the 1980s (1,2). Although the specificity of this association was initially unclear, systematic research has demonstrated that teenage girls and women with type 1 diabetes are at significantly increased risk of DEB compared with their nondiabetic peers (3). Such DEB includes dieting, fasting, binge-eating, and a range of compensatory and purging behaviors that can directly interfere with optimal diabetes management. A slide set summarizing this article is available online.

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Section: Discussionmentioning

confidence: 99%

Eating Disorders in Girls and Women With Type 1 Diabetes: A Longitudinal Study of Prevalence, Onset, Remission, and Recurrence

et al. 2015

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“…For example, Singh and colleagues found that for the vast majority of service users, transition from children's mental health to adult mental health services was poorly planned, poorly executed, and poorly experienced. 22 The physical health needs of people with psychosis are well documented, 23,24 and reflected in English national guidance. 25,26 However, this paper suggests that both primary and secondary care health services and service users themselves have yet to respond fully to the physical health challenges posed by the condition, lifestyle, and treatments.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Service users' views of moving on from early intervention services for psychosis: a longitudinal qualitative study in primary care

Lester

Khan²,

Jones³

et al. 2012

Br J Gen Pract

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BackgroundThe role of primary care for young people with psychosis, and transitions between specialist mental health services and primary care, are underexplored areas, both clinically and in research terms. AimTo explore service users' perspectives of early intervention services and primary care, in-depth and over time. Design and settingLongitudinal qualitative methodology in five geographically diverse sites across England. MethodSemi-structured interviews with 21 young people with first-episode psychosis at two time points. ResultsEarly intervention services are highly prized by service users; however, the 'gold standard' nature of the care is difficult to replicate in other services and may lead to unrealistic expectations. Flexibility in terms of the timing of discharge does appear to be happening in practice, but continuity is not always well established before discharge. Primary care seems to be under-utilised, both as a location of care during time with the early intervention service and as a skill set, particularly for physical health problems. Service users expected GPs to advocate for and navigate the health system, particularly at times of crisis or relapse. ConclusionEarly intervention services should focus on actively establishing relationships between service users and either the community mental health team or the GP in the months leading up to discharge, and ensuring that service users' expectations about access and availability of care are 'realistic'. Primary care could be better utilised, even when service users are actively engaged with early intervention services, to help ensure physical health needs are met from the start of treatment. Keywordscontinuity of care; health; primary care; psychoses; qualitative research.

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“…As an iterative process, it enabled amendment and additions to the analytic framework throughout, grounding the analysis in participants' accounts. The Framework method allowed for dyadic analysis (Akeson et al, 2007;Ellis et al, 2012;Singh et al, 2010), aided by separate interviews for patients and their partners (Eisikovits & Koren, 2010).…”

Section: Designmentioning

confidence: 99%

Shared recovery: Couples' experiences after treatment for colorectal cancer

White

Newman

2016

European Journal of Oncology Nursing

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DisclosureThe authors declare no conflict of interest or external funding. COUPLES' EXPERIENCES AFTER COLORECTAL CANCER AbstractPurpose: Completing cancer treatment involves significant challenges for patients as well as their families. This study aimed to explore couples' experiences of colorectal (bowel) cancer, focusing on the transition after treatment.Method: Separate, semi-structured interviews were conducted within 12 months of completing treatment with a purposeful sample of ten participants, comprising five patientpartner dyads. Data were analysed using the Framework approach, incorporating dyadic analysis to compare narratives within as well as between couples.Results: Three main themes were elaborated: the process of recovery, the relationship dynamics, and the mixed experiences of healthcare services. The lasting impact of cancer following completion of treatment was evident for patients as well as their partners, and was shaped by their reciprocal influence on each other.Conclusions: The findings underscore the value of a systemic approach for supporting couples during recovery from colorectal cancer and demonstrate the need for consistency of healthcare provision across the cancer trajectory, including post-treatment.

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

Abstract: 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 AMHS.

Cited by 322 publications

References 14 publications

Eating Disorders in Girls and Women With Type 1 Diabetes: A Longitudinal Study of Prevalence, Onset, Remission, and Recurrence

Eating Disorders in Girls and Women With Type 1 Diabetes: A Longitudinal Study of Prevalence, Onset, Remission, and Recurrence

Service users' views of moving on from early intervention services for psychosis: a longitudinal qualitative study in primary care

Shared recovery: Couples' experiences after treatment for colorectal cancer

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