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Lees R, Lawn W, Petrilli K, Brown A, Trinci K, Borissova A, Ofori S, Mokrysz C, Curran HV, Hines LA, Freeman TP. Persistent increased severity of cannabis use disorder symptoms in adolescents compared to adults: a one-year longitudinal study. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01806-y. [PMID: 38709252 DOI: 10.1007/s00406-024-01806-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/02/2024] [Indexed: 05/07/2024]
Abstract
Adolescence is a developmental period characterised by increased vulnerability to cannabis use disorder (CUD). However, previous investigations of this vulnerability have relied on cross-sectional comparisons and lack a detailed assessment of cannabis quantity, a potentially important confounding factor. Here, we aimed to investigate the one-year course of CUD in adolescents compared to adults who currently use cannabis, adjusting for a comprehensive measure of cannabis quantity. Data are from a one-year observational longitudinal study (CannTeen) of adolescents and adults who currently used cannabis regularly with five waves of assessment at 3-monthly intervals, based in London, UK. Participants were n = 70 adults (26-29, 45.7% female), who did not regularly use cannabis when they were under age 18, and n = 76 adolescents (16-17, 50.0% female). The exposure was adolescent (compared to adult) frequent cannabis use. The primary outcome was CUD symptoms measured using the cannabis use disorder identification test revised (CUDIT-R) at five time points. Models were adjusted for cannabis quantity using mean weekly standard THC units (one unit = 5 mg THC). Other covariates included gender, and whether each session occurred before or during the COVID-19 pandemic. In models adjusted for pre-registered covariates, adolescents scored 3.7 points higher on the CUDIT-R compared to the adult group across the 5 assessment waves (3.66 95% CIs 1.99, 5.34). There was also evidence of a linear reduction in symptoms over time in both groups (-0.47, 95%CIs -0.67, -0.27). Adolescents had persistently increased CUD symptoms compared to adults across the 12-month period. This association was robust after adjusting for the quantity of cannabis consumed and other covariates.
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Affiliation(s)
- Rachel Lees
- Addiction and Mental Health Group, Department of Psychology, University of Bath, Bath, UK.
| | - Will Lawn
- Department of Psychology, Kings College London, London, UK
| | - Kat Petrilli
- Addiction and Mental Health Group, Department of Psychology, University of Bath, Bath, UK
| | - Amelia Brown
- Addiction and Mental Health Group, Department of Psychology, University of Bath, Bath, UK
| | - Katie Trinci
- Clinical Psychopharmacology Unit, UCL, London, UK
| | - Anya Borissova
- Clinical Psychopharmacology Unit, UCL, London, UK
- Department of Neuroimaging, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Shelan Ofori
- Clinical Psychopharmacology Unit, UCL, London, UK
| | | | | | - Lindsey A Hines
- Addiction and Mental Health Group, Department of Psychology, University of Bath, Bath, UK
| | - Tom P Freeman
- Addiction and Mental Health Group, Department of Psychology, University of Bath, Bath, UK
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Brown-Hollie JP, Suarez-Balcazar Y. Participation Outcomes Among Black Children with Disabilities: A Scoping Review. Phys Occup Ther Pediatr 2023; 44:78-95. [PMID: 37211802 DOI: 10.1080/01942638.2023.2212073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 05/23/2023]
Abstract
AIM Participation disparities among Black children with disabilities are widely documented in a variety of disciplines. Grounded in the Social Model of Disability and Disability Critical Race Theory, the purpose of this scoping review was to examine the extent to which occupational therapy has contributed to the study of participation outcomes among Black children with disabilities. METHODS Empirical studies published from 2010 to 2021 that reported participation outcome data published in nine frequently cited journals were included in this scoping review. Twenty studies were found to meet the criteria. RESULTS Participation outcomes were reported for six occupations: play, social participation, activities of daily living (ADLs), education, sleep, and health management). The majority of studies reviewed recruited small samples of Black children with disabilities and provided limited to no description of the specific participation differences by racial/ethnic demographics. CONCLUSION Occupational therapy has made few contributions to the growing literature on participation disparities for Black children with disabilities. Implications for practice are discussed.
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Markoulakis R, Cader H, Chan S, Kodeeswaran S, Addison T, Walsh C, Cheung A, Charles J, Sur D, Scarpitti M, Willis D, Levitt A. Transitions in mental health and addiction care for youth and their families: a scoping review of needs, barriers, and facilitators. BMC Health Serv Res 2023; 23:470. [PMID: 37165343 PMCID: PMC10171912 DOI: 10.1186/s12913-023-09430-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/20/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Transitional-aged youth (TAY) with mental health and/or addictions (MHA) concerns and their families experience significant challenges finding, accessing, and transitioning through needed MHA care. To develop appropriate supports that assist TAY and their families in navigating MHA care, their experiences of transitions in the MHA care system must be better understood. This scoping review identifies and explores the needs, barriers, and facilitators for TAY and their families when transitioning through MHA care. METHODS This scoping review commenced with a search of five relevant databases. Three research team members were involved in title, abstract, and full-text scanning and data extraction. Sources focusing on TAY anywhere between the ages of 12-29 years and meeting the study objectives were included. Extractions compiled background and narrative information about the nature and extent of the data. Analysis and synthesis of findings involved numerical description of the general information extracted (e.g., numbers of sources by country) and thematic analysis of narrative information extracted (e.g., family involvement in TAY help-seeking). RESULTS A total of 5894 sources were identified. Following title and abstract scanning, 1037 sources remained for full-text review. A total of 66 sources were extracted. Findings include background information about extracted sources, in addition to five themes that emerged pertaining to barriers and facilitators to access and transitions through care and the needs and roles of TAY and families in supporting help-seeking and care transitions: holistic supports, proactive preparation, empowering TAY and families, collaborative relationships, and systemic considerations. These five themes demonstrate approaches to care that can ensure TAY and families' needs are met, barriers are mitigated, and facilitators are enhanced. CONCLUSION This review provides essential contextual information regarding TAY with MHA concerns and their families' needs when seeking care. Such findings lend to an enhanced understanding of how MHA programs can support this population's needs, involve family members as appropriate, reduce the barriers experienced, and work to build upon existing facilitators.
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Affiliation(s)
- Roula Markoulakis
- Sunnybrook Research Institute, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
| | - Hinaya Cader
- Sunnybrook Research Institute, Toronto, ON, Canada
| | | | | | | | - Cathy Walsh
- Family Advisory Council, Family Navigation Project at Sunnybrook, Toronto, ON, Canada
| | - Amy Cheung
- Sunnybrook Research Institute, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jocelyn Charles
- University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Deepy Sur
- Ontario Association of Social Work, Toronto, ON, Canada
| | | | - David Willis
- Keystone Child, Youth, and Family Services, Owen Sound, ON, Canada
| | - Anthony Levitt
- Sunnybrook Research Institute, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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[The transition of psychiatric ill adolescents from child and adolescent psychiatric care to adult psychiatric care]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2023; 37:26-32. [PMID: 36414829 DOI: 10.1007/s40211-022-00441-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022]
Abstract
Transition in psychiatry describes the transition from child psychiatric to adult psychiatric care. This transition is not purely medical, it takes place on many levels of care. Transition in the narrow sense describes the targeted and planned process of making this change ideal for patients and medical treaters.Due to the legally fixed border to be an adult at the age of 18 years and different financing systems for children and adults, there is often a break in care of psychiatric ill adolescents. The few available studies show that only about a quarter of patients are satisfied with the process of transition and 90% of employees in the healthcare system also experience this phase as deficient.So far there are no general concepts for an orderly transition in Austria, different individual solutions are available regionally.It is necessary to include all professional groups involved, but due to the regionally very heterogeneous supply, adapted concepts are necessary. It is aimed to include a meeting of all involved professionals, the establishment of good communication and flexibility regarding to the age of transition. Concerning the need for specialized transition facilities, there is currently a lack of solid data in Austria, these data should be collected. Likewise, legal framework conditions would have to be specified and then outpatient, day clinic and inpatient settings would have to be created under child psychiatric and adult psychiatric co-management in order to support the process of transition as best as possible.
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Stewart SE, Best J, Selles R, Naqqash Z, Lin B, Lu C, Au A, Snell G, Westwell-Roper C, Vallani T, Ewing E, Dogra K, Doan Q, Samji H. Age-specific determinants of psychiatric outcomes after the first COVID-19 wave: baseline findings from a Canadian online cohort study. Child Adolesc Psychiatry Ment Health 2023; 17:20. [PMID: 36747252 PMCID: PMC9901839 DOI: 10.1186/s13034-023-00560-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/09/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Canadians endured unprecedented mental health (MH) and support access challenges during the first COVID-19 wave. Identifying groups of individuals who remain at risk beyond the acute pandemic phase is key to guiding systemic intervention efforts and policy. We hypothesized that determinants of three complementary, clinically actionable psychiatric outcomes would differ across Canadian age groups. METHODS The Personal Impacts of COVID-19 Survey (PICS) was iteratively developed with stakeholder feedback, incorporating validated, age-appropriate measures. Baseline, cross-sectional online data collected between November 2020-July 2021 was used in analyses. Age group-specific determinants were sought for three key baseline MH outcomes: (1) current probable depression, generalized anxiety disorder, obsessive-compulsive disorder and/or suicide attempt during COVID-19, (2) increased severity of any lifetime psychiatric diagnosis, and (3) inadequate MH support access during COVID-19. Multivariable logistic regression models were constructed for children, youth (self- and parent-report), young adults (19-29 years) and adults over 29 years, using survey type as a covariate. Statistical significance was defined by 95% confidence interval excluding an odds ratio of one. RESULTS Data from 3140 baseline surveys were analyzed. Late adolescence and early adulthood were identified as life phases with the worst MH outcomes. Poverty, limited education, home maker/caregiver roles, female and non-binary gender, LGBTQ2S + status and special educational, psychiatric and medical conditions were differentially identified as determinants across age groups. INTERPRETATION Negative psychiatric impacts of COVID-19 on Canadians that include poor access to MH support clearly persisted beyond the first wave, widening pre-existing inequity gaps. This should guide policy makers and clinicians in current and future prioritization efforts.
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Affiliation(s)
- S. Evelyn Stewart
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada
| | - John Best
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Robert Selles
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Zainab Naqqash
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Boyee Lin
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Cynthia Lu
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Antony Au
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Gaelen Snell
- grid.61971.380000 0004 1936 7494Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Clara Westwell-Roper
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Tanisha Vallani
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Elise Ewing
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Kashish Dogra
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Quynh Doan
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Pediatrics, University of British Columbia, Vancouver, BC Canada
| | - Hasina Samji
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital Research Institute, Vancouver, BC Canada ,grid.418246.d0000 0001 0352 641XBritish Columbia Centre for Disease Control, Vancouver, BC Canada
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Jackson B, Booth R, Jackson KT. The Good, the Bad, and the Vision: Exploring the Mental Health Care Experiences of Transitional-Aged Youth Using the Photovoice Method. QUALITATIVE HEALTH RESEARCH 2022; 32:1915-1931. [PMID: 36036205 DOI: 10.1177/10497323221121209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Transitional-aged youth (TAY) between the ages of 16 and 24 experience higher rates of mental distress than any other age group. It has long been recognized that stability, consistency, and continuity in mental health care delivery are of paramount importance; however, the disjointed progression from paediatric to adult psychiatric services leaves many TAY vulnerable to deleterious health outcomes. In Spring 2019, eight TAY living with mental health challenges participated in a Photovoice study designed to: (1) illuminate their individual transition experiences; and, (2) support a collective vision for optimal mental health care at this nexus. Participants took photographs that reflected three weekly topics-the good, the bad, and the vision-and engaged in a series of three corresponding photo-elicitation focus group sessions. Twenty-four images with accompanying titles and captions were sorted into nine participant-selected themes. Findings contribute to an enhanced awareness of psychiatric service delivery gaps experienced by TAY, and advocate for seamless and supportive transitions that more effectively meet the mental health care needs of this population.
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Affiliation(s)
- Brianna Jackson
- Yale School of Nursing, 5755Yale University, Orange, CT, USA
| | - Richard Booth
- Arthur Labatt Family School of Nursing, 6221Western University, London, ON, Canada
| | - Kimberley T Jackson
- Arthur Labatt Family School of Nursing, 6221Western University, London, ON, Canada
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Jackson B, Jackson KT, Booth R. "I Fell through the Cracks": Navigating the Disjointed Transition from Paediatric to Adult Psychiatric Services. Issues Ment Health Nurs 2022; 43:507-515. [PMID: 35025711 DOI: 10.1080/01612840.2021.2009604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The transition from adolescence to adulthood is a tumultuous time riddled with stress, confusion, and uncertainty. An abrupt shift in biobehavioural development between the ages of 16 and 24 corresponds with an increase in mental health challenges; thereby necessitating comprehensive and coordinated psychiatric services that bridge pediatric and adult care realms. Unfortunately, this transition is often unsupportive and disjointed, leaving many transitional-aged youth (TAY) overwhelmed and ill-equipped to cope with the increased demands of adulthood independently. Eight TAY with mental health challenges were invited to participate in a PhotoVoice study that explored the strengths and shortcomings of this transition process, through a combination of photography and photo-elicitation focus group discussions. A descriptive qualitative approach was used to analyze all participant dialogue. Four themes emerged from the data: accessibility, coordination, independence, and support. Participant insights illuminated critical gaps in mental health care delivery, but also revealed novel solutions and opportunities for transformational change.
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Affiliation(s)
- Brianna Jackson
- Yale School of Nursing, Yale University, Orange, Connecticut, USA.,Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Kimberley T Jackson
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Richard Booth
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
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Pontoni G, Di Pietro E, Neri T, Mattei G, Longo F, Neviani V, Neri G, Stagi P, Caffo E, Starace F, Galeazzi GM. Factors associated with the transition of adolescent inpatients from an intensive residential ward to adult mental health services. Eur Child Adolesc Psychiatry 2022; 31:805-818. [PMID: 33491124 DOI: 10.1007/s00787-020-01717-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
Transition of young people from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is a complex process. Transition rates are heterogeneously reported, with wide definitions and ranges. Few data are available regarding predictive factors of a successful transition. We explored factors associated with transition in a cohort of former inpatients of a Children and Adolescents Intensive Treatment Ward (CAITW). Socio-demographic and clinical features of patients previously admitted to CAITW were matched to AMHS data for those patients having reached age requirements. We built multiple logistic regression models to identify factors associated with transfer to AMHS (either inpatient or outpatient) and with successful retention in treatment (RIT) at six (short RIT), 12 (intermediate RIT) and 24 months after transfer (long RIT). From a cohort of 322 inpatients, 126 reached the age threshold for transfer to AMHS in the study period. The transfer rate was 50%. Two years after transition-age boundary, CAMHS-AMHS continuity of care was found in 40% and disengagement in 6% of cases. Longer and multiple hospitalizations, atypical antipsychotics prescription and a diagnosis of psychotic disorders were factors associated with short and intermediate RIT. A positive psychiatric family history was negatively associated with successful short and intermediate RIT. Diagnosis of psychosis and learning-supported school attendance were associated with long RIT. Young adults with a history of psychiatric inpatient admission as children or adolescents have a relatively high rate of transition to AMHS. A diagnosis of psychosis seems to be the strongest predictor for transition in these patients. Further research should focus on patients' schooling needs and on children of parents with mental health problems to enhance family and educational system engagement.
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Affiliation(s)
- Giancarlo Pontoni
- Psychiatry Section, Psychophysiological Selection Office, Italian Army National Recruitment and Selection Center, 06034, Foligno, PG, Italy
| | - Elena Di Pietro
- Private Accredited Hospital Villa Igea, 41126, Saliceta San Giuliano, MO, Italy
| | - Tommaso Neri
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125, Modena, Italy
| | - Giorgio Mattei
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125, Modena, Italy
- Marco Biagi Department of Economics and Marco Biagi Foundation, University of Modena and Reggio Emilia, 41121, Modena, Italy
| | - Fedora Longo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125, Modena, Italy
| | - Vittoria Neviani
- Private Accredited Hospital Villa Igea, 41126, Saliceta San Giuliano, MO, Italy
| | - Giovanni Neri
- Private Accredited Hospital Villa Igea, 41126, Saliceta San Giuliano, MO, Italy
| | - Paolo Stagi
- Child and Adolescent Mental Health Service Empoli, Azienda USL Toscana Centro, 50053, Empoli, FI, Italy
| | - Ernesto Caffo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125, Modena, Italy
| | - Fabrizio Starace
- Department of Mental Health and Drug Abuse, Azienda USL Modena, 41124, Modena, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125, Modena, Italy.
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Farrell ML. Transitioning adolescent mental health care services: The steps to care model. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2022; 35:301-306. [DOI: 10.1111/jcap.12377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 02/01/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Marian L. Farrell
- Department of Nursing University of Scranton Scranton Pennsylvania USA
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The Impact of Community Mental Health Programs for Australian Youth: A Systematic Review. Clin Child Fam Psychol Rev 2022; 25:573-590. [PMID: 35171386 PMCID: PMC8853061 DOI: 10.1007/s10567-022-00384-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/27/2022]
Abstract
Australia has undergone significant youth mental health reform over the past 10 years, leading to numerous studies examining the effects of community-based mental health care programs for Australian youth. However, no synthesis of this literature currently exists. Therefore, this systematic review aimed to: (1) describe the types of community-based mental health programs that have been delivered to Australian youth in the past 10 years; and (2) examine their impact in improving young people’s mental health symptomology and psychosocial functioning. A systematic search of the peer-reviewed literature was conducted. Studies were included if they evaluated the extent to which such programs improved mental health symptomology (e.g., depression, anxiety, substance use) and/or psychosocial outcomes (e.g., social functioning, school engagement, employment) for Australian youth aged 10–25 years. Thirty-seven studies were included. Four types of community-based youth mental health care programs were identified: therapy (n = 16), case management (n = 9), integrated ‘one-stop-shop’ (n = 6) and lifestyle (n = 6) programs. The majority of therapeutic programs were effective in reducing mental health symptomology. Case management and integrated approaches consistently yielded significant improvements in both symptomology and psychosocial outcomes. Lifestyle programs were effective in alleviating depressive symptoms, but inconclusive for other outcomes. This review provides support for youth-friendly, systemic, multidisciplinary and integrated assertive outreach models of community mental health care to improve outcomes for young Australians experiencing mental health concerns. Several recommendations for future research are provided to strengthen the local evidence-base supporting community mental health programs to ultimately enhance young people’s life trajectory.
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Bory C, Schmutte T, Davidson L, Plant R. Predictive modeling of service discontinuation in transitional age youth with recent behavioral health service use. Health Serv Res 2022; 57:152-158. [PMID: 34396526 PMCID: PMC8763280 DOI: 10.1111/1475-6773.13871] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/12/2021] [Accepted: 08/02/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To develop and test predictive models of discontinuation of behavioral health service use within 12 months in transitional age youth with recent behavioral health service use. DATA SOURCES Administrative claims for Medicaid beneficiaries aged 15-26 years in Connecticut. STUDY DESIGN We compared the performance of a decision tree, random forest, and gradient boosting machine learning algorithms to logistic regression in predicting service discontinuation within 12 months among beneficiaries using behavioral health services. DATA EXTRACTION We identified 33,532 transitional age youth with ≥1 claim for a primary behavioral health diagnosis in 2016 and Medicaid enrollment of ≥11 months in 2016 and ≥11 months in 2017. PRINCIPAL FINDINGS Classification accuracy for identifying youth who discontinued behavioral health service use was highest for gradient boosting (80%, AUC = 0.86), decision tree (79%, AUC = 0.84), and random forest (79%, AUC = 0.86), as compared with logistic regression (71%, AUC = 0.71). CONCLUSIONS Predictive models based on Medicaid claims can assist in identifying transitional age youth who are at risk of discontinuing from behavioral health care within 12 months, thus allowing for proactive assessment and outreach to promote continuity of care for younger persons who have behavioral health needs.
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Affiliation(s)
| | - Timothy Schmutte
- Department of Psychiatry, School of MedicineYale UniversityNew HavenConnecticutUSA
| | - Larry Davidson
- Department of Psychiatry, School of MedicineYale UniversityNew HavenConnecticutUSA
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Broersen M, Frieswijk N, Coolen R, Creemers DHM, Kroon H. Case Study in Youth Flexible Assertive Community Treatment: An Illustration of the Need for Integrated Care. Front Psychiatry 2022; 13:903523. [PMID: 35633809 PMCID: PMC9133493 DOI: 10.3389/fpsyt.2022.903523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Youth Flexible Assertive Community Treatment (Youth Flexible ACT) is a client- and family-centered service delivery model for young people up to 24 years of age who have interrelated psychiatric- and social problems across multiple life domains and do not readily engage with office-based mental health services. Youth Flexible ACT teams were set up to meet the multifaceted needs of this subgroup in an integrated manner. In this paper, we present a case study to (1) describe the core principles of Youth Flexible ACT and (2) illustrate the application of the mental healthcare model. Subsequently, we describe the contribution of model elements to a positive care process and discuss the challenges of the team in working with the model. The case study displays the importance of integrated flexible and personalized care services to enable adolescents to remain engaged in care.
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Affiliation(s)
- Marieke Broersen
- GGZ Oost Brabant, Oss, Netherlands.,Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | | | | | | | - Hans Kroon
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Trimbos Institute, Utrecht, Netherlands
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Vusio F, Thompson A, Laughton L, Birchwood M. After the storm, Solar comes out: A new service model for children and adolescent mental health. Early Interv Psychiatry 2021; 15:731-738. [PMID: 32519457 DOI: 10.1111/eip.13009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 05/13/2020] [Accepted: 05/24/2020] [Indexed: 11/29/2022]
Abstract
AIM Existing children and adolescent mental health services in the United Kingdom have many gaps, such as reduced access to community-based services, and a lack of early intervention, prevention, and 24/7 crisis care. These gaps prevent timely access to appropriate levels of care, decrease children and young people's engagement with providers, and lead to increased pressures on urgent and emergency care. In this paper, we outline a newly created 0-19 model and its crisis service, which have been transformed into a fully integrated, "joint partnership" service, in line with the recommendations from the recent UK policies that aim to meet the aforementioned challenges. METHOD The "Solar" service is described as a case study of a 0-19 service model. We cover the national and local contexts of the service, in addition to its rationale, aims, organizational structure, strengths and limitations. RESULTS The presented model is a fully integrated and innovative example of a service model that operates without tiers, and helps to create an inclusive, compassionate, stigma-free and youth-friendly environment. Additionally, the model aims to prioritize recovery, early intervention, prevention and the development of resilience. CONCLUSION The 0-19 model is a result of the recent transformation of children and youth mental health services in the United Kingdom. The ongoing evaluation of the 0-19 model and its crisis component will investigate the model's effectiveness, accessibility and acceptability, as well as understanding the potential of the model to contribute towards solving numerous gaps in the existing mental health service provision within the United Kingdom.
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Affiliation(s)
- Frane Vusio
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Liam Laughton
- Solar Service, Bishop Wilson Clinic, Craig Croft, Chelmsley Wood, UK
| | - Max Birchwood
- Warwick Medical School, University of Warwick, Coventry, UK
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Jiang I, Major G, Singh-Grewal D, Teng C, Kelly A, Niddrie F, Chaitow J, O'Neill S, Hassett G, Damodaran A, Bernays S, Manera K, Tong A, Tunnicliffe DJ. Patient and parent perspectives on transition from paediatric to adult healthcare in rheumatic diseases: an interview study. BMJ Open 2021; 11:e039670. [PMID: 33397662 PMCID: PMC7783517 DOI: 10.1136/bmjopen-2020-039670] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To describe the experiences, priorities, and needs of patients with rheumatic disease and their parents during transition from paediatric to adult healthcare. SETTING Face-to-face and telephone semistructured interviews were conducted from December 2018 to September 2019 recruited from five hospital centres in Australia. PARTICIPANTS Fourteen young people and 16 parents were interviewed. Young people were included if they were English speaking, aged 14-25 years, diagnosed with an inflammatory rheumatic disease (eg, juvenile idiopathic arthritis, juvenile dermatomyositis, systemic lupus erythematosus, panniculitis, familial Mediterranean fever) before 18 years of age. Young people were not included if they were diagnosed in the adult setting. RESULTS We identified four themes with respective subthemes: avoid repeat of past disruption (maintain disease stability, preserve adjusted personal goals, protect social inclusion); encounter a daunting adult environment (serious and sombre mood, discredited and isolated identity, fear of a rigid system); establish therapeutic alliances with adult rheumatology providers (relinquish a trusting relationship, seek person-focused care, redefine personal-professional boundaries, reassurance of alternative medical supports, transferred trust to adult doctor) and negotiate patient autonomy (confidence in formerly gained independence, alleviate burden on patients, mediate parental anxiety). CONCLUSIONS During transition, patients want to maintain disease stability, develop a relationship with their adult provider centralised on personal goals and access support networks. Strategies to comprehensively communicate information between providers, support self-management, and negotiate individualised goals for independence during transition planning may improve satisfaction, and health and treatment outcomes.
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Affiliation(s)
- Ivy Jiang
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gabor Major
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle Faculty of Health and Medicine, Callaghan, New South Wales, Australia
| | - Davinder Singh-Grewal
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Department of Rheumatology, The Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Claris Teng
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Ayano Kelly
- Rheumatology, Canberra Rheumatology, Canberra City, Australian Capital Territory, Australia
- College of Health and Medicine, Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Fiona Niddrie
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Jeffrey Chaitow
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
- Department of Rheumatology, The Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Sean O'Neill
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Geraldine Hassett
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Arvin Damodaran
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Rheumatology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Sarah Bernays
- School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
- Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Karine Manera
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David J Tunnicliffe
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- University of Sydney, Sydney School of Public Health, New South Wales Ministry of Health, Sydney, New South Wales, Australia
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15
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Ford T. Transitional care for young adults with ADHD: transforming potential upheaval into smooth progression. Epidemiol Psychiatr Sci 2020; 29:e87. [PMID: 31915090 PMCID: PMC7214737 DOI: 10.1017/s2045796019000817] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 01/10/2023] Open
Abstract
Increasing numbers of young adults need continued support for their attention deficit hyperactivity disorder (ADHD) beyond the age-boundary for children's services. The sparse literature on transition in general suggests patchy provision and huge gaps in transitional care, but also that young people with ADHD and other neurodevelopmental disorders fair particularly badly. Transition in health care coincides with many other important life-transitions while the difficulties associated with ADHD may make these challenges particularly hard to cope with. Parents or other advocates therefore often need to be involved, which can present problems in adult mental health services given that they tend to be less family oriented than children's services. Importantly, young people need help negotiating the transition from passive recipient of care to active self-management, and in building relationships with the adult team.In addition to patchy provision of adult ADHD services, transition is currently hampered by poor understanding of ADHD as a long term condition and uncertain knowledge of what services are available among young people and parents as well as the clinicians working with them. Guidelines recommend, and more importantly young people want, access to psycho-social interventions as well as medication. However, available evidence suggests poor quality transitional care and adult services that are highly focused on medication.Adult ADHD services need to undergo similar development to that experienced by Child and Adolescent Mental Health Services and community paediatrics over the last few decades. While we debate the relative merits of dedicated or specialist v. generic adult mental health services, for young adults with ADHD the training, experience and availability of professionals are more important than their qualifications or setting.
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Affiliation(s)
- Tamsin Ford
- Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road Cambridge CB2 2AH, Exeter, UK
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16
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Broersen M, Frieswijk N, Kroon H, Vermulst AA, Creemers DHM. Young Patients With Persistent and Complex Care Needs Require an Integrated Care Approach: Baseline Findings From the Multicenter Youth Flexible ACT Study. Front Psychiatry 2020; 11:609120. [PMID: 33324268 PMCID: PMC7724087 DOI: 10.3389/fpsyt.2020.609120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/29/2020] [Indexed: 12/27/2022] Open
Abstract
Background: The Multicenter Youth Flexible ACT Study is an ongoing observational prospective cohort study that examines the effects of Youth Flexible ACT (Assertive Community Treatment) on young people with complex care needs who are difficult to engage in traditional (office-based) mental health services. However, a clear and detailed description of this patient group is lacking. In the current paper, we present baseline characteristics and psychosocial outcomes of the Youth Flexible ACT target group and explore the existence of underlying specific patient subgroups. Methods: Sixteen Youth Flexible ACT teams from seven mental healthcare institutes in the Netherlands participated in the study. Research participants were monitored for 18 months and administered questionnaires measuring psychiatric- and social functioning every 6 months, yielding four measurements. Baseline data were obtained from 199 adolescents, their mental health workers, and parents/carers. Latent Class Analysis based on HoNOSCA scores (measuring psychosocial and daily functioning) was conducted to identify underlying subgroups. Results: The target group of Youth Flexible ACT mainly consisted of patients older than 15 years of age with a history of (specialized) mental healthcare. They face many complex problems, including trauma; developmental, mood, and anxiety disorders; and problems with school attendance, family life, and peer relationships. Other frequently reported difficulties were substance misuse, the involvement of the legal system or police, problems with intellectual functioning, and personal finance. Patients were classified into four distinct classes: the "internalizing," "externalizing," "non-specific," and the "overly impulsive" subgroup. Each subgroup had its unique pattern of difficulties and focus, respectively, high levels of depression and anxiety, disruptive behavior, unspecific difficulties, and substance misuse. Conclusions: As expected, patients in Youth Flexible ACT experienced many severe problems, rendering them vulnerable to fragmented and, thus, ineffective care. Our findings underscore the need for an integrated care approach with a multidisciplinary team of skilled professionals that can bridge these wide-ranging psychosocial problems, as each class of participants experienced a different set of difficulties. Youth Flexible ACT teams need to adjust their care services accordingly.
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Affiliation(s)
- Marieke Broersen
- GGZ Oost Brabant, Oss, Netherlands.,Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | | | - Hans Kroon
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Trimbos Institute, Utrecht, Netherlands
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17
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Toulany A, Stukel TA, Kurdyak P, Fu L, Guttmann A. Association of Primary Care Continuity With Outcomes Following Transition to Adult Care for Adolescents With Severe Mental Illness. JAMA Netw Open 2019; 2:e198415. [PMID: 31373654 PMCID: PMC6681550 DOI: 10.1001/jamanetworkopen.2019.8415] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Adolescents with severe mental illness often age out of pediatric care without a clear transfer of care to adult services. The extent to which primary care provides stability during this vulnerable transition period is not known. OBJECTIVE To analyze the association between primary care continuity during the transition from pediatric to adult care and need for acute mental health services in young adulthood. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used linked health and demographic administrative data for all adolescents aged 12 to 16 years with severe mental illness ascertained by hospitalization for schizophrenia, eating disorder, or mood disorder between April 1, 2002, and April 1, 2014, in Ontario, Canada. Participants were followed up through March 31, 2017. Data were analyzed from July 2018 to January 2019. EXPOSURES Continuous primary care (same physician as baseline [age 12-16 years] always or sometimes), discontinuous primary care (visits to a primary care physician during the transition period who was not the patient's usual physician), and no primary care during the transition period (age 17-18 years). MAIN OUTCOMES AND MEASURES Mental health-related hospitalizations and emergency department visits in young adulthood (age 19-26 years) adjusted for sex, rurality, neighborhood income, mental illness type, and health service use before transition. RESULTS Among 8409 adolescents with severe mental illness (5720 [68.0%] female; mean [SD] age, 14.8 [1.2] years), 5478 (65.1%) had continuous primary care, 2391 (28.4%) had discontinuous primary care, and 540 (6.4%) had no primary care during the transition period. Youths with no primary care during transition were more likely to be male (57.2%), have lower socioeconomic status (31.5%), and have no usual primary care practitioner at baseline (25.6%). Compared with continuous care, patients with discontinuous and no primary care had an increased rate of mental health-related hospitalization in young adulthood (adjusted relative rate, 1.20; 95% CI, 1.10-1.30; and adjusted relative rate, 1.30; 95% CI, 1.08-1.56, respectively). CONCLUSIONS AND RELEVANCE In the context of decreasing outpatient specialist mental health visit rates following transition to adult care, ensuring adequate access to primary care during this vulnerable period may improve mental health outcomes in young adulthood.
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Affiliation(s)
- Alène Toulany
- Division of Adolescent Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Thérèse A. Stukel
- ICES, Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Astrid Guttmann
- ICES, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
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18
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Woody C, Baxter A, Wright E, Gossip K, Leitch E, Whiteford H, Scott JG. Review of services to inform clinical frameworks for adolescents and young adults with severe, persistent and complex mental illness. Clin Child Psychol Psychiatry 2019; 24:503-528. [PMID: 30818969 DOI: 10.1177/1359104519827631] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Severe, persistent and complex mental illness (SPCMI) affects a small proportion of young people but is associated with severe disability and a large burden on families and health services. This article identifies and describes service models for adolescents and young adults with SPCMI. METHODS A systematic search was conducted for services for young people aged 12-25 years with SPCMI. The review sought service models providing extended care and/or multidisciplinary services to meet the complex and long-term needs of this population. RESULTS A total of 43 sources were identified. Evidence of effectiveness was found for both community- and bed-based services. Specific components suggested as important in service delivery included care provided by multidisciplinary teams, consumer and family involvement in care planning, intensive case management and service integration through the continuum of care. CONCLUSION Clinical frameworks for this population must incorporate effective community care integrated with inpatient treatment of short duration. Frameworks require consumer and family-centred care with flexibility to support progression through developmental stages and tasks while addressing issues related to risk management, fluctuation in illness severity and stages of recovery. A continuum of care is necessary to meet the needs that arise from SPCMI in adolescents and young adults.
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Affiliation(s)
- Charlotte Woody
- 1 School of Public Health, Faculty of Medicine, The University of Queensland, Australia.,2 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Amanda Baxter
- 1 School of Public Health, Faculty of Medicine, The University of Queensland, Australia.,2 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Eryn Wright
- 1 School of Public Health, Faculty of Medicine, The University of Queensland, Australia.,2 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Kate Gossip
- 1 School of Public Health, Faculty of Medicine, The University of Queensland, Australia.,2 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Elizabeth Leitch
- 1 School of Public Health, Faculty of Medicine, The University of Queensland, Australia.,2 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Harvey Whiteford
- 1 School of Public Health, Faculty of Medicine, The University of Queensland, Australia.,2 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - James G Scott
- 1 School of Public Health, Faculty of Medicine, The University of Queensland, Australia.,2 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia.,3 Metro North Mental Health, Royal Brisbane and Women's Hospital, Australia
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19
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Russet F, Humbertclaude V, Dieleman G, Dodig-Ćurković K, Hendrickx G, Kovač V, McNicholas F, Maras A, Paramala S, Paul M, Schulze UME, Signorini G, Street C, Tah P, Tuomainen H, Singh SP, Tremmery S, Purper-Ouakil D. Training of adult psychiatrists and child and adolescent psychiatrists in europe: a systematic review of training characteristics and transition from child/adolescent to adult mental health services. BMC MEDICAL EDUCATION 2019; 19:204. [PMID: 31196080 PMCID: PMC6567390 DOI: 10.1186/s12909-019-1576-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/24/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND Profound clinical, conceptual and ideological differences between child and adult mental health service models contribute to transition-related discontinuity of care. Many of these may be related to psychiatry training. METHODS A systematic review on General Adult Psychiatry (GAP) and Child and Adult Psychiatry (CAP) training in Europe, with a particular focus on transition as a theme in GAP and CAP training. RESULTS Thirty-four full-papers, six abstracts and seven additional full text documents were identified. Important variations between countries were found across several domains including assessment of trainees, clinical and educational supervision, psychotherapy training and continuing medical education. Three models of training were identified: i) a generalist common training programme; ii) totally separate training programmes; iii) mixed types. Only two national training programs (UK and Ireland) were identified to have addressed transition as a topic, both involving CAP exclusively. CONCLUSION Three models of training in GAP and CAP across Europe are identified, suggesting that the harmonization is not yet realised and a possible barrier to improving transitional care. Training in transition has only recently been considered. It is timely, topical and important to develop evidence-based training approaches on transitional care across Europe into both CAP and GAP training.
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Affiliation(s)
- Frederick Russet
- CHU Montpellier-Saint Eloi, Médecine Psychologique de l’Enfant et de l’Adolescent, 80, Av Fliche, 34295 Montpellier Cedex 5, France
| | - Veronique Humbertclaude
- CHU Montpellier-Saint Eloi, Médecine Psychologique de l’Enfant et de l’Adolescent, 80, Av Fliche, 34295 Montpellier Cedex 5, France
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Gaelle Hendrickx
- Department of Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium
| | | | - Fiona McNicholas
- Department of Child and Adolescent Psychiatry, School of Medicine and Medical Science and Geary Institute, University College Dublin, Dublin, Ireland
| | - Athanasios Maras
- Yulius Academy, Rotterdam, Netherlands
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Santosh Paramala
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK
- HealthTracker Ltd, Gillingham, UK
| | - Moli Paul
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Stratford Child and Adolescent Health Service, Coventry and Warwickshire Partnership Trust, Stratford on Avon, UK
| | - Ulrike M. E. Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Giulia Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Centre, Brescia, Italy
| | - Cathy Street
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Priya Tah
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Helena Tuomainen
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Swaran P. Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sabine Tremmery
- Department of Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium
- Department of Child & Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - Diane Purper-Ouakil
- CHU Montpellier-Saint Eloi, Médecine Psychologique de l’Enfant et de l’Adolescent, 80, Av Fliche, 34295 Montpellier Cedex 5, France
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20
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Tran QN, Lambeth LG, Sanderson K, Graaff B, Breslin M, Tran V, Huckerby EJ, Neil AL. Trends of emergency department presentations with a mental health diagnosis by age, Australia, 2004–05 to 2016–17: A secondary data analysis. Emerg Med Australas 2019; 31:1064-1072. [DOI: 10.1111/1742-6723.13323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/17/2019] [Accepted: 04/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Quang Nhat Tran
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
| | - Leonard G Lambeth
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
| | - Kristy Sanderson
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
- School of Health SciencesUniversity of East Anglia East Anglia UK
| | - Barbara Graaff
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
| | - Monique Breslin
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
| | - Viet Tran
- Emergency Department, Royal Hobart HospitalTasmanian Health Service Hobart Tasmania Australia
- School of Medicine, College of Health and MedicineUniversity of Tasmania Hobart Tasmania Australia
| | - Emma J Huckerby
- Emergency Department, Royal Hobart HospitalTasmanian Health Service Hobart Tasmania Australia
| | - Amanda L Neil
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
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21
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Hawke LD, Mehra K, Settipani C, Relihan J, Darnay K, Chaim G, Henderson J. What makes mental health and substance use services youth friendly? A scoping review of literature. BMC Health Serv Res 2019; 19:257. [PMID: 31029109 PMCID: PMC6486969 DOI: 10.1186/s12913-019-4066-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 04/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are increasing calls to make mental health and substance use services youth friendly, with hopes of improving service uptake, engagement and satisfaction. However, youth-friendliness in this area has not been clearly defined and there is a lack of information about the characteristics that make such services youth friendly. The purpose of this scoping review was to examine the literature available on youth-friendly mental health and substance use services in order to identify the characteristics, outline the expected impacts, and establish a definition. METHODS A scoping review of seven databases and grey literature sources was conducted. Twenty-eight documents were retained as relevant to the research questions. Relevant data from these documents was extracted, analyzed and presented to stakeholders, including youth, caregivers and service providers to validate and refine the results. RESULTS Youth-friendly mental health and substance use services include integrated, inclusive, confidential and safe organization and policy characteristics; bright, comfortable, environment with informational materials; welcoming and genuine service providers with appropriate communication and counselling skills; an accessible location; minimal wait times; and individualized and innovative approaches. All areas in which youth friendliness should be implemented in a mental health and substance use service organization had a core value of youth voice. CONCLUSION Improving the youth friendliness of mental health and substance use services includes incorporating youth voice in organization, policy, environment, service providers, and treatment services, and has implications for treatment uptake, engagement and satisfaction. Further research is required to determine the impact of youth friendliness in such services.
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Affiliation(s)
- Lisa D. Hawke
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada
- University of Toronto, 250 College Street, Toronto, ON M5T 1R8 Canada
| | - Kamna Mehra
- University of Toronto, 250 College Street, Toronto, ON M5T 1R8 Canada
| | - Cara Settipani
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada
| | - Jaqueline Relihan
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada
| | - Karleigh Darnay
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada
| | - Gloria Chaim
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada
- University of Toronto, 250 College Street, Toronto, ON M5T 1R8 Canada
| | - Joanna Henderson
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada
- University of Toronto, 250 College Street, Toronto, ON M5T 1R8 Canada
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22
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Scholz B, Battams S, Platania-Phung C, Happell B. Transitioning from Adolescent to Adult Mental Health Services: An Integrative Literature Review. Issues Ment Health Nurs 2019; 40:97-111. [PMID: 30571153 DOI: 10.1080/01612840.2018.1524534] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This article aims to present a review of the peer-reviewed, published literature related to the transition from adolescent mental health services to adult mental health services. Six databases (PubMED, Medline, PsycINFO, CINAHL, EMBASE, and Google Scholar) were searched for peer-reviewed, published literature on the transition from adolescent to adult mental health services. Articles on primary research were included in the review if they were published in English between 2000 and 2018, and if they were explicitly about alignment and/or transition between adolescent and adult mental health services. Fifty articles were included in the final review. The findings are discussed in two overarching streams of research from the literature: evaluations of transition arrangements, and the perspectives of various stakeholders (including consumers, carers, and health professionals). The results emphasise the problematic siloes of adolescent and adult mental health services. While there are still no randomised controlled trials on transition to assess transition pathways, our findings have implications to inform best practice in the sector. Given that transitioning to adult mental health services is seen as a point of vulnerability for young people, this review contributes to understandings about how services can offer better support during transition periods.
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Affiliation(s)
- Brett Scholz
- a Medical School , The Australian National University , Canberra , Australia
| | - Samantha Battams
- b Southgate Institute for Health, Society and Equity , Flinders University , Adelaide , South Australia.,c Health Outcomes International , Glynde , Australia
| | - Chris Platania-Phung
- d School of Nursing and Midwifery , University of Newcastle , Newcastle , Australia
| | - Brenda Happell
- d School of Nursing and Midwifery , University of Newcastle , Newcastle , Australia
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Fusar-Poli P. Integrated Mental Health Services for the Developmental Period (0 to 25 Years): A Critical Review of the Evidence. Front Psychiatry 2019; 10:355. [PMID: 31231250 PMCID: PMC6567858 DOI: 10.3389/fpsyt.2019.00355] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022] Open
Abstract
Background: The developmental period from 0 to 25 years is a vulnerable time during which children and young people experience many psychosocial and neurobiological changes and an increased incidence of mental illness. New clinical services for children and young people aged 0 to 25 years may represent a radical transformation of mental healthcare. Method: Critical, non-systematic review of the PubMed literature up to 3rd January 2019. Results: Rationale: the youngest age group has an increased risk of developing mental disorders and 75% of mental disorders begin by the age of 24 and prodromal features may start even earlier. Most of the risk factors for mental disorders exert their role before the age of 25, profound maturational brain changes occur from mid-childhood through puberty to the mid-20s, and mental disorders that persist in adulthood have poor long-term outcomes. The optimal window of opportunity to improve the outcomes of mental disorders is the prevention or early treatment in individuals aged 0 to 25 within a clinical staging model framework. Unmet needs: children and young people face barriers to primary and secondary care access, delays in receiving appropriate treatments, poor engagement, cracks between child and adult mental health services, poor involvement in the design of mental health services, and lack of evidence-based treatments. Evidence: the most established paradigm for reforming youth mental services focuses on people aged 12-25 who experienced early stages of psychosis. Future advancements may include early stages of depression and bipolar disorders. Broader youth mental health services have been implemented worldwide, but no single example constitutes best practice. These services seem to improve access, symptomatic and functional outcomes, and satisfaction of children and young people aged 12-25. However, there are no robust controlled trials demonstrating their impact. Very limited evidence is available for integrated mental health services that focus on people aged 0-12. Conclusions: Children and young people aged 12-25 need youth-friendly mental health services that are sensitive to their unique stage of clinical, neurobiological, and psychosocial development. Early intervention for psychosis services may represent the starting platform to refine the next generation of integrated youth mental health services.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
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White PH, Cooley WC, Boudreau ADA, Cyr M, Davis BE, Dreyfus DE, Forlenza E, Friedland A, Greenlee C, Mann M, McManus M, Meleis AI, Pickler L. Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home. Pediatrics 2018; 142:peds.2018-2587. [PMID: 30348754 DOI: 10.1542/peds.2018-2587] [Citation(s) in RCA: 411] [Impact Index Per Article: 68.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Risk and vulnerability encompass many dimensions of the transition from adolescence to adulthood. Transition from pediatric, parent-supervised health care to more independent, patient-centered adult health care is no exception. The tenets and algorithm of the original 2011 clinical report, "Supporting the Health Care Transition from Adolescence to Adulthood in the Medical Home," are unchanged. This updated clinical report provides more practice-based quality improvement guidance on key elements of transition planning, transfer, and integration into adult care for all youth and young adults. It also includes new and updated sections on definition and guiding principles, the status of health care transition preparation among youth, barriers, outcome evidence, recommended health care transition processes and implementation strategies using quality improvement methods, special populations, education and training in pediatric onset conditions, and payment options. The clinical report also includes new recommendations pertaining to infrastructure, education and training, payment, and research.
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Affiliation(s)
- Patience H. White
- Got Transition/The National Alliance to Advance Adolescent Health and Department of Medicine and Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia; and
| | - W. Carl Cooley
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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