[Transitional and Adolescent Psychiatry in Austria: A Pilot Study on the Attitudes of Experts]

[Transitional psychiatric needs and identity development of adolescents in Tyrol]

BACKGROUND

Due to the structural separation of child and adolescent psychiatric treatment and adult psychiatric treatment, a switch between these two systems upon the age of 18 is necessary. Considering the importance of an organized transition, patients from an age of 17 were asked about their transition needs and aspects of their identity development. Thus future improvements in the treatment structures in this sensitive phase should derive.

METHODS

With the help of the Transition Readiness and Appropriateness Measure (TRAM), the transition-specific needs of 17 to 24-year-old patients (N = 42) at the Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy in Hall in Tirol were surveyed. In addition, the connection between identity development and transition was examined using the Assessment of Identity Development in Adolescence (AIDA).

RESULTS

Almost 80% of the patients stated that they needed further care. 'Patient-related factors' and 'family support' were described as barriers to the willingness to transition. A significant connection was found between identity development and the willingness or need for transition (r = 0.431, p < 0.01), although this was more pronounced in relation to the need for transition (r = 0.821 p < 0.01). In addition, those affected stated that they were frequently and severely burdened by stress, 45% reported self-injurious behavior, 48% suicidal thoughts or behavior in the last six months. In terms of psychopathology, anxiety and depression were among the most common symptoms. In terms of functional impairment, the 'relationships' area was the most affected.

CONCLUSIONS

The study provides initial insights into the transition-specific characteristics and needs of patients in transition age. The integration of standardized measuring instruments in institutional care systems, which individually record the transition-related needs, the willingness and need of young people in transition age, can facilitate targeted and needs-based treatment or transition. Interdisciplinary cooperation between child and adolescent psychiatry and adult psychiatry as well as a continuous transfer of the therapeutic relationships in the transition process should also be guaranteed.

[The transition of psychiatric ill adolescents from child and adolescent psychiatric care to adult psychiatric care]

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.

[Care, provision of care and models of care in child and adolescent psychiatry in Austria]

BACKGROUND

The situation of child and adolescent psychiatric care has gradually improved since 2007, since the creation of the special medical specialty CAP+P. The workinggroup "Versorgung" of the OGKJP provides an overview of the CAP-Services in Austria. There are still massive deficits in supply. This introduction deals with the presentation of the legal requirements and their implementation. The currently valid care concept is laid down in the Austrian Structure Plan Health (ÖSG) and includes outpatient, day-care and inpatient care. Regulatory structures exist for outpatient and inpatient care, but not for dayclinic care. The field of CAP has various special features: the multimodality, the multiprofessionalism, the age groups of those affected, different and differently presented diseases per age, the restriction to a certain age group (< 19 years) and-this connects it with adult psychiatry-a high prevalence of the diseases as well as the integration of psychotherapeutic medicine into the specialization. The consequences resulting from these special features have not yet found their way into the structural and financial calculations.

CONCLUSIONS

Based on the terms describing the term care: "care", "provision" and "supply", a model is presented that could be used as a way of thinking when planning health measures in this area. Since mentally ill children and adolescents can be found in all parts of society, the establishment of a centrally responsible and interdepartmental body for mental health is required.

[Day care clinics central and/or distributed. A standard element of child and adolescent psychiatric care]

BACKGROUND

Day-care clinics as specialized care units of child and adolescent psychiatric care in Austria represent an important component for person-orientated treatment offers. In addition to numerous advantages, they also put higher demands on the young patients and their relatives.

METHODS

The Austrian structure for day-care settings is recorded in the Austrian structure plan for health. Therefore, particular attention is paid to structural quality criteria, which are based on the Austrian concept of performance-oriented hospital financing.

RESULTS

A high demand and need for readiness for transdisciplinary, multimodal treatment concepts and forms is discussed. It becomes ovious that there is a need for large spatial resource requirements. The establishment of several day clinic groups at one location and spatial requirements cannot be found in the concept of performance-oriented hospital financing.

CONCLUSION

To ensure and evaluate the quality of treatment, recommendations are made on a patient-related and team- or organization-related level. The workgroup "day-care-clinic" of the Austrian Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy recommends a treatment structure characterized by transdisciplinarity and participation. Further, it regionalized and local access and the integration of the day clinic into the community is necessary. Networking with other care structures and using social-psychiatric networks is essential. Regional characteristics should be taken into account and specialized, topic-specific day clinic groups should be increasingly included in further planning and concepts.