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Price A, Smith JR, Mughal F, Salimi A, Melendez-Torres GJ, Newlove-Delgado T. Protocol for the mixed methods, Managing young people (aged 16-25) with Attention deficit hyperactivity disorder in Primary care (MAP) study: mapping current practice and co-producing guidance to improve healthcare in an underserved population. BMJ Open 2023; 13:e068184. [PMID: 37429692 DOI: 10.1136/bmjopen-2022-068184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and adolescents, with an average worldwide prevalence of 5%. Up to 40% of young people continue to experience symptoms into adulthood. Young people with ADHD experience poorer outcomes than their peers across multiple domains, with treatment shown to reduce these risks. Primary care practitioners play an important role in healthcare provision for this group in the UK. However, many feel unsure about how best to provide support, reporting prescribing concerns and need for more evidence-based guidance. A lack of national data on primary care provision hinders efforts to improve access to care and optimise outcomes. This mixed-methods study aims to provide evidence that may be used to improve primary care services for young people aged 16-25 years with ADHD. METHODS AND ANALYSIS There are three interlinked work packages: (a) a mapping study including a survey of stakeholders (healthcare professionals, people with ADHD and commissioners) will map ADHD prescribing practice, shared-care arrangements, available support and practitioner roles by geographic locations across England for different respondent groups; (b) a qualitative study involving semi-structured interviews with stakeholders (10-15 healthcare professionals and 10-15 people with ADHD) will explore experiences of 'what works' and 'what is needed' in terms of service provision and synthesise findings; (c) workshops will integrate findings from (a) and (b) and work with stakeholders to use this evidence to codevelop key messages and guidance to improve care. ETHICS AND DISSEMINATION The protocol has been approved by Yorkshire and the Humber-Bradford Leeds Research Ethics Committee. Recruitment commenced in September 2022. Findings will be disseminated via research articles in peer-reviewed journals, conference presentations, public involvement events, patient groups and media releases. A summary of study findings will be shared with participants at the end of the study. TRIAL REGISTRATION NUMBER NCT05518435.
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Affiliation(s)
- Anna Price
- Health and Community Sciences, University of Exeter Medical School, Exeter, UK
| | - Jane R Smith
- Health and Community Sciences, University of Exeter Medical School, Exeter, UK
| | - Faraz Mughal
- Keele University School of Medicine, Keele, UK
- Keele University, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - Anita Salimi
- Health and Community Sciences, University of Exeter Medical School, Exeter, UK
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Scarpellini F, Bonati M. Transition care for adolescents and young adults with attention-deficit hyperactivity disorder (ADHD): A descriptive summary of qualitative evidence. Child Care Health Dev 2022; 49:431-443. [PMID: 36223008 DOI: 10.1111/cch.13070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 09/07/2022] [Accepted: 10/08/2022] [Indexed: 11/28/2022]
Abstract
The review presents a summary of available evidence about transition care of ADHD patients from all service users' perspectives. Common barriers, and suggestions for improvement ADHD of transition care, were extrapolated from qualitative research, including case notes studies, and were exposed. A comprehensive search of the PubMed, Embase, PsychInfo and Web of Science databases for articles published up to October 2021 was conducted to summarize recent evidence on the experiences of all stakeholders involved in the transition process. Reviews, other chronic conditions and different meaning of transition were excluded. Authors extracted data and assessed study quality independently. Findings were discussed taking into consideration barriers and suggestions from all service users' perspectives. Findings from 23 studies with different context and methods were collected and summarized. Most of the studies were conducted in UK, using interviews and questionnaires, and addressed to the physicians. The lack of information about ADHD as a condition and about transition process were the barriers most reported, while joint working and sharing transition protocols were the suggestions pointed out by all stakeholders. Despite different perspectives, all stakeholders exposed similar needs. The review reveals an evident need for defining and evaluating the effectiveness of transition programmes from child to adult ADHD services.
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Affiliation(s)
- Francesca Scarpellini
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maurizio Bonati
- Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Titheradge D, Godfrey J, Eke H, Price A, Ford T, Janssens A. Why young people stop taking their attention deficit hyperactivity disorder medication: A thematic analysis of interviews with young people. Child Care Health Dev 2022; 48:724-735. [PMID: 35102579 PMCID: PMC9545018 DOI: 10.1111/cch.12978] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 01/20/2022] [Accepted: 01/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that can persist into adulthood. Young people often stop taking ADHD medication during adolescence despite evidence that continuation would be beneficial. Increasingly, young people are restarting medication in early adulthood suggesting that cessation was premature. In this paper we explore the reasons given by young people for discontinuing ADHD medication. METHODS Qualitative data from the Children and Adolescents with ADHD in Transition between Children's and Adult Services (CATCh-uS) project was analysed to look for reasons for stopping medication. Semi-structured interviews with three groups of young people were analysed using thematic and framework analysis; this included young people prior to transition (n = 21); young people that had successfully transitioned to adult services (n = 22); and young people who left children's services prior to transition but re-entered adult services later (n = 21). RESULTS Reasons given by young people for stopping ADHD medication included the following: the perceived balance between benefits and adverse effects of medication; perceptions of ADHD as a childhood or educational disorder; life circumstance of the young person and challenges young people faced in accessing services. CONCLUSIONS A multidimensional approach is needed to address discontinuation of ADHD medication in order to improve the long-term prospects and quality of life for these young people. Possible approaches include access to non-pharmacological treatments and improved psychoeducation. As many reasons given by young people are not unique to ADHD, these findings are also of relevance to medication adherence in other chronic childhood conditions.
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Affiliation(s)
- Daniel Titheradge
- College of Medicine and HealthUniversity of ExeterExeterUK,Population Health Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
| | - Jo Godfrey
- College of Medicine and HealthUniversity of ExeterExeterUK,Livewell SouthwestPlymouthUK
| | - Helen Eke
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Anna Price
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Tamsin Ford
- College of Medicine and HealthUniversity of ExeterExeterUK,Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Astrid Janssens
- College of Medicine and HealthUniversity of ExeterExeterUK,Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
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Quintero J, Rodríguez-Quiroga A, Álvarez-Mon MÁ, Mora F, Rostain AL. Addressing the Treatment and Service Needs of Young Adults with Attention Deficit Hyperactivity Disorder. Child Adolesc Psychiatr Clin N Am 2022; 31:531-551. [PMID: 35697400 DOI: 10.1016/j.chc.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The transition from adolescence to adulthood is a complex period in which multiple changes take place (education, work, independent living, and social relations). This stage is especially difficult for adolescents suffering from attention deficit hyperactivity disorder (ADHD), who have to move on from child and adolescent mental health services to adult mental health services. This review analyzes developmental and environmental risk and protective factors as well as critical variables such as executive functioning and self-monitoring that influence the course of ADHD in transitional age youth and guide the priorities for an optimal transition of care. The influence of the COVID-19 pandemic is also discussed. We reflect on the unmet needs for an optimal transition of care and propose practice and policy recommendations to achieve this goal.
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Affiliation(s)
- Javier Quintero
- Psychiatry and Mental Health Department, Hospital Universitario Infanta Leonor, Avenida de la Gran Vía del Este 80, Madrid 20830, Spain; Department of Legal Medicine & Psychiatry, Complutense University, Spain.
| | - Alberto Rodríguez-Quiroga
- Psychiatry and Mental Health Department, Hospital Universitario Infanta Leonor, Avenida de la Gran Vía del Este 80, Madrid 20830, Spain; Department of Legal Medicine & Psychiatry, Complutense University, Spain
| | - Miguel Ángel Álvarez-Mon
- Psychiatry and Mental Health Department, Hospital Universitario Infanta Leonor, Avenida de la Gran Vía del Este 80, Madrid 20830, Spain; Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, 28801 Alcala de Henares, Spain; Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Fernando Mora
- Psychiatry and Mental Health Department, Hospital Universitario Infanta Leonor, Avenida de la Gran Vía del Este 80, Madrid 20830, Spain; Department of Legal Medicine & Psychiatry, Complutense University, Spain
| | - Anthony L Rostain
- Department of Psychiatry, Cooper Medical School of Rowan University, 401 Broadway, Camden, NJ 08103, USA
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Appleton R, Loew J, Mughal F. Young people who have fallen through the mental health transition gap: a qualitative study on primary care support. Br J Gen Pract 2022; 72:e413-e420. [PMID: 35504728 PMCID: PMC9090175 DOI: 10.3399/bjgp.2021.0678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/17/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Owing to poor continuity of care between child and adult mental health services, young people are often discharged to their GP when they reach the upper boundary of child and adolescent mental health services (CAMHS). This handover is poorly managed, and GPs can struggle to support young people without input from specialist services. Little is known about young people's experiences of accessing mental health support from their GP after leaving CAMHS. AIM To explore the experiences and perspectives of young people and the parents/carers of young people receiving primary care support after CAMHS and to identify barriers and facilitators to accessing primary care. DESIGN AND SETTING Qualitative study with young people and parents in two English counties: London and West Midlands. METHOD Narrative interviews were conducted with 14 young people and 13 parents who had experienced poor continuity of care after reaching CAMHS transition boundary. Data were analysed using reflexive thematic analysis. RESULTS Three themes were identified: unmet mental health needs, disjointed care, and taking responsibility for the young person's mental health care. Barriers included the perception that GPs couldn't prescribe certain medication, anxiety caused by the general practice environment, and having to move to a new practice at university. Young people's positive experiences were more likely to include having a long-term relationship with their GP and finding that their GP made time to understand their needs and experiences. CONCLUSION GPs could help to meet the unmet needs of young people unable to access specialist mental health services after leaving CAMHS. There is a need for comprehensive handover of care from CAMHS to GPs, which could include a joint meeting with the young person and a member of the CAMHS team. Future research should focus on interventions which improve continuity of care for young people after leaving CAMHS, and collaborative working across community mental health services.
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Affiliation(s)
- Rebecca Appleton
- National Institute for Health Research (NIHR) Mental Health Policy Research Unit, Division of Psychiatry, UCL, London
| | - Joelle Loew
- Department of Languages and Literatures, University of Basel, Switzerland; lecturer in English business communication, Lucerne University of Applied Sciences and Arts, Switzerland
| | - Faraz Mughal
- School of Medicine, Keele University, Keele; honorary clinical research fellow, Unit of Academic Primary Care, University of Warwick, Coventry; affiliate, NIHR Greater Manchester Patient Safety Translational Research Centre, Keele University, Keele
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Brede J, Cage E, Trott J, Palmer L, Smith A, Serpell L, Mandy W, Russell A. “We Have to Try to Find a Way, a Clinical Bridge” - autistic adults' experience of accessing and receiving support for mental health difficulties: A systematic review and thematic meta-synthesis. Clin Psychol Rev 2022; 93:102131. [DOI: 10.1016/j.cpr.2022.102131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 12/04/2021] [Accepted: 01/28/2022] [Indexed: 12/28/2022]
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Young S, Asherson P, Lloyd T, Absoud M, Arif M, Colley WA, Cortese S, Cubbin S, Doyle N, Morua SD, Ferreira-Lay P, Gudjonsson G, Ivens V, Jarvis C, Lewis A, Mason P, Newlove-Delgado T, Pitts M, Read H, van Rensburg K, Zoritch B, Skirrow C. Failure of Healthcare Provision for Attention-Deficit/Hyperactivity Disorder in the United Kingdom: A Consensus Statement. Front Psychiatry 2021; 12:649399. [PMID: 33815178 PMCID: PMC8017218 DOI: 10.3389/fpsyt.2021.649399] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Despite evidence-based national guidelines for ADHD in the United Kingdom (UK), ADHD is under-identified, under-diagnosed, and under-treated. Many seeking help for ADHD face prejudice, long waiting lists, and patchy or unavailable services, and are turning to service-user support groups and/or private healthcare for help. Methods: A group of UK experts representing clinical and healthcare providers from public and private healthcare, academia, ADHD patient groups, educational, and occupational specialists, met to discuss shortfalls in ADHD service provision in the UK. Discussions explored causes of under-diagnosis, examined biases operating across referral, diagnosis and treatment, together with recommendations for resolving these matters. Results: Cultural and structural barriers operate at all levels of the healthcare system, resulting in a de-prioritization of ADHD. Services for ADHD are insufficient in many regions, and problems with service provision have intensified as a result of the response to the COVID-19 pandemic. Research has established a range of adverse outcomes of untreated ADHD, and associated long-term personal, social, health and economic costs are high. The consensus group called for training of professionals who come into contact with people with ADHD, increased funding, commissioning and monitoring to improve service provision, and streamlined communication between health services to support better outcomes for people with ADHD. Conclusions: Evidence-based national clinical guidelines for ADHD are not being met. People with ADHD should have access to healthcare free from discrimination, and in line with their legal rights. UK Governments and clinical and regulatory bodies must act urgently on this important public health issue.
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Affiliation(s)
- Susan Young
- Psychology Services Limited, London, United Kingdom.,Department of Psychology, Reykjavik University, Reykjavik, Iceland.,ADHD Foundation, Liverpool, United Kingdom
| | - Philip Asherson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Tony Lloyd
- ADHD Foundation, Liverpool, United Kingdom
| | - Michael Absoud
- Department of Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,King's Health Partners Academic Health Science Centre, London, United Kingdom.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Muhammad Arif
- Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| | | | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences & Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Solent NHS Trust, Southampton, United Kingdom.,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, United States
| | - Sally Cubbin
- The ADHD Clinic, Manor Hospital, Oxford, United Kingdom
| | - Nancy Doyle
- Genius Within, Plumpton Green, United Kingdom.,Department of Organizational Psychology, Birkbeck College, University of London, London, United Kingdom
| | - Susan Dunn Morua
- AADD-United Kingdom, Bristol, United Kingdom.,Bristol Adult ADHD Support Group, Bristol, United Kingdom
| | - Philip Ferreira-Lay
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, United Kingdom
| | - Gisli Gudjonsson
- Department of Psychology, Reykjavik University, Reykjavik, Iceland.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | | | - Alexandra Lewis
- Cambridge & Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Peter Mason
- ADHD Foundation, Liverpool, United Kingdom.,ADHD and Psychiatry Services Limited, Liverpool, United Kingdom.,Cheshire and Wirral Partnership NHS Foundation Trust, Chester, United Kingdom
| | | | - Mark Pitts
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Helen Read
- ADHD Consultancy Limited, London, United Kingdom
| | - Kobus van Rensburg
- Adult ADHD and Asperger's Team & Children and Young People's ADHD and ASD Service, Northamptonshire Healthcare NHS Foundation Trust, Kettering, United Kingdom
| | - Bozhena Zoritch
- ADDmire Clinic, West Byfleet, United Kingdom.,Epsom and St. Helier University Hospital, Epsom, United Kingdom
| | - Caroline Skirrow
- Cambridge Cognition, Cambridge, United Kingdom.,Psychological Sciences, University of Bristol, Bristol, United Kingdom
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8
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Janssens A, Eke H, Price A, Newlove-Delgado T, Blake S, Ani C, Asherson P, Beresford B, Emmens T, Hollis C, Logan S, Paul M, Sayal K, Young S, Ford T. The transition from children’s services to adult services for young people with attention deficit hyperactivity disorder: the CATCh-uS mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Attention deficit hyperactivity disorder was previously seen as a childhood developmental disorder, so adult mental health services were not set up to support attention deficit hyperactivity disorder patients who became too old for child services. To our knowledge, this is the first in-depth study of the transition of attention deficit hyperactivity disorder patients from child to adult health services in the UK.
Objectives
Our objectives were to explore how many young people with attention deficit hyperactivity disorder are in need of services as an adult, what adult attention deficit hyperactivity disorder services are available and how attention deficit hyperactivity disorder stakeholders experience transition from child to adult services.
Design
An interactive mixed-method design was adopted with three study streams: (1) a 12-month surveillance study with 9-month follow-up to find out how many young people required ongoing medication when they were too old for child services (929 surveys completed by children’s clinicians); (2) a mapping study to identify and describe services for young adults with attention deficit hyperactivity disorder (2686 respondents to online surveys for patients and health workers and freedom of information requests to service providers and commissioners); and (3) a qualitative study to explore key stakeholders’ experiences of transition from child to adult services (144 interviews with 64 attention deficit hyperactivity disorder patients, 28 parents and 52 health clinicians; 38 working in child or adult secondary health services and 14 general practitioners). Members of the public advised at each stage of the study.
Results
When corrected for non-response and case ascertainment, the annual number of young people with an ongoing need for medication for attention deficit hyperactivity disorder lies between 270 and 599 per 100,000 people aged 17–19 years. Among 315 individuals eligible for transition, 64% were accepted, but only 22% attended their first adult services appointment. Our interactive map describes 294 unique services for adults with attention deficit hyperactivity disorder across the UK, of which 44 are ‘dedicated’ attention deficit hyperactivity disorder services. Few services provide the full range of recommended provision; most focus on diagnosis and medication. Services are unevenly distributed across the UK, with nearly all ‘dedicated’ services being in England. Exploring stakeholders’ experiences revealed how invested the stakeholders are in continuing attention deficit hyperactivity disorder treatment and how the architecture of services affects transition. An association between attention deficit hyperactivity disorder, education and continuance of medication into young adulthood, plus parent involvement and feeling prepared for transition and adult life with attention deficit hyperactivity disorder, influenced investment. However, even with investment, how accessible adult services are, how patient needs fit with the remit of the adult service and the level of patient information available affect transition outcomes. The results also highlight how general practitioners can end up as care co-ordinators during transition by default.
Limitations
Transition estimates were based on those who want medication, so these indicate a minimum level of need.
Conclusions
Few of those who need ongoing support for attention deficit hyperactivity disorder successfully transfer to adult services, and a small proportion of those who transfer experience optimal transitional care. Adult attention deficit hyperactivity disorder service provision is patchy. Even among ‘dedicated’ services, few provide the whole range of National Institute for Health and Care Excellence-recommended treatments.
Future work
We need to evaluate various models of transitional care and adult attention deficit hyperactivity disorder provision, as well as develop and evaluate psychosocial interventions for young people and adults with attention deficit hyperactivity disorder.
Trial registration
Current Controlled Trials ISRCTN12492022.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 42. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Astrid Janssens
- Child Health Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
- User Perspectives, University of Southern Denmark, Odense, Denmark
| | - Helen Eke
- Child Health Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Anna Price
- Child Health Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Tamsin Newlove-Delgado
- Child Health Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Sharon Blake
- Child Health Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Cornelius Ani
- Division of Psychiatry, Faculty of Medicine, Imperial College London, London, UK
- Surrey and Borders Partnership NHS Foundation Trust, Chertsey, UK
| | - Philip Asherson
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | - Chris Hollis
- School of Medicine, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
- National Institute for Health Research MindTech MedTech Co-operative and National Institute for Health Research Biomedical Research Centre, Mental Health Theme, Institute of Mental Health, Nottingham, UK
| | - Stuart Logan
- Child Health Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, Exeter, UK
| | - Moli Paul
- Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Kapil Sayal
- School of Medicine, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | | | - Tamsin Ford
- Child Health Research Group, University of Exeter Medical School, University of Exeter, Exeter, UK
- University of Cambridge, Cambridge, UK
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Lockertsen V, Nilsen L, Holm LAW, Rø Ø, Burger LM, Røssberg JI. Experiences of patients with anorexia nervosa during the transition from child and adolescent mental health services to adult mental health services. J Eat Disord 2020; 8:37. [PMID: 32793350 PMCID: PMC7418380 DOI: 10.1186/s40337-020-00313-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/12/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The transition between the Child and Adolescent Mental Health Services (CAMHS) and the Adult Mental Health Services (AMHS) is identified as an especially critical time for the continuity of care for patients with anorexia nervosa (AN). However, research on this topic is scarce. In the present study, we explore the patients' experiences of the transition between CAMHS and AMHS. METHODS A qualitative explorative study was carried out based on recorded interviews from one multi-step focus group and six individual interviews with patients who experienced the transition from CAMHS to AHMS in Norway. This study is service user-initiated, meaning service users were involved in all steps of the research process. RESULTS The adolescents' experiences are characterized by four overall themes regarding the transition process between CAMHS and AMHS: (1) "Being unprepared and alone in the transition process" describes how a lack of preparation for the transition between CAMHS and AMHS makes them feel alone and increases stress. (2) "It takes time to create a trusting relationship" describes how time influences patients' trust in therapists and motivation for treatment. (3) "We are not all the same" describes how adolescents develop differently but are not treated differently despite their diverse ability to be self-sufficient. (4) "How they see me and treat me affects my hope for the future" describes the interaction between adolescents and therapists. CONCLUSIONS Acknowledging the patients' needs during the transition period and considering their readiness for the transition is important. Taking into account the four dimensions described in the present study might improve the transition process and enhance the patients' self-sufficiency and maturity.
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Affiliation(s)
- Veronica Lockertsen
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, Nydalen, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Liv Nilsen
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, Nydalen, Oslo, Norway
| | | | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål HF, Postboks 4950 Nydalen, 0424 Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | | | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, Nydalen, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
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Price A, Newlove-Delgado T, Eke H, Paul M, Young S, Ford T, Janssens A. In transition with ADHD: the role of information, in facilitating or impeding young people's transition into adult services. BMC Psychiatry 2019; 19:404. [PMID: 31847827 PMCID: PMC6918680 DOI: 10.1186/s12888-019-2284-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/11/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Many national and regional clinical guidelines emphasise the need for good communication of information to young people and their parent/carers about what to expect during transition into adult services. Recent research indicates only a minority of young people in need of transition for Attention Deficit Hyperactivity Disorder (ADHD) experience continuity of care into adulthood, with additional concerns about quality of transition. This qualitative study explored the role that information plays in experiences of transition from the perspectives of parent/carers and young people. METHODS Participants were recruited from 10 National Health Service Trusts, located across England, with varying service configurations. Ninety two qualitative interviews were conducted: 64 with young people with ADHD at different stages relative to transition, and 28 with parent/carers. Thematic analysis of data was completed using the Framework Method. RESULTS Interviewees reported a range of experiences; however reliance on parent/carers to gather and translate key information, and negative experiences associated with poor communication of information, were universal. Three themes emerged: Navigating information with help from parents; Information on ADHD into adulthood; Information about the transition process. The first revealed the essential role of parent in the translation and application of information, the other two explored distinct types of information necessary for a smooth transition. Interviewees made recommendations for clinical practice similar to UK (United Kingdom) National Institute for Health and Care Excellence (NICE) guidelines, with an additional emphasis on providing nuanced information on ADHD as a potentially long term condition. It was important to interviewees that General Practitioners had a basic understanding of adult ADHD and also had access to information about service provision. CONCLUSIONS Our findings illustrate that the availability and communication of information to young people and their parent/carers is an essential component of the transition process between child and adult ADHD services. How and when it is provided may support or impede transition. This study constitutes a substantial contribution to the evidence base, drawing on interviews from a range of participants across England and from Trusts offering different types of services.
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Affiliation(s)
- Anna Price
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | | | - Helen Eke
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Moli Paul
- Stratford CAMHS, Coventry and Warwickshire Partnership Trust, Stratford Healthcare, Stratford upon Avon, CV37 6NQ UK
- Honorary Associate Clinical Professor of Psychiatry, University of Warwick, Coventry, CV4 7AL UK
| | | | - Tamsin Ford
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Astrid Janssens
- University of Exeter Medical School, St Luke’s Campus, Exeter, EX1 2LU UK
- Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, DK-5000 Odense, Denmark
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11
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Newlove-Delgado T, Ford TJ, Hamilton W, Janssens A, Stein K, Ukoumunne OC. Resumption of attention-deficit hyperactivity disorder medication in early adulthood: findings from a UK primary care prescribing study. Eur Child Adolesc Psychiatry 2019; 28:1589-1596. [PMID: 30949828 PMCID: PMC6861538 DOI: 10.1007/s00787-019-01325-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/26/2019] [Indexed: 11/30/2022]
Abstract
This study aimed to examine the resumption of attention-deficit hyperactivity disorder (ADHD) prescriptions in early adulthood in young people whose ADHD prescriptions stopped in adolescence. Whilst prescribing studies indicate that the proportion of those with ADHD stopping treatment in late adolescence remains in excess of the proportion expected to be symptom free, very few studies have examined patterns of resumption amongst young adults previously prescribed medication. Primary care records from the UK Clinical Practice Research Datalink from 2008 to 2013 were used to examine the outcome of resumption of ADHD prescriptions from age 20 years in a sample of cases with ADHD whose prescriptions stopped aged 14-18 years. A Cox regression model was fitted to explore variables that could theoretically be associated with resumption of prescriptions. Of 1440 cases, 109 (7.6%) had their ADHD prescriptions resumed. Characteristics associated with an increased probability of resumption included female gender, learning disability, referral to adult mental health services, and prescription of antipsychotic medication. In this study, only a small proportion of adolescents who stopped ADHD medication subsequently resumed their prescriptions in primary care. Those that did resume were a more complex group. As many vulnerable individuals with ongoing ADHD symptoms may not have the resources required to surmount the barriers to re-enter services, the implication is that not all those who could benefit from resuming medication are able to do so. The findings raise questions around whether current care models are flexible enough and whether primary care services are adequately supported in managing this group.
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Affiliation(s)
- Tamsin Newlove-Delgado
- University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Tamsin J Ford
- Child and Adolescent Psychiatry, University of Exeter Medical School, Exeter, UK
| | - Willie Hamilton
- Primary Care Diagnostics, University of Exeter Medical School, Exeter, UK
| | - Astrid Janssens
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ken Stein
- Public Health, NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Obioha C Ukoumunne
- Medical Statistics, NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
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12
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Newlove-Delgado T, Blake S, Ford T, Janssens A. Young people with attention deficit hyperactivity disorder in transition from child to adult services: a qualitative study of the experiences of general practitioners in the UK. BMC FAMILY PRACTICE 2019; 20:159. [PMID: 31747903 PMCID: PMC6864948 DOI: 10.1186/s12875-019-1046-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/31/2019] [Indexed: 11/10/2022]
Abstract
Background Many young people with Attention Deficit Hyperactivity Disorder (ADHD) have impairing symptoms that persist into adulthood, yet only a minority experience continuity of care into adult life. Despite growing emphasis on the primary care role in ADHD management in NICE ADHD and transition guidance, little is known about GPs’ perspectives, which could hamper efforts to improve outcomes for young people leaving children’s services. This study aimed to understand GPs’ experiences of involvement with this group and explore their views on the roles and responsibilities of primary and secondary care in transition, to inform recommendations for policy and practice. Method Qualitative interview study with GPs across the UK. Semi-structured telephone interviews were carried out with 14 GPs recruited through a linked mapping study, social media, and snowballing; data were analysed using thematic analysis. Results In the absence of a smooth transition from child to adult services, many GPs became involved ‘by default’. GPs reacted by trying to identify suitable specialist services, and were faced with the decision of whether to continue ADHD prescribing. Such decisions were strongly influenced by perceptions that prescribing carried risks, and concerns over responsibility, particularly where specialist services were lacking. Participants described variation in service availability, and some highlighted tensions around how shared care works in practice. Conclusion Implementation of NICE guidance is highly variable, with implications for GPs and patients. Risk and responsibility for primary care ADHD prescribing are central concerns that need to be addressed, as is the inclusion of GPs in a planned transition process.
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Affiliation(s)
| | - Sharon Blake
- University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, United Kingdom
| | - Tamsin Ford
- University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 2AH, United Kingdom
| | - Astrid Janssens
- University of Exeter Medical School, St Luke's Campus, Exeter, EX1 2LU, United Kingdom.,Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, DK-5000, Odense C, Denmark
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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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