Lost in transition? Perceptions of health care among young people with mental health problems in Germany: a qualitative study

[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.

Transitions in mental health and addiction care for youth and their families: a scoping review of needs, barriers, and facilitators

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.

For a better understanding of the relationship between caregivers and young adults living with a concomitant substance-related mental health and substance use disorder: an integrative review

Introduction

The importance of a quality relationship between young adults living with dual diagnosis and their health care providers is well documented.

Context

Although this complex phenomenon was mostly studied from an individual perspective, the results indicated the systemic nature of this relationship.

Objective

This study aims to better understand the relationship between young adults living with dual diagnosis and their health care providers, with a systemic perspective.

Method

Six data bases were consulted; manual research in gray literature and references screening enhanced the process.

Results

Of a total of 532 studies and reports identified, 44 were included in the review. Thematic data analysis was carried out, and two themes were identified: the health care system as a constraining environment; and the relationship at the heart of care.

Discussion

This study confirms the joint role played by the young adult in question and their health care provider in developing and maintaining the relationship, by acknowledging the importance of the care, of mutual confidence, and of a hierarchic relationship.

Conclusion

This integrative review provides a basis for future nursing interventions that foreground the relationship and take a systemic approach.

The black hole of the transition process: dropout of care before transition age in adolescents

Recent evidence confirms the risks of discontinuity of care when young people make a transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS), although robust data are still sparse. We aimed to identify when and how patients get lost to care during transition by tracking care pathways and identifying factors which influence dropping out of care during transition. This is a retrospective observational study of 760 patients who reached the transition age boundary within 12 months before transition time and being treated at CAMHS for at least during preceding 18 months. Data were collected at two time points: last visit to CAHMS and first visit to AHMS. Socio-demographic, clinical and service utilization variables on CAMHS treatment were collected. In the 12 months leading up to the transition boundary, 46.8% of subjects (n = 356) withdrew from CAHMS without further contact with AHMS, 9.3% withdrew from CAHMS but were referred to AHMS by other services, 29% were transferred from CAHMS to AHMS, 10% remained at CAHMS and 5% patients were transferred to alternative services. Fifty-six percent of subjects experience cessation of care before the transition age. The risk of dropout increases with shorter contact time in CAMHS, is greater in subjects without pharmacological treatment, and decreases in subjects with psychosis, bipolar disorder, eating disorders, mental retardation, and neurodevelopmental disorders. This study confirms that a large number of people drop out of care as they approach the CAMHS transition and experience discontinuity of care during this critical period.

"I'm truly free from my eating disorder": Emerging adults' experiences of FREED, an early intervention service model and care pathway for eating disorders

BACKGROUND

Eating disorders (EDs) typically start during adolescence or emerging adulthood, periods of intense biopsychosocial development. FREED (First Episode Rapid Early Intervention for EDs) is a service model and care pathway providing rapid access to developmentally-informed care for emerging adults with EDs. FREED is associated with reduced duration of untreated eating disorder and improved clinical outcomes, but patients' experiences of treatment have yet to be assessed.

OBJECTIVE

This study aimed to assess emerging adults' experiences of receiving treatment through FREED.

METHOD

This study triangulated qualitative data on participants' experiences of FREED treatment from questionnaires and semi-structured interviews. Participants were 106 emerging adults (aged 16-25; illness duration < 3 yrs) (questionnaire only = 92; interview only = 6; both = 8). Data were analysed thematically.

RESULTS

Most participants reported psychological and behavioural changes over the course of treatment (e.g. reduction in symptoms; increased acceptance and understanding of difficulties). Participants identified five beneficial characteristics of FREED treatment: i) rapid access to treatment; ii) knowledgeable and concerned clinicians; iii) focusing on life beyond the eating disorder; iv) building a support network; v) becoming your own therapist.

CONCLUSION

This study provides further supports for the implementation of early intervention and developmentally-informed care for EDs. Future service model development should include efforts to increase early help-seeking.

Mental health professionals' experiences transitioning patients with anorexia nervosa from child/adolescent to adult mental health services: a qualitative study

Background

The transition period between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) has been identified as an especially critical time for patients with anorexia nervosa. In the present study, to better facilitate patients’ recovery process, we explored the experiences of professionals concerning the transition from CAMHS to AMHS.

Method

A qualitative explorative study was carried out based on recorded interviews from one multi-step focus group and two individual interviews with eight experienced health care professionals. Together they had experience with treating patients with AN and the transition from CAMHS to AMHS, both from specialized eating disorder units, specialized mental health care units, and from a school nurse context. Service users with parents` perspectives and patients’ perspectives were involved in all steps of the research process.

Results

Barriers experienced during the transition process were classified into four categories: (1) different treatment cultures that describe differences in how parents are included in CAMHS and AMHS; (2) mistrust between CAMHS and AMHS that can create a lack of collaboration and predictability for the patients’ transition; (3) Clinicians` factors such as lack of professional self-confidence can influence continuity of care for patients; and (4) lack of trust between services and not enough focus on building a new alliance in AMHS negatively influences the transition.

Conclusions

The present study revealed four important categories that professionals needs to consider when participating in the transition for patients with AN from CAMHS to AMHS. Awareness of these challenges might improve the transition process for patients with AN.

Young Patients With Persistent and Complex Care Needs Require an Integrated Care Approach: Baseline Findings From the Multicenter Youth Flexible ACT Study

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.

Transitioning from Adolescent to Adult Mental Health Services: An Integrative Literature Review

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.