1
|
Singh SP, Tuomainen H, Bouliotis G, Canaway A, De Girolamo G, Dieleman GC, Franić T, Madan J, Maras A, McNicholas F, Paul M, Purper-Ouakil D, Santosh P, Schulze UME, Street C, Tremmery S, Verhulst FC, Wells P, Wolke D, Warwick J. Effect of managed transition on mental health outcomes for young people at the child-adult mental health service boundary: a randomised clinical trial. Psychol Med 2023; 53:2193-2204. [PMID: 37310306 PMCID: PMC10123823 DOI: 10.1017/s0033291721003901] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Poor transition planning contributes to discontinuity of care at the child-adult mental health service boundary (SB), adversely affecting mental health outcomes in young people (YP). The aim of the study was to determine whether managed transition (MT) improves mental health outcomes of YP reaching the child/adolescent mental health service (CAMHS) boundary compared with usual care (UC). METHODS A two-arm cluster-randomised trial (ISRCTN83240263 and NCT03013595) with clusters allocated 1:2 between MT and UC. Recruitment took place in 40 CAMHS (eight European countries) between October 2015 and December 2016. Eligible participants were CAMHS service users who were receiving treatment or had a diagnosed mental disorder, had an IQ ⩾ 70 and were within 1 year of reaching the SB. MT was a multi-component intervention that included CAMHS training, systematic identification of YP approaching SB, a structured assessment (Transition Readiness and Appropriateness Measure) and sharing of information between CAMHS and adult mental health services. The primary outcome was HoNOSCA (Health of the Nation Outcome Scale for Children and Adolescents) score 15-months post-entry to the trial. RESULTS The mean difference in HoNOSCA scores between the MT and UC arms at 15 months was -1.11 points (95% confidence interval -2.07 to -0.14, p = 0.03). The cost of delivering the intervention was relatively modest (€17-€65 per service user). CONCLUSIONS MT led to improved mental health of YP after the SB but the magnitude of the effect was small. The intervention can be implemented at low cost and form part of planned and purposeful transitional care.
Collapse
Affiliation(s)
- S. P. Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - H. Tuomainen
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - G. Bouliotis
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - A. Canaway
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - G. De Girolamo
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - G. C. Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - T. Franić
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - J. Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - A. Maras
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, the Netherlands
- Yulius Academy, Rotterdam, the Netherlands
| | - F. McNicholas
- Department of Child and Adolescent Psychiatry, University College Dublin School of Medicine and Medical Science, Dublin, Republic of Ireland
- Geary Institute, University College Dublin, Dublin, Republic of Ireland
- Department of Child Psychiatry, Our Lady's Hospital for Sick Children, Dublin, Republic of Ireland
- Lucena Clinic SJOG, Dublin, Republic of Ireland
| | - M. Paul
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - D. Purper-Ouakil
- Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, Unit of Child and Adolescent Psychiatry (MPEA1), Montpellier, France
| | - P. Santosh
- 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
| | - U. M. E. Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - C. Street
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - S. Tremmery
- Department of Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium
| | - F. C. Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - P. Wells
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - D. Wolke
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Psychology, University of Warwick, Coventry, UK
| | - J. Warwick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | | |
Collapse
|
2
|
Gerritsen SE, van Bodegom LS, Dieleman GC, Overbeek MM, Verhulst FC, Wolke D, Rizopoulos D, Appleton R, van Amelsvoort TAMJ, Bodier Rethore C, Bonnet-Brilhault F, Charvin I, Da Fonseca D, Davidović N, Dodig-Ćurković K, Ferrari A, Fiori F, Franić T, Gatherer C, de Girolamo G, Heaney N, Hendrickx G, Jardri R, Kolozsvari A, Lida-Pulik H, Lievesley K, Madan J, Mastroianni M, Maurice V, McNicholas F, Nacinovich R, Parenti A, Paul M, Purper-Ouakil D, Rivolta L, de Roeck V, Russet F, Saam MC, Sagar-Ouriaghli I, Santosh PJ, Sartor A, Schulze UME, Scocco P, Signorini G, Singh SP, Singh J, Speranza M, Stagi P, Stagni P, Street C, Tah P, Tanase E, Tremmery S, Tuffrey A, Tuomainen H, Walker L, Wilson A, Maras A. Demographic, clinical, and service-use characteristics related to the clinician's recommendation to transition from child to adult mental health services. Soc Psychiatry Psychiatr Epidemiol 2022; 57:973-991. [PMID: 35146551 PMCID: PMC9042957 DOI: 10.1007/s00127-022-02238-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/22/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians' advice to continue treatment at AMHS. METHODS Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians' transition recommendations. RESULTS Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. CONCLUSION Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services.
Collapse
Affiliation(s)
- S E Gerritsen
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - L S van Bodegom
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
| | - G C Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.
| | - M M Overbeek
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
- Clinical Child and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - F C Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - D Wolke
- Department of Psychology, University of Warwick, Coventry, UK
| | - D Rizopoulos
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - T A M J van Amelsvoort
- Department of Psychiatry and Neuropsychology, University of Maastricht, Maastricht, The Netherlands
- Mondriaan Mental Health Care, Heerlen, The Netherlands
| | | | | | - I Charvin
- Centre Hospitalier Universitaire de Marseille, Marseille, France
| | - D Da Fonseca
- Centre Hospitalier Universitaire de Marseille, Marseille, France
| | - N Davidović
- University Hospital Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - K Dodig-Ćurković
- Faculty for Dental Care and Health, Osijek, Croatia
- University Health Center Osijek, Osijek, Croatia
- Unit for Child and Adolescent Psychiatry, Osijek, Croatia
| | - A Ferrari
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- DISM, ULSS 16, SOPROXI Onlus, Padua, Italy
| | - F Fiori
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
- HealthTracker Ltd, Kent, UK
| | - T Franić
- University Hospital Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - C Gatherer
- Warwick Medical School, University of Warwick, Coventry, UK
| | - G de Girolamo
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - N Heaney
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - G Hendrickx
- Department of Neurosciences, Centre for Clinical Psychiatry, KU Leuven, Leuven, Belgium
| | - R Jardri
- Lille Neurosciences and Cognitions, Plasticity and Subjectivity Team, CURE Platform, Université de Lille, INSERM (U-1172), Fontan Hospital, CHU Lille, Lille, France
| | | | | | - K Lievesley
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - J Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - M Mastroianni
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - V Maurice
- Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, Montpellier, France
| | - F McNicholas
- School of Medicine & Medical Science, University College Dublin, Dublin, Republic of Ireland
- Lucena CAMHS, SJOG, Dublin, Republic of Ireland
| | - R Nacinovich
- Child and Adolescent Neuropsychiatry Unit, ASST Monza, Monza, Italy
- Università Degli Studi Milano Bicocca, Milan, Italy
| | - A Parenti
- Centre Hospitalier Universitaire de Lille, Lille, France
| | - M Paul
- Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - D Purper-Ouakil
- Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, Montpellier, France
- INSERM, CESP U1018, PsyDev, University Paris Saclay, UVSQ, Versailles, France
| | - L Rivolta
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
- Department of Mental Health, Psychiatry Unit, San Gerardo Hospital, Monza, Monza Brianza, Italy
| | - V de Roeck
- Department of Neurosciences, KU Leuven, Leuven, Belgium
- Child and Youth Studies, Campus Social School, University Colleges Leuven Limburg, Heverlee, Belgium
| | - F Russet
- Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, Montpellier, France
| | - M C Saam
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - I Sagar-Ouriaghli
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - P J Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
- HealthTracker Ltd, Kent, UK
| | - A Sartor
- Josefinum Augsburg, Klinik für Kinder- und Jugenspsychiatrie und Psychotherapie, Augsburg, Germany
| | - U M E Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - P Scocco
- Department of Mental Health, ULSS 6 Euganea, Padua, Italy
- SOPROXI Onlus, Padua, Italy
| | - G Signorini
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - S P Singh
- Warwick Medical School, University of Warwick, Coventry, UK
| | - J Singh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - M Speranza
- INSERM, CESP U1018, PsyDev, University Paris Saclay, UVSQ, Versailles, France
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier de Versailles, Versailles, France
| | - P Stagi
- Child and Adolescent Neuropsychiatry Unit, AUSL Modena, Modena, Italy
| | - P Stagni
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- Child and Adolescent Neuropsychiatry, Department of Mental Health, Modena, Italy
| | - C Street
- Warwick Medical School, University of Warwick, Coventry, UK
| | - P Tah
- Warwick Medical School, University of Warwick, Coventry, UK
| | - E Tanase
- Abteilung für Psychiatrie und Psychotherapie des Kindes-und Jugendalters Weissenau, ZfP Südwürttemberg, Ravensburg, Germany
| | - S Tremmery
- Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - A Tuffrey
- Warwick Medical School, University of Warwick, Coventry, UK
| | - H Tuomainen
- Warwick Medical School, University of Warwick, Coventry, UK
| | - L Walker
- Warwick Medical School, University of Warwick, Coventry, UK
| | - A Wilson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - A Maras
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
| |
Collapse
|
3
|
Santosh P, Adams L, Fiori F, Davidović N, de Girolamo G, Dieleman GC, Franić T, Heaney N, Lievesley K, Madan J, Maras A, Mastroianni M, McNicholas F, Paul M, Purper-Ouakil D, Sagar-Ouriaghli I, Schulze U, Signorini G, Street C, Tah P, Tremmery S, Tuomainen H, Verhulst FC, Warwick J, Wolke D, Singh J, Singh SP. Protocol for the development and validation procedure of the managing the link and strengthening transition from child to adult mental health care (MILESTONE) suite of measures. BMC Pediatr 2020; 20:167. [PMID: 32299401 PMCID: PMC7161143 DOI: 10.1186/s12887-020-02079-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/13/2020] [Indexed: 02/06/2023] Open
Abstract
Background Mental health disorders in the child and adolescent population are a pressing public health concern. Despite the high prevalence of psychopathology in this vulnerable population, the transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) has many obstacles such as deficiencies in planning, organisational readiness and policy gaps. All these factors contribute to an inadequate and suboptimal transition process. A suite of measures is required that would allow young people to be assessed in a structured and standardised way to determine the on-going need for care and to improve communication across clinicians at CAMHS and AMHS. This will have the potential to reduce the overall health economic burden and could also improve the quality of life for patients travelling across the transition boundary. The MILESTONE (Managing the Link and Strengthening Transition from Child to Adult Mental Health Care) project aims to address the significant socioeconomic and societal challenge related to the transition process. This protocol paper describes the development of two MILESTONE transition-related measures: The Transition Readiness and Appropriateness Measure (TRAM), designed to be a decision-making aide for clinicians, and the Transition Related Outcome Measure (TROM), for examining the outcome of transition. Methods The TRAM and TROM have been developed and were validated following the US FDA Guidance for Patient-reported Outcome Measures which follows an incremental stepwise framework. The study gathers information from service users, parents, families and mental health care professionals who have experience working with young people undergoing the transition process from eight European countries. Discussion There is an urgent need for comprehensive measures that can assess transition across the CAMHS/AMHS boundary. This study protocol describes the process of development of two new transition measures: the TRAM and TROM. The TRAM has the potential to nurture better transitions as the findings can be summarised and provided to clinicians as a clinician-decision making support tool for identifying cases who need to transition and the TROM can be used to examine the outcomes of the transition process. Trial registration MILESTONE study registration: ISRCTN83240263 Registered 23-July-2015 - ClinicalTrials.gov NCT03013595 Registered 6 January 2017.
Collapse
Affiliation(s)
- P Santosh
- Department of Child and Adolescent Psychiatry, King's College London, London, UK. .,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK. .,HealthTracker Ltd, Gillingham, Kent, UK.
| | - L Adams
- School of Psychology, Plymouth University, Plymouth, UK
| | - F Fiori
- Department of Child and Adolescent Psychiatry, King's College London, London, UK.,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK.,HealthTracker Ltd, Gillingham, Kent, UK
| | - N Davidović
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - G de Girolamo
- Unità di Psichiatria Epidemiologica e Valutativa, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - G C Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - T Franić
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - N Heaney
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - K Lievesley
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - J Madan
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick Medical School, Coventry, UK
| | - A Maras
- Yulius Academy, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Mastroianni
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - F McNicholas
- Department of Child and Adolescent Psychiatry, University College Dublin School of Medicine and Medical Science, Dublin, Republic of Ireland.,Geary Institute, University College Dublin, Dublin, Republic of Ireland.,Department of Child Psychiatry, Our Lady's Hospital for Sick Children, Dublin, Republic of Ireland.,Lucena Clinic, SJOG, Dublin, Republic of Ireland
| | - M Paul
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Coventry, UK.,Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - D Purper-Ouakil
- CHU Montpellier / University of Montpellier; Saint Eloi Hospital, Médecine Psychlogique de l'enfant et de adolescent (MPEA1), Montpellier, France
| | - I Sagar-Ouriaghli
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - U Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - G Signorini
- Unità di Psichiatria Epidemiologica e Valutativa, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - C Street
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Coventry, UK
| | - P Tah
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Coventry, UK
| | - S Tremmery
- Department of Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium.,Department of Child & Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - H Tuomainen
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Coventry, UK
| | - F C Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J Warwick
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick Medical School, Coventry, UK
| | - D Wolke
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Coventry, UK.,Department of Psychology, University of Warwick, Coventry, UK
| | - J Singh
- Department of Child and Adolescent Psychiatry, King's College London, London, UK.,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - S P Singh
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Coventry, UK.,Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | | |
Collapse
|
4
|
Tuomainen H, Schulze U, Warwick J, Paul M, Dieleman G, Franić T, Madan J, Maras A, McNicholas F, Purper-Ouakil D, Santosh P, Signorini G, Street C, Tremmery S, Verhulst F, Wolke D, Singh SP. Managing the link and strengthening transition from child to adult mental health Care in Europe (MILESTONE): background, rationale and methodology. BMC Psychiatry 2018; 18:167. [PMID: 29866202 PMCID: PMC5987458 DOI: 10.1186/s12888-018-1758-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/22/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Transition from distinct Child and Adolescent Mental Health (CAMHS) to Adult Mental Health Services (AMHS) is beset with multitude of problems affecting continuity of care for young people with mental health needs. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge globally. The overall aim of the Managing the Link and Strengthening Transition from Child to Adult Mental Health Care in Europe (MILESTONE) project (2014-19) is to improve transition from CAMHS to AMHS in diverse healthcare settings across Europe. MILESTONE focuses on current service provision in Europe, new transition-related measures, long term outcomes of young people leaving CAMHS, improving transitional care through 'managed transition', ethics of transitioning and the training of health care professionals. METHODS Data will be collected via systematic literature reviews, pan-European surveys, and focus groups with service providers, users and carers, and members of youth advocacy and mental health advocacy groups. A prospective cohort study will be conducted with a nested cluster randomised controlled trial in eight European Union (EU) countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS users, their carers, and clinicians. DISCUSSION Improving transitional care can facilitate not only recovery but also mental health promotion and mental illness prevention for young people. MILESTONE will provide evidence of the organisational structures and processes influencing transition at the service interface across differing healthcare models in Europe and longitudinal outcomes for young people leaving CAMHS, solutions for improving transitional care in a cost-effective manner, training modules for clinicians, and commissioning and policy guidelines for service providers and policy makers. TRIAL REGISTRATION "MILESTONE study" registration: ISRCTN ISRCTN83240263 Registered 23 July 2015; ClinicalTrials.gov NCT03013595 Registered 6 January 2017.
Collapse
Affiliation(s)
- H. Tuomainen
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - U. Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - J. Warwick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - M. Paul
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - G.C. Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, Netherlands
| | - T. Franić
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - J. Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - A. Maras
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, Netherlands
- Yulius Academy, Yulius Mental Health Organization, Barendrecht, Netherlands
| | - F. McNicholas
- Department of Child and Adolescent Psychiatry, University College Dublin School of Medicine and Medical Science, Dublin, Republic of Ireland
- Geary Institute, University College Dublin, Dublin, Republic of Ireland
- Department of Child Psychiatry, Our Lady’s Hospital for Sick Children, Dublin, Republic of Ireland
- Lucena Clinic SJOG, Dublin, Republic of Ireland
| | - D. Purper-Ouakil
- Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - P. Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- HealthTracker Ltd, Gillingham, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK
| | - G. Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
| | - C. Street
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - S. Tremmery
- Department of Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium
- Department of Child & Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - F.C. Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, Netherlands
| | - D. Wolke
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Psychology, University of Warwick, Coventry, UK
| | - S. P. Singh
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
5
|
Tuomainen H, Singh S. Novel research on transition from child to adult mental health services in Europe: The MILESTONE project. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionCurrent service configuration of distinct Child and Adolescent Mental Health (CAMHS) and Adult Mental Health Services (AMHS) is considered the weakest link where the care pathway should be most robust. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge for the EU.ObjectivesThe overall objective of the MILESTONE project is to improve transition from CAMHS to AMHS in diverse healthcare settings in Europe.AimsTo improve the understanding of current transition-related service characteristics, and processes, outcomes and experiences of transition from CAMHS to AMHS using a bespoke suite of measures; to explore the ethical challenges of providing appropriate care to young people as they move to adulthood; to test a model of managed transition in a cluster randomized controlled trial (cRCT) for improving health, social outcomes and transition to adult roles; and to develop training modules for clinicians and policy guidelines.MethodsData will be collected via systematic literature reviews; bespoke surveys to CAMHS professionals, experts and other stakeholders; focus groups with service providers and users and members of youth and mental health advocacy groups; and a longitudinal cohort study with a nested cRCT in eight EU countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS service users, their parents/carers, and clinicians, with assessments at baseline, 9, 18 and 27 months.ResultsFirst results are expected in 2016 with further major findings following in 2019.ConclusionsThe MILESTONE project will provide unprecedented information on the nature and magnitude of problems at the CAMHS-AMHS interface, and potential solutions to overcome these.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Collapse
|
6
|
Airavaara M, Tuomainen H, Piepponen TP, Saarma M, Ahtee L. Effects of repeated morphine on locomotion, place preference and dopamine in heterozygous glial cell line-derived neurotrophic factor knockout mice. Genes Brain Behav 2006; 6:287-98. [PMID: 16879618 DOI: 10.1111/j.1601-183x.2006.00260.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Glial cell line-derived neurotrophic factor (GDNF) has been shown to be involved in the maintenance of striatal dopaminergic neurons. Neurotrophic factors are crucial for the plasticity of central nervous system and may be involved in long-term responses to drug exposure. To study the effects of reduced GDNF on dopaminergic behaviour related to addiction, we compared the effects of morphine on locomotor activity, conditioned place preference (CPP) and extracellular accumbal dopamine in heterozygous GDNF knockout mice (GDNF+/-) with those in their wild-type (Wt) littermates. When morphine 30 mg/kg was administered daily for 4 days, tolerance developed towards its locomotor stimulatory action only in the GDNF+/- mice. A morphine 5 mg/kg challenge dose stimulated locomotor activity only in the GDNF+/- mice withdrawn for 96 h from repeated morphine treatment, whereas clear and similar sensitization of the locomotor response was seen after a 10 mg/kg challenge dose in mice of both genotypes. Morphine-induced CPP developed initially similarly in Wt and GDNF+/- mice, but it lasted longer in the Wt mice. The small challenge dose of morphine increased accumbal dopamine output slightly more in the GDNF+/- mice than in the Wt mice, but doubling the challenge dose caused a dose-dependent response only in the Wt mice. In addition, repeated morphine treatment counteracted the increase in the accumbal extracellular dopamine concentration we previously found in drug-naive GDNF+/- mice. Thus, reduced endogenous GDNF level alters the dopaminergic behavioural effects to repeatedly administered morphine, emphasizing the involvement of GDNF in the neuroplastic changes related to long-term effects of drugs of abuse.
Collapse
Affiliation(s)
- M Airavaara
- Division of Pharmacology and Toxicology, Faculty of Pharmacy, University of Helsinki, Finland.
| | | | | | | | | |
Collapse
|
7
|
Abstract
AIM To investigate the health service experiences and needs of parents in the period around diagnosis of ophthalmic disorders in their children. METHODS Parents of children newly diagnosed with visual impairment and/or ophthalmic disorders at a tertiary level hospital in London participated in a questionnaire survey, using standard instruments, followed by in-depth individual interviews, to elicit their views about the processes of care, their overall level of satisfaction, and their unmet needs. RESULTS 67% (147) of eligible families (135 mothers, 76 fathers) participated. Overall satisfaction with care was high, being greater among parents of children with milder visual loss or isolated ophthalmic disorders than those with more severe visual loss or multiple impairments. Nevertheless, parents' reported greatest need was the provision of general information, including about their child's ophthalmic disorder and educational and social services and support. Mothers reported greater information needs than fathers, as did white parents compared to those from ethnic minorities. White parents also regarded the processes of care to be less comprehensive and coordinated, as well as less enabling, than did parents from ethnic minorities. CONCLUSIONS Although parents reported high overall satisfaction with services, improving the medium, content, and scope of general information provided by professionals to parents of visually impaired children emerges as a priority. Equitable planning and provision of health services for families of children with visual impairment needs to take into account that informational and other needs vary by whether the parent is the primary carer or not and their ethnicity, as well as by the severity and complexity of their child's visual loss.
Collapse
Affiliation(s)
- J S Rahi
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
| | | | | | | |
Collapse
|
8
|
Rahi JS, Manaras I, Tuomainen H, Lewando Hundt G. Engaging families in health services research on childhood visual impairment: barriers to, and degree and nature of bias in, participation. Br J Ophthalmol 2004; 88:782-7. [PMID: 15148212 PMCID: PMC1772196 DOI: 10.1136/bjo.2003.033258] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To investigate the barriers to, and degree and nature of bias in, participation in health services research by parents of children with visual impairment. METHODS Parents of children newly diagnosed with ophthalmic disorders at Great Ormond Street Hospital, London, participated in a study to elicit their health service experiences and needs through a postal questionnaire survey followed by in-depth interviews. The participating and non-participating families were compared at different stages of recruitment, according to sociodemographic and clinical characteristics. RESULTS 20% (55) of all eligible families could not be invited to participate because of out of date contact details for either the family and/or family doctor in the hospital and/or community record systems. Completed questionnaires were received from 67% (147/221) of contacted families, although only 6% actively declined to take part. Compared to non-participating parents, those who took part were more likely to be white British, from higher socioeconomic groups, have English as their main language, and have no other visually impaired family members. There were no significant differences according to the clinical characteristics of their affected children. CONCLUSIONS Families from socioeconomically deprived and ethnic minority groups are likely to be less visible than others in health services research on childhood visual impairment. Geographical mobility in families of young children with visual disability poses a potentially important obstacle to engaging them in research on their experiences of health services. These findings indicate the importance of addressing potential biases in the design and interpretation of future studies, to ensure equity in recommendations for policy and practice, and in implementation of services.
Collapse
Affiliation(s)
- J S Rahi
- Centre for Paediatric Epidemiology and Biostatistics and the Department of Ophthalmology, Institute of Child Health/Great Ormond Street Hospital, London, UK.
| | | | | | | |
Collapse
|
9
|
Abstract
Although oral squamous cell carcinoma accounts for only a small proportion of malignant neoplasms in the UK, oral cancer incidence and mortality rates have been rising in recent years. The natural history of oral cancer is not adequately understood at present and there is very little information about the epidemiology of precancerous lesions in the UK. There are also insufficient data to provide firm evidence that the percentage of cases arising de novo is greater in the UK and the Western world as compared to the Indian subcontinent. Screening for oral cancer by visual examination is simple, inexpensive and causes little discomfort; however, there is no evidence for the effectiveness of screening for oral cancer either in reducing mortality from the disease or in reducing the incidence of invasive disease by detection and treatment of precancerous lesions. There is currently insufficient evidence to recommend population screening for oral cancer in the UK. Measures aimed at primary prevention of the disease may be a more feasible method of disease control at present.
Collapse
Affiliation(s)
- V C Rodrigues
- Cancer Screening Evaluation Unit, Block D, Institute of Cancer Research, Sutton, Surrey, UK
| | | | | |
Collapse
|