Abstract
PurposeThe 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.MethodsDemographic, 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.ResultsYoung 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.ConclusionAlthough 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.
Highlights
Mental health services for children and adolescents will usually provide care until the young person is aged 16–19 years
Some argue that the provision of distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may hamper the continuity of care [1, 2] and that this discontinuity may adversely affect the mental health of young people
We found that the recommendation to continue treatment was primarily determined by clinician-reported severity of psychopathology and selfand parent-reported need for ongoing treatment, whereas the recommendation to continue treatment at AMHS rather than CAMHS was associated with treatment and service-userelated characteristics only, such as the length of CAMHS use and the availability of appropriate AMHS
Summary
Mental health services for children and adolescents will usually provide care until the young person is aged 16–19 years. Previous studies often do not clearly indicate whether or not the discontinuity of care is in accordance with the recommendation from the CAMHS clinician, i.e., that further mental health care was not required. If continuation of mental health care is deemed necessary, the clinician needs to decide where such care should be provided. In certain circumstances, this might include continuing at CAMHS for a short period to conclude treatment, or alternatively, transfer to AMHS or to another type of mental health service. The clinician’s recommendation regarding continuity of care is the first step in the process of transition and may have a significant impact on the young person’s outcomes. Our study focusses on the clinician’s transition recommendation and aims to describe which factors are associated with this recommendation
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