https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)61238-0.pdf

No health without mental health.

INTRODUCTION: The transition between paediatric and adult care for young people with chronic illness or disability is often poorly managed, with adverse consequences for health. Although many agree that adolescent services need to be improved, there is little empirical data on which policies can be based. OBJECTIVES: To systematically review the evidence of effectiveness of transitional care programmes in young people aged 11-25 with chronic illness (physical or mental) or disability, and identify their successful components. DESIGN: A systematic literature review in July 2010 of studies which consistently evaluated health outcomes following transition programmes, either by comparison with a control group or by measurement pre-intervention and post-intervention. RESULTS: 10 studies met the inclusion criteria, six of which showed statistically significant improvements in outcomes. Descriptive analysis identified three broad categories of intervention, directed at: the patient (educational programmes, skills training); staffing (named transition co-ordinators, joint clinics run by paediatric and adult physicians); and service delivery (separate young adult clinics, out of hours phone support, enhanced follow-up). The conditions involved varied (eg, cystic fibrosis, diabetes mellitus), and outcome measures varied accordingly. All six interventions that resulted in significant improvements were in studies of patients with diabetes mellitus, with glycosylated haemoglobin level, acute and chronic complications, and rates of follow-up and screening used as outcome measures. CONCLUSIONS: The most commonly used strategies in successful programmes were patient education and specific transition clinics (either jointly staffed by paediatric and adult physicians or dedicated young adult clinics within adult services). It is not clear how generalisable these successful studies in diabetes mellitus will be to other conditions.

https://adc.bmj.com/content/archdischild/96/6/548.full.pdf

Improving the transition between paediatric and adult healthcare: a systematic review

Our children deserve better: prevention pays

Objective To investigate a framework of correlates of both mental illness and wellbeing in a large, current, and nationally representative sample of children in the United Kingdom. Method An ecologic framework of correlates including individual (sociodemographic and human capital), family, social, and wider environmental factors were examined in 12,347 children aged 11 years old from the UK Millennium Cohort Study. Mental illness and wellbeing scores were standardized to allow comparisons, and the variance explained by the different predictors was estimated. Results Mental illness and wellbeing were weakly correlated in children ( r  = 0.2), and their correlates were similar in some instances (e.g., family structure, sibling bullying, peer problems) but differed in others (e.g., family income, perceived socioeconomic status, cognitive ability, health status, neighborhood safety). The predictors included in the study explained 47% of the variance in symptoms of mental illness, with social relationships, home environment, parent health, cognitive ability, socioeconomic status, and health factors predicting large amounts of variance. A comparatively lower 26% of the variance in wellbeing was explained by the study variables, with wider environment, social relationships, perceived socioeconomic status, and home environment predicting the most variance. Conclusion Correlates of children's mental illness and wellbeing are largely distinct, stressing the importance of considering these concepts separately and avoiding their conflation. This study highlights the relevance of these findings for understanding social gradients in mental health through the life course and the conceptualization and development of mental illness and wellbeing in childhood as precursors to lifelong development in these domains.

Correlates of Mental Illness and Wellbeing in Children: Are They the Same? Results From the UK Millennium Cohort Study

Background 

Transfer of care from one healthcare provider to another is often understood as a suboptimal version of the process of transition.

Aims 

To separate and evaluate concepts of transfer and transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS).

Method 

In a retrospective case-note survey of young people reaching the upper age boundary at six English CAMHS, optimal transition was evaluated using four criteria: continuity of care, parallel care, a transition planning meeting and information transfer.

Results 

Of 154 cases, 76 transferred to AMHS. Failure to transfer resulted mainly from non-referral by CAMHS ( n = 12) and refusal by service users ( n = 12) rather than refusal by AMHS ( n = 7). Four cases met all criteria for optimal transition, 13 met none; continuity of care ( n = 63) was met most often.

Conclusions 

Transfer was common but good transition rare. Reasons for failure to transfer differ from barriers to transition. Transfer should be investigated alongside transition in research and service development.

/pdf/transfers-and-transitions-between-child-and-adult-mental-2ziatlo0po.pdf

Transfers and transitions between child and adult mental health services.

Getting it right for children and young people: overcoming cultural barriers in the NHS so as to meet their needs

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Getting it right for children and young people: overcoming cultural barriers in the NHS so as to meet their needs