Transitioning between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) is a complicated process. Multiple issues can arise during this process, which can lead to deterioration of the patient’s diagnosis. This study is aimed at gaining a better understanding of these issues, their causes and potential changes to the transition that can help resolve them. Its results can be used to propose better moral and ethical standards for the transition.
The current research on the transition process from CAMHS to AMHS primarily focuses on issues related to specific diagnoses or health care contexts. A study by Lepièce, et al. (2019) provides background by showing that this age group is vulnerable to anxiety disorders. Cvejic & Trollor (2018), as well as Reale, et al. (2018) focus on ADHD and intellectual disability; both of these studies indicate issues with continuity of care between CAMHS and AMHS. These issues arise from limitations in the eligibility and poor transition planning (Cvejic & Trollor, 2018; Reale et al., 2018). Schraeder, et al (2019) points at the same gap in transition services. The systematic review by Paul, et al. (2015) further highlights the need for evidence on the subject and identifies more issues related to this transition gap. Most importantly, this review finds no clear evidence in favor of any particular model (Paul, et al., 2015). Finally, King, et al. (2020) describes the issues young people, especially those with autism spectrum disorders, face during the transition period. Although these studies do not propose any solutions, they identify a number of issues that occur during the transition period, as well as shortcomings in the associated medical pathways.
Methodology and Design
As this study focuses on the moral and ethical issues that arise during the transition process between CAMHS and AMHS, it should gather a number of critical sets of data. First, transitional pathways need to be examined and collated to identify areas where such issues arise. To this end, practice guidelines and mental health policies need to be examined. Second, a survey aimed at practitioners must be created and administered to clinicians to identify the prevalent view on the relevant moral and ethical issues. Third, the transitioning patients’ perspectives and challenges must be assessed using a questionnaire aimed at them and their parents/carers, identifying their concerns and satisfaction. Finally, the results need to be compared against medical records to identify any correlations between one’s experience and treatment during the transition period to his or her outcomes. Furthermore, a follow-up study is advisable to evaluate changes in these outcomes after five or ten years.
The first survey’s questionnaire should focus on the decision making process of practitioners as they handle their patients’ transition. Thus, questions should concern the themes of difficulty in referring patients, challenges concerning informed consent and interactions with the patients’ parents/caretakers. The questionnaire for the second survey, aimed at the patients and carers, should discuss their experiences and their views on any issues that can arise during the transition period. Besides obvious questions related to satisfaction, factors such as patient/carer agency and self-efficacy need to be estimated. Specifically, the questionnaire should seek to determine whether the patients and carers felt that they had sufficient options for further treatment and were sufficiently informed about these options. This survey can be presented together with a patient satisfaction survey since it includes similar questions.
As this is a non-intervention study focusing on a relatively small subset of the population, the most appropriate sampling method is a simple random sampling. Eligible subjects for the practitioner survey are chosen from those working in CAMHS and AMHS and have taken part in their patients’ transition process within the last 6 months. Patient and parent/carer subjects are chosen 6 to 12 months after their transition.
The study centers on three separate surveys, are administered together. Each of these surveys should focus on one patient transition. The surveys should use a mixed format, primarily consisting of yes or no questions, but added numerical ranking and open-ended items. Listed are the critical items for each one of these questionnaires.
Survey 1: Practitioners
- When referring the patient to AMHC, were there any issues in providing the information necessary for the patient and his or her parents/carers o make an informed decision. (Yes/No)
- When referring the patient, were there any issues when determining to whom he or she should be referred? (Yes/No)
- How do you estimate the effect the transition process on the patient’s treatment progress (1 — significant deterioration, 10 — significant improvement).
Survey 2: Patients
- Were you unable to access any mental care facilities at any time during the transition period? (Yes/No)
- Did you experience anxiety from the transition process (1 — none, 10 — required medical intervention)
- Did you experience depression from the transition process (1 — none, 10 — required medical intervention)
- Did you have any difficulty understanding the details involved in the transition process (Yes/No)
- How satisfied are you with the care you receive at AMHC, compared to CAMHC (1 — much worse, 10 — much better)
Survey 3: Parents/carers
- Did you feel the information provided to you about the transition process was sufficient to make an informed decision? (Yes/No)
- How do you feel [the patient’s] diagnosis changed as a result of the transition (1 — significantly deteriorated, 10 — significantly improved)
Cvejic, R. C., & Trollor, J. N. (2018). Transition to adult mental health services for young people with an intellectual disability. Journal of Paediatrics and Child Health, 54(10), 1127–1130.
King, C., Merrick, H., & Le Couteur, A. (2020). How should we support young people with ASD and mental health problems as they navigate the transition to adult life including access to adult healthcare services. Epidemiology and psychiatric sciences, 29, e90.
Lepièce, B., Zdanowicz, N., de Becker, E., de Timary, P., & Lorant, V. (2019). Adolescents in transition to young adulthood: evolution of mental health status and risk factors associated with depressive and anxiety disorder. Psychiatria Danubina, 31(Suppl 3), 371–375.
Paul, M., Street, C., Wheeler, N., & Singh, S. P. (2015). Transition to adult services for young people with mental health needs: A systematic review. Clinical child psychology and psychiatry, 20(3), 436–457.
Reale, L., Costantino, M. A., Sequi, M., & Bonati, M. (2018). Transition to Adult Mental Health Services for Young People With ADHD. Journal of attention disorders, 22(6), 601–608.
Schraeder, K. E., Reid, G. J., & Brown, J. B. (2019). An exploratory study of children’s mental health providers’ perspectives on the transition to adult care for young adolescents in the Canadian context. Journal of Pediatric Nursing, 49, 51–59.