Service Transition From Adult To Child

Question 1

Issues with transition

Answer 1

Transition within the mental health service can be challenging:
 It may confirm for the young person that they will experience ongoing concerns with their mental health. It can mean contact with older and more chronically unwell people and the loss of hope for recovery.
 Families/carers can be uncertain about the new system and their role in the care system. They may be concerned about being labelled as over-protective and interfering when previously they have been the main care co-ordinator. Although they may remain the main support, they frequently report reduced access to information and involvement in care planning.
 CAMHS and AMHS are philosophically and operationally different. There are frequently very different expectations between the services in relation to a young person‟s ability to act independently and take responsibility for their own care.
 The initiation of transition is generally driven by organisational issues such as age criteria and/or educational status or service capacity. The duration of transition often reflects service capacity rather than the needs of the young person. with due regard to confidentiality, demonstrated by exploring the mother‟s reluctance for the transfer of care and her understanding of the purpose of ongoing care; explores the mother‟s perception of her role and potential changes in the developmental context and in the context of ongoing care for her daughter; correctly advises on the balance between confidentiality and the need for family to be involved and informed so as to provide support;

Question 2

How to manage the transition well

Answer 2

Recognising and managing the key risks in the process: increased clinical risk, risk of being lost to follow-up.
 Developing an individualised transition plan in collaboration with the key players ensuring continuity of care that is well communicated to the patient, the family/carers and the clinical teams. Such a plan may incorporate: an explicit transition period (e.g. 3-6 months), joint clinical review by teams, written documentation etc. consider the broad range of people who should be involved in developing the plan including Vivienne and her family; clinicians from both teams; GP; individual and family therapists; teacher, vocational therapist etc – recognises importance of considering timing and length of time for transfer and considers possibilities such as case conferencing and co-management by teams to facilitate communication and transfer; clear about the differences in roles and what is their role in the process.