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S58

24th European Congress of Psychiatry / European Psychiatry 33S (2016) S56–S71

W06

A systematic review of service

transitions in people with ADHD

F. McNicholas

1 , 2 ,

, M. Tatlow-Golden

1

, B. Gavin

1

, S. Singh

3

1

University College Dublin, School of Medicine and Medical Science,

Dublin, Ireland

2

Lucena Clinic- St John of God-Dublin, Child Psychiatry, D6, Ireland

3

University of Warwick, medical School, Warwick, United Kingdom

Corresponding author.

Background

Young people (YP) with attention deficit hyperac-

tivity disorder (ADHD) are recognized to be a group who are

particularly vulnerable to falling through the gap regarding transi-

tioning fromChild and Adolescent Mental health Services (CAMHS)

to Adult Mental Health Services (AMHS). This presentation will

combine a systematic review of the literature with some clinical

examples of the pathway for a number of YP with ADHD who reach

the transition boundary (TB).

Method

(1) Databases (e.g., PubMed, PsycINFO, AMED, CINAHL,

EMBASE, Web of Knowledge), and grey literature, were searched

systematicallywith database-specific keywords, variants and trun-

cations, to cover six subject areas: ADHD; transition or transfer;

age; experiences or views; service development; and policies or

protocols. Hand searching of key journals, ancestry and forward

searches of references, and expert consultation were conducted.

Two reviewers critically evaluated studies using a validated

appraisal tool for mixed methodologies and findings were syn-

thesized. (2) Following ethical approval, CAMHS clinicians from 9

clinics in Republic of Ireland identified all cases where a YP with

ADHD had reached the TB, and identified referral/service outcomes

(

n

= 20).

Results

The search yielded 27 studies, covering areas of service

review and recommendations (7), guidelines (3), medication (5),

case note audit (3), professional’s views (5), pilot transition clinics

(2). A further set of papers covered the perspective of the young

person (4) and parent (2). Overall these highlighted the less than

optimum experience by both clinicians and service users of the

experience with suggestions for future developments. These find-

ings were mirrored in the review of clinical notes and individual

interviews of YP identified through their CAMHS. Of the 20 young

people identified, only 1 was directly transferred to AMHS. Eight

were retained in CAMHS, on average for over a year. A significant

number (7) refused onward referral. A perception from CAMHS

clinicians, that AMHS did not accept such cases or lacked relevant

service/expertise, may have contributed to the low rate of referral.

Conclusion

Both the extant literature and the specific study

presented highlight the lack of clear cut consensus about the appro-

priate management of young people with ADHD have who reach

the transition boundary. Low rates of AMHS transfer may come

from CAMHS clinicians’ perceptions of AMHS, and preferences of

young people and families. Before assuming the very low rate of

referral by CAMHS clinicians is poor practice, clinical outcomes

need to be identified, young people’s reasons for refusing transfer

explored and service options identified.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.940

W07

Developing and measuring

transition-related decision-making in

Europe

P. Santosh

Institute of Psychiatry, Psychology and Neuroscience King’s College

London, Department of Child and Adolescent Psychiatry, London,

United Kingdom

The MILESTONE project developed the Transition Readiness and

Appropriateness Measure (TRAM) and the Transition-Related Out-

come Measure (TROM) on the HealthTracker

TM

platform, each

prepared in versions for young people, parents/carers and clini-

cians. Together these instruments aim to support and then evaluate

clinician decision-making with respect to transition. The suite of

measures were developed on and hosted on the HealthTracker

TM

Platform. FDA approved protocols were evoked in scale develop-

ment and validation. A comprehensive list of items potentially

significant in transition decision-making was generated from a

thorough literature review and discussion with experts. Focus

groups were conducted with young people, parents/carers and

clinicians centring on the themes of “who should transition” and

“identifying successful transition”. Inopendiscussion, further items

considered important in transition decision-making were elicited,

and the importance of listed items was rated. Analysis of the

data allowed items to be removed, kept or amalgamated. Domains

considered universally important in transition decision-making

emerged; these included diagnosis, impairment, risk, life changes,

barriers to a successful transition and transition success mark-

ers. A beta version of the scale was tested for comprehension and

usability by transition experts, young people and parents/carers.

Following pilot testing, qualitative interviews were conductedwith

some participants to identify further issues. Scales were translated

from English into French, Italian, German, Croatian and Dutch and

translations uploaded to theHealthTracker

TM

online platform. Vali-

dation of the scales required completion of the TRAM and TROM

alongside a series of proxy “gold-standard” measures to assess psy-

chometric validity, test-retest validity and sensitivity to change.

Disclosure of interest

The author has not supplied his declaration

of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.941

W08

Novel research on transition from

child to adult mental health services

in Europe: The MILESTONE project

H. Tuomainen

, S.P

. Singh , The MILESTONE Consortium

Warwick Medical School, University of Warwick, Coventry, United

Kingdom

Corresponding author.

Introduction

Current service configuration of distinct Child and

Adolescent Mental Health (CAMHS) and Adult Mental Health Ser-

vices (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.

Objectives

The overall objective of the MILESTONE project is to

improve transition from CAMHS to AMHS in diverse healthcare

settings in Europe.

Aims

To improve the understanding of current transition-related

service characteristics, and processes, outcomes and experiences of

transition fromCAMHS 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 man-

aged 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.

Methods

Data will be collected via systematic literature reviews;

bespoke surveys to CAMHS professionals, experts and other stake-

holders; focus groups with service providers and users and

members of youth and mental health advocacy groups; and a lon-

gitudinal 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.