European Psychiatry - Volume 33 - March 2016

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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 ∗, M. Tatlow-Golden , B. Gavin , S. Singh
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.
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 HealthTrackerTM 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 HealthTrackerTM
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 theHealthTrackerTM 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.
W08
Novel research on transition from
child to adult mental health services
in Europe: The MILESTONE project
H. Tuomainen ∗ . 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.