This article provides a national perspective on the schools and school programs for students with emotional disturbances (ED) who are served in special education, using nationally representative da...

Educating Students With Emotional Disturbances: A National Perspective on School Programs and Services

Purpose of review: Adolescents with mental health problems often require transition of care from child and adolescent to adult mental health services. This review is a synthesis of current research and policy literature on transition to describe the barriers at the interface between child and adolescent mental health services and adult mental health services and outcomes of poor transition.

Recent findings: Adolescence is a risk period for emergence of serious mental disorders. Child and adolescent mental health services and adult mental health services use rigid age cut-offs to delineate service boundaries, creating discontinuities in provision of care. Adolescent mental health services are patchy across the world. Several recent studies have confirmed that problems occur during transition in diverse settings across several countries. In physical health, there are emerging models of practice to improve the process and outcomes of transition, but there is very little comparable literature in mental healthcare.

Summary: Poor transition leads to disruption in continuity of care, disengagement from services and is likely to lead to poorer clinical outcomes. Some young people, such as those with neurodevelopmental disorders and complex needs, are at a greater risk of falling through the care gap during transition. Services need robust and high-quality evidence on the process and outcomes of transition so that effective intervention strategies can be developed.

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Transition of care from child to adult mental health services: the great divide.

This study examines rates of admission and patterns of mental health service use by persons of transition age (16–25 years) in the USA based on the nationally representative 1997 Client/Patient Sample Survey and population data from the US Census Bureau. A precipitous decline in utilization was observed at the age of emancipation: the yearly admission rate for inpatient, outpatient, and residential services was 34 per 1,000 for 16- and 17-year-olds and 18 per 1,000 for 18- and 19-year-olds. Among 20- and 21-year-olds, more were referred from criminal justice and fewer from family or friends and social services, and proportionately more were Medicaid recipients. Targeting resources to enhance shared planning between child and adult systems may facilitate continuity of care for young adult clients who are aging out of child mental health systems, as well as for those who experience their first episodes of mental disorder in early adulthood.

US Patterns of Mental Health Service Utilization for Transition-Age Youth and Young Adults

Although young people's transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) in England is a significant health issue for service users, commissioners and providers, there is little evidence available to guide service development. The TRACK study aims to identify factors which facilitate or impede effective transition from CAHMS to AMHS. This paper presents findings from a survey of transition protocols in Greater London. A questionnaire survey (Jan-April 2005) of Greater London CAMHS to identify transition protocols and collect data on team size, structure, transition protocols, population served and referral rates to AMHS. Identified transition protocols were subjected to content analysis. Forty two of the 65 teams contacted (65%) responded to the survey. Teams varied in type (generic/targeted/in-patient), catchment area (locality-based, wider or national) and transition boundaries with AMHS. Estimated annual average number of cases considered suitable for transfer to AMHS, per CAMHS team (mean 12.3, range 0–70, SD 14.5, n = 37) was greater than the annual average number of cases actually accepted by AMHS (mean 8.3, range 0–50, SD 9.5, n = 33). In April 2005, there were 13 active and 2 draft protocols in Greater London. Protocols were largely similar in stated aims and policies, but differed in key procedural details, such as joint working between CAHMS and AMHS and whether protocols were shared at Trust or locality level. While the centrality of service users' involvement in the transition process was identified, no protocol specified how users should be prepared for transition. A major omission from protocols was procedures to ensure continuity of care for patients not accepted by AMHS. At least 13 transition protocols were in operation in Greater London in April 2005. Not all protocols meet all requirements set by government policy. Variation in protocol-sharing organisational units and transition process suggest that practice may vary. There is discontinuity of care provision for some patients who 'graduate' from CAMHS services but are not accepted by adult services.

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Transitions of care from child and adolescent mental health services to adult mental health services (TRACK study): a study of protocols in Greater London

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.

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Transfers and transitions between child and adult mental health services.

The ability of state child mental health (MH) systems to facilitate the transition to adulthood of adolescents in their systems was studied by interviewing members of the Children, Youth and Families Division of the National Association of State Mental Health Program Directors (NASMHPD). Results demonstrated that transition services within the state child MH systems are sparse, nationally. Continuity of services as youth age into adulthood is hampered because of generally separate child and adult MH systems, each with separate policies defining who accesses those services, lack of clarity about procedures to access adult MH services, and lack of shared client planning between adult and child MH systems. These findings suggest that adolescents in state child MH systems have difficulty accessing services that will help them with the difficult task of learning to function as an adult. Public MH systems should examine their capacity to provide transition supports and make needed improvements.

State child mental health efforts to support youth in transition to adulthood.

This article examines data for 8,484 transition-aged youth (TAY) in different age groups who received services in 45 federally funded systems of care between 1997 and 2006. Data from the national evaluation of these systems of care were used to compare descriptive and clinical characteristics at intake of TAY aged 14–15, 16–17, and 18 years, and service use and outcomes of TAY aged 14–15 and 16–17 at 6 and 12 months after system of care intake. Few studies have examined outcomes of TAY. The large national evaluation database provides a unique opportunity to examine outcomes for TAY in relation to increases in age. Results revealed differences in severity and type of behavioral and emotional problems, living situations, access to Medicaid, service use, and outcomes among younger and older youth. Findings support the need to enhance access to services for older TAY and to customize services to the unique needs of each age group.

Characteristics, Service Experiences, and Outcomes of Transition-Aged Youth in Systems of Care: Programmatic and Policy Implications

Cluster analysis was conducted to examine clinical characteristics of 10- to 19-year-old boys (N = 1,961) and girls (N = 1,320) with serious emotional disturbance entering systems of care funded by...

Describing the Population of Adolescents Served in Systems of Care.

Systems of care: A strategy to transform children's mental health care.

Since the mid-1990s, research has established a clear picture of the poor real-life outcomes achieved by transition-age youth and young adults who have been diagnosed with a serious mental health disorder. The purpose of this article is to: (1) introduce the reader to the other eight articles in this special issue on Transition to Adulthood Research; (2) illustrate how each is contributing to the research base available to more fully understand these challenges as well as guide the creation of developmentally appropriate and effective services and supports for youth and young adults and their families; and (3) suggest future directions for continuing to advance this field of research and program implementation to improve outcomes though practice and policy improvements.

Research on Transition to Adulthood: Building the Evidence Base to Inform Services and Supports for Youth and Young Adults with Serious Mental Health Disorders

Diane L. Sondheimer

Papers

State child mental health efforts to support youth in transition to adulthood.

Characteristics, Service Experiences, and Outcomes of Transition-Aged Youth in Systems of Care: Programmatic and Policy Implications

Describing the Population of Adolescents Served in Systems of Care.

Systems of care: A strategy to transform children's mental health care.

Research on Transition to Adulthood: Building the Evidence Base to Inform Services and Supports for Youth and Young Adults with Serious Mental Health Disorders