Transition from children’s to adult services for young people with attention deficit hyperactivity disorder.

This review aims to identify, review and compare guidelines, specifically focussed on transition for young adults with ADHD within England.

Abstract
Background
In recent years, the difficulty for young people with mental health issues who require a transition to adult services has been highlighted by several studies. In March 2018 the National Institute of Health and Care Excellence (NICE) produced detailed guidelines for the diagnosis and management of attention deficit hyperactivity disorder (ADHD), updated from previous versions in 2008 and 2016, which included general recommendations for transition to an adult service. Yet, there is limited research on transition specifically for those with ADHD. This review aims to systematically identify, review and compare guidelines, specifically focussed on transition for young adults with ADHD within England.

Methods
Following the general principles for systematic reviewing as published by the University of York, 10 electronic databases were searched. Further documents were identified through searches of grey literature and additional sources.

Results
Sixteen documents were included. Results indicate very limited publically accessible guidelines in England for transition of young people with ADHD. Nearly all identified documents based their recommendations for transition on the existing NICE guidelines. Neurodevelopmental conditions such as ADHD are often encompassed within one overarching health policy rather than an individual policy for each condition.

Conclusions
Guidelines should be available and accessible to the public in order to inform those experiencing transition; adjusting the guidelines to local service context could also be beneficial and would adhere to the NICE recommendations. Further review could examine transition guideline policies for mental health in general to help identify and improve current practice.

Full reference: Eke, H. , Janssens, A. and Ford, T. (2018), Review: Transition from children’s to adult services: a review of guidelines and protocols for young people with attention deficit hyperactivity disorder in England. Child &Adolescent Mental Health.

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Youth mental health recovery from a parental perspective

This paper discusses a model which provides an understanding of (a) the characteristics of youth mental health recovery, (b) the facilitators of recovery and (c) the barriers to recovery.

Abstract
Background
Mental health disorders have a negative impact on the individual, society and global economy. The prevalence of mental disorders is increasing in young people, if unaddressed, they may develop into severe and chronic illnesses. Despite this, research into youth mental health recovery is limited. The current study aims to develop a theoretical framework of recovery in youth mental health and identify what facilitates this process.

Methods
Fourteen parents of children engaged with the Child and Adolescent Mental Health Service were interviewed in relation to their understanding of youth mental health recovery. The transcripts of these interviews were analysed using the constructivist grounded theory approach.

Results
A theoretical model of youth mental health was developed. The model provides an understanding of (a) the characteristics of youth mental health recovery, (b) the facilitators of recovery and (c) the barriers to recovery. The theory suggests that due to developmental factors youth mental health recovery occurs within the ecological context of complex social systems.

Conclusions
The theory reflects elements of existing developmental and recovery research and provides a novel understanding of youth mental health recovery. This model may inform social, government and service attitudes and policy, and highlights areas for future research.

Full reference: Kelly, M. & Coughlan, B. (2018), A theory of youth mental health recovery from a parental perspective. Child & Adolescent Mental Health

The NHS Long-Term Plan: Centre for Mental Health’s response

In June this year, the UK government pledged a long term settlement for the NHS, and chose mental health as one of the key priority areas to receive sustained funding. Since this announcement, NHS England have approached many organisations with expertise in mental health, including the Centre for Mental Health, inviting them to share their views on what should be prioritised in the upcoming long-term plan for mental health.

This response is based on research the Centre for Mental Health has carried out in recent years, and builds on the report to the Mental Health Taskforce, Priorities for Mental Health.

Full document: The NHS Long-Term Plan: Response from Centre for Mental Health

Striking increase in mental health conditions in children and young people

University of Exeter |September 2018 | Striking increase in mental health conditions in children and young people

The first national-level study in over a decade to investigate trends in mental health problems in children and young people in the UK reports that there has been a notable increase in mental health conditions in children and young people. This research involved academics at University College London, Imperial College London, Exeter University and the Nuffield Trust. Researchers analysed data from 140,830 participants aged between 4 and 24 years, in 36 national surveys in England, Scotland and Wales over time.

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They found since 1995 where just 0.8 % of children and young people (ages 4-24) had a mental health condition, by 2014 this figure had increased to 4.8 %. Data for this period demonstrates the increase in treatment in England (60%), Scotland (75% )  and Wales (41%).

Key findings include:

  • Between 1995 and 2014 the proportion of children and young people aged 4-24 in England reporting a long-standing mental health condition increased six fold, meaning that by 2014 almost one in twenty children and young people in England reported having a mental health condition.
  • In 2008, when comparable data from the other two countries was available, 3% of 4-24 year olds in England and 3.7% in Scotland said they had a long-standing mental health condition, with 2.9% of 4-24 year olds in Wales saying they had received treatment. By 2014 these figures had grown to 4.8% in England, 6.5% in Scotland and 4.1% in Wales.
  • The age group with the biggest increases were young people aged 16-24, with young people in England almost 10 times  more likely to report a long-standing mental health condition in 2014 than in 1995 (0.6 vs. 5.9%).
  • Young boys aged 4-12 were consistently more likely to report a long-standing mental health condition than young girls. This was true across all countries. There was less of a consistent gender pattern in the 12-15 and 16-24 age groups.
  • Over the corresponding time period, the prevalence of total long standing conditions (both physical and mental) decreased slightly in England (20.3 to 19.5%,), increased slightly in Scotland (17.6% to 22.0%) and was broadly unchanged in Wales (13.1% vs. 13.5%).
  • Long-term trends in reported symptoms of mental health problems (as opposed to reports of a long-standing condition) showed no consistent evidence of an increase in emotional distress. However, the most recent evidence (from 2011-2014) showed concerning early signs of worsening emotional or psychological distress among young adults. For example, the odds of reporting above-threshold symptoms of emotional distress increased by 15% per year among young adults in Scotland.

Dr Dougal Hargreaves of Imperial College London and a Visiting Research Analyst at the Nuffield Trust said:

“We know that there is already a growing crisis in the availability of Child and Adolescent Mental Health Services, with many more children and young people needing treatment than there are services to provide it. Our study suggests that this need is likely to continue to grow in future. Without more radical action to improve access to and funding for CAMHS services, as well as a wider strategy to promote positive mental health and wellbeing, we may be letting down some of the most vulnerable in society.

“But it’s not all bad news. The increase in reports of long-standing mental health conditions may also mean that children and young people are more willing to open up about their mental health, suggesting that we have made some progress in reducing the stigma associated with mental ill health.” (Source: University of Exeter)

The study is published in the journal Psychological Medicine

Pitchforth, J., Fahy, K., Ford, T., Wolpert, M., Viner, R., & Hargreaves, D| (n.d.|  Mental health and well-being trends among children and young people in the UK, 1995–2014: Analysis of repeated cross-sectional national health surveys| Psychological Medicine| 1-11. doi:10.1017/S0033291718001757

Abstract

BackgroundThere is a growing concern about the mental health of children and young people (CYP) in the UK, with increasing demand for counselling services, admissions for self-harm and referrals to mental health services. We investigated whether there have been similar recent trends in selected mental health outcomes among CYP in national health surveys from England, Scotland and Wales.

MethodsData were analysed from 140 830 participants (4–24 years, stratified into 4–12, 13–15, 16–24 years) in 36 national surveys in England, Scotland and Wales, 1995–2014. Regression models were used to examine time trends in seven parent/self-reported variables: general health, any long-standing health condition, long-standing mental health condition; Warwick–Edinburgh Mental Wellbeing Score (WEMWBS), above-threshold Strengths and Difficulties Questionnaire Total (SDQT) score, SDQ Emotion (SDQE) score, General Health Questionnaire (GHQ) score.

ResultsAcross all participants aged 4–24, long-standing mental health conditions increased in England, Scotland and Wales. Among young children (4–12 years), the proportion reporting high SDQT and SDQE scores decreased significantly among both boys and girls in England and girls in Scotland. The proportion with high SDQE scores but increased in Wales. The proportion with high GHQ scores decreased among English women.

ConclusionsDespite a striking increase in the reported prevalence of long-standing mental health conditions among UK CYP, there was relatively little change in questionnaire scores reflecting psychological distress and emotional well-being.

 

The article is available in full from Psychological Medicine 

 

Related:

Read the accompanying blog on Nuffield Trust Striking increase in mental health conditions in children and young people

 

A tailored approach to child and adolescent mental health

NIHR | August 2018 | A tailored approach to child and adolescent mental health

Although one-tenth of school children have a mental illness, less than a third of mental health research focuses on children and young people. NIHR spotlights an example in Yorkshire and Humber which takes a ‘child oriented’ approach to research. The Child Oriented Mental Health Intervention Centre (COMIC) is based in York and operates in partnership with Leeds and York Partnership NHS Foundation Trust and the Hull and York Medical School at the University of York, as part of a large Mental Health and Addictions Research Group.

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This is unusual as Professor Barry Wright, a child psychiatrist who leads a team of 12 at COMIC explains:  “Normally, the approach with children is to adapt a treatment or intervention which works in adults, but we don’t do that. We design our interventions specifically for young people.”

COMIC researchers meet with a number of young people’s patient and public involvement (PPI) groups, such as the Bradford-based Young Dynamos, to shape, design and develop research. “Some of our projects have come from PPI, which is our raison d’etre, really,” adds Professor Wright.

Projects COMIC have worked on involve resources such as Social Stories (trademark) to encourage and develop social skills for children and young people with autism. Lego is also used by the team to support interaction for young people with atuism, lego-based therapy puts children in a group of three. One child is the engineer, another is the supplier, and the third one is the builder. With each one directing the other what pieces to get to build a model together. (Source: NIHR)

Read the full story at NIHR 

You might also be interested in reading more about ASPECT  here 

The impact of homelessness on young children

Sandel M, Sheward R, Ettinger de Cuba S, et al. | 2018 | Timing and Duration of Pre- and Postnatal Homelessness and the Health of Young Children | Pediatrics | 2018| 142 | 4 | e20174254

A US study that looked at the impact of homelessness on young children has found that children who are for more than 6 months were at the highest risk of negative health outcomes. The findings have been published in the journal Pediatrics, where the abstract has been filmed it can be viewed here 

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Read the article at Pediatrics 

See also:

Science Direct Experiencing homelessness for longer than six months can cause significant damage to a child

Addressing child to adult transition in national clinical audit – A guide

Health Quality Improvement Programme | August 2018 | Addressing child to adult transition in national clinical audit – A guide

Health Quality Improvement Programme (HQIP) have produced a  guide that explores the topic of child to adult transition and its relevance to national clinical audits within the national healthcare context. It offers a practical guide on how to address transition through the different stages of audit development for those who commission, design and participate in national clinical audits and includes information on policies, guidelines, standards and healthcare commissioning incentives that align with child to adult transition.

 

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Image source: hqip.org.uk

It is aimed at Commissioners of national clinical audit including NHS England and other funders, the Healthcare Quality Improvement Partnership, professional groups and patient charities.

All those involved in the shaping and delivery of a national clinical audit whether they are national clinical directors, clinical leads, programme/project managers, clinicians, patient or parent representatives. Although written primarily with the National Clinical Audit and Clinical Outcome Review Programme (NCAPOP) national clinical audits in mind, the principles of this guidance are intended to be applicable to all national audits (Source: HQIP).

Download the guide from HQIP