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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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

Depression in children and young people

NICE has published a guideline on identifying and managing depression in children and young people aged between 5 and 18 years.

This guideline covers identifying and managing depression in children and young people aged between 5 and 18 years. Based on the stepped care model, it aims to improve recognition and assessment and promote effective treatments for mild, moderate and severe depression.

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Image source: www.nice.org.uk

This guideline includes recommendations on:

Full guideline: Depression in children and young people: identification and management

Position Statement On Children And Young Peoples’ Mental Health

The Royal Colleges of GPs (RCGP), Paediatrics and Child Health (RCPCH), and Psychiatrists (RCPsych) have committed to five shared principles that they hope will lead to tangible actions to improve the care and support of children and young people (CYP) with mental health problems.

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The three Colleges say that as well as the commissioning of specialist treatment, an effective CYP mental health system requires:

  • Acknowledgment that CYP mental health is everybody’s business, and should be supported by a shared vision for CYP mental health across all government departments, particularly health, education and justice.
  • A preventative, multi-agency approach to mental health across all ages, incorporating attention to education for young people and families, social determinants, and health promotion. This should focus on public mental health and early intervention in CYP, including minimising the need for admission and effective crisis services to maintain CYP in their homes.
  • A system of national and local accountability for population-level CYP mental health and well-being, delivered via integrated local area systems.
  • Training and education for the whole children’s workforce in their role and responsibilities for CYP mental health.
  • More support, both from specialist services and other sectors, for professionals dealing with CYP who do not meet referral threshold to a Child and Adolescent Mental Health Service (CAMHS).

Following the development of the joint principles, the three Colleges have committed to a number of ongoing actions. These include ensuring the highest quality training and standards in CYP mental health; supporting the development of evidence based models of care that are focused on integration of care; and calling for greater investment and resources to be focused on developing services in CYP friendly settings that promote early intervention and resilience.

Read the full statement here

Pharmacological guidelines for schizophrenia

Keating, D. et al. BMJ Open. 7:e013881

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Objectives: Clinical practice guidelines (CPGs) support the translation of research evidence into clinical practice. Key health questions in CPGs ensure that recommendations will be applicable to the clinical context in which the guideline is used. The objectives of this study were to identify CPGs for the pharmacological treatment of first-episode schizophrenia; assess the quality of these guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument; and compare recommendations in relation to the key health questions that are relevant to the pharmacological treatment of first-episode schizophrenia.

 

Conclusions: An individual’s experience of using antipsychotic medication for the initial treatment of first-episode schizophrenia may have implications for future engagement, adherence and outcome. While guidelines of good quality exist to assist in medicines optimisation, the evidence base required to answer key health questions relevant to the pharmacological treatment of first-episode schizophrenia is limited.

Read the full article here

Improving the mental health of children and young people

Reports to support commissioners in improving the mental health and wellbeing of children and young people. | Public Health England

These reports describe the importance of mental health and wellbeing among children and young people and the case for investment in mental health. They also summarise the evidence of what works to improve mental health among children and young people in order to inform local transformation of services.

The mental health of children and young people in England

The mental health of children and young people in London

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Image source: http://www.gov.uk

NICE issues guidance on inappropriate sexual behaviour in children

NICE | Published online September 2016

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This guideline covers children and young people who display harmful sexual behaviour, including those on remand or serving community or custodial sentences. It aims to ensure these problems don’t escalate and possibly lead to them being charged with a sexual offence. It also aims to ensure no-one is unnecessarily referred to specialist services.

‘Young people’ refers mainly to those aged 10 to 18 but also includes people up to 25 with special educational needs or a disability.

This guideline does not discuss people who have experienced sexual abuse. NICE will publish a guideline on child abuse and neglect in September 2017.

Recommendations

This guideline includes recommendations on:

Read the full guideline here