A Process Map and Proposed Model to Overcoming Barriers to Care | Journal of Pediatric Psychology
Objective: To provide a topical review of the personal vulnerabilities and systemic barriers facing transitional age young adults with attention-deficit hyperactivity disorder (ADHD), followed by a proposed model for overcoming those barriers.
Methods: Drawing from a growing, but limited, literature on the topic, we outline a process map for identifying and troubleshooting barriers to care in this at-risk population.
Results: Young adults with ADHD frequently lack the organizational skills, time management, prioritization, and persistence to manage their health care at an expected level of adult independence. These difficulties are compounded by a health-care system that has less time or fewer resources for supporting young adult patients.
Conclusions: Recommendations for easing the transition from pediatric to adult care for late adolescents with ADHD include heavily leveraging the doctor–patient relationship, and capturing the young adult’s attention through technologies that already absorb them.
Full reference: Fogler, J.M. et al. (2017) Topical Review: Transitional Services for Teens and Young Adults With Attention-Deficit Hyperactivity Disorder: A Process Map and Proposed Model to Overcoming Barriers to Care. Journal of Pediatric Psychology. Published online: 01 August 2017
Mandip Kaur for the King’s Fund Blog | 16th March 2017
Traditionally, mental health services are delivered by Children and Adolescent Mental Health Services (CAMHS) up until the age of 16 or 18 – or when a young person leaves school or college – at which point they’re expected to transition to adult mental health services. It’s long been recognised that this is a poor boundary for service transition, often having a further detrimental effect on mental health.
Forward Thinking Birmingham delivers mental health services for children and young people aged up to 25, combining the expertise of Birmingham Children’s Hospital, Worcester Health and Care Trust, Beacon UK, The Children’s Society and The Priory Group. The partnership’s vision is that Birmingham should be the first city where mental health problems are not a barrier to young people achieving their dreams. The transformational changes to the service were driven by the need to address disjointed and fragmented care provision, complicated service models, long waiting lists and rising demand. The service operates a ‘no wrong door’ policy and aims to provide joined-up care, focusing on individual needs, with improved access and choice for young people.
Read the full blog post here
New online learning resource for Community Nurses | The Queens Nursing Institute
The Queen’s Nursing Institute has launched Transition from Children’s to Adult Community Services Learning Resource.
The resource is designed to improve the experience of young people transitioning from children’s services to adult community services. It contains modules for district nurses, general practice nurses and healthcare educators. To produce the resource, the QNI held ten focus groups in different parts of the country and conducted three online surveys, as well as undertaking wider stakeholder involvement. In all, the views of around 900 people were used to inform the resource.
The QNI also carried out a review of academic literature in this area, which can be downloaded: Young people’s transition from children’s to adult services in primary and community care settings.
Trachtenberg, M. LSE Health & Social Care Blog. Published online: 18 April 2016
by Marija Trachtenberg
Common challenges for young people transitioning from children’s to adult services
First, an issue that is most common is that young people may not be adequately prepared to handle new responsibilities that come with using adult services. Adult services, compared to children’s services take a different approach in interacting with young people. Adult services tend to assume that these young people will take full responsibility and act appropriately in handling appointments, adhering to their medications, and restrain from risk-taking activity that may harm their health. Children’s services on the other hand may be over-involved and may take more responsibility than they should as the young person reaches thirteen or fourteen years old. These problems with preparation by children’s services and reception by adult services may mean that young people’s health may deteriorate when they transition if it is the case that they don’t know how to manage their health with this new responsibility.
Second, young people’s brains are still developing and likewise they are developing ‘socially’ i.e. they are very conscious of their peers. They also like to experiment and seek novelty. Such behaviours are true for everyone but the adolescent brain has a period when the regulation and inhibition of certain behaviours by the front part of the brain tends to be overridden by a rapidly developing part of the brain called the limbic system which determines emotions and reward seeking. This isn’t necessarily a problem but it may be a problem if a young person attends a party and wants to drink or smoke to the extent it interacts with their medical condition and affects their health. Or, they may avoid taking medications so that they can party and this could harm their health. Allan Colver highlights the need for practitioners to recognize this as potentially inevitable rather than pretend this won’t occur at all. Rather than telling them ‘not to do it’, practitioners should have honest dialogue and help the young person “do both” (i.e. party and take care of their health).
Read the full blog post here