The MILESTONE Study: Improving Transition From Child to Adult Mental Health Care
- Conditions
- Mental Health DisorderMental Health Impairment
- Interventions
- Behavioral: TRAM feedback
- Registration Number
- NCT03013595
- Lead Sponsor
- University of Warwick
- Brief Summary
This study evaluates the longitudinal health and social outcomes of adolescent mental health service users who are at the transition boundary of their child and adolescent mental health service, and whether the implementation of a model of managed transition at the service boundary benefits them, as compared to usual care.
- Detailed Description
The MILESTONE study focuses on the period when young people attending a children and adolescents mental health service (CAMHS) need to move on, or "transition", to an adult mental health service (AMHS), if they still require care or treatment. We know from other research that this transition is not always properly managed and that improving the transition process can have a positive impact on the health and well-being of young people in this position. We want to evaluate what impact the different transition experiences have on young people's health and well-being, and whether the process of Managed Transition has any benefits as compared to usual care.
The MILESTONE study is run in eight European countries (UK, Ireland, Belgium, Holland, France, Germany, Italy and Croatia). CAMHS in the study regions are selected to provide the young people in their care that are reaching transition age either usual care or a novel service called "Managed Transition", which includes the use of a new decision support tool, the Transition Readiness and Appropriateness Measure (TRAM). This should help with decision making and enable better transitions by identifying cases for whom transition from CAMHS to AMHS is advisable and appropriate, or who can be safely discharged or referred to a community based service. CAMHS are randomly assigned to provide the intervention of Managed Transition or usual care. The health and well-being of the young people attending these services is assessed at the start of the study and then followed-up for 24 months to see whether they transition to AMHS or are discharged or referred to some other service.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 1000
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Young person inclusion:
- Provides valid written informed consent, or assent, if below the legal age of consent
- If age is within one year of reaching the transition boundary of their CAMHS during the trial recruitment period, and, in exceptional cases, not more than 3 months older than the transition boundary, if a decision about transition has not yet been made
- Has a mental disorder defined by DSM-IV-TR, DSM-5 or ICD 10/11, or is under the regular care of CAMHS (if not yet diagnosed)
- Has an IQ ≥ 70 as ascertained by previous standardised assessment or diagnosed by clinician, or no indication of intellectual impairment
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- Does not provide valid written informed consent, or assent, if below the legal age of consent 2. Is younger than a year before the transition boundary of their CAMHS 3. Has intellectual impairment (IQ <70) as ascertained by previous standardised assessment or diagnosed by clinician (if no data on intellectual functioning are available [because it has never been assessed] then care coordinators will be asked to make a clinical judgement on intellectual impairment before baseline assessment takes place) 4. If not able to (or expected not to be able to) complete the questionnaires due to severe physical disabilities or language problems, even with assistance from family members or research assistant 5. Service user in a secure forensic institution
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description TRAM feedback TRAM feedback 1. The completion of the "Transition Readiness and Appropriateness Measure" (TRAM, a standardized structured assessment ) prior to the transition boundary by the child and adolescent mental health service (CAMHS) clinician, young person and parent/carer. 2. Feedback of TRAM findings to the CAMHS clinician to support decisions made regarding transition, communication with stakeholders and the transition process. Clinicians will be expected to communicate the findings to the young person and parent/carer, and, if a referral is made, to send the TRAM feedback to the adult clinician along with the referral letter. 3. The clinicians will also receive information prior to recruitment begin on the use of TRAM and the way in which it fits in with optimal transition.
- Primary Outcome Measures
Name Time Method Mental health status (need for care) as measured by Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA - clinician version) at 15 months 15 months The measure will be completed by a trained MILESTONE research assistant taking into account all available sources of information (including the young person, parent/carer, relevant clinician and the medical records) to ensure accuracy of data.
- Secondary Outcome Measures
Name Time Method Self-rated (i.e. completed by young person) mental health status (need for care) on Health of the Nation Outcome Scale for Children and Adolescents (HONOSCA) Baseline, 9, 15, and 24 months Transition outcome assessed by the Transition Related Outcome Measure (TROM) questionnaire Baseline, 9, 15, and 24 months The TROM is a questionnaire completed by the young person, parent/carer and clinician
Emotional and behavioural problems assessed by the Achenbach System of Empirically Based Assessment (ASEBA) Youth Self Report (YSR)/Adult Self Report (ASR) questionnaires (young person) Baseline, 9, 15, and 24 months YSR is completed by young people aged 17 years or less; ASR by those 18 years or over
Emotional and behavioural problems assessed by the Achenbach System of Empirically Based Assessment (ASEBA) Child Behavior Checklist (CBCL) or Adult Behavior Checklist (ABCL) questionnaires (parent/carer) Baseline, 9, 15, and 24 months Parent/carer completes CBCL if young person is 17 years or less; ABCL if young person is 18 years or over
Barriers to care assessed by Barriers to Care (BtC) checklist 9, 15, and 24 months, if young person is no longer a service user Transition experience and readiness assessed by On Your Own Feet - Transition Experience Scale (OYOF-TES) at 9, 15 or 24 months, completed only once at the first assessment after transition Adult functioning assessed by Specific Levels of Functioning Scale (SLOF) Baseline and 24 months Quality Adjusted Life Years (QALYs) assessed by EuroQol generic quality of life questionnaire (EQ-5D-5L) Baseline, 9, 15, and 24 months Service use assessed by a MILESTONE specific Client Service Receipt Inventory (CSRI) Baseline, 9, 15, and 24 months Mental health status as measured by Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA - clinician version) Baseline, 9 months, 24 months The measure will be completed by a trained MILESTONE research assistant taking into account all available sources of information (including the young person, parent/carer, relevant clinician and the medical records) to ensure accuracy of data.
Illness severity assessed by Clinical Global Impression Severity (CGIS) scale (CGIseverity) Baseline, 9, 15, and 24 months Quality of life assessed by World Health Organisation Quality of Life Assessment (WHOQOLBREF) Baseline, 15, and 24 months Independent behaviour assessed by Independent Behaviour During Consultation Scale (IBDCS) Baseline, 9, 15, and 24 months, if young person is a current service user Illness perception assessed by the Brief Illness Perception Questionnaire (BIPQ) Baseline and 24 months
Trial Locations
- Locations (10)
Katholieke Universiteit Leuven
🇧🇪Leuven, Belgium
University College Dublin
🇮🇪Dublin, Ireland
King's College London
🇬🇧London, United Kingdom
Warwick Medical School, University of Warwick
🇬🇧Coventry, United Kingdom
Erasmus Medical Centre
🇳🇱Rotterdam, Netherlands
University Hospital Split
🇭🇷Split, Croatia
CHRU Montpellier-St Eloi hospital
🇫🇷Montpellier, France
University of Ulm
🇩🇪Ulm, Germany
Yulius Academy
🇳🇱Barendrecht, Netherlands
IRCCS Fatebenefratelli
🇮🇹Brescia, Italy