The MILESTONE Study: Improving Transition From Child to Adult Mental Health Care

University of Warwick1,000 enrolled

Overview

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.

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.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

DOUBLE

Enrollment

1,000

Conditions

Mental Health Impairment Mental Health Disorder

Interventions

TRAM feedbackBEHAVIORAL

Eligibility

Sex: ALLMin age: 15 YearsMax age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Young person inclusion: 1. Provides valid written informed consent, or assent, if below the legal age of consent 2. 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 3. 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) 4. Has an IQ ≥ 70 as ascertained by previous standardised assessment or diagnosed by clinician, or no indication of intellectual impairment Exclusion Criteria: * 1\. 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

Locations (10)

Katholieke Universiteit Leuven

Leuven, Belgium

University Hospital Split

Split, Croatia

CHRU Montpellier-St Eloi hospital

Montpellier, France

University of Ulm

Ulm, Germany

Outcomes

Primary Outcomes

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

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.

Time frame: 15 months

Secondary Outcomes

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)

Time frame: Baseline, 9, 15, and 24 months

Transition outcome assessed by the Transition Related Outcome Measure (TROM) questionnaire

The TROM is a questionnaire completed by the young person, parent/carer and clinician

Time frame: Baseline, 9, 15, and 24 months

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)

YSR is completed by young people aged 17 years or less; ASR by those 18 years or over

Time frame: Baseline, 9, 15, and 24 months

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)

Parent/carer completes CBCL if young person is 17 years or less; ABCL if young person is 18 years or over

Time frame: Baseline, 9, 15, and 24 months

Illness severity assessed by Clinical Global Impression Severity (CGIS) scale (CGIseverity)

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.