title: Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study.
abstract: BACKGROUND
  Many adolescents with mental health problems experience transition of care from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS).
  
  
  OBJECTIVE
  As part of the TRACK study we evaluated the process, outcomes and user and carer experience of transition from CAMHS to AMHS.
  
  
  METHODS
  We identified a cohort of service users crossing the CAMHS/AMHS boundary over 1 year across six mental health trusts in England. We tracked their journey to determine predictors of optimal transition and conducted qualitative interviews with a subsample of users, their carers and clinicians on how transition was experienced.
  
  
  RESULTS
  Of 154 individuals who crossed the transition boundary in 1 year, 90 were actual referrals (i.e. they made a transition to AMHS), and 64 were potential referrals (i.e. were either not referred to AMHS or not accepted by AMHS). Individuals with a history of severe mental illness, being on medication or having been admitted were more likely to make a transition than those with neurodevelopmental disorders, emotional/neurotic disorders and emerging personality disorder. Optimal transition, defined as adequate transition planning, good information transfer across teams, joint working between teams and continuity of care following transition, was experienced by less than 5% of those who made a transition. Following transition, most service users stayed engaged with AMHS and reported improvement in their mental health.
  
  
  CONCLUSIONS
  For the vast majority of service users, transition from CAMHS to AMHS is poorly planned, poorly executed and poorly experienced. The transition process accentuates pre-existing barriers between CAMHS and AMHS.
authors.affiliation: Health Services Research Institute, Medical School Building, Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK. S.P.Singh@warwick.ac.uk
authors.forename: Swaran P
authors.initials: SP
authors.lastname: Singh
authors.forename: Moli
authors.initials: M
authors.lastname: Paul
authors.forename: Tamsin
authors.initials: T
authors.lastname: Ford
authors.forename: Tami
authors.initials: T
authors.lastname: Kramer
authors.forename: Tim
authors.initials: T
authors.lastname: Weaver
authors.forename: Susan
authors.initials: S
authors.lastname: McLaren
authors.forename: Kimberly
authors.initials: K
authors.lastname: Hovish
authors.forename: Zoebia
authors.initials: Z
authors.lastname: Islam
authors.forename: Ruth
authors.initials: R
authors.lastname: Belling
authors.forename: Sarah
authors.initials: S
authors.lastname: White
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration; D000328:Adult; D002648:Child; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000592:standards; D004739:England; D005260:Female; D006302:Health Services Research; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008499:Medical Records; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care; D036301:Qualitative Research; D012017:Referral and Consultation / Q000458:organization & administration