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The adolescent/young adult transition: models of service .

The adolescent/young adult transition: models of service . Dr Clare Lamb North Wales Adolescent Service Conwy & Denbighshire NHS Trust Nov. 2006. Adolescence to Adulthood. Crucial stage of development (social, personal, emotional) Time of major transitions

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The adolescent/young adult transition: models of service .

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  1. The adolescent/young adult transition: models of service. Dr Clare Lamb North Wales Adolescent Service Conwy & Denbighshire NHS Trust Nov. 2006

  2. Adolescence to Adulthood • Crucial stage of development (social, personal, emotional) • Time of major transitions • Coincides with emergence of a number of severe mental illnesses (including psychoses) • Evidence for continuity of psychiatric disorders, social, behavioural and emotional problems from adolescence to adult life

  3. Key Issues 1 • Few mental health services specific to older adolescents • Patchy provision for those over 16 years • Transition between CAMHS and Adult Services often problematic • Capacity of CAMHS at Tiers 2/3 • Shortage of CAMHS inpatient services

  4. Key Issues 2 • Some philosophical differences between CAMHS & Adult Services • Differences in eligibility/entry thresholds • Differences in level/style of intervention • Few opportunities to work together in flexible, user led way • Few opportunities for joint training

  5. Mental Health Policy Implementation Guide ( DH. March 2001). Early Intervention Services for 1st episode Psychosis • Young people aged 14 - 35 years • 1st presentation of psychotic symptoms • 1st 3 years of psychotic illness

  6. USER CENTRED SERVICE • Seamless service from age 14 - 35 years • Effective integration of child,adolescent and adult mental health services • Partnership work between Mental Health Services and Primary Care, Social Services, Education, Youth Services

  7. RANGE OF INTERVENTIONS • Meaningful Engagement • Medication • Psychological therapies • Assessment of Daily Living Needs • Involvement of families/carers • Pathway to education/occupation

  8. 24 HOUR CRISIS COVER 16 YEARS OR OVER: Adult Mental Health Crisis Resolution/Home Treatment Team UNDER 16 YEARS: Local arrangements between Crisis Resolution/Home Treatment Team , Early Intervention Team and CAMHS

  9. Provision of Age Appropriate Residential Care • Inpatient beds and Respite beds for adults over 22 years • Young Person’s beds for 16-21 year olds • Regional Adolescent beds

  10. Survey of Mental Health Teams for Older Adolescents. 1999: England - 14 teams Wales - 0 2001: England - 19 teams Wales - 0 2005: England - 31 services Wales - 0

  11. Where are young people seen?

  12. Services provided

  13. Hours of Service

  14. Regular Joint Work / Effective Working Relationship

  15. Involvement in NSF Plan for Early Onset Psychosis in 2001

  16. All clinicians/teams either linked with, liaising with or part of local Early Intervention Service. Involvement in NSF Plan for Early Onset Psychosis in 2005

  17. Creative solutions at CAMHS /Adult interface Multi-agency commissioning Transition mental health teams for young people leaving care More CAMHS/Adult links via EIS Lack of appropriate day services & inpatient beds National Survey 2005

  18. TRANSITION PROTOCOLS Severe Mental Illness ADHD Autistic Spectrum Disorder Emerging Borderline Personality Disorder Psychological sequelae of chronic physical illness National Survey 2005

  19. KEY PRINCIPLES • Transition “link worker” or MDT with youth based, flexible and outreach approach • Developmental and Family oriented • Emphasis on meaningful engagement

  20. KEY PRINCIPLES • Joint working and close liaison with other agencies – statutory and non statutory • Range of psychological, psychiatric and psychosocial interventions • Mix of expertise from CAMHS & Adult Mental Health

  21. KEY PRINCIPLES • Appropriate crisis, day unit and inpatient care • An emphasis on supporting young people towards getting on with their lives • Ask young people for their ideas/views

  22. Views of Young People • “The white walls make it like a hospital. You should paint them a colour.” • I need somewhere I can go in the day.” • “Playing snooker got me used to going out.” • “The most important thing is having my meetings in my GP surgery.If anyone sees me I can just say I was seeing the doctor.” • “They explained things to my parents and had meetings with them that I didn’t have to go to.”

  23. Views of Young People • “ R. met with my mate and explained the thing about weed.” • “I could have appointments in my lunchbreak.” • “The people at football were just normal.”

  24. Working at the CAMHS/Adult Interface How can we improve access to appropriate services for young people ? • View the service & access to it from the perspective of the young person • Identify a local forum to take things forward • Accept neither CAMHS nor Adult M.H. have all the answers

  25. Working at the CAMHS/Adult Interface • Health needs to work in partnership with a range of statutory & non statutory agencies to design and deliver services that young people want to engage with • Develop joint CAMHS/Adult M.H. training opportunities & possibilities for joint working • Further research on effective interventions & models of service

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