Demographic, clinical, and service-use characteristics related to the clinician’s recommendation to transition from child to adult mental health services
Authors: Gerritsen S. E. , van Bodegom L. S. , Dieleman G. C. , Overbeek M. M. , Verhulst F. C. , Wolke D. , Rizopoulos D. , Appleton R. , van Amelsvoort T. A. M. J. , Bodier Rethore C. , Bonnet-Brilhault F. , Charvin I. , Da Fonseca D. , Davidović N. , Dodig-Ćurković K. , Ferrari A. , Fiori F. , Franić T. , Gatherer C. , de Girolamo G. , Heaney N. , Hendrickx G. , Jardri R. , Kolozsvari A. , Lida-Pulik H. , Lievesley K. , Madan J. , Mastroianni M. , Maurice V. , McNicholas F. , Nacinovich R. , Parenti A. , Paul M. , Purper-Ouakil D. , Rivolta L. , de Roeck V. , Russet F. , Saam M. C. , Sagar-Ouriaghli I. , Santosh P. J. , Sartor A. , Schulze U. M. E. , Scocco P. , Signorini G. , Singh S. P. , Singh J. , Speranza M. , Stagi P. , Stagni P. , Street C. , Tah P. , Tanase E. , Tremmery S. , Tuffrey A. , Tuomainen H. , Walker L. , Wilson A. , Maras A. ,   for the Milestone Consortium, Adams Laura , Allibrio Giovanni , Armando Marco , Aslan Sonja , Baccanelli Nadia , Balaudo Monica , Bergamo Fabia , Bertani Angelo , Berriman Jo , Boon Albert , Braamse Karen , Breuninger Ulrike , Buttiglione Maura , Buttle Sarah , Schandrin Aurélie , Cammarano Marco , Canaway Alastair , Cantini Fortunata , Cappellari Cristiano , Carenini Marta , Carrà Giuseppe , Ferrari Cecilia , Chianura Krizia , Coleman Philippa , Colonna Annalisa , Conese Patrizia , Costanzo Raffaella , Daffern Claire , Danckaerts Marina , de Giacomo Andrea , Ermans Jean-Pierre , Farmer Alan , Fegert Jörg M. , Ferrari Sabrina , Galea Giuliana , Gatta Michela , Gheza Elisa , Goglia Giacomo , Grandetto MariaRosa , Griffin James , Levi Flavia Micol , Humbertclaude Véronique , Ingravallo Nicola , Invernizzi Roberta , Kelly Caoimhe , Killilea Meghan , Kirwan James , Klockaerts Catherine , Kovač Vlatka , Liew Ashley , Lippens Christel , Macchi Francesca , Manenti Lidia , Margari Francesco , Margari Lucia , Martinelli Paola , McFadden Leighton , Menghini Deny , Miller Sarah , Monzani Emiliano , Morini Giorgia , Mutafov Todor , O’Hara Lesley , Negrinotti Cristina , Nelis Emmanuel , Neri Francesca , Nikolova Paulina , Nossa Marzia , Cataldo Maria Giulia , Noterdaeme Michele , Operto Francesca , Panaro Vittoria , Pastore Adriana , Pemmaraju Vinuthna , Pepermans Ann , Petruzzelli Maria Giuseppina , Presicci Anna , Prigent Catherine , Rinaldi Francesco , Riva Erika , Roekens Anne , Rogers Ben , Ronzini Pablo , Sakar Vehbi , Salvetti Selena , Martinelli Ottaviano , Sandhu Tanveer , Schepker Renate , Siviero Marco , Slowik Michael , Smyth Courtney , Conti Patrizia , Spadone Maria Antonietta , Starace Fabrizio , Stoppa Patrizia , Tansini Lucia , Toselli Cecilia , Trabucchi Guido , Tubito Maria , van Dam Arno , van Gutschoven Hanne , van West Dirk , Vanni Fabio , Vannicola Chiara , Varuzza Cristiana , Varvara Pamela , Ventura Patrizia , Vicari Stefano , Vicini Stefania , von Bentzel Carolin , Wells Philip , Williams Beata , Zabarella Marina , Zamboni Anna , Zanetti Edda 
Published: February 2022

Abstract
Purpose
The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians’ advice to continue treatment at AMHS.

Methods
Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians’ transition recommendations.

Results
Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS.

Conclusion
Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services.