McNicholas F, Adamson M, McNamara N, Gavin B, Paul M, Ford T, Barry S, Dooley B, Coyne I, Cullen W, Singh S P
Deparment of Child Psychiatry, University College Dublin, Dublin, Ireland.
Lucena Clinic, Dublin, Ireland.
Ir J Psychol Med. 2015 Mar;32(1):61-69. doi: 10.1017/ipm.2015.2.
The ITRACK study explored the process and predictors of transition between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) in the Republic of Ireland.
Following ethical approval, clinicians in each of Ireland's four Health Service Executive (HSE) areas were contacted, informed about the study and were invited to participate. Clinicians identified all cases who had reached the transition boundary (i.e. upper age limit for that CAMHS team) between January and December 2010. Data were collected on clinical and socio-demographic details and factors that informed the decision to refer or not refer to the AMHS, and case notes were scrutinised to ascertain the extent of information exchanged between services during transition.
A total of 62 service users were identified as having crossed the transition boundary from nine CAMHS [HSE Dublin Mid-Leinster (n=40, 66%), HSE South (n=18, 30%), HSE West (n=2, 3%), HSE Dublin North (n=1, 2%)]. The most common diagnoses were attention deficit hyperactivity disorder (ADHD; n=19, 32%), mood disorders (n=16, 27%), psychosis (n=6, 10%) and eating disorders (n=5, 8%). Forty-seven (76%) of those identified were perceived by the CAMHS clinician to have an 'on-going mental health service need', and of these 15 (32%) were referred, 11 (23%) young people refused and 21 (45%) were not referred, with the majority (12, 57%) continuing with the CAMHS for more than a year beyond the transition boundary. Young people with psychosis were more likely to be referred [χ 2 (2, 46)=8.96, p=0.02], and those with ADHD were less likely to be referred [χ 2 (2, 45)=8.89, p=0.01]. Being prescribed medication was not associated with referral [χ 2 (2, 45)=4.515, p=0.11]. In referred cases (n=15), there was documented evidence of consent in two cases (13.3%), inferred in another four (26.7%) and documented preparation for transition in eight (53.3%). Excellent written communication (100%) was not supported by face-to-face planning meetings (n=2, 13.3%), joint appointments (n=1, 6.7%) or telephone conversations (n=1, 6.7%) between corresponding clinicians.
Despite perceived on-going mental health (MH) service need, many young people are not being referred or are refusing referral to the AMHS, with those with ADHD being the most affected. CAMHS continue to offer on-going care past the transition boundary, which has resource implications. Further qualitative research is warranted to understand, in spite of perceived MH service need, the reason for non-referral by the CAMHS clinicians and refusal by the young person.
ITRACK研究探讨了爱尔兰共和国儿童及青少年心理健康服务（CAMHS）与成人心理健康服务（AMHS）之间过渡的过程及预测因素。
获得伦理批准后，研究人员联系了爱尔兰四个卫生服务执行局（HSE）地区的临床医生，告知其研究情况并邀请他们参与。临床医生确定了2010年1月至12月期间所有达到过渡界限（即该CAMHS团队的年龄上限）的病例。收集了临床、社会人口学细节以及影响转诊或不转诊至AMHS决策的因素的数据，并仔细查阅病例记录以确定过渡期间服务之间信息交换的程度。
共确定62名服务使用者越过了从九个CAMHS的过渡界限[HSE都柏林中莱因斯特地区（n = 40，66%）、HSE南部地区（n = 18，30%）、HSE西部地区（n = 2，3%）、HSE都柏林北部地区（n = 1，2%）]。最常见的诊断为注意力缺陷多动障碍（ADHD；n = 19，32%）、情绪障碍（n = 16，27%）、精神病（n = 6，10%）和饮食失调（n = 5，8%）。CAMHS临床医生认为其中47名（76%）有“持续的心理健康服务需求”，其中15名（32%）被转诊，11名（23%）年轻人拒绝转诊，21名（45%）未被转诊，大多数（12名，57%）在越过过渡界限后继续接受CAMHS服务超过一年。患有精神病的年轻人更有可能被转诊[χ²（2，46）= 8.96，p = 0.02]，而患有ADHD的年轻人被转诊的可能性较小[χ²（2，45）= 8.89，p = 0.01]。开具药物治疗与转诊无关[χ²（2，45）= 4.515，p = 0.11]。在转诊病例（n = 15）中，有两份病例（13.3%）有书面同意的记录，另外四份（26.7%）推断有同意，八份（53.3%）有过渡准备的记录。相应临床医生之间的面对面规划会议（n = 2，13.3%）、联合预约（n = 1，6.7%）或电话交谈（n = 1，6.7%）并未支持出色的书面沟通（100%）。
尽管存在持续的心理健康（MH）服务需求，但许多年轻人未被转诊或拒绝转诊至AMHS，其中ADHD患者受影响最大。CAMHS在过渡界限之后继续提供持续护理，这对资源有影响。有必要进行进一步的定性研究，以了解尽管存在MH服务需求，但CAMHS临床医生不转诊及年轻人拒绝转诊的原因。
