Protocol for a cohort study of adolescent mental health service users with a nested cluster randomised controlled trial to assess the clinical and cost-effectiveness of managed transition in improving transitions from child to adult mental health services (the MILESTONE study)

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Abstract

Introduction

Disruption of care during transition from child and adolescent mental health services (CAMHS) to adult mental health services may adversely affect the health and well-being of service users. The MILESTONE (Managing the Link and Strengthening Transition from Child to Adult Mental Healthcare) study evaluates the longitudinal course and outcomes of adolescents approaching the transition boundary (TB) of their CAMHS and determines the effectiveness of the model of managed transition in improving outcomes, compared with usual care.

Methods and analysis

This is a cohort study with a nested cluster randomised controlled trial. Recruited CAMHS have been randomised to provide either (1) managed transition using the Transition Readiness and Appropriateness Measure score summary as a decision aid, or (2) usual care for young people reaching the TB. Participants are young people within 1 year of reaching the TB of their CAMHS in eight European countries; one parent/carer and a CAMHS clinician for each recruited young person; and adult mental health clinician or other community-based care provider, if young person transitions. The primary outcome is Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) measuring health and social functioning at 15 months postintervention. The secondary outcomes include mental health, quality of life, transition experience and healthcare usage assessed at 9, 15 and 24 months postintervention. With a mean cluster size of 21, a total of 840 participants randomised in a 1:2 intervention to control are required, providing 89% power to detect a difference in HoNOSCA score of 0.30 SD. The addition of 210 recruits for the cohort study ensures sufficient power for studying predictors, resulting in 1050 participants and an approximate 1:3 randomisation.

Ethics and dissemination

The study protocol was approved by the UK National Research Ethics Service (15/WM/0052) and equivalent ethics boards in participating countries. Results will be reported at conferences, in peer-reviewed publications and to all relevant stakeholder groups.

Trial registration number

ISRCTN83240263; NCT03013595 (pre-results).

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Most cited references 59

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The Development and Well-Being Assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology.

H. Meltzer, Suzanne H Richards, Jason R Goodman … (2000)

The Development and Well-Being Assessment (DAWBA) is a novel package of questionnaires, interviews, and rating techniques designed to generate ICD-10 and DSM-IV psychiatric diagnoses on 5-16-year-olds. Nonclinical interviewers administer a structured interview to parents about psychiatric symptoms and resultant impact. When definite symptoms are identified by the structured questions, interviewers use open-ended questions and supplementary prompts to get parents to describe the problems in their own words. These descriptions are transcribed verbatim by the interviewers but are not rated by them. A similar interview is administered to 11-16-year-olds. Teachers complete a brief questionnaire covering the main conduct, emotional, and hyperactivity symptoms and any resultant impairment. The different sorts of information are brought together by a computer program that also predicts likely diagnoses. These computer-generated summary sheets and diagnoses form a convenient starting point for experienced clinical raters, who decide whether to accept or overturn the computer diagnosis (or lack of diagnosis) in the light of their review of all the data, including transcripts. In the present study, the DAWBA was administered to community (N = 491) and clinic (N = 39) samples. There was excellent discrimination between community and clinic samples in rates of diagnosed disorder. Within the community sample, subjects with and without diagnosed disorders differed markedly in external characteristics and prognosis. In the clinic sample, there was substantial agreement between DAWBA and case note diagnoses, though the DAWBA diagnosed more comorbid disorders. The use of screening questions and skip rules greatly reduced interview length by allowing many sections to be omitted with very little loss of positive information. Overall, the DAWBA successfully combined the cheapness and simplicity of respondent-based measures with the clinical persuasiveness of investigator-based diagnoses. The DAWBA has considerable potential as an epidemiological measure, and may prove to be of clinical value too.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2017

Publication date (Electronic): 16 October 2017

Volume: 7

Issue: 10

Electronic Location Identifier: e016055

Affiliations

[1 ]departmentMental Health and Wellbeing, Division of Health Sciences, Warwick Medical School , Universityof Warwick , Coventry, UK

[2 ]departmentPsychiatric Epidemiology and Evaluation Unit , Saint John of God Clinical Research Center , Brescia, Italy

[3 ]Yulius Academy , Rotterdam, The Netherlands

[4 ]departmentDepartment of Child and Adolescent Psychiatry and Psychology , Erasmus Medical Center , Rotterdam, The Netherlands

[5 ]departmentDepartment of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience , King’s College London , London, UK

[6 ]departmentCentre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services , MaudsleyHospital , London, UK

[7 ]HealthTracker Ltd , Gillingham, UK

[8 ]departmentDepartment of Child and Adolescent Psychiatry , University College Dublin School of Medicine and Medical Science , Dublin, Republic of Ireland

[9 ]departmentGeary Institute , University College Dublin , Dublin, Republic of Ireland

[10 ]departmentDepartment of Child Psychiatry , Our Lady’s Hospital for Sick Children , Dublin, Republic of Ireland

[11 ]departmentLucena Clinic , SJOG , Dublin, Republic of Ireland

[12 ]departmentDepartment of Child and Adolescent Psychiatry/Psychotherapy , University of Ulm , Ulm, Germany

[13 ]Centre Hospitalier Universitaire de Montpellier , Montpellier, France

[14 ]departmentDepartmentof Neurosciences, Child & Adolescent Psychiatry , University of Leuven , Leuven, Belgium

[15 ]departmentDepartment of Child & Adolescent Psychiatry , University Hospitals Leuven , Leuven, Belgium

[16 ]departmentDepartment of Psychiatry , Clinical Hospital Center Split , Split, Croatia

[17 ]departmentWarwick Clinical Trials Unit, Warwick Medical School , Warwick Medical School , Coventry, UK

[18 ]Coventry and Warwickshire Partnership NHS Trust , UK

[19 ]departmentDepartment of Clinical Medicine , University of Copenhagen , Copenhagen, Denmark

[20 ]departmentDepartmentof Psychology , Universityof Warwick , Coventry, UK

[21 ]departmentSchool of Psychology , Plymouth University , UK

[22 ]SJOG Research Foundation , Dublin, Republic of Ireland

Author notes

[Correspondence to ] Professor Swaran P Singh; s.p.singh@ 123456warwick.ac.uk

SPS and HT contributed equally.

Article

Publisher ID: bmjopen-2017-016055

DOI: 10.1136/bmjopen-2017-016055

PMC ID: 5652531

PubMed ID: 29042376

SO-VID: aff66864-0174-425b-a7ed-354ff08969f1

License:

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

History

Date received : 20 January 2017

Date revision received : 18 August 2017

Date accepted : 25 August 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100004963, Seventh Framework Programme;

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ScienceOpen disciplines: Medicine

Keywords: mental health,child and adolescent mental health services,transition,health services research,cluster randomised controlled trial,longitudinal cohort study,youth mental health,europe

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ScienceOpen disciplines: Medicine

Keywords: mental health, child and adolescent mental health services, transition, health services research, cluster randomised controlled trial, longitudinal cohort study, youth mental health, europe

Protocol for a cohort study of adolescent mental health service users with a nested cluster randomised controlled trial to assess the clinical and cost-effectiveness of managed transition in improving transitions from child to adult mental health services (the MILESTONE study)

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Abstract

Introduction

Methods and analysis

Ethics and dissemination

Trial registration number

Related collections

Special series on COVID-19 and Mental Health

Most cited references 59

The Development and Well-Being Assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology.

Patient reported outcome measures in practice.

Transition from child-centered to adult health-care systems for adolescents with chronic conditions. A position paper of the Society for Adolescent Medicine.

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Affiliations

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Article

History

Funding

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