Detailed Work Packages
WP 1 Mapping the CAMHS-AMHS Interface across European Mental Health Services
WP1 will collect detailed information on CAMHS and AMHS characteristics and interface at national and regional levels across all EU states, including legal aspects of adolescent care. In a second step, this WP will identify transition policies and models in different EU healthcare and social settings (including paediatric/adult medical care, developmental disabilities, social services and child safeguarding).
WP1 will develop a typology that enables services to be categorised according to (a) transition practice (for example, how transition boundaries are defined, such as by age cut-off, diagnostic categories, educational or work status and any other criteria or combination of criteria) and (b) service configuration (for example, presence or absence of specialist liaison workers, adolescent teams, policies for joint working, liaison models etc.). And finally, WP1 will identify how decisions about transition are made within each national mental health system, and which professionals are involved in such decision
WP 2 Development and E-monitoring using the MILESTONE Suite of Measures
The goal of WP2 is to develop a low burden, reliable and efficient, bespoke MILESTONE Suite of Measures related to transitioning from CAMHS to AMHS (Transition Readiness and Appropriateness Measure and Transition Outcomes Measure). The rating scales will have versions to be completed by adolescents/ parents/ clinicians and adults/ partners/ parents/ clinicians and will be developed such that it can be used as a web-based system using the HealthTracker technology platform, which simplifies administration, scoring and determination of cut-offs for clinical concern. The HealthTrackerTM system is an online multi-media suite of questionnaires that allows accurate measures of change across a wide range of symptoms, side-effects, psychological functions and quality of life. All the monitoring instruments being used in the programme will be uploaded onto the HealthTrackerTM system, which will be used for E-monitoring and data capture.
WP 3 Longitudinal cohort study of transition of care from CAMHS to AMHS
WP3 will deliver a prospective cohort study of CAMHS users whose care will finish because they have reached transition age for their CAMHS. This cohort will include service users for both the experimental and control clusters (WP4). We will use a longitudinal observation study design that repeatedly assesses the mental health and functioning from late adolescence into early adulthood. It will identify those who would benefit most from long-term care and transition into AMHS care and those who show no deterioration or improvements in mental health without further AMHS care. Because of the variation in services offered, different ages at transition from child/adolescent to adult services, and differences in types of care across European countries, we will include eight countries in this prospective, multisite cohort study of adolescents who reach the specific age of transition within each participating service (n=50-150/country/9 months; total n ~ 1000
WP 4 Cluster- randomised control trial of managed transition in improving outcomes for young people
The overall aim of WP4 is to determine the effectiveness of a model of managed transition (including appropriate discharge from CAMHS care) in improving the outcomes of young people who reach the transition boundary between CAMHS and AMHS.The intervention is an evidence-based decision-making process for identifying those who should make a transition to adult mental health care, those who can be managed by other services, and those who can be discharged from CAMHS (managed end of care). In WP2 we will have developed a Transition Readiness and Appropriateness Measure (TRAM) that identifies high-risk, high-need cases for whom transition to AMHS is advisable and appropriate and also those who can be appropriately discharged from CAMHS. WP2 will also develop a Transition Outcome Measure (TROM) for assessing the quality and outcomes of transitional care. In WP3 we will recruit a cohort of about 1000 service users who reach the transition boundary in the participating services, from which we will identify CAMHS services and users for participation in the cluster randomised trial of WP4. CAMHS in each participating country will be randomized to either experimental intervention (managed transition using TRAM supported decision making process between CAMHS and AMHS, or appropriate discharge from CAMHS) or treatment as usual (control arm) in 1:4 ratio.
Please find here the Statistical Analysis Plan for the intervention study.
WP 5 Economic Evaluation of the Experimental Intervention
The overall aim of WP5 is to evaluate the cost-effectiveness of a managed transition model by assessing its resource use implications and long-term health impact. Analyses will be structured around a decision model informed by a number of sources, including the randomised controlled trial of the TRaM intervention and a systematic review of the relevant literatu
WP 6 Ethics
Successful research must have methodology informed by and compatible with research ethics guidelines, research governance and the law in each participating country. Good research should also be underpinned and informed by consultation with service users, their carers and other stakeholders. MILESTONE also has a detailed Standard Operation Procedure (SOP) and will include an expert on ethics on the project advisory group. There is an assumption in transitions research that young people are always better served by moving from child to adult services upon reaching the transitional boundary. The pros and cons of continuing within mental health services remain to be elucidated by evidence and, therefore, efforts aimed at maximising transfer rates from CAMHS to AMHS may be premature.
WP 7 Dissemination of Study Progress and Results to Key Stakeholders
The overall aim of WP7 is to ensure proper diffusion of knowledge and project results accor-ding to an agreed strategy aimed at securing maximum impact and value throughout the MILESTONE project team and timeline.
WP 8 Training programme for improving transitional care across the EU
The main objective of WP8 is to develop training models and training procedures based on the findings and recommendations of the MILESTONE project. The specific objectives of WP8 are a) to describe current training models used across EU for CAMHS and AMHS and assess their contribution to health service organizations b) to design and implement training models for MILESTONE investigators, and c) to develop training models and guidelines for universities and policy makers according to the results of the MILESTONE studies in order to optimize transition between CAMHS and adult care.
WP 9 Project management (Leader: UoW / S Singh)
Effective project management is a central element of successful research. This is because large research projects entail a lot of administrative work. The following objectives will be actively pursued by WP9:
- Make MILESTONE achieve its objectives and to deliver in time, budget and quality its milestones and deliverable
- help the consortium abide by the regulations and contractual obligations according to the grant agreement, ist annexes and the consortium agreement
- look after the project`s finances and to report them properly to the European Commission
- establish a communication infrastructure which enables the partners to communicate efficiently and to stay connected for the run-time of the project
- preserve the rights of the partners regarding intellectual property and to act as a mediator in case of dispute