‘The Service user / Carer Experience of Transferring Services’ Dr. Gayathri Venkatesan Specialty Trainee Year 6

Challenges during transition Sudden change in treatment ethos –Protective to responsibility Individual responsibility Changing role for parents/carers Coincide with other changes

Barriers to smooth transition Referral Criteria Local policies Protocols

The Transition Protocol There is no gold standard protocol NTW eating disorder services is one of the first to develop a transition protocol

CYPS (all Tier 3 and Tier 4 in Northern Part of Region) Identify a patient aged 17 ½ years and over with a eating disorder that will require ongoing care past aged 18 (fulfils ICD-10 criteria) Refer to local CMHT Refer to REDS Joint Assessment Care Review Meeting Patient and carer attend with CYPS, CMHT and REDS Care Plan CMHT Care Co-ordinator REDS for treatment CYPS transfer care to CMHT and REDS at a time agreed with patient and carer, usually around 18 th birthday Transition Protocol for Patients With Eating Disorders: from Children and Young People Services (CYPS) to Richardson Eating Disorders (REDS) and Local Adult Community Mental Health Team

Re Audit – November 2013

Aim Current protocol revised in 2007 To review adherence to transition protocol by teams involved.

Methodology List of all service users aged 18 – 19 seen at REDS between October 2011 and October 2013 obtained Review of records looking for the relevant details

Age at Assessment REDS Mean 17y 11m Mode 17y 11m Range 17y 9 m to 18y 3m CMHT Mean 18y 2m Mode 18y 1m Range 17y 11m to 18y 3m

Findings 72% of service users were referred simultaneously to REDS and CMHT 79% had transition meeting at the appropriate time 79% of the meetings had CMHT and REDS representative.

Joint assessment 14 patients 3 joint assessment 11 separate assessments

Local developments Transition meeting Review of protocol

CYPS (all Tier 3 and Tier 4 in Northern Part of Region) Identify a patient aged 17 ½ years and over with a eating disorder that will require ongoing care past aged 18 (fulfils ICD-10 criteria) Refer to local CMHT Refer to REDS Joint Assessment Care Review Meeting Patient and carer attend with CYPS, CMHT and REDS Care Plan CMHT Care Co-ordinator REDS for treatment CYPS transfer care to CMHT and REDS at a time agreed with patient and carer, usually around 18 th birthday Transition Protocol for Patients With Eating Disorders: from Children and Young People Services (CYPS) to Richardson Eating Disorders (REDS) and Local Adult Community Mental Health Team

References Arcelus J., Morgan J,. Treating Young People with Eating Disorders: Transition from Child Mental Health to Specialist Adult Eating Disorder Services Eur. Eat. Disorders Rev. 16, 30–36 (2008) Treasure J., Schmidt U., and Hugo P. Mind the gap. The service transition and interface problems for patients with eating disorders. British Journal of Psychiatry (2005), 187, 398 – 400. Dimitropoilos, G., Tran AF.,Agarwal B., Sheffield B., Woodside B., Challenges in making the transition between pediatric and adult eating disorder programs: a qualitative study from the perspective of service providers. Eating disorders, 2013; 21 (1): 1 to 15