JMIR Publications

ABSTRACT

Background:

Young people moving from adolescent secure inpatient units to adult care present with multiple and complex needs and are more likely to experience poor transition outcomes. Poorly managed transitions can lead to enduring use and dependency on mental health services and a long-term financial burden associated with limited life prospects and social functioning. However, there is a dearth of research about long-term transition outcomes for young people in secure care and there are no formal interventions targeting transitional care in secure settings. There is lack of knowledge about the feasibility of transitional care models.

Objective:

This study aims to develop and test a feasibility cluster randomised trial for young people transitioning from adolescent secure services to adult-oriented settings. The overarching aim of the MOVING FORWARD study is to provide a preliminary estimate of the effectiveness and cost-effectiveness of a new transition intervention model and to inform a future full-scale cluster randomised controlled trial.

Methods:

The design of the study is a three-arm feasibility, cluster randomised controlled trial comparing the MOVING FORWARD intervention against standard transition preparation (usual care: CPA discharge meeting and individual meeting with responsible clinician) conducted in six adolescent secure services, of which four units will receive the intervention and two will serve as controls. Eligible young people between 17-19 years, their parents/carers and key workers will be invited to participate. Young people and parents/carers will be allocated in two conditions (young people alone and young people with parent/carer) and will receive four transition preparation workshops across six months. Six adolescent secure hospitals will be randomly allocated, stratified by area and service type. Data will be collected at three time points: (T0) baseline, (T1) 6-12 months post-intervention, and (T2) 18-24 months post-baseline. Primary and secondary outcomes will be based on assessment measures and interviews conducted in Times 1 and 2.

Results:

Six hospitals have agreed to participate. Advisory Groups with young people and healthcare staff have informed the design of the proposed intervention. We are in the process of establishing Steering Groups with young people, parents/carers, healthcare staff and NHS England Commissioners. This study will last four years. The first 10 months will be used to gain necessary ethical approvals and pilot the study with the lead site. Participants will be recruited over the course of six months. The intervention will be delivered over the course of 16 months.

Conclusions:

This research will provide practitioners and policy makers with an evidence-based framework of how training and familiarisation with the prospective transitions can yield positive outcomes. This study will test whether a psychosocial intervention can be implemented in adolescent secure hospitals. The results will identify barriers and facilitators to the proposed intervention and will enable services to reflect on quality of transitional care delivery.