Mental health problems affect 10-20% of children and adolescents worldwide, with early intervention and prevention a key global priority to prevent the emergence of adult morbidity. In the next 10 years, mental health problems are expected to increase among children and youth, with current predictions estimating at least 50% increase in incidence rates.

The TRACK study in the UK was the first systematic attempt to understand the policy, process, outcome and experience of transition from CAMHS to AMHS. The findings were alarming: almost half the young people fell through the care gap between services, and those that managed transition received very poor transitional care. For those who make the transition, poor transitional care impacts on their engagement with services and is very stressful for service users and their carers.

Overall, very little research has been carried out on transition from CAMHS to AMHS in Europe. There is, however, some evidence that the problem linked with transition is not restricted to UK alone, but is an issue across the EU and throughout the developed world. Previously there have been no attempts to gather systematic and structured evidence on the nature and severity of transition related problems across differing health care contexts within EU.

Recent systematic review of CAMHS transitional care (Paul et al, 2014) found 17 papers of which only three defined interventions for improving transitional care. All three were local initiatives from USA and included a case management model, a transition support model and an outpatient transition programme. Although all three programmes showed improved clinical and social outcomes for those with facilitated transition, none of these was a randomised trial and each model was deeply rooted within its own particular and specific healthcare context.

There is an urgent need to develop, implement and test a robust model of managed transitional care. The managed transition model we will test in our MILESTONE study consists of an evidence-based decision-making process and managed transition. The latter incorporates the key principles of continuity of care (adequate information transfer, appropriate joint working, therapeutic and relational continuity, and engagement with adult services) and managed ending of care.

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