Dataset Information

Transition readiness of youth with co-occurring chronic health and mental health conditions: A mixed methods study.

ABSTRACT:

Background

A large proportion of youth with chronic conditions have mental health comorbidities. However, the effect of these comorbidities on paediatric-adult transition readiness, and the relevance of widely used tools for measuring transition readiness, are unknown.

Objective

The objectives of this study were to describe and explore the transition readiness of youth with co-occurring chronic health and mental health conditions using a combination of quantitative data obtained from participants completing the Transition Readiness Assessment Questionnaire (TRAQ) and qualitative data.

Design and participants

A three-phase sequential explanatory mixed methods design was employed, with the qualitative strand taking priority. First, the TRAQ scores (range 1-5) of youth with co-occurring conditions (n = 61) enroled in a multisite randomized controlled trial were measured, followed by qualitative interviews with a sample of youth (n = 9) to explain the quantitative results. Results from both strands were then integrated, yielding comprehensive insights.

Results

Median TRAQ scores ranged from 2.86 on the appointment keeping subscale to 5.00 on the talking with providers subscale. The qualitative results uncovered the complexities faced by this group concerning the impact of a mental health comorbidity on transition readiness and self-management skills across TRAQ domains. The integrated findings identified a diverse and highly individualized set of strengths and challenges amongst this group that did not align with overarching patterns as measured by the TRAQ.

Conclusions

This mixed methods study generated novel understandings about how youth with co-occurring conditions develop competencies related to self-care, self-advocacy and self-management in preparation for paediatric-adult service transitions. Results demonstrated the assessment of transition readiness using a generic scale does not address the nuanced and complex needs of youth with co-occurring chronic health and mental health conditions. Our findings suggest tailoring transition readiness practices for this group based on youths' own goals, symptoms, coping mechanisms and resources.

Patient or public involvement

This study was conducted in collaboration with five young adult research partners (YARP) with lived experience transitioning from paediatric to adult health/mental health services. The YARP's contributions across study phases ensured the perspectives of young people were centred throughout data collection, analysis, interpretation and presentation of findings. All five YARP co-authored this manuscript.

SUBMITTER: Allemang B

PROVIDER: S-EPMC10632650 | biostudies-literature | 2023 Dec

REPOSITORIES: biostudies-literature

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Publications

Transition readiness of youth with co-occurring chronic health and mental health conditions: A mixed methods study.

Allemang Brooke B Samuel Susan S Greer Katelyn K Schofield Keighley K Pintson Karina K Patton Megan M Farias Marcela M Sitter Kathleen C KC Patten Scott B SB Mackie Andrew S AS Dimitropoulos Gina G

Health expectations : an international journal of public participation in health care and health policy 20230714 6

<h4>Background</h4>A large proportion of youth with chronic conditions have mental health comorbidities. However, the effect of these comorbidities on paediatric-adult transition readiness, and the relevance of widely used tools for measuring transition readiness, are unknown.<h4>Objective</h4>The objectives of this study were to describe and explore the transition readiness of youth with co-occurring chronic health and mental health conditions using a combination of quantitative data obtained f ...[more]

PMID: 37452518

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Project description:PurposeMany youth with medical conditions also have co-occurring mental health concerns. Limited attention has been given to the mental health transition needs of these youth. We explore bringing transition readiness assessment into the mental health care of youth with co-occurring disorders.Design and methodsMental health transition readiness was assessed in transition-aged youth seen in a hospital-based specialty mental health clinic for youth with co-occurring medical and mental health conditions. Patients and/or parents reported on their awareness of transition policies and experiences. Clinicians formally assessed youth mental health transition readiness using the TRXANSITION Index.ResultsOnly 46.53 % of families knew about the clinic's transition policy. Less than 1/3 reported their provider ever mentioning transition and only 6.93 % knew the deadline for transfer to adult care. Few patients had a transition goal in their treatment plan, even when required by the payor. By assessing transition readiness, clinicians were able to identify deficits in need of remediation in 95 % of patients. Transition readiness was highest in the following domains of the TRXANSITION Index: Ongoing support (85.15 %), Adherence (78.38 %), and Trade/School (71.29 %). Transition readiness was lowest in New Providers (30.94 %), Rx/Medications (37.99 %), and Insurance (42.57 %). Few knew when their current health insurance coverage would end (10.89 %) or how to get health insurance coverage when they became an adult (11.88 %). Mental health transition readiness and medical condition transition readiness did not differ in a sub-sample of youth with available data, t(14) = -1.33, p =.20.ConclusionMental health transition readiness is suboptimal in youth with co-occurring mental health and medical conditions. Findings point to specific targets for future intervention to improve patient mental health transition readiness and patient/family awareness of transition practices.

Project description:PurposeTo identify predictors of community-based employment and employment quality for young adults ages 23-30 with intellectual disability and co-occurring mental health conditions (YA-ID-MH).MethodsWe conducted secondary analysis of the 2017-2018 National Core Indicators® (NCI®) In-Person Survey. The NCI® survey was conducted in 35 states and Washington DC. Participants: YA with ID, ages 23-30 who had complete data. We conducted multiple regression analyses to examine demographic and environmental predictors of community-based employment, in addition to employment quality indicators: hourly wages, hours worked, and job duration. We also descriptively examined job satisfaction.ResultsYA-ID-MH were somewhat less likely to be employed per record review and self-report than YA with ID only, but these findings did not reach statistical significance. On average, YA with ID only had higher hourly wages and worked more hours than those with ID-MH, but there were no significant differences in job duration. For YA-ID-MH, predictors of employment included gender, race, level of ID, and residential setting. Multiple demographic and environmental factors predicted employment quality.ConclusionsYA-ID-MH experience employment disparities compared to YA with ID only. Service providers should specifically attend to those at the highest risk of unemployment/low quality employment.IMPLICATIONS FOR REHABILITATIONYoung adults with intellectual/developmental disabilities and co-occurring mental health conditions (ID-MH) experience employment disparities.Young adults with ID-MH who are non-white and female may have particularly low employment rates and employment quality.Societal-level interventions to address racial and gender-based bias may support individuals with ID-MH to acquire and maintain jobs by addressing disparities in social networks/social capital and ensuring equitable service provision and supports for those at the highest risk for unemployment.Policy makers should consider additional funding for employment services for transition-age youth with ID-MH, particularly those from marginalized populations.

Project description:ObjectiveThis study aimed to assess the feasibility of a future trial comparing the collaborative care model with usual care for patients with musculoskeletal conditions and co-existing symptoms of anxiety and depression.DesignA single-centre, parallel-arm, one-to-one, randomised controlled trial design using a mixed-methods approach was used. semistructured interviews and focus groups were conducted post intervention with all participants and staff respectively to explore acceptability towards the model and identify recommendations for improvements.SettingAn orthopaedic rehabilitation outpatient tertiary hospital.ParticipantsAdult patients with musculoskeletal conditions and co-existing moderate or severe symptoms of anxiety and depression attending outpatient therapy appointments.InterventionThe collaborative care model consisted of a tailored management programme to facilitate the integration of care provided by physical and mental healthcare professionals. A case manager screened and coordinated targeted mental health support for participants. Participants allocated to usual care had no support from the case manager.Main outcomes measureFeasibility indicators (rates of recruitment, randomisation and retention), acceptability of clinical outcome measures, usage of additional resources and cost of intervention implementation.ResultsOf the 89 patients who provided consent to take part, 40 participants who matched the eligibility criteria were randomised to either the intervention (n=20) or usual care arm (n=20). Overall adherence to the intervention was 58.82%, while the withdrawal rate was 37.5% at 6 months. All of the 27 participants who were retained completed self-reported outcomes. Qualitative data highlighted that integrated mental health support was favourably perceived. In addition to prenegotiating protected psychology time, the need for operationalised communication between the case manager and clinicians was identified as a recommendation for a future trial.ConclusionsThe trial and intervention were acceptable to patients and healthcare professionals. While the findings demonstrate the feasibility of trial recruitment, a future trial will require optimised retention strategies to improve adherence and withdrawal rates.Trial registration numberNCT05018039.

Dataset Information

Transition readiness of youth with co-occurring chronic health and mental health conditions: A mixed methods study.

Background

Objective

Design and participants

Results

Conclusions

Patient or public involvement

Publications

Transition readiness of youth with co-occurring chronic health and mental health conditions: A mixed methods study.

Similar Datasets

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