Literature Collection

Around 25,000 young people (YP) transition to Adult Mental Health Services (AMHS) from Child and Adolescent Mental Health Services (CAMHS) annually in the United Kingdom. A small percentage experience all the key features of an effective transition-with suboptimal transitions potentially contributing to disengagement as YP approach or undergo the transition. Semistructured interviews were conducted with five YP, five CAMHS practitioners and seven AMHS practitioners working in the Personality Disorder Community Service (PDCS) to ascertain the barriers to engagement during the transition process. Transcripts were analysed using thematic analysis. Four themes were identified: Fragmented and Reactive Transitions, Relational Discontinuity, Systemic Rigidity and Alienation and Fragility of Autonomy. Findings indicated that unclear pathways, relational disruptions and mismatched expectations were key contributors to disengagement and negative perceptions of new services. No features of an optimum transition were being met consistently. Emotional dependency, lack of preparation and systemic rigidity further compounded difficulties for YP navigating the transition. CAMHS should prepare the YP prior to their referral and ensure that it is an informed decision. AMHS must clarify their service offer and provide accessible resources for CAMHS practitioners, YP and families to enable better management of expectations. Both services should collaborate throughout the transition, offer individualised plans and allow time for YP to adjust to the new service environment.

Neonatal opiate withdrawal syndrome (NOWS), previously known as neonatal abstinence syndrome (NAS), is a growing public health concern as opiate misuse and opioid-related overdoses, from both prescription and illicit sources, continue to rise in the USA. As more than 90% of females abusing opioids are of child-bearing age, the failure to adequately address the opioid epidemic continues to negatively impact the next generations. Accurate and timely identification of infants at risk for withdrawal from in-utero exposure is critical to ensure high-quality perinatal and neonatal care. Beginning with an evaluation of current best practices and performing a literature review, we identify the challenges to current screening processes and how these limitations limit the ability to provide appropriate care to infants at the risk of withdrawal. We first describe the limitations of the available assays for the detection of opioid and opioid metabolites across different biological sources from both the mother and the infant. We then present a discussion surrounding factors that contribute to maternal willingness to disclose use. Particularly, in light of the limitations of biological screening, any barrier to maternal disclosure further complicates effective care delivery. Barriers to disclosure include legal ramifications and state policies, provider and societal behaviors and biases, and maternal factors. Moving forward, universal prenatal screening surveys coupled with enhanced outreach and education to providers centering on the limitations of both patient report and biological sampling, as well as comprehensive and supportive services for women of reproductive age with substance use disorders, are needed to both enhance detection for NOWS and improve long-term maternal-child health.

In-depth understanding of dementia carer experience can assist clinicians by providing insight into dementia onset, symptoms and management, and help conceptualize and understand the pattern of dementia progress over time and what help is needed. We undertook a qualitative study to understand dementia carers experiences of providing care and reasons for admission to a residential aged care facility (RACF). Three themes were identified: (1) Challenges in the path to diagnosis and care, leading to delays accessing support; (2) Carer role impacted by living circumstances; and (3) Variation in decision support prior to admission to a RACF. Identifying dementia carer experiences, reinforces the need for more timely diagnosis, referral for support and interventions to promote better quality of life for a people living with dementia and their carer and to delay premature RACF placement.