Implementing a Youth Transition Protocol in London-Middlesex, Oxford and Elgin
What is the system challenge?
The transition to adulthood can be challenging for any youth, but this period is especially difficult for young people with mental health and addiction problems. In London-Middlesex, transitional-age youth (age 16-24) too often have difficulty making a move into adult mental health and addiction services, leading them to miss out on crucial services and supports. This system challenge is commonly caused by a lack of connectivity between services and to unclear service pathways.
What are we doing about it?
In December 2015, a diverse group of community partners in London-Middlesex came together for a Moving on Mental Health Collective Impact Summit. The partners agreed that the community needed to improve transition pathways for youth so that youth were better able to access appropriate adult mental health and addiction services and that these pathways should be clear, coordinated, and efficient.
The community partners initially established the Transitional Age Protocol Community Implementation Team (TAPCIT) and then this team convened a TAPCIT working group to use evidence to improve youth transitions. The working group included 15 members representing different mental health and addiction agencies in London-Middlesex and chose three organizations as its co-chairs: Vanier Children’s Services; the Transitional Age Project at London Health Science Centre; and CAMH.
The partners recognized from the beginning that a youth transition protocol required the active input of the people it was to serve to be a success. So, importantly, TAPCIT included youth representatives.
Evidence:
The TRACK study evaluated transitions from youth to adult mental health services in the United Kingdom. It identified organizational factors that interfere with effective transitions. These barriers include, ineffective implementation of existing protocols and lack of collaboration and communication between sectors. The study also provided recommendations on how services can best be organized and delivered to support youth transitions. It identified four components for high quality transitions:
Information continuity: effective information transfer.
Relational continuity: a period of parallel care and joint working between services.
Cross boundary and team continuity: transition planning with at least one meeting that includes the young person, parent or caregiver, youth service provider, adult service provider, and other services.
Care continuity: continued connections between the youth and adult service providers after the transition is complete.
The TAPCIT working group learned from three other regions in Ontario that were already confronting similar service transition problems. In particular, these regions were adapting findings from TRACK, a large U.K. study on effective transition pathways. The working group subsequently developed a youth transition protocol tailored to London-Middlesex, Oxford, and Elgin that utilizes the results of the TRACK study and the implementation experiences of the three other regions in Ontario.
TAPCIT aimed to improve:
transfers of client information
communication between agencies
collaboration among the people involved (including youth, youth agencies, and adult agencies).
Project Implementation Progress
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To develop a youth transition protocol, the TAPCIT Working Group decided it needed information about the current state of transitions from youth to adult service in the region. The group developed a map of current mental health and addiction services for transitional age youth in the London-Middlesex (figure 1). It then identified 12 agencies (highlighted in figure 1) that were critical to study in order to gain greater insight into current service transition practices. In fall 2017, the working group gathered extensive information from these 12 agencies through surveys and interviews.
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In October 2017, TAPCIT held an event called the TAPCIT Design Studio to co-create the protocol materials with youth. This event was led by staff at mindyourmind, a provincial agency that works with young people to co-develop interactive tools and innovative resources. Eight youth, between 16-25 years old and of different genders, participated in the two-day event. They described their own personal experiences preparing for and transitioning to adult services. On the second day, the youth reviewed materials developed in other jurisdictions and recommended content and designs for the TAPCIT protocol.
Oxford and Elgin counties also joined the development and implementation of this protocol. The TAPCIT Working Group, with the help of mindyourmind staff, then developed the transitional age youth (TAY) protocol and accompanying resources for providers and youth.
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The draft protocol and accompanying resources will now be pilot tested in the community. The TAPCIT Working Group will identify a small number of agencies as protocol pilot sites and will develop tailored agency-level action plans to assist with implementation and evaluation.
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TAPCIT launched the new protocol and its accompanying resources in March 2019. Agency-level implementation coaching for service providers is ongoing. The team is also evaluating the implementation and service user experience.
Who is involved?
TAPCIT aims to be inclusive. As a result, its members reflect a broad range of sectors, organizations, and impacted individuals, including:
children’s mental health;
adult mental health;
Catholic and public school boards;
youth justice;
hospital inpatient and ambulatory service;
University of Western Ontario;
youth and adult addiction services;
community counseling services;
peer-driven community agencies;
youth representatives (those impacted by the protocol).
Resources
Information Resources
For more information, please contact:
Beth Powell, Implementation Specialist
London, Ontario
519-858-5158 ext. 20082