Transition from CAMHS to adult services — managed transition plan (MEQ)

(i) Transfer versus transition. Transfer is the administrative move or referral of care. Transition is a purposeful, planned developmental process from child-centred to adult-oriented systems (Blum), spanning preparation, joint work, transfer, and engagement. Immediate transfer next week without readiness work, pathway confirmation, or medication bridge is inadequate and matches TRACK descriptions of poorly planned/executed/experienced care.^[1][2]

(ii) Assessment priorities. Confirm diagnoses and residual impairment (ADHD multi-setting organisation; depression residual symptoms). Risk: self-harm history, current intent/plans, protective factors, substance use (cannabis), driving/safety if relevant. Function: school completion threat, peer/family supports, housing. Map adult options and local AMHS thresholds early; anticipate dual-threshold exclusion (not 'severe enduring' enough for CMHT yet still needing specialist input). Document crisis plan and who holds interim risk if adult triage is delayed.^[2][3]

(iii) Managed plan and medication. Timeline from now (five months): written transition plan with young person; transition readiness work; complete clinical summary (formulation, risks, meds/doses, what worked). Medication continuity: do not stop long-acting methylphenidate or sertraline 100 mg oral daily solely for age — arrange adult ADHD shared care or private/public adult pathway and GP shared care with monitoring (BP/HR, appetite/sleep/mood for stimulant; mood/suicidality/side-effects for SSRI) and a prescription bridge. If AMHS declines: adult ADHD pathway, youth 12–25 service if available, psychology for mood/self-harm, GP shared care with explicit re-referral triggers; named interim CAMHS or youth clinician until first adult contact confirmed. Joint meeting and period of parallel care where possible; audit engagement after transfer.^[2][6][7]

(iv) Capacity, parents, cannabis. Assess functional capacity (Appelbaum) for treatment and information-sharing decisions; negotiate parental involvement with the young person; share minimum necessary if safeguarding thresholds for serious harm apply under local law (no invented sections). Address cannabis with motivational approach; it worsens ADHD/mood outcomes and adherence — integrate rather than using it as a reason to abandon care.^[5][2]

(v) Evidence anchors. TRACK multiperspective: most transitions poorly planned/executed/experienced; Appleton SR: only about a quarter transition to AMHS; Crowley SR: structured transitional care programmes; MILESTONE RCT: managed transition evaluation at the boundary; McGorry: youth service redesign as structural alternative.^{[2][3][4][6][7]}