The effect of managed transition on the proportion of young people transitioning from CAMHS to AMHS: Analysis of the Milestone Cluster Randomised Clinical Trial

Clinical Snapshot

Key Findings

• P Value: p = 0.002 for primary outcome; p < 0.001 for appropriate transitions

• Effect Size: 10.7 percentage point increase in transition rate

• Primary Outcome: 24.9% in managed transition group vs 14.2% in usual care group transitioned to AMHS at 15 months

• Nnt Or Sensitivity: Number needed to treat = 9.3 (1 additional appropriate transition for every 9-10 young people receiving managed transition)

• Confidence Interval: Not reported in abstract

Clinical Application

Requires training of CAMHS staff and systematic assessment protocols; may need additional resources for implementation Highly relevant to Australian mental health services given similar CAMHS-AMHS transition challenges; aligns with National Mental Health Strategy priorities for youth mental health continuity Young people aged 16-18 years with mental health conditions transitioning from child to adult services, particularly those with IQ ≥70

Abstract

BACKGROUND: Transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is poorly managed, with discontinuity of care commonplace, leading to poorer outcomes, while evidence-based interventions to improve transition are scarce. This study is a secondary analysis of the MILESTONE trial, aiming to determine whether managed transition increases the proportion of young people who appropriately transition from CAMHS to AMHS. METHODS: The MILESTONE trial was a multicenter, two-arm, cluster-randomized controlled trial across eight countries at 40 CAMHS sites to compare usual care (UC) to managed transition (MT). MT consisted of training, identification, and assessment of transition readiness and appropriateness. Eligible participants were receiving CAMHS care, IQ ⩾ 70 and within 1 year of their service transition boundary. CAMHS sites were randomized 2:1 between UC and MT. The main outcome was whether participants were receiving care from AMHS at 15 months follow up. RESULTS: The MILESTONE study included 793 participants, 552 receiving UC and 241 receiving MT. In the MT group, 24.9% transitioned to AMHS at 15 months compared to 14.2% in the UC group (p = 0.002), and appropriate transitions (in those with a need for transition at baseline or ongoing clinical need at 15 months) were 32.3% in the MT group compared to 16.4% in the UC group (p < 0.001). CONCLUSIONS: A higher proportion of the MT group transitioned to AMHS at 15 months, and there was a higher proportion of appropriate transitions compared to UC. Clinicians and services should consider the incorporation of MT into routine clinical care.

References

1. 1.Rowland, T., Winsper, C., Morroni, D., Appleton, R., Tuomainen, H., Dieleman, G. C., Franić, T., de Girolamo, G., Madan, J., Maras, A., McNicholas, F., Paul, M., Purper-Ouakil, D., Santosh, P., Schulze, U. M., Street, C., Tremmery, S., Verhulst, F., Wolke, D., & Singh, S. P. (2026). The effect of managed transition on the proportion of young people transitioning from CAMHS to AMHS: Analysis of the Milestone Cluster Randomised Clinical Trial. Psychological Medicine. https://doi.org/10.1017/S0033291726103766