Participant characteristics
Of the 87 experts sent the Round 1 survey, 58 participated in the survey, resulting in a participation rate of 66.7%. The three panels included 21 clinicians and administrators, 17 caregivers, and 20 youth. All participants who provided a response in Round 1 (58) were sent the Round 2 survey, of which 51(87.9%) responded to at least one item.
In the caregiver panel, nearly two-thirds were biological mothers (64.7%), and most resided in the province of Ontario, Canada (88.2%). Just over half had female children (58.5%) and their child’s first access to mental health care was, on average, at age 14 (sd = 4.4). The most commonly reported diagnosis was an anxiety disorder (64.7%), and the majority of their children were still receiving mental health care (58.8%). See Table 2 for a full description of the panels.
The youth experts were mostly female (80.0%) and from Ontario (80.0%). Just over half were currently enrolled in school (60.0%) and living with parents/in a family home (55.0%). Almost all reported a diagnosis of an anxiety disorder (95.0%), with fewer reporting a mood (65%) and/or personality (30.0%) disorder. On average, the youth first accessed mental health care at age 15 (sd = 2.9), and many were still using mental health services (55%). The mean age of the youth experts was 21.5 (sd = 1.8). See Table 2.
In the clinician and administrator panel of experts, the largest professional group was psychiatrists (38.1%), followed by nurses (23.8%) and service managers (14.3%). Most of the panel members were practicing at an Ontario academic hospital (81.0%), and nearly all primarily with a clinical population of children and youth under 18 (95.2%). On average, the panel members had worked in their profession for 20.5 years (sd = 10.2). See Table 2.
Round 1
Results of the Round 1 survey are displayed in Supplementary File 1, indicating the number and percentage of experts ranking each core component as 8 or 9 (i.e. highly endorsed) for importance or feasibility for each panel.
Importance Among clinicians/administrators, the level of agreement for importance was the greatest for core component 1.6, which was highly endorsed by 100% (see Supplementary File 1). Eight other core components were highly endorsed by ≥ 90% of the panel (1.4, 1.5, 3.2, 3.3, 4.2, 4.3 4.8–4.10), while six core components did not reach ≥ 70% agreement (2.2, 3.1, 4.5, 4.11, 5.2 and 6.1). Among caregivers, the level of agreement was the greatest for core components 4.6 and 4.7, which were highly endorsed by 92.9%. These were the only two core components highly endorsed by ≥ 90% of the panel; only two core components did not reach ≥ 70% agreement (2.2 and 4.3). Among youth, level of agreement for importance was the greatest at just over 94% highly endorsed for core components 1.6 and 4.2; these were the only two core components highly endorsed by ≥ 90% of the panel. Seven core components did not reach ≥ 70% agreement (1.1, 1.3, 2.1, 4.1, 4.4, 4.6, and 5.2). Across the panels, 14 core components were highly endorsed by ≥ 70% in each group, while none the core components were endorsed by < 70% in all three panels.
Feasibility Within all panels, levels of agreement for feasibility were much lower. Among the clinicians/administrators, the greatest level of agreement at ≥ 70% highly endorsed was found for core components 4.3, 4.8, and 4.9, meaning that the remaining 25 core components did not reach 70% agreement (see Supplementary File 1). Among the caregivers, level of agreement was greatest at 78.6% highly endorsed for core component 4.9, with five other core components being highly endorsed by ≥ 70% (3.2, 4.1, 4.8, 4.10, and 6.1). Among the youth, the greatest level of agreement was 77.8% highly endorsed for core component 4.9, with only one other core component achieving ≥ 70% agreement (4.2). Across the panels, one core component was endorsed by ≥ 70% (4.9) in each group.
Changes from Round 1 to Round 2
Only 1 core component (5.2) was removed and no new core components were added, resulting in a total of 26 core components to be used for Round 2.
Round 2
Of the experts who participated in Round 1, 19 clinicians/administrators (90.4%), 14 caregivers (82.4%), and 18 youth (90%) participated in Round 2 (i.e. responded to at least one item). The results of the Round 2 survey are displayed in Supplementary File 2, indicating the number and percentage of experts ranking each core component as 8 or 9 (i.e. highly endorsed) for importance or feasibility for each panel.
Importance Among the clinicians/administrators, the level of agreement for importance was the greatest for core components 1.6, 4.2, and 4.8 (100.0% highly endorsed), with eight other core components highly endorsed by ≥ 90% of the panel (1.4, 1.7, 2.1, 3.2, 3.3, 4.3, 4.6, and 4.9). Only three core components did not reach ≥ 70% agreement (down from 7 in Round 1; 2.2, 3.1, and 4.11). Among the caregivers, the level of agreement was greatest at 100% for core components 1.4, 4.9, and 4.10, with 10 other core components highly endorsed by ≥ 90% (1.1, 1.6, 3.2, 3.3, 4.2, 4.5–4.7, 5.1 and 5.3). Three core components did not reach ≥ 70% agreement (up from 2 in Round 1; 1.7, 2.1, and 4.11). Among the youth, the level of agreement for importance was the greatest for core component 4.2 (94.4%) and this was the only core component that was highly endorsed by ≥ 90%; four core components did not reach ≥ 70% agreement (down from 7 in Round 1; 2.1, 2.2, 3.1, and 4.1). Across the panels, 20 core components were highly endorsed by ≥ 70% by each group (up from 14 in Round 1), but, mirroring Round 1, none of the core components were endorsed by < 70% in all three panels. There were differences in the core components that were ranked most important and feasible by the panels (see Table 3).
Table 3 Top 3 Components Based on Percentage Highly Endorsed per Panel for Feasibility and Importance in Round 2 Feasibility Similar to Round 1, levels of agreement for feasibility were much lower than for importance. Among the clinicians/administrators, three core components were highly endorsed by > 70% (4.8, 4.9, and 5.3, see Supplementary File 2). For the caregivers, only one core component was endorsed by ≥ 70% (4.9). Among the youth, four core components were endorsed by ≥ 70% (1.5, 1.6, 4.6, and 4.8). None of the core components were endorsed at ≥ 70% in all three panels.
Round 2 consensus and final list of core components
Any core component highly endorsed at ≥ 70% on importance or feasibility by at least one panel was retained. This resulted in all 26 core components being retained.
Final list of transition core components
The final list of transition core components, with all changes made following EAC input and both Delphi Rounds, is available in Table 1 (see column “Final description of core components”).
Qualitative themes
Three themes were identified from the open-ended qualitative comments provided by experts when asked to elaborate on their reasoning and differences in the rating of the core components in both Rounds. The themes identified were: (1) need for CAMHS and AMHS collaboration; (2) suggestions on how to operationalize core component in practice; and (3) barriers to implementation in practice. A sample of supporting participant quotes for each of these themes are provided in Supplementary File 3. Clinicians and service administrators repeatedly emphasized the need for enhanced communication and active engagement/relationship development between AMHS and CAMHS to increase collaboration between these services. Many participants from all three panels made suggestions on how to implement the core components, such as creating integrated care pathways/plans, ensuring appropriate education and training of involved care providers, and providing readily available online centralized transition resources. A number of barriers to component implementation and feasibility were mentioned in comments across all three expert panels, such as (1) AMHS wait times, (2) challenges posed by differences in CAMHS and AMHS service funding structures, and (3) resources required for training on transitions best practices and for administrative support.