Skip to main content


Log in

Preventing Youth from Falling Through the Cracks Between Child/Adolescent and Adult Mental Health Services: A Systematic Review of Models of Care

  • Original Paper
  • Published:
Community Mental Health Journal Aims and scope Submit manuscript


Optimizing the transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) is a priority for healthcare systems. The purpose of this systematic review is to: (1) identify and compare models of care that may be used to facilitate the transition from CAMHS to AMHS; and (2) discuss trends and implications to inform future research and practice. Results identified three models of care which move beyond healthcare services and incorporate a broader range of services that better meet the dynamic needs of transition-aged youth. Joint working among providers, coupled with individualized approaches, is essential to facilitating continuity of care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  • Anderson, K. K., Flora, N., Archie, M., Morgan, C., & Mackenzie, K. (2014). Race, ethnicity, and the duration of untreated psychosis: a systematic review. Social Psychiatry Psychiatric Epidemiology, 49, 1175–1177.

    Article  Google Scholar 

  • Blum, R., Britto, M., Rosen, D., Sawyer, S., & Siegel, D. (2003). Transition from child-centered to adult health-care systems for adolescents with chronic conditions: A position paper of the Society for Adolescent Medicine. Journal of Adolescent Health, 33(4), 309–311.

    Article  PubMed  Google Scholar 

  • Carver, J., Cappelli, M., Davidson, S., Caldwell, W., Belair, M.A., & Vloet, M. (2015). Taking the next step forward: Building a responsive mental health and addictions system for emerging adults. Ottawa: Mental Health Commission of Canada.

    Google Scholar 

  • Certo, N., Mautz, D., Pumpian, I., Sax, C., Smalley, K., Wade, H. A., Noyes, D., Luecking, R., Wechsler, J., & Batterman, N. (2003). Review and discussion of a model for seamless transition to adulthood. Education and Training in Developmental Disabilities, 38(1), 3–17.

    Google Scholar 

  • Clarke, H. B. (2005). Transition to independence process (TIP) system: A community-based model for improving the outcomes of youth and young adults with EBD. National Network on Youth Transition for Behavioural Health. Retrieved from Model Overview.pdf.

  • Clarke, H. B. (2012). TIP model definition & guidelines for improving the progress & outcomes with youth & young adults, (Vols. 1–12). Retrieved from

  • Crowley, R., Wolfe, I., Lock, K., & McKee, M. (2011). Improving the transition between paediatric and adult health care: A systematic review. Archives of Disease in Childhood, 96, 548–553. doi:10.1136/adc.2010.202473.

    Article  CAS  PubMed  Google Scholar 

  • Davidson, P., Halcomb, E., Hickman, L., Phillips, J., & Graham, B. (2006). Beyond the rhetoric: what do we mean by a “model of care”? The Australian Journal of Advanced Nursing: A Quarterly Publication of the Royal Australian Nursing Federation, 23(3), 47–55.

  • Davidson S, Cappelli, M. (2011). We’ve got growing up to do: Transitioning youth from child and adolescent mental health services to adult mental health services. Ontario Centre of Excellence for Child and Youth Mental Health.

  • Davidson, S. (2011). The state of child and youth mental health in Canada: Past problems and future fantasies. Healthcare Quarterly, 14, 9–13.

    Article  Google Scholar 

  • Davis, M., Geller, J. L., & Hunt, B. (2006). Within-state availability of transition-to-adulthood services for youths with serious mental health conditions. Psychiatric Services, 57(11), 1594–1599. doi:10.1176/ (Washington, D.C.)

    Article  PubMed  Google Scholar 

  • Di Rezze, B., Nguyen, T., Mulvale, G., Longo, C.J., Randall, G.E., Barr, N.G. (2015). A review of evidence-based interventions that address developmental transitions for youth with mental health disorders. Child, 42(2), 176–187. doi:10.1111/cch.12306.

    Google Scholar 

  • Embrett, M. G., Randall, G. E., Longo, C. J., Nguyen, N., & Mulvale, G. (2015). Effectiveness of health system services and programs for youth to adult transitions in mental health care: A systematic review of academic literature. Administration and Policy in Mental Health Research and Mental Health Services Research, 42, (Vols. 1–11). doi:10.1007/s10488-015-0638-9.

    Article  Google Scholar 

  • Ezzati, M., Lopez, A. D., Rodgers, A., & Murray, C.J.L. (2004). Comparative quantification of health risks: global and regional burden of disease due to selected major risk factors (Vol. 1). Geneva: WHO.

    Google Scholar 

  • Fraser, S. (2007). Transition of care in children with chronic disease: healthcare teams need to adapt to change as much as patients and their families. BMJ (Clinical research ed.), 334, 1231.

    Article  Google Scholar 

  • Gall, C., Kingsnorth, S., & Healy, H. (2006). Growing up ready: a shared management approach. Physical and Occupational Therapy in Pediatrics, 26, 47–62.

    PubMed  Google Scholar 

  • Gorter, J. W., Stewart, D., Woodbury Smith, M., King, G., Wrigt, M., Nguyen, T., Freeman, M., & Swinton, M. (2014). Pathways Toward Positive Psychosocial Outcomes and Mental Health for Youth with Disabilities: A Knowledge Synthesis of Developmental Trajectories. Canadian Journal of Community Mental Health, 33(1), 45–61.

    Article  Google Scholar 

  • Gorter, J. W., Stewart, D., Cohen, E., Hlyva, O., Morrison, A., Galuppi, B., Nguyen, T., Amaria, K., & Punthakee, Z. (2015). Are two youth-focused interventions sufficient to empower youth with chronic health conditions in their transition to adult healthcare: A mixed-methods longitudinal prospective cohort study. BMJ Open, 5, e007553. doi:10.1136/bmjopen-2014-007553.

    Article  PubMed  PubMed Central  Google Scholar 

  • Haber, M. G., Karpur, A., Deschênes, N., & Clark, H. B. (2008). Predicting improvement of transitioning young people in the partnerships for youth transition initiative: findings from a multisite demonstration. The Journal of Behavioral Health Services & Research, 35(4), 488–513. doi:10.1007/s11414-008-9126-2.

    Article  Google Scholar 

  • Hamdani, Y., Jetha, A., & Norman, C. (2011). Systems thinking perspectives applied to healthcare transition for youth with disabilities: a paradigm shift for practice, policy and research. Child: care, health and development, 37(6), 806–814.

    CAS  Google Scholar 

  • Kmet, L.M., Lee, R.C. & Cook, L.S. (2004). Standard quality assessment criteria for evaluating primary research papers from a variety of fields. Alberta Heritage Foundation for Medical Research.

  • Kutcher, S., & McLuckie, A. (2013). Evergreen: Creating a Child and Youth Mental Health Framework for Canada. Mental Health Commission of Canada.

  • Kutcher, S., Hampton, M., & Wilson, J. (2010). Child and adolescent mental health policy and plans in Canada: An analytical review. The Canadian Journal of Psychiatry, 55(2), 100–107.

    Article  PubMed  Google Scholar 

  • Lamb, C., & Murphy, M. (2013) The divide between child and adult mental health services: points for debate. The British Journal of Psychiatry, 202(s54), s41–s44.

    Article  Google Scholar 

  • Lavis, J. N., Rottingen, J. A., Bosch-Capblanch, X., Atun, R., El-Jardali, F., Gilson, L., Lewin, S., Oliver, S., Ongolo-Zogo, P., & Haines, A. (2012). Guidance for evidence-informed policies about health systems: linking guidance development to policy development. PLoS Medicine, 9(3), e1001186. doi:10.1371/journal.pmed.1001186.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lindgren, E., Soderberg, S., & Skar, L. (2013). The gap in transition between child and adolescent psychiatry and general adult psychiatry. Journal of Child and Adolescent Psychiatric Nursing, 26(2), 103–109.

    Article  PubMed  Google Scholar 

  • Luecking, R. G., & Certo, N. (2003). Integrating service systems at the point of transition for youth with significant support needs: A model that works. American Rehabilitation, 27(1), 2–9.

    Google Scholar 

  • Maslow, G.R., Haydon, A., McRee, A.L., Ford, C.A. & Halpern, C.T. (2011) Growing up with a chronic illness: social success, educational/ vocational distress. Journal of Adolescent Health 2011;49:206–212. doi:10.1016/j.jadohealth.2010.12.001.

    Article  PubMed  PubMed Central  Google Scholar 

  • McConachie, H., Hoole, S., & LeCouteur, A. S. (2011). Improving mental health transitions for young people with autism spectrum disorder. Child, 37, 764–766.

    CAS  Google Scholar 

  • McGorry, P., Bates, T., & Birchwood, M. (2013). Designing youth mental health services for the 21st century: examples from Australia, Ireland and the UK. The British Journal of Psychiatry. 202(Supplement 54), s30–5. doi:10.1192/bjp.bp.112.119214.

    Article  Google Scholar 

  • McGrandles, A., & McMahon, K. (2012). Transition from child and adolescent to adult mental health services. British Journal of Nursing, 21(17), 1031–1039.

    Article  PubMed  Google Scholar 

  • McLaren, S., Belling, R., Paul, M., Ford, T., Kramer, T., Weaver, T., Hovish, K., Islam, Z., White, S., & Singh, S. P. (2013). “Talking a different language”: an exploration of the influence of organizational cultures and working practices on transition from child to adult mental health services. BMC Health Services Research, 13(1), 254. doi:10.1186/1472-6963-13-254.

    Article  PubMed  PubMed Central  Google Scholar 

  • Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine, 6(7), e1000097. doi:10.1371/journal.pmed.1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  • Munson, M. R., Jaccard, J., Smalling, S. E., Kim, H., Werner, J. J., & Scott, L. D. (2012). Static, dynamic, integrated, and contextualized: A framework for understanding mental health service utilization among young adults. Social Science & Medicine, 75(8), 1441–1449. doi:10.1016/j.socscimed.2012.05.039.

    Article  Google Scholar 

  • Nguyen, T, & Baptiste, S. (2014a). Innovative Practice: Exploring acculturation theory to advance rehabilitation from pediatric to adult “cultures” of care. Disability and Rehabilitation, Early online 1–8. doi:10.3109/09638288.2014.932443.

  • Nguyen, T., & Baptiste, S. (2014b). An innovative lens for comprehending the human experience in society: An analysis of acculturation. In J. Merton (Ed.), Acculturation: Psychology, processes and global perspectives, pp. 105–205). New York: Nova Publications, Inc.

    Google Scholar 

  • Nguyen, T., & Gorter, J. W. (2014). Use of the international classification of functioning, disability and health as a framework for transition from paediatric to adult healthcare. Child, 40(6), 759–761.

    CAS  Google Scholar 

  • Orygen Youth Health. (2010). Retrieved from

  • Paul, M., Street, C., Wheeler, N., & Singh, S. P. (2014). Transition to adult services for young people with mental health needs: A systematic review. Clinical Child Psychology and Psychiatry, 1–22. doi:10.1177/1359104514526603. (published online ahead of print April 7, 2014).

  • Pottick, K. J., Bilder, S., Vander Stoep, A., Warner, L. A., & Alvarez, M. F. (2008). US patterns of mental health service utilization for transition-age youth and young adults. The Journal of Behavioral Health Services & Research, 35(4), 373–389. doi:10.1007/s11414-007-9080-4.

    Article  Google Scholar 

  • Prior, M., McManus, M., White, P., & Davidson, L. (2014). Measuring the “triple aim” in transition care: a systematic review. Pediatrics, 134, 1648–1661.

    Article  Google Scholar 

  • Randall, G. E., Mulvale, G. M., Wakefield, P. A., Embrett, M. G., Barr, N. G., Miatello, A. M., Longo, C. J., Nguyen, T., Di Rezze, B. M., Vania, D. K., McRae, S. A. (2016). Mapping the policy to practice landscape for youth mental health in Ontario: A report from the “youth to adult transitions in health care—the case of mental health services in Ontario” research team. Prepared for the Ontario Ministry of Health and Long-Term Care.

  • Rosen, D. S., Blum, R. W., Britto, M., Sawyer, S., & Siegel, D. (2003). Transition to adult health care for adolescents and young adults with chronic conditions: Position paper of the Society for Adolescent Medicine. Journal of Adolescent Health, 33, 309–311. doi:10.1016/1054-139X(93)90143-D.

    Article  PubMed  Google Scholar 

  • Schmid, A., Cacace, M., Götze, R., & Rothgang, H. (2010). Explaining health care system change: problem pressure and the emergence of “hybrid” health care systems. Journal of Health Politics, Policy and Law, 35(4), 455–486. doi:10.1215/03616878-2010-013.

    Article  PubMed  Google Scholar 

  • Singh, S. P., Evans, N., Sireling, L., & Stuart, H. (2005). Mind the gap: the interface between child and adult mental health services. The Psychiatric Bulletin, 29(8), 292–294.

    Article  Google Scholar 

  • Singh, S. P., Paul, M., Ford, T., Kramer, T., McLaren, S., Hovish, K., Islam, Z., Belling, R., & White, S. (2010). Process, outcome and experience of transition from child to adult mental healthcare: Multiperspective study. The British Journal of Psychiatry, 197(4), 305–312.

    Article  PubMed  Google Scholar 

  • Singh, S. P., Paul, M., Ford, T., Kramer, T., & Weaver, T. (2008). Transitions of care from child and adolescent mental health services to adult mental health services (TRACK Study): a study of protocols in Greater London. BMC Health Services Research, 8, 135. doi:10.1186/1472-6963-8-135.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stewart, D., Law, M., Young, N., Forhan, M., Healy, H., Burke-Gaffney, J., & Freeman, M. (2014). Complexities during transitions to adulthood for youth with disabilities: person-environment interactions. Disability and Rehabilitation, 36, 1998–2004.

    Article  PubMed  Google Scholar 

  • Swift, K. D., Sayal, K., & Hollis, C. (2014). ADHD and transitions to adult mental health services: a scoping review. Child: care, health and development, 40(6), 775–786.

    CAS  Google Scholar 

  • Taylor, J. L., McPheeters, M. L., Satha, N. A., Dove, D., Veenstra-VanderWeele, J., & Warren, Z. (2012). A systematic review of vocational interventions for young adults with autism spectrum disorders. Pediatrics, 130, 531–538. doi:10.1542/peds.2012-0682.

    Article  PubMed  PubMed Central  Google Scholar 

  • Waddell, C., McEwan, K., Shepherd, C., Offord, D. R., & Hua, J. M. (2005). A public health strategy to improve the mental health of Canadian children. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 50(4), 226–233.

    Article  PubMed  Google Scholar 

  • Wendt, C., Frisina, L., & Rothgang, H. (2009). Health care system types: A conceptual framework for comparison. Social Policy & Administration, 43(1), 70–90. doi:10.1111/j.1467-9515.2008.00647.x.

    Article  Google Scholar 

  • While, A., Forbes, A., Ullman, R., Lewis, S., Mathes, L., & Griffiths, P. (2004). Good practices that address continuity during transition from child to adult care: synthesis of the evidence. Child, 30(5), 439–452.

    CAS  Google Scholar 

  • World Health Organization. (2009). Global health risks: mortality and burden of disease attributable to selected major risks. Geneva: World Health Organization.

    Google Scholar 

Download references


This study was funded by the Government of Ontario through a Ministry of Health and Long-Term Care Health System Research Fund grant entitled ‘Harnessing Evidence and Values for Health System Excellence’. The views expressed in this manuscript are the views of the authors and should not be taken to represent the views of the Government of Ontario. The first author would like to acknowledge support from the Canadian Institutes of Health Research Doctoral Scholarship (2013–2016) and Postdoctoral Fellowship (2016–2019). The authors would like to acknowledge the support and feedback we have received from other Transitions study research team members: Patricia Wakefield, Ashleigh Miatello, and Christopher Longo. We also thank our Research Services Librarian Jeannie An. Most importantly, thank you to our Steering Committee members for their generosity in sharing their time and expertise.


This study was funded the Government of Ontario through a Ministry of Health and Long-Term Care Health System Research Fund grant entitled ‘Harnessing Evidence and Values for Health System Excellence’. The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Tram Nguyen.

Ethics declarations

Conflict of Interest

All authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nguyen, T., Embrett, M.G., Barr, N.G. et al. Preventing Youth from Falling Through the Cracks Between Child/Adolescent and Adult Mental Health Services: A Systematic Review of Models of Care. Community Ment Health J 53, 375–382 (2017).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: