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Purpose: The presence of distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) impacts continuity of mental health treatment for young people. However, we do not know the extent of discontinuity of care in Europe nor the effects of discontinuity on the mental health of young people. Current research is limited, as the majority of existing studies are retrospective, based on small samples or used non-standardised information from medical records. The MILESTONE prospective cohort study aims to examine associations between service use, mental health and other outcomes over 24 months, using information from self, parent and clinician reports. Participants: Seven hundred sixty-three young people from 39 CAMHS in 8 European countries, their parents and CAMHS clinicians who completed interviews and online questionnaires and were followed up for 2 years after reaching the upper age limit of the CAMHS they receive treatment at. Findings to date: This cohort profile describes the baseline characteristics of the MILESTONE cohort. The mental health of young people reaching the upper age limit of their CAMHS varied greatly in type and severity: 32.8% of young people reported clinical levels of self- reported problems and 18.6% were rated to be 'markedly ill', 'severely ill' or 'among the most extremely ill' by their clinician. Fifty-seven per cent of young people reported psychotropic medication use in the previous half year. Future plans: Analysis of longitudinal data from the MILESTONE cohort will be used to assess relationships between the demographic and clinical characteristics of young people reaching the upper age limit of their CAMHS and the type of care the young person uses over the next 2 years, such as whether the young person transitions to AMHS. At 2 years follow-up, the mental health outcomes of young people following different care pathways will be compared.

The majority of adolescents with mental health problems do not experience continuity of care when they reach the transition boundary of their child and adolescent mental health service. One of the obstacles for a smooth transition to adult mental health services concerns the lack of training for health-care professionals involved in the transition process. This study aims to seek psychiatric trainees' opinions regarding training on transition and the knowledge and skills required for managing transition. A survey was distributed to trainees residing in European countries. Trainees from 36 countries completed the questionnaire, of which 63% reported that they came into contact with youth and young adults (16-26 years) during their clinical practice. Twenty-seven percent of trainees stated they have good to very good knowledge about the transition process. Theoretical training about transition was reported in only 17% of the countries, and practical training in 28% of the countries. Ninety-four percent of trainees indicated that further training about transition is necessary. The content of subsequent transition-related training can be guided by the findings of the MILESTONE project. ispartof: EUROPEAN CHILD & ADOLESCENT PSYCHIATRY vol:29 issue:1 pages:41-49 ispartof: location:Germany status: published

current research trend is the identification of psychosocial variables that moderate and/or mediate the association between stressors and psychopathological symptoms. Research has shown Locus of Control (LoC) is a key cognitive component of this psychological process in adolescents from individualist cultures. It is unclear whether this finding can be generalized to collectivist adolescents given that LoC is argued to be a culturally relative construct. The study examined the moderating and mediating effects of LoC on the relationship between negative events and psychopathological symptoms (anxiety and depressive symptoms) in adolescents from collectivist countries (n = 2800). Consistent with prior research, negative life events and external LoC were associated with more psychopathological symptoms. Unlike past studies with samples from individualist countries, the study did not produce clear evidence that LoC moderated or mediated this relationship. Results are discussed in terms of cultural differences in the (un)desirability of external control.

Background Profound clinical, conceptual and ideological differences between child and adult mental health service models contribute to transition-related discontinuity of care. Many of these may be related to psychiatry training. Methods A systematic review on General Adult Psychiatry (GAP) and Child and Adult Psychiatry (CAP) training in Europe, with a particular focus on transition as a theme in GAP and CAP training. Results Thirty-four full-papers, six abstracts and seven additional full text documents were identified. Important variations between countries were found across several domains including assessment of trainees, clinical and educational supervision, psychotherapy training and continuing medical education. Three models of training were identified: i) a generalist common training programme; ii) totally separate training programmes; iii) mixed types. Only two national training programs (UK and Ireland) were identified to have addressed transition as a topic, both involving CAP exclusively. Conclusion Three models of training in GAP and CAP across Europe are identified, suggesting that the harmonization is not yet realised and a possible barrier to improving transitional care. Training in transition has only recently been considered. It is timely, topical and important to develop evidence-based training approaches on transitional care across Europe into both CAP and GAP training. Electronic supplementary material The online version of this article (10.1186/s12909-019-1576-0) contains supplementary material, which is available to authorized users.

Dejan Stevanovic,1 Rajna Knez,2,3 Tatjana Zorcec,4 Marija Anderluh,5 Jana Kodrič,5 Petar Petrov,6 Feriha Hadžagić Ćatibušić,7 Azra Deljković,8 Slavica Brkic Cvetkovic,1 Nikolina Vrljičak Davidovic,9 Radenka Kuzmanić Šamija,10 Ana Ðorić,11 Christopher Gillberg12 1Psychiatry Department, Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia; 2Department of Child and Adolescent Psychiatry, Skaraborgs Hospital, Skövde, Sweden; 3Department of Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia; 4Developmental Department, University Children’s Hospital, Skopje, Macedonia; 5Department of Child Psychiatry, University Children’s Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia; 6Department of Child and Adolescent Psychiatry, University Hospital St Marina, Varna, Bulgaria; 7Pediatric Clinic, Clinical Center Sarajevo, Bosnia and Herzegovina; 8Psychiatry Department, Mental Health Center Pljevlja, Pljevlja, Montenegro; 9Department of Child and Adolescent Psychiatry, Clinical Hospital Center, Split, Croatia; 10Clinic for Children’s Disorders, Clinical Hospital Center, Split, Croatia; 11Center of Applied Psychology, Faculty of Humanity and Social Sciences, University of Rijeka, Rijeka, Croatia; 12Gillberg Neuropsychiatry Center, University of Gothenburg, Gothenburg, Sweden Purpose: The Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations – Questionnaire (ESSENCE-Q) was developed as a brief screener to identify children with developmental concerns who might have neurodevelopmental disorders (NDDs). This study aimed to translate the ESSENCE-Q into south Slavic languages, namely, Bosnian, Bulgarian, Croatian, Macedonian, Montenegrin, Serbian, and Slovenian, and to evaluate its psychometric properties for screening purposes in clinical settings. Patients and methods: In the study, the ESSENCE-Q was completed for 251 “typically developing” children and 200 children with 1 or more diagnosed NDDs, all aged 1–6 years. Internal consistency and construct validity were tested first, followed by generating receiver operating characteristic curves and the area under the curve. Optimal cutoff values were then explored. Results: The Cronbach’s α coefficients were 0.91, 0.88, and 0.86 for ESSENCE-Q parent-completed form, and the telephone and direct interview forms administered by trained nurse or specialist, respectively. The 3 versions produced area under the curve values (95% confidence interval): 0.96 (0.93–0.99), 0.91 (0.86–0.95), and 0.91 (0.86–0.97), respectively. An optimal cutoff for ESSENCE-Q parent-completed form was found to be ≥3 points, while for the telephone and direct interviews, it was ≥5 points. Conclusion: We found adequate measurement properties of the south Slavic languages versions of the ESSENCE-Q as a screener for NDDs in clinical settings. This study provided additional data supporting sound psychometric properties of the ESSENCE-Q. Keywords: early screening, questionnaire, autism, intellectual disability

Objectives: To test the sensitivity and specificity of the parent form of the ESSENCE-Q South Slavic language versions as a screening instrument for neurodevelopmental disorders (NDDs) in clinical settings. Methods: Children under the age of 6 assessed for developmental problems from seven centers in Bosnia and Herzegovina, Bulgaria, Croatia, Macedonia, Montenegro, Serbia, and Slovenia were included. Forty eight children had one or more NDDs, while 86 were of normal development. One parent per child completed the ESSENCE-Q with 12 items (possible scores 0-24). Results: Cronbach’s alpha for the total score was 0.91. The area under the curve (AUC) was 0.96, where an optimal cut-off ≥ 3 had sensitivity of 0.96 (95% confidence interval [CI]: [0.86, 0.99]) and specificity of 0.84 (95% CI: [0.75, 0.91]). The diagnostic accuracy was similar when screening boys and girls separately (Youden index was 0.78 and 0.79, respectively), while it was greater when screening children aged 12-36 months than children aged 37-72 months (Youden index was 0.86 and 0.57, respectively). Conclusions: The ESSENCE-Q South Slavic language versions completed by parents could be used as a screening tool to identify children with NDDs in clinical settings. The screening instrument might have greater diagnostic accuracy when screening younger than older children, but this trend should be further confirmed.