Randomized Controlled Trial

. 2020 Jun 23;10(6):e033324.

doi: 10.1136/bmjopen-2019-033324.

Validation of the Transition Readiness and Appropriateness Measure (TRAM) for the Managing the Link and Strengthening Transition from Child to Adult Mental Healthcare in Europe (MILESTONE) study

Paramala Santosh^{1

2

3}, Jatinder Singh^{4

2}, Laura Adams⁵, Mathilde Mastroianni^{4

2}, Natalie Heaney⁴, Kate Lievesley³, Ilyas Sagar-Ouriaghli⁴, Giovanni Allibrio⁶, Rebecca Appleton⁷, Nikolina Davidović⁸, Giovanni de Girolamo⁹, Gwen Dieleman¹⁰, Katarina Dodig-Ćurković¹¹, Tomislav Franić⁸, Charlotte Gatherer⁷, Suzanne Gerritsen¹⁰, Elisa Gheza¹², Jason Madan¹³, Lidia Manenti⁶, Athanasios Maras^{10

14}, Francesco Margari¹⁵, Fiona McNicholas^{16

17

18

19}, Adriana Pastore¹⁵, Moli Paul^{7

20}, Diane Purper-Ouakil²¹, Francesco Rinaldi¹², Vehbi Sakar²², Ulrike Schulze²², Giulia Signorini⁹, Cathy Street⁷, Priya Tah⁷, Sabine Tremmery^{23

24}, Amanda Tuffrey⁷, Helena Tuomainen⁷, Frank Verhulst¹⁰, Jane Warwick¹³, Anna Wilson⁷, Dieter Wolke^{7

25}, Federico Fiori^{4

2

3}, Swaran Singh^{7

20}; MILESTONE Consortium

Affiliations

¹ Child and Adolescent Psychiatry, King's College London, London, UK paramala.1.santosh@kcl.ac.uk.
² Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), South London and Maudsley NHS Foundation Trust, London, UK.
³ HealthTracker, Gillingham, UK.
⁴ Child and Adolescent Psychiatry, King's College London, London, UK.
⁵ School of Psychology, University of Plymouth, Plymouth, Devon, UK.
⁶ Unit of Neuropsychiatry, ASST Spedali Civili di Brescia Dipartimento di Salute Mentale, Brescia, Lombardia, Italy.
⁷ Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK.
⁸ Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia.
⁹ Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy.
¹⁰ Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands.
¹¹ Department of Pediatric and Adolescent Psychiatry, KBC Osijek, Osijek, Croatia.
¹² Neuropsychiatry Service of Childhood and Adolescence, Mental Health Department, ASST della Valcamonica, Breno, Lombardia, Italy.
¹³ Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Coventry, UK.
¹⁴ Yulius Academy, Rotterdam, The Netherlands.
¹⁵ Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Puglia, Italy.
¹⁶ School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
¹⁷ Geary Institute, University College Dublin, Dublin, Ireland.
¹⁸ Department of Child Psychiatry, Our Lady's Hospital For Sick Children, Crumlin, Ireland.
¹⁹ Lucena Clinic, Saint John of God Hospitaller Services, Dublin, Ireland.
²⁰ Coventry and Warwickshire Partnership NHS Trust, Coventry, Coventry, UK.
²¹ Psychological Medicine for Children and Adolescents, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France.
²² Department of Child and Adolescent Psychiatry/Psychotherapy, Universitatsklinikum Ulm, Ulm, Baden-Württemberg, Germany.
²³ Department of Neurosciences, Child & Adolescent Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.
²⁴ Department of Child & Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium.
²⁵ Department of Psychology, University of Warwick, Warwick, UK.

PMID: 32580979
PMCID: PMC7312331
DOI: 10.1136/bmjopen-2019-033324

Randomized Controlled Trial

Validation of the Transition Readiness and Appropriateness Measure (TRAM) for the Managing the Link and Strengthening Transition from Child to Adult Mental Healthcare in Europe (MILESTONE) study

Paramala Santosh et al. BMJ Open. 2020.

. 2020 Jun 23;10(6):e033324.

doi: 10.1136/bmjopen-2019-033324.

Authors

Affiliations

¹ Child and Adolescent Psychiatry, King's College London, London, UK paramala.1.santosh@kcl.ac.uk.
² Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), South London and Maudsley NHS Foundation Trust, London, UK.
³ HealthTracker, Gillingham, UK.
⁴ Child and Adolescent Psychiatry, King's College London, London, UK.
⁵ School of Psychology, University of Plymouth, Plymouth, Devon, UK.
⁶ Unit of Neuropsychiatry, ASST Spedali Civili di Brescia Dipartimento di Salute Mentale, Brescia, Lombardia, Italy.
⁷ Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK.
⁸ Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia.
⁹ Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy.
¹⁰ Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands.
¹¹ Department of Pediatric and Adolescent Psychiatry, KBC Osijek, Osijek, Croatia.
¹² Neuropsychiatry Service of Childhood and Adolescence, Mental Health Department, ASST della Valcamonica, Breno, Lombardia, Italy.
¹³ Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Coventry, UK.
¹⁴ Yulius Academy, Rotterdam, The Netherlands.
¹⁵ Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Puglia, Italy.
¹⁶ School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
¹⁷ Geary Institute, University College Dublin, Dublin, Ireland.
¹⁸ Department of Child Psychiatry, Our Lady's Hospital For Sick Children, Crumlin, Ireland.
¹⁹ Lucena Clinic, Saint John of God Hospitaller Services, Dublin, Ireland.
²⁰ Coventry and Warwickshire Partnership NHS Trust, Coventry, Coventry, UK.
²¹ Psychological Medicine for Children and Adolescents, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France.
²² Department of Child and Adolescent Psychiatry/Psychotherapy, Universitatsklinikum Ulm, Ulm, Baden-Württemberg, Germany.
²³ Department of Neurosciences, Child & Adolescent Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium.
²⁴ Department of Child & Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium.
²⁵ Department of Psychology, University of Warwick, Warwick, UK.

PMID: 32580979
PMCID: PMC7312331
DOI: 10.1136/bmjopen-2019-033324

Abstract

Objective: Young people moving from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) are faced with significant challenges. To improve this state of affairs, there needs to be a recognition of the problem and initiatives and an urgent requirement for appropriate tools for measuring readiness and outcomes at the transfer boundary (16-18 years of age in Europe). The objective of this study was to develop and validate the Transition Readiness and Appropriateness Measure (TRAM) for assessing a young person's readiness for transition, and their outcomes at the transfer boundary.

Design: MILESTONE prospective study.

Setting: Eight European Union (EU) countries participating in the EU-funded MILESTONE study.

Participants: The first phase (MILESTONE validation study) involved 100 adolescents (pre-transition), young adults (post-transition), parents/carers and both CAMHS and AMHS clinicians. The second phase (MILESTONE cohort study and nested cluster randomised trial) involved over 1000 young people.

Results: The development of the TRAM began with a literature review on transitioning and a review of important items regarding transition by a panel of 34 mental health experts. A list of 64 items of potential importance were identified, which together comprised the TRAM. The psychometric properties of the different versions of the TRAM were evaluated and showed that the TRAM had good reliability for all versions and low-to-moderate correlations when compared with other established instruments and a well-defined factor structure. The main results of the cohort study with the nested cluster randomised trial are not reported.

Conclusion: The TRAM is a reliable instrument for assessing transition readiness and appropriateness. It highlighted the barriers to a successful transition and informed clinicians, identifying areas which clinicians on both sides of the transfer boundary can work on to ease the transition for the young person.

Trial registration number: ISRCTN83240263 (Registered 23 July 2015), NCT03013595 (Registered 6 January 2017); Pre-results.

Keywords: Transition Readiness and Appropriateness Measure (TRAM); adult mental health services; child and adolescent mental health services; validation; young persons.

PubMed Disclaimer

Conflict of interest statement

Competing interests: PS is the co-inventor of the HealthTracker and is the Chief Executive Officer and shareholder in HealthTracker. FF is a Chief Technical Officer and KL is a Project Manager employed by HealthTracker. FV is the Dutch distributor of ASEBA from which he receives remuneration. SPS is part-funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care WM (NIHR CLAHRC WM).

Figures

**Figure 1**
Summary of the main stages, methods and analyses of the TRAM. AD, adolescent; AMHS, adult mental health services; CAMHS, child and adolescent mental health services; CL, clinician; PC, parent/carer; TRAM, Transition Readiness and Appropriateness Measure.

See this image and copyright information in PMC

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Validation of the Transition Readiness and Appropriateness Measure (TRAM) for the Managing the Link and Strengthening Transition from Child to Adult Mental Healthcare in Europe (MILESTONE) study

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Validation of the Transition Readiness and Appropriateness Measure (TRAM) for the Managing the Link and Strengthening Transition from Child to Adult Mental Healthcare in Europe (MILESTONE) study

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