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, Jatinder Singh, Laura Adams, Mathilde Mastroianni, Natalie Heaney, Kate Lievesley, Ilyas Sagar-Ouriaghli, Giovanni Allibrio, Rebecca Appleton, Nikolina Davidović, Giovanni de Girolamo, Gwen Dieleman, Katarina Dodig-Ćurković, Tomislav Franić, Charlotte Gatherer, Suzanne Gerritsen, Elisa Gheza, Jason Madan, Lidia Manenti, Athanasios Maras, Francesco Margari, Fiona McNicholas, Adriana Pastore, Moli Paul, Diane Purper-Ouakil, Francesco Rinaldi, Vehbi Sakar, Ulrike Schulze, Giulia Signorini, Cathy Street, Priya Tah, Sabine Tremmery, Amanda Tuffrey, Helena Tuomainen, Frank Verhulst, Jane Warwick, Anna Wilson, Dieter Wolke, Federico Fiori, Swaran Singh, MILESTONE Consortium, Paramala Santosh, Jatinder Singh, Laura Adams, Mathilde Mastroianni, Natalie Heaney, Kate Lievesley, Ilyas Sagar-Ouriaghli, Giovanni Allibrio, Rebecca Appleton, Nikolina Davidović, Giovanni de Girolamo, Gwen Dieleman, Katarina Dodig-Ćurković, Tomislav Franić, Charlotte Gatherer, Suzanne Gerritsen, Elisa Gheza, Jason Madan, Lidia Manenti, Athanasios Maras, Francesco Margari, Fiona McNicholas, Adriana Pastore, Moli Paul, Diane Purper-Ouakil, Francesco Rinaldi, Vehbi Sakar, Ulrike Schulze, Giulia Signorini, Cathy Street, Priya Tah, Sabine Tremmery, Amanda Tuffrey, Helena Tuomainen, Frank Verhulst, Jane Warwick, Anna Wilson, Dieter Wolke, Federico Fiori, Swaran Singh, MILESTONE Consortium

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.

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).

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
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.

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