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
Dieter Wolke,
Jason Madan,
Jatinder Singh,
Federico Fiori,
Paramala Santosh,
Helena Tuomainen,
Swaran 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,
Lidia Manenti,
Athanasios Maras,
Francesco Margari,
Adriana Pastore,
Moli Paul,
Diane Purper-Ouakil,
Francesco Rinaldi,
Vehbi Sakar,
Ulrike Schulze,
Giulia Signorini,
Cathy Street,
Priya Tah,
Sabine Tremmery,
Amanda Tuffrey,
Frank Verhulst,
Anna Wilson
Affiliations
Dieter Wolke
Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
Jason Madan
Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Coventry, UK
Jatinder Singh
Aff7 Primary Biostatistical Solutions 2042 Carnarvon Ct V8R2V3 Victoria BC Canada
Federico Fiori
Child and Adolescent Psychiatry, King's College London, London, UK
Paramala Santosh
Child and Adolescent Psychiatry, King's College London, London, UK
Helena Tuomainen
Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
Swaran Singh
Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
Laura Adams
School of Psychology, University of Plymouth, Plymouth, Devon, UK
Mathilde Mastroianni
Child and Adolescent Psychiatry, King's College London, London, UK
Natalie Heaney
Child and Adolescent Psychiatry, King's College London, London, UK
Kate Lievesley
HealthTracker, Gillingham, UK
Ilyas Sagar-Ouriaghli
Child and Adolescent Psychiatry, King's College London, London, UK
Giovanni Allibrio
Unit of Neuropsychiatry, ASST Spedali Civili di Brescia Dipartimento di Salute Mentale, Brescia, Lombardia, Italy
Rebecca Appleton
Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
Nikolina Davidović
Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
Giovanni de Girolamo
Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
Gwen Dieleman
Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
Katarina Dodig-Ćurković
Department of Pediatric and Adolescent Psychiatry, KBC Osijek, Osijek, Croatia
Tomislav Franić
Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
Charlotte Gatherer
Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
Suzanne Gerritsen
Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
Elisa Gheza
Neuropsychiatry Service of Childhood and Adolescence, Mental Health Department, ASST della Valcamonica, Breno, Lombardia, Italy
Lidia Manenti
Unit of Neuropsychiatry, ASST Spedali Civili di Brescia Dipartimento di Salute Mentale, Brescia, Lombardia, Italy
Athanasios Maras
Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
Francesco Margari
Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Puglia, Italy
Adriana Pastore
Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Puglia, Italy
Moli Paul
Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
Diane Purper-Ouakil
Psychological Medicine for Children and Adolescents, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
Francesco Rinaldi
Neuropsychiatry Service of Childhood and Adolescence, Mental Health Department, ASST della Valcamonica, Breno, Lombardia, Italy
Vehbi Sakar
Department of Child and Adolescent Psychiatry/Psychotherapy, Universitatsklinikum Ulm, Ulm, Baden-Württemberg, Germany
Ulrike Schulze
Department of Child and Adolescent Psychiatry/Psychotherapy, Universitatsklinikum Ulm, Ulm, Baden-Württemberg, Germany
Giulia Signorini
Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
Cathy Street
Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
Priya Tah
Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
Sabine Tremmery
Department of Neurosciences, Child & Adolescent Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
Amanda Tuffrey
Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
Frank Verhulst
Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
Anna Wilson
Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
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.
