Child and Adolescent Psychiatry, King's College London, London, UK
Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), South London and Maudsley NHS Foundation Trust, London, UK.
BMJ Open. 2020 Jun 23;10(6):e033324. doi: 10.1136/bmjopen-2019-033324.
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.
MILESTONE prospective study.
Eight European Union (EU) countries participating in the EU-funded MILESTONE study.
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.
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.
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.
ISRCTN83240263 (Registered 23 July 2015), NCT03013595 (Registered 6 January 2017); Pre-results.
从儿童和青少年心理健康服务（CAMHS）过渡到成人心理健康服务（AMHS）的年轻人面临着重大挑战。为了改善这种状况，需要认识到这一问题，并采取主动措施，迫切需要在转移边界（欧洲为 16-18 岁）上衡量准备情况和结果的适当工具。本研究的目的是开发和验证过渡准备和适宜性衡量工具（TRAM），以评估年轻人过渡的准备情况及其在转移边界的结果。
里程碑式前瞻性研究。
参与欧盟资助的里程碑研究的 8 个欧盟国家。
第一阶段（里程碑验证研究）涉及 100 名青少年（过渡前）、年轻成年人（过渡后）、父母/照顾者以及 CAMHS 和 AMHS 临床医生。第二阶段（里程碑队列研究和嵌套集群随机试验）涉及 1000 多名年轻人。
TRAM 的开发始于对过渡的文献回顾，以及由 34 名心理健康专家组成的小组对过渡相关重要项目的回顾。确定了 64 项潜在重要项目的清单，这些项目共同构成了 TRAM。对不同版本的 TRAM 的心理测量学特性进行了评估，结果表明，所有版本的 TRAM 都具有良好的可靠性，与其他已建立的工具相比，相关性较低至中等，且具有明确的因子结构。嵌套集群随机试验的队列研究的主要结果未报告。
TRAM 是一种可靠的评估过渡准备情况和适宜性的工具。它突出了成功过渡的障碍，并为临床医生提供了信息，确定了转移边界两侧的临床医生可以努力的领域，以减轻年轻人的过渡压力。
ISRCTN83240263（2015 年 7 月 23 日注册），NCT03013595（2017 年 1 月 6 日注册）；预结果。
