THE MILESTONE PROJECT: Managing the Link and Strengthening the Transition from Child to Adult Mental Health Care;Protocol for the validation of the MILESTONE Suite of Measures - The Transition Readiness and Appropriateness Measure (TRAM) and the Transition Related Outcome Measure (TROM) (Work package 2)

Transition to adulthood is the period of onset of most of the serious mental
disorders that disable or kill in adult life, however, only a small proportion
of young people in this age group, less than one in six, access services or
receive appropriate care. The current service configuration of distinct Child
and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services
(AMHS) is increasingly viewed as an impediment to holistic and comprehensive
care for young people, especially those who make a transition from one model to
another.

In current clinical practice, there is no consensus on who can be discharged on
reaching CAMHS transitional boundary, who should receive transitional care and
how this care should be delivered. There is an urgent need to develop,
validate, implement and test a robust model of managed transitional care.
Ideally all young people reaching a transition boundary would be assessed in a
structured and standardised manner to determine their on-going need for care.
Review of the literature suggests that there are no validated and reliable
measures that specifically assess the outcomes, experience and effectiveness of
transitional care.

King's College London has developed a low burden, reliable and efficient,
bespoke MILESTONE Suite of Measures related to transitioning from CAMHS to
AMHS. These include the Patient Reported Transition Outcome Measure (TrOM) for
assessing the quality and outcome of transition and the Transition Readiness
Measure (TRaM) to identify high-risk, high-need cases for whom transition to
AMHS is critical These will be used on the Health Tracker website, which is a
new way to monitor which things get better or worse during treatment for
physical or emotional problems.

The purpose of the MILESTONE validation study is to validate low burden,
reliable and efficient bespoke MILESTONE measures related to transition from
CAMHS to AMHS. The primary objective is to validate the MILESTONE Suite of
Instruments:
a. The Transition Readiness and Appropriateness Measure (TRAM) that identifies
high-risk, high-need cases for whom transition to AMHS is critical
b. Transition Related Outcome Measure (TROM) for evaluating the success of
transitions
The secondary objectives are:
2. To translate the Transition Readiness and Appropriateness Measure (TRAM) and
the Transition Related Outcome Measures (TROM)
3. To add the Transition Readiness and Appropriateness Measure (TRAM) and the
Transition Related Outcome Measures (TROM) and its translations to the
HealthTracker*
4. To assist and train all Centres to use the web-based customized
HealthTracker* system
5. To optimise the TRAM on HealthTracker* based on Decision Making Algorithms
(to serve as the platform for optimization of transitions to Adult Mental
Health in the EU

Measure development and validation

No risk and minimal burden.