Two important factors appear to influence the process and outcome of health care transition: cognitive ability and whether a disability is progressive. Young people and families tend to view transition as a developmental process composed of three stages: (i) "envisioning a future," which begins at diagnosis; (ii) "age of responsibility," during which children are taught and expected to carry out tasks of daily living and medical self-care; and (iii) "age of transition," which is associated with the same expectations and timeframes for independence as in the general population (38). The quality of parent-provider interactions correlates with the extent to which transition services are addressed by pediatric providers (44).
In the United States, a professional consensus statement between the pediatric and adult physician professional organizations was put forth in 2002 that delineated several first steps to ensuring successful transitioning to adult oriented health care for young people with special health care needs (4). These recommendations are incorporated into Table 1 and include:
1. Identifying a health care professional who acts as a transition coordinator in partnership with the young person/family
2. Educating health care professionals to provide developmentally appropriate transition services
3. Preparing and maintaining an up-to-date medical summary that is portable and accessible
4. Creating a written health care transition by age 14 together with the young person/family
5. Applying same guidelines for primary and preventive care;
6. Ensuring affordable, continuous health insurance coverage that includes compensation for transition planning and care coordination
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