Professional Training for Transition

To exacerbate the lack of transition readiness in providers, both pediatricians and adult providers feel unprepared for their roles in this transition process. A study of general pediatric practices in the Northeastern part of the United States showed that general pediatric practices were not ready for their patients to transfer. For example, most had not decided on transition policies for their practice or, if they had, did not post them. They had few office processes that supported transition and wanted help to become more competent (46). McDonagh et al. showed that rheumatology health care providers (pediatric and adult) would welcome more training in adolescent and transition issues (47). Table 4 presents a check list based on the U.S. Consensus Statement for pediatric practices to see how their practice measures up on transition processes developed for the Bureau of

Table 4 Checklist for Transition: Core Knowledge and Skills for Pediatric Practices

This checklist addresses one of the critical first steps to ensuring successful transitioning to adult-oriented health care: the need for core knowledge and skills required to provide developmentally appropriate health-care transition services to young people with special health-care needs.

The HRTW National Resource Center believes these skills apply to all youth with and without a diagnosis.

Core knowledge and skills checklist for practices policy Yes No

1. Dedicated staff position coordinates transition activities

2. Office forms are developed to support transition processes

3. CPT coding is used to maximize reimbursement for transition services

4. Legal health-care decision making is discussed prior to youth turning 18

5. Prior to age 18, youth sign assent forms for treatments, whenever possible

6. Transition policy states age youth should no longer see a pediatrician is posted

Medical home

1. Practice provides care coordination for youth with complex conditions

2. Practice creates an individualized health transition plan before age 14

3. Practice refers youth to specific family or internal medicine physicians

4. Practice provides support and confers with adult providers post-transfer

5. Practice actively recruits adult primary care/specialty providers for referral

Checklist for Transition:

Core Knowledge & Skills:

for Pediatric Practices

Checklist for Transition:

Core Knowledge & Skills:

for Pediatric Practices

(Continued)

Table 4 Checklist for Transition: Core Knowledge and Skills for Pediatric Practices (Continued)

Family/youth involvement Yes No

1. Practice discusses transition after diagnosis, and planning with families/youth begins before age 14

2. Practice provides educational packet or handouts on transition

3. Youths participate in shared care management and self-care (calling for apppointments/Rx refills)

4. Practice assists families/youth to develop an emergency plan (health crisis and weather or other environmental disasters)

5. Practice assists youth/family in creating a portable medical summary

6. Practice assists with planning for school and/or work accommodations

7. Practice assists with medical documentation for program eligibility (SSI, VR, college)

8. Practice refers family/youth to resources that support skill-building: mentoring, camps, recreation, activities of daily living, volunteer/ paid work experiences

Health-care insurance

1. Practice is knowledgeable about state-mandated and other insurance benefits for youth after age 18

2. Practice provides medical documentation when needed to maintain benefits

Screening

1. Exams include routine screening for risk-taking and prevention of secondary disabilities

2. Practice teaches youth lifelong preventive care, how to identify health baseline and report problems early; youth know wellness routines, diet/exercise, etc.

Notes: The HRTW National Resource Center is headquartered at the Maine State Title V CSHN Program and is funded through a cooperative agreement (U39MC06899-01-00) from the Integrated Services Branch, Division of Services for Children with Special Health Needs (DSCSHN) in the Federal Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS). Activities are coordinated through the Center for Self-Determination, Health and Policy at the Maine Support Network. The Center enjoys working partnerships with the Shriners Hospitals for Children and the KY Commission for CSHCN.

The opinions expressed herein do not necessarily reflect the policy or position nor imply official endorsement of the funding agency or working partnership.

Maternal and Child Health Healthy and Ready to Work National Center. Health-care providers in the adult-care system have had little or no training in adolescent developmental issues or in diseases that, until recently, did not present to adult physicians. An American survey of 3066 physicians and other health care professionals showed major deficits in their knowledge of and skills in adolescent health care, including care for young with SHCN (48). Similar results have been reported in a more recent survey of the staff a large U.K. children's hospital providing tertiary care, where over a third of the patients at any one time are adolescents (49). Training is further discussed in Chapter 17.

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