Making Transitioning a Process
Successful Approaches to Transitioning
Multiple factors influence the timing of a patient's transition, including departmental policies at various health care facilities and the patient's own health status. Many pediatric emergency rooms and pediatric intensive care units will not admit youth over the age of 18, so these adolescents are required to transition to adult services. When chronic illness affects a young person's cognitive and developmental functioning, transitioning is usually delayed, as it benefits these patients and their families to remain with pediatric or adolescent programs through age 24.
As soon as you feel it appropriate, explain the transitioning process to youth and their families, so that thoughts, feelings, fears, and potential barriers can be addressed before the patient changes care settings.
The following approaches can improve the likelihood of a successful transition for patients aging into more mature care settings: 8
- Plan a meeting with the patient, his or her family members, and the patient's other health care providers to collaboratively develop a transition plan that includes skills-acquisition screens, service referrals, and the emotional preparation needed for a successful transition. From a cultural perspective, it may be important to assess how much independence the family caregivers believe the adolescent can handle. Ask what kinds of responsibilities the young persons handle on their own. Are they responsible for their medication? Do they arrange transportation to their medical appointments? Do they attend medical appointments on their own? Do they see the medical caregiver alone while one or more members of their family wait for them?
- In advance of the patient's transition, develop a care plan but remain flexible. Available medical services, patient needs, and matters pertaining to insurance coverage all can change by the time a patient actually transitions, so you may have to adjust your plan to ensure that all service needs will be met, including social and spiritual support, concrete service needs (eg, housing, nutrition, transportation), educational services, and developmental intervention.
- Involve adolescent patients when developing their care plans, as engaging them in the process fosters independence and creative problem-solving skills.
- If possible, select an adult care setting that offers multidisciplinary support similar to the support provided by the pediatric or adolescent program the patient is leaving. Moving into this type of medical setting can facilitate the changeover from a supportive care program to one that emphasizes more independence.
- Ease the patient into change with a stepped transition, slowly transferring to successive adult services such as pharmacy, case management, or gynecology before switching the patient to an adult primary care provider. Providers should be aware, however, that many insurance plans require a patient's care to be delivered in one setting or another (eg, no reimbursement for services rendered at an "old" clinic once enrolled in a "new" clinic).
- Advocate the notion that the transition is a very special rite of passage.
- Reiss J, Gibson R. Health care transition: destinations unknown. Pediatrics. 2002 Dec;110(6 Pt 2):1307-14.