Tips for Transitioning Children from Pediatric to Adult Care Providers

The transition from child to adult is one filled with many changes. And one of the most important changes is transitioning from a pediatric to adult health care practitioner.

Proper planning and ongoing discussions with both parents and children beginning in early adolescence can make the transition occur more smoothly. This process can be accomplished through provider, family, and adolescent readiness planning.

A 2011 American Academy of Pediatrics (AAP) report titled "Supporting the Health Care Transition from Adolescence to Adulthood in the Medical Home" offers physicians practical guidance to help plan and execute this transition for children and their families.

Create an Office Policy

It is recommended that care providers create an office policy regarding their transition process that is readily available to practitioners, parents/guardians, and adolescents. According to gottransition.org , this policy and process should be a part of planning for all adolescents, including those with special needs.

The policy should outline how this process is going to be documented, such as with a form in a paper chart or through prompts in an electronic health record (EHR), and at what age it should begin.

Educate Families, Empower Children

Family members need to be educated about their role in the transition process, including the legal changes that occur once a child reaches age 18 and how pediatric and adult care are delivered differently. Providers should be prepared to address any family stress and questions regarding this transition.

The adolescent must be viewed as the driver behind this process, according to gottransition.org . Discussions should begin in early adolescence, ideally around 12 years of age, with the goal to complete the process between the ages of 18 and 21. To assess the patient's readiness for transition, physicians can download and administer the Boston Children’s Hospital's ADAPT Survey .

Topics that should be discussed during this process include plans after graduation, such as attending college, joining the military, or entering the workforce, as these can impact the care transition process for young adults.

Key Transition Plan Components

In its report, the AAP recommends including four key components in a transition plan:

1. Assess for transition readiness. Begin talking to patients and families about the transition to adult care, including the child's awareness of his/her personal medical needs and age-appropriate preventive care. Measure transition progress at each visit using the same criteria/checklist.
2. Plan a dynamic and forward-moving process for accomplishing realistic goals. Establish formal goals for a seamless transition. Write down the goals and include specific actions to achieve them. Also include timelines for reaching those goals and note who will be responsible for completing them. This information should be part of the patient's medical record by age 14.
3. Implement the plan by educating everyone involved and empowering children in areas of self-care. Begin teaching children specific needed health care skills. Such skills may include learning personal medical history, talking one-on-one with a doctor, and understanding any required medications they are using. Pediatric providers should assist children and families in identifying potential adult practices one to two years before medical care is transferred.
4. Document progress and movement of medical information to the adult care provider. Whether using paper records or an EHR, ensure documentation is complete and ready for transition to the receiving care provider. Ensure the medical documentation includes the transition plan, readiness checklists, and a portable medical summary.