Healthcare Transition: Getting on the Same Page

Peter Scal, MD MPHDepartment of PediatricsUniversity of Minnesota

July 21, 2012

Disclosure

No conflicts of Interest to disclose

All to common comment…..

“I have 17 year old identical twin daughters with spastic cerebral palsy.  We have received no assistance in the transition from pediatric to adult health care services. Everything we have set up  has been parent initiated”

Learning Objectives

You should be able to: Describe the goals of health care

transition Locate and begin using HCT specific

resources and tools Understand how to incorporate HCT into

every healthcare visit

Social & Health Policy

Family & Community

Youth

The goal….

“is to maximize lifelong functioning and well-being…

by ….. ensuring that high-quality, developmentally appropriate health care

…..uninterrupted as the person moves from adolescence to adulthood”

Teens are telling us…

“I want to make my [health condition here] less of a bother in my life”

Working Definition of HCT Counseling:Process of supporting teens and their parents develop the –

Skills

Resources

Motivation

-to reduce the impact their chronic health condition on their everyday activities and future opportunities

HCT is a Process not an event:

Begins early…at time of diagnosis

Stepwise…building skills over time

Meets the needs of teens, families AND healthcare providers. (no single right way)

Transfer of care is only ONE (important) element of a successful transition….

Social & Health Policy

Family & Community

Youth

No Easy Treatments

www.gottransition.org

www.sickkids.ca/Myhealthpassport

Building Internal Motivation: by meeting basic needs

Competence Ability to have an impact and

change a behavior

Autonomy Behavior is volitional or

undertaken by choice

Relatedness Feeling cared for and caring for

others

Coming Next ?

Web-based assessment and self-management tools (integrated into EMR or stand-alone)

EMR Templates Quality Measures specific and related to

HCT Training for ‘adult practitioner’ in

One Day?

“My 22 year old multiply disabled technology dependent daughter transitioned successfully from a pediatric practice last year. This was an emotional and traumatic change for me, her mother. I was grateful to be referred to Dr. X. She had a pediatric and internal medicine background she made the proper referrals … and counseled us …

….I am impressed with the time spent with us at appointments and the fact that she answers all of my questions, and some I never even thought to ask! I now refer other parents in the transition process to Dr. X in hopes that they may also experience a successful transition in their primary health care provider.”

Thank You

Pediatrics 2011;128:182-200

©2011 by American Academy of Pediatrics

Health care transition-planning

algorithm for all youth and young adults within a medical home interaction.

Add a motivational approach

Motivational interviewing Patient centered style aimed at resolving

ambivalence Self-Determination

Foster intrinsic motivation

Quality Improvement “Learning Collaborative s”

Youth and Family Involvement in Clinical Service Improvements

Based on Medical Home model Utilizes Health Care Transition Index

Practice self-rating on transition processes

2 practices in Minnesota