Development and Evaluation of an Adolescent and Young Adult Healthcare Transition Program

Background: The 2009-2010 National Survey of Children with Special Health Care Needs revealed that almost twenty percent of adolescents in the United States have a physical, mental, emotional or learning disability (NS-CSHCN, 2014).  Advances in treatment modalities, technologies and scientific breakthroughs, 90%, 750,000 children annually are living well into adulthood (Betz, 2012). Most adolescents/young adults (AYA) lack the needed preparation for transition from the pediatric providers.  A barrier for healthcare providers to transitioning AYA is lack of skills to provide transition assessment and planning (AAP, 2009). Consequences to failing to transition have been associated with declining health, lack of care continuity,   and disengagement with the medical community (Woodward, Swigonski &Ciccarelli, 2012). Promoting transition readiness and providing an organized, coordinated transition program fosters best outcomes for AYA, and caregivers.

Issue: The purpose of the practice improvement project is to develop an adolescent, young adult healthcare transition (AYAHT) program, develop training modules on the AYAHT program for clinic staff and conduct and evaluates the initial education on the AYAHT program for the clinic staff. The AYAHT program promotes transition for the AYA (14-21) with special healthcare needs followed in the outpatient pediatric rehabilitation department of a national pediatric health system.  The significance and anticipated outcomes of this project are that AYA and their caregivers are provided a program to be implemented that fosters transition in a safe, effective, patient- centered efficient, timely and equitable manner.  

Methods:  Implementation of program development takes place in an outpatient pediatric rehabilitation department of a major metropolitan inner city. The program is developed in four phases over eight weeks. The participants in program development and evaluation are the healthcare staff, AYA and their family members. The entire pediatric rehabilitation staff will receive an in-service on the AYAHT program.

Evaluation: Pre and post presentation of the AYAHT program based on the Transition Readiness Assessment Questionnaire (TRAQ) (Sawicki, 2011), a survey on knowledge of transition, confidence in executing transition and experiencing in transition .is evaluated. Descriptive statistics summarizing program evaluator characteristics, such as years practicing in the department and years in practice are noted. Qualitative commenting is themed. 

Implications: Educating providers to the AYAHT program facilitates safe, patient centered, timely, effective and, equitable outcomes (IOM, 2001). Education is a first step in promoting policy development ensuring successful transition for AYA and family members. 

Relevance:  Thirteen years post publication of the consensus statement on transition (AAP, 2002); there remains a gap in consistent coordinated care transition in pediatric institutions (McManus et al., 2015).  AYA transition program development and dissemination builds extant literature and promotes research regarding transitions of care.  Program replication for implementation promotes future translational to improve practice outcomes. 

References:

American Academy of Pediatrics (2009).AAP Department of Research Survey: AAP News; 30; 12. Doi: 10.1542/aapnews.20093011-12

Betz, C.L. (2013) Health care transition for adolescents with special healthcare needs: Where is nursing? Nursing Outlook, 61(5), 258-265.

Institute of Medicine. (2001) Crossing the quality chasm: a new health system for the 21st century.  Washington, DC: National Academy Press.

McManus, M., White, P., Barbour, A., Downing, B., Hawkins, K., Quoin, N., Tuchman, L., Cooley, W.C., & McAllister, J.W. (2015) Pediatric to Adult Transition: A Quality Improvement Model for Primary Care. Journal of Adolescent Health , 56 (1), 73-78.

National survey of children with special health care needs-NS-CSHCN (2014).Retrieved from www.childhealthdata.org/learn/NS-CSHCN

Sawicki, G, Lukens-Bull, K., Bull, K., Yin, X., Demars, N., Huang, I., Livingood, W., Reiss, J., & Wood, D. (2011).Measuring the transition readiness of youth with special healthcare needs: Validation of the TRAQ—transition readiness assessment questionnaire. Journal of Pediatric Psychology.36(2), 160-171. 

Woodward, J.F., Swigonski, N.L., & Ciccarelli, M.R. (2012) Assessing the health, functional characteristics, and health needs of youth attending a noncategorical transition support