1. Using Readiness Assessment for Youth With Special Health Care Needs to Improve Medical Students' Understanding of Transition Nathan Bradford Sr, MD Brian Mulroy, DO

2. Disclosures Dr. Bradford has no financial disclosures Dr. Mulroy has no financial disclosures

3. Reflections “Sometimes just helping an individual create their own independence or helping them to find the resources to do this is one of the best ways we can help.” -BY “I learned how hard it is for some patients to get to their appointments, get their medicines, and in some cases, just to be heard by their physician.” -TT “I feel more confident to handle complex socioeconomic situations, more knowledgeable about community resources, and more capable to care for similar patients in the future as a result of having had this experience.” -MJ

4. Transition is a Process “The purposeful, planned movement of adolescents and young adults with chronic physical and mental conditions from child- centered to adult-oriented health care systems.” (SAHM)

5. Youth with Special Healthcare Needs (YSHCN) Increasing in number, they often fall through the cracks Each year YSHCN graduate and need to find adult PCPs –YSHCN can be complicated –We don’t prepare them on the pediatric side THERE ARE OTHER BARRIERS

6. Barriers for YSHCN Insurance coverage Transportation Caregivers Lack of ability to advocate

7. Barriers for the Adult Provider Discomfort with medical issues Time limitations –Psychosocial needs take time –Paperwork Communicating with pediatric providers End of life issues

8. Same Planet, Different Worlds Pediatric CareAdult Care NurturingInforming Parent CenteredPatient Centered Universal fundingUnderfunded Family insurance providedEmployment based insurance PaternalisticTotal Autonomy CentralizedFragmented Usually informed providersPotentially less informed providers (Modified from Eckman)

9. AnMed Health Anderson, South Carolina Children’s Health Center (CHC) Family Medicine Center (FMC)

10. Previously, we experienced many of the same barriers! Lack of organized follow-up No-shows at FMC Mystification at FMC –Who are these people? (complexity) –What services are available?

11. Our Solution: Medical Students as Coaches in Transitions of YSHCN

12. Medical Students as Coaches in Transition of YSHCN Recruited med students (12+10=22) Pretest on knowledge of issues facing YSHCN Brief didactic session –The problem –The study –Info on relating to YSHCN

13. Our Project Each MS-3 was assigned a YSHCN patient Attended last visit at CHC (exit visit) –Readiness checklist (patient/parent) –Summary of medical history –Stayed in contact with their YSHCN Attended entrance visit at FMC –Repeat readiness checklist (patient/parent) Coordination with social worker Reflective piece Post-test

14. Issues Addressed New adult providers DME Bowel/bladder Independent living End-of-life issues Educational Vocational Psychosocial Sexual Insurance coverage

15. Outcomes Successful transitions –Transition Clinic vs. current project Readiness checklists –Patients –Parents Reflections from students

16. Outcomes: Successful Transition Successfully transitioned 12/12 (100%) YSHCN with class of 2016 –5/10 from class of 2017 thus far Successful transition from the Transition Clinic was 20/27 (74%) –24/27 (89%) eventually made it to the office

17. Readiness Checklists There was no improvement in independence scores for the patients that successfully transitioned No correlation between the parents’ desires for transition and successful transition No correlation between the parents’ view of their child’s independence and successful transition

18. Outcomes: Reflections “Having a positive impact does not have to mean curing some terrible illness. It can be as simple as helping somebody devise a goal towards more independent function. “ -JO “As someone interested in a career in pediatrics, my experiences with my transition patient furthered my desire to ensure that my patients are medically empowered and adequately able to care for themselves.” -EB “It has helped guide me and be more apt to ask patients why and what their barriers are to being compliant with follow ups and taking their medications.” -KA

19. Conclusions No identifiable factors that lead to successful transition Increased numbers of successful transitions Improved medical student knowledge on dealing with YSHCN, community resources, importance of transition

20. References American Academy of Pediatrics Clinical Report — Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home, Pediatrics Vol. 128, No. 1. July 1, 2011 pp. 182 -200. Blum, R., Britto, M., Rosen, D., Sawyer, S., & Siegel, D. (2003). Transition from child-centered to adult health-care systems for adolescents with chronic conditions: A position paper of the Society for Adolescent Medicine. Journal of Adolescent Health, 33(4): 309- 311. D’Agata, et al. Medical Care for the Disabled Patient, Family Medicine Residency Curriculum Resource, STFM.org. Gottransition.org a program of The National Alliance to Advance Adolescent Medicine supported by HRSA/MCHB http://gottransition.org/resourceGet.cfm?id=239.

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