1. Healthcare Transition: Getting on the Same Page Peter Scal, MD MPH Department of Pediatrics University of Minnesota July 21, 2012

2. Disclosure No conflicts of Interest to disclose

3. 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”

4. 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

8. 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”

9. Teens are telling us… “I want to make my [health condition here] less of a bother in my life”

10. 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

11. 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….

13. No Easy Treatments

15. www.gottransition.org

18. www.sickkids.ca/Myhealthpassport

20. 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

21. 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

22. 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 …

23.  ….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.”

24. Thank You

26. 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.

27. Add a motivational approach  Motivational interviewing  Patient centered style aimed at resolving ambivalence  Self-Determination  Foster intrinsic motivation

28. Quality Improvement “Learning Collaboratives”  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