Targeting Transitions in Care for Transitional Age Youth with Complex Medical Illness

Abstract: As children with chronic severe medical problems live longer into adulthood, the previously unanticipated challenge of transitioning a pediatric patient to adult care has become critical. Adolescence can be a difficult time, especially for those with chronic conditions who face unique challenges in accomplishing normal developmental tasks, necessitating an increased focus on “transitional age youth” (TAY) and the special needs of older adolescents and younger adults between 15 and 25 years. The transition between pediatric and adult care for youth with chronic physical conditions is often poorly managed, for both clinical and systemic reasons, resulting in adverse consequences for both physical and mental health¹. Successful transition into adult care requires an individualized process for each patient and their families², predicated on effective communication between pediatric and adult clinicians, and between the patient, parents, and providers.
This symposium, sponsored by the Pediatric C-L Psychiatry SIG, is structured to address the training gap for pediatric and primary care providers, as well as child-adolescent psychiatrists providing care for TAY patients³. Dr. Eva Ihle will welcome participants to the symposium by providing the background and context for the presentations. Dr. Mounika Ganguly will describe the launch of a specialized outpatient clinic for medically complex TAY patients, designed to mitigate transition distress. Dr. Aishwarya Rajagopalan will review patient and parent support groups and describe preliminary outcomes from her study examining peer health coaching in the outpatient setting for TAY with chronic conditions and their parents. Dr. Katherine Ort will address the unique needs of TAY with eating disorders on inpatient units, with a specific focus on comprehensive medical provider and staff education in both pediatric and adult inpatient settings. Dr. Susan Turkel will provide an overview of approaches to the problem, reviewing the range of interventions and their core features, and describing their health-promoting potential on adolescent mental health and maturation to adulthood.
Child-adolescent psychiatrists are in the special position to meet the health care needs of TAY patients, facilitating coordinated care between disciplines, and setting up transformative patterns of care that will prove essential throughout a patient’s lifespan.

References

1. Crowley R, Wolfe I, Locke K, McKee M. Improving the transition between paediatric and adult healthcare: a systematic review. Arch Dis Child 2011; 96; 548-553. doi: 10.1136/adc.2010202473
< 2. Tsang VWL, Fletcher S, Jassermi S, Smith S. Youth, caregiver, and provider perception of the transition from pediatric to adult care for youth with chronic diseases. J Dev Behav Pediatr 2021. doi: 10.1097/DBP.00000000001024

< 3. Sadun RE, Chung RJ, Pollock MD, Maslow GR. Lost in transition: resident and fellow training and experience caring for young adults with chronic conditions in a large United States’ academic medical center. Med Educ Online 2019; 24:1065783. doi: 10.1080/10872981.2019.160578