Division of Transition of Care

Ideally, patients over the age of 14 with special health care needs will develop transition plans with their providers and parents. The patients who typically
benefit most from working with our Transition of Care team are kids who:

• see multiple subspecialists in pediatrics and, therefore,
  may have a complicated transition
• have disabilities that will make it difficult to be completely independent as adults

A senior pediatrician and social coordinator run our Transition of Care program. Together, we work with young adults and their families to create transition plans. To gauge progress, we meet with the family and child on a regular basis.

Transitioning care involves a lot of preparation and is a process, not just a transfer. A great place to start is by finding ways to increase independence or co-manage medical issues. To assist teens in beginning the process of developing a transition of care plan with their providers and parents, we help: 

• identify adult health care providers who are knowledgeable about the child’s medical condition and with whom the family/child are comfortable
• kids learn more about their medical conditions
• teens and young adults manage their own care and become advocates of their own health (e.g., how to refill prescriptions and talk to adult providers) 
• families work with insurance providers
• kids and their families learn about residential options, especially for patients who have disabilities that don’t allow them to function completely independently