Transcript Slide 1

Transition or transfer?
Meeting the needs of young
people
Sue Dolby
Consultant Clinical Psychologist
Bristol Children’s Hospital
Definitions of transition
The purposeful, planned movement of adolescents and
young adults with chronic physical and medical
conditions from child – centered to adult orientated
healthcare systems.
Society for Adolescent Medicine, 1993.
Transition planning
• Phase 1: Preparation
• Phase 2: Active transfer
• Phase 3 :Integration into adult healthcare
Bennett et al. (2005) MJA,182,8, 373 – 74.
BRISTOL CHILDREN’S HOSPITAL RENAL TRANSITION PATHWAY 2006
IN LIAISON WITH:
School nurses
PSCHE curriculum
Connexions
Locality SS Disability
Health Promotion
etc
YEAR 9: INTRODUCTION TO TRANSITON PROGRAMME
-Aims and pathway outline
-Identify key worker (SW/Clin Psychol/Comm nurse)
- Initial personal plan
YEAR 10 : REVIEW
-Increase self management , knowledge,
-Assess social, health, education & developmental needs
-Personal plan
Clinic reviews
& PsychoSocial
meetings
YEAR 11 : REVIEW
As year 10 + discussion of transfer timing at 16+
YEAR 12 &13
-Increase self management
-Assess needs as before
-Separation/independence
6/12 reviews re transfer
EVALUATION OF PROCESS &
JOINT REVIEW OF
PROGRAMME –
Patient experience/staff experience
PREPARATION FOR TRANSFER
-Strengths/needs /risks social, emotional, vocational, health
-Information on adult Unit
-Introductory visit & links to staff
-Joint complex care meeting –sig. needs (YP invited)
Transfer report written with YP
ENTER TRANSITION CLINIC PROCESS IN ADULTS
Joint Paed /Adult Nephrologists process varies across
region
Annual transition programme
interview- paediatric preparation
• What do you know already about the programme– any questions
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/particular areas you want to discuss?
Social, educational and vocational – now /near future
Peer relationships and influences
Family relationships – individual issues re independence, individuation
etc
Becoming a young person …. Normal developmental trajectories – your
experience ( psychological & biological)
Looking after yourself in relation to renal condition, transplant kidney
& choosing health (specific medical concordance &
sex/drugs/drinking/smoking/ obesity/ mental health)
Managing own condition ( medical/ Renal Patient view/ clinic)
Information on adult services – expectations = reality
What do we need to work on with you over the next year?
What do you want other people to be aware of / support you with over
the next year?
Final year plan – when to go, what the process will be & links to adults
POTENTIAL BARRIERS TO SUCCESSFUL TRANSITION
• Minimising transition to transfer – manageable
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process
Paediatric anxieties about quality of adult provision
Attachment to patients – ‘parenting’ by the
healthcare team / parenting by carers
Lack of preparation for expectations/reality of adult
services
Adult provider concerns about managing young
people
Lack of preparation for ‘independence’ and self care
that is developmentally appropriate- challenge for
both services
Based on Fox, MA. (2002). Physicians as barriers to successful transitional
care. Int. J. Adolesc. Med. Health. 14, (1), 3-7.
Definition of transition (2)
“multi-faceted, active process that
attends to the medical, psychosocial
and educational/vocational needs of
adolescents as they move from childorientated to adult-orientated lifestyles
and systems”.
White, PH. Rheum Dis Clin N Am 1997;23:697-707
Quoted by Donal O’Donoghue ww.nephronline.org
Integrating transition
• Developing self
management knowledge
& skills (making own
choices)
• Integrating ‘Choosing
Health’ ( Obesity,
smoking, drinking, mental
health, sexual health)
• Integrating Every Child
Matters (Be Healthy, Stay
Safe, Enjoy & Achieve,
Make a Positive
Contribution & Achieve
Economic Wellbeing)
Integrating transition
• Information about
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paediatric /young
adult/ adult systems
Informed choice about
where to be treated
Supported transition
between teams / sites
Professionals who
consider the impact of
cancer on normal
developmental
trajectories
Developmental challenges in
adolescence & young adulthood
• Achieving biological and sexual maturation
• Developing cognitive capacity to utilise abstract
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thinking rather than concrete thinking
Develop personal identity
Develop intimate relationships with peers (
friendships as well as sexual with appropriate
partner)
Establish independence & autonomy in the
context of their individual socio-cultural
environment
Based on Christie,D. & Viner, R. (2005) BMJ 330:301-304
NEEDS OF YOUNG PEOPLE ?
• Information ( about services , condition,
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treatments, life with / after cancer, etc) multimedia
Peer support and information
Continuity of care and staff
Follow up as a survivor – long term effects /
information about childhood treatment
Staff who understand the impact of cancer in
young adulthood
‘Treat us as individuals … we’re not all the same
just because we’re the same age’
X
Survivor
Bio-psycho-social-vocational development
X
Survivor
Beliefs, expectations, values,
knowledge, understanding,
perceptions of risk, goals,
priorities etc etc
Understood & shared,
Adolescence
Individualised, developmentally
appropriate approach (reflecting
changes over time)
Phase 1: Preparation
Phase 2: Active transfer
Integrate an understanding of the
developmental challenges of this
period in a young person’s life –
what does it mean for this young
person at this point in their journey
(bio-psycho-social-vocational)
Phase 3 :Integration
Identity & independence
Peers & parents
Informed choices – choices about
Information (what, when, how)
Adulthood
jimmyteenstv.com provides films and animations made
by young cancer patients to give their views on living and coping with cancer.
Films are provided by various cancer wards around the UK.
http://www.jimmyteenstv.com/2008/04/tya-session-5/
https://www.teenagecancertrust.org/
http://www.clicsargent.org.uk
Transition: Getting it right
DoH DVD
www.dh.gov.uk/PolicyAndGuidance/HealthAndSocial
careTopics/ChildrenServices/Transitions/fs/en