Graduating from pediatric to adult health care

For Health Care Practitioners

If you provide health-related services to young adults with chronic health conditions or disabilities, please be sure you are listed in our Health Services Directory for Young Adults.  Visit Submission Instructions to add or update your program information.

Clinical Guidelines

  • Updated Six Core Elements of Health Care Transition 2.0:  Comprehensive tool packages are available for three transition processes: 1) transitioning youth to adult health care providers, 2) transitioning youth to an adult approach to health care without changing providers and 3) integrating youth into adult health care. These packages include sample policies,registries, transition readiness/self-care assessments, condition fact sheets, medical summary and emergency care plans, transfer letters and checklists, young adult orientation material, care plans, feedback surveys and measurement approaches. Download the Six Core Elements and the supporting tool packages on the Got Transition web site here.
  • Condition-Specific Tools from the American College of Physicians are now available for the following subspecialties: general internal medicine (intellectual/developmental disabilities and physical disabilities), cardiology, endocrinology, gastroenterology, hematology, nephrology, and rheumatology.  The toolkit includes transition readiness assessments, self-care assessments, and medical summaries customized from Got Transition’s Six Core Elements.
  • Pathways to preparation, planning and transfer:
  • The 2011 Clinical Report on Health Care Transitions from the AAP/ACP/AAFP was published in the July 2011 issue of Pediatrics and is available for download here.

Education &  Training for Professionals

  • See our Health Care Transition Training for Health Care Professionals
  • Incorporating Transition into Epic Electronic Health Record Software: A Survey of Expert Users(January 2015 from Got Transition)
  • Coding and Reimbursement Tip Sheet.  Got Transition and the American Academy of Pediatrics developed a transition payment tip sheet to support the delivery of recommended transition services in pediatric and adult primary and specialty care settings. It provides a summary of alternative payment methodologies and comprehensive listing of transition-related CPT codes and corresponding Medicare fees, effective as of 2017.

Transition 2 Go

A series of informational briefs with transition-related tips and resources for consumers and health care providers in Florida:

Instructional Videos

  • Healthy Transitions Mobile App, from University of Delaware’s Center for Disabilities Studies,
    is designed to help young adults with special health care needs build skills for independence and health care self-management. It features videos that explain how to handle real life scenarios and an interactive game to reinforce the ideas presented in the videos. The videos are categorized into four sections; healthcare, insurance, healthy lifestyles and relationships. The app can be downloaded for free through iTunes and Google Play. For Google Play, click here. For iTunes, log in to your iTunes account and search for Healthy Transitions.

Transition Readiness Assessments, Checklists & Care Plans

  • TRAQ, Transition Readiness Assessment Tool from JaxHATS. TRAQ is a validated, patient-centered questionnaire that providers and families can use to assess youths’ ability to make appointments, to understand their medications and to develop other skills needed for transition to adult care. It is designed to be self-administered and it takes less than 5 minutes for youth to fill it out. The questionnaire can also be filled out by caretakers to get their perspective on their youth’s transition skills. Use of this instrument has the potential to improve transition assessment and support and improve health outcomes during healthcare transition for youth with special health care needs. TRAQ is available in an Excel file to input, score and aggregate results, or in PDF. Visit the JaxHATS web site to learn more.
  • TRAScore [© 2013 Mountain Area Health Education Center (MAHEC), Asheville, NC;  20-item assessment with automatic score calculation]
  • Brief Transition Checklist (ages 12 – 18+)
  • Transition Timeline (from Shriner’s Hospitals and University of Washington)
  • Teen Transition Checklist (from AAP’s Illinois Chapter)

Workbooks from the Institute of Child Health Policy at University of Florida and CMS:

Guidelines for Adolescent Preventive Services (GAPS; from the American Medical Association):

Examples of anticipatory guidance for adolescent and young adult patients (adapted from AAP’s Bright Futures guidelines by University of South Florida to include transition activities)

See other resources listed in FloridaHATS Brochure, in English, Spanish and Haitian Creole

Medical Summary Forms

Condition-Specific Checklists & Care Plans

Autism Spectrum Disorders

Cornelia de Lange Syndrome

Cystic Fibrosis

Diabetes

Down Syndrome

HIV/AIDS

Hormone Deficiency

Intellectual Disability/Developmental Disability  (ID/DD)

Juvenile Arthritis

Metabolic Conditions

Neuromuscular Disease

Pulmonary Disease

Sickle Cell Disease

Solid Organ Transplantation

Spina Bifida

Service System Materials

Children’s Medical Services

Juvenile Justice

Secondary & Post-Secondary Education

Foster Care

Mental Health

Oral Health

  • Oral Health Training for Caregivers (2014, from FDDC).  This webinar/video is for anyone who provides personal care to an individual with a developmental disability, demonstrating how to perform oral hygiene techniques such as positioning, brushing and flossing.
  • Oral Health Florida
  • Project: Dentists Care (Florida Dental Health Foundation 2010)  Dental access resource guide for underserved Floridians.
  • Florida Donated Dental Services (DDS) provides dental care to elderly, disabled and medically at-risk clients. One must be unable to pay for dental care and need extensive treatment (more than routine care).  Visit here to learn more and to apply for services.
  • Oral Health Sustainability Resource Center  (developed by Palm Beach State College)

Scholarly Publications

Other Resources