Care Coordination for Children with Special Healthcare Needs Anticipating Transition: A Program Evaluation

Transition of care readiness among adolescents with chronic pain between 2021-2022 in a Nationally representative sample

Chronic pain impacts 11-33% of children and will continue into adulthood for over half of them. Transition of pain management to adult care is crucial given high risk of interruption of care which is associated with subsequent poor medical, social, and vocational outcomes. Yet the transition experience for these youth is poorly characterized. Using a sample from the 2021 and 2022 National Survey of Children's Health (conducted by parent report), we aimed to determine the prevalence of transition readiness among adolescents with chronic pain in the U.S. and estimate the association of readiness with biopsychosocial-cultural and health system characteristics. Of the 2584 adolescents aged 14-17 with chronic pain, 23.9% of adolescents met criteria for transition readiness. Using Poisson regression, we determined those more likely to meet criteria were older (PR 1.8 95%CI: 1.3, 2.6), female (PR 1.6 95% CI: 1.2, 2.2), White (Asian PR 0.4, 95% CI: 0.2, 0.9, Multi-racial PR 0.6 95% CI: 0.4, 0.9), and experienced shared decision making (aPR 1.7 95% CI: 1.1, 2.8). Fewer than half met criteria for medical home, effective care coordination, and adequate insurance. Poor mental health emerged as a concern with high levels of anxiety and/or depression (48%) and low levels of flourishing (42%). This is an important first step in demonstrating low transition readiness among adolescents with chronic pain and identifying mental health and healthcare continuity concerns. Future research should incorporate stakeholder perspectives and investigate pain specific factors relevant to transition readiness and investigate how readiness relates to transition outcomes. PERSPECTIVE: This article establishes low readiness to transition from pediatric to adult healthcare among adolescents with chronic pain and identifies disparities in readiness. Poor mental health and inadequate healthcare access were identified as factors which may impact transition intervention delivery. These findings can guide development and implementation of a transition intervention.

Family Navigation for Children with Autism: A Scoping Review of Quantitative and Qualitative Evidence

Family navigation (FN) has emerged as a promising intervention for reducing barriers and addressing social and economic inequities in autism service delivery. Little is known regarding the implementation and effectiveness of FN for children with autism. The aims of this scoping review are to: (1) summarize the breadth, quantity, and characteristics of the existing literature on FN for children diagnosed with autism; (2) describe the models and outcomes of FN for this population; and (3) identify knowledge gaps and provide directions for future research. Authors used Arksey and O'Malley's methodological framework for scoping reviews. Searches were conducted in PubMed, CINAHL, Embase, Social Services Abstracts, and Web of Science, resulting in identification of 308 papers. Two independent raters completed title/abstract and full-text screenings. Data was extracted using a researcher-developed tool. Results synthesis involved content and construct analysis and descriptive numerical summaries. 17 publications met inclusion criteria. Among these, seven studies evaluated FN models delivered by professional or peer navigators. Three studies investigated FN tools. The remaining seven papers included five qualitative and two mixed methods studies that provided valuable insights on improving FN programs. Overall, studies on FN models reported positive impacts on family activation and well-being, knowledge, and service access and utilization. None addressed improvements in child developmental status or behavioral profiles. FN is a promising intervention for improving family outcomes and increasing service access and utilization. Further research is needed to establish best practices, identify child- and family-centered outcome metrics, and promote scalability and sustainability.

Integrated care for children and young people with special health and care needs: a systematic review

CONTEXT

There is a dearth of high-quality evidence on integrated, coordinated and cost-effective care for children with special health and care needs (CSHCN).

OBJECTIVE

To assess the effectiveness of integrated/coordinated care models for CSHCN.

DATA SOURCES

Embase, Ovid Medline(R), HMIC Health Management Information Consortium, Maternity & Infant Care Database (MIDIRS), PsycARTICLES, PsycINFO, Social Policy and Practice, Cochrane Central Register of Controlled Trials (CENTRAL), Global Health and PubMed.

STUDY SELECTION

Inclusion criteria comprised (1) randomised trials, including cluster randomised trials; (2) an integrated/coordinated care intervention; (3) for children and young people under 25 with special healthcare needs including medical complexity; (4) assessing child-centred outcomes, health-related quality of life among parents and carers, and health or social care use, processes of care and satisfaction with care.

DATA EXTRACTION

Data were extracted and assessed by two researchers, and descriptive data were synthesised according to outcome and intervention.

RESULTS

14 randomised controlled studies were included. Seven out of the 14 studies had a dedicated key worker/care coordinator as a vital part of the integrated/coordinated care intervention; however, the certainty of evidence for all outcomes was either 'low' or 'very low'.

LIMITATIONS

Included studies were mostly from high-income countries. Variable study outcomes and quality of evidence precluded meta-analysis.

CONCLUSIONS

Limited evidence favours integrated care for CSHCN using a dedicated key worker/care coordinator; however, heterogeneity in study outcomes and definitions of CSHCN limit the strength and utility of evidence obtained. Recommendations are made for improving integrated care practice, research and evaluation which are important for evidence-based health services for CSHCN.

PROSPERO REGISTRATION NUMBER

CRD42020209320.

Transition of patients with Gaucher disease type 1 from pediatric to adult care: results from two international surveys of patients and health care professionals

Introduction

Gaucher disease (GD) is a rare, autosomal recessive lysosomal storage disorder caused by a deficiency in the enzyme glucocerebrosidase. The most common subtype in Europe and the USA, type 1 (GD1), is characterized by fatigue, cytopenia, splenomegaly, hepatomegaly, bone disease, and rarely pulmonary disease. Increased life expectancy brought about by improved treatments has led to new challenges for adolescents and their transition to adult care. Efficient healthcare transition to adult care is essential to manage the long-term age-related complications of the disease.

Methods

This international study consisted of two online surveys: one survey for patients with GD1 and one survey for healthcare professionals (HCPs) involved in treatment of patients with GD1. The aims of this international, multi-center project were to evaluate the current transition process in various countries and to understand the challenges that both HCPs and patients experience.

Results

A total of 45 patients and 26 HCPs took part in the survey, representing 26 countries. Our data showed that a third (11/33) of patients were aware of transition clinics and most stated that the clinic involved patients with metabolic diseases or with GD. Seven patients attended a transition clinic, where most patients (5/7) received an explanation of the transition process. Approximately half of HCPs (46%; 12/26) had a transition clinic coordinator in their healthcare center, and 10 of HCPs had a transition clinic for patients with metabolic diseases in their healthcare center. HCPs reported that transition clinics were comprised of multi-disciplinary teams, with most patients over the age of 18 years old managed by hematology specialists. The main challenges of the transition process reported by HCPs included limited funding, lack of expertise and difficulty coordinating care amongst different specialties.

Discussion

Our study demonstrates the lack of a standardized process, the need to raise awareness of transition clinics amongst patients and the differences between the transition process in different countries. Both patients and HCPs expressed the need for a specialist individual responsible for transition, efficient coordination between pediatricians and adult specialists and for patient visits to the adult center prior to final transition of care.

Gaps in transitional care to adulthood for patients with cerebral palsy: a systematic review

PURPOSE

The transition from pediatric to adult care can be complex and difficult to navigate for adolescents with cerebral palsy (CP). We aimed to assess the current state of transitional care for young persons with CP and delineate guidelines for best practice with opportunities for intervention.

METHODS

A systematic review was conducted using PRISMA guidelines to search PubMed, Embase, and Scopus databases. Articles were screened for relevance via title and abstract prior to full-text review.

RESULTS

Of 3151 resultant articles, 27 observational studies were included. Fourteen (52%) studies assessed clinical outcomes of patients with CP during and post-transition. Transition-associated poor outcomes included housing instability, unemployment, difficulty forming relationships, increased hospital admission rates, and decreased use of rehabilitation services. Factors associated with improved outcomes included family participation, promotion of self-efficacy, and meeting the adult team before transition. Nine (33%) studies conducted interviews with transition-age persons with CP. Key themes were a lack of transition preparedness, difficulty navigating the adult system, gaps in seamless care, and limited accessibility to specialists and environments suitable for patients with complex care needs. Four (15%) studies examined features of current transition services. Perceived barriers included poor communication within health service teams, limited adult providers accepting CP patients, and the lack of financial resources for specialized care. There was no standardized transition tool or approach.

CONCLUSION

These findings underscore the importance of a planned transition process in optimizing long-term medical and psychosocial outcomes for persons with CP. Further research, including translational, team-based, and community-engaged research, are needed.

Current Situation of Disaster Preparedness for Effective Response in Japanese Special Needs Schools

OBJECTIVE

Schools may serve as shelters in the event of a disaster, but little is known about the requirements of children with disabilities in such situations. This study, therefore, aimed to investigate disaster preparedness in Japanese special needs schools depending on the designation of welfare shelters.

METHODS

A questionnaire was distributed to schools nationwide. The respondents (authorities from 531 schools) answered questions about their jobs, disaster experiences, the school type, its students' disabilities, its designation as a welfare shelter, its evacuation readiness, and the items of a disaster prevention awareness scale. Differences in preparedness among schools and the relationship between preparedness and designation as a welfare shelter were determined.

RESULTS

Most respondents had never experienced a natural disaster. Schools had insufficient resources to cope with disasters. While the majority (68.2%) had resources for children to stay overnight, a substantial minority of schools (31.8%) did not. No differences were found in preparedness among schools with different types of children with disabilities. Schools designated as welfare shelters were significantly better prepared than others.

CONCLUSIONS

Special needs schools in Japan have limited disaster preparedness. The designation of schools as welfare shelters may increase their preparedness for disasters.

Readiness for transition to adult health care among US adolescents, 2016-2020

OBJECTIVE

Adolescence is a critical period of transition from paediatric to adult health care, but readiness for this transition has been described as low in the general adolescent population. We aimed to investigate whether transition readiness improved over time among US adolescents and to examine associations between demographic and clinical characteristics and transition readiness over time.

METHODS

Deidentified caregiver-reported repeated cross-sectional data from the 2016-2020 National Survey of Children's Health were analysed for caregiver-reported measures of transition readiness among adolescents age 12-17 years. Logistic regression was used to identify trends in transition readiness and change over time in factors associated with this outcome.

RESULTS

Among 55 022 adolescents represented in the five survey years, the proportion meeting a composite definition of transition readiness increased from 15% (95% confidence interval [CI]: 14%, 16%) in 2016 to 19% (95% CI: 17%, 20%) in 2020. After multivariable adjustment, each additional year was associated with 12% greater odds of caregiver-reported transition readiness (95% CI: +8%, +15%; P < 0.001), and transition readiness was more likely for girls, older adolescents and adolescents with special health care needs. Associations between adolescent characteristics and transition readiness did not change over the study period.

CONCLUSIONS

Population-level caregiver-reported transition readiness among US adolescents has increased but remains low. Factors previously associated with transition readiness (age, sex, race and ethnicity, family income and presence of special health care needs) have persisted over recent years.

Healthcare Transition in Inherited Metabolic Disorders-Is a Collaborative Approach between US and European Centers Possible?

Inherited metabolic diseases (IMDs) are rare heterogenous genetic conditions. Advanced technology and novel therapeutic developments have led to the improved life expectancy of patients with IMDs. Long-term, they require close surveillance from specialist adult metabolic providers. Healthcare transition (HCT) is the planned, purposeful process of preparing adolescents for adult-centered medical care and has been recognized globally as a necessary component of care for IMDs. Two recent surveys outlined barriers to the HCT in the US and the UK. The limited knowledge of IMDs among adult physicians was one of the barriers. Some work on specialty curriculum has started and aims to improve the structured training and awareness of rare diseases. Other barriers included social and legal aspects of adulthood, social, vocational and educational support for young adults, care fragmentation and insurance coverage. Although various HCT tools are available, they cannot always be standardized for IMDs. Despite the remarkable differences in the healthcare systems and physicians' training, collaboration among metabolic centers is possible. International rare disease alliance may enhance the patients' management via guidelines development and standardized training for adult metabolic providers.