Transitioning cognitively impaired young patients with special health needs to adult-oriented care: collaboration between medical providers and pediatric psychologists

Strategies and tools to aid the transition between paediatric and adult health services for young adults with neurodevelopmental disorders: a scoping review protocol

INTRODUCTION

The transition from paediatric to adult healthcare comes with risk and vulnerability for young adults with neurodevelopmental disorders and their carers. Deficits in health, social and disability systems and the fragmentation of services exacerbate problems during the transition period, leaving young people and their carers feeling disconnected with existing services. With advances in healthcare, the number of young adults with neurodevelopmental disorders requiring transition services is increasing. This scoping review aims to summarise the strategies and tools that help ease the transition to adult services for young adults with neurodevelopmental disorders.

METHODS AND ANALYSIS

Systematic searches of MEDLINE, EMBASE and PsychInfo on the OVID platform were performed on 28/05/2022. Studies that describe tools or strategies designed to ease the transition from child-centred to adult-orientated healthcare for young adults with neurodevelopmental disorders will be included. Two authors will independently review titles, abstracts and full-text articles against the inclusion criteria to determine eligibility. Data will be extracted and synthesised using descriptive stats and thematic analysis. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines will be followed.

CONCLUSION

This scoping review will synthesise the published literature describing strategies and tools to improve the transition of young adults with neurodevelopmental disorders to adult services. The findings of the review may inform areas of future research to improve care for all involved in the transition process.

ETHICS AND DISSEMINATION

This review will include published data; as such, ethics approval is not required. We will publish our findings in an open-access, peer-reviewed journal and summarise the results for dissemination to the wider community of clinicians, allied healthcare professionals, teaching professionals, policymakers, non-governmental organisations, impacted youth and parents.

Health Care Transition in Adolescents and Young Adults With Chronic Kidney Disease: Focus on the Individual and Family Support Systems

Health care transition (HCT) from pediatric to adult-focused services is a longitudinal process driven by the collaboration and interactions of adolescent/young adult patients, their families, providers, health care agencies, and environment. Health care providers in both pediatric and adult-focused settings must collaborate, as patients' health self-management skills are acquired in the mid-20s, after they have transferred to adult-focused care. Our manuscript discusses the individual and family support systems as they relate to adolescents and young adults with chronic or end-stage kidney disease. In the individual domain, we discuss demographic/socioeconomic characteristics, disease complexity/course, cognitive capabilities, and self-management/self-advocacy. In the family domain, we discuss family composition/culture factors, family function, parenting style, and family unit factors. We provide a section dedicated to patients with cognitive and developmental disability. Furthermore, we discuss barriers for HCT preparation and offer solutions as well as activities for HCT preparation.

Psychosocial considerations and recommendations for care of pediatric patients on dialysis

Dialysis treatment has evolved to enable children to live longer and transition to adulthood. Thus, the focus of care shifts to a consideration of pediatric patients' quality of life and psychosocial functioning across childhood, adolescence, and young adulthood. Despite well-documented concerns in various domains (including depression/anxiety, self-esteem and social functioning, behavior problems, and academic and cognitive functioning), limited literature exists regarding psychosocial guidelines for children and adolescents undergoing dialysis. This article aims to address this gap by providing a review of the pediatric literature examining psychosocial functioning in patients treated with dialysis, as well as recommendations for specific psychosocial concerns. Overall recommendations for care include screening for anxiety and depression, referral to pediatric psychologists for evidence-based intervention, utilization of child life specialists, opportunities to promote social functioning, neuropsychological evaluation and school programming, ongoing support in preparing for transition to adult care, and periodic measure of quality of life. Together, these suggestions promote a holistic approach to patient-centered care by supporting both physical and psychosocial well-being.

The Role of Pediatric Psychologists in the Transition of Youth to Adult Health Care: A Descriptive Qualitative Study of Their Practice and Recommendations

Transition from pediatric to adult health care setting is a challenge for young patients because of the psychosocial issues they may present that could hinder their commitment to treatment and medical care. Psychologists play a key role in supporting these patients. They intervene with the most vulnerable ones for whom the current transitional practice does not necessarily meet their specific needs and help them to develop an appropriate level of autonomy despite medical condition. To date, few studies have described their clinical practice in this field. This study aimed to gather in-depth information about the elements that characterize their different roles in transition care. Following a semi-structured interviews with ten pediatric psychologists, we conducted a thematic content analysis to identify common themes among participants. The results indicate that the psychologists' practice focuses on four main aspects: assessment, intervention, education, and liaison. Their recommendations point towards a better organization of health care services and a reflection on the best practices in psychology. These results highlight the specific roles that pediatric psychologists play in the transition process within the health care environment.

Health professionals' and managers' definitions of developmentally appropriate healthcare for young people: conceptual dimensions and embedded controversies

OBJECTIVES

We aimed to (i) explore how health professionals and managers who work with young people seek to define developmentally appropriate healthcare (DAH), (ii) identify the range of conceptual dimensions present in their definitions and (iii) explore the controversies embedded in their characterisations of DAH.

METHODS

A qualitative multisite ethnographic study was conducted across three hospitals in England. We undertook face-to-face semi-structured interviews with health professionals and managers; and non-participant observation in clinics, wards and meetings. Anonymised field notes and interview transcripts were analysed using thematic analysis. The theme 'conceptualisations of DAH' was then further analysed, and the resulting themes categorised to form conceptual dimensions.

RESULTS

We recruited 192 participants and conducted 65 interviews (41 with health professionals and 24 with managers) and approximately 1600 hours of non-participant observations (involving 103 health professionals and 72 managers). Despite the wide range of definitions provided by participants, five conceptual dimensions of DAH were identified: (i) biopsychosocial development and holistic care, (ii) acknowledgement of young people as a distinct group, (iii) adjustment of care as the young person develops, (iv) empowerment of the young person by embedding health education and health promotion and (v) interdisciplinary and interorganisational work. Also, some controversies were identified within most dimensions.

CONCLUSIONS

This study illustrates the lack of a generalised definition of DAH for young people among UK health professionals and managers, and presents a set of five core dimensions that can inform future research to help define and evaluate DAH for young people.

Primary care interventions to improve transition of youth with chronic health conditions from paediatric to adult healthcare: a systematic review

OBJECTIVE

To determine effective interventions to improve primary care provider involvement in transitioning youth with chronic conditions from paediatric to adult care.

DESIGN

Systematic review. Multiple electronic databases were searched including Ovid MEDLINE, EMBASE and Web of Science (from 1 January 1947 to 5 August 2015). Evidence quality was assessed using a 36-point scoring system for disparate study designs.

SETTING

Studies with paediatric-to-adult transition programmes and interventions involving primary care providers or in primary care settings.

PARTICIPANTS

Youth aged 16 years and over.

OUTCOMES

Relevant outcomes were grouped into 3 main domains based on the Triple Aim Framework: experience of care, population health, cost.

RESULTS

A total of 1888 unique citations were identified, yielding 3 studies for inclusion. Overall, primary care provider roles were not well defined. 2 studies used case managers to facilitate referrals to primary care, and the remaining study was the only 1 situated in a primary care setting. None of the studies examined transition in all 3 Triple Aim Framework domains. The most commonly reported outcomes were in the cost domain.

CONCLUSIONS

There is limited empiric evidence to guide primary care interventions to improve transition outcomes for youth with chronic conditions. Future research and policy should focus on developing and evaluating coordinated transition interventions to better integrate primary care for high need populations.

Transition von der Kindheit in das Erwachsenenalter bei chronischen Krankheiten

Dank des medizinischen Fortschritts erleben zunehmend mehr Kinder mit chronischen Erkrankungen das Erwachsenenalter. Patienten mit angeborenen Stoffwechselkrankheiten stellen nur eine, jedoch in ihrer Größe und Problematik besondere Gruppe heranwachsender Patienten dar. Allerdings fehlen vielfach begleitende Strukturen im Gesundheitssystem, um eine erfolgreiche Transition zu ermöglichen. Dies kann zu erheblicher Beeinträchtigung der Gesundheit der Betroffenen führen. Der Artikel beschreibt den Transitionsprozess des gesunden Adoleszenten zum jungen Erwachsenen sowie die Schwierigkeiten dieses Prozesses für chronisch kranke junge Menschen mit erhöhtem Bedarf an Gesundheitsbetreuung, die zusätzlich den Übergang aus der pädiatrischen Medizin in die Erwachsenenmedizin zu bewältigen haben.

Developmentally appropriate healthcare for young people: a scoping study

BACKGROUND

There is increasing recognition of the importance of providing quality healthcare to meet the biopsychosocial needs of young people. 'Developmentally appropriate healthcare' (DAH) for young people is one term used to explain what these services consist of. However, this term remains ill defined.

AIMS

(i) To analyse the use of the term DAH in the scientific literature and (ii) to identify and explore the range of meanings attributed to the term in relation to young people.

METHODS

A scoping review was conducted to map the presence of the term DAH in the literature. To analyse the use and meanings attributed to the DAH terminology, data underwent qualitative content analysis using a summative approach.

RESULTS

62 papers were selected and subjected to content analysis. An explicit definition of DAH was provided in only 1 of the 85 uses of the term DAH within the data set and in none of the 58 uses of the prefix 'developmentally appropriate'. A link between the use of the term DAH and the domains of adolescent medicine, young people, chronic conditions and transitional care was identified; as were the core ideas underpinning the use of DAH.

CONCLUSIONS

There is a need for consistency in the use of the term DAH for young people, the related stage-of-life terminology and age range criteria. Consensus is now needed as to the content and range of a formal conceptual and operational definition.

Doenças crônicas em crianças e adolescentes: uma revisão bibliográfica

O artigo analisa artigos publicados entre 2003 e 2011 enfocando discussões sobre condições crônicas ou doenças crônicas de crianças e adolescentes. Metodologicamente conjuga a revisão de literatura a uma análise de conteúdo temática com vistas a identificar quais os elementos que caracterizam doenças crônicas em crianças e adolescentes e as especificidades geradas por essas condições. A revisão resultou na descrição do conjunto dos artigos, caracterizando-os quanto ano de publicação, país, tipo de estudo, população e condição de cronicidade abordada. A análise de conteúdo temática gerou dois temas: Definição de Doença Crônica e Formas de se lidar com as doenças crônicas em crianças e adolescentes. Destaca-se como conclusão que as transições etárias quando uma doença é diagnosticada e tratada desde a infância, vai passar por transformações que incluem a maneira como se dá o seu fluxo entre os serviços e as mudanças que envolvem processos de alta, de tomada de decisão e de construção de rede que inclua família, hospital, escola e sistema de garantia de direitos.

The Postpediatrician Transition

A variety of factors impacts the transition from childhood to adulthood for persons with special health care needs or disabilities. Among these are the barriers in care coordination associated with our bifurcated health care delivery system in which pediatric medicine does not smoothly link up with the medical care received by adults. After reviewing the literature, we discuss the strong case to be made for reconceptualizing the medical home model, introducing a life span perspective to resolve the postpediatrician transition. Rather than a “hand off” from pediatrician to adult provider, this approach provides a pathway to fully integrating this patient population into our evolving health care system.