Transitioning Our Youth: It s a Team Approach. Anna Gozdzik, MN, RN, Cneph(C) University Health Network Toronto, ON

Transcription

1 Transitioning Our Youth: It s a Team Approach Anna Gozdzik, MN, RN, Cneph(C) University Health Network Toronto, ON

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3 Objectives Literature Teens & young adults Our experience Transition initiative Next Steps

4 By the Numbers Patient survival rates Pediatric diseases Small number of transfers

5 Transition versus Transfer Purposeful Planned Holistic psychological &social

6 Barriers to Transition Developmental Psychosocial Family Systemic

7 Teen Brain

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9 The Nature of Things

10 The Nature of Things Dopamine Risk taking Romantic love Parental Involvement

11 Chronic Illness and Adolescent Development Biological Social Psychological

12 Psychosocial Implications Psychiatric and behavioural Emotional problems Low self-esteem Self-Management Struggles

13 Cognitive Delay IQ testing Fullest capacity Tailor approach Opportunity

14 Goals of Transition Address the barriers Start early

15 Goals of Transition Developmentally appropriate and individualized Dedicated adult team

16 Recommendations Consensus statement by International Society of Nephrology (ISN) and the International Pediatric Nephrology Association (IPNA)

17 Our Experience

18 Commonly Observed Behaviours Role of parents Apathy Non-adherence Communication difficulties

19 Environment Scan Kidney transplant patients Sickle cell program transition specialist

20 Sick Children s Good 2 Go Program

21 MyHealth Passport Accessed from: file:///d:/7348-myhealth_pass_07feb08.pdf

22 Collaboration Division of Nephrology Colleagues at Sick Kids

23 Transition Clinic Transition clinic participants Purpose of clinic Therapeutic relationship

24 Transition Brochure

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26 Gaining Experience Resources at Sick Kids Educational sessions

27 Outcomes No formal evaluation Anecdotal evidence

28 Next Steps Gaining knowledge Ontario Renal Network criteria Evaluation

29 Prefrontal cortex Summary Individualized Developmentally appropriate Psychological needs Start early & include adult team

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31 Acknowledgments Zoe Levitt Melissa Rubin Michela Verdirame Contact:

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33 References Alpay, H. (2009). Transition of the adolescent patient to the adult clinic. Peritoneal Dialysis International, 29(S2), S180 S182. Amaria, K., Stinson, J., Cullen-Dean, G., Sappleton, K., & Kaufman, M. (2011). Tools for addressing systems issues in transition. Healthcare Quarterly, 14, Gorter, J. W., Stewart, D., Cohen, E., Hlyva, O., Morrison, A., Galuppi, B. TRACE Study group. (2015). Are two youth-focused interventions sufficient to empower youth with chronic health conditions in their transition to adult healthcare: a mixed-methods longitudinal prospective cohort study. BMJ Open, 5. doi: /bmjopen Grant, C., & Pan, J. (2011). A comparison of five transition programmes for youth with chronic illness in Canada. Child: Care, Health and Development, 37, 6, Kaufman, M. (2006). Transition of cognitively delayed adolescent organ transplant recipients to adult care. Pediatric Transplantation, 10,

34 Lindsday, S., Kingsnorth, S., Hamdani, Y. (2011). Barriers and facilitators of chronic illness self-management among adolescents: a review and future directions. Journal of Nursing and Healthcare of Chronic Illness, 3, McDonagh, J.E., Southwood, T.R., & Shaw, K.L. (2007). The impact of a coordinated transitional care programme on adolescents with juvenile idiopathic arthritis. Rheumatology, 46, McQuillan, R.F., Toulany, A., Kaufman, M., & Schiff, J.R. (2015). Benefits of a transfer clinic in adolescent and young adult transplant patients. Canadian Journal of Kidney Health and Disease, 2(45). doi: /s Michaud, P., Suris, J., & Viner, R. (2007). The adolescent with a chronic condition: Epidemiology, Developmental Issues and Health Care Provision. Retrieved from World Health Organization, Department of Child and Adolescent Health and Development website: The Nature of Things with David Suzuki (Producer). (2015, February 7). Surviving :) the teenage brain [Video file]. Retrieved from: Pai, A.L.H., & Ostendort, H.M. (2011). Treatment adherence in adolescents and young adults affected by chronic illness during the health care transition from pediatric to adult health care: a literature review. Children s Health Care, 40,

35 Price, C.S., Corbett, S., Lewis-Barned, N., Morgan, J., Oliver, L.E., & Dovey-Pearce, G. (2011). Implementing a transition pathway in diabetes: a qualitative study of the experiences and suggestions of young people with diabetes. Child: Care, Health and Development, 37, Sable, C., Foster, E., Uzark, K., Bjornsen, K., Cannobbio, M. M., Connolly, H. M.on behalf of the American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease (2011). Best practices in managing transition to adulthood for adolescents with congenital heart disease: The transition process and medical and psychosocial issues: A scientific statement from the American Heart Association. Circulation, 123(13), doi: /CIR.0b013e c56 Tong, A., Wong, G., Hodson, E., Walker, R.G., Tjaden, L., Craig, J.C. (2013). Adolescent views on transition in diabetes and nephrology. European Journal of Pediatrics, 172, Watson, A.R. (2005). Problems and pitfalls of transition from paediatric to adult renal care. Pediatric Nephrology, 20, Watson, A.R., Harden, P.N., Ferris, M.E., Kerr, P.G., Mahan, J.D., Ramzy, M.F. (2011). Transition from pediatric to adult renal services: a consensus statement by the Internal Society of Nephrology (ISN) and the International Pediatric Nephrology Association (IPNA). Kidney International, 80, Watson, A.R., & Warady, B.A. (2011). Transition from pediatric to adultcentred care. Dialysis & Transplantation, 40(4),