Transition or transfer? Meeting the needs of young people

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Transition or transfer?Meeting the needs of
young people

• Sue Dolby
• Consultant Clinical Psychologist
• Bristol Childrens Hospital

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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.
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Transition planning

• Phase 1 Preparation
• Phase 2 Active transfer
• Phase 3 Integration into adult healthcare
• Bennett et al. (2005) MJA,182,8, 373 74.

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BRISTOL CHILDRENS HOSPITAL RENAL TRANSITION
PATHWAY 2006

• YEAR 9 INTRODUCTION TO TRANSITON PROGRAMME
• Aims and pathway outline
• Identify key worker (SW/Clin Psychol/Comm nurse)
• - Initial personal plan

IN LIAISON WITH School nurses PSCHE
curriculum Connexions Locality SS
Disability Health Promotion etc
Clinic reviews Psycho- Social meetings

• YEAR 10 REVIEW
• -Increase self management , knowledge,
• Assess social, health, education developmental
  needs
• -Personal plan

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
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
EVALUATION OF PROCESS JOINT REVIEW OF
PROGRAMME Patient experience/staff experience
ENTER TRANSITION CLINIC PROCESS IN ADULTS Joint
Paed /Adult Nephrologists process varies
across region
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Annual transition programme interview- paediatric
preparation

• What do you know already about the programme any
  questions /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

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POTENTIAL BARRIERS TO SUCCESSFUL TRANSITION

• Minimising transition to transfer manageable
  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.

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Definition of transition (2)
multi-faceted, active process that attends to
the medical, psychosocial and educational/vocation
al needs of adolescents as they move from
child-orientated to adult-orientated lifestyles
and systems. White, PH. Rheum Dis Clin N Am
199723697-707 Quoted by Donal ODonoghue
ww.nephronline.org
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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)

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Integrating transition

• Information about 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

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Developmental challenges in adolescence young
adulthood

• Achieving biological and sexual maturation
• Developing cognitive capacity to utilise abstract
  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  330301-304 

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NEEDS OF YOUNG PEOPLE ?

• Information ( about services , condition,
  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 were not all the same
  just because were the same age

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(No Transcript)
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X
Survivor
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Bio-psycho-social-vocational development
X
Survivor
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Beliefs, expectations, values, knowledge,
understanding, perceptions of risk, goals,
priorities etc etc Understood shared,
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Adolescence
Individualised, developmentally appropriate
approach (reflecting changes over
time) Integrate an understanding of the
developmental challenges of this period in a
young persons life what does it mean for this
young person at this point in their
journey (bio-psycho-social-vocational) Identity
independence Peers parents Informed choices
choices about Information (what, when, how)

• Phase 1 Preparation
• Phase 2 Active transfer
• Phase 3 Integration

Adulthood
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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
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Transition Getting it right DoH
DVDwww.dh.gov.uk/PolicyAndGuidance/HealthAndSoci
alcareTopics/ChildrenServices/Transitions/fs/en