Transition Counseling Research Articles

Longitudinal assessment of preparation for care transition among adolescents and young adults with rheumatologic disease: a single-center pilot study

Adolescents and young adults (AYA) with rheumatologic diseases are at high risk for poor outcomes and gaps in care when transitioning from pediatric to adult care. However, tools for evaluating transition readiness and assessing the impact of transition interventions are limited. We implemented a written transition policy at our pediatric rheumatology center and evaluated preparation for transition among AYA 16 and older before and after distribution. 31 of 77 patients completed the follow-up survey (response rate 40%). Patient report of transition counseling increased following written transition policy implementation, though these results were not statistically significant in our small cohort. Most follow-up respondents (n = 19, 61%) had not yet completed care transfer; 4 (13%) had arranged a visit with an adult rheumatologist and 8 (26%) had fully transitioned to adult care. Those who successfully completed care transfer were older, had completed higher levels of education, and had significantly higher baseline transition preparation scores compared to those with no transfer arranged or planned visit only. Our single-center pilot study demonstrated that longitudinal assessment of transition preparation is feasible and that scores are significantly associated with care transfer outcomes. Tracking transition preparation over time may provide practices with information on areas of highest need for transition guidance and predict successful transfer among AYA with rheumatologic disease.

Konseling Dan Pengembangan Karir PNS: Literature Review

The purpose of this article is to describe several forms of career counseling services that can be adopted in the implications of civil servant management in central and local government agencies considering that career development is one form of civil servant management as regulated in Law Number 11 of 2017 concerning Civil Servant Management. However, career development does not always go well, various problems faced by employees can be an obstacle to career development. Career counseling as a service that aims to overcome employee problems is expected to be able to help so that the mandate of the Law can be achieved. Counseling aims not only to address pathological problems and provide interventions for those with mental health challenges but also includes the goals of promoting health, personal growth, education, and career development. The method used in this article is to use a Systematic Literature Review involving 15 documents from 2012 to 2018 and to identify 3 forms of career counseling services that are relevant to the management of civil servants, including civil servant career transition counseling, counseling for civil servants with disabilities, counseling for elderly civil servants.

Assessing preparation for care transition among adolescents with rheumatologic disease: a single-center assessment with patient survey

BackgroundDespite the risk for poor outcomes and gaps in care in the transfer from pediatric to adult care, most pediatric rheumatology centers lack formal transition pathways. As a first step in designing a pathway, we evaluated preparation for transition in a single-center cohort of adolescents and young adults (AYA) with rheumatologic conditions using the ADolescent Assessment of Preparation for Transition (ADAPT) survey.FindingsAYA most frequently endorsed receiving counseling on taking charge of their health and remembering to take medications. Less than half reported receiving specific counseling about transferring to an adult provider.AYA with lower education attainment compared with those who had attended some college or higher had lower scores in self-management (1.51 vs 2.52, p = 0.0002), prescription medication counseling (1.96 vs 2.41, p = 0.029), and transfer planning (0.27 vs 1.62, p < 0.001). AYA with a diagnosis of MCTD, Sjögren’s or SLE had higher self-management scores than those with other diagnoses (2.6 vs 1.9; p = 0.048). Non-white youth indicated receiving more thorough medication counseling than white youth (2.71 vs 2.07, p = 0.027).When adjusting for age, educational attainment remained an independent predictor of transfer planning (p = 0.037). AYA with longer duration of seeing their physician had higher transition preparation scores (p = 0.021).ConclusionFew AYA endorsed receiving comprehensive transition counseling, including discussion of transfer planning. Those who were younger and with lower levels of education had lower preparation scores. A long-term relationship with providers was associated with higher scores. Further research, including longitudinal assessment of transition preparation, is needed to evaluate effective processes to assist vulnerable populations.

Health Care Transition in Youth With Type 1 Diabetes and an A1C >9%: Qualitative Analysis of Pre-Transition Perspectives.

OBJECTIVE | To explore expectations for transition to adult care and experiences with transition planning among adolescents and young adults with type 1 diabetes and an A1C >9% at a tertiary care U.S. pediatric center. METHODS | We conducted semi-structured interviews in a purposive sample of patients 14-23 years of age who had had type 1 diabetes for at least 1 year and had an A1C >9%. A multidisciplinary team conducted iterative thematic analysis with deductive and inductive coding aided by NVivo software. RESULTS | Fourteen subjects participated (nine adolescents and five young adults, mean age 17.1 ± 3.2 years, 57% male, 79% Caucasian, 14% Hispanic, diabetes duration 8.2 ± 4.6 years, mean A1C 10.0 ± 0.8% for adolescents and 10.1 ± 0.7% for young adults). Qualitative analysis yielded four key themes. The first was lack of formal preparation; participants of all ages demonstrated a lack of preparation for transition and ignorance about the process, describing it as coming "out of the blue." The second was a desire for delayed and gradual transition; participants wanted to defer being "serious" about transition to a later/uncertain date, with a preference to "wait until I'm older" among all ages. Participants described ideal transition as a gradual process, taking place "a little at a time." The third was attachment to pediatric providers; participants demonstrated a nearly universal attachment to and "familiarity" with their pediatric diabetes care providers and expressed worries about an "uncomfortable" transition to adult providers. The fourth was concern about an impersonal adult care setting: participants perceived adult care as "formal," "scarier," and "tougher," with increased criticism about poor control; participants expressed fear that adult providers would not "know me" or appreciate "my diabetes journey." CONCLUSION | We demonstrated a lack of transition preparation and anxiety about transition and adult care among youth with type 1 diabetes and elevated A1C. Our results may help guide early, iterative pediatric transition counseling, with a special focus on addressing attachment and fears about adult diabetes care.

Coming Out of "Retirement"-Predictors of Driving Resumption Among Older Drivers.

Background and ObjectivesPredictors and consequences of driving cessation in older adults have been studied extensively. This study sought to establish the extent to which former drivers resume driving and identify associated factors.Research Design and MethodsDescriptive analysis of the 2011–2015 National Health and Aging Trends Study data (Round 1: n = 6,680; Round 5: n = 3,409) characterized the extent of driving resumption through 2015 by baseline driving status (driver, former driver, never driver). Weighted multivariate logistic regression and multilevel longitudinal models examined predictors of driving resumption.ResultsAmong drivers who stopped driving during the study, 17%–28% resumed driving. Age, vehicle ownership, stroke, hospitalization, memory, and perceived transportation barriers were associated with resumption in regression analysis. In multilevel analysis stratified by baseline driving status, poor word recall (OR = 0.62; 95% CI = 0.40, 0.95) and use of public transportation (OR = 9.74; 95% CI = 1.54, 61.77) were significantly associated with driving resumption for baseline drivers, while use of taxi (OR < 0.001; 95% CI = <0.001, 0.02) was negatively associated with resumption for baseline former drivers.Discussion and ImplicationsThis study highlights several factors associated with driving resumption. Uncertainty about the underlying causes for resumption remains, so results should be interpreted with caution. However, predictive factors may help to identify individuals in need of additional mobility transition counseling. Ongoing transportation assessment may be warranted among former drivers.

'Which Way I Ought to Go?' Career Trajectories of Entrepreneurs, Executives, and Senior Managers in High-Tech

For decades, career transition counseling and research have focused on myopic insights on the next job versus understanding optimal career path. While the research mind-set was well placed to understand the evolution of skills to suggest possible terminal job outcomes, a lack of relevant data and computation resources posed challenges in developing valuable career transition insights. Furthermore, because of the data limitations, the extant research focused on the role of generalizable and specialized skills in highly heterogeneous career transitions. Technology, big data, and analytics have now enabled organization and management science research to investigate these questions. This paper analyzes 67,000 career profiles for entrepreneurs, executives, and senior managers from a popular social networking platform to predict career outcomes for these professionals. We built career trajectories as network graphs that provide insights on career paths of entrepreneurs, executives, and senior managers. In these graphs, each node is a job consisting of an industry-level and seniority-level classification. Focusing on the high-tech industry, we found that individuals with certain transferable skills—notably technical, management, mixed, or boundary-spanning experience—can successfully capitalize on these skills when transitioning across industries. During the process we determined common patterns in career trajectories for entrepreneurs, executives, and persons in senior-level roles within firms. Furthermore, we tested the validity of these insights by developing and refining a learning model for predicting individual career transitions of 10,000 individuals and achieved 48% accuracy for 204 job choices. Managerially, these insights can help in recruitment (candidate identification), career planning, and job search.

Growing Up and Moving On — Transition of Care for Patients with Childhood-onset Rheumatic Disease

Transition, as defined by the Society of Adolescent Health and Medicine, is the “purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented healthcare systems”1. Included in this group is the growing population of adolescents and young adults with childhood-onset rheumatic conditions, such as juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (SLE), as well as several other less common chronic inflammatory conditions. Recent longterm outcome studies have demonstrated that the majority of children with JIA continue to have active disease into adulthood, dispelling the notion that children can “outgrow” JIA2,3. Similarly, newer literature suggests that patients with childhood-onset SLE are likely to require treatment into adulthood, and are at significant risk for early morbidity and mortality in young adulthood4,5,6. These findings highlight the importance of ensuring that our patients transition successfully from pediatric to adult care, and that this transition is seamless without disruptions in treatment or planned followup. Fractured transition has the potential to lead to poor healthcare outcomes and increased healthcare system costs7,8,9. Studies examining transition in pediatric rheumatology and other chronic childhood diseases suggest that significant barriers exist with the current healthcare transition process. Using data from the National Survey of Children with Special Health Care Needs, Scal, et al reported on the proportion of adolescents with arthritis who received transition counseling. They determined that only half of young people had had a discussion with their provider about how their … Address correspondence to Dr. Hersh, Department of Pediatrics, University of Utah’s Primary Children’s Medical Center, 295 Chipeta Way, Salt Lake City, Utah 84103, USA. E-mail: aimee.hersh{at}hsc.utah.edu

Group counseling for students transitioning out of postsecondary education

This paper proposes a narrative-based group counseling model for postsecondary students preparing to graduate and transition out of university life. The challenges associated with this transition are both psychological and career-related in nature. The author utilizes multiple transition frameworks to provide a conceptualization of the graduation transition, and offers an overview of narrative therapy, its use in transition counseling, and its use in groupwork. The proposed intervention calls for two facilitators and between six and eight members. An intervention overview is provided that includes recruitment and prescreening instructions as well as content for eight sessions.

Addressing Individual Differences in Mobility Transition Counseling With Older Adults

In the final phase of a 3-phase project, the Assessment of Readiness for Mobility Transition (ARMT) was clinically validated, emphasizing assessment/intervention. ARMT and coping, health/vision status, and social support measures were administered to 133 community-dwelling older adults. Concurrent validity is supported. Higher readiness to cope with mobility transition and self-confidence related to fall risk, higher self-rated health/vision, and fewer maladaptive behaviors, but not social support/adaptive coping, suggesting that those at risk can benefit from person-centered intervention to mobilize strengths for transportation/mobility planning. Older drivers may harbor unrealistic expectations regarding nonfamily mobility support. Implications for practice, education, research, and policy are presented.

Group counseling for students transitioning out of postsecondary education

This paper proposes a narrative-based group counseling model for postsecondary students preparing to graduate and transition out of university life. The challenges associated with this transition are both psychological and career-related in nature. The author utilizes multiple transition frameworks to provide a conceptualization of the graduation transition, and offers an overview of narrative therapy, its use in transition counseling, and its use in groupwork. The proposed intervention calls for two facilitators and between six and eight members. An intervention overview is provided that includes recruitment and prescreening instructions as well as content for eight sessions.

Youth report of healthcare transition counseling and autonomy support from their rheumatologist

BackgroundTo increase understanding of the healthcare transition (HCT) process for young people living with Juvenile Idopathic Arthritis (JIA) by examining: 1) the extent to which youth report discussing HCT topics with their rheumatologist and 2) the association between youth perceptions of autonomy support from their rheumatologist and HCT discussions.MethodsData are from an online survey of youth in the United States with rheumatologic conditions (n= 134). HCT discussion was measured by 4 questions from the National Survey of Children with Special Health Care Needs. Youth perception of autonomy support was measured using a validated 6-item scale.ResultsOne third of the youth (33.7%) reported talking to their rheumatologist about transferring to adult medicine. Less than half (40.8%) of respondents talked with their rheumatologist about adult healthcare needs, and less than a quarter (22.0%) discussed acquiring health insurance as an adult. Nearly two-thirds of respondents (62.7%) reported that their rheumatologist usually/always encourages self-care responsibility. Multivariate analyses revealed significant associations between rheumatologist support for youth autonomy and HCT counseling.ConclusionThe low frequency of HCT counseling reported indicates a continuing need to increase awareness among rheumatologist in the USA. The strong associations between rheumatologist’s support for youth autonomy and HCT counseling suggest that developmentally “in-tune” providers may deliver the best guidance about transition planning for youth living with arthritis.

Assessment of Readiness for Mobility Transition (ARMT): a tool for mobility transition counseling with older adults.

Individualized assessment is important when counseling older adults concerning the transition from driving to nondriving mobility. This study validated a measure of emotional and attitudinal readiness in support of mobility transition counseling (MTC). Items derived from a mixed-methods approach were administered by mailed questionnaire to community-dwelling adults (n = 297; ages 57-95). Factor analysis was employed to form the 24-item Assessment of Readiness for Mobility Transition (ARMT). The ARMT-Total Score (ARMT-TS) demonstrated sound internal consistency and split-half reliability (.88 each). The ARMT-TS correlated as hypothesized with validity measures, including self-reported physical functioning, mental health, and openness to experience. High scorers, who evidenced strong self-reliance and an unwillingness to be a burden on others, are considered to be at risk when faced with a significant mobility transition. An appreciation for such differences can allow for personalized, tailored discussion and planning for when it is time to "hang up the keys."

Receipt of Health Care Transition Counseling in the National Survey of Adult Transition and Health

The goal of this study was to examine factors associated with receiving health care transition counseling services as reported by young adults. We analyzed data from the 2007 Survey of Adult Transition and Health, a nationwide survey of young adults aged 19 to 23 years conducted by the National Center for Health Statistics, to explore self-reported receipt of services to support transition from pediatric to adult health care. Multivariate logistic regression was used to identify whether sociodemographic characteristics, health status, or markers of provider-youth health communication were associated with the receipt of 3 key transition counseling services. Among the 1865 Survey of Adult Transition and Health respondents, 55% reported that their physicians or other health care providers had discussed how their needs would change with age, 53% reported that their physicians or other health care providers had discussed how to obtain health insurance as an adult, and 62% reported having participated in a transition plan in school. Only 24% reported receiving all 3 transition counseling services. In multivariate logistic regression analyses, although gender, age, and race were not associated with increased receipt of the transition-related outcomes, markers of strong communication with the health system were associated with increased rates of receiving transition guidance. Many young adults reported not having received health care transition counseling. Provider-youth communication was associated with increased health care transition guidance, and suggests that a medical home model that promotes anticipatory guidance for health care transition could promote improvements in the transition process.

Receipt of Health Care Transition Counseling in the National Survey of Adult Transition and Health

Receipt of Health Care Transition Counseling in the National Survey of Adult Transition and Health

Adult Care Transitioning for Adolescents with Special Health Care Needs: A Pivotal Role for Family Centered Care

To examine the relationship between having a usual source of care, family centered care, and transition counseling for adolescents with special health care needs. Data are from 18,198 parents/guardians, of youth aged 12-17 years, who participated in the 2005-2006 National Survey of Children With Special Health Care Needs. Linear and logistic regression models were used to define relationships between parent report of identification of a usual place and provider of medical care for their child and counseling on four transition issues: transfer to adult providers, review of future health needs, maintaining health insurance in adulthood, and youth taking responsibility for care. The direct mediating effect of family centered care was evaluated. Youth having a usual source of care (vs. not) were more likely to receive counseling on future health needs (47.4 vs. 33.6%, P < 0.001) and taking responsibility for their own care (79.3 vs. 64.4%, P < 0.001). Having a high level of family centered care (vs. low) was also associated with high rates of discussing future health needs (56.3 vs. 39.6%, P < 0.001) and encouragement to take responsibility for care (91.2 vs. 70.3%, P < 0.001). Family centered care mediated 39.1% of the effect of a usual source of care on discussion of future health needs and 94.9% of the effect of a usual source of care on encouragement to take responsibility for care. Study findings support the development of health care delivery models focusing on family centered care to the same degree as other health care access issues.

Health care transition counseling for youth with arthritis: Comment on the article by Scal et al

Health care transition counseling for youth with arthritis: Comment on the article by Scal et al

Preparing for adulthood: Health care transition counseling for youth with arthritis

To determine the proportion of adolescents with arthritis who receive health care transition services and to compare the rates with those reported for adolescents with other special health care needs and adolescents with diabetes. We used data from the 2005-2006 National Survey of Children with Special Health Care Needs. A parent/guardian identified youth ages 12-17 years with arthritis (n = 1,052), diabetes (n = 389), and special health care needs (n = 18,189). Four questions examined the extent to which providers discussed health care transition issues, including 1) transfer of care to adult providers, 2) health care needs of adults, 3) acquiring health insurance, and 4) encouraging self-care responsibility. Bivariate comparisons assessed the associations between sociodemographic characteristics and health care transition services, and multivariate regression models compared outcomes between conditions. Many adolescents with arthritis are being encouraged to assume self-care responsibilities (74.8%); fewer discussed how health needs will change in adulthood (52.1%), acquiring insurance (22.5%), or transferring care to a provider who sees adults (19.0%). These results are similar to youth with other special health care needs, but behind youth with diabetes. Among this sample of US adolescents, many report discussions about health care needs and self-management, but few are addressing critical aspects of the transition to adult-oriented health care.

Individual differences in outplacement success

PurposeAlthough outplacement consulting and career transition services have become a standard management practice and are almost universally provided when terminating executives, these services have not been carefully evaluated and their benefits are not clearly understood. The purpose of this paper is to consider the role of individual differences in determining outplacement success using the Big Five framework as measured by the occupational personality questionnaire (OPQ).Design/methodology/approachThe behavior of a sample of 53 executives was examined during outplacement as well as their success following reemployment.FindingsThe study's hypotheses were largely supported with agreeableness, conscientiousness, and openness to experience making a significant contribution to the understanding of outplacement effectiveness both during and after the transition.Practical implicationsThese results suggest that providers should assess individual differences as part of career transition counseling and question recent trends toward making outplacement a commodity service. They also suggest that the diagnostic and counseling skills of a trained professional help to secure a successful outplacement experience and that the process should recognize the unique needs and personality of individual clients.Originality/valueThis paper considers the behavior of actual executives in career transition. It also extends previous research on the Big Five typology to executive outplacement and provides evidence of the usefulness of the OPQ as a measure of these personality traits.

The Career Switcher Program

The authors describe a program, begun at Old Dominion University, that brings into the teaching profession highly qualified people -- many of them able to teach in hard-to-staff disciplines. AN ARMY captain, an Air Force lieutenant colonel, and a Marine lieutenant all enrolled in the Career Switcher Program (CSP) at Old Dominion University with the shared goal of becoming teachers. want to teach because I have a passion for helping children, said the Army captain, who had served eight years. The Air Force lieutenant colonel, who wants to teach English as a second language, explained her reason: Ever since I remember, I have always wanted to teach. The Marine lieutenant said that he thinks he can have a positive influence on children. One unique feature of the CSP makes the program somewhat controversial: career switchers receive licensure after just a brief summer program of instruction and one year of mentoring. The CSP has clear benefits for Virginia school systems in a time of increasing shortages of qualified teachers. First, it brings highly qualified people into the teaching profession. And second, these new teachers often have backgrounds that are appropriate for hard-to-staff disciplines -- mainly math, science, foreign languages, and educational technology. A Collaborative Effort The Virginia Department of Education proposed the idea of the CSP to the staff of Old Dominion University's Virginia Center for Career Transition (VCCT) because of that center's proven record in providing alternative certification for teachers. The CSP began in 2000. As early as 1988, the Military Career Transition Program (MCTP) was started at Old Dominion as a program to provide alternative teacher licensure. Its instructional curriculum meets standards and competencies derived from the various professional associations. The MCTP joined the national to placement program in 1995. Currently, Troops to Teachers and the MCTP operate jointly as the VCCT. The MCTP includes specialized competency-based alternative certification courses; career transition counseling, academic advising, and mentoring; early and frequent in-school experiences with children and adolescents; a minimum of six weeks of student teaching; and placement assistance and career induction services. Career Switchers: The First Class The first Career Switcher Program in 2000 enrolled 61 students at two sites, one at Old Dominion University and one in northern Virginia. Of the 61 students who enrolled, two withdrew during the summer training. Fifty-nine students graduated from the program, and 47 accepted teaching positions. Recruitment. Recruitment of the first class of career switchers focused mainly on various government transition assistance offices and an existing VCCT database of military, defense, and NASA personnel. Announcements were placed on appropriate websites, information was disseminated through military network announcements, posters and fliers were sent to military commands, briefings were conducted at education centers on military bases, and advertisements were placed in military newspapers. Nearly a hundred people applied to the program in its first year. Admission. The first class of career switchers included only military people; however, people from other professions have been included in subsequent classes. Those admitted to the CSP must have verifiable teaching experiences in their former fields; management training experiences; academic credit sufficient to meet subject-area licensure requirements in math, science, or other critical-need areas; and a passing score on two teacher-preparatory exams, PRAXIS I and II. The first group completed a three-week training institute, which focused on such topics as classroom management, differentiated instruction, subject methodology, and the implementation of Virginia's Standards of Learning. …

The Mid Life Transition and Career Counseling in Britain

The Mid Life Transition and Career Counseling in Britain