Transitional Care For Adolescents Research Articles

"An urgent need for transition of care programs for adolescents and young adults with neurogastroenterology and motility disorders".

Transition of Care for Adolescents and Young Adults (AYA) with Neurogastroenterology & Motility (NGM) Disorders.

Transition of care of adolescents with rheumatic diseases in Saudi Arabia, current practice and obstacles

BackgroundThe importance of transition of care for adolescents with rheumatological illnesses from pediatric to adult rheumatology is increasing as the childhood rheumatologic diseases continue to adulthood. Despite that, transition practice in Saudi Arabia is not yet well-developed. ObjectivesThis study aims to evaluate the current transition of care practice for adolescents with rheumatological diseases to the adult healthcare facilities and the obstacles in achieving the best transition of care in Saudi Arabia. Setting and methodsThis is a non-interventional cross-sectional study conducted using an online survey that was distributed to pediatric and adult rheumatologists in Saudi Arabia. Google forms and Microsoft Excel 2016 were used for data entry and analysis. Descriptive statistics, frequencies and percentages were performed for categorical variables. ResultsA total number of 60 rheumatologists (27 pediatric and 33 adult) participated in the survey. Fifty-six (94%) of the participants do not follow any standardized programs for transition of care. All participants agreed on the need for a defined protocol for transition of care. The major barriers for successful transition of care were lack of protocols (63%), lack of healthcare providers (56%), and lack of well-developed systems that makes it difficult to access patient's electronic health records (55%). ConclusionA well-structured protocol for transition of care of adolescents with rheumatologic illnesses from pediatric to adult rheumatology in Saudi Arabia is still an unmet need. Efforts should be directed towards improving the practice of transition of care by establishing this protocol, enhancing the connectivity between pediatric and adult healthcare facilities, and encouraging pediatric and adult rheumatologists to adapt the transition of care protocol in their daily clinical practice.

Transitional care of adolescents and young adults with asthma and allergy—The healthcare professional perspective

Transitional care of adolescents and young adults with asthma and allergy—The healthcare professional perspective

Transitional care of adolescents with inflammatory bowel disease to adult services varies widely across Australia and New Zealand.

Children and adolescents account for approximately 14% of inflammatory bowel disease (IBD) diagnoses. At an appropriate age and level of development adolescents with IBD have their care transferred from the pediatric to adult clinical team during a process termed "transition". The study aim was to survey pediatric gastroenterologists throughout Australasia to identify commonality in the transition process to contribute to standardized guideline development. A descriptive survey captured key variables: transition clinic format, process and infrastructure, transition assessments, and guidelines. The survey was distributed electronically to 59 Pediatric Gastroenterologists throughout Australasia in January 2023. Seventeen (29%) clinicians completed the survey: Australia 13 (76%). New Zealand 4 (24%). Thirteen (76%) respondents had access to a dedicated IBD transition clinic. Adolescents attended transition clinics 1-7 times, and the main processes transferred were: prescription provision, biologic appointments, and adult team contacts. Transition was first discussed age 13-15 years (53%), or 16-18 years (47%), with the main discussion topics including: continuing adherence (88%), smoking (59%), alcohol use (59%), recreational drug use (59%). Transition readiness assessments were done infrequently (24%). The minority (24%) used formal guidelines to inform the transition process, but 15 (88%) considered the development of a standardized Australasian guideline as beneficial/extremely beneficial. This survey highlighted that transition care for adolescents with IBD is variable across Australasia. Australasian guideline development may optimize the transition process for adolescents with IBD and improve their longitudinal outcomes.

Consensus evidence-based recommendations for transition of care for adolescents with juvenile idiopathic arthritis: meeting patients’, parents’, and rheumatologists’ perspectives

BackgroundTransition of care means the process of educating and empowering adolescents and young adults to take an active role in their own healthcare, develop decision-making skills, and eventually transition from paediatric to adult healthcare providers. Most people do not switch doctors until they are young adults, but it can be beneficial to start preparing children earlier. We aimed to develop a specific toolkit tailored to paediatric and adult rheumatologists to assist them in transitioning of care of young people with juvenile onset rheumatic musculoskeletal diseases from the paediatric to adult rheumatology care.ResultsThe expert panel was confined to an online survey (n = 18), all the experts completed the two rounds. At the conclusion of round 2, a total of 10 points were gathered. The range of respondents (ranks 7–9) who agreed with the recommendations was 88.9 to 100%. All 10 clinical standards identified by the scientific committee were written in the same way. Based on the answers to the structured key questions and the literature review, a structured template was developed presenting transition of care integrated pathway.ConclusionThe developed rheumatology-specific guideline offers adolescents and young adults a focussed, multidisciplinary transition of care approach with equity of access, quality of care and flexibility and set up standards for transitional care for young adults with juvenile rheumatological diseases.

Transition of Care in Adolescents with Epilepsy: Perspective of Pediatric Neurologists in India.

This cross-sectional study was designed to determine the current status of transition of care for adolescents with epilepsy to adult neurological services in India and to understand pediatric neurologists' perspectives. After approval from the appropriate Ethics Committee, a pre-designed questionnaire was distributed electronically. Twenty-seven pediatric neurologists from 11 cities across India responded. Pediatric care ended under 15 y for 55.4% responders and at 18 y in another 40.7%. Eighty nine percent introduced the concept of transition or had transition discussions with their patients and parents. Majority of providers did not have a formal plan for transferring the children with epilepsy to an adult neurologist, and very few had transition clinics. Communication with adult neurologists was also variable. Several pediatric neurologists followed patients after transfer for varying periods of time. This study demonstrates increasing awareness regarding the importance of transition of care in this population.

Transition of care for adolescents living with a chronic disease

Transition of care for adolescents living with a chronic disease

Planning Transition of Care for Adolescents Affected by Congenital Heart Disease: The Irish National Pathway.

At some point in their life, adolescent patients with a congenital heart disease (CHD) transition from paediatric services to adult care facilities. The process is not without any risks, as it is often linked with a significantly progressive deterioration in adolescents' health and loss of follow-up. In fact, transition patients often encounter troubles in finding a care giver who is comfortable managing their condition, or in re-establishing trust with the new care provider. Planning the rules of transition is pivotal in preventing these risks. Unfortunately, the American and European guidelines on CHD provide just generic statements about transition. In a recently published worldwide inter-societies consensus document, a hybrid model of transition, which should be adapted for use in high- and low- resource settings, has been suggested. Currently, in literature there are a few models of transition for CHD patients, but they are by far local models and cannot be generalized to other regions or countries. This paper describes the Irish model for transition of care of CHD patients. Due to the peculiarity of the healthcare organization in the Republic of Ireland, which is centralized with one main referral centre for paediatric cardiology (in Dublin, with a few smaller satellite centres all around, according to the "hub and spoke" model) and one centre for adult with CHD (in Dublin), the model can be considered as a national one and the first to be released in the old continent.

Various aspects of transition of care for adolescents with urological conditions.

Transition into adulthood is a common issue in many disciplines. However, urology faces additional difficulties due to different models of care and training as well as a wide diversity of pathologies. The goal of this paper is to discuss various aspects of the transition of urological care. This review provides some examples of pathologies that might require special attention of specialists. Most patients with rare diseases must be closely followed up in the long term. However, high-volume conditions may also have a huge impact on the well-being and quality of life in adulthood. Children who are cured due to oncological conditions will probably need additional attention in adulthood. The urological care during childhood is provided by a pediatric urologist, a pediatric surgeon or a urologist, depending on the local regulations and the organization of care. All patients are subsequently referred to a general urologist. Nowadays, a multidisciplinary approach is recommended in many cases, with a pediatric urologist as one of the team members. The patient, caregivers and healthcare professionals must be fully involved and focused on close cooperation to make the transition process smooth and successful.

Disease and medication burden of medically complex adolescents seen in an interdisciplinary transitional care clinic.

Transitional care for adolescents with complex diseases, who are entering adulthood, is challenging. The purpose of this study is to quantify the disease and medication burden of this population, who are transitioning though an interdisciplinary specialty clinic. This study is a retrospective observational study of all patients seen in a transitional care clinic between July 2012 and March 2015. The main outcomes assessed included disease state and medication burden. Descriptive statistics, along with the paired t-test and McNemar's test, were used. The study cohort included 216 patients. The median patient age was 20.7 years, and the median number of clinic encounters was 6. Patients had at least 1 of 8 primary diagnoses. On average, patients took medications from 5 classes and used 3 dose forms. Among 163 patients who had medication reconciliation performed, the average number of medication classes increased by 0.44±1.53 (p = 0.0003). There was an average increase of 3.70%(SD±36.31%; p = 0.27) in the number of required medication lab assessments ordered for patients who had medication reconciliation performed. There is a high disease and medication burden among adolescent patients with complex disease states who are to transition to adult care.

13.3 The Impact of Psychiatric Comorbidities in Transition of Care for Adolescents with Epilepsy

Transition from pediatric to adult care is important for patients with special health care needs, who overall have greater mental health needs. This study explores transition perceptions among parents of children and youths with epilepsy (CYEs). We examined correlations between parental responses on the Transition Readiness Assessment Questionnaire (TRAQ) and chart data. The main hypothesis is that mental illness comorbidities relate to less confidence in preparing for transition. The secondary hypothesis is that other comorbidities and care utilization also relate to perceived difficulty with transition. Thirty-five parents of CYEs aged 12 to 22 years in the Cleveland Clinic system completed TRAQ in 2020 and 2021. TRAQ items assess the importance of and confidence about transition. Demographic information (age, gender, race, insurance), number of emergency department (ED) visits and inpatient stays within 1 year of completing the survey, number of medical, mental illness, and neurological comorbidities, and number of antiepileptic drugs (AEDs) prescribed were extracted from electronic medical records. Spearman’s Rho test was performed between these variables and ratings on transition items using SAS 9.4. The average age of CYEs was 16.89 years, 45.7% were female, 74.3% were White, 17.1% were Black or multiracial, 65.8% held private insurance, and 34.3% were publicly insured. CYEs had an average of 1.63 mental illness, 1.89 medical, and 1.26 neurological comorbidities. On the TRAQ survey confidence item, the average rating was 4.57 out of 10. There was a significant moderate negative association between transition confidence and the number of mental illness comorbidities (rs[33] = –0.37; p < 0.03). No statistically significant correlation was found between transition confidence and number of medical or neurological comorbidities, ED visits, inpatient stays, or AEDs. Our main hypothesis was supported: mental illness comorbidities were significantly associated with less confidence in transition ability. The findings highlight the importance of identifying and managing mental illness comorbidities in CYEs. The limitations of the study include the small sample size and the lack of a standardized and normalized transition scale. Further work is needed to assess the transition perceptions of CYEs themselves.

Transitional care of adolescents with Multiple Osteochondromas: a convergent mixed-method study ‘Patients’, parents’ and healthcare providers’ perspectives on the transfer process’

ObjectivesMultiple osteochondromas (MO) is a rare hereditary disease characterised by numerous benign bone tumours. Its chronic aspect requires a well-organised transition from paediatric care to adult care; however, little is...

Transition of care for adolescents with chronic pain

In the Lancet Child & Adolescent Health Commission on paediatric pain, Christopher Eccleston and colleagues1 proposed a timely and much-needed call for transformative action in the field of paediatric pain research and treatment. They outline a far-reaching and strategic path forward for the field, clearly organised under four goals to make pain matter, make pain understood, make pain visible, and make pain better. Research has shown that pain experiences in early life can have consequences that last into adulthood,2 and adolescents with chronic pain are highly likely to have unresolved pain and associated symptoms as adults.

Key components of successful transition for adolescents born with anorectal malformations-a Nordic focus group study.

Transitional care for adolescents with congenital malformations, such as anorectal malformations (ARM), is described sparsely in the literature and referred to as being inadequate. In order to organize future successful healthcare structures, knowledge of patient-reported important aspects of transition is required. The aim of the study was therefore to explore the needs and expectations of transitional- and adult healthcare among adolescents and adults born with ARM. Two tertiary paediatric surgical centres, in collaboration with two tertiary pelvic floor centres, in Sweden and Norway, conducted a qualitative study, involving adolescents and adults born with ARM in focus group discussions regarding transitional care. Discussions were analyzed by qualitative content analysis. Ethical approval was obtained. Sixteen participants (10 women) with a median age of 24 (19-47) years, born with mixed subtypes of ARM were included in gender-divided focus groups. Participants emphasized a need for improved knowledge of ARM, both among patients and adult care providers. Participants identified a need for support with coping strategies regarding challenging social- and intimate situations due to impaired bowel function. Participants pin-pointed well-functioning communication between the patient and the paediatric- and adult care providers as a key factor for a successful transitional process. Further, participants emphasized the importance of easy access to specialized adult healthcare when needed, suggested to be facilitated by appointed patient navigators. Adolescents and adults born with ARM identify improved knowledge of ARM, well-functioning communication and easy access to specialized adult care as key components of a successful transition.

A Cross-Sectional Survey on the Transitional Care of Adolescents with Inflammatory Bowel Disease in Hungary

PurposeSince little is known about transitional care practices of adolescents with inflammatory bowel diseases (IBD) in Central-Eastern Europe, we aimed to investigate the currently applied transition practices in Hungary. Design and methodsA nationwide, multicentre survey was conducted with the invitation of 41 pediatric and adult IBD centres in February 2019.We developed a 34-item questionnaire, which included single- and multiple-choice questions related to the current clinical practice of IBD transition. ResultsThe overall response rate was 31.7% (13/41); answers came predominantly from tertiary centres. Only 15.4% of the respondent centres followed international IBD guidelines. The majority of the IBD centres provided transition support; however, responses revealed a marked heterogeneity of these services. Joint visits were held only in 54% of the clinics. Gastroenterologists and next of kin are not provided education regarding transition across most centres (85 and 92%). Although adolescents received age-specific education, transition readiness was not measured. More IBD nurses and dietitians were employed in adult centres than in pediatric ones. ConclusionsThe current survey revealed critical gaps in the Hungarian IBD transition practices. As the beneficial effects of structured IBD transition programmes are recognized in Hungary, there is a growing need for the introduction of new, more effective transition practices. Practice implicationsOur results can serve as a basis for planning more effective transition strategies.

Nurses' perceptions regarding transitional care for adolescents and young adults with childhood-onset chronic diseases.

Nurses are expected to have a role in the transition of care from pediatric to adult medical practices for adolescents and young adults with childhood-onset chronic diseases. This study compares the experience, knowledge, and perceptions regarding the ideal care among adult unit and pediatric nurses regarding the transition to adult care for those with childhood-onset chronic diseases. A cross-sectional study using self-report questionnaires was conducted with nurses in a tertiary hospital in Tokyo. Questions were generated based on a literature review and expert discussion. Data from 1,064 participants were analyzed (adult unit nurses: n = 959, 90.1%; pediatric nurses: n = 105, 9.9%). Among 623 adult unit nurses who had care experience for adult patients with a childhood-onset chronic disease, 458 nurses (73.6%) were unaware of the concept of transitional care. As the obstructive factors for transition, pediatric nurses recognized problems in healthcare providers' attitudes and lack of transitional care coordinators, while the adult unit nurses emphasized the patients' wishes to continue to receive pediatric healthcare. Most adult unit nurses expected pediatric nurses to function as transitional care coordinators. Adult unit and pediatric nurses had different perceptions of the barriers in transitioning children with chronic diseases to adult care. It is important to have educational programs focusing on transitional care for all nurses, both to enable pediatric nurses to improve transition readiness of children with chronic diseases and to offer adult patients with a childhood-onset chronic disease continuing support through adult unit nurses.

Electronic Health Record Tools to Promote Transition Readiness and Knowledge for Adolescents and Young Adults with Hemophilia

Introduction: Challenges to the transition of care for adolescents and young adults with bleeding disorders negatively impact clinical outcomes. Transition of care is a Healthy People 2020 measure, and many Hemophilia Treatment Centers (HTCs) in the United States are developing a systematic approach based on the Got TransitionTM framework, which includes six core elements designed to aid patients and their families during this vulnerable period. To improve the quality of care delivered to transition-aged individuals with hemophilia, we developed a quality improvement initiative (QI) to track and monitor transition, to assess transition readiness, and to provide education based on patient-centered goals. Our global aim is to improve transition readiness and rate of successful transfer to an adult hemophilia provider by age 18-21y. We report results for the specific aim to increase the percentage of transition-aged individuals who complete transition readiness assessments and receive patient-centered goals education at annual comprehensive clinic appointments over a six-month cycle from 0 to 80%. Methods: We developed metrics and reports in Epic (electronic health record system) to track patients with hemophilia aged 12y and older who are eligible to begin the transition process. We also developed a Transition Readiness Assessment and a 15-question hemophilia-specific Skills Practicum to be completed by the patient in EPIC during their appointment. Based on responses to the Transition Readiness Assessment, patients select 2-3 goals for the year. Each selected goal generates a corresponding education handout. The tools are completed by patients with hemophilia between the ages of 12-21y at the time of rooming by the medical assistant for the annual comprehensive clinic appointment. Patients are excluded if they have significant developmental delays. During the appointment, the child life specialist for the HTC reviews the results of the Skills Practicum with the patient, and the HTC nurse reviews the Transition Readiness Assessment and the education handouts with the patient. Descriptive statistics were used to analyze the population and the results. Results: During the QI cycle, 20 of 43 transition-aged patients attended a comprehensive clinic visit and 17/20 (85%) completed all age-appropriate assessments. Patient characteristics and transition readiness results are shown in Table 1. The most frequently selected patient goals were "know my doctors' and nurses' names and roles" (29%), "know my doctor's phone number and call my doctor's office to make or change an appointment" (65%), and "have access to MyChart account and check MyChart" (47%). Four questions on the Skills Practicum test how to read a prescription. Five patients (29%) correctly answered all four questions. Conclusions: In summary, the Epic transition tools were successfully integrated into the HTC comprehensive clinic workflow, and 85% of eligible patients completed the assigned assessments. Utilization of MyChart is low, and access to MyChart was a frequently selected goal. Further work is underway to increase MyChart utilization which would facilitate workflow changes such that assessments may be completed in MyChart before the visit and educational and other resources can be accessed in MyChart. Achievement of patient goals, improvements in knowledge (e.g. how to read a prescription), and successful transfer are being tracked over time. Disclosures Thornburg: Sanofi Genzyme: Other: Data Safety Monitoring Board; Sanofi Genzyme: Research Funding; NovoNordisk: Research Funding; Genentech: Speakers Bureau; Bluebird bio: Other: Data Safety Monitoring Board; Ironwood: Other: Data Safety Monitoring Board.

Transitional care of adolescents with bronchial asthma

Transitional care of adolescents with bronchial asthma

The Temple Star Transitional Model of Care for epilepsy; the outcome of a quality improvement project

ObjectiveThe aim and objective of this study was to assess the knowledge and views of parents on transitional and adolescent care in young adults with epilepsy, and to develop a transitional and adolescent program for epilepsy. MethodsData were collected from questionnaires completed by parents during focus groups exploring transitional care and inherent issues for young adults, aged 12–18years, with epilepsy. The questionnaire assessed the current knowledge and views of parents of children with epilepsy on transitional care, and following a presentation on “Transition in Epilepsy” (including themes such as self-advocacy, independent healthcare behavior, sexual health, psychosocial support, educational and vocational planning, health and lifestyle issues) assessed feedback on the proposed model of care in transitional and adolescent care. ResultsData were collected from 34 parents; the majority of parents, 74% (n=25), wish their children to be transitioned and transferred over to the adult epilepsy sites at the age of 18years. Over 82% (n=28) of parents believe the concept of transition should be introduced between the ages of 12–16years. ConclusionThis quality improvement initiative identified the need for transitional care to begin at an early age. This study engaged parents in a process to improve adolescent and transitional care for adolescents with epilepsy. This study also highlights the importance of introducing a detailed preparatory phase for a transitional and adolescent care in epilepsy.

SPN Position Statement: Transition of Pediatric Patients Into Adult Care

SPN leadership has been active in organizing various task forces composed of members with recognized expertise and interest to work together and produce quality documents that provide guidance to the practice of pediatric nursing. The most recently published position paper follows this introduction and was produced by a team chaired by Cecily L. Betz PhD, RN, FAAN. These activities demonstrate fulfillment of SPN’s Mission, Vision and Core Values, which are: Mission The mission of the Society of Pediatric Nurses is to advance the specialty of pediatric nursing through excellence in education, research and practice. Vision To be the premier resource for nurses caring for children and their families. Core Values Commitment Accountability to members and to decision making that contributes to the profession of pediatric nursing; dedication to life-long learning, generation of new knowledge and scholarship, innovation, and advocacy for exceptional pediatric nursing care of children and families. Integrity Respectful, ethical, transparent, and fiscally responsible. Consistent expectations of collaboration and alignment of intellectual, professional, and organizational values. Leadership Visionary, leading with one voice, seeking diversity of thought, inspiring and advancing the leader qualities and strengths of the membership. Excellence Development and dissemination of evidence based standards and research based knowledge that transcends into exceptional quality outcomes for the nursing care of children and families and the promotion of the specialty of pediatric nursing. The Society of Pediatric Nurses (SPN) is committed to addressing the long-term biopsychosocial needs of adolescents and emerging adults. This includes adolescents with disabilities and/or special health care needs (ASHCN) as they prepare to leave the pediatric and child-centered systems of care and enter the- adult-focused systems of care. During this transition from pediatric to adult care, pediatric nurses can help these emerging adults as they proceed with their own development to the extent possible in achieving the competencies associated with adulthood. Adolescent health issues have become more pressing as nearly 90% of ASHCN survive into adulthood (Ferris et al., 2006Ferris M.E. Gipson D.S. Kimmel P.L. Eggers P.W. Trends in treatment and outcomes of survival of adolescents initiating end-stage renal disease care in the United States of America.Pediatric Nephrology. 2006; 21: 1020-1026Crossref PubMed Scopus (96) Google Scholar, Quinn et al., 2010Quinn C.T. Rogers Z.R. McCavit T.L. Buchanan G.R. Improved survival of children and adolescents with sickle cell disease.Blood. 2010; 115: 3447-3452Crossref PubMed Scopus (599) Google Scholar, Reiss and Gibson, 2002Reiss J. Gibson R. Health care transition: destinations unknown.Pediatrics. 2002; 110: 1307-1314Crossref PubMed Google Scholar, Scal and Ireland, 2005Scal P. Ireland M. Addressing transition to adult health care for adolescents with special health care needs.Pediatrics. 2005; 115: 1607-1612https://doi.org/10.1542/peds.2004- 0458Crossref PubMed Scopus (0) Google Scholar). Research demonstrates improved transition models of care are needed to better prepare adolescents and emerging adults for the transfer to adult services (Betz et al., n.dBetz, C.L., O’Kane, L., Lobo, M., & Nehring, A Systematic Review: Health Care Transition Service Models. Nursing Outlook Doi:http://dx.doi.org/10.1016/j.outlook.2015.12.011Google Scholar, Chu et al., 2015Chu P.Y. Maslow G.R. von Isenburg M. Chung R.J. Systematic Review of the Impact of Transition Interventions for Adolescents With Chronic Illness on Transfer From Pediatric to Adult Healthcare.Journal of Pediatric Nursing. 2015; 5: e19-e27https://doi.org/10.1016/j.pedn.2015.05.022. EpubCrossref Google Scholar, Prior et al., 2014Prior M. McManus M. White P. Davidson L. Measuring the “Triple Aim” in transition care: A systematic review.. 2014; 134: e1648-e1661Google Scholar). This position statement is designed as framework for pediatric nurses to provide comprehensive health care transition services based upon a family-centered, adolescent-focused and interdisciplinary framework of care. For many ASHCN, the transition from pediatric to adult health care is not well planned and often results in disruptions in care, preventable complications, and avoidable costs. Despite the need for continuous, coordinated care from a pediatric to an adult medical home, research findings demonstrate that ASHCN report that they did not receive needed transition support. (Betz et al., 2013Betz C.L. Nehring W. Lobo M. Bui K. Voices Not Heard: A Systematic Review of Adolescents’ and Emerging Adults’ Perspectives of Health Care Transition.Nursing Outlook. 2013; 61: 311-336Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar, Joly, 2015Joly E. Transition to Adulthood for Young People with Medical Complexity: An Integrative Literature Review.Journal of Pediatric Nursing. 2015; 30: e91-103https://doi.org/10.1016/j.pedn.2015.05.016Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, National Med-Peds Residents' Association, 2013National Med-Peds Residents' Association Transition for Youth and Young Adults from Pediatric to Adult Health Care: A Practice Quality Improvement Approach.https://medpeds.org/transition-for-youth-and-young-adults-from-pediatric-to-adult-health-care-a-practice-quality-improvement-approach/Date: 2013Google Scholar). It is suggested that schools of nursing, healthcare institutions and community based health care programs wherein pediatric nursing care is taught and/or provided utilize this document as a resource to ensure that appropriate education, training, resources and effective staffing plans are provided to ensure the provision of quality, customer focused care for pediatric patients and their families. Transfer of care refers to the dual process of locating and arranging primary, specialty and interdisciplinary health care providers who provide care to adolescents as their eligibility for services provided by pediatric providers ends. Health Care Transition (HCT) refers to the comprehensive services based upon an interdisciplinary framework of care that addresses the biopsychosocial needs of early adolescents (11-15 years of age), late adolescents (16-18 years of age), and emerging adults (18-25 years of age). This framework of services is utilized throughout the lifespan and intensifies in early adolescence to ensure adolescents and emerging adults learn the self-management knowledge and skills necessary to manage their daily treatment needs as independently as possible and become a literate health consumer. Comprehensive services include coordination of care that involves referrals to the service systems of education and training, employment, community living, rehabilitation and advocacy. Since 2002, a number of studies have examined both practice-based approaches and barriers to transition from the perspectives of pediatric and adult health care providers. This research has identified a range of barriers in facilitating the successful transfer of care and health care transition. Barriers include inadequate and delayed planning for transfer and transition; lack of formalized guidelines to direct provision of health care transition services including a written transition plan and portable medical summary; and insufficient health care transition resource materials. Other barriers identified include shortages of available adult providers, lack of providers’ HCT knowledge about the planning process and transition and adult community-based resources; and lack of an identified person responsible for transition planning (Fegran et al., 2014Fegran L. Hall E.O.C. Uhrenfeldt L. Aagaard H. Ludvigsen M.S. Adolescents’ and young adults’ transition experiences when transferring from paediatric to adult care: A qualitative metasynthesis.International Journal of Nursing Studies. 2014; 51: 123-135https://doi.org/10.1016/j.ijnurstu.2013.02.001Abstract Full Text Full Text PDF PubMed Scopus (156) Google Scholar, Joly, 2015Joly E. Transition to Adulthood for Young People with Medical Complexity: An Integrative Literature Review.Journal of Pediatric Nursing. 2015; 30: e91-103https://doi.org/10.1016/j.pedn.2015.05.016Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, National Med-Peds Residents' Association, 2013National Med-Peds Residents' Association Transition for Youth and Young Adults from Pediatric to Adult Health Care: A Practice Quality Improvement Approach.https://medpeds.org/transition-for-youth-and-young-adults-from-pediatric-to-adult-health-care-a-practice-quality-improvement-approach/Date: 2013Google Scholar, Nehring et al., 2015Nehring W.N. Betz C.L. Lobo M.L. Uncharted Territory: Systematic Review of Providers’ Roles, Understanding and Views Pertaining to Health Care Transition.Journal of Pediatric Nursing. 2015; 30: 732-747https://doi.org/10.1016/j.pedn.2015.05.030Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar, Reiss et al., 2005bReiss J.G. Gibson R.W. Walker L.R. Health care transition: youth, family, and povider perspectives.Pediatrics. 2005; 115: 112-120Crossref PubMed Scopus (307) Google Scholar, Schultz, 2013Schultz R.J. Parental experiences transitioning their adolescent with epilepsy and cognitive impairments to adult health care.Journal of Pediatric Health Care. 2013; 27: 359-366https://doi.org/10.1016/j.pedhc.2012.03.004Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar, Speller-Brown et al., 2015Speller-Brown B. Patterson K.K. VanGraafeiland B. Feetham S. Sill A. Darbari D. Meier E.R. Measuring Transition Readiness: A Correlational Study of Perceptions of Parent and Adolescents and Young Adults with Sickle Cell Disease.Journal of Pediatric Nursing. 2015; 30: 788-796https://doi.org/10.1016/j.pedn.2015.06.008Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar, Young et al., 2009Young N.L. Barden W.S. Mills W.A. Burke T.A. Law M. Boydell K. Transition to adult-oriented health care: Perspectives of youth and adults with complex physical disabilities.Physical and Occupational Therapy in Pediatrics. 2009; 29: 345-361https://doi.org/10.3109/01942630903245994Crossref PubMed Scopus (70) Google Scholar). The transition to adult health care services for the adolescent or young adult both with and without special health care needs is a process that occurs over time with increasing emphasis during early adolescence. Many young adults who have transferred their care into the adult health care system have experienced barriers to care. These barriers include expectations of adult care, decreased provider familiarity with complex chronic conditions of childhood or adolescent and young adult development, and a lack of support around the access to specialty and community services (Cook et al., 2013Cook K. Siden H. Jack S. Thabane L. Browne G. Up against the system: A case study of young adult perspectives transitioning from pediatric palliative care.Nursing Research and Practice. 2013; 2013: 1-10https://doi.org/10.1155/2013/286751Crossref Google Scholar, Fegran et al., 2014Fegran L. Hall E.O.C. Uhrenfeldt L. Aagaard H. Ludvigsen M.S. Adolescents’ and young adults’ transition experiences when transferring from paediatric to adult care: A qualitative metasynthesis.International Journal of Nursing Studies. 2014; 51: 123-135https://doi.org/10.1016/j.ijnurstu.2013.02.001Abstract Full Text Full Text PDF PubMed Scopus (156) Google Scholar, Reiss et al., 2005bReiss J.G. Gibson R.W. Walker L.R. Health care transition: youth, family, and povider perspectives.Pediatrics. 2005; 115: 112-120Crossref PubMed Scopus (307) Google Scholar, Schultz, 2013Schultz R.J. Parental experiences transitioning their adolescent with epilepsy and cognitive impairments to adult health care.Journal of Pediatric Health Care. 2013; 27: 359-366https://doi.org/10.1016/j.pedhc.2012.03.004Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar, Young et al., 2009Young N.L. Barden W.S. Mills W.A. Burke T.A. Law M. Boydell K. Transition to adult-oriented health care: Perspectives of youth and adults with complex physical disabilities.Physical and Occupational Therapy in Pediatrics. 2009; 29: 345-361https://doi.org/10.3109/01942630903245994Crossref PubMed Scopus (70) Google Scholar). Although many of these barriers can be attributed to differences between pediatric and adult health care, pediatric nurses can play an important role in addressing these barriers as they care for adolescents and emerging adults prior to, during and following the transition to adult care. Health care transition is a service model that involves three distinct yet integrated components of care: a) the period of Extended HCT Preparation; b) the Transfer of Care Period; and c) the period of Post Health Care Transition/Transfer of Care. Each period is an essential component of this service model and is integral to promoting successful health care transition outcomes for adolescents and emerging adults as they transition to adult care and adulthood. Extended HCT Preparation, beginning in early adolescence, refers to the long-term health care transition planning needed to assist and support the adolescent/young adult to become competent as is developmentally appropriate with self-management knowledge and skills and the acquisition of life skills. The Transfer of Care Period, occurring between ages 18 to 21 years, refers to the intensive effort directed to the transfer of care to adult care providers and resources. Post Health Care Transition/Transfer of Care addresses the recommendations to facilitate achievement of HCT outcomes, which include implementation of quality improvement and research efforts that are needed for evidence based practice and to contribute to the science of health care transition. As described below, these components of care, although focused in their objectives of care represent an integration of purpose and effort to effect optimal outcomes for adolescents and young adults and their families during health care transition. The Society of Pediatric Nursing recognizes that in order to provide optimal transitional care from pediatric to adult care, there must be adequate preparation in the framework of services initiated prior to transition. This preparation involves nurses and interdisciplinary colleagues with the expertise in the comprehensive biopsychosocial needs of all adolescents as they move from pediatric focused care to emerging adult and adult provider systems. Concepts of autonomy, independence, self-determination, and self-advocacy are integrated into the principles of care.1.HCT planning should be initiated well before the intensive period (beginning at 12 years of age) of planning, preferably in early adolescence.2.HCT planning includes the adolescent/young adult, the family, the current healthcare team (Bridgett et al., 2015Bridgett M. Abrahamson G. Ho J. Transition, It's More Than Just An Event: Supporting Young People With Type 1 Diabetes.Journal of Pediatric Nursing. 2015; 30: e11-e14https://doi.org/10.1016/j.pedn.2015.05.008Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar, Findley et al., 2015Findley M.K. Cha E. Wong E. Faulkner M.S. A Systematic Review of Transitional Care for Emerging Adults with Diabetes.Journal of Pediatric Nursing. 2015; 30: e47-e62https://doi.org/10.1016/j.pedn.2015.05.019Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, Joly, 2015Joly E. Transition to Adulthood for Young People with Medical Complexity: An Integrative Literature Review.Journal of Pediatric Nursing. 2015; 30: e91-103https://doi.org/10.1016/j.pedn.2015.05.016Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar).3.HCT plans should be based upon a framework of care that incorporates health care transition best practices for the adolescent/family and emerging adult. This care should focus on the adolescent’s interests, needs and preferences. The plan of care should also have measureable outcomes, benchmarks of achievement, and an interdisciplinary approach to care incorporating the nursing process; Benchmarks should be created based upon a detailed timeline, which may be unique for each individual adolescent and family (American Academy of Pediatrics et al., 2011American Academy of Pediatrics American Academy of Family Physicians American College of Physicians Transitions Clinical Report Authoring Group Cooley W.C. Sagerman P.J. Supporting the health care transition from adolescence to adulthood in the medical home.Pediatrics. 2011; 128: 182-200https://doi.org/10.1542/peds.2011-0969Crossref PubMed Scopus (785) Google Scholar, Betz et al., 2014Betz C.L. Ferris M.E. Woodward J.F. Okumura M.J. Jan S. Wood D.L. authoring group for the Health Care Transition Research Consortium The Health Care Transition Research Consortium Health Care Transition Model: A Framework for Research and Practice.Journal of Pediatric Rehabilitation Medicine. 2014; 7: 3-15https://doi.org/10.3233/PRM-140277Crossref PubMed Scopus (66) Google Scholar, Findley et al., 2015Findley M.K. Cha E. Wong E. Faulkner M.S. A Systematic Review of Transitional Care for Emerging Adults with Diabetes.Journal of Pediatric Nursing. 2015; 30: e47-e62https://doi.org/10.1016/j.pedn.2015.05.019Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, Joly, 2016Joly E. Integrating Transition Theory and Bioecological Theory: A theoretical perspective for nurses supporting the transition to adulthood for young people with medical complexity.Journal of Advanced Nursing. 2016; 72: 1251-1262https://doi.org/10.1111/jan.12939Crossref PubMed Scopus (13) Google Scholar).4.A formalized process of assessment based upon a HCT framework should be used as the basis for plan development. There are several assessment tools available that can be used to measurewhat has been referred to as transition readiness. The plan is expected to be fluid and responsive to the needs of the adolescent and emerging adult based upon continuous assessment of needs and readiness (American Academy of Pediatrics et al., 2011American Academy of Pediatrics American Academy of Family Physicians American College of Physicians Transitions Clinical Report Authoring Group Cooley W.C. Sagerman P.J. Supporting the health care transition from adolescence to adulthood in the medical home.Pediatrics. 2011; 128: 182-200https://doi.org/10.1542/peds.2011-0969Crossref PubMed Scopus (785) Google Scholar, Celona, 2015Celona C.A. Measuring Acuity and Patient Progress for Youth With Special Health Care Needs in Transition Care Utilizing Nursing Outcomes.Journal of Pediatric Nursing. 2015; 30: e15-e18https://doi.org/10.1016/j.pedn.2015.05.005Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, Disabato et al., 2015Disabato J.A. Cook P.F. Hutton L. Dinkel T. Levisohn P.M. Transition from Pediatric to Adult Specialty Care for Adolescents and Young Adults with Refractory Epilepsy: A Quality Improvement Approach.Journal of Pediatric Nursing. 2015; 30: e37-e45https://doi.org/10.1016/j.pedn.2015.06.014Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, Ferris et al., 2015Ferris M. Cohen S. Haberman C. Javalkar K. Massengill S. Mahan J.D. Hooper S.R. Self-Management and Transition Readiness Assessment: Development, Reliability, and Factor Structure of the STARx Questionnaire.Journal of Pediatric Nursing. 2015; 30: 691-699https://doi.org/10.1016/j.pedn.2015.05.009Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar, Fredericks et al., 2010Fredericks E.M. Dore-Stites D. Well A. Magee J.C. Freed G.L. Shieck V. Lopez M.J. Assessment of transition readiness skills and adherence in pediatricliver transplant recipients.Pediatric Transplantation. 2010; 14: 944-953https://doi.org/10.1111/j.1399-3046.2010.01349.xCrossref PubMed Scopus (136) Google Scholar, Moynihan et al., 2015Moynihan M. Saewyc E. Whitehouse S. Paone M. McPherson G. Assessing readiness for transition from paediatric to adult health care: Revision and psychometric evaluation of the ‘Am I ON TRAC for Adult Care’ questionnaire.Journal of Advanced Nursing. 2015; 71: 1324-1335https://doi.org/10.1111/jan.12617Crossref PubMed Scopus (46) Google Scholar, Speller-Brown et al., 2015Speller-Brown B. Patterson K.K. VanGraafeiland B. Feetham S. Sill A. Darbari D. Meier E.R. Measuring Transition Readiness: A Correlational Study of Perceptions of Parent and Adolescents and Young Adults with Sickle Cell Disease.Journal of Pediatric Nursing. 2015; 30: 788-796https://doi.org/10.1016/j.pedn.2015.06.008Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar, Uzark et al., 2015Uzark K. Smith C. Donohue J. Yu S. Afton K. Norris M. Cotts T. Assessment of Transition Readiness in Adolescents and Young Adults with Heart Disease.Journal of Pediatrics. 2015; 67: 1233-1238https://doi.org/10.1016/j.jpeds.2015.07.043Abstract Full Text Full Text PDF Scopus (40) Google Scholar, Wood et al., 2014Wood D.L. Sawicki G.S. Miller M.D. Smotherman C. Lukens-Bull K. Livingood W.C. Kraemer D.F. The Transition Readiness Assessment Questionnaire (TRAQ): Its Factor Structure, Reliability, and Validity.Academic Pediatrics. 2014; 14: 415-422https://doi.org/10.1016/j.acap.2014.03.008Abstract Full Text Full Text PDF PubMed Scopus (214) Google Scholar).5.A health care transition coordinator (HCTC) should be identified to provide leadership in the coordination of the transition. This HCTC will organize and guide the transition based on a predetermined policy unique to the patient population served, but structurally consistent with other specialty practices in the same organization (NCYP, 2013). The care coordinator must consider the clinical, psychosocial and educational needs of the adolescent (Hopper et al., 2014; National Institute for Health and Care Excellence, 2016National Institute for Health and Care Excellence. (2016). Transition from children’s to adults' services for young people using health or social care services: NICE guidance. Retrieved from https://www.nice.org.uk/guidance/ng43Google Scholar; NCYP, 2013; Royal College of Nursing, 2013Royal College of Nursing Adolescent transition care: Guidance for nursing staff.https://www.rcn.org.uk/professional-development/publications/pub-004510Date: 2013Google Scholar).6.In the event there is not a designated HCTC available, the pediatric nursing staff will be well positioned to coordinate the care between pediatrics and adult health care. Ideally, one nurse can assume the role of the HCTC coordinating the preparation of patients to move into the adult care world. The coordinating care must include clinical, psychosocial, and educational needs and coordinate all for a successful transition (Betz and Redcay, 2005Betz C.L. Redcay G. Dimensions of the Transition Service Coordinator Role.Journal of Specialized Pediatric Nursing. 2005; 10: 49-59Crossref PubMed Scopus (58) Google Scholar: Disabato et al., 2015Disabato J.A. Cook P.F. Hutton L. Dinkel T. Levisohn P.M. Transition from Pediatric to Adult Specialty Care for Adolescents and Young Adults with Refractory Epilepsy: A Quality Improvement Approach.Journal of Pediatric Nursing. 2015; 30: e37-e45https://doi.org/10.1016/j.pedn.2015.06.014Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar; Hopper et al., 2014; Maturo et al., 2015Maturo D. Powell A. Major-Wilson H. Sanchez K. De Santis J.P. Friedman L.B. Transitioning Adolescents and Young Adults With HIV Infection to Adult Care: Pilot Testing the "Movin' Out" Transitioning Protocol.Journal of Pediatric Nursing. 2015; 30: e29-e35https://doi.org/10.1016/j.pedn.2015.06.013Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar).7.Emerging adults need to acquire the self-management knowledge and skills to ensure independence with daily treatment regimen as appropriate for their developmental level. The pediatric nurse plays a key role educating patients about their disease, and the self care skills required to maintain health and wellbeing including emergency preparedness as they transition to adult care (Disabato et al., 2015Disabato J.A. Cook P.F. Hutton L. Dinkel T. Levisohn P.M. Transition from Pediatric to Adult Specialty Care for Adolescents and Young Adults with Refractory Epilepsy: A Quality Improvement Approach.Journal of Pediatric Nursing. 2015; 30: e37-e45https://doi.org/10.1016/j.pedn.2015.06.014Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, Findley et al., 2015Findley M.K. Cha E. Wong E. Faulkner M.S. A Systematic Review of Transitional Care for Emerging Adults with Diabetes.Journal of Pediatric Nursing. 2015; 30: e47-e62https://doi.org/10.1016/j.pedn.2015.05.019Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar).8.In addition to teaching personal care skills, the pediatric nurse should provide education for life skills necessary to successfully function in the adult health care setting, namely skills in communication, decision making, assertiveness, self- determination and advocacy (Findley et al., 2015Findley M.K. Cha E. Wong E. Faulkner M.S. A Systematic Review of Transitional Care for Emerging Adults with Diabetes.Journal of Pediatric Nursing. 2015; 30: e47-e62https://doi.org/10.1016/j.pedn.2015.05.019Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, Hait et al., 2006Hait E. Arnold J.H. Fishman L.N. Educate, communicate, anticipate- practical recommendations for transitioning adolescents with IBD to adult health care.Inflammatory Bowel Diseases. 2006; 12: 70-73Crossref PubMed Scopus (84) Google Scholar, Joly, 2015Joly E. Transition to Adulthood for Young People with Medical Complexity: An Integrative Literature Review.Journal of Pediatric Nursing. 2015; 30: e91-103https://doi.org/10.1016/j.pedn.2015.05.016Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, Mannino, 2015Mannino J.E. Resilience and Transitioning to Adulthood among Emerging Adults with Disabilities.Journal of Pediatric Nursing. 2015; 30: e131-e145https://doi.org/10.1016/j.pedn.2015.05.017Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar).9.The HCTC and/or the pediatric nursing staff should coordinate referrals for services to promote a successful transition, including but not limited to and as needed (Betz et al., 2014Betz C.L. Ferris M.E. Woodward J.F. Okumura M.J. Jan S. Wood D.L. authoring group for the Health Care Transition Research Consortium The Health Care Transition Research Consortium Health Care Transition Model: A Framework for Research and Practice.Journal of Pediatric Rehabilitation Medicine. 2014; 7: 3-15https://doi.org/10.3233/PRM-140277Crossref PubMed Scopus (66) Google Scholar, Betz and Redcay, 2005Betz C.L. Redcay G. Dimensions of the Transition Service Coordinator Role.Journal of Specialized Pediatric Nursing. 2005; 10: 49-59Crossref PubMed Scopus (58) Google Scholar, Disabato et al., 2015Disabato J.A. Cook P.F. Hutton L. Dinkel T. Levisohn P.M. Transition from Pediatric to Adult Specialty Care for Adolescents and Young Adults with Refractory Epilepsy: A Quality Improvement Approach.Journal of Pediatric Nursing. 2015; 30: e37-e45https://doi.org/10.1016/j.pedn.2015.06.014Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar).a.School based career planning and job training and placement programsb.Post-secondary planning supports (i.e. Disabled Student Services, Department of Rehabilitation)c.Housingd.Transportatione.Community Living Programs (i.e. recreational, social)f.Health care coverage10.The age of majority (meaning the age at which the adolescent has the legal authority to make decisions for care) needs to be considered for appropriate planning purposes. For the adolescent who has an intellectual disability and his/her family, there needs to be discussion about guardianship well before the age of majority occurs. This discussion should include information about the need and rationale for guardianship, the types of guardianships available and resources available in the community to assist families in obtaining a guardianship (e.g. referrals to no or low cost guardianships).11.During the period of health care transition, pediatric nurses should discuss with adolescents and their parents the changing dynamics of their relationship from the parent’s role as primary caregiver and case manager to that of coach, consultant and/or organizational assistant and its implications. The implementation of this transfer of care should occur during the later adolescent period (between ages 18 and 21 years), and should begin when the emerging adult exhibits signs of readiness. The process of execution will begin prior to the transition to adult care, and the intensity of the execution process will increase as plans progress. Teaching provided to the older adolescent and emerging adult getting ready for transition will intensify during the execution process, to ensure that he/she is indeed ready to transition.1.The professional Pediatric Registered Nurse is in a unique position to act as a liaison between the pediatric and adult practices. Pediatric nurses can provide resources, consultation and/or training, as requested for interdisciplinary providers and services in adult and primary care who may have limited training in the management of childhood- onset special health care needs (Disabato et al., 2015Disabato J.A. Cook P.F. Hutton L. Dinkel T. Levisohn P.M. Transition from Pediatric to Adult Specialty Care for Adolescents and Young Adults with Refractory Epilepsy: A Quality Improvement Approach.Journal of Pediatric Nursing. 2015; 30: e37-e45https://doi.org/10.1016/j.pedn.2015.06.014Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, Findley et al., 2015Findley M.K. Cha E. Wong E. Faulkner M.S. A Systematic Review of Transitional Care for Emerging Adults with Diabetes.Journal of Pediatric Nursing. 2015; 30: e47-e62https://doi.org/10.1016/j.pedn.2015.05.019Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar; Hopper et al., 2014; Joly, 2016Joly E. Integrating Transition Theory and Bioecological Theory: A theoretical perspective for nurses supporting the transition to adulthood for young people with medical complexity.Journal of Advanced Nursing. 2016; 72: 1251-1262https://doi.org/10.1111/jan.12939Crossref PubMed Scopus (13) Google Scholar).2.For adolescents with intellectual disabilities, the family should have by this point taken the steps to obtain power of attorney (POA), guardianship or needed services for the adolescent. The goal should be that the adolescent will be as independent as safely possible. He/she may require supports in some areas but be independent in others. This will need to be an individualized plan for each older adolescent based on specific limitations and capabilities.3.All records are appropriately transferred to the adult primary and specialty care providers and agencies prior to the actual transfer of care. It is recommended that, if possible, a direct handoff between pediatric and adult providers should occur (Disabato et al., 2015Disabato J.A. Cook P.F. Hutton L. Dinkel T. Levisohn P.M. Transition from Pediatric to Adult Specialty Care for Adolescents and Young Adults with Refractory Epilepsy: A Quality Improvement Approach.Journal of Pediatric Nursing. 2015; 30: e37-e45https://doi.org/10.1016/j.pedn.2015.06.014Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar).4.The pediatric nurse needs to ensure that all the necessary referrals are made. Additionally, arrangements should be made for the ordering and provision of necessary equipment and supplies to prevent gaps in services. The recommendations in the previous sections addressing care prior to HCT and during the transfer of care are important so that successful outcomes can be achieved. These potentially can reduce untoward outcomes such as service discontinuities, emergency department visits and readmissions to children’s hospitals as well as lack of access to transition an adult services and supports (McDonnell et al., 2010McDonnell W.M. Kocolas I. Roosevelt G.E. Yetman A.T. Pediatric emergency department use by adults with chronic pediatric disorders.Archives of Pediatrics and Adolescent Medicine. 2010; 164: 572-576https://doi.org/10.1001/archpediatrics.2010.60Crossref PubMed Scopus (19) Google Scholar). Although pediatric nurses do not generally provide direct care for young adults following the transfer of care, there are several important considerations to be addressed following the transfer to adult care to ensure successful outcomes.1.Pediatric nurses should ensure that documentation has occurred in the pediatric records indicating that the transfer has taken place and young adults have connected with adult providers (Disabato et al., 2015Disabato J.A. Cook P.F. Hutton L. Dinkel T. Levisohn P.M. Transition from Pediatric to Adult Specialty Care for Adolescents and Young Adults with Refractory Epilepsy: A Quality Improvement Approach.Journal of Pediatric Nursing. 2015; 30: e37-e45https://doi.org/10.1016/j.pedn.2015.06.014Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, Got Transition and Center for Healthcare Transition Improvement, 2014Got Transition Center for Healthcare Transition Improvement Six core elements for healthcare transition 2.0.http://www.gottransition.org/resourceGet.cfm?id=206Date: 2014Google Scholar, McManus et al., 2015McManus M. White P. Barbour A. Downing B. Hawkins K. Quion N. Mcallister J.W. Pediatric to Adult Transition: A Quality Improvement Model for Primary Care.Journal of Adolescent Health. 2015; 56: 73-78https://doi.org/10.1016/j.jadohealth.2014.08.006Abstract Full Text Full Text PDF PubMed Scopus (99) Google Scholar, National Institute for Health and Care Excellence, 2016National Institute for Health and Care Excellence. (2016). Transition from children’s to adults' services for young people using health or social care services: NICE guidance. Retrieved from https://www.nice.org.uk/guidance/ng43Google Scholar).2.The young adult and family should be encouraged to continue to engage in ongoing involvement and communication with community, public health and school programs that may provide additional guidance and support around other areas of transition to adult services after the transition to adult health services has occurred (Findley et al., 2015Findley M.K. Cha E. Wong E. Faulkner M.S. A Systematic Review of Transitional Care for Emerging Adults with Diabetes.Journal of Pediatric Nursing. 2015; 30: e47-e62https://doi.org/10.1016/j.pedn.2015.05.019Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar).3.Pediatric nurses should be involved in the development of quality improvement, evaluation and research projects exploring achievement of outcomes such as independence, self-management, adherence, quality of life, involvement in education, vocation and/or recreation, and social network formation as adults. Outcomes explored should be relevant to the patient population services. Such work can provide an indication of the success of and areas of improvement for health care transition planning and implementation (Aldiss et al., 2015Aldiss S. Ellis J. Cass H. Pettigrew T. Rose L. Gibson F. Transition from child to adult care – ‘It’s not a one-off event’: Development of benchmarks to improve the experience.Journal of Pediatric Nursing. 2015; 30: 638-647https://doi.org/10.1016/j.pedn.2015.05.020Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar, American Academy of Pediatrics et al., 2011American Academy of Pediatrics American Academy of Family Physicians American College of Physicians Transitions Clinical Report Authoring Group Cooley W.C. Sagerman P.J. Supporting the health care transition from adolescence to adulthood in the medical home.Pediatrics. 2011; 128: 182-200https://doi.org/10.1542/peds.2011-0969Crossref PubMed Scopus (785) Google Scholar, Campbell et al., 2016Campbell F. Biggs K. Aldiss S.K. O’Neill P.M. Clowes M. McDonagh J. Gibson F. 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Transitioning Adolescents and Young Adults With HIV Infection to Adult Care: Pilot Testing the "Movin' Out" Transitioning Protocol.Journal of Pediatric Nursing. 2015; 30: e29-e35https://doi.org/10.1016/j.pedn.2015.06.013Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar). REVIEWED AND APPROVED BY: Subject Matter Expert/Task Force: SPN Transition to Care Task Force Date: 09/15/2016 Chair: Cecily L. Betz, PhD, RN, FAAN Task Force Members: Joanne Barton, MSN, RN, CPN Mary (Molly) Benkert, MS, RN-BC, CBIS Elizabeth Doyle, DNP, APRN, CDE Sandra Fleishman, MSN, RN, CPN, CPAN Ginger Holloway, MSN, RN, CPN, CNE Elizabeth Joly Straus, MN, RN Barbara Martens, BSN, RN, PHN, CPN Lori Williams, DNP, RN, RNC-NIC, CCRN, NNP-BC Linda Wray, MSN, RN, CPN SPN Board of Directors: Date: 10/14/2016