Evaluation After Transition Has Occurred
Post-Transition Assessment by the Adult Care Provider or Team
Recommendations. The adult care provider or team should devise a plan to achieve the following on an ongoing basis:
Assessment of whether an individual patient is adequately caring for his/her own health (AIII)
Assessment of barriers that the patient is facing, what support is needed, and who will provide this support (AIII)
Skills training and support, either through the multidisciplinary team in the clinic or by liaison with a mental health or psychosocial support provider (AIII)
Many adolescents and young adults transitioning to adult clinics will not have much experience in practicing the healthcare behaviors that often develop with maturity. The adult care provider should be alert to signs that a young patient needs additional support or skills training. Offering immediate support will reduce the risk of the patient withdrawing from care. Any 1 of the following behaviors may alert the clinician that the patient requires additional support and indicates a need to revise the individual's transition plan:
Multiple missed appointments
Discontinuation of medications
Substance use or other behaviors suggestive of poor adjustment
Loss of entitlements
The checklist in Table 4 can be used to evaluate the success of the transition.
Table 4. Checklist for Successful Transition
Follow-up From Adolescent or Pediatric Care Provider
Recommendations. If adolescents withdraw from care in the adult clinic and return to their previous pediatric/adolescent clinic, the adolescent care provider should be prepared to help the patient identify services that can provide increased support and should encourage re-engagement in adult medical care. (AIII)
After transitioning to an adult care setting, patients may continue to have contact with their pediatric/adolescent care team providers, which may reinforce a successful transition or may uncover potential pitfalls in maintaining ongoing care at the adult facility. Therefore, continued communication between adult and pediatric providers remains a crucial aspect of the transition process.
Both the patient's and the pediatric/adolescent care provider's desire to "check in" at the beginning of the transition process is part of normal and healthy closure and can mitigate the patient's sense of loss. However, transitioning patients may continue to rely on their pediatric/adolescent care provider for emotional support. This provider should defer clinical management decisions to the new provider and should be alert to the risk of hindering the patient from establishing a trusting therapeutic relationship with his/her adult care provider.
Young patients who withdraw from care in an adult clinic will often return to their adolescent or pediatric provider. When this happens, the provider should be prepared to help the patient identify services that can provide increased support and should encourage re-engagement in adult medical care.
Medscape HIV/AIDS © 2011
Cite this: Jacob Abadi, Michael G. Rosenberg. Transitioning HIV-Infected Adolescents Into Adult Care - Medscape - Aug 29, 2011.