About the ImPACT Program: transitioning adolescents and young adults from pediatric to adult healthcare
We support and advocate for all young people and their families during the transition process from pediatric to adult healthcare through:
- Inclusion: We partner with young people and their families to integrate their long-term healthcare goals into the transition plan.
- Education: We serve as coaches to patients and their families to provide health education and to enhance confidence in disease self-management.
- Collaboration: We foster communication between pediatric and adult care teams and patients and families to create an individualized, uninterrupted continuum of care.
What is transition and transfer of care?
- Transition is preparation for the change from a pediatric model of care (where parents make most of the decisions) to an adult model of care (where the patient takes responsibility for decision-making).
- Transfer is the process of identifying an adult provider, collecting and transferring all appropriate medical records to adult providers and communicating the unique needs of the patient to the adult provider. This process requires collaboration and communication among the patient, the patient’s family and the healthcare teams.
What is the timeline for transitioning to adult healthcare?
The transition process should begin as early as possible, typically between the ages of 12 to 14 years. The transition to adult healthcare should include the patient, the patient’s family and the healthcare team so everyone understands the expectations of the adult healthcare setting. More collaboration will be needed for patients with chronic conditions.
The timeline and age of transition may vary by patient readiness, specialty clinic planning and/or adult care specialist availability. Some specialties will have a general plan for the timing of transition based on the conditions they treat, and others will have stricter guidelines. The hospital policy encourages transition to adult care no later than a patient’s 22nd birthday. Talk to your child’s specialists about their policies and procedures related to transition to adult healthcare, and that your child’s primary care provider is included.
At Children’s Colorado, there are unique situations, for example, rare genetic conditions, where a teenager or young adult may not transfer to an adult healthcare facility but instead remain at our hospital with an adult model of care.
Below are some general age guidelines for the transition process:
- Age 6 to 11: Parents should begin teaching and including their child in self-management of their general health and medical condition(s).
- Age 13 to 16: Parents, providers and teens should begin discussing readiness for transition and encourage increased independence in activities related to their health
- By 18 years of age: Young adults should be fully involved in their own medical care. Adjustments will be made as needed for youth with conditions that prevent them from making healthcare decisions.
- Young adults (19 to 21 years): Most young adults will successfully transfer to an adult healthcare team, but some young adults may be able to continue to receive some medical care in a pediatric facility while additional care may take place at an adult healthcare facility.
How can children prepare for the transition to adult healthcare?
As a child enters the teen years, the medical team will spend more time talking with them individually without the presence of caregivers. Many young adult patients still may choose to continue to involve their families in their healthcare decisions, but the team will encourage patients to become more involved in their own medical decisions and health management in preparation for taking primary responsibility for their healthcare. The process depends on the child’s developmental ability to take on their own healthcare management.
During visits, older youth and adolescent patients will learn more about their medical conditions, their medications and the tasks associated with taking care of their health, such as scheduling regular clinic visits and ordering prescription refills. Teenagers are best prepared to take on the primary management of their illness when they are encouraged to ask questions and take on an active role.
Parents and providers will need to offer support, coaching and answer questions as needed. Ways to support children include:
- Encourage teens to play a role in scheduling their own medical visits, checking in when they arrive and spending time with their provider without a parent/caregiver present.
- Spend time with teens discussing the division of responsibility for healthcare tasks.
- Gradually increase expectations for adolescents’ responsibility in their healthcare while continuing to supervise these tasks.
Condition-specific transition programs at Children’s Hospital Colorado
How is adult healthcare different than pediatric healthcare?
- Young adults must schedule their own appointments.
- Adult healthcare providers will support and manage care, but young adults are primarily responsible.
- Young adults are responsible for their own finances and payment.
- Young adults need to know about their healthcare coverage.
- Young adults must request their own treatment information.
While most young adults say they are ready for these differences, many will need additional support during transition. We recommend that young adults reach out for help from their friends, family and psychosocial providers if they are struggling with the transition process.
Legal issues related to adult healthcare decision-making
When patients turn 18, they take charge of making their own healthcare decisions, and they become — legally — the only person who can access their medical information, unless other plans are made or permissions are documented in the medical record. This includes access to MyChart and other healthcare platforms where patients can communicate directly with providers, check labs and schedule appointments. Young adults ages 18 and older become the sole decision-makers about their healthcare and the sharing of personal health information. Only with the young adult’s written permission can healthcare providers discuss any personal health information with family members.
There is a range of options for assistance in decision-making after age 18 (the least restrictive is a signed consent form at the hospital, and the most restrictive option is legal guardianship). If young adults need support in making healthcare decisions, disability groups in each state can help guide you to legal resources.
Getting additional support for transition to adult healthcare
Transition can come with additional stress and challenges for some teens and families. Consider reaching out to your medical team to obtain additional support, particularly the psychosocial providers on the team.
If teens are having significant difficulty with aspects of the transition process (such as adherence, emotional health or coping with a diagnosis), it may be helpful to consider getting additional support from specialists. These can include pediatric psychologists, social workers or other behavioral health providers who can provide additional support to teens and help them develop strategies to cope with challenges related to transition.
Family resource assistance
Our Family Resource Liaisons are master’s level clinicians who are available to help individuals and families navigate the mental healthcare system by providing contact information for mental health resources in your community.
Family Resource Liaisons are available by phone at 720-777-4978, Monday through Friday, 8 a.m. to 6 p.m.
Parents can check out our Parent Toolkit to get more resources for maximizing their child’s health.