Transition for Teens – Paediatric into Adult care services

Transition for Teens

We all experience many transitions in our lives whatever our age but health transition for young people and their families means the process of addressing the medical, psychological, social, and educational-vocational needs of young people (11-24 year olds) with long term health conditions such as JIA as they move from child-oriented to adult-oriented life-styles and systems.

It is best compared with the move (or transitions) from primary to secondary school and then later from school to university or work– important positive steps for young people whilst acknowledging that secondary school/university/work are very different environments which require a wide range of knowledge and skills which should be nurtured during adolescence.

Transitional care in rheumatology is this “nurturing process” which promotes positive youth development and provides the education and skills required as well as providing opportunities for young people to put these skills into practice thus preparing them for the world of adulthood. Transitional care should also address the needs of the parents of such young people during this process.

Transition is a lengthy process, which should begin as the young person enters adolescence, usually when they move into secondary school. Your child doesn’t stay in primary school for ever so likewise they won’t stay in paediatric care forever and transition is all about the preparation for growing up including their eventual move into adult health services.

NZ Starship rheumatology transition program

Young people with rheumatic conditions such as juvenile idiopathic arthritis (JIA) and lupus (SLE) are better prepared to manage their condition in the long term if they are confident looking after their own health before they move to adult services. Planning early allows time for young people to develop their skills and confidence so that they can become more independent.

Start talking about transition when a young person is between 11 and 12 years old. At Starship, the move to adult services happens after the young person turns 15 years old.

Transition planning with a young person and their family (whānau) starts at about 13 years of age. This is done in a separate transition appointment. At this appointment the young person’s confidence is assessed in relation to their own health care. A plan is made based on the understanding and skills they already have, which can be added to over time.

At about 14 years old, it is suggested that the young person starts spending some time at their appointments alone with their health care team. This helps the young person to build independence and confidence. It also recognises their right to talk privately with their healthcare team.

Discussions are had with the young person about some of the issues they might face as they get older and how this could affect their health.

Before moving to adult services, a young person and their whānau is given information about the service. The adult health care team is consulted to make sure they are well prepared to take over the health care of the young person.

What are the aims of transition in the rheumatology clinic?

The aims of transition are:

      • To ensure that health care is co-ordinated, uninterrupted and comprehensive, appropriate to the age and maturity of the young person;
      • To promote skills in communication, decision-making, assertiveness and self-care;
      • To enhance sense of control and independence of healthcare.

Moving towards independence for a JIA teenagers own healthcare

During the clinic visit

  • Encourage healthcare professionals to direct their conversations to your son/daughter rather than you. If you find they are speaking to you more than your son/daughter you can:
  • Make sure your son/daughter is sat slightly in front of you and preferably next to the healthcare professional.
  • Change your eye contact – people will continue talking to you whilst you are looking at them. However, if you move your gaze from them and look towards your son/daughter, they will also shift their gaze and begin talking to your son/daughter.
  • If they ask you a question, redirect it to your son/daughter. Involve your son/daughter in all the decisions made in the management of their arthritis.

And Remember…

This is a process; it will not happen overnight but will usually take place over many clinic visits.  Practice will make perfect!  If the process starts early however, by the time they are young adults they will be independent in their own healthcare management and you will be confident in their ability to do so. Allowing your son/daughter to become more independent does not mean you are less involved – it means that you will now be involved in a different way. 

Tips to help young people take their own medication

 

Nobody likes taking medicines but sometimes they are necessary. Lots of people, young and old, find it difficult to remember to take them. Here are some handy hints to try and help young people remember to take their own medicines rather than depend on their parent(s) to remember.

If you are worried that they will just forget, try letting them look after one of the medicines to start with and see how they go and remember – adults forget too!

An important part of taking responsibility for their own medicines is understanding what they are being used for, their side effects etc. Encourage your son/daughter to ask questions about their drug therapy.

Ways of remembering to take medication for a teenager

    • Set a reminder on their phone
    • Use a reminders tool or a medicine reminder app on their phone
    • Try a ‘Don’t Forget’ sticker on the mirror to remind them
    • Suggest taking medication at the same time as a regular daily activity like brushing teeth or with meals

Not missing doses

    • Plan ahead – get them a water / drink bottle so they can take tablets anywhere
    • Give them a pill box they can take if they go out – but they need to remember to fill it up!
    • Encourage them to order their own repeat prescriptions with their GP or rheumatologist

Encourage a good relationship with their doctor

If they are having problems with their medicines or are worried about their side effects, do encourage them to discuss them with the doctor.

Information for young people with rheumatic conditions

Click here to Download a PDF of information for young people with rheumatic conditions