Health Care Transition is the change from a PEDIATRIC model of care (parents and caregivers make most decisions) to an ADULT model of care (most adults make their own healthcare decisions).
Although a planned transition is important for all youth, it is especially important for children and youth with special health care needs (CYSHCN). A well-planned transition supports continuity of care, medication management, and prevention and management of chronic conditions.
Barriers to a successful transition may include: lack of available adult providers who are comfortable caring for young adults with special health care needs; lack of provider time and reimbursement; and lack of youth/family preparation and education around transition.
Background
Nationally, the number of CYSHCN who receive the services they need to make successful transitions to adult health care, work, and independence, has risen from 16.7% to 22.5% according to data from the 2020 National Survey of Children with Special Health Care Needs. WI performs higher than the national average, but the data still shows that only one third (34%) of WI youth are receiving necessary services. This is too low and needs to continue to be addressed.
The goal of NPM 12 is to increase the percent of youth with and without special health care needs who have received the services necessary to make transitions to all aspects of adult life, including adult health care, work, and independence. This goal will be accomplished by an increase in the proportion of youth with special health care needs whose health care provider has discussed transition planning from pediatric to adult health care.
Children and Youth with Special Healthcare Needs (CYSHCN)
CYSHCN are children who have or are at increased risk for chronic physical, developmental, behavioral, or emotional conditions. They also require health and related services of a type or amount beyond that required by children generally.i McPherson et al (1998) Pediatrics 102/1.
According to our National Survey of Children’s Health (NSCH) (PDF – 344 KB), in our country:
- About 14 million children under 18 years old (19%) have a special healthcare need
- 25% of homes had one or more children with a special healthcare need
- CYSHCN are more likely to live in poverty, be non-Hispanic Black, and have public insurance than non-CYSHCN
https://mchb.hrsa.gov/programs-impact/focus-areas/children-youth-special-health-care-needs-cyshcn
NPM 12
NPM 12: Adolescents aged 12-17 years must meet three components:
1) doctor spoke with child privately without an adult in the room during last preventive check-up;
2) if a discussion about transitioning to adult care was needed it must have happened; and
3) doctors actively worked with child to gain skills and understand changes in health care.
If an adolescent had at least one valid positive response to any of these components and the remainder of the components were missing or legitimately skipped, these adolescents were categorized as receiving adequate transition to adult healthcare.
NPM 12 State and National Data 2016-20
From the 2016-2020 National Survey of Children’s Health National Performance Measure 12
From the 2016-2020 National Survey of Children’s Health National Performance Measure 12