Title: Medical Home in Pediatrics: The HOW TO Webinar Series brought to you by the National Center for Medical Home Implementation
1Medical Home in Pediatrics The HOW TO Webinar
Seriesbrought to you by the National Center for
Medical Home Implementation
How To Engage Youth in their Health CareKitty
OHare, MD, FAAPTeresa NguyenJustin
ThompsonFebruary 27, 2013
2Disclosures
- We have no relevant financial relationships with
the manufacturers(s) of any commercial
products(s) and/or provider of commercial
services discussed in this CME activity. - I do not intend to discuss an unapproved/investiga
tive use of a commercial product/device in my
presentation.
3Webinar Objectives
- By the end of this webinar, the participant will
be able to - Review the importance of empowering all youth in
their health care using a strength-based approach
- Describe promising practices for pediatric
providers to empower youth, especially during the
process of transition from pediatric to adult
care - Describe the impact of empowerment on positive
health outcomes and successful transition
from pediatric to adult care
4Case Presentation Maria
- 20 yo Hispanic female h/o Type 1 diabetes
presents to emergency room with sugars out of
control. - Lost to follow-up since age 18 after she lost
health insurance and stopped seeing her
pediatrician. - She has weight loss and 2 years of amenorrhea.
- She works part-time, but has difficulty
maintaining her job since she rarely feels
well.
5Case Presentation Maria
Is there a better way to get Maria out of
pediatrics
and into adult-oriented care?
6Definition of Transition
The purposeful, planned movement of adolescents
and young adults with chronic physical and
medical conditions from child-centered to
adult-oriented health care systems. -So
ciety for Adolescent Medicine
7Goals of Transition and Empowerment
- Transfer of care from child-oriented to
adult-oriented services with uninterrupted
services - Promote autonomy, self-care and
self-determination - Allow assumption of adult roles and
responsibilities when appropriate - Maximize life-long functioning and potential
8Should we be transitioning and empowering
everyone?
Adults, including those with childhood-acquired
chronic conditions, should receive adult-oriented
primary health care from appropriately trained
and certified providers, in adult health care
settings.
-Society for Adolescent Medicine
9Why not stay with the pediatric provider?
- Expertise in adult medical care
- Long-term effects of childhood diseases
- Promote independence and autonomy
- The population of adults with complex pediatric
conditions continues to grow!
10There are many barriers
11Communication
12MCHB Core Outcome 6
The National Survey of Children with Special
Health Care Needs, Data Resource Center for Child
and Adolescent Health. Retrieved on February 18,
2013 at http//www.childhealthdata.org/learn/NS-CS
HCN.
13Patient-Centered Medical Home
14A Team Effort
15Strengths-Based Care
- Providing strength-based care requires that
pediatricians do the - following
- ask questions,
- provide feedback,
- use a framework or checklist to identify the
patients assets, - share decision-making, and
- ask parents and the patient for feedback.
- Empower to promote the self-actualization or
influence of
16Parent-Youth Interaction
- How comfortably do the youth and parent interact,
both verbally and nonverbally? - Who asks and answers most of the questions?
- Does the youth express an interest in managing
his own health issues (including youth who have
special health care needs)?
17Parent-Youth Interaction Teresa
- Both parents are immigrants from Vietnam. I was
born in the U.S. - I became an early self-advocate due to language
barrier my parents spoke Vietnamese and
understood minimal English - In healthcare this meant (at 16 yrs.)
- Scheduling my own Doctors appointments
- Interpreting
- Becoming a key decision maker in important
healthcare decisions equally with my parents - Begin transition conversation
18Taking Charge of Healthcare Justin
- Transition began around the age of 14.
- Mom would take me, but would not go into the
room. - Began going completely on my own at 16.
- Before the appointment, parents would go over the
visit with me.
19Surveillance of Development Does the Youth
- Demonstrate physical, cognitive, emotional,
social, and moral competencies - Engage in behaviors that promote wellness and
contribute to a healthy lifestyle - Form a caring, supportive relationship with
family, other adults, and peers - Engage in a positive way in the life of the
community
- Display a sense of self-confidence, hopefulness,
and well-being - Demonstrate resiliency when confronted with life
stressors - Demonstrate increasingly responsible and
independent decision making
20Building Resilience
- Nurture disabled and non-disabled friends
- Seek family and peer support
- Encourage parental support without
over-protectiveness
- Develop self-perception as not handicapped
- Involve in household chores
21Six Core Elements of Health Care Transition
221 Transition Policy
Martha Eliot Health Center is committed to a
smooth transition from childhood to adolescence
to young adulthood. This process requires
collaboration between patients/families and the
medical team. By age 14 years, all youth in our
practice will begin transition planning by moving
to an adolescent medicine care model. By age 18
years, all youth will participate in their own
care as adults, with modifications as needed for
youth with special needs. By age 22 years, all
patients will receive primary care from an adult
medicine provider.
231 Transition Policy
242 Transitioning Youth Registry
252 Transitioning Youth Registry
- Especially critical for CSHCN
- But helpful for all transitioning youth
- Track by diagnosis, progress
- Establish a timeline
263 Transition Preparation
Medical Needs
Non-Medical Needs
- Patient has opportunity to talk to provider alone
- Review of disease-specific guidelines
- Review of age-specific guidelines
- Checklist in visit notes
- Patient is developing self-efficacy
- Education-gt vocation
- Plans for independent living
- Plans for adult support services
- Legal services
273 Transition Preparation - Assessment
283 Transition Preparation EMR Checklist
- Ages 12 to 14 years
- Patient can name their chronic conditions
- Patient can name their allergies
- Patient can name their medications
- Patient has attended an IEP meeting
- The IEP includes a transition plan
- Family has started to keep their own health
record - Patient is assigned household chores and
participates in family life - Patient has hobbies and engages in exercise
- Family has discussed sexuality
- Family is working with patient to help them
live independently
- Ages 15 to 17 years
- Patient can describe how their chronic
conditions impact their health - Patient can describe what each medication is
for - Patient can take their medication without
supervision - Patient has tried to refill a medication
- Patient is carrying their insurance card
- Patient has scheduled a doctor's appointment
on their own - Patient is updating their own health summary
- Patient is investigating adult doctors for
primary and specialty care - Patient/family are investigating secondary
education, employment or vocational opportunities
- Family has begun guardianship applications
-
- Age 18 years
- Signed HIPAA form (Patient or Guardian) is in
EMR - Patient has selected adult doctors for primary
and specialty care - Patient can refill their medication
- Patient has insurance/SSI benefits
- There is a formal plan in place for adult
living/vocation
294 Transition Planning
304 Transition Planning Action Plan
314 Transition Planning Portable Medical Summary
324 Transition Planning Emergency Plan
335 Transfer of Care
345 Transfer of Care
356 Completion
- Review of the adult model of care
- Opportunity for feedback
36Acknowledgements
- Patti Hackett-Hunter, Med
- Niraj Sharma, MD MPH
- Richard Antonelli, MD
- Additional Resource The Spina Bifida
Experience Managing Your Own Medical Care from
the National Center on Birth Defects and
Developmental Disabilities (Video)
37Got Transition?
- HRSA/MCHB funded collaborative
- Tools to implement health care transition
- Links to other transition sites
- Free webinars
www.gottransition.org
38Teresa
- 24 years old
- Graduated from Univ. of Colorado Boulder in
2011. - Has worked with Got Transition in the past with
webinars.
- Halfway transitioned to adult care in D.C. for
an internship. - Not yet transitioned in home town-Denver, CO.
- Has worked closely with with the Colorado Medical
Home Initiative, and served on the Medical Home
Youth Leadership Council.
39Teresa My Health Care Experience
- The Transition to Adult Care conversation
started when I was 17 or 18 years old - Many aspects of early advocacy helped me feel
comfortable with managing my own health care - For me factors of a successful transition
include - Provider/Specialist/Insurance matchup
- Provider is in area accessible by public
transportation - Best possible health condition for transition
- My taste of transition happened when I moved to
DC for an internship. - Things I loved
- New Provider took time with me during our consult
appt. - Portable Medical Summary
- Being put in touch with other providers that have
expertise in transitioning special needs
patients. - Knowing that theres an option to always contact
my previous provider. - Transition is still in-the-works in Denver, CO
for me
40Justin The College Years
- Made to transition to making all of my
appointments. - Primary doctors were still in hometown.
- Was not comfortable or equipped to find new
primary care physicians. - Medical Emergency.
41Early Adulthood
- A move for a job forced me to find new doctors.
- Transition between insurance was eased by job.
- Company insurance changed during employment.
- Insurance forms can be intimidating.
42Questions?
43Were Here to Help You!
- Have a question about medical home?
- Contact us!
- Medical_home_at_aap.org800/433-9016 ext 7605