Transition Programs in Pediatric Diabetes: One Step in the Journey of Healing & True Self-Management

.Transition means:

If you were an adolescent ready to move on to an adult diabetes clinic, you would want to have:

1. ______________________________2. ______________________________3. ______________________________

If you were a parent of an adolescent moving on to an adult clinic you want to be assured about and have:

1. ____________________________2. ____________________________3. ____________________________

Transitions: Exist in Context – Successful transitions mean comprehensive, long term preparation! In diabetes, usually

addressed at HS Graduation:

Childhood Adolescence

Challenges:• optimal metabolic control• normal growth & development• integration of diabetes into daily life• parental stress

Challenges:• burnout, despair, depression• integration into work & family life• achieving & maintaining optimal metabolic control

Needed Resources:• relevant, effective messaging to adolescent & family• family counseling & support• peer support

Challenges:• dependence vs. independence• responsible management behavior• less than optimal metabolic control• risk taking intensity

Needed Resources:• optimal self management education• individual & family counseling• health care team support 24/7

Needed Resources:• individual & family counseling & support•Access to comprehensive care• self-management long term care strategy• Transition: Adolescence > Adulthood

Adulthood

Transitions: Exist in Context – Successful transitions mean comprehensive, long term preparation! In diabetes, usually

addressed at HS Graduation:

Childhood Adolescence

Challenges:• optimal metabolic control• normal growth & development• integration of diabetes into daily life• parental stress

Challenges:• burnout, despair, depression• integration into work & family life• achieving & maintaining optimal metabolic control

Needed Resources:• relevant, effective messaging to adolescent & family• family counseling & support• peer support

Challenges:• dependence vs. independence• responsible management behavior• less than optimal metabolic control• risk taking intensity

Needed Resources:• optimal self management education• individual & family counseling• health care team support 24/7

Needed Resources:• individual & family counseling & support•Access to comprehensive care• self-management long term care strategy• Transition: Adolescence > Adulthood

Adulthood

>>Must happen before launching:Assessment For Family Functioning:

While in Pediatrics in order to move to >>> Adults>

• Family emotional supportiveness– Between parents -- are mother and father emotionally available to

each other?– Availability -- is there flexibility with daily schedules?

• Family organization– Joint decision making -- between spouses– Value congruence -- between spouses– Communications patterns -- are messages about rules clear or

confusing?• Competence/effectiveness

– Response to initial symptoms

Baker, Rosman, Nogueira, Sargent; Unpublished research data, 1979

Transition Clinics: A Bridge from where they’ve been to where they’re going:

Challenges:• Providing effective continuum of care• Adequate preparation for “launching” & associated anxiety

related to separation• Having to tell my whole story again/being an “unknown”• No “chemistry”/No show! – Lost Children/Lost Adults• Preparing for leaving home/being on one’s own

Transition Clinics: A Bridge from where they’ve been to where they’re going:( cont.)

• at least 6 month ramp up preparation for transition – from both clinics

• effective patient & family needs assessment to help facilitate leaving home/doing daily diabetes management more independently

• Identification of on-going support personnel and resources/role clarification

Transition Clinics: A Bridge from where they’ve been to where they’re going:

Resources Needed:• individual & family counseling – impact of past

management behavior on reality of future plans• launching & landing support – collaborative

clinical support from both peds and adult clinics working together

• adult clinicians at peds clinic & peds clinicians at adult clinic

educate

advocate

enrich

emphasize