Dr Rachel Tattersall's presentation from Osteoporosis 2016: Successful transition from paediatric to adult services. Find out more at: https://nos.org.uk/conference

1. Successful transition from
paediatric to adult services

2. Outline
• Understanding young peoples’ care
– What is (special about) adolescence
– Transition impossible without acknowledging this
• What is transition?
– More than just transfer…..
• How can/should you do transition?
– Or even better: how to deliver age and
developmentally appropriate care

4. “That awkward period between sexual
maturation and the attainment of
adult roles and responsibilities”
Biological
Delayed growth/
puberty
Psychological
Sick role, regression,
mental health (esp
girls), body image, less
resilient
independence,
failure of peer
relationships, poor
school attendance,
family dynamics
(other siblings)
Social + emotional

5. Tasks of Adolescence
Move from dependent
child to independent,
resilient, autonomous
(healthcare using) adult
– Puberty
– Adult thinking and
personal identity
– Sex, drugs ‘n’ rock
and roll…..risky
behaviours
– Education/vocation
– Social media
– Social pressures

6. Adolescents are a big population
• Paediatrics caters for
small children
• Adult medicine caters
for middle/older age
• 16-25 big population
– Utilise health care
– 85% seek medical care at
least x1 pa (average x2)
• Noncommunicable
disease starts here!

7. Timelapse MRI age 5-20 (Grey matter is red) synaptic pruning reduces GM through
adolescence
Neurocognitive development

8. The developing adolescent brain
• Adult brain (‘yourself’) develops ability to
– Abstract think
– Impulse control/delay gratification
– Act independently from peers
– Understand long term consequences
• More related to experience than age
• Risk taking (hallmark behaviour)in adolescence
– necessary
– appropriate
– Ask about it (HEEADSSS) and ask alone….
Steinberg 2004, 2008

9. Communicating with adolescents –
standard care for 10-24 year olds
HEEADSSS 3.0
• Home
• Education
• Eating
• Activities
• Drugs and alcohol
• Sexual health
• Suicide/spirituality/sleep
• Social media/general safety
•http://contemporarypediatrics.modernmedicine.com/contemporary-pediatrics/content/tags/adolescent-
medicine/heeadsss-30-psychosocial-interview-adolesce?page=full

10. The mismatch
Early adolescence Middle
adolescence
Late adolescence +
young adulthood
puberty
Brain development
‘Starting the engine without training the driver’

11. The Gap
‘Children’
(0-16) looked
after by
paediatricians
‘Adults’
(16+) looked after
in adult services
Development in all aspects

12. The mismatch
Early adolescence Middle
adolescence
Late adolescence
puberty
Brain development
‘Starting the engine without training the driver’
Paediatric
to Adult
Gap

13. Transition bridges the gap
ALL children move from childhood to adulthood
Young people with ill health have more to lose if they ‘fall into
the gap’ while growing up
multi-faceted, active process attending to the
medical, psychological and
educational/vocational needs of adolescents
as they move from child to adult-centered
care

14. How to do transition?
Need identified and
enshrined in policy
• 2010 Kennedy Report
• DOH 2012, 2013
– Moving on well
– You’re welcome
• CQC report 2014
• NICE Guidance 2016
• Ready, Steady, Go!

15. Paediatrics
Adolescent
OPD
Young Adult
OPD
Letter
Or via GP
Adult
Transition Models:
Same Dr
Different Dr
Nurse / Therapist

16. General Barriers
Reasons for failure of successful transition into adult healthcare:
• Financing / politics
• Lack of incentive to invest
• Lack of service
• Lack of planning for transition
• Information transfer /admin
• Time
• Training*
*43% health professionals in national survey reported
unmet training needs as barrier
McDonagh JE 2004

17. Current Sheffield ‘mirror’ service
10 - 16 16 - 25
Weekly YP clinic 10-15
Monthly transfer clinic 15+
YP clinic 16-25

18. Both paed and adult services need to:
• provide YPF care
– HEEADSSS, see YP alone, promote resilience etc
– Train and support each other
• agree how they will prepare/receive YP and what
transition for their service looks like
– Write a policy and stick to it (don’t reinvent wheels)
– Transition is MUCH more than transfer
– Ready steady go?
• Address barriers
– Collect and audit data, harangue managers, get patients
involved, invoke NICE
• Start low, go slow!

19. Summary
• Adolescence is a distinct developmental stage
• NHS systems constrain good adolescent care
• Work across + within systems in ‘YP friendly way’
• Prioritise
– good communication
– Engagement
– Choice
– Resilience
• Remain open to change and challenge!