Article Assesses Evidence on Transition for Youth with Special Health Care Needs

April 6, 2012

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"Determining the key elements of transition programs that lead to better outcomes will contribute to the design of efficient models of care," write the authors of an article published in the Journal of Adolescent Health online on March 22, 2012. Increasing numbers of youth with special health care needs (YSHCN) are surviving into adulthood. The authors of this article conducted a literature review to examine existing evidence on health care transitions for YSHCN transitioning from pediatric to adult care. In particular, they sought to answer two questions about such transitions: (1) what are the general outcomes for YSHCN whose transition proceeds without special intervention? and (2) what transition activities lead to better health care outcomes for YSHCN?

The authors searched four databases: Medline, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and Social Sciences Citation Index. They selected for inclusion articles published between 1986 and 2010, in English, from developed countries, and including an abstract. To be included, articles needed to contain an intervention, a comparison group, and an outcome. The authors also included descriptive reports from the National Survey of Children with Special Health Care Needs and other broad population-based surveys, articles recommended by advisory board members, and additional references from reviews and abstracted articles. The search identified 3,370 articles, of which 156 were selected for more careful review. Of the 156 articles, 13 met methodological criteria and were included in this review. The authors identified 3 additional articles from the cited literature of various references, for a total of 15.

The authors found that

  • Transition appears to proceed smoothly for many YSHCN, especially for those with, on average, milder conditions with no limitations in activities or cognitive impairment. However, YSHCN with more complex medical conditions, although often experiencing social and mental health outcomes that are comparable to their peers, seem to have generally lower educational achievement, more limited work experience, and lower incomes; those with multiple health problems or severe cognitive or mental impairments appear to experience more significant difficulty transitioning from childhood to adulthood.
  • Little evidence has been published about programs that may help YSHCN in transition; what evidence exists appears to indicate that providing YSHCN with some direct contact with adult health professionals before leaving the pediatric system may enhance transition, especially in improving likelihood of follow-up, some metabolic markers, and satisfaction with adult care.

The authors conclude that "after [key elements of transition programs] are identified, policymakers and practitioners will need to consider various questions regarding their implementation."

Bloom SR, Kuhlthau K, Van Cleave J, et al. 2012. Health care transition for youth with special health care needs. Journal of Adolescent Health (published online on March 22, 2012)