Transition Toolkit

Overview

As a part of the Medical Home Implementation Project, TNAAP has developed a Transition Toolkit that can be used as an effective tool to assist providers and families in developing Transition plans for Children and Youth with Special Health Care Needs (CYSHCN).

Health care transition is the process of a patient and their family changing from a pediatric to an adult model of health care. The goal of transition is to optimize health and assist youth and their families in ensuring continuity of care. This process requires an organized transition process to support youth in acquiring independent health care skills, preparing for an adult model of care, and transferring to new providers without disruption in care. We want to provide support and resources for providers as they implement their practice's Transition Planning.

It is important to have resources available for the physicians, the office staff and the families. The core elements in planning for a Transitions Policy:

Develop a Transitions Policy
Tracking and monitoring patients - establishing a register and using tracking templates.
Determining Transitions Readiness Evaluation for CYSHCN Patients and Families
Transition Planning coordinating with adult provider
Transfer of Care to an adult provider
Completion of Transfer of Care

Patients that have special health care needs have more positive outcomes from a fully developed Transitions Policy. It is an essential element in the care of CYSHNC and their families. We encourage you to check the www.tnaap.org website for more information and updates.

Videos

Slides for each presentation are also available for download. Click the link below each video to download the slides for that particular presentation.