Trends in transition from pediatric to adult health care services for young adults with chronic conditions

Purpose: The rationale underlying this study was the need to move the trans ition health services model from a theoretical framework to an empirically- based investigation. Thus, it was necessary to identify programs for youth with chronic or disabling conditions that assist in transitioning from chil d- to adult-focused health services by (a) discrete types, (b) functional c ategories, and (c) problems and issues faced by these programs. Methods: Nominations for transition health services programs were solicited from 1025 organizational agencies at the local, state, regional, and natio nal levels. Two solicitations yielded 277 nominees. After pilot testing, a survey of 163 forced responses and open-ended questions was mailed to each nominated transition health services program. A total of 122 programs retur ned completed surveys. Results: Program services were categorized as adolescent-focused. (38%), co ndition-focused (36%), and specialty-specific programs (26%). Few programs were primary cafe-based. Categories were subsequently collapsed into two ty pes: adolescent-focused and condition-focused. No significant differences w ere noted between adolescent- and condition-focused programs regarding prov ision of mental health services, vocational counseling, self-efficacy train ing, or health education. The primary barriers to transition health service s were identified as funding and access to key staff, rather than family an d adolescent resistance. Conclusion: In general, self-identified transition health care programs do not achieve the goal of collaborative, coordinated, and integrative service s to adolescents with chronic or disabling conditions. Furthermore, the bar riers to attaining the goal are the limitations of the health care system i tself. (C) Society for Adolescent Medicine, 1999.