Chronic Illness Transition Team
As youth with special health care needs continue to survive and thrive into adulthood, there is a need to address the longitudinal life-span transitions of these patients, while also preparing them for adult health care.
The Chronic Illness Transition Team is a hospital-wide initiative to enhance the transition process and available transition services for adolescent and young adult patients at the hospital. It serves as a focal point to address these hospital-wide needs; begins to implement systematic programs; and provides education to patients and families, providers and the community.
Chronic Illness Transition Medical Director Parag Shah, MD
Dr. Shah is a hospitalist physician who works primarily with children with chronic illness. More here about Dr. Shah »
Chronic Illness Transition Specialist Rebecca Boudos, LCSW
Ms. Boudos is a social worker in the spina bifida clinic and spends a lot of her time focusing on transition work with teens. She also serves as the hospital-wide transition specialist.
Our vision: We are guided by the belief that all youth with special health care needs should be prepared for adult life with maximum integration into school, work and community. These youth should also be prepared for adult health care and have continued access to medical care as an adult. Our vision is inspired by the numerous children with special health care needs who are now surviving and thriving into adulthood.
Our mission: Our mission is to prepare all teens with special health care needs for adult life and improve health care competency in order to ensure a successful transition to adult health care. In order to do so we focus on the following areas:
Clinical
- Build relationships with adult providers for primary and specialty care, and develop comprehensive, efficient, and satisfactory methods for transfers of care between pediatric and adult providers
- Improve readiness of young adult patients with chronic illnesses to transfer care to adult providers
- Prepare young adults to enter the adult world with regards to professional and social maturity
- Ensure patients and families are aware of all public benefits and insurance opportunities that are available to them
- Support specialty clinics to implement transition programming
Research
- Enhance knowledge of best practices in transition
- Enhance the understanding of the current state of adolescent and transition related issues
Education
- Competency training for providers on transition
- Education for patients, families, and the community to prepare for transition to adult life and adult health care
- Education for outside medical providers on the adult health care needs of patients with special health care needs