1. Med Students as Coaches in Transitions of Care for Youth with Special Health Care Needs Nathan F. Bradford, M.D. Brian Mulroy, D.O.

2. Disclosures Dr. Bradford has nothing to disclose Dr. Mulroy has nothing to disclose

3. Reflections “Sometimes just helping an individual create their own independence or helping them to find the resources to do this is one of the best ways we can help.” -BY “I learned how hard it is for some patients to get to their appointments, get their medicines and in some cases just to be heard by their physician.” -TT “I feel more confident to handle complex socioeconomic situations, more knowledgeable about community resources, and more capable to care for similar patients in the future as a result of having had this experience.” -MJ

4. Transition is a process “The purposeful, planned movement of adolescents and young adults with chronic physical and mental conditions from child- centered to adult-oriented health care systems.” (SAHM)

5. While YSHCN are increasing in number, they often fall through the cracks. YSHCN can be complicated We don’t prepare them Adult providers feel inadequate Each year YSHCN graduate and need to find adult PCPs BUT THERE ARE BARRIERS

6. Barriers for the YSHCN patient Coverage Transportation Caregivers Lack of ability to advocate

7. Barriers for the adult provider Discomfort with medical issues Time limitations Psychosocial needs take time Communicating with pediatric providers Paperwork End of life issues

8. Same planet, different worlds Pediatric CareAdult Care NurturingInforming Parent CenteredPatient Centered Universal fundingUnderfunded Family insurance providedEmployment based insurance PaternalisticTotal Autonomy CentralizedFragmented Usually informed providersPotentially less informed providers (Modified from Eckman)

9. AnMed Health Anderson, South Carolina Children’s Health Center Family Medicine Residency

10. Previously, we experienced many of the same barriers! Lack of organized system for follow-up No-shows at FMR Mystification at FMR –Who are these people? (complexity) –What services are available?

11. Our Solution: med students as coaches in transitions of YSHCN

12. Our Project Recruited med students (12) Pretest on knowledge of issues facing YSHCN Brief didactic session –The problem –The study –Info on relating to YSHCN

13. Our Project Each MS-3 was assigned a YSHCN patient Attended last visit at CHC (exit visit) –Readiness checklist –Summary of medical history –Stayed in contact with their YSHCN Attended entrance visit at FMR (in process) Social worker Reflective piece Post-test

14. Issues to be Addressed New adult providers DME Bowel/bladder Independent living End-of-life issues? Educational Vocational Psychosocial Sexual Insurance coverage

15. Outcomes (pending) Data on pre-test vs. post-test Data on gaining independence –Readiness checklists Data on no show rates –Transition Clinic vs. current project Reflections from students

16. Reflections “Having a positive impact does not have to mean curing some terrible illness. It can be as simple as helping somebody devise a goal towards more independent function. “ -JO “As someone interested in a career in pediatrics, my experiences with my transition patient furthered my desire to ensure that my patients are medically empowered and adequately able to care for themselves.” -EB “It has helped guide me and be more apt to ask patients why and what their barriers are to being compliant with follow ups and taking their medications.” -KA

17. Please evaluate this session at: stfm.org/sessionevaluation

18. References American Academy of Pediatrics Clinical Report — Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home, Pediatrics Vol. 128, No. 1. July 1, 2011 pp. 182 -200.Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home Blum, R., Britto, M., Rosen, D., Sawyer, S., & Siegel, D. (2003). Transition from child-centered to adult health-care systems for adolescents with chronic conditions: A position paper of the Society for Adolescent Medicine. Journal of Adolescent Health, 33(4): 309- 311. Transition from child-centered to adult health-care systems for adolescents with chronic conditions D’Agata, et al. Medical Care for the Disabled Patient, Family Medicine Residency Curriculum Resource, STFM.org. Gottransition.org a program of The National Alliance to Advance Adolescent Medicine supported by HRSA/MCHB http://gottransition.org/resourceGet.cfm?id=239. http://gottransition.org/resourceGet.cfm?id=239