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The Psychology of Transition Dr Janie Donnan (Principal Clinical Psychologist) Royal Hospital for Sick Children, Glasgow WoSPGHAN Annual Education Day.

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Presentation on theme: "The Psychology of Transition Dr Janie Donnan (Principal Clinical Psychologist) Royal Hospital for Sick Children, Glasgow WoSPGHAN Annual Education Day."— Presentation transcript:

1 The Psychology of Transition Dr Janie Donnan (Principal Clinical Psychologist) Royal Hospital for Sick Children, Glasgow WoSPGHAN Annual Education Day 21/04/11

2 Transition  “a purposeful, planned process that addresses the medical, psychosocial and educational/vocational needs of adolescents and young adults with chronic physical and medical conditions as they move from child-centred to adult-orientated health care systems” (DoH, 2006)  Transition generally happens during one of the most vulnerable periods in a child’s life – adolescence

3 Challenges of Chronic Illness Hospital visits Potential fear of losing Child/sibling Routine/Diet -whole family change Medication regime Building relationships with hospital staff Cope with medical procedures Dealing with diagnosis

4 Coping with treatment regime Worries about Procedures / future Coping with change in body image, Impact on Quality of life What challenges do children/young people with a chronic illness face? Adjustment to Disease / Understanding condition Maintaining friendships/ Interests/ “normal” daily life (nursery/school) Restricted independence / restricted activities Feeling different from friends

5 Adjustment over time Kubler-Ross (1969)

6 Key adolescent developmental stages Cognitive and emotional development Physical development and sexual maturation Increased independence and autonomy Increased identification with peers Key tasks of adolescence (Erikson, 1968; Newman, 1991) Group identity vs alienation Identity vs role confusion Family lifecycle (McCarter and Goldrick, 1989) Adjusting parent-child relationships Adjusting marital relationships ↑strains ↓well-being AUTONOMYINDEPENDENCEAUTONOMYINDEPENDENCE

7 Specific Cognitive and Emotional Development Challenges Formal Operational Stage (Piaget) -more adult like -Abstract thought -Work things out in head -egocentric Future thinking and greater Knowledge of illness= assess possible outcomes re Health/life Expectancy career/family etc Can increase Anxiety/ Depression/ Self Consciousness Need Communication And Empathy But also increased Problem solving skills

8 Specific Social Development Challenges “Chaotic” lifestyle Less routine More spontaneity Different bedtimes/diet Increased Desire for Peer acceptance Physical development And sexual Maturation Development of personal identity and self esteem Impact of CI And mgmt on Sexual identity/ Body Image Establishing Independence / autonomy Difficult if not managing Treatment well Risk taking behaviours “bulletproof” But also valuable Social support

9 Research Study (English Hospital) Perceptions of child vs adult Interviews, focus groups or open-ended questionnaires 15 paediatric patients (10 male; 5 female; mean age 17.8 years) Pre transfer to adult service All covered:  what is good/bad transition  when and how best to transition  when and how best to transfer

10 A child unit is: Friendly Supportive Holistic Welcoming Colourful Childish

11 An adult unit is: Grubby Depressing Confusing Vast Scary

12 “It’s a little more friendly over there (paediatric transplant clinic), where you can walk in and everyone knows who you are. Here you’ll recognise them but they will be like they won’t know you from Adam. So it’s a big shock when you first start coming” (paediatric patient)

13 ID16: Probably moving from children’s to adult’s, is probably best bit about it Researcher: What do you think is good about that? ID16: Cause you’re not a kid no more (Patient in paediatrics) ID18: Mmm, I think I’m ready to move to adult side but I’m scared (Patient in paediatrics)

14 Supporting the move: Parent/carer perspective “I think it’s also hard for us as parents to stand back and say ‘well I’m not coming in’ because you really want to know what’s going on. You know they are not going to say everything you want them to say” Shaw, K.L. (2004)

15 Supporting the move: Parent/carer perspective Difficult for parents to let go Professionals need to respect this Discuss early to allow time Parent support groups Support (friendship) /supervision/confidentiality Educate parents e.g. about need for independence Point of contact in adult centre for parent – at least initially Parent buddies Talking to YP about life expectancy Sibling support Financial issues including DLA, prescription charges etc…

16 SOLUTIONS ? Structured co-ordinated programme of transitional care [Shaw et al 07] Development of transition models… which can be trialled and evaluated…to inform how resources need to be distributed [Steinbeck et al 07] … understanding the impact of adolescent development on the transition process [Kaufman 06] Collaborative efforts by paediatric and adult teams [Freyer et al 06] Cultural shift in NHS staff attitudes and training [Viner 08] …strategies need to be informal, flexible, highly individualized and prepare adolescents steadily for adult services [Soanes & Timmons 04]

17 “Adolescence is a time of many transitions; physiological, hormonal, psychological and environmental. In considering the type of service that is provided for adolescents, attention needs to be paid to all of these factors, as well as the interplay between them.” (Eiser, 1995)

18 Thank you for listening! Any questions or comments?


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