1. Angele M. Valerio N 8303 Health Economics and Information Systems in Primary Care Temple University

2.  The transition period between adolescence and adulthood is an important developmental stage, marked by a complex set of changes in social and behavioral functioning (Pai & Schwartz, 2011).  Less than half of adolescents with medical or behavioral health care needs receive the services and aid required to assist them in making a successful transition from pediatric to adult care (Sawicki, Whitworth, Gunn, Butterfield, Lukens-Bull & Wood, 2011)  Federal Government Policies mandate that health care transition planning for adolescents with medical and behavioral health care challenges [AMBC] begin no later than 16 years of age (Family Voices, 2013).

3. AMBC Challenges: navigating the unfamiliarity of adult care systems. adjusting to the differences in pediatric and adult care. lack of communication between pediatric and adult providers. ( Pai & Schwartz, 2011) The lack of health care transition [HCT] guidance can initiate a cycle of disengagement from the medical world in adulthood. (Cheak-Zamora, Yang, Farmer, & Clark, 2013). Caregiver Challenges: anxiety about leaving the familiarity of the Pediatric Primary Care Provider (Academy of American Pediatrics [AAP] 2011) finding an Adult Care Provider who is sensitive and empathetic to the social needs of their adolescent during office visits lack education on the healthcare system their adolescent is about to enter. (El-Ghouroury, 2013) Lack of coordination between caregiver and provider strips the adolescent of a vital source of support. (El-Ghouroury, 2013)

4. The concept of Puzzle pieces is associated strictly with Autism. HCT can be likened to a puzzle. The adolescent and caregiver are surrounded by various pieces that they know fit together to form a complete picture. The challenge comes in how to correctly access and place the pieces.

5.  Mission To support adolescents with medical and behavioral health care challenges and their caregivers in maximizing their full potential through education and access to resources to assist them in health care transition from pediatric to adult care providers. (Valerio, 2015a)  Vision To adequately prepare every adolescent with medical and behavioral challenges for entrance into the adult health care system. (Valerio, 2015a)

6.  Enabled me to provide a website that could be accessed exclusively for the information the application provided.  Provided a venue to communicate with users of the application  Allowed me to create my own station on YouTube.  Allowed me to access video and podcast information.

7. “ Are You Transition Ready?”  Created a 10 item survey to assess the AMBC adolescent or caregiver’s readiness to assume health care transition activities. https://www.surveymonkey.co m/s/V8D8C9D  The survey examines the AMBC adolescents and their caregiver’s perceived level of competency and identifies areas of intervention to enhance self-management knowledge and skills in HCT process.(Valerio, 2015b) “Let’s Talk”  Chat with other adolescents and caregivers like themselves  Develop a support network and comraderies through a shared experience.  Allows networking within the community to access resources and services.

8. HCT: Health Care Transitions https://www.youtube.com/playlist?list=PL4Lqi F9iJITmYU2ezjtPUMnRYy6qdcWeQ GOT TRANSITION PODCAST https://www.youtube.com/playlist?list=PL4Lqi F9iJITmDVu3_512kqnhHvSbDh0cn o Utilized the “Got Transition” podcast series. o “Got Transition” was developed by the o Radio broadcast dealing with transition issues. o Conducted by adolescents like themselves. Help caregivers to gain perspective o Utilized a reputable institution as a resource o Leading experts in the field of Pediatrics and Adolescent health care transition. o Allowed them to see other adolescents like themselves could be successful. Gave experiences about what to anticipate

9. What I learned :  Limited ability to provide online links due to free subscription.  Should have used multiple Website Icons to list links to resource sites. SITES  Adolescent Transition for People with Special Health Care Needs http://www.health.ri.gov/specialhealthcareneeds/about/adolescenttransition/inde x.php  AHTP: Adolescent Health Transition http://depts.washington.edu/healthtr/ AHTP: Adolescent Health Transition  Chapin Hall Center for Children at the University of Chicago http://www.chapinhall.org/ http://www.chapinhall.org/  Children’s Hospital of Philadelphia: Center for Autism Research [CAR], Autism Roadmap http://carautismroadmap.org/  Duke Center for Child and Family Policy http://childandfamilypolicy.duke.edu/http://childandfamilypolicy.duke.edu/  Got Transition http://www.gottransition.org/youthfamilies/index.cfm  Future of Children: Princeton and Brookings http://futureofchildren.org/  National Center for Children in Poverty http://nccp.org/  The National Alliance to Advance Adolescent Health http://thenationalalliance.org The National Alliance to Advance Adolescent Health  National Adolescent Health Information Center http://nahic.ucsf.edu/  Pennsylvania State Department of Health: Special Kids Network http://www.portal.state.pa.us/portal/server.pt/gateway/PTARGS_0_75878_133512 4_0_0_18/The%20FINAL%20Transition%20May%209%202013%20pdf%20copy1- %20Adobe%20Acrobat%20Pro%20pdf.pdf

10. Advanced practice nurses can a positive impact the quality of health care transition for adolescents with medical and behavioral challenges. This can be established through education and research.  The presence of the profession of Nursing has been very limited in this area of patient care (Betz, 2013).  Through producing research on the topic, nursing can integrate nursing philosophies and theoretical frameworks into the development of effective health care transition programs.  Nursing can utilize this application and other research as a building block to formulate best standards of practice in regard to HCT.  Pursuit of HCT and formulation of quality in HCT practice research further distinguishes the Advanced Practice Nurse as a qualified healthcare provider and enhances their ability to function as the expert clinicians they are.

11.  American Academy of Pediatrics (AAP). (2011). Clinical Report- Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home. Pediatrics: Official Journal of the American Academy of Pediatrics, 128, 182-200. http://dx.doi.org/10.1542/peds.2011-0969  Betz, C. L. (2013). Health care transition for adolescents with special health care needs: Where is nursing? Nursing Outlook, 61, 258-265. http://dx.doi.org/10.1016/j.outlook.2012.08.009http://dx.doi.org/10.1016/j.outlook.2012.08.009  Cheak-Zamora, N. C., Yang, X., Farmer, J. F., & Clark, M. (2013, February 11). Disparities in Transtion Planning for Youth with Autism Spectrum Disorder. Pediatrics Official Journal of the American Academy of Pediatrics, 131, 447-454. http://dx.doi.org/10.1542/peds.2012-1572http://dx.doi.org/10.1542/peds.2012-1572  El-Ghouroury, N. H. (2012, Winter). Resilience and the Narratives of Caregivers of Adults with Autism Spectrum Disorders. Narrative Inquiry in Bioethics, 2, 189-197. Retrieved from http://muse.jhu.edu/journals/nib/summary/v002/2.3.el-ghouroury.html. http://muse.jhu.edu/journals/nib/summary/v002/2.3.el-ghouroury.html  Family Voices.(2013). Title V of the Social Security Act/ SLAITS Survey. Retrieved from http:///www.familyvoices.org http:///www.familyvoices.org  The National Alliance to Advance Adolescent Health (2015). Got Transition YouTube video channel. Retrieved on February 10, 2015 from https://www.youtube.com/channel/UChzkAvbVTHNVhl1HmH_5XTw https://www.youtube.com/channel/UChzkAvbVTHNVhl1HmH_5XTw  Pai, A. L., & Schwartz, L. A. (2011, October). Introduction to the Special Section: Health Care Transitions of Adolescents and Young Adults with Pediatric Chronic Conditions. Journal of Pediatric Psychology, 36, 129-133. http://dx.doi.org/10.1093/jpepsy/jsq100  Sawicki, G. S., Whitworth, R., Gunn, L., Butterfield, R., Lukens-Bull, K., & Wood, D. (2011, August 8). Receipt of Health Care Transition Counseling in the National Survey of Adult Transition and Health. Pediatrics Official Journal of The American Academy of Pediatrics, 128, e521-e529. http://dx.doi.org/10.1542/peds.2010-3017  Seattle Hospital for Children, 2015. The Center for Children with Special Needs YouTube Video channel. Retrieved on February 10, 2015 from https://www.youtube.com/user/CSHCN/videoshttps://www.youtube.com/user/CSHCN/videos  Valerio, A., (2015a). Making the Pieces Fit. Accessed on April 10, 2015 from http://apps.appypie.com/html5/making-the-pieces-fit http://apps.appypie.com/html5/making-the-pieces-fit  Valerio, A., (2015b). Are you transition ready?. Retrieved from Survey Monkey on April 10, 2015 from https://www.surveymonkey.com/s/V8D8C9D