TABLE 2

Adult and Pediatric Clinician Transition Barriers22,82,85109

Communication and/or consultation gaps
 Lack of communication, coordination, guidelines, and protocols between the pediatric and adult systems
 Inadequate communication from pediatric clinicians, often with a lack of medical records and follow-up recommendations
 Lack of long-term follow-up guidelines with care information for youth with SHCN
 Gap in consultation with pediatric clinicians
 Adult clinicians’ concerns about not enough adult subspecialty or mental health care clinicians to care for young adults
Training limitations
 Lack of knowledge and/or training in pediatric-onset conditions and adolescent development and behavior
 Difficulty meeting psychosocial needs of young adults with pediatric-onset conditions
 Caring for adult patients reliant on caregivers
Care delivery, care coordination, and/or staff support gaps
 Lack of care coordination and follow-up
 Lack of mental health and supportive services
 Unfamiliarity with local and regional resources for young adults with chronic conditions
 Lack of adequate infrastructure and training
 Administrative constraints and lack of time and reimbursement
 Lack of coverage for young adults
Lack of patient knowledge and engagement
 Young adults’ lack of knowledge about disease treatments, medications, and medical history
 Lack of information about community resources and/or support groups
 Dependency on parents or guardians
 Lack of self-advocacy, decision-making skills, and self-care skills
 Poor adherence to care
 Unrealistic expectations of youth or young adult knowledge of adult medical system and lack of readiness for adult care
Lack of comfort with adult care
 Unrealistic youth, young adult, and family expectations of time and attention
 Concerns regarding loss of strong relationships with previous clinicians (patient, parent, and/or staff)
 Pediatric clinician’s lack of confidence in adult clinician and in the stylistic differences between pediatric and adult care, particularly for some youth and young adults with intellectual or developmental disabilities or behavioral health conditions
 Parents’ reluctance to relinquish responsibility
 Parents unaware of changes in privacy issues