The Academy has endorsed a consensus statement on the pediatric neurologists’ role in helping adolescent patients with neurologic conditions transition to the adult health care system.
The statement, The Neurologist’s Role in Supporting Transition to Adult Health Care, is published in Neurology and available at http://bit.ly/2dMv5pF. It includes eight common principles for promoting a patient’s successful transition, with appropriate documentation in the medical record.
Responsibilities of the child neurology team include the following:
- Discuss with the youth (before age 13) and caregivers the expectation of the future transition to the adult system.
- Assess the youth’s self-management skills beginning by age 12 and annually thereafter.
- Engage each youth and caregiver in phased transition planning, patient education and transfer readiness at age 13 and annually thereafter.
- Initiate discussion by age 14 years with the caregivers regarding expected legal competency (whether there is need for legal guardianship and powers of attorney).
- Ensure the transition plan meets the needs of the youth in collaboration with other providers, school personnel, etc.
- Develop and verify the neurologic component of the plan and update it annually.
- Along with the youth and caregivers, identify an appropriate adult provider before the time of transfer.
- Communicate directly with the adult provider.
The Child Neurology Foundation convened a multidisciplinary panel, including AAP members, to develop the transition model. The authors noted that the model applies to the “broad spectrum of pediatric neurologic diagnoses, feasible in a wide range of practice settings and likely to make a real difference in the lives of … patients.”