Health Care Transition: The Struggle to Define Itself Betz, Cecily L.; Coyne, Imelda; Hudson, Sharon M.
Comprehensive child and adolescent nursing,
07/2023, Volume:
ahead-of-print, Issue:
ahead-of-print
Journal Article
Peer reviewed
Health care transition is an expanding field of health care practice and research focused on facilitating adolescents and emerging adults with long-term conditions to transfer uninterruptedly from ...pediatric to adult health care services and to transition successfully into adulthood and beyond. There is a widespread need to develop and implement service models as approximately one million adolescents and emerging adults with long-term conditions transfer their care into the adult system and enter adulthood. The purpose of this article is to explore major issues associated with the current state of health care transition practice, research and ultimately policymaking and systems change. The prominent issues addressed in this article include the following. Defining clearly what constitutes models of health care transition practice as ambiguity exists with terminology used with concepts integral to health care transition. The indistinct meanings of health care transition terminology commonly used, such as transition, transfer, readiness, and preparation, need to be operationalized for widespread application. Furthermore, questions remain as to what goal-directed outcomes are expected within this field of practice and science.
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DOBA, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Youth and young adults (YYA) with intellectual and developmental disabilities (IDD) have high rates of co-occurring mental health (MH) conditions. The time during transition from pediatric to adult ...health and mental health care can be a very challenging, with risk of loss of services leading to poor outcomes. This study aimed to explore barriers to transition from pediatric to adult health and mental health care and services for individuals with IDD and co-occurring MH conditions, by eliciting the view of stakeholders, including disability advocates. Qualitative analysis was conducted using grounded theory, and themes were coded based upon the social-ecological model (SEM). We generated themes into multiple levels: the individual level, the family level, the provider level, the systems of care level, and the societal level. Stakeholders expressed a critical need to improve coordination between systems, and to increase provider availability to care for YYA with IDD and co-occurring MH conditions.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background. In studies of hepatitis C virus (HCV) seroconversion in injection drug users (IDUs), some have questioned whether underreporting of syringe sharing, a stigmatized behavior, has led to ...misattribution of HCV risk to other injection-related behaviors. Methods. IDUs aged 15–30 years who were seronegative for human immunodeficiency virus and HCV antibodies were recruited into a prospective study in 5 US cities. Behavioral data were collected via computer-assisted self-interviewing to reduce socially desirable reporting. Hazard ratios (HRs) were estimated to assess associations between behavior and HCV seroconversion. Because the shared use of cookers, cottons, and rinse water was highly correlated, a summary variable was created to represent drug preparation equipment sharing. Results. Among 483 IDUs who injected during the period covered by the follow-up assessments, the incidence of HCV infection was 17.2 cases per 100 person years; no HIV seroconversions occurred. Adjusting for confounders, the shared use of drug preparation equipment was significantly associated with HCV seroconversion (adjusted HR, 2.66; 95% confidence interval, 1.03–23.92), but syringe sharing was not (adjusted HR, 0.91). We estimated that 37% of HCV seroconversions in IDUs were due to the sharing of drug preparation equipment. Conclusions. Associations between sharing drug preparation equipment and HCV seroconversion are not attributable to underascertainment of syringe sharing. Avoiding HCV infection will require substantial reductions in exposure to all sources of contaminated blood.
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BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
ABSTRACT
Background
Grief and loss are common experiences for children and adolescents, particularly during the COVID‐19 pandemic. Educators feel unprepared to support grieving students due to lack ...of training. We studied educator experiences receiving grief‐sensitive training as part of the grief‐sensitive schools initiative (GSSI), which provides grief‐sensitive training, online video‐based and print resources, and a financial grant to schools and school districts for use in supporting grieving students.
Methods
Fourteen New York and Florida educators who received GSSI training participated in small focus groups or semi‐structured interviews on their experiences receiving GSSI training and supporting grieving students during the pandemic. Transcripts were analyzed using grounded‐theory analysis.
Results
Emergent themes included increased confidence engaging grieving students, the desire for recurring trainings, the value of receiving training from an expert on pediatric grief and loss and the opportunity to ask questions, the need for grief‐sensitive training to reflect the cultural diversity of school communities, the unique losses experienced by students during the pandemic, and compassion fatigue and burnout in educators.
Implications for School Health Policy, Practice, and Equity
Policymakers should recognize the effects of grief on students' learning and development and collaborate with educators to develop resources.
Conclusions
Educators found GSSI training useful in supporting grieving students, particularly during the pandemic.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Describe the career and work environment of pediatric program directors (PDs) and associated factors, including salary disparities and long-term career plans.
A national, anonymous, electronic survey ...was sent to all categorical residency PD members of the Association of Pediatric Program Directors. Surveys assessed PD demographics, characteristics of the residency program and PD positions (including salary), and measures of satisfaction. Chi-square and Fisher's exact tests were used to analyze results.
A total of 149 PDs (74%) responded. Significantly more men earned $250,000 or more annually (26.9% vs 6.1% of women), and gender remained a significant independent predictor of salary after controlling for age, academic rank, and subspecialty. Satisfaction was high for most measures, although 20% or more reported low satisfaction with pay (38.9%), administrative workload (32.1%), managing accreditation and expectations of the Accreditation Council for Graduate Medical Education (31.9%), resources (27.9%), work/life balance (24.1%), and being valued by administration (20.0%). Only 34.3% saw the PD position as an end goal, and 29.5% stated they would be in their current position in 5 years. Satisfaction with the PD career, with faculty relationships, with resident performance, and with administrative workload was associated with plans to remain.
Most pediatric program directors did not view the position of PD as their long-term career goal, and many identified administrative duties and work/life balance as contributing to significant dissatisfaction. Without changes to address these issues, PD turnover may be high, with potential negative implications for the success of training programs.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, VSZLJ, ZAGLJ, ZRSKP
Abstract Objective This qualitative study aimed to identify doctors’ and nurses’ perceptions of patient-, provider-, and system-level factors associated with human papillomavirus (HPV) vaccine ...completion that may be targets for intervention. Methods We analyzed data from 61 qualitative interviews with pediatricians, family medicine physicians, and immunization nurses at medical centers that had the highest and lowest HPV vaccine completion rates within the same health care system. Results In both groups, almost all providers reported strong support for the HPV vaccine. In detailing how they talk to parents and patients about the vaccine, more of the providers working at higher completion centers described using effective communication techniques, including engaging parents and patients in two-way conversation and demonstrating awareness of cultural and practical barriers to completion that families may face. Providers at higher completion centers were also more likely to depict a local medical culture supportive of and committed to HPV vaccine completion, with greater levels of proactivity and teamwork. In contrast, providers working at lower completion medical centers described a lack of proactivity, and the strategies they suggested to improve HPV vaccine completion tended to be approaches that someone other than medical providers would implement. The comments made by these providers sometimes reflected a level of negativity and judgment absent from the comments of providers at higher completion centers. Conclusion Interventions to improve HPV vaccination completion rates should address both individual- and system-level factors. Improving communication skills, encouraging a supportive medical culture, and addressing resource issues is likely to improve vaccine adherence.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Objective. To examine hepatitis C virus (HCV) seroprevalence among injection drug users in 4 US cities from 1994 through 2004. Methods. Demographic characteristics, behaviors, and prevalence of HCV ...antibody among 5088 injection drug users aged 18–40 years from Baltimore, Maryland; Chicago, Illinois; Los Angeles, California; and New York, New York, enrolled in 3 related studies—Collaborative Injection Drug User Study (CIDUS) I (1994–1996), CIDUS II (1997–1999), and CIDUS III/Drug User Intervention Trial (2002–2004)—were compared using the χ2 and Mantel-Haenszel tests of significance. Trends over time were assessed by logistic regression. Results. Prevalence of HCV infection was 65%, 35%, and 35% in CIDUS I, CIDUS II, and CIDUS III, respectively. The adjusted prevalence odds ratio (OR) of being HCV antibody positive increased with the number of years of injection drug use (OR, 1.93 95% confidence interval {CI}, 1.68–2.21 for each year of injecting within the first 2 years; OR, 1.09 95% CI, 1.07–1.11 for each year of injecting beyond the first 2 years). Significant decreases were observed in the prevalence of HCV antibody between CIDUS I and CIDUS III in Baltimore (OR, 0.30; 95% CI, 0.20–0.43) and Los Angeles (OR, 0.17; 95% CI, 0.09–0.31) and among people of races other than black in Chicago (OR, 0.12; 95% CI, 0.08–0.17). No decrease in prevalence was seen in New York (OR, 1.04; 95% CI, 0.69–1.58) or among blacks in Chicago (OR, 0.55; 95% CI, 0.16–1.90). Conclusion. Although regional differences exist, our data suggest that the incidence of HCV infection among injection drug users in the United States decreased from 1994 through 2004.
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BFBNIB, NUK, PNG, UL, UM, UPUK
In the complex decisions involved in foster care, the needs of adult caregivers and the needs of children may sometimes reflect competing priorities. Foster children can be negatively impacted by ...adult-centered decisions that cause trauma beyond that which led to their entrance into the system. Though dictated by laws and policies meant to increase a child's well-being, foster care decisions often prioritize adult-centered concerns over a child's attachment needs. Utilizing case examples, this discussion paper examines foster care decisions that disrupt important child-caregiver relationships. Considerations for child-centered decision-making may help to reduce emotional trauma in foster children.
•Examines foster care decisions that influence child-caregiver relationships.•Advocates a child-centered approach to reduce toxic stress in foster children•Case studies describe differences between child- and adult-centered decisions.•Proposes considerations to mitigate the effects of toxic stress
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The purpose was to identify the educational needs of pediatric nurses and pediatric nurse practitioners providing direct care to transition-aged youth with chronic illness and disability and to ...identify strategies to develop health care transition planning (HCTP) expertise.
Mixed-methods descriptive analyses were performed on survey data extracted from a larger national study exploring the provision of HCTP activities performed by nurses of two pediatric nursing professional organizations.
Items querying educational needs were completed by 1,162 pediatric nurses serving in advanced practice and staff roles. Twenty percent reported having specialized HCTP education. Of which more than half received it outside of the workplace. Factor analysis revealed two constructs explaining 73.4% of the variance in nurses’ reported level of knowledge.
HCTP education and the development of nurse-led services to facilitate optimal health care transitions outcomes are necessitated. Academia and service have a shared responsibility in educating nurses.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background
As a means to provide safety for a population at great risk of harm through abandonment, every state in the United States now has laws and practices for the safe relinquishment of newborns ...and infants. However, there is no national database tracking the population of infants surrendered through such programmes, and few states monitor these numbers. The primary aim of this study was therefore to examine the descriptive characteristics of infants who have been safely surrendered in a large, socio‐economically diverse urban area. The secondary aim was to compare them with local population norms to determine whether differences exist and to begin exploring what implications such differences may have for the treatment provided to these infants.
Methods
A retrospective cross‐sectional study was conducted among safely surrendered infants.
Results
Over half of the infants had medical issues, and the majority of the infants were surrendered in communities characterized by low median income.
Conclusions
Preliminary information highlights potential economic, social, and medical risk factors, suggesting that these infants may require increased monitoring and/or specialized care.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
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