1.5 Determine clear responsibilities for all roles within the organization involved in the transition of care, to be further informed by the needs of each youth.
1.5 Determine clear responsibilities for all roles within the organization involved in the transition of care, to be further informed by the needs of each youth.
Role clarity is an essential component of positive interprofessional collaboration (IPEC, 2016; McLaneyet al., 2022) A clear organizational framework that defines ownership of different aspects of the transition can help teams effectively plan and manage transition care. At an organizational level, it is important to determine who is responsible for supporting transitions. This includes identifying those responsible for developing a transitions policy, building capacity and training team members, and creating integrated care pathways for your organization's transitions. You might consider what “typical” involvement should look like for:
- Youth making the transition between services
Child and Adolescent Mental Health Services staff
Community or Adult Mental Health Services staff
Peer support workers (if applicable)
Transition Navigators (if applicable)
Family members/Caregivers, (if applicable)
When defining roles and responsibilities, considerations should include:
- Who is responsible for transitions at a management or leadership level within the organization? Who is responsible for transitions within the circle of care?
- How will youth (and family/caregivers if appropriate) be involved in the determining who makes up their transition support team?
- How will the responsibilities of the care team be adapted, where possible, to reflect the unique needs of each individual youth?
- How will this process can be incorporated into daily clinical practice? For example, how can clinical rounds be utilized to provide ongoing touchpoints, ensuring continued role clarity?
The above considerations may be written into the organizational policy discussed in component 1.2
Resources
Rating tool to assess caregivers involvement and improve interactions with healthcare providers
Roles and tasks for transition
Speaking from experience, a roadmap and game book as a parent would have been incredibly valuable... I needed to adjust and adapt as my daughter progressed through the recovery lifecycle of her condition. I also needed to learn new skills in order to effectively communicate, respond to 'crisis' situations and problem solve. It would have been valuable to learn this right from the start
- Clinician
