GuidebookSix Core ElementsElement 3 Transition ReadinessElement 3.1

3.1 Conduct regular transition readiness assessments, and in collaboration with youth (and family members/caregivers, if appropriate) identify youths’ needs and goals, update regularly.

Transition readiness refers to the level of ability to self-manage illness (with tasks in domains such as managing prescriptions, making appointments, and communicating with care providers, etc.) and navigate to the adult mental health care system.

Transition readiness should be assessed early (i.e., at least six months prior to planned transitions in care) and regularly throughout the period leading to the transfer of care. This can help prioritize the learning areas where youth need support (i.e., self-management of prescriptions) before transitioning out of child and adolescent mental health services. Regular transition readiness re-assessment (i.e., every six months or every third appointment) can help evaluate progress and identify the youth's evolving transition and care goals.

NOTES FROM A NAVIGATOR

In that [readiness] assessment, I'm looking for information about [the youth]… is the parent supported...It could also be about school... We also assess for sexuality, for suicidality, to see if they have a crisis plan in place. Also talk about medication…From that assessment, I have a pretty good idea of this family's gonna need a weekly call…or the youth feels that they're confident enough to handle some of the transition pieces on their own. 

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Uncomplicated access, seamless transitions, continuous care.

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Copyright Dr. Kristin Cleverley 2023.