TRANSITIONTO ADOLESCENCE

AND BEYOND

Dan Wood Consultant in Adolescent and Reconstructive

UrologyUniversity College London Hospitals

Honorary Consultant UrologistGreat Ormond Street

OBJECTIVES

Some definitions What does transition mean? ‘C’ing the issues Other issues

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ADOLESCENCE

Latin Adolescere

(to) grow Presents Challenges

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“An increasing number of chronically ill children are surviving into young adulthood. Achieving a seamless

transfer is becoming one of the greatest challenges facing both children's and

adult services.”

Fiona Smith Adviser in Children's and Young People's

Nursing Royal College of Nursing

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WHAT DO WE THINK?

Friday November 7th 2008

Tranisition clinic - GOSH

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CHALLENGES

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ChangeChange

consultation

consultation

CONSULTATION

Different environment New personnel Information loss Different medical approach Potential for conflicting messages

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CONSULTATION

Building for the rest of your life Regular checks Baseline New team members Watch for problems ?Need for travel???

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CHALLENGES

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ChangeChange

consultation

consultation

confidentiality

confidentiality

CONFIDENTIALITY

Parents in vs. parents out New issues Embarrassment We have to look to build a trust They will grow up

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CHALLENGES

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ChangeChange consentconsent

consultation

consultation

confidentiality

confidentiality

CONSENT

No consent is just me All complex decisions need time …and discussion Important role of our CNS Choices – this can be difficult

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CONSENT

For straight forward procedures – usually no problem

Able to sign for themselves May raise issue from the past Should be a process not an event

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CHALLENGES

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ChangeChange

concordanceconcordance consentconsent

consultation

consultation

confidentiality

confidentiality

CONCORDANCE

With freedom comes responsibility Some have difficulty with this Unsafe? Difficult Usually finite

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CHALLENGES

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ChangeChange

conjugation

conjugation

concordance

concordance

consentconsent

consultation

consultation confidentialit

yconfidentialit

y

CONJUGATION

Permission Ability Fertility Concerns

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CHALLENGES

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ChangeChange

conjugationconjugation

concordance

concordance

consent

consent

consultationconsultation

conflictconflict

confidentiality

confidentiality

CONFLICT

With me With you With others With themselves

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CONFLICT

Listen Understand Explain Give time Re-Explain Empower

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OTHER CONCERNS

Future surgery Continence Other diseases Children (1/70 – 1/100) Historical comparison

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OBSTETRICS

Several studies – 45 ladies 49 deliveries May need Caesarian section All likely to need shared care Prolapse is a problem but treatable

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THE LONG-TERM

Regular reviews Good communication with GPs Follow-up bloods Scans Expertise Outcomes - ?database

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SUMMARY

Some definitions What does transition mean? ‘C’ing the issues Other issues

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THANK YOUAny Questions?

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