Osteoporosis 2016 | Successful transition from paediatric to adult services: Dr Rachel Tattersall...
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Transcript of Osteoporosis 2016 | Successful transition from paediatric to adult services: Dr Rachel Tattersall...
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Successful transition from paediatric to adult services
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Outline
• Understanding young peoples’ care– What is (special about) adolescence– Transition impossible without acknowledging this
• What is transition?– More than just transfer…..
• How can/should you do transition?– Or even better: how to deliver age and
developmentally appropriate care
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“That awkward period between sexual maturation and the attainment of adult roles and responsibilities”
Biological
Delayed growth/ puberty
Psychological
Sick role, regression, mental health (esp
girls), body image, less resilient
independence, failure of peer
relationships, poor school attendance,
family dynamics (other siblings)
Social + emotional
WHAT AGE?
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Tasks of AdolescenceMove from dependent child to independent, resilient, autonomous (healthcare using) adult– Puberty– Adult thinking and
personal identity– Sex, drugs ‘n’ rock
and roll…..risky behaviours
– Education/vocation– Social media– Social pressures
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Adolescents are a big population
• Paediatrics caters for small children
• Adult medicine caters for middle/older age
• 16-25 big population– Utilise health care– 85% seek medical care at
least x1 pa (average x2)• Noncommunicable
disease starts here!
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Timelapse MRI age 5-20 (Grey matter is red) synaptic pruning reduces GM through adolescence
Neurocognitive development
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The developing adolescent brain• Adult brain (‘yourself’) develops ability to– Abstract think– Impulse control/delay gratification– Act independently from peers– Understand long term consequences
• More related to experience than age• Risk taking (hallmark behaviour)in adolescence– necessary– appropriate – Ask about it (HEEADSSS) and ask alone….
Steinberg 2004, 2008
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Communicating with adolescents – standard care for 10-24 year olds
HEEADSSS 3.0• Home• Education• Eating• Activities• Drugs and alcohol• Sexual health• Suicide/spirituality/sleep• Social media/general safety
•http://contemporarypediatrics.modernmedicine.com/contemporary-pediatrics/content/tags/adolescent-medicine/heeadsss-30-psychosocial-interview-adolesce?page=full
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The mismatch
Early adolescence Middle adolescence
Late adolescence + young adulthood
puberty
Brain development
‘Starting the engine without training the driver’
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The Gap
‘Children’ (0-16) looked
after by paediatricians
‘Adults’ (16+) looked after in adult services
Development in all aspects
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The mismatch
Early adolescence Middle adolescence
Late adolescence
puberty
Brain development
‘Starting the engine without training the driver’
Paediatric to Adult
Gap
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Transition bridges the gap
ALL children move from childhood to adulthoodYoung people with ill health have more to lose if they ‘fall into the
gap’ while growing up
multi-faceted, active process attending to the medical, psychological and
educational/vocational needs of adolescents as they move from child to adult-centered care
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How to do transition?
Need identified and enshrined in policy• 2010 Kennedy Report• DOH 2012, 2013– Moving on well– You’re welcome
• CQC report 2014• NICE Guidance 2016• Ready, Steady, Go!
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Paediatrics
AdolescentOPD
Young AdultOPD
LetterOr via GP
Adult
Transition Models:
Same Dr
Different Dr
Nurse / Therapist
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General Barriers
Reasons for failure of successful transition into adult healthcare:
• Financing / politics• Lack of incentive to invest• Lack of service• Lack of planning for transition• Information transfer /admin• Time• Training*
*43% health professionals in national survey reported unmet training needs as barrierMcDonagh JE 2004
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Current Sheffield ‘mirror’ service
10 - 16 16 - 25
Weekly YP clinic 10-15
Monthly transfer clinic 15+YP clinic 16-25
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Both paed and adult services need to:
• provide YPF care – HEEADSSS, see YP alone, promote resilience etc– Train and support each other
• agree how they will prepare/receive YP and what transition for their service looks like– Write a policy and stick to it (don’t reinvent wheels)– Transition is MUCH more than transfer– Ready steady go?
• Address barriers– Collect and audit data, harangue managers, get patients involved,
invoke NICE• Start low, go slow!
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Summary
• Adolescence is a distinct developmental stage• NHS systems constrain good adolescent care• Work across + within systems in ‘YP friendly way’• Prioritise – good communication– Engagement– Choice– Resilience
• Remain open to change and challenge!
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