Youth Health Transition: Maximizing Adolescent Well-Care Visits

The American Academy of Pediatrics and Bright Futures recommend annual well-care visits throughout adolescence to promote healthy behaviors, prevent risky ones, and detect conditions that can interfere with physical, social, and emotional development. Adolescent well-care visits promote better health during the transition from childhood to adolescence and adolescence to adulthood.

This provider toolkit is designed to help clinics provide high-quality adolescent well-care visits that integrate best practices for Youth Health Transition (YHT) services into their regular clinic practice. Based on clinical practice guidelines from national experts and lessons learned from the field, this resource can be used by any health care or social service professional working with adolescents and young adults, such as physicians, nurses, social workers, clinic managers, and support staff.

All practices have some level of existing transition services in place, so this toolkit can help build on what is already being done. It is customizable based on your goals and will help you assess, plan, and implement YHT services at your own pace. You can also access the printable version of the toolkit here.

 

What is Youth Health Transition?

YHT is the process of shifting from a pediatric to an adult model of health care and represents an important milestone for adolescents and young adults. YHT also includes specific anticipatory guidance and care coordination that gradually transfers health care responsibility from a parent or guardian to their adolescent or young adult.

Adolescent well-care visits are the mainstay of youth health transition services, and receiving transition services improves short and long-term health outcomes for adolescents who receive them. Pediatric providers can assist adolescents in this process by meeting with them without their parents in the room and discussing their role in managing their health care routines, how to transition to an adult primary care provider, vocational/education choices, adult health/dental insurance options, and independent living supports.

YHT has been identified as important by leading physician groups, including the American Academy of Pediatrics (AAP), the American Academy of Family Physicians, and the American Colleges of Physicians. Decades of research show associations between unplanned or abrupt YHT and poor health outcomes.

Many adolescents and young adults don’t receive transition services and, as a result, experience gaps in care that include separation with treatment regimens. Research identifies the association between failed healthcare transition and increased morbidity and mortality for youth with special physical or mental health care needs.

Got Transition®, a Leading National Organization on Youth Health Transition, Developed the Six Core Elements of Health Care Transition.

Got Transition’s Six Core Elements, now in its third iteration, is a widely adopted approach to transition outlined in the 2022 Clinical Report, Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home from the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians. 

The Six Core Elements 3.0 defines the basic components of a structured transition process and are intended to be used by providers to help youth transition to an adult model of care.

The Six Core Elements is not a model of care but a structured process that can be customized for use in a busy practice and applied to many different types of transition care models. These elements (listed below) are incorporated into the steps of this toolkit:

1. Create a clinic transition policy

2. Track transition progression

3. Assess transition readiness and/or orientation to adult practice

4. Plan for transition

5. Transfer to adult care

6. Transfer completion and ongoing care

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Social determinants of health significantly influence the successful transition from adolescence to adulthood. Research has identified social connections, economic factors, health behaviors, and one’s physical environment as drivers of health outcomes. Due to this, a holistic approach to supporting youth health care transition is essential.  

All practices serving adolescents offer some level of YHT services. For individuals insured by Medicaid, many of these services are incorporated within the Early Periodic Screening Diagnosis Treatment (EPSDT) adolescent well-exam.

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This example demonstrates the importance of youth health transition services and how support from a healthcare provider can be beneficial. It can be challenging for any teen to transfer to a new provider or take responsibility for their health care. This process is often more complex for adolescents with chronic health conditions and disabilities.

Adolescents with special health care needs tend to see multiple providers and require more coordinated care to maintain their health. Youth health transition services are an integral component of preventive care for adolescents both with and without special needs.

 

This web-based resource is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $12,947,060.00 with 0% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.

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