“Transition is the purposeful, planned movement of adolescents and young adults
with chronic physical and medical conditions from child-centered to adult-oriented health care systems.”
(Blum et al, 1993)
At CMO we are committed to providing outstanding care to infants, children, and adolescents as they grow and develop. We believe strongly that children are not “just small adults” and we treat them accordingly for both medical and developmental concerns. However, this process of growth, development, and emotional maturation, does naturally come to an end — children become adults.
In early adolescence, we start treating our patients differently — we give them more responsibility for their health maintenance, and encourage independence in their self-care and advocacy (see our Adolescent Confidentiality Policy). We believe that by teaching adolescents how to care for their bodies and talk to physicians about their ailments, they are better able to transition into adulthood and assume adult roles and activities.
There are several reasons both adolescent patients and pediatricians feel it is necessary to transition towards adult providers between the ages of 18 and 21 years.
First, many of our older adolescents begin to feel uncomfortable in a waiting room full of infants and toddlers. While this is not a true medical reason for transition, it certainly creates a tension in the doctor-patient relationship.
Second, adolescents and adults have different medical issues than younger children. While we are capable of managing these illnesses, it begins to make more sense to have patients develop relationships with adult providers who can manage these illnesses in the long-term.
Third, adult patients require different medical and social resources and specialists from pediatric patients. Our typical referral base to pediatric specialists at Mass General Hospital and Children’s Hospital is no longer applicable to new patients over age 18. We want to provide high quality care and referrals but have fewer adult care resources.
When to transition?
Not all young people are ready to transition at the same time. We consider each individual’s cognitive and physical development, emotional maturity, and state of health. However, in general, adolescents should start considering the transition of care around age 18. We expect patients to be fully transitioned to adult-oriented care by the end of college or before age 22, whichever is first.
What about patients with complex medical or behavioral issues?
These patients need to transition their care as well. We understand that it can be difficult; adolescents with chronic medical issues may have a large team of doctors and other caregivers, and each of these doctors may have different age limits and expectations around transition to adult care. We want to make this transition as smooth as possible and are happy to help identify and speak with specialists directly to ensure that needed services continue. We have developed a list of adult practices equipped to handle the special needs of our complex patients, to assist in the transition.
Young women who have carried or are carrying a pregnancy to term, and young men who have fathered a child will be asked to leave the practice immediately. These life decisions are consistent with full adult decision-making and require immediate transition to adult medical care. We will be happy to care for the new baby when it arrives.
We will continue to accept new adolescent patients to our practice until age 16. Dr. Summers, who specializes in adolescent medicine, will accept new patients until age 18. We will continue to provide routine well adolescent care for our established patients between ages 18-21, but will discuss transition of care at each of these visits.
For patients ages 20-21 requesting an annual well visit, the front desk will discuss directly with your primary provider whether a visit is recommended at our office or whether transition of care has already been initiated to an adult provider. We will not schedule well or sick visits for patients above age 22 or for patients who have already transitioned their care to an adult provider.
Full Medical Records should follow every patient to their adult care provider. We will provide a Medical Record Release Form to be signed by patients who are 18 and over. Records are forwarded to the new primary care office within 1-2 weeks of receiving a signed form in our office.
We have developed a list of adult physicians that we are happy to provide. This is by no means an exhaustive list, nor does it mean that these physicians are specifically recommended over others. It is merely a “jumping off point” to help the transition process along.