At seventeen, a young woman has seen the same pediatrician since she was two. Her mother makes the appointments, holds the insurance card, and answers most of the questions in the exam room. The pediatric practice says it will stop seeing patients at twenty-one. No one has asked whether she knows her medications.
Moving from child to adult health care is part of growing up, and it is easy to skip because nothing forces it until the day it must happen. This guide offers a checklist built on a national model, with ideas for the school's transition plan. It is general information, not medical or legal advice. Your child's clinician is the best source for your child's health plan.
What health care transition means
Got Transition, a program of the National Alliance to Advance Adolescent Health, describes health care transition as the process of getting ready for health care as an adult. It notes that parents usually handle appointments, forms, and medications in childhood, and that as the young person grows those tasks become the young person's responsibility. An organized process helps build independent health care skills and move to adult clinicians.
The six core elements
Got Transition publishes the Six Core Elements of Health Care Transition, a framework for health care practices. The page notes that version 3.0 is widely adopted and is called for in a 2018 clinical report from the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians. The elements come with ages.
| Element | Ages on the timeline | What it means |
|---|---|---|
| Transition and care policy | 12 to 14 | The practice develops, discusses, and shares a policy or guide about how transition works |
| Tracking and monitoring | 14 to 18 | The practice tracks progress with a flow sheet or registry |
| Readiness | 14 to 18 | The young person's self-care skills are assessed, and needs are taught |
| Planning | 14 to 18 | A health care transition plan is made, with a medical summary |
| Transfer of care | 18 to 21 | The young person moves to adult-centered care or an adult practice |
| Transition completion | 18 to 23 | The transfer is confirmed, and the young person gives feedback |
These are elements for practices to carry out. Families can ask the clinician whether the practice uses them.
A checklist by stage
The Got Transition pages do not give an age-by-age family checklist in the text we read, so this list is a practical outline built from the framework and the skills the pages name, such as scheduling, tracking medications, and self-advocacy. Adapt it with your child's clinician.
| Stage | Steps |
|---|---|
| Around 12 to 14 | Ask the practice whether it has a transition policy. Let the young person speak first in part of each visit |
| Around 14 to 16 | Take the readiness quiz from Got Transition. Teach the names of conditions and medications. Practice describing symptoms |
| Around 16 to 18 | Have the young person schedule a visit, refill a prescription, and keep the insurance card. Ask for a medical summary and a transition plan |
| Around 17 to 18 | Ask the doctor's office what changes at 18 for consent and records. Learn about decision-making supports. See age of majority in the IEP |
| Around 18 to 21 | Identify an adult clinician or an adult-centered approach. Transfer records. Confirm the first visit |
| After the move | Check that the young person is comfortable, and share feedback with both practices |
Skills a teen can build
Got Transition's pages describe the work in terms of managing your own health care needs, such as scheduling appointments and keeping track of medications, and learning to speak up for yourself. Practice can be built into ordinary life.
- Know the basics. Name the diagnoses and medications, and the reason for each.
- Carry key information. A medical ID on a smartphone is one resource Got Transition links to.
- Make the call. Schedule one appointment, with a parent beside the teen.
- Ask questions. Write three questions before each visit and ask them. Got Transition offers a resource called Questions to Ask Your Doctor.
- Keep records. A folder or an app with the insurance card, provider list, and medication list.
How the school can help
The IEP's transition section can include health-related independent living goals where the team finds them appropriate. Examples of goals teams might write, with invented wording: "After graduation, Kim will schedule and attend her own medical appointments," or "After graduation, Sam will take his medication as prescribed using a phone reminder." See independent living skills goals for the pattern.
The federal definition of related services includes school health services and school nurse services, which are health services designed to enable a child with a disability to receive a free appropriate public education as described in the IEP. If your child needs health services at school, the IEP team decides what is needed. That is a school matter, and it is separate from the child's health care transition, though the two can inform each other.
Questions for your child's clinician
Insurance and coverage
Coverage can change at the same ages. Some young people move from a children's program to an adult program, and some programs have waiting lists. This guide does not give coverage rules, because they depend on the state and the program. For an orientation on one important program, see Medicaid waivers overview, and ask your state Medicaid agency and your insurer what changes.
Health care transition mix-ups
- Waiting until 18. The framework starts with policy and readiness years earlier.
- Doing everything for the teen until the day of the move. Skills need practice.
- Assuming the pediatric practice will arrange the transfer. Ask whether it does.
- Forgetting records. Request a medical summary.
- Treating school health plans and the health care transition as one thing. They overlap but are separate.
Terms are in the glossary.