Transition Programs

The American Academy of Pediatrics' National Center of Medical Home Initiatives is interested in learning about state and clinically-based programs focused on transitioning youth from the pediatric healthcare community into adult healthcare provision. If you know of such a program, please complete the following survey. We would appreciate receipt of this information by February 15, 2008.
Thank you!

1. Please provide primary contact information for the program.

Please provide primary contact information for the program. Program Name:
Primary Contact Name:
Address:
Address 2:
City/Town:
State:
Zip:
Email for Primary Contact:
Phone Number:

2. Which of the following most appropriately describes the setting in which the program exists?

Which of the following most appropriately describes the setting in which the program exists? Pediatric primary care provider's office

Adult primary care provider's office

Referral-based; consultative service

Community health center

Academic institution

School-based program

State-based program

Other (please specify)

3. What is the primary source of funding for the program?

What is the primary source of funding for the program? Federal grant

State grant

State funding (non-grant related)

Institutional support

Provider reimbursement - private

Provider reimbursement - Medicaid

Other (please specify)

4. Please indicate all of the disciplines involved in the program's implementation and maintenance.

Please indicate all of the disciplines involved in the program's implementation and maintenance. Physician

Advanced practice nurse

Physician assistant

Social Worker

Case Manager

Parent

Youth

Educator

Legal expert

Insurance expert

Other (please specify)

5. Of all the disciplines you indicated in question #4, which is the primary discipline necessary for the program's operationalized success?

Of all the disciplines you indicated in question #4, which is the primary discipline necessary for the program's operationalized success? Physician

Advanced practice nurse

Physician assistant

Social Worker

Case Manager

Parent

Youth

Educator

Legal expert

Insurance expert

Other (please specify)

6. Please indicate the greatest barrier your program has experienced to date.

Please indicate the greatest barrier your program has experienced to date. Accessing initial funding

Sustaining funding

Receiving adequate reimbursement

Locating physical space

Recruiting patients

Provider resistance to broach transition issues

Provider resistance to receive transitioning patients

Patient/ family resistance

Communication between providers

Communication among systems of care (i.e. school, health, legal, etc.)

Other (please specify)

7. Describe the assessment tool the program uses. Please include information about the fields included (i.e. health, social, education), when it is administered, how often a patient is assessed with this tool, and if more than one assessment tool is used by the program.

Describe the assessment tool the program uses. Please include information about the fields included (i.e. health, social, education), when it is administered, how often a patient is assessed with this tool, and if more than one assessment tool is used by the program.

8. Describe the program's means of evaluation.

Describe the program's means of evaluation.

9. Describe any tools the program has developed. In your description, please indicate if those tools could be shared with the National Center for Medical Home Initiatives.

Describe any tools the program has developed. In your description, please indicate if those tools could be shared with the National Center for Medical Home Initiatives.

10. Please provide additional narrative regarding uniqueness of the program's patient population, as well as any other information you would like us to know.

Please provide additional narrative regarding uniqueness of the program's patient population, as well as any other information you would like us to know.

11. May we contact the primary contact listed above for further information?

May we contact the primary contact listed above for further information? Yes