2022 Family Physician Assessment - Health Care Transition for Youth with Special Health Care Needs

Health Care Transition for Youth with Special Health Care Needs Survey

Thank you for taking the time to provide your feedback on the medical care provided to adolescent and young adult patients. Your feedback is appreciated and will assist our efforts in assessing the health care services available to this population.

The survey is completely voluntary and will only take you approximately 5 minutes to complete.

Question Title

* 1. How long since your residency?

0 > 5 years

6 to 15 years

15 to 20 years

> 20 years

Question Title

* 2. Which county do you primarily provide medical services?

Question Title

* 3. Is the practice that you primarily provide services for recognized as patient centered medical home?

Yes

I don't know

Other (please specify)

Question Title

* 4. Have you provided care to patients 12 years of age and older within the past six months?

Yes

Other (please specify)

Question Title

* 5. At what age do you typically begin to meet with your adolescent patient without their parent/caregiver?

Question Title

* 6. Do you discuss reproductive health care and family planning with your adolescent and young adult patients?

Never

Rarely

Often

Sometimes

All of the Time

Question Title

* 7. Do you discuss drug use with your adolescent and young adult patients?

Always

Most of the Time

Sometimes

Rarely

Never

Question Title

* 8. How often do you contribute to, or participate in, special education services through the Individualized Education Plan for your patients

Always

Most of the Time

Sometimes

Rarely

Never

Question Title

* 9. How often does your practice conduct mental health screenings for your adolescent and young adult patients?

Always

Most of the Time

Sometimes

Rarely

Never

Question Title

* 10. Does your practice have a policy or protocol for addressing concerns of bullying for your adolescent and young adult patients?

Yes

I don’t know

Question Title

* 11. Does your practice have a policy or protocol to explain the legal changes that take place in privacy and consent at age 18 for your adolescent and young adult patients?

Yes

I don't know

Question Title

* 12. Do you utilize an evidence based standardized periodicity schedule, tools and anticipatory guidance for the infants, children and adolescent populations that you serve?

Yes

I don't know

Please provide the name of the evidence based tool

Question Title

* 13. How often do you have adolescents transfer to your practice from a pediatric primary care setting?

Always

Most of the Time

Sometimes

Rarely

Never

Question Title

* 14. How often do you communicate with the adolescents’ pediatric specialist to assist with coordinating care?

Always

Most of the Time

Sometimes

Rarely

Never

Question Title

* 15. How often does your practice assists your young adult patients with navigating assistance programs such as SSI Disability and prescription assistance programs to ensure the patient is able to maintain health care coverage as they age out of pediatric assistance programs?

Always

Most of the Time

Sometimes

Rarely

Never

Question Title

* 16. Please rate your comfort level in treating adolescents and young adults with the following health conditions:

	very comfortable	comfortable	somewhat comfortable	least comfortable	not comfortable
Asthma	Asthma very comfortable	Asthma comfortable	Asthma somewhat comfortable	Asthma least comfortable	Asthma not comfortable
Autism – nonverbal	Autism – nonverbal very comfortable	Autism – nonverbal comfortable	Autism – nonverbal somewhat comfortable	Autism – nonverbal least comfortable	Autism – nonverbal not comfortable
Autism - verbal	Autism - verbal very comfortable	Autism - verbal comfortable	Autism - verbal somewhat comfortable	Autism - verbal least comfortable	Autism - verbal not comfortable
Autoimmune disorders e.g. diabetes type I, celiac disease, lupus juvenile idiopathic arthritis	Autoimmune disorders e.g. diabetes type I, celiac disease, lupus juvenile idiopathic arthritis very comfortable	Autoimmune disorders e.g. diabetes type I, celiac disease, lupus juvenile idiopathic arthritis comfortable	Autoimmune disorders e.g. diabetes type I, celiac disease, lupus juvenile idiopathic arthritis somewhat comfortable	Autoimmune disorders e.g. diabetes type I, celiac disease, lupus juvenile idiopathic arthritis least comfortable	Autoimmune disorders e.g. diabetes type I, celiac disease, lupus juvenile idiopathic arthritis not comfortable
Behavioral health concerns	Behavioral health concerns very comfortable	Behavioral health concerns comfortable	Behavioral health concerns somewhat comfortable	Behavioral health concerns least comfortable	Behavioral health concerns not comfortable
Cancer (e.g. leukemia, brain and other central nervous system tumors, neuroblastoma, wilms tumor)	Cancer (e.g. leukemia, brain and other central nervous system tumors, neuroblastoma, wilms tumor) very comfortable	Cancer (e.g. leukemia, brain and other central nervous system tumors, neuroblastoma, wilms tumor) comfortable	Cancer (e.g. leukemia, brain and other central nervous system tumors, neuroblastoma, wilms tumor) somewhat comfortable	Cancer (e.g. leukemia, brain and other central nervous system tumors, neuroblastoma, wilms tumor) least comfortable	Cancer (e.g. leukemia, brain and other central nervous system tumors, neuroblastoma, wilms tumor) not comfortable
Care for Transgender Adolescents	Care for Transgender Adolescents very comfortable	Care for Transgender Adolescents comfortable	Care for Transgender Adolescents somewhat comfortable	Care for Transgender Adolescents least comfortable	Care for Transgender Adolescents not comfortable
Cerebral palsy	Cerebral palsy very comfortable	Cerebral palsy comfortable	Cerebral palsy somewhat comfortable	Cerebral palsy least comfortable	Cerebral palsy not comfortable
Chromosomal/metabolic disorders	Chromosomal/metabolic disorders very comfortable	Chromosomal/metabolic disorders comfortable	Chromosomal/metabolic disorders somewhat comfortable	Chromosomal/metabolic disorders least comfortable	Chromosomal/metabolic disorders not comfortable
Congenital heart disease	Congenital heart disease very comfortable	Congenital heart disease comfortable	Congenital heart disease somewhat comfortable	Congenital heart disease least comfortable	Congenital heart disease not comfortable
Cystic fibrosis	Cystic fibrosis very comfortable	Cystic fibrosis comfortable	Cystic fibrosis somewhat comfortable	Cystic fibrosis least comfortable	Cystic fibrosis not comfortable
Downs syndrome	Downs syndrome very comfortable	Downs syndrome comfortable	Downs syndrome somewhat comfortable	Downs syndrome least comfortable	Downs syndrome not comfortable
Hematological disorders (ie, sickle cell, thrombocytopenia, anemias, platelet disorders)	Hematological disorders (ie, sickle cell, thrombocytopenia, anemias, platelet disorders) very comfortable	Hematological disorders (ie, sickle cell, thrombocytopenia, anemias, platelet disorders) comfortable	Hematological disorders (ie, sickle cell, thrombocytopenia, anemias, platelet disorders) somewhat comfortable	Hematological disorders (ie, sickle cell, thrombocytopenia, anemias, platelet disorders) least comfortable	Hematological disorders (ie, sickle cell, thrombocytopenia, anemias, platelet disorders) not comfortable
Learning disorders (dyslexia, dysgraphia - considered neurologically based - but can co-exist with behavioral/mental disorders - ie, ADHD/ADD)	Learning disorders (dyslexia, dysgraphia - considered neurologically based - but can co-exist with behavioral/mental disorders - ie, ADHD/ADD) very comfortable	Learning disorders (dyslexia, dysgraphia - considered neurologically based - but can co-exist with behavioral/mental disorders - ie, ADHD/ADD) comfortable	Learning disorders (dyslexia, dysgraphia - considered neurologically based - but can co-exist with behavioral/mental disorders - ie, ADHD/ADD) somewhat comfortable	Learning disorders (dyslexia, dysgraphia - considered neurologically based - but can co-exist with behavioral/mental disorders - ie, ADHD/ADD) least comfortable	Learning disorders (dyslexia, dysgraphia - considered neurologically based - but can co-exist with behavioral/mental disorders - ie, ADHD/ADD) not comfortable
Mental health disorders (e.g. anxiety, depression, bipolar disorder, ADD/ADHD)	Mental health disorders (e.g. anxiety, depression, bipolar disorder, ADD/ADHD) very comfortable	Mental health disorders (e.g. anxiety, depression, bipolar disorder, ADD/ADHD) comfortable	Mental health disorders (e.g. anxiety, depression, bipolar disorder, ADD/ADHD) somewhat comfortable	Mental health disorders (e.g. anxiety, depression, bipolar disorder, ADD/ADHD) least comfortable	Mental health disorders (e.g. anxiety, depression, bipolar disorder, ADD/ADHD) not comfortable
Musculoskeletal disorders (ie, Ehlers-Danlos, Marfan's, scoliosis)	Musculoskeletal disorders (ie, Ehlers-Danlos, Marfan's, scoliosis) very comfortable	Musculoskeletal disorders (ie, Ehlers-Danlos, Marfan's, scoliosis) comfortable	Musculoskeletal disorders (ie, Ehlers-Danlos, Marfan's, scoliosis) somewhat comfortable	Musculoskeletal disorders (ie, Ehlers-Danlos, Marfan's, scoliosis) least comfortable	Musculoskeletal disorders (ie, Ehlers-Danlos, Marfan's, scoliosis) not comfortable
Obesity	Obesity very comfortable	Obesity comfortable	Obesity somewhat comfortable	Obesity least comfortable	Obesity not comfortable
Pregnancy	Pregnancy very comfortable	Pregnancy comfortable	Pregnancy somewhat comfortable	Pregnancy least comfortable	Pregnancy not comfortable
Seizure disorders	Seizure disorders very comfortable	Seizure disorders comfortable	Seizure disorders somewhat comfortable	Seizure disorders least comfortable	Seizure disorders not comfortable
Spina bifida	Spina bifida very comfortable	Spina bifida comfortable	Spina bifida somewhat comfortable	Spina bifida least comfortable	Spina bifida not comfortable
STDs	STDs very comfortable	STDs comfortable	STDs somewhat comfortable	STDs least comfortable	STDs not comfortable
Urgent care needs - rashes, influenza, GI and ENT problems	Urgent care needs - rashes, influenza, GI and ENT problems very comfortable	Urgent care needs - rashes, influenza, GI and ENT problems comfortable	Urgent care needs - rashes, influenza, GI and ENT problems somewhat comfortable	Urgent care needs - rashes, influenza, GI and ENT problems least comfortable	Urgent care needs - rashes, influenza, GI and ENT problems not comfortable

Question Title

* 17. How helpful would you find each of the following in increasing your comfort level in accepting youth with special health care needs into your practice.

	Most helpful 5	Very helpful 4	Helpful 3	Somewhat Helpful 2	Least Helpful 1
In office CME on pediatric chronic illnesses	In office CME on pediatric chronic illnesses Most helpful 5	In office CME on pediatric chronic illnesses Very helpful 4	In office CME on pediatric chronic illnesses Helpful 3	In office CME on pediatric chronic illnesses Somewhat Helpful 2	In office CME on pediatric chronic illnesses Least Helpful 1
Written information about condition	Written information about condition Most helpful 5	Written information about condition Very helpful 4	Written information about condition Helpful 3	Written information about condition Somewhat Helpful 2	Written information about condition Least Helpful 1
Support from sub-specialist	Support from sub-specialist Most helpful 5	Support from sub-specialist Very helpful 4	Support from sub-specialist Helpful 3	Support from sub-specialist Somewhat Helpful 2	Support from sub-specialist Least Helpful 1
More office support/care coordination	More office support/care coordination Most helpful 5	More office support/care coordination Very helpful 4	More office support/care coordination Helpful 3	More office support/care coordination Somewhat Helpful 2	More office support/care coordination Least Helpful 1
Conversation with prior physician	Conversation with prior physician Most helpful 5	Conversation with prior physician Very helpful 4	Conversation with prior physician Helpful 3	Conversation with prior physician Somewhat Helpful 2	Conversation with prior physician Least Helpful 1
Written medical transfer summary	Written medical transfer summary Most helpful 5	Written medical transfer summary Very helpful 4	Written medical transfer summary Helpful 3	Written medical transfer summary Somewhat Helpful 2	Written medical transfer summary Least Helpful 1
Information about resources	Information about resources Most helpful 5	Information about resources Very helpful 4	Information about resources Helpful 3	Information about resources Somewhat Helpful 2	Information about resources Least Helpful 1
Online CME	Online CME Most helpful 5	Online CME Very helpful 4	Online CME Helpful 3	Online CME Somewhat Helpful 2	Online CME Least Helpful 1