Research Summaries

Healthcare transition is a very complex process. You may think of many more things that impact a successful transition.

As a summary of healthcare transition models in autism, you can review the research presented in the table below.

Which aspects of these models do you like?
What’s missing?
What questions do you have about applying this research to Vermont?

**Side-by-side comparison of Healthcare Transition models**
#1: Medical HOME & Managed care	#2: Fearless Tearless Transition	#3. Experiences at a Large Healthcare System	#4: Center for Autism within a primary care practice (CAST)	#5: Group Family Education “Transitioning Together”
Survey of	Pre-post design and Survey of	Phone interviews	Focus group and chart review	Pre-post design and survey
129 caregivers	22 caregivers	14 Autistic participants 17 Caregivers 8 providers	10 Autistic adults without ID 74 charts	11 caregivers
Specialty autism clinic Providing primary care, care coordinator and other services in the same clinicFunded by Medicaid and private insurance as a HMO	Shared care communication book Transition manager meets youth with pediatrician Transition assessment Transition plan Training portal for provider Network of specialists Resource Guide		Clinic for Autistic adolescents and adults. In a primary care, medical home clinic. Pre-visit phone call Accommodations 60 min for first visit Training videos “Happy Visits”	2 individual sessions to set up goals 8 group sessions for parents only (1.5h)Topics covered: Adult Autism, transition planning, problem solving, home- family-behavior, independence, community access, health, legal issues.
All ages Complex needs Transition at age 22 Salt Lake City Pop. 200,000	Starts at age 15 Complex needs Progressive age 16-18 Melbourne, Australia Pop. 5 million	All ages All levels of needs Transition at age 18 Northern California Pop. 4.5 million	All ages All levels of needs No set age Columbus Ohio Pop. 900 000	Ages 15-18, all needs USA

**Outcomes**
#1. Medical HOME & Managed care	#2: Fearless Tearless Transition	#3. Experiences at a Large Healthcare System	#4: Center for Autism within a primary care practice (CAST)	#5: Group Family Education “Transitioning Together”
Compared to national data	No comparison.		No comparison.	No comparison.
More family-centered More shared decisions More coordination of care More access to medical home model Less stress with bills Easier to get care More discussion of transition	67% found it useful More prepared Not more confident Less concerns and unmet needs Improved: Self-care of health needs Home-family life, lifestyle (diet, exercise, etc.) Funding for healthcare Work emotional wellbeing/mental health friends and activities No change: sexual health Age 16 reported for first transition discussion	Autistics and caregivers want: To be included in decisions Skills to transition Support for change in parent role More preventative, not reactive care Sexual healthcare Gradual transition Providers want: Transition coordinator Information and tools to better care for autistics Longer visits for transition care	23% of Autistics needed a modified visit 7 of 17 had difficulty completing part of the exam Difficulty waiting and noises were the most common challenges Skipping the waiting room was most common change to practice Able to decrease follow-up visit to 20 min as expertise developed Growing quickly Funding of extra services is challenging	Improved: Learned about their teens Learned about services Improved relationships More positive view of teen Improved predicting child behavior No changes: No change in behavior No change in parent stress