Adolescence to adulthood transition programme

The transition from paediatric to adult care is a carefully planned and organised process that entails the transfer of a patient from a child and family-centred healthcare system to one that is geared towards adults.

In this process, transfer refers to the point at which the young patient starts to receive treatment from adult services and is discharged from paediatric services. The transfer does not represent the end of the transition, which is only complete when the young patients are fully integrated and receiving treatment in the adult service.

The process entails three phases: preparation, transfer and integration into adult services

Transition team

The transition process is a joint effort which involves the participation of numerous professionals who meet on a regular basis, particularly in the most complex cases: nursing, paediatric and adult specialists, clinical psychologists, health and social workers, Pharmacy Department team, administration and associations of patients and families.

General objectives

The goals of this process are: to prepare the patient and his/her family or carers for the move from the supervised paediatric environment to the adult services, where they will have greater autonomy: to ensure a successful transition from the paediatric care team to the adult care team - which is accepted by the teenager and his/her family - to provide continuity of comprehensive specialised care; and to ensure proper integration of the young person in the adult healthcare model.

Stages of the transition programme

The child-to-adolescent and adolescent-to-adult transitions, which allow the patient to acquire the skills and knowledge that are required in order to lead an independent life, entail the following aspects:

  • Personal autonomy and autonomy in the management of the disease and its treatment, including awareness of the disease and the importance of adhering to the treatment.
  • Personal development and emotional health.
  • Social situation: detecting any social requirements that need to be worked on, which serves to facilitate the transition process. Guidance on studies, work, social grants, degree of disability, etc.
  • Involvement of parents in the transition. Progressive reduction of their role as caregivers.
  • Accompaniment. Assessment of preparation or suitability for transition.

Questions and answers

Once the transfer has been completed and the patient is over 18 years of age, they can attend the medical visits on their own. However, they can always opt for a family member to come with them.

No. When the paediatric patient who receives pharmaceutical treatments from the Women and Children Pharmacy reaches adult age, they will start receiving said treatments in the General Hospital pharmacy, in the Traumatology, Rehabilitation and Burns Unit, at another hospital or from the local pharmacy.

In the event that a patient is referred from another medical centre to the adult units at Vall d'Hebron, a similar process is followed - albeit with some differences. This may involve a joint video call involving the staff from referring centre, the patient and/or their family and the Vall d’Hebron transition team.

If the patient needs to receive palliative care, a specific evaluation will be carried out to ascertain the most appropriate circuit based on their individual circumstances.

Additional Information

Document

Information for adolescents (in Catalan)

The process begins when the patient is 12-14 years of age, and ends when he/she is fully integrated into the adult hospital. One of the objectives of this programme is to ascertain the most suitable time to make the transfer to adult care. It also seeks to make sure that the patient and his/her family are comfortable with the decision taken.

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Document

Transfer to adult units (in Catalan)

You will move from paediatric care to adult care when you are duly prepared to manage your own care. In short, you will complete the transfer when you have the required knowledge, skills and attitude. This transfer usually occurs between the ages of 16 and 18.

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Document

Information for young adults (in Catalan)

Once you are aged between 16 and 18 and have reached a suitable level of maturity and preparation, you may undergo the transfer and begin the phase of integration into adult care.

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Document

Information for family or caregivers (in Catalan)

You are always accompanied by the Pediatrics team, and if required, the professionals of Clinical Psychology and Social Work. Gradually, your child becomes independent, which is why your involvement is key.

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Document

Information for families or caregivers of patients with intellectual disabilities (in Catalan)

We accompany the patient and you to make the transition from pediatric to adult units.

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