Young People Lost and Found in Transition?

Abstract

When I was working in practice as Charge Nurse in children’s renal nursing and later as a Nurse Specialist in pediatric hematology in the late 1980s and early 1990s, we were beginning to grapple with the challenge of facilitating a smooth transfer of our teenage patients with long-term conditions such as end-stage renal failure and hemophilia to adult services. Understandably this was a worrying time for both the young people involved and their families. They had come to rely on health-care staff and organizations whom they had grown to trust and rely upon over most of the young person’s life so far and moving on felt like a leap into the dark. In those early days, we aimed to respond to their concerns by organizing joint visits to adult services to give young people and parents a chance to get to know adult service providers and arranged for the young people to be in small peer support groups so that they did not lose all the friends that had been made because of the transfer. Since then, the move to adult services has been recognized as a “transition” process that begins ideally in the early teens, rather than a “transfer” event when a young person reaches age 16 or 18. Consequently, we have seen the development of a wide range of innovative approaches to assessing transition readiness and provision of transition preparation and support programmes in the intervening years. Professional bodies; organizations such as the National Institute for Health and Care Excellence and Social Care Institute for Excellence in the U.K.; service commissioners and service providing organizations and community organizations advocating for young people and families have provided wide-ranging guidance, yet seamless transition is still not experienced by all young people. In health and care services, the process often tends to be led by enthusiastic individual practitioners rather than through universal, comprehensive strategic approaches. This means that many young people still “fall through the net” in their transition to young adulthood, with potential loss to follow up and ongoing support and therefore numerous associated risks to health and emotional wellbeing. Through academic study in applied Psychology, and my own research in the area of Transition (Medforth, 2022; Medforth & Huntingdon, 2018a, 2018b; Medforth et al., 2019) I have come to recognize that transition is a developmental journey experienced by all young people but is also complex and multi-faceted. It involves development across numerous trajectories (sometimes simultaneously) such as education to employability; friendships and relationships; family and independence. For young people who live in complex circumstances such as having a disability, long-term or life-limiting