The Transition Clinical Pathway (TCP) was developed through stakeholder engagement in pediatric, adult, and community settings. This standardized tool:
- Offers a youth-focused approach that facilitates patient engagement
- Increases efficiency by reducing long-hand or unnecessary documentation
- Ensures a patient-centred approach when assessing youth and families' progression towards requirements for transfer
- Supports early identification of those needing additional support
- Reduces variation amongst clinical practices
- Provides direction for standardized processes, benchmarking, and accreditation.
The TCP is a developmentally-appropriate measure of the youth's skills, knowledge and behaviours, initiated at 12 years of age in the pediatric setting and completed at age 24 in the adult system.
The TCP has 3 components:
- Age-sensitive, developmentally-appropriate indicators for youth-focused care and transition readiness.
- Summary of patient profile, including eligibility for adult services, list of adult care providers and reports and assessments required on transfer.,
- Youth-centered written strengths, concerns and goals on transfer.
The TCP (Simple) has been developed for youth who have one chronic health condition without significant cognitive, physical or emotional special needs. The goal is for youth to be engaged in their transition planning to the best of their ability and capacity and, where needed, assisted by others. Download here.
The TCP (Complex) has been developed for youth who have complex health conditions including 2 or more conditions and possible cognitive, physical and emotional special needs. The goal is for youth to be engaged in their transition planning to the best of their ability and capacity and, where needed, assisted by others. Download here.
Indicators within the Transition Pathways correlate directly to the Youth Quiz and Parent & Family Checklist (integrated self-assessment tools for patients and families). Every item on the Youth Quiz and Parent & Family Checklist is linked directly to specialized resources in the Youth Toolkit and Family Toolkit to support self-directed learning.