Perhaps the most significant difference between a SchoolKit Clinic and a SchoolKit Transition Clinic is that the focus is on the transition process rather than a medical, behavioural or psychological issue.

The most important outcome from the clinic is that the young person and their family come away from it secure in the knowledge that they will continue to have access to the support and guidance they need to help them through the transition process, and understand how it will be made available to them.

Parents may experience a real sense of loss, anxiety and even anger as their young person is required to transition to new, adult service providers. They may also feel an overwhelming sense of responsibility and a loss of confidence in their own capacity to manage the situation.

It has been established that the best way to handle transition is if one person has primary responsibility for coordination of the process. The person may be the transition coordinator, a member of the medical team, or an appointed case manager. The specific issues associated with transition from school will involve a transition teacher.

A Tailored Transition Plan

The individual transition plan may include recommendations and practical assistance in the following areas:

  • Transfer of medical care from a paediatric or adolescent specialist to an adult specialist
  • Referrals to dental services
  • Referrals to disability services
  • Obtaining medical summaries and copies of medical records from paediatric services
  • Providing names and contact details for support groups
  • Providing names and contacts for leisure groups and activities
  • Providing the young person with a hand-held personal medical record
  • Completing applications for financial supports
  • Following-up new or outstanding medical issues identified during the clinic
Ongoing Consultation and Support

Plans and decisions made during the SchoolKit Transition Clinic are recorded and distributed, with permission from the family. The transition care coordinator and other clinic participants may continue to talk together as necessary.

Most importantly, the care coordinator will continue to talk with the family to ensure that all commitments given in the transition plan (whether by themselves or others) have been acted upon.

It is rare that just one SchoolKit Transition Clinic will be sufficient to meet all the young person’s needs, address the family’s fears and concerns, and put the necessary plans in place for the transition to adulthood. A key part of following-up on a clinic, therefore, is planning for the next one. This alone can play an important role in generating, for the family, a sense of confidence that they are not being abandoned or cast adrift.

Ideally, routine adult clinics should take place in the year following transfer to adult services to ensure continuity of care.