Multidisciplinary care considerations for gender nonconforming adolescents with eating disorders: A case series.

Gender nonconforming youth are at risk for body dissatisfaction and disordered eating. Currently, only a small body of literature addresses this high-risk group. The five cases in this series highlight important themes for this patient population from an interdisciplinary perspective. Identified themes include increased risk for self-harm/suicide, complex psychiatric, and medical implications of delay to treatment for either gender dysphoria or disordered eating, and the importance of collaborative management to maximize care and facilitate healthy development to adulthood. The purpose of this case series is to expand the interdisciplinary discussion regarding the breadth of presentation and management considerations for gender nonconforming adolescents with disordered eating. An interdisciplinary approach to care might enhance access to comprehensive, collaborative treatment for disordered eating, and gender dysphoria in this unique population.

Transitions to Adult Care for Rhode Island Youth with Special Healthcare Needs.

The transitioning of youth from pediatric to adult care systems is often fraught with discontinuity, miscommunication and gaps in care. This is most significant for youth with special health care needs. A panel discussion on transitioning youth to adult care systems that was part of a learning collaborative held by The RI Care Transformation Collaborative (CTC) is presented here, illustrated by a pertinent case of a youth with type 1 diabetes. [Full article available at http://rimed.org/rimedicaljournal-2016-08.asp, free with no login].

Patient Engagement for Youth in Multiple Facets of Healthcare in Rhode Island.

Health reform strives to be patient-centered but often emphasizes institutional and financial well-being at the expense of patient responsiveness. Rhode Island is a pioneer, with innovative youth engagement programs in health care. The Youth Advisory Board of the Adolescent Patient-Centered Medical Home (PCMH) Initiative at Brown Family Medicine has brought together adolescents to gather feedback about participants' preferences for their health care and bring that feedback to health care providers. The Adolescent Leadership Council (TALC) of Hasbro Children's Hospital is comprised of adolescents with chronic medical illnesses and serves as an advisory group. The Rhode Island Department of Health's Office of Special Needs offers Dare to Dream, a youth leadership development program, a youth advisory council and a healthy lifestyles program. These youth engagement programs allow youth to help shape the health care system to meet their needs and contribute to youth empowerment in the state. [Full article available at http://rimed.org/rimedicaljournal-2016-08.asp, free with no login].

Health care transition for adolescents with special health care needs: a report on the development and use of a clinical transition service.

BACKGROUND: A growing population of adolescents with special healthcare needs is aging into adulthood. These emerging adults face the transition challenges of their healthy peers but also potentially heightened risks and challenges related to their conditions. We describe the process of developing a pilot program to support healthcare services for emerging adults with chronic conditions and present preliminary data on utilization. RESULTS: An outpatient multidisciplinary consult model was developed based on patient, family and physician feedback. Patients with diverse conditions were equally referred from primary care, subspecialists and families and community agencies. Services provided included needs assessments (100%), referral to adult physicians (77%), care coordination (52%) and referrals to adult community services (10%). Clinical billing did not fully support the cost of providing services. CONCLUSION: The pilot program offered multidisciplinary transition services that were utilized by a diverse patient population. Local and national resources for health care transition are provided.

An evaluation of a positive youth development program for adolescents with chronic illness.

PURPOSE: Youth with chronic illness often struggle transitioning to adulthood and adult medical care. This article examines the outcomes of a group mentoring program called The Adolescent Leadership Council (TALC) that brings together high school participants and college mentors, all with chronic illness. TALC uses a positive youth development (PYD) approach, emphasizing strong relationships between youth and adults in an environment where youth can learn important life skills and take a leadership role. METHODS: A pre-/postprogram participant survey was conducted for high school participants using a loneliness scale and a transition readiness survey. An alumni survey was conducted with all high school and college mentor graduates to assess educational-, vocational-, and health care-related outcomes. RESULTS: Program records review and the alumni survey indicated that TALC was consistent with the PYD program model. Twenty high school students participated in the pre-/postprogram outcomes evaluation, which demonstrated a decrease in loneliness from 46 to 38.5 (p < .001) and an increase in health care self-advocacy from 3.8 to 4.2 (p < .001). Thirty-four alumni participated in the alumni survey. All high school and college mentor alumni had graduated from high school and college, respectively, and all were either currently in school or working. The majority of alumni were seeing adult providers for medical care. CONCLUSIONS: The TALC program applies the principles of PYD to support positive educational, vocational, and health care outcomes for youth with chronic illness. Program development using the PYD perspective is an important new approach for supporting adult development of youth with chronic illness.