Improving transition:  Navigating from pediatric to adult health services for young adults with complex care needs

November 12, 2013
12:00 noon – 1:00 pm ET


Transition to adulthood is associated with a number of milestones, chief among them obtaining adult employment, realizing fulfilling roles in the adult community, living independently, and experiencing satisfactory personal and social relationships. For patients with chronic physical and mental conditions and their families, transition from pediatric to an adult care system is especially challenging: not only are they entering a new stage of life in adulthood, they are also tasked with learning how to manage their health, medical and social needs within an adult health system and community that is not designed to address their unique needs. 

Unsuccessful transition from pediatric to adult services in young adults with complex care needs has been associated with deterioration of health status and acceleration of mortality (through lack of appropriate follow up care, for example).  Successful transition programs can significantly Increase the quality and efficiency  of healthcare through reducing emergency room visits, increasing continuity of care, and improving patient and physician relationships.


Join CFHI and guest speakers Miriam Kaufman, ‎Head of the Division of Adolescent Medicine, Hospital for Sick Children; Dolly Menna-Dack, Youth transition facilitator at the LIFEspan clinic at Holland Bloorview with personal transition experience; and Mary Paone, Nursing Lead for Transition, BC Children’s Hospital, for this session of On Call, where participants will hear about and discuss:

  • successful transition programs and strategies that have improved the coordination and efficiency of transition from pediatric to adult health services for young adults with complex care needs.
  • strategies for how to engage youth, families, and providers to promote successful transition
  • factors that have promoted successful implementation and sustainability of transition programs within organizations

 Join the discussion!

Dolly Menna-Dack imageDolly Menna-Dack
Youth Facilitator, LIFEspan transition clinic, Holland Bloorview Kids Rehabilitation Hospital and UHN’s Toronto Rehab

Donna Menna-Dack is a Youth Facilitator in the cross-organizational LIFEspan transition clinic at Holland Bloorview Kids Rehabilitation Hospital and UHN’s Toronto Rehab. Dolly also works in the Participation & Inclusion department helping clients build their advocacy and life skills. Dolly a former client of both Sick Kids and Holland Bloorview Kids Rehabilitation Hospital. After having a rocky transition to adult medical care she became passionate about engaging youth and families in thinking about the future and taking steps to ensure their own success.

Miriam Kaufman imageMiriam Kaufman BSN MD FRCPC
Head of the Division of Adolescent Medicine, The Hospital for Sick Children.

Miriam Kaufman is a paediatrician and public educator. She graduated from Duke University School of Nursing in 1976 and Queen’s University in 1980. Her first two years of paediatric residency were at McMaster and she then came to SickKids for a third year of residency and a fellowship in Adolescent Medicine. She joined the SickKids staff shortly thereafter.

Dr. Kaufman’s main clinical interest is with teens who have a chronic illness or disability. She works with these teens around issues of transition, coping, adherence, sexuality and reproduction, substance use and body image. Miriam has written books and articles for teens and their parents and speaks at schools, conferences and to the media frequently.

Mary Paone imageMary Paone RN MSN
Nursing Lead for Transition, ON TRAC Transition Initiative, BC Children's Hospital

Mary Paone is the Nursing Lead for the ON TRAC Transition Initiative. With years of experience working with and learning from youth with chronic health conditions and their families, she has a personal passion to improve health care services for youth as they prepare for and reach adulthood. Experiences in marketing, business planning and education in the clinical and university settings has been beneficial in the development of a provincial initiative designed to meet the needs of a variety of stakeholders. Mary’s commitment to the field of transition began in 1998 with the inception of the original ON TRAC framework, numerous publications, clinical work and presentations throughout North America. She is delighted to have a second opportunity to continue the work of ON TRAC and share her learning nationally as the co-chair for the Transition Community of Practice for Canadian Association of Paediatric Health Centres (CAPHC) in the development of National Clinical Practice Guidelines.