The International Perspective on Healthcare Transition

  • Beth E. Anderson
  • Swaran P. Singh
  • Claire Stansfield
  • Kristin Liabo


This chapter identifies effective models and components of good practice in supporting young people as they move from children’s to adults’ health services, from an international perspective. The chapter builds on systematic review evidence to identify recent lessons from emerging international practice. There is insufficient evidence to identify one single model as best practice overall. There is, however, consensus in the literature about the broad principles that should underpin all models and some promising clusters of practice from which others can learn.


Effectiveness Transition models Health care Young people Adolescents 



The reviews informing this chapter were funded by the Department of Health and commissioned by the National Institute for Health and Care Excellence in the United Kingdom.


  1. 1.
    Hagell A, Coleman J, Brooks F. Key data on adolescence 2013. London: Association for Young People’s Health; 2013.Google Scholar
  2. 2.
    World Health Organization. Adolescents: health risks and solutions. Factsheet. 2016.
  3. 3.
    Sawyer SM, Afifi RA, Bearinger LH, Blakemore SJ, Dick B, Ezeh AC, Patton GC. Adolescence: a foundation for future health. Lancet. 2012;379(9826):1630–40.PubMedCrossRefGoogle Scholar
  4. 4.
    Office for National Statistics. Population estimates by single year of age and sex for local authorities in the UK, mid-2015. ONS. 2016.Google Scholar
  5. 5.
    U.S. Census Bureau. Annual estimates of the resident population for selected age groups by sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2015. 2016.Google Scholar
  6. 6.
    Statistics Canada. Table 051-0001 – Estimates of population, by age group and sex for July 1, Canada, provinces and territories, annual (persons unless otherwise noted), CANSIM (database). Accessed 15 May 17.
  7. 7.
    Australian Bureau of Statistics. Australian demographic statistics. June Quarter 2015. 3101.0. 2015.Google Scholar
  8. 8.
    Viner RM, Barker M. Young people’s health: the need for action. BMJ. 2005;330(7496):901–3.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Patton GC, Coffey C, Cappa C, Currie D, Riley L, Gore F, Degenhardt L, Richardson D, Astone N, Sangowawa AO, Mokdad A. Health of the world’s adolescents: a synthesis of internationally comparable data. Lancet. 2012;379(9826):1665–75.PubMedCrossRefGoogle Scholar
  10. 10.
    Sixty-fourth World Health Assembly. Resolution WHA 64.28: youth and health risks. Geneva: World Health Organization; 2011.Google Scholar
  11. 11.
    Singh SP, Winsper C. Adolescent mental health: the public health response. In: International handbook on adolescent health and development. 2017. doi:
  12. 12.
    Scal P, Ireland M. Addressing transition to adult health care for adolescents with special health care needs. Pediatrics. 2005;115(6):1607–12.PubMedCrossRefGoogle Scholar
  13. 13.
    Blum RW, Garell D, Hodgman CH, Jorissen TW, Okinow NA, Orr DP, Slap GB. Transition from child-centered to adult health-care systems for adolescents with chronic conditions: a position paper of the Society for Adolescent Medicine. J Adolesc Health. 1993;14(7):570–6.CrossRefGoogle Scholar
  14. 14.
    Rachas A, Lefeuvre D, Meyer L, Faye A, Mahlaoui N, de La Rochebrochard E, Warszawski J, Durieux P. Evaluating continuity during transfer to adult care: a systematic review. Pediatrics. 2016;138(1):e20160256.PubMedCrossRefGoogle Scholar
  15. 15.
    In UK policy, for example, this included: Department for Children, Schools and Families/Department of Health (2007) A transition guide for all services; and, Commissioning Panel for Mental Health (2012) Guidance for commissioners of mental health services for young people making the transition from child to adult mental health services.
  16. 16.
    Nguyen T, Embrett MG, Barr NG, Mulvale GM, Vania DK, Randall GE, Direzze B. Preventing youth from falling through the cracks between child/adolescent and adult mental health services: a systematic review of models of care. Community Ment Health J. 2017;53(4):375–82.PubMedCrossRefGoogle Scholar
  17. 17.
    Hepburn CM, Cohen E, Bhawra J, Weiser N, Hayeems RZ, Guttmann A. Health system strategies supporting transition to adult care. Arch Dis Child. 2015;100(6):559–64.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Davis AM, Brown RF, Taylor JL, Epstein RA, McPheeters ML. Transition care for children with special health care needs. Pediatrics. 2014;134(5):900–8.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    NICE. Transition from children’s to adults’ services for young people using health or social care services. Appendix C3 – Economic Report. London: National Institute for Health and Care Excellence; 2016.Google Scholar
  20. 20.
    Patton GC, Viner R. Pubertal transitions in health. Lancet. 2007;369(9567):1130–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Steinberg L. Risk taking in adolescence: new perspectives from brain and behavioral science. Curr Dir Psychol Sci. 2007;16(2):55–9.CrossRefGoogle Scholar
  22. 22.
    McDonagh JE, Viner RM. Lost in transition? Between paediatric and adult services: it’s time to improve the transition of adolescents from paediatric to adult services. BMJ. 2006;332(7539):435.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Shaw KL, Southwood TR, McDonagh JE. Developing a programme of transitional care for adolescents with juvenile idiopathic arthritis: results of a postal survey. Rheumatology. 2004;43(2):211–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Swift KD, Sayal K, Hollis C. ADHD and transitions to adult mental health services: a scoping review. Child Care Health Dev. 2014;40(6):775–86.PubMedCrossRefGoogle Scholar
  25. 25.
    Paul M, Street C, Wheeler N, Singh SP. Transition to adult services for young people with mental health needs: a systematic review. Clin Child Psychol Psychiatry. 2015;20(3):436–57.PubMedCrossRefGoogle Scholar
  26. 26.
    Singh SP. Transition of care from child to adult mental health services: the great divide. Curr Opin Psychiatry. 2009;22(4):386–90.PubMedCrossRefGoogle Scholar
  27. 27.
    Beresford B, Cavet J. Transitions to adult services by disabled young people leaving out authority residential schools. Social Policy Research Unit, University of York; 2009.Google Scholar
  28. 28.
    Clarke S, Sloper P, Moran N, Cusworth L, Franklin A, Beecham J. Multi-agency transition services: greater collaboration needed to meet the priorities of young disabled people with complex needs as they move into adulthood. J Integr Care. 2011;19(5):30–40.CrossRefGoogle Scholar
  29. 29.
    Care Quality Commission. From the pond into the sea. Children’s transition to adult health services. London: Care Quality Commission; 2014.Google Scholar
  30. 30.
    Betz CL, O'Kane LS, Nehring WM, Lobo ML. Systematic review: health care transition practice service models. Nurs Outlook. 2016;64(3):229–43.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Bloom SR, Kuhlthau K, Van Cleave J, Knapp AA, Newacheck P, Perrin JM. Health care transition for youth with special health care needs. J Adolesc Health. 2012;51(3):213–9.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Kime NH, Bagnall AM, Day R. Systematic review of transition models for young people with long-term conditions: a report for NHS Diabetes. 2013.Google Scholar
  33. 33.
    Watson R, Parr JR, Joyce C, May C, Le Couteur AS. Models of transitional care for young people with complex health needs: a scoping review. Child Care Health Dev. 2011;37(6):780–91.PubMedCrossRefGoogle Scholar
  34. 34.
    Por J, Golberg B, Lennox V, Burr P, Barrow J, Dennard L. Transition of care: health care professionals’ view. J Nurs Manag. 2004;12(5):354–61.PubMedCrossRefGoogle Scholar
  35. 35.
    Jordan L, Swerdlow P, Coates TD. Systematic review of transition from adolescent to adult care in patients with sickle cell disease. J Pediatr Hematol Oncol. 2013;35(3):165–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Mills J, Cutajar P, Jones J, Bagelkote D. Ensuring the successful transition of adolescents to adult services: Jonathan Mills and colleagues discuss findings from an audit of the referral and transfer of children with learning disabilities to services for adults. Learn Disabil Pract. 2013;16(6):26–8.CrossRefGoogle Scholar
  37. 37.
    Beresford B, et al. Making a difference for young adult patients. Research Briefing. Bristol: Together for Short Lives; 2013.Google Scholar
  38. 38.
    Binks JA, Barden WS, Burke TA, Young NL. What do we really know about the transition to adult-centered health care? A focus on cerebral palsy and spina bifida. Arch Phys Med Rehabil. 2007;88(8):1064–73.PubMedCrossRefGoogle Scholar
  39. 39.
    Garvey K, Wolpert H, Laffel L, Rhodes E, Wolfsdorf J, Finkelstein J. Health care transition in young adults with type 1 diabetes: barriers to timely establishment of adult diabetes care. Endocr Pract. 2013;19(6):946–52.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Sebastian S, Jenkins H, McCartney S, Ahmad T, Arnott I, Croft N, Russell R, Lindsay JO. The requirements and barriers to successful transition of adolescents with inflammatory bowel disease: differing perceptions from a survey of adult and paediatric gastroenterologists. J Crohn’s Colitis. 2012;6(8):830–44.CrossRefGoogle Scholar
  41. 41.
    Zhou H, Roberts P, Dhaliwal S, Della P. Transitioning adolescent and young adults with chronic disease and/or disabilities from paediatric to adult care services–an integrative review. J Clin Nurs. 2016;25(21–22):3113–30.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Singh SP, Paul M, Islam Z, Weaver T, Kramer T, McLaren S, Belling R, Ford T, White S, Hovish K, Harley K. Transition from CAMHS to adult mental health services (TRACK): a study of service organisation, policies, process and user and carer perspectives. London: Report for the National Institute for Health Research Service Delivery and Organisation Programme; 2010.Google Scholar
  43. 43.
    Liabo K, McKenna C, Ingold A, Roberts H. Leaving foster or residential care: a participatory study of care leavers’ experiences of health and social care transitions. Child Care Health Dev. 2017;43(2):182–91.PubMedCrossRefGoogle Scholar
  44. 44.
    Beresford B. On the road to nowhere? Young disabled people and transition. Child Care Health Dev. 2004;30(6):581–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Crowley R, Wolfe I, Lock K, McKee M. Improving the transition between paediatric and adult healthcare: a systematic review. Arch Dis Child. 2011;96(6):548–53. Scholar
  46. 46.
    Butterworth S, Singh SP, Birchwood M, Islam Z, Munro ER, Vostanis P, Paul M, Khan A, Simkiss D. Transitioning care-leavers with mental health needs: ‘they set you up to fail!’. Child Adolesc Mental Health. 2017;22(3):138–47.CrossRefGoogle Scholar
  47. 47.
    Doug M, Adi Y, Williams J, Paul M, Kelly D, Petchey R, Carter YH. Transition to adult services for children and young people with palliative care needs: a systematic review. Arch Dis Child. 2011;96(1):78–84.PubMedCrossRefGoogle Scholar
  48. 48.
    Bhawra J, Toulany A, Cohen E, Hepburn CM, Guttmann A. Primary care interventions to improve transition of youth with chronic health conditions from paediatric to adult healthcare: a systematic review. BMJ Open. 2016;6(5):e011871.PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Campbell F, Biggs K, Aldiss SK, O'Neill PM, Clowes M, McDonagh J, While A, Gibson F. Transition of care for adolescents from paediatric services to adult health services. Cochrane Database Syst Rev. 2016;4:CD009794.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Clemente D, Leon L, Foster H, Minden K, Carmona L. Systematic review and critical appraisal of transitional care programmes in rheumatology. Semin Arthritis Rheum. 2016;46(3):372–9. WB SaundersPubMedCrossRefGoogle Scholar
  51. 51.
    Watson AR. Problems and pitfalls of transition from paediatric to adult renal care. Pediatr Nephrol. 2005;20(2):113–7.PubMedCrossRefGoogle Scholar
  52. 52.
    Allen D, Cohen D, Hood K, Robling M, Atwell C, Lane C, Lowes L, Channon S, Gillespie D, Groves S, Harvey J. Continuity of care in the transition from child to adult diabetes services: a realistic evaluation study. J Health Serv Res Policy. 2012;17(3):140–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Huang JS, Terrones L, Tompane T, Dillon L, Pian M, Gottschalk M, Norman GJ, Bartholomew LK. Preparing adolescents with chronic disease for transition to adult care: a technology program. Pediatrics. 2014;133(6):e1639–46.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    NICE. Guideline 43: Transition from children’s to adults’ services for young people using health or social care services. In: National Institute for Health and Care Excellence. 2016.Google Scholar
  55. 55.
    Swift KD, Hall CL, Marimuttu V, Redstone L, Sayal K, Hollis C. Transition to adult mental health services for young people with Attention Deficit/Hyperactivity Disorder (ADHD): a qualitative analysis of their experiences. BMC Psychiatry. 2013;13(1):74.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Kaehne A. Transition from children and adolescent to adult mental health services for young people with intellectual disabilities: a scoping study of service organisation problems. Adv Ment Health Intellect Disabil. 2011;5(1):9–16.CrossRefGoogle Scholar
  57. 57.
    Singh SP, Paul M, Ford T, Kramer T, Weaver T, McLaren S, Hovish K, Islam Z, Belling R, White S. Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study. Br J Psychiatry. 2010;197(4):305–12.PubMedCrossRefGoogle Scholar
  58. 58.
    Kipps S, Bahu T, Ong K, Ackland FM, Brown RS, Fox CT, Griffin NK, Knight AH, Mann NP, Neil HA, Simpson H. Current methods of transfer of young people with type 1 diabetes to adult services. Diabet Med. 2002;19(8):649–54.PubMedCrossRefGoogle Scholar
  59. 59.
    McCallum C. Supporting young people’s transition from children’s to adult services in the community. Br J Community Nurs. 2017;22(1):668–74.PubMedCrossRefGoogle Scholar
  60. 60.
    Mackie AS, Islam S, Magill-Evans J, Rankin KN, Robert C, Schuh M, Nicholas D, Muhll IV, McCrindle BW, Yasui Y, Rempel GR. Healthcare transition for youth with heart disease: a clinical trial. Heart. 2014;100(14):1113–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Nakhla M, Daneman D, To T, Paradis G, Guttmann A. Transition to adult care for youths with diabetes mellitus: findings from a universal health care system. Pediatrics. 2009;124(6):e1134–41.PubMedCrossRefGoogle Scholar
  62. 62.
    Cadario F, Prodam F, Bellone S, Trada M, Binotti M, Allochis G, Baldelli R, Esposito S, Bona G, Aimaretti G. Transition process of patients with type 1 diabetes (T1DM) from paediatric to the adult health care service: a hospital-based approach. Clin Endocrinol. 2009;71(3):346–50.CrossRefGoogle Scholar
  63. 63.
    Prestidge C, Romann A, Djurdjev O, Matsuda-Abedini M. Utility and cost of a renal transplant transition clinic. Pediatr Nephrol. 2012;27(2):295–302.PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Bent N, et al. Team approach versus ad hoc health services for young people with physical disabilities: a retrospective cohort study. Lancet. 2002;360(9342):1280–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Beth E. Anderson
    • 1
  • Swaran P. Singh
    • 2
  • Claire Stansfield
    • 3
  • Kristin Liabo
    • 4
  1. 1.Social Care Institute for ExcellenceLondonUK
  2. 2.University of WarwickCoventryUK
  3. 3.University College LondonLondonUK
  4. 4.University of ExeterExeterUK

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