Table 4.

Recommendations for Adolescent and Young Adult Program Development

Getting started
Conduct community and institutional needs assessments	Start slow, getting to know institution's needs and constraints. Catalog existing services and resources for AYAs including those in-house as well as those available through community partnerships. Identify institutional strengths that can be leveraged for AYA program development, as well as existing gaps in AYA care delivery. Ask AYA patients and family members about their priorities for AYA care.
Establish mission and model of care	Build a bridge between pediatric and adult oncology by involving representation from both. Talk to other AYA programs to get ideas about potential models of care.
Take a phased-in approach to program development	Consider starting with an area of particular need, a circumscribed age range, specific disease group, or specific domain of care, and building program capacity over time. This will help establish early wins to build momentum and culture change.

Engaging key individuals
Keep the patient voice central	Establish a patient advisory board. Facilitate communication between patients and providers. Use the patient voice to motivate all program developments.
Engage providers	Interview providers serving AYAs on how to work collaboratively and maximize their impact. Engage providers from both pediatric and adult oncology and from across disciplines and disease group clinics.
Build leadership buy-in	Establish a clear plan before proposing AYA program development to leadership. Present leaders with a strategic plan in which AYA program priorities are aligned with institutional priorities.
Identify AYA champions	Identify formal AYA champions (e.g., program director, medical director). Identify informal AYA champions across disease groups to promote referrals to AYA program. Build community partnerships.
Generate culture change	Provide continuous opportunities for education on the unique needs of AYAs.

Building the team
Build AYA-specific staff over time	Start with a program director. Use patient experiences to inform staffing growth with the ultimate goal of building a multidisciplinary or transdisciplinary team. Allow specific institutional needs guide program staff growth
Get creative with funding sources	Seek philanthropic and grant funding; demonstrate program's success to garner institutional support over time.

Evaluating and adapting
Formalize metrics for program evaluation	Work with researchers, including those with health outcomes research expertise, to identify or develop metrics for program evaluation. While exploring formalized metrics, engage in more informal ongoing process of soliciting feedback and refining program priorities and activities accordingly.