Table 1.

Critical steps in transition.

Steps	Actions	Ref.
1. Ask young people and their parents	• Inquire about patients’ feelings and concerns • Understand patients’ needs to balance independence with continued care and education • Solicit desired outcomes after transfer • Discuss transfer specifics (early preparation and clinic location)	(3)
2. Engage/train colleagues	• Different perceptions of levels of competency and involvement of paediatric vs adult physicians during transition care • Lack of training and inadequate resources are main barriers to successful transition service	(4)
3. Choose a clinic structure	• Multidisciplinary collaboration across all health sectors, including primary and secondary care, enhances successful transfer of care	(5)
4. Structured transition programme	• Requested by adolescents with discussions starting early in disease course, possibly soon after diagnosis • Example of successful generic transition programme is ‘Ready Steady Go’, implemented within a large National Health Service teaching hospital in the UK	(3) (6) (7)
5. Help with navigation	• Both hands-on and hands-off approach beneficial; a transitional care coordinator can assist with young people navigating transition and transfer and access to adult services	(8)
6. Monitoring	• Useful tools to monitor successful outcomes can include evaluation of specific disease markers (e.g., HbA1c), quality-of-life questionnaires, monitoring of attendance/adherence at clinic visits and reduced morbidity/mortality	(9)
7. Engaging the disengaged	• Get adolescents involved in monitoring and design; use technology-based transition interventions designed for adolescents with diverse chronic illnesses	(10)