Table 1.

Considerations for transition.

Considerations for transition	Pediatric perspective	Adult perspective	Organizational perspective
Preparation for transition (young person and their family)	Start transition process early Normalize the transition process Joint clinics Regular assessment of readiness for transition See the young person on their own Encourage their independence and assuming responsibility for healthcare	Meet the young person prior to formal transition Normalize the transition process Joint clinics Adolescent health screen to build rapport Organize tour of adult site	Encourage joint clinics Consider formalized transition pathway/process Appoint a specific transition co-ordinator Facilitate visit to adult site
Poor adherence to treatment	Open and honest discussion about barriers to poor adherence Problem solving with the young adult Focus on immediate consequences, personal appearance Screening for depression	Open and honest discussion about barriers to poor adherence Problem solving with the young adult Focus on immediate consequences, personal appearance Screening for depression	Consider formalized transition pathway/process Appoint a specific transition co-ordinator
Avoiding being lost to follow-up	Ensure formal transition to adult team with letters and good communication Consider booking a final appointment/phone consult after seeing adult team to ensure everything is in place	Ensure clear communication with pediatric team as to when adult team will be taking over Ensure adult team knows contact details for young person and correct address to send appointment to Consider a written handout about arranging appointments or urgent review	Establish a “safety net”—transition co-ordinator or respiratory nurse to ensure follow-up has occurred
Clinical deterioration during transition process	Ensure follow-up with adult team occurs Address poor adherence as much as possible Delay transition if a major change in clinical status occurs Flag young people with complex issues to inform adult team May require several joint appointments Ensure verbal and written handover for all medical and allied health services Assess medical knowledge and understanding for the young person prior to transition	Close liaison with pediatric team to cover all outstanding issues Be prepared to attend more than one joint appointment	Have a “Transition Checklist” to ensure nothing is missed