Table 1.

Transitional Care and Mental Health of Young People

Area of Transitional Care	Examples of Important Considerations for Developmentally Appropriate Transitional Care Provision with Specific Reference to Mental Health
Organizational	Coordination of care in peritransfer period to include mental health-care provision
	Inclusion of mental health related knowledge and skills in transition readiness check lists to ensure regular assessment
	Mental health training of rheumatology health professionals
	Ideally, specific psychological expertise within the rheumatology team in both adolescent and adult services, eg psychologist
Specific clinical issues	Routine developmental assessment during adolescence to assess whether young people are predominantly concrete thinkers or have developed abstract thought
	Adherence to therapy—nonadherence may be associated with low mood, anxiety, etc so important to routinely address in a nonjudgemental manner, eg when did you last forget to take your meds?
	Consideration of impact of having serious medical illness, eg SLE, juvenile dermatomyositis, vasculitides—potentially life-threatening
	Consideration of biographical disruption and adjusting to life with a long-term health condition
	Drug toxicity, eg depressed mood on corticosteroids
	SLE—risk of neuropsychiatric disease which may present subtly as headache, cognitive impairment or mood disorder
	Knowledge and skills in disclosure of condition to others
	Body image—steroid-related side effects particularly during peripubertal stage; skin rashes; lipodystrophy and calcinosis in juvenile dermatomyositis; localized growth impairment, eg limb length discrepancy in inflammatory arthritis; nasal cartilage loss in granulomatosis with polyangiitis