Youth Service Manager, Nottingham Children’s Hospital Young people with long-term health conditions face many challenges throughout their adolescent life and with more young people surviving well into adulthood; the issue of transition from a ‘safe’ familiar paediatric environment into an unknown adult unit remains ever high on the agenda. Consequently, youth work can play an important role in assisting with this process. The Department of Health (Department of Health 2006a) describes transition as ‘a purposeful, planned process that addresses the medical, psychosocial and educational/vocational needs of adolescents and young adults with chronic physical and medical conditions as they move from child-centered to adult-oriented health care systems’, also reinforced by Blum et al. (1993). It is no new concept that arranging transfer for young people from paediatric to adult services is a crucial part of care for adolescent patients. With many conditions once deemed as childhood illnesses, such as cystic fibrosis, now continuing well into adulthood (Viner and Keane 1998) and the fact that over 85% of children with chronic illnesses are surviving into adulthood (Betz 1999), it is even more evident that we need to give the area of transition special attention. When talking about transition, however, it is important to recognise that this is not just a one-off event that sees young people move from one service to another but is in fact a process (Department of Health 2006a). Throughout the process from childhood to adulthood, children are dependent, while adults are independent. Children are developing in competence, whereas adults have achieved this (Batsleer 2008). The transition process is a journey from one place to another incorporating both personal and social aspects. The personal aspects are associated with biological maturity while the social aspects refer to growth from dependence to independence (Harrison and Wise 2005). The recommendation for good practice in transition from the Royal College of Paediatrics and Child Health (2003) is that ‘Young people should not be transferred fully to adult services until they have the necessary skills to function in an adult service and have finished growth and puberty’. When going on a journey, especially one that you haven’t been on before, you need a guide. Not one that tells you what to do and which path to take but one that gives you the necessary information and advice to choose the right way for yourself (Young 1999). Different models of transition are adapted to meet the needs of each specific group in the UK. McDonagh (2007) maintains that there is no evidence to suggest that one model works better than another. The adolescent rheumatology transition process in Birmingham, described in detail by McDonagh (2007), includes a variable age range of 16–18 and is divided into three phases: early, middle and late. However, it is important to ensure that each transition is individualised. The three main models of transition described by Esmond (2000) are: While the most successful transition programmes involve both paediatric and adult services, the whole process should also be undertaken in partnership with the wider multiprofessional team including psychosocial support, as previously discussed in Chapter 12. Viner and Keane (1998) suggest that to achieve effective transition, it is important to recognise that there is much more to transition than just focusing on healthcare. For those young people who have not had a personalised transition plan and have experienced more of a ‘transfer’ to adult services, words they have used to describe this are: ‘dumped’, ‘sudden’, ‘thrown out’ and ‘abandoned’ (McDonagh 2007). When young people were asked what they thought was important for their transition, key words that came up were ‘preparation’, ‘support’, ‘choice’, ‘planning’, ‘peer support’, ‘skills’ and ‘guidance’ (Nottingham University Hospitals Youth Service 2005). In short, youth workers can be described as a ‘guide’ for young people to help them on their journey into adulthood. ‘A key aspect of youth work is to build relationships with young people which enable them to explore and make sense of their experiences, and plan and take action’ (Sapin 2009). Youth workers encourage and challenge young people to think about what they want to achieve in life, reflect on their behaviour and consider whether the choices they make are helping them get where they want to be (National Youth Agency 2007). According to the Social Exclusion Unit (2005), one of the five key principles that underpin service delivery within transition is to offer young people a trusted adult who can both challenge and support them. Youth workers primarily work with young people aged 12–19 years and those based within hospital settings are ideally placed to support adolescent patients through the transition process. Youth work can take place in many settings, usually where young people are situated. Youth work within a hospital setting is currently very rare but the evidence that is available for such provision suggests that it is very effective in addressing young people’s experiences in hospital and throughout the transition process (Hilton et al. 2004; Yates et al. 2009). Key aspects of youth work include building personal and social development. Ways of doing this can include arts-based work, ICT and media projects, sport and outdoor activities, accreditation opportunities, participation projects, addressing youth issues (e.g. sexual health, drugs and alcohol), residentials and volunteering (National Youth Agency 2002). Based on the experiences of Nottingham University Hospitals (NUH) Youth Service, which is known to be the longest running hospital provision in the UK (National Youth Agency 2008), there have been many positive examples of youth work opportunities within a hospital setting. With long periods of absences from school, the hospital youth service offers the opportunity to facilitate and support young people with issues such as those outlined in Box 14.1. Young people become involved in youth work activities because they want to – the youth worker’s role is to make sure that these opportunities contribute to the young people’s learning and development (National Youth Agency 2002).
Introduction
Transition as a journey
The guide
Hospital youth work
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Transition to adult services
Learning objectives
After studying this chapter the reader will have an understanding of:
Box 14.1 Examples of youth work
