Evaluation of the TAC Program

Launched by THE HOSPITAL FOR SICK CHILDREN · Aug 30, 2024

Keywords

ClinConnect Summary

This study is evaluating a Transition to Adult Care (TAC) program at The Hospital for Sick Children in Toronto. It looks at whether an intensive, team-based transition program can help high-risk teens and young adults with multiple health problems or a rare disease move smoothly from pediatric to adult care. Researchers will collect numbers from surveys and also talk with participants to learn about their experiences. They’re interested in whether the program improves readiness to transition, confidence in managing health, knowledge about their care, and overall quality of life, as well as how satisfied youths and caregivers are with the health care process. They will also examine how feasible it is to put the program into real-world use.

Who can participate and what to expect: About 126 people are being invited to join, aged 16–18, who have three or more long-term health conditions or a rare disease, and who do not yet have a clear adult health care provider or face barriers related to social factors. People with moderate to severe developmental or intellectual disabilities, those already in SickKids’ transition program, or those who cannot consent are not eligible. This is a single-group study, so all participants receive the Intensive Transition Support, delivered by a nurse practitioner and a social worker for about one year after moving to adult services. Participants will have baseline, 12‑month, and 24‑month assessments, with additional steps like creating a personalized transition plan, sharing information, and warm handovers to adult care documented in medical records and sometimes explored in interviews. The study began in 2024 in Toronto, with results anticipated around 2027.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• Aged 16-18 years old and have a complex medical history, as defined by:
• • 1. Clinical Characteristics: Multi-morbidity (≥ 3 long-term chronic physical and/or mental health conditions (with primary condition being a physical health condition AND/OR Rare disease/ genetic condition.
• • 2. High Risk: No clearly identified adult provider/services following transfer AND/OR experiencing significant barriers related to Social and Structural Determinants of Health.
• Exclusion Criteria:
• • 1. Moderate to severe developmental/intellectual disabilities
• • 2. Followed by services at SickKids which has an established transition program/provider
• • 3. Does not provide consent