Transitioning to adult care: Starting Early and Finishing Strong

When teenagers with chronic illnesses turn 18, they graduate from pediatric to adult care. For our patients, it means they will no longer be followed at the Montreal Children’s Hospital but will move on to an adult hospital, clinic or doctor’s office.

Transitioning to adult care: one step at a time

Many young people and their families have been coming to the Children’s for years and are very familiar with how things are done here. A lot of them have come to know their nurses, doctors and other members of their healthcare team very well. Moving on to adult care can therefore be challenging to some patients. To help our patients get ready to make the change, we help them through a variety of stages called transition. This gradual preparation for care at an adult hospital can sometimes last several years.

We try to introduce the idea to our patients early so that the process of transitioning to adult care can be as smooth as possible. There is not one standard process for transition and currently, each health care team at the Children’s handles transition preparation a little bit differently. 

We are working on developing a series of guided steps and information packages that can be used throughout the hospital. They include things called Transition Preparation Tools, a Medical Passport and Transfer Readiness Checklists. These have all been created to help our patients understand their illness well so that they are prepared for the next phase when they meet the people who will help them manage their health in the future. We want our patients to become comfortable asking questions, expressing concerns and taking care of their everyday needs.  When they move to adult care we want them to be able talk easily to their new doctors and nurses.

Helping you make the first steps

Leading up to a patient’s transition, our health care teams will help young people learn about their new hospital and the health care providers who work there. We’ll help them book their first appointments with their new team. We’ll also help family members prepare for the transition.

1. Information session: Transition from pediatric to adult health care for young adults who have an intellectual impairment

Information evenings for parents of young adults who have an intellectual impairment are held twice yearly and announced on the MCH Twitter feed and on this webpage. Guest speakers include an attorney, a notary and a financial advisor, as well as a parent who has lived through the experience.  Health care delivery in the pediatric and adult settings is described by two McGill University Health Centre (MUHC)  nurses.  A representative from WIAIH (West Island Association for the Intellectually Handicapped), a community organization which provides services throughout the island of Montreal describes the many services offered by their organization.

Please email dale.macdonald@muhc.mcgill.ca if you want to receive notification of the next session. Please consult our information pamphlet for additional information. 

2. Living a healthy life with chronic conditions: the MUHC's chronic disease self-management program (My Tool Box)

My Tool Box is a free 6-week program for individuals living with chronic disease and their loved ones. The program is designed to teach people the skills they need to live well with chronic health conditions such diabetes, heart disease, asthma, arthritis, cancer, MS, muscular dystrophy, stroke, hypertensiand chronic pain. These fun, practical and interactive workshops emphasize coping strategies and practicals skills. Register for the sessions here.

3. Registering onto a waiting list to access a family doctor

It is very important that your child have a family doctor, and can register for one as soon as he or she is 14 years old. If you do not have a family doctor, your Health and Social Services Centre (CSSS) can help you find one. Regardless of your health, you can use your CSSS « guichet d’accès pour la clientèle sans médecin de famille » for people without a family doctor to register onto a waiting list.

1. Good 2 Go Transition Program (Sick Kids, Toronto)

2. ON TRAC: Transitioning Responsibly to Adult Care (BC Children’s Hospital)

3. My Health Passport (Sick Kids, Toronto)

4. The Montreal Children's Hospital's Family Resource Library: books and resources on transition

The Family Resource Library, a bright, modern space located in Room A RC 1107 and is a welcoming place for parents and patients alike. The above website allows parents and patients to reserve books and consult health-related websites easily.