title: The Role of Health Advocacy in Transitions from Pediatric to Adult Care for Children with Special Health Care Needs: Bridging Families, Provider and Community Services.
abstract: BACKGROUND
  Youth and young adults with special healthcare needs (YASHCN) experience challenges during transition from pediatric to adult care. Prior studies have not examined how community and healthcare resources can work together to assist YASHCN in transitioning from child-focused care and services to adult-oriented providers.
  
  
  OBJECTIVE
  The aim of this study was to develop a theoretical understanding of how family, healthcare providers and community supports can assist YASHCN during the transition from pediatric to adult healthcare and services.
  
  
  METHODS
  We conducted 41 semi-structured interviews with YASHCN aged 16-25, their family members and healthcare and community providers. We focused our interviews on support mechanisms, both within the traditional healthcare system, and those available in the community. Using grounded theory methods, we performed a multi-step analysis process.
  
  
  RESULTS
  The theoretical code "Transition Advocacy" was developed from the data. This theoretical perspective arose from three major categories, which were developed in the analysis: "Fighting for healthcare", "Obtaining resources", and "Getting ready to transition". Transition Advocacy consists of the presence of, or need for, a healthcare "advocate" who did or can assist the YASHCN with the healthcare transition, particularly to navigate complex health or community services. The "advocate" role was performed by family members, healthcare or agency professionals, or sometimes the YASHCN themselves. If advocates were identified, youth were more likely to obtain needed services.
  
  
  CONCLUSIONS
  Parents, health providers, and community agencies are potentially well-poised to assist transitioning YASHCN. Efforts to encourage development of strong advocacy skills will facilitate better transitions for YASHCN.
authors.affiliation: Divisions of General Pediatrics and General Internal Medicine, University of California, San Francisco, San Francisco, CA. Electronic address: megumi.okumura@ucsf.edu.
authors.forename: Megumi J
authors.initials: MJ
authors.lastname: Okumura
authors.affiliation: University of California, San Francisco, San Francisco, CA.
authors.forename: Mara
authors.initials: M
authors.lastname: Saunders
authors.affiliation: Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA.
authors.forename: Roberta S
authors.initials: RS
authors.lastname: Rehm
mesh_terms: D000293:Adolescent; D000328:Adult; D002140:California; D003153:Community Health Services / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration; D002658:Developmental Disabilities / Q000175:diagnosis / Q000628:therapy*; D005190:Family; D006282:Health Personnel / Q000458:organization & administration; D006301:Health Services Needs and Demand; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D017063:Outcome Assessment, Health Care; D010344:Patient Advocacy; D036301:Qualitative Research; D012380:Role; D060305:Transition to Adult Care / Q000458:organization & administration*; D055815:Young Adult
keywords: Children with special health care needs; Health advocacy; Qualitative research; Transitions to adulthood