Clinical Outcomes and Predictors of Improvement With Virtual Behavioral Health Care for Gambling Disorder: Retrospective Cohort Study.

Health care transition (HCT) is now recognized as a necessary service component to facilitate the transfer of care from pediatric to adult-focused health care providers, as well as the transition to adulthood for youth and young adults with chronic conditions, including referrals to transition and adult-focused community-based services and supports. Nevertheless, evidence-based models of care to support HCT are lacking in this emerging field of practice, and what constitutes successful youth and young adult outcomes is not well defined. It is against this background of HCT practice and research that considerable and ongoing interdisciplinary and international efforts are underway to generate the evidence needed to implement models of care that will affect improved HCT outcomes for youth and young adults with chronic conditions, including those with intellectual and/or developmental disabilities (IDD). The concept of HCT was first introduced just over 30 years ago, when it was widely understood to be focused on the transfer of health care from pediatric to adult-focused care, as reflected in the following quotation: “…the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented health-care systems.” However, what has been missing in this early introduction of the HCT service model is the underlying assumption aligned with this statement: “Transition is a multifaceted, active process that attends to the medical, psychosocial, and educational/vocational needs of adolescents as they move from the child-focused to the adult-focused health-care system. Health care transition facilitates transition in other areas of life as well (e.g., work, community, and school).”
A comprehensive HCT model has subsequently been advocated for and supported. Importantly, the inclusive HCT model is in alignment with the World Health Organization definition of health as “….a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This concept of health is especially relevant for the population of youth, young adults, and older adults with IDD. A noticeable area of need is the development of HCT programs for the IDD population, as service disparities have been reported when compared to other groups of individuals with chronic conditions. Additionally, youth and young adults with IDD can present with challenging developmental needs, unlike other populations of those with chronic conditions, as they have cognitive, sensory, and developmental challenges requiring ongoing and lifelong specialized services and support. Regrettably, youth and young adults with IDD are faced with insufficient services and resources that can accommodate their significant needs, such as assistance with activities of daily living, augmentative communication devices, and access to American Sign Language interpretation, large print and illustrative educational materials, and transportation assistance. As well, youth and young adults with IDD face other challenges pertaining to lifestyle outcomes, including postsecondary education and training and employment outcomes, as compared to other populations of individuals with chronic conditions. Postsecondary education, employment and community living outcomes are not typically identified in HCT literature.