CE/CME

Transition Services for Children and Youth with Special Health-Care Needs

Welcome to the training on Transition Services for Children and Youth with Special Health-Care Needs provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).

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Goal

The goal of this module is to equip Texas Health Steps providers and other health-care professionals to initiate and implement health-care transition planning services for children and youth with chronic health conditions or disabilities at pivotal points, especially as youth approach school age, adolescence, and adulthood.

Target Audience

Texas Health Steps providers and other interested health-care professionals.

Specific Learning Objectives

After completing the activities of this module, you will be able to:

  1. Formulate a strategy to address the health, education, and social needs of all children and youth, with emphasis on those with special health-care needs, at key transition points, especially as they approach school age, adolescence, and adulthood.
  2. Differentiate and integrate the functions of health-care professionals involved in transition assistance for youth with special health-care needs.
  3. Apply legal requirements and appropriate guidelines for aiding the transition of children and youth with special health-care needs as they approach school age, adolescence, and adulthood. 

Please note this module expires on 3/12/2023.

This module was released on 3/12/2020.

Share with Patients and Families

Got Transition.

Health Care Transition Initiative, Institute for Child Health Policy, University of Florida Health Care Transition Workbooks. Offer separate health-care transition workbook for ages 12 through 14 years, 15 through 17 years, and ages 18 years and older.

KASA: Kids As Self Advocates.

National Alliance for Caregiving.

National Center for Medical Home Information, Building Your Care Notebook. 

National Collaborative on Workforce and Disability.

National Collaborative on Workforce and Disability, The 411 on Disability Disclosure: A Workbook for Youth with Disabilities.

National Collaborative on Workforce and Disability. Paving the Way to Work: A Guide to Career-Focused Mentoring.

Navigate Life Texas, a multilingual website created by parents for parents of children with disabilities and special health-care needs. It offers comprehensive, relevant, and reliable information for families, professionals, advocates, and anyone working with children who have disabilities and their families. Sponsored by the Texas Interagency Task Force on Children with Special Needs.

Parent Companion First Five Years, a bilingual website focusing on young children with disabilities. It was created to comfort, inspire, and connect parents to helpful disability resources.

Seattle Children’s Hospital. Transitioning to Adult Healthcare. Transition resources and other helpful information about transition for children and adolescent with special health-care needs.

Social Security Administration’s Benefits for Children with Disability brochure.

Social Security Administration. (2019). What You Need To Know About Your Supplemental Security Income (SSI) When You Turn 18.

State Supported Living Centers.

Texas Department of Family and Protective Services. Preparation for Adult Living Program.

Texas Department of Family and Protective Services, Education and Voucher Training (ETV) Program.

Texas Department of Family and Protective Services. Circles of Support and Transition Plan Meetings web page.

Texas Department of Family and Protective Services. Extended Foster Care, including a brochure for youth in English and Spanish.

Texas Department of State Health Services. Texas Consumer Guide to Health Care.

Texas Department of State Health Services, Texas Immunization Registry (ImmTrac2). Adult consent form.

Texas Health and Human Services Commission, Children with Special Health Care Needs (CSHCN) Services Program. Family Support Services information.

Texas Health and Human Services Commission. Independent Living Services, including a list of independent living centers in Texas.

Texas Health and Human Services Commission. Day Activity and Health Services

Texas Health and Human Services Commission. Disability services web page.

Texas Health and Human Services Commission. Person-centered Planning.

Texas Health and Human Services Commission. Take Time Texas, a web page that provides a state inventory of respite services. 

Texas Health and Human Services Commission. Community Attendant Services.

Texas Parent to Parent, peer support for parents of children with special health-care needs.

Texas Project FIRST. Transition in the Individual Education Plan (IEP) website.

Texas Workforce Commission. Vocational Rehabilitation Services

Think College, a national organization dedicated to developing, expanding, and improving inclusive higher education options for people with intellectual disability. 

Featured

78th Texas Legislature. (2003). Texas Insurance Code, Title 8, Chapter 1201, Section 1201.059.

Agree, E. M. (2014). The potential for technology to enhance independence for those aging with a disability. Disability and Health Journal, 7(1): 533-539.

American Academy of Pediatrics, Got Transitions. (2019). 2019 Coding and Reimbursement Tip Sheet for Transition from Pediatric to Adult Health Care.

American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians, and Transitions Clinical Report Authoring Group. (2018). Clinical Report: Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home. Pediatrics, 142(5): e20182587.

American Academy of Pediatrics, American Academy of Family Physicians, & American College of Physicians. (2011, reaffirmed 2015). Clinical Report: Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home. Pediatrics, 128(1):182-200. (This version of the report contains the AAP algorithm).

American Academy of Pediatrics, Department of Research. (2009). Survey: Transition services lacking for teens with special needs. AAP News 2009, 30(11):12. (Log in required.)

American Academy of Pediatrics, American Academy of Family Physicians, & American College of Physicians. (2002). A Consensus Statement on Health Care Transitions for Young Adults With Special Health Care Needs. Pediatrics, 110(Supplement 3):1304-1306.

Bryant, B. R., Seok, S., & Ok, M. (2012). Individuals with Intellectual and/or Developmental Disabilities Use of Assistive Technology Devices in Support Provision. Journal of Special Education Technology, 27(2):53.

Centers for Disease Control and Prevention. (2012). Childhood Overweight and Obesity.

Child and Adolescent Health Measurement Initiative, Data Resource Center on Child and Adolescent Health. (2018). 2017/2018 National Survey of Children with Special Health Care Needs.

Council on Children with Disabilities. (2009). Supplemental Security Income (SSI) for Children and Youth With Disabilities. Pediatrics, 124(6):1702-1708. 

Davis, A. M., Brown, R. T., Taylor, J. L., Epstein, R. A., & McPheeters, M. L. (2014). Transition Care for Children With Special Health Care Needs. Pediatrics, 134(5):900-908.

Disability Rights Texas. (2011). Legally Adequate Consent.

Disabato, J. A., Mannino, J. E., & Betz, C. L. (2019). Pediatric Nurses' Role in Health Care Transition Planning: National Survey Findings and Practice Implications. Journal of Pediatric Nursing, 49:60-66.

Fortuna, R. J., Halterman, J. S., Plucino, T., & Robbins. B. W. (University of Rochester School of Medicine and Dentistry). (2012). Delayed transition of care: a national study of visits to pediatricians by young adults. Academic Pediatrics, 2(5):405-11.

Goldenring, J. M. & Rosen, D. S. (2004). Getting into adolescent heads: an essential update. Contemporary Pediatrics, 21(64).

Goossens. E., Bovjin. L., Gewillig. M., Budts. W., & Moons, P. (2016) Predictors of Care Gaps in Adolescents With Complex Chronic Condition Transitioning to Adulthood. Pediatrics, 137(4): 2015-2413. 

University of Massachusetts Boston, Institute for Community Inclusion. (2012).

Institute of Medicine of the National Academies, Committee on Disability in America and Board on Health Sciences Policy. (2007). The Future of Disability in America. The National Academies Press, Washington, D.C.

Lebrun-Harris, L. A., McManus, M. A., Ilango, S. M., Cyr, M., McLellan, S. B., Mann, M. Y., White, P. H. (2018). Transition Planning Among US Youth With and Without Special Health Care Needs. Pediatrics, 142(4):e20180194.

Lebensburger, J. D., Bemrich-Stolz, C. J., & Howard, T. H. (2012). Barriers in transition from pediatrics to adult medicine in sickle cell anemia. Journal of Blood Disorders, 3:105-112.

McPherson, M., Arango, P., Fox, H., Lauver, C., McManus, M., Newacheck, P.W., … Strickland, B. (1998). A new definition of children with special health care needs. Pediatrics, 102:137-40.

Minihan, P. M., Fitch, S. N., & Must, A. (2007). What Does the Epidemic of Childhood Obesity Mean for Children with Special Health Care Needs? The Journal of Law, Medicine, & Ethics, 35(1): 61-77.

National Center for Medical Home Implementation. (2012). What has your experience as a parent of a child with special health care needs been like? - Brad Thompson [Video]. AAP Medical Home's YouTube channel.

National Center for Medical Home Implementation (Producer). (2012). What is important for care coordinators to know about patients and their families? - Brad Thompson [Video].

National Center for Medical Home Implementation. (2012). Example of when a care coordinator helped to navigate your child's care - Brad Thompson [Video].

National Center for Medical Home Implementation. (n.d.). Building Your Care Notebook.

NEMJ Catalyst. (2017). What Is Patient-Centered Care?

Newman, L., Wagner, M., Cameto, R., & Knokey, A. M. (2009). The Post-High School Outcomes of Youth with Disabilities up to 4 Years After High School. A Report of Findings from the National Longitudinal Transition Study-2 (NLTS2) (NCSER 2009-3017). Menlo Park, CA: SRI International.

North Carolina Division of Public Health, Children and Youth Branch. (2010).  Health Care Transition: A Health Care Provider’s Guide to Helping Youth Transition from Pediatric to Adult Health Care. Appendix D: Provider Transition Checklist and Timeline, Institute for Community Inclusion at Children’s Hospital, Boston. 

Olsen, D. G. & Swigonski, N. L. (2004). Transition to Adulthood: The Important Role of the Pediatrician. Pediatrics, 113(3):e159-e162.

Texas Department of Family and Protective Services. (n.d.). Transitional Living Services.

Texas Department of State Health Services. (2019). Children and Youth with Special Health Care Needs 2018 Outreach Survey Report.

Texas Department of State Health Services. (n.d.). Adolescent Health – A Guide for Providers.

Texas Department of State Health Services, Division for Family & Community Health Services. (2015). Scientific Analysis of the Current State and Needs of the Maternal and Child Health Population in Texas, Children with Special Heath Care Needs: Stand Alone Needs Assessment.

Texas Department of State Health Services. (2012). Facts About Case Management.

Texas Education Agency. (2012). Education Service Centers Map.

Texas Foster Youth Justice Project. A Guide for Those Aging Out of Foster Care in Texas.

Texas Health and Human Services Commission. (n.d.). Person-centered Planning.

Texas Medicaid & Healthcare Partnership. (2020).   Texas Medicaid Provider Procedures Manual.

U.S. Department of Education, National Center for Special Education Research. (2011). The Post-High School Outcomes of Young Adults With Disabilities up to 8 Years After High School: A Report From the National Longitudinal Transition Study-2 (NLTS2).

U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2019). National Survey of Children’s Health NSCH: Fact Sheet, October.

U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2018). 2017-2018 National Survey of Children's Health (NSCH) Interactive Data Query (2016-2018).

U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2014). Transition Care for Children With Special Health Needs, Technical Brief, No. 15.

U.S. Department of Health and Human Services, Health Resources and Services Administration. (2013). The National Survey of Children with Special Health Care Needs Chartbook 2009–2010.

U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2007). Healthy People 2020

University of Massachusetts Boston, Institute for Community Inclusion. (2012).

University of Washington. (2003). Sarah Goes to College.

Weissberg-Benchell, J., Wolpert, H., & Anderson, B. J. (2007). Transitioning from Pediatric to Adult Care: A New Approach to the Post-Adolescent Young Person with Type 1 Diabetes. Diabetes Care, 30(10):2441-2446.

Youth Engaged 4 Change. (2019). Transition Planning and Self-Determination for Youth with Disabilities.

Additional

Health Day: News for Healthier Living. (2014). Coordinated Care Through ‘Medical Home’ Best for Chronically Ill Kids: Study.

Garcia-Iriarte, E., Balcazar, F., & Taylor-Ritzler, T. (2007). Analysis of case managers' support of youth with disabilities transitioning from school to work. Journal of Vocational Rehabilitation, 26(3):129-140.

International Fibrodysplasia Ossificans Progressiva Association

Rosenau, N. (2000). Do We Really Mean Families for All Children? Permanency Planning for Children with Developmental Disabilities. Policy Research Brief 11(2).

Schor, E. L. (2015). Transition: Changing Old Habits. Pediatrics, 135(6):958-960.

White, P., Schmidt, A., McManus, M., & Irwin, C. E. (2018). Readying Youth and Young Adults for Transition to Adult Care During Preventive Care Visits: New Clinician Toolkit. Journal of Adolescent Health, 63(2018):673−674.

Continuing Medical Education

The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians. 

The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded contact hour(s) of Continuing Nursing Education.

Social Workers

The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded contact hour(s) of Continuing Social Work Education.

Certified Community Health Worker

The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.

Certificate of Attendance

The Texas Department of State Health Services, Continuing Education Service has designated hour(s) for attendance.

General Disclosure

One of the requirements of continuing education is disclosure of the following information to the learner:

  1. Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
    • Create a Texas Health Steps account.
    • Complete on-line registration process.
    • Thoroughly read the content of the module.
    • Complete the on-line examination.
    • Complete the evaluation.
  2. Commercial Support.
    The THSTEPS Web-based Continuing Education Series has received no commercial support.
  3. Disclosure of Relevant Financial Relationships.
    The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
  4. Non-Endorsement Statement.
    Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
  5. Off-Label Use.
    Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).

The following are policies and definitions of terms related to continuing education disclosure:

The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.

All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.

Glossary of Terms

Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.

Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.

Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).

Texas Health Steps courses are best viewed using a current browser. If you are using an out-of-date browser or a version of Internet Explorer less than 11, lesson progress and interactive features may not function properly.

Health-Care Providers

Transition Resources by Topic

General Information about Transition:

American Academy of Pediatrics guidelines:

Got Transition. Resources about a variety of transition topics for youth, families, and health-care providers. 

Health Care Transition Initiative, Institute for Child Health Policy, University of Florida Health Care Transition Workbooks.

Health Services for Children with Special Needs. Health Care Transition for Adolescents and Young Adults CME training.

Navigate Life Texas: Transition to Adulthood. In-depth information for families of children with disabilities or special health-care needs about support, resources, and links to available services. 

Texas Department of Family and Protective Services. Transitional Living Services.

Texas Parent to Parent. Peer support and training to improve the lives of Texas children who have disability, chronic illness, and/or special health-care needs.

Assisted Living

Texas 24-Hour Residential Services web page. Information about residential care, including nursing homes and assisted living facilities in the community.

Texas Health and Human Services Commission's Area Agencies on Aging web page, for information on supportive housing resources.

Attendant Services

Texas Health and Human Services Commission's Day Activity and Health Services.

Texas Health and Human Services Commission’s Community Attendant Services (personal care services).

Case Management

Texas Health and Human Services Commission. Case Management Providers for Children and Pregnant Women.

  • Download the case management referral form (scroll down to Forms) and fax it to the Texas Health Steps Special Services Unit at 512-533-3867.
  • Find a case manager with the DSHS Case Management Providers locator map and make a direct referral to a case management provider.
  • Find a community-based organization that provides case management and support  services to children with special health-care needs and their families.

Early Childhood Intervention 

Early Childhood Intervention (ECI) Services.

ECI Provider Referral and Feedback form.

ECI Qualifying Diagnosis Search web page.

Texas Education Agency (TEA) auditory and visual impairment rule, 10 TAC Section 89.1040.

Education and Employment Resources

Communities in Schools, works within the publicschool system to provide students with needed resources.

Early Childhood Special Education (ESCE) program (formerly known as Preschool Program for Children with Disabilities [PPCD], a title that still may be used on some websites). Provides the many supports and opportunities for Local Education Agency (district and charter schools) staff who provide educational services for children ages birth through 5 years who have disabilities.

Easterseals. Information about education, employment training, and life services for children and adults through community and home-based services.

Individualized Education Programs (IEPs). Transition in the IEP web page.

Head Start, promotes school readiness for children ages 4 years and younger.

National Center on Secondary Education and Transition. Resources, technical assistance, and information about secondary education and transitions for youth with disabilities.

National Collaborative on Workforce and Disability.

National Technical Assistance Center on Transition. Resources to prepare high school graduates for success in postsecondary education and employment.

Texas Council for Developmental Disabilities. Resource Guide on Higher Education for People with Disabilities.

Texas Education Agency Educational Service Centers. The TEA has 20 Educational Services Centers in Texas that answer questions about the transition process in schools.

Texas Project First. A parent-to-parent website sponsored by the Family to Family Network that provides resources for parents and families of students with disabilities in Texas.

Texas Workforce Commission. Resources for those who want to go to school, seek job training, or find employment.

Think College. Resources and tools for students with disabilities, families, and professionals.

University of Washington’s DO-IT (Disabilities, Opportunities, Internetworking, and Technology) Center. College: You Can Do It! web page.

Financial Matters and Resources

American Academy of Pediatrics, policy statement. (2015). Supplemental Security Income (SSI) for Children and Youth With Disabilities.

FinAid's Financial Aid for Students with Disabilities.

Social Security Administration (SSA): Benefits for Children with Disabilities.

Social Security Administration. Supplemental Security Income Program Entry at Age 18 and Entrants' Subsequent Earnings.

University of Washington. DO-IT's College Funding for Students with Disabilities.

Health Benefits

Social Security Administration. Disability Evaluation Under Social Security, prepared for physicians and other health-care providers.

STAR Kids. Texas Medicaid managed care for children with disabilities who are ages birth through 20 years. Provides benefits such as prescription drugs, hospital care, primary and specialty care, preventive care, personal care services, private duty nursing, and durable medical equipment and supplies.

STAR+PLUS. Texas Medicaid managed care program for adults with disabilities.

Social Security Administration. Disability Office.

Texas Health and Human Services Commission. Case Management for Children and Pregnant Women

Texas Health and Human Services Commission. Children with Special Health Care Needs Services.

Texas Department of State Health Services: Consumer Guide to Health Care, for information about Medicaid, Medicaid managed care, and Children’s Health Insurance Program (CHIP) benefits in Texas.

Texas Health and Human Services Commission, Home and Community Based Services (HCBS).

Texas Health and Human Services Commission. Intellectual Disabilities & Related Conditions Assessment Resources. 

Texas Insurance Code, Title 8, Chapter 1201, Section 1201.059. Maintaining coverage for adults dependent on their parent’s health insurance.

Texas Medicaid Waiver programs and interest list (wait list):

Signing up for the interest list (a recommended step as early in a child’s life as possible). Call the Texas Health and Human Services Commission (HHSC) toll-free at 877-438-5658 for these Medicaid Waiver programs:

  • Home and Community-based Services
  • Texas Home Living 
  • Youth Empowerment Services

Texas Medicaid Buy-in Program 

Health Care for Adults with Intellectual and Developmental Disabilities 

Intellectual and Developmental Disabilities (IDD) Toolkit Telehealth Project. Developed for Tennessee health-care professionals, this site provides checklists for preventive care needs, typical screening approaches for individuals with certain disabilities, and other resources.

Housing

Some agencies that may provide local housing information and resources:

Independent Living

Texas Health and Human Services Commission. Independent living services, including a list of independent living centers in Texas.

United Cerebral Palsy. Provides a variety of resources about independent living, including home modification information.

Legal Issues

Disability Rights Texas. Protection and advocacy agency for people with disabilities in Texas.

Supported decision-making options—Guardianship:

Texas Council for Developmental Disabilities. Extending Health Insurance: What You Need to Know.

Texas Department of State Health Services, Adolescent Health Guide.  Downloadable guidelines on health and legal issues during the adolescent years.

Medical Transportation

Texas Health and Human Services Commission, Medical Transportation Program.

Organizational Resources

Care notebooks: 

Health-tracking Applications:

Permanency Planning

Permanency Planning Resource Guide

Surveys & Studies

2017-2018 National Survey of Children’s Health.

American Academy of Pediatrics, clinical report. (2018). Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home.

American Academy of Pediatrics, clinical report, with algorithm endorsed by AAP 2018 clinical report. (2011). Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home.

National Longitudinal Transition Study-2 (NLTS2).

Texas Department of State Health Services. Children and Youth with Special Health Care Needs 2018 Outreach Survey Report.

Technology Assistance

Quality Indicators for Assistive Technology (QIAT). Identifies, disseminates, and implements a set of widely-applicable quality indicators for assistive technology in school settings.

Texas Health and Human Services Commission. Texas Specialized Telecommunications Assistance Program (STAP).

Texas Technology Access Program. List of resources and possible funding sources in Texas for a variety of adaptive needs.

Texas Workforce Commission (TWC). Assistance with acquiring adaptive aids, vehicle modifications, or other technologies, including services for those who are blind or who have hearing impairments.