HCT Intervention Tools

Purpose: The Welcome and Care Policy is intended to be shared with students and parents/caregivers early in high school and periodically repeated. Developed by your SBHC with input from students and staff, the policy formalizes the clinic’s approach to HCT. It should be at the appropriate reading level, offered in languages common among your student population, and no more than one page. See pages 11-12 in Got Transition’s Implementation Guide for more information.

Objectives:

1. Develop an HCT policy with input from students and parents/caregivers that describes the SBHC’s approach to HCT, privacy and consent information, contact information, and open hours for the SBHC.
2. Educate all SBHC staff about the clinic’s approach to HCT and the distinct roles that students and the SBHC health care team play in the transition process, considering cultural preferences.
3. Display the welcome and care policy somewhere accessible in the SBHC space and discuss and share with students, beginning with freshmen and new students coming into the SBHC. Regularly review it as part of ongoing care.

Considerations:

1. Does the policy describe the SBHC’s approach to transition, including privacy and consent information and other HCT services (e.g., offering students an HCT readiness assessment, medical summary)?
2. Is the reading level of the SBHC policy appropriate for your students?
3. Was the policy tested with 3-4 students to see if any words were not understood?
4. Will the SBHC electronic health system incorporate a tickler to review the policy?
5. Whose job is it to share and discuss the HCT policy with the students?
6. Whose job is it to ask if the student has any questions?
7. How are all SBHC staff informed about the clinic’s approach to transition?
8. How do all SBHC staff discuss the different ways the clinic is taking the cultural preferences of their students into account throughout the transition process?

Examples/Samples:

1. Got Transition’s Implementation Guide (pages 11-20)
2. SBHC Welcome and Care policy

Purpose: The Transition Readiness Assessment (TRA) is used to assess students’ HCT readiness skills, such as addressing self-care skill needs to prepare them for an adult approach to care and preparing them to use health care services independently. The TRA can be completed annually with any student, beginning as a freshman and continuing throughout high school. Offer it in languages common among your student population and make it no more than one page. The TRA is a tool for discussion between SBHC staff and the student about the skills they want to learn to help them manage their own health and to navigate health care. See pages 30-39 in Got Transition’s Implementation Guide for more information.

Objectives:

1. Conduct regular TRAs to identify and discuss their self-care needs and how to use health care services with students.
2. Offer education and resources on needed skills identified through the TRA.

Considerations:

1. Consider the patient population of your SBHC. What HCT skills and knowledge about health care services do they need to learn before leaving high school?
2. Are you planning to use the existing example TRA or modify questions?
3. Should questions about accessing community services (e.g., food, housing) be added to the TRA? Resource: CDC Community Resource
4. Should questions about teen privacy or accessing medical records be added to the TRA? What about mental health questions? Resource: State privacy laws
5. Are the TRAs at the correct reading level and language for students in your school? Do a test with 3-4 students who are at different ages and grade levels to see if they have any difficulty understanding questions or specific words. If so, make needed changes to the TRA and test again. 
6. How often are you planning on offering the TRA to students?
7. Who will administer the TRA in the SBHC? Will it be completed in the waiting room or the clinic room?
8. If school is virtual, how will students complete the TRA?
9. Who will offer the identified needed education? Will it be incorporated into follow-up appointments and/or documented in the medical record?
10. Create a document for SBHC staff to reference that describes the SBHC process students will follow to complete the TRA process.
11. Consider including the school health staff, social workers, and counselors in the planning and distribution process.

Examples/Samples:

1. Got Transition’s Implementation Guide (pages 30-39)
2. Readiness Assessment for Students in SBHCs

Purpose: A medical summary can help students plan for the transition by building health literacy, independent self-care skills, and preparing for changes at age 18. See pages 40-50 in Got Transition’s Implementation Guide for more information.

Objectives:

1. Create and regularly update the medical summary with the student and document it in their medical record.
2. Share the medical summary with the student either electronically or as a hard copy.

Considerations:

1. Does the SBHC have a medical summary template in its electronic medical records (EMR) or a way to create a medical summary within its EMR?
2. Are you planning to use the example medical summary or modify the content?
3. Who is responsible for completing the medical summary and keeping it up to date?
4. How will the practice share the medical summary with students (i.e., discuss it at the visit or send it to the student before a visit to review during the visit)?
5. For students requiring supported decision-making, who else should be involved in creating this medical summary?
6. How can students who see a PCP outside of the SBHC coordinate completing a medical summary?

Examples/Samples:

1. Got Transition’s Implementation Guide (pages 40-50)
2. Sample Medical Summary

Purpose: This sample resource offers a list of steps and tips on finding medical and mental health services in the community. It also includes an example listing of nearby clinics and services that serve adults. 

Objectives:

1. Offer tips and considerations for searching for a new adult provider.
2. Guide students to find convenient and affordable adult primary care, mental/behavioral health care, and sexual/reproductive services in the community.

Considerations:

1. Are you planning to use the example resource and modify it with local services?
2. What local services would you like to include in the resource (e.g., primary care, mental, substance use, sexual/reproductive health, and/or insurance information)?
3. To what extent is your sponsoring agency able to accept exiting students (who are not leaving the area) for continued care?
4. Can you discover which of these sites your students leaving school most often use?
5. How will students who attend a university away from your community find an adult doctor?
6. How would you plan to transfer a student to and communicate with the new adult provider?

Examples/Samples:

1. Sample Finding an Adult Doctor Resource
2. Sample Transfer Letter
3. Sample Transfer of Care Checklist