Implementing transitions for youth with complex chronic conditions using the medical home model

Anne M. Kelly, Barbara Kratz, Mary Bielski, Peggy Mann Rinehart, Robert W. Blum

Research output: Contribution to journalReview articlepeer-review


The concept of a medical home is endorsed as an effective model for implementing successful transitions for youth with complex chronic conditions. The U Special Kids program at the University of Minnesota is described as a medical home designed to improve service delivery for children and youth with complex medical conditions to help them achieve optimal health and functioning. Two case studies depict effective communication methods, including a concise written health history summary, that promote shared understanding of the adolescent's and family's strengths and their skills. Specific components of a transition plan are detailed with the recommendation that a formal assessment occur to develop an individualized transition plan. The individualized plan incorporates goals for the adolescent to gain independence and to obtain support in required areas.

Original languageEnglish (US)
Pages (from-to)1322-1327
Number of pages6
Issue number6 II
StatePublished - Dec 1 2002
Externally publishedYes


  • Adolescent
  • Chronic illness
  • Medical home
  • Transition

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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