System Principles, Standards and Key Questions for Assessment of State Systems of Care for CYSHCN DOMAIN: TRANSITION TO ADULTHOOD Youth with special health care needs receive the services necessary to make transitions to all aspects of adult life, including adult health care, work, and independence. State: ___________________________________ Date: _____________________ Type of Agency Completing this Tool: Title V State Medicaid CHIP Health Plan/Insurer Provider (please specify _________) Family/Consumer Other (please specify: _____________________________) When providing answers in this assessment tool, please do so from the perspective of the organization or system in which you work or are affiliated. Column A Column B Column C Column D System Standards Within my organization, there are What agencies/entities in your Please rate your organization’s (Structure and Process) policies and procedures in place for state have the authority to authority to implement or improve this standard: implement and/or ensure this policies and procedures that support standard? (Check all that this standard. apply.) Pediatric Setting: Yes Title V 0 None A policy and process for 1 Weak (IF YES) How effective are those State Medicaid transition preparation and policies and procedures? CHIP 2 Moderate planning for youth with special 1 Not effective Health Plan/Insurer 3 Strong health care needs (YSHCN) and 2 Somewhat effective Provider (please specify) Very effective their families as they prepare to 3 Family/Consumer move between pediatric and Other (please specify) adult care systems is in place within the health plan and OPTIONAL: medical home. YSHCN are Why? encouraged to learn about and No for score, above ) (Select “0” engage in their health care as Not applicable to my organization part of this process. Enter Score: Enter Score:
System Principles, Standards and Key Questions for Assessment of State Systems of Care for CYSHCN DOMAIN: TRANSITION TO ADULTHOOD Youth with special health care needs receive the services necessary to make transitions to all aspects of adult life, including adult health care, work, and independence. State: ___________________________________ Date: _____________________ Type of Agency Completing this Tool: Title V State Medicaid CHIP Health Plan/Insurer Provider (please specify _________) Family/Consumer Other (please specify: _____________________________) When providing answers in this assessment tool, please do so from the perspective of the organization or system in which you work or are affiliated. Column A System Standards (Structure and Process) Column B Within my organization, there are policies and procedures in place for this standard: Column C What agencies/entities in your state have the authority to implement and/or ensure this standard? (Check all that apply.) Column D Please rate your organization’s authority to implement or improve policies and procedures that support this standard. Pediatric Setting: A policy and process for transition preparation and planning for youth with special health care needs (YSHCN) and their families as they prepare to move between pediatric and adult care systems is in place within the health plan and medical home. YSHCN are encouraged to learn about and engage in their health care as part of this process. Yes (IF YES) How effective are those policies and procedures? 1 Not effective 2 Somewhat effective 3 Very effective No (Select “0” for score, above ) Not applicable to my organization Enter Score: Title V State Medicaid CHIP Health Plan/Insurer Provider (please specify) Family/Consumer Other (please specify) 0 None 1 Weak 2 Moderate 3 Strong OPTIONAL: Why? Enter Score:
7_Transition%20to%20Adulthood_In%20DepthFINAL.docx