December 16, 2019

When Jackson Guyre was born with tetralogy of Fallot – a rare and complex heart defect – he was one of 40,000 children born with a congenital heart defect (CHD) in the United States each year. Today, thanks to the expert care he’s received at Texas Children’s Heart Center®, Jackson is an extremely active 15-year-old. He even runs half marathons.

He’s also now one of the hundreds of teenagers who have begun a new chapter in their journey with CHD – the transition from pediatric to adult care – through Texas Children’s Cardiology Transition Medicine Program.

Identifying the need

Though CHDs are the most common type of birth defect (affecting one in every 100 births), advancements in care have contributed to a steady decline in childhood mortality over the past two decades and helped more than one and a half million CHD survivors reach adulthood. Because a large proportion of patients are palliated and not fully cured, they are at risk for future health complications and even death. For this reason, they require lifelong care and disease management by physicians who specialize in taking care of adults with CHD.

However, lapses in care do occur. And according to several studies, including a 2018 study out of Texas Children’s Hospital and academic affiliate Baylor College of Medicine, and led by the Cardiology Transition Medicine Program’s medical director Dr. Keila N. Lopez, there are serious disparities in the care provided to the growing adolescent CHD survivor population, involving poor transition from pediatric to adult-centered care. It was a problem Lopez had seen firsthand.

“When I became a cardiology attending in 2012, I was seeing a lot of pre-teen and teenage patients who, universally, didn’t know anything about what was going on with their heart,” Lopez recalled. “I realized there was no way these kids were going to successfully transition to adulthood if they didn’t know what their condition is and weren’t able to answer basic questions about their health or what to do in the event of a medical emergency.”

Additionally, Lopez saw patients were being transferred to adult care without being properly transitioned first, which only exacerbated the problem. She noted, “Transition and transfer of care are not the same thing. Transition is the shift in the responsibility of health care management from the parents to the patient and is a gradual process that takes several years. Transfer of care is the movement of patients and their care from one medical facility or provider to another. Patients often find transfer of care much harder if a solid transition program has not been a part of their preparation.”

It was a passion for the adolescent CHD population and the obvious clinical need for a better, more comprehensive approach to transition cardiology care that drove Lopez to put together a business proposal that addressed why Texas Children’s could be the ideal place to pilot a cardiology transition program.

From the ground up

In the first year, the small but mighty team – made up of Lopez; cardiology transition coordinator DK Lovick, RN; and social worker Nicole Broussard, LCSW – began developing the program from scratch, first by surveying adolescent CHD patients, their parents or guardians, pediatricians, providers in each service at the Heart Center, and Texas Children’s Adult Congenital Heart Disease (ACHD) team, to find out things like what patients typically know about their condition, medicines, insurance, etc.; where the gaps in knowledge usually are; and what other factors patients struggle with (i.e., coping with anxiety or depression).

“There was a lot of trial and error, and lots of focus groups,” Lovick said. “We were asking providers what patients and families need to be better at, as far as really understanding and managing their condition, and asking the patients and families what they felt they needed to know more about. We discovered a critical piece of the puzzle: most of them wanted an individualized learning plan.”

At the heart of the process, and the primary method for information-gathering, assessment, and development of individualized learning plans, is motivational interviewing, which involves empathetic listening, positive reinforcement, and providing prompts based on the patient’s values and feelings to help them find the motivation they need to change behaviors.

The result is an approach to transition care built on shared decision-making that motivates the patient to become the captain of their care team, with the parent or guardian as co-captain, and their doctor as coach.

Helping patients take the lead

The transition journey typically begins when a patient is 14 years old with a preliminary visit that is used as an introduction. They meet the team and learn about the process, the individual learning plan, and what the expectations are for the process of transition. The team also tells the patient about opportunities such as meeting other teens with CHD, volunteering or mentoring. During this visit, parents or guardians provide the team with information about their understanding of the patient’s condition and trajectory, the patient’s knowledge of basic health skills (e.g., carrying health information with them, knowing their doctor’s phone number), and whether the patient might be dealing with a learning disability or psychological concerns.

When a patient is 15, they have their first official visit with the cardiology transition team by themselves. This is the first step in helping the patient take more ownership of their care journey. Using motivational interviewing, the team administers transition readiness and CHD knowledge assessments and begins individualized CHD education and health care skills training. This begins to prepare the patient to know and understand their condition, and to learn how to communicate health care information to providers or to someone in the case of an emergency. Patients have a similar visit at 16 years old.

At each of these appointments, the team also asks the parent or guardian what they think the patient needs to work on. Once all the information and responses have been gathered, the cardiology transition team begins building the patient’s learning plan and setting goals to work on before the next visit using CHHATT, the Congenital Heart Health Activation Transition Tool.

This tool, developed entirely by the Texas Children’s cardiology transition team, takes all the information reviewed in the appointment and collates it in a format that will help the patient learn, retain and understand how it fits into the larger picture of their long-term care. This includes:

  • A three-sentence summary of the patient’s personal information, details of their CHD and what an emergency situation looks like
  • Basic self-management information about such things as medications, high-risk behaviors, traveling tips, and everyday activities and restrictions
  • An outline of their trajectory and lifelong management, including possible long-term issues, reproductive risks and genetic risk of passing on the condition, and basic insurance information

The CHHATT is reviewed at all subsequent meetings (including at 17 and 18 years old). After a review with the patient, the patient will then teach their parent or guardian what they’ve learned. If parents ask a question, the patient can use the tool as a prompt to help answer. If the patient is able to repeat the information in the CHHATT twice in a row with minimal or no prompting, that usually means a patient is prepared to transfer to adult care. After their 18th birthday, patients will also have an adult planning visit with the transition team and their pediatric cardiologist, where an ACHD physician is officially identified as their next cardiologist, advance directives are discussed, insurance options are reviewed, and a transfer summary (comprehensive summary of pediatric cardiac care) is completed.

The cardiology transition team also helps prepare families of patients who may not be able to live independently in the future or have some developmental delay. In these cases, the team works with the patient so that they can, if they’re able, at least repeat their three-sentence summary from CHHATT. The team also helps enter the patient’s information in their medical app on their phone, or will encourage the parent or guardian to get a medical ID bracelet. The team may also start walking the family through guardianship or supported decision-making that may happen in the future, sometimes referring the family to Texas Children’s Medical-Legal Partnership, a collaboration with Houston Volunteer Lawyers. When patients with special needs turn 17, in addition to pointing them toward important legal information, the team also provides them with information on numerous resources and programs available, and community organizations able to offer assistance.

Access through technology

In addition to publishing all original materials in Spanish, the Cardiology Transition Medicine Program also uses special real-time translation technology to make the program accessible to non-English speakers. The program was also the first at Texas Children’s to create an outpatient ambulatory education template for EPIC. Providers are able to simply click on a tab to see who was educated, what they learned, what the response was, and if follow-up is needed. Additionally, the transition team is hoping to expand its reach to satellite clinics in the future through the use of telemedicine. And currently, Lopez is working with the Center for Collaborative and Interactive Technologies at Baylor College of Medicine to develop a mobile app that will be the first of its kind for CHD. The app – a project supported by the National Institutes of Health – will act as a portable medical summary and will include information for the patient’s specific CHD, what surgeries or repairs they’ve undergone, diagrams, and more.

Learning to “Adult” with CHD

In addition to presenting about the program at major conferences and symposiums on a national and international level – including the Adult Congenital Heart Association (ACHA) and America Heart Association – the Cardiology Transition Medicine Program also hosts events at Texas Children’s to raise awareness around the need for more comprehensive cardiology transition care, to share the methodology, and to provide information and resources.

One example was the “Adulting with CHD” symposium, which was held this past summer at Texas Children’s Pavilion for Women. The event was staffed by more than 30 volunteers, all of whom were ACHD patients and connected to the program through relationships with outside CHD groups. Many of the volunteers acted as table hosts to facilitate conversations with the more than 40 attendees, including CHD patients and parents. One of those parents was Jackson Guyre’s mom, Emily.

At her table were other families with children who had been born with tetralogy of Fallot, and adult patients who had lived through the diagnosis.

“As a parent of a child with a congenital heart condition, it’s hard to think about them being an adult because the parent is the one who checks all the boxes for so long,” Emily said. “Ahead of Jackson’s first appointment with the Cardiology Transition Medicine Program, it was so helpful to learn about the program and to meet and see adults who have the same condition who are now living normal lives.”

And now that Jackson has attended his first appointment with the team, Emily has seen the program’s value firsthand.

“We thoroughly enjoyed our first visit with the cardiology transition team,” she said. “It gave my husband and me a chance to sit back and listen to how much Jackson knows about his condition and how to maintain a healthy lifestyle. We appreciate Texas Children’s for creating this program and introducing our family to it as we transition to Jackson’s teenage years. It proves they really care about both his medical condition and his emotional needs, and it gives us all the confidence necessary as he prepares to move to his adult heart team.”

Another attendee of the symposium was Angel Olvera, Executive Vice President of Sales at Patient Educational Media Systems. Olvera and his associate, both parents of children with CHD, founded the company to provide CHD and ACHD education and to raises awareness through film, innovative media, and streaming platforms. As part of their research for an upcoming film about cardiology transition care, they had been traveling the country visiting several heart programs.

What Olvera learned at the “Adulting with CHD” event left quite an impression.

“I’d heard so much about Texas Children’s Cardiology Transition Medicine Program and actually knew people who’d moved to the area specifically to be closer, and now I understand why,” Olvera said. “From what we’ve seen, Texas Children’s cardiology transition program is one of the best in the country by far. A lot of programs have pieces of the puzzle, but they lack a structure. Texas Children’s has a continuous, measured process. Patients and families always know where they are and what they need to improve toward taking ownership of their condition. It was really impressive.”

One of Patient Educational Media Systems’ projects, “The Heart Within,” is currently available on Amazon Prime. The new film on transition medicine will be released in February 2020.

Looking ahead

It’s been three and a half years since the pilot program launched. The concept has been proved, and the success has been undeniable. A study conducted by Dr. Lopez and presented at the American Heart Association assessed Texas Children’s cardiology transition program and demonstrated that with each successive visit to the cardiology transition team, there were reduced lapses in care, and each successive visit made for even more reduction in gaps in care. This demonstrable success for a cardiology transition program has never previously been reported in the United States.

“The growth we’ve seen has been tremendous,” said Broussard. “Currently, we’re seeing more than 700 patients a year. We’re constantly affirmed by families, patients and providers, who see that their patients are doing well. The more people find out about us, the more the demand for our services grows. And the ACHD patients with whom we work are constantly telling us they wish they’d had this resource available to them when they were teens, and that we’re on the right track.”

Added Lovick, “The key to our success, and the reason why the process works, is that we listen – to our patients, their parents, and the providers. They all told us what they needed and how it needed to be delivered. We’re looking forward to continuing to grow outside of the services we currently work with and delivering this much-needed resource to even more patients.”

Learn more about Texas Children’s Cardiology Transition Medicine Program, part of the nation’s No. 1 heart center, according to U.S. News & World Report.

For information about volunteering at Texas Children’s Heart Center or at Cardiology Transition Medicine Program events, please contact DK Lovick at DKLovick@texaschildrens.org.

June 11, 2019

More Texas Children’s Pediatrics patients over the age of 18 will have the opportunity for a smooth shift to adult care as the Transition Medicine program expands to include seven locations: Corinthian Pointe, East, Gulfgate, Gulfton, Kingsland, Palm Center, and Ripley House.

Transition Medicine is the process of educating, organizing and eventually transferring patient care from the pediatric to the adult health care system. During this time the patient and their parent are informed of various ways to optimize the patient’s health moving forward. Texas Children’s is dedicated to helping patients transfer care smoothly without a decline or break in their treatment.

In 2016 Dr. Cynthia Peacock, medical director of Texas Children’s Hospital and Baylor College of Medicine’s Transition Medicine Clinic, was awarded the “Healthy Tomorrows Partnership for Children Program” 5-year grant from the Health Services Research Administration to increase transition readiness at Texas Children’s Pediatrics.

“I wrote the grant to help the Texas Children’s practices because lots of the referrals within the Texas Children’s family were struggling in the community to find someone to take care of them,” Peacock said. “This was especially prevalent amongst children and youth with special health care needs.”

The grant provides funding that also serves as an incentive to encourage clinics to become involved in the program and begin developing their own transition medicine process by educating their staff and providers.

“As we are providing care for an increasing number of complex care patients, our need to have a well-defined system for transitioning care to adult providers who are capable of continuing to provide the care these patients and their families need has never been greater,” Vice President and Chief Medical Officer of Texas Children’s Pediatrics and Texas Children’s Urgent Care, Dr. Stan Spinner said. “Our partnership with Dr. Peacock is providing us with the education and the tools necessary to help ensure a successful transition for our patients and their families.”

Upon receiving the grant, Dr. Rebecca Laster was selected as the physician leader to work with the clinics and help them identify specific tools that they could use to promote transition readiness and transfer. Her experience as a physician in the community clinics sparked her desire to want to assist these patients during this transition.

“I always think back to a time when one of my patients had a really hard time transitioning to adult medicine. That made me want to learn more about the process so I could better assist them,” Laster said. “Although, we have a lot of patients who’d like to stay with us forever, sometimes that’s not appropriate because we’re not trained in adult care. Therefore, I have the transition conversation with every single one of my patients so they know how important it is to eventually find an adult physician, and if they can start the process of thinking about it early on then everybody’s prepared.”

Many young adults between the ages of 18 to 21 transition their care to adult providers when they leave for college or enter the workforce. But for those with complex chronic pediatric diseases, transitioning is a struggle filled with barriers and challenges that include patient maturity, psychosocial and family needs, coordination and reimbursement issues, and identification of adult providers able to care for unique patient populations.

“Coordination of care is essential to avoiding gaps in care and adverse health outcomes for our patients. This is especially true with our vulnerable populations who have multiple chronic illnesses and complex health and social needs,” Nurse Care Coordinator of Texas Children’s Pediatrics, Pam Brock said. “We help provide support and guidance to our patient/families in navigating this process and by making sure all needs are met prior to transition. This helps to ensure a smooth transfer and avoids disruptions in their care. This program has increased overall fund of knowledge surrounding transition and continues to help improve the transition process for our patient/families.”

Jimmy Garcia is a 20-year-old patient at the Texas Children’s Pediatrics Ripley House location and has recently transitioned to adult care at The Transition Medicine Clinic at Baylor College of Medicine (BMC). Garcia has a global developmental delay, cerebral palsy, scoliosis, an intellectual delay, and is also non-verbal and non-mobile. He has been a patient at Texas Children’s since he was only a few months old, and is one of the many patients who benefit from the Transition Medicine program as they get older. His mother, Cynthia Garcia says that she didn’t know what to expect during the transitioning process, and is thankful for the assistance that their physician provided.

“I still wanted him to continue to see Dr. Wright,” Garcia said. “She was such a great pediatrician to him and our family, and Jimmy just feels so comfortable with her. However, everyone in the office was very positive during the process and prepared and helped us to be comfortable with accepting that Jimmy was eventually going to leave them.”

Texas Children’s academic partnership with BCM allows for an effortless transition for our patients. The goal of the BMC clinic is to prevent urgent health care crisis and to minimize the impact of a shrinking social support network that these patients and families have come to rely on in the pediatric health care system. According to Garcia, transitioning into adult care was just as easy as transferring out of the pediatric system. Their pediatrician, along with the Garcia’s social worker were very instrumental in assisting with paperwork and other aspects of the process.

“When it came time to schedule Jimmy’s first appointment, it was so smooth and easy,” Garcia said. “Our first visit to the transition clinic was also amazing. It was a joy seeing everyone so accepting of Jimmy. When we go to the doctor now, he knows the clinic, and he recognizes the environment. Jimmy is non-verbal so he doesn’t exactly express his words or anything, but the smiles, his reactions, those are things that let us know he’s comfortable and he’s aware of his surroundings. He’s doing really well!”

The program began with two clinics during the pilot year and grew through the third year. While currently in its fourth year of the grant, the goal is to identify additional clinics that are willing to participate. At the beginning of the process, clinics sign a memorandum of understanding, then identify the activities they would like to implement and goals they want to achieve to help with addressing transition.

Patients like Garcia represent the hard work that the transition medicine team has put forth, and the success of the program as a whole allows for more practices to be added and even more patients to be helped. Identifying patients who will need help transitioning in the future is key.

“Transition is not an event, it’s a process,” Peacock said. “You can’t drop someone off at the curb. It’s really about making sure that they engage.”

Engaging with the teenager and parent to make sure they have a plan, looking into insurance options, knowing what the next steps will be in advance helps to facilitate the transfer more efficiently. All seven participating practices have done this and more as they recently met their goals for the 2018 grant cycle and are looking forward to celebrating their continued success.

“Texas Children’s Pediatrics is excited to have many locations become a part of the Transition Medicine Program,” President of Texas Children’s Pediatrics, Kay Tittle said. “The goal is that this success continues on past the length of the grant, more practices are added, and we to continue to address transition effectively.”

These clinics are provided with an array of resources in the form of trainings, Epic tools, and supports for developing their own transition initiatives. If you work with TCP and are interested in learning more about Transition Medicine and how you can help support these efforts, please reach out to Pam Brock, RN pmbrock@texaschildrens.org, or Dr. Rebecca Laster, rblaster@texaschildrens.org.

November 7, 2017

Physicians, administrators, former patients and community partners came together at Third Coast restaurant on October 5 for the 5th Annual Transition Medicine Reception.

The event served as an opportunity to discuss the long-term care of Texas Children’s patients and welcome a number of attendees of the 18th annual Chronic Illness and Disability Conference: Transition from Pediatric to Adult Based Care, led by Dr. Albert Hergenroeder, Chief of Adolescent & Sports Medicine. Additionally, the 2017 Benjamin B. Ligums Scholar Award was presented to Dr. Mark W. Stephenson and his Conroe dental practice for his success in following special needs patients through the continuum of care.

The “Transition Medicine Road Trip” took attendees on a journey to the various components of the transition medicine process, with Texas Children’s employees, physicians and former patients at stations talking to attendees about: parent/guardian engagement, patient engagement, partnerships with adult providers, patient education, and technology.

A number of former patients, along with their families were also present to share their personal accounts and experience transitioning from Texas Children’s to adult providers. Stories reflected a wide range of challenges and opportunities that serve as a resource for improving the transition process.

Attendees also participated in a silent auction to score items ranging from Houston Texans items to work from local artists. All funds raised will be used to allot grants for future transition medicine pilots to grow and develop programs and help usher patients into the world of adult care.

December 15, 2015

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Falon Wiesner-Jones was just a baby when she had her first visit to the Texas Children’s Heart Center diagnosed with a congenital heart disease that has been a fabric of her life ever since. Now 33, she’s still a patient at the heart center. Today, she sees specialists in the Adult Congenital Heart Disease Program, part of the transitional medicine program that allows pediatric patients to continue their care here at Texas Children’s Hospital into their adult years.

“I’ve been here from day one and I’ll continue my care here,” said Wiesner-Jones who now drives to Houston from Dallas to see her doctors. “The doctors are well-versed in my history and it makes it easier to come to one place and receive all of the care I need.”

Wiesner is part of a growing population of adults with congenital heart disease. The Centers for Disease Control and Prevention (CDC) estimates that about 40,000 babies are born each year with a congenital heart disease. It is the most common birth defect.

“The data shows that people who were born in the 1940s and 50s, before the era of advanced surgical and interventional repairs had only about a 15 percent chance of survival past their first birthday,” said Dr. Wayne Franklin, director of the Adult Congenital Heart Disease Program at Texas Children’s Hospital. “In the modern area, we’ve reversed that and now 85 to 90 percent survive into adulthood so there is a real need for the right care for these adults who have had heart disease throughout their lives.”

That care now includes women’s care for Wiesner who just delivered her second child at Texas Children’s Pavilion for Women. When she told her physician, Dr. Wayne Franklin, director of the Adult Congenital Heart Disease Program at Texas Children’s Heart Center, she was pregnant again, he was thrilled to know her care coordination would take place in the ob-cardiac clinic at The Pavilion where both her cardiology doctors and her obstetrician meet in one place to see her during her monthly appointments.

“Women’s health and cardiology were an underserved area in medicine,” said Franklin. “With the Pavilion, we’re able to offer that to her and all of our other patients. We offer multidisciplinary care that is most crucial to these patients during pregnancy.”

Because the heart has to work harder during pregnancy, patients with heart disease are watched closely by an interdisciplinary team, meeting often in the ob-cardiac clinic for appointments.

“It’s reassuring to know all the resources we need are in one spot, all here to help me deliver safely,” Wiesner-Jones said.

Texas Children’s Hospital offers several programs for adults outside of women’s care including heart disease programs, cystic fibrosis programs as well as a program for survivors of pediatric cancer.

“Texas Children’s is now in the arena of adult medicine,” Franklin said.

October 20, 2015

102115TransitionMedinside640Texas Children’s Transition Medicine Team hosted its third annual dinner event with the evening’s theme – Transition is a Victory. The celebration was held at Texas Children’s Pavilion for Women in conjunction with the 16th Annual Chronic Illness and Disability Conference. More than 100 people attended the dinner to learn about the progress Texas Children’s has made developing transition solutions.

Nearly 90 percent of children born with chronic or disabling conditions are surviving into adulthood. People with sickle cell disease are living into their sixties and the number of adults with cystic fibrosis now outnumbers the children. This victory has left providers and hospitals nationwide with the challenge of defining and constructing appropriate and timely transitions of care.

Transition Medicine describes the planned process of educating, coordinating and transferring patient care from the pediatric to the adult health care system in a way that optimizes a patient’s health and ability to function. Texas Children’s is dedicated to helping patients transfer care smoothly without a decline or break in their treatment.

Many young adults between the ages of 18 to 21 transition their care to adult providers when they leave for college or enter the workforce. But for those with complex chronic pediatric diseases, transitioning is a struggle filled with barriers and challenges that include patient maturity, psychosocial and family needs, coordination and reimbursement issues, and identification of adult providers able to care for unique patient populations.

At the conference and the dinner, Texas Children’s patients, family and staff shared their inspirational stories and spoke to the importance of a solid transition program. The conference featured discussions on legal issues and quality improvement strategies involved in health care transition, as well as opportunities to meet and talk with faculty, exchange ideas among participants, and share knowledge and information about how best to plan for a successful transition from pediatric to adult care.

Physician speakers from Texas Children’s delivered presentations including conference founder and chair Dr. Albert Hergenroeder and Drs. Heidi Schwarzwald, Carla Tapia and Connie Wiemann.

Administration leaders John Nickens, Diane Scardino, and Daniel DiPrisco along with Drs. Marcia Katz, Angelo Giardino and Albert Hergenroeder spoke about educational efforts, innovative quality and process improvement strategies and recognized supporters of transition medicine. They were joined by family advisor, Jeb Ligums who awarded the 2015 Benjamin B. Ligums Scholar to Dr. Rebecca Laster from Texas Children’s Pediatrics Gulfton location. The scholar program allows a provider in the community to receive training on the adult special needs population and project management assistance in setting up a referral process between providers.

The dinner also included a presentation from Texas Children’s congenital heart patient Kristin Edwards who shared her touching story of transition from pediatric to an adult care at Texas Children’s. The evening wrapped up with Dr. Ahmet Uluer, director of the Weitzman Family BRIDGES Program at Boston Children’s Hospital, who spoke in support of a collaborative nationwide approach to Transition Medicine.

Click here to watch a video about Texas Children’s Transition Medicine Program. For questions or additional information, contact Kris Barton at Ext. 4-1265 or email her at krbarton@texaschildrens.org

December 23, 2014

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Texas Children’s Transition Medicine Team hosted a dinner this fall at Texas Children’s Pavilion for Women in conjunction with the Annual Chronic Illness and Disability Conference. More than 100 people interested in transition medicine attended to learn about Texas Children’s program and the progress being made in this new branch of medicine.

Transition medicine describes the planned process of moving pediatric patients into the adult health care system in a way that optimizes their health and ability to function. Texas Children’s is dedicated to helping these patients smoothly transfer to adult care without a decline or break in treatment needed for optimal health.

David Gonzalez, a Texas Children’s patient and student at Saint Thomas University, kicked off the dinner with his inspirational story and spoke to the importance of a solid transition program. He encouraged the audience to support the hospital’s efforts so that future patients will not have the same difficulties he had during his transition period.

The October 2 dinner also offered an opportunity to award the second Benjamin B. Ligums Scholar to Dr. David Hall, medical director for the Harris Health System’s El Franco Lee Health Center. The scholar program allows a provider in the community to receive training on the adult special needs population as well as project management assistance in setting up a referral process between them and their surrounding pediatric providers. Hall will build upon the successes of Dr. Elizabeth Bosquez, the first Benjamin B. Ligums Scholar.

This night also celebrated and acknowledged two remarkable families who have dedicated themselves to the transition medicine cause with their generous philanthropic support. The Ligums family was acknowledged for their support in creating the Benjamin B. Ligums Scholar Program, and the Robbins family was acknowledged for their commitment to support the Annual Chronic Illness and Disability Conference each year.

The transition medicine team has been working together for more than two years and has made great progress. They have focused on:

Readiness – preparing patients to self manage their disease and succeed in the adult world.
Handoff – ensuring that patients are not lost to follow-up during the move from the pediatric to the adult health care system.
Transfer – guaranteeing an adult provider for our patients to transition to at the appropriate age.

For a more comprehensive look inside the transition medicine plan, visit www.texaschildrens.org/transitionmedicine. For questions or additional information, please contact Caitlyn Barrow at crbarrow@texaschildrens.org or 713-798-3323, or Kris Barton at krbarton@texaschildrens.org or Ext. 4-1265.