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Editor,—We read with interest the article by Viner regarding transition from paediatric to adult care.1 The need for planned transition is indeed very real2 and its recognition led us to develop a specific service for young people aged 16 to 25 with physical disability—the Young Adult Team. This multidisciplinary team (doctor, physiotherapist, occupational therapist, speech and language therapist, psychologist, and social worker) was established in 1988 through joint funding from health and social services with the aim of increasing the young person's autonomy while addressing parental concerns.3 It works in conjunction with the rehabilitation medicine physician and has strong links with paediatric, adult health, education, and social services. Nationally there are similar services run by members of the British Society of Rehabilitation Medicine. The impact and cost effectiveness of this type of intervention is currently the subject of a National Health Service research and development funded controlled study comparing organised transitional services and ad hoc services.
Viner suggests that the most suitable professional for transitional arrangements is a nurse specialist. While this may be appropriate for young people with conditions such as diabetes, the needs of young people with complex physical disability resulting from neurological disease are likely to be best met through a multidisciplinary approach of which the Young Adult Team is an example.
We agree that disease specific combined paediatric–adult clinics can facilitate the transitional period. However disabled young people with various diagnoses often have issues in common such as those relating to life skills, which are often independent of the disease process. These are likely to be best addressed through generic young adult services. Transitional services must acknowledge the need for disabled young people to learn how to monitor their own condition and how to access help. In Leeds we have had jointly run (paediatrician and adult physician) arthritis4 and cerebral palsy clinics for several years. These clinics have direct links with the Young Adult Team and other adult services. It is important however to recognise that services solely organised around diagnoses may exclude vulnerable young people. Therefore transitional services should be inclusive and developed using both approaches and not one approach solely to the exclusion of the other. By doing so (although we await the evidence!) we believe that the needs of young people and their parents will be best served.
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