This discussion paper draws on a range of personal and other published research articles to respond to calls for a re-conceptualization of the concept of Transition. Acknowledging the roots of the concept in developmental and health psychology, the article briefly considers application to fields of practice in formal and informal education, health, social care, counseling, and psychotherapy that underpin approaches to supporting young people to navigate the journey to adulthood. UK service provision is discussed to consider why linear developmental approaches may be problematic, alongside recent calls for a re-conceptualization of what we mean by Transition to successfully understand, support, and enable complex journeys to young adulthood. The paper concludes by proposing a holistic, non-linear bio-ecological systems approach within which it is possible to integrate globally evolving research, pathways, models, and interventions. The approach will be of interest to an international readership because principles can be adapted to respond to shared and country-specific challenges, developments, and models of service provision as we approach the second quarter of the twenty-first century.

Transition to adulthood for young people is complex and multi-faceted, with additional hurdles for young people who have disabilities, long-term, or life-limiting conditions or mental health problems. The challenges in providing effective transition support are not new; researchers, policymakers, commissioners, and service providers have been grappling with the problem for several decades, with varying degrees of success. The aims of this integrative review were firstly to build on previous research to synthesize and evaluate recently published evidence. Secondly to provide an overview of the effectiveness of interventions (in one or a combination of health, social care, and education transitions) designed to support transition to adulthood in these groups of young people. A search of a range of databases retrieved published literature from January 2015 to January 2021 demonstrating global interest in the topic. Fifty-one articles were included following an appraisal of quality and eligibility. Qualitative, quantitative, mixed methods studies, and evidence synthesis were included. Some studies were clinically orientated whilst others examined the impact of the transition process, or utilized participatory approaches which give young service-users and families a voice. Transition between children's and adult health or care services as well as other life-course trajectories, such as life-skills development, education transitions, social inclusion and employability were evaluated. Thematic analysis and synthesis of articles retrieved in this review highlighted themes identified in previous reviews: timing of, and preparation for transition; perceptions and experience of transition; barriers and facilitators; transition outcomes. Additional themes included special considerations; dealing with complexity; advocacy, participation, autonomy, aspirations, and young people's rights; future work, research, and evaluation. Novel perspectives and diverse data sources contributed to holistic understanding of an ongoing priority for international policy, service development, and research: the complexity of providing effective transition support and achieving positive outcomes for young people with long-term and life-limiting health conditions, disabilities, and mental health difficulties.

These Evidence Summary Tables support the publicationChallenges, Complexity and Developments in Transition Services for Young People with Disabilities, Mental Health, and Long-term Conditions: An Integrative Review.1. Quality Appraisal Summary Table 2. Emerging Core Themes and Sub-themes

Click to increase image sizeClick to decrease image sizeKEYWORDS: Transitionyoung peoplehealthcare Disclosure statementNo potential conflict of interest was reported by the author(s).Additional informationFundingThe author(s) reported that there is no funding associated with the work featured in this article.

A growing evidence base highlights the challenges and support needs of young carers and young adult carers, however research and policy frequently neglect the voice and experience of young people themselves. A team at NHS England developed the Young Carer Health Champions programme to bring together young carers and young adult carers from across England, establishing a network of peer support, sharing of experiences and improving confidence, health literacy and wellbeing. This commissioned independent evaluation aimed to explore the impact of the programme and inform future delivery. Taking a qualitative case study approach, young participants have a central voice, illuminated through the observations of the researcher during residential activities, and data generated during a focus group and telephone and on-line interviews. Findings demonstrate positive impact on the personal development and lifestyles of the Young Carer Health Champions, and their journey from beneficiary to pro-active shaper of services and policy.

This article discusses the growing body of evidence on the importance of health for looked after children and young people and evaluates a project, Hearty Lives (Liverpool), designed to produce positive results. Unhealthy weight and lifestyles are significant issues for young people in care, whether living at home with parents under the supervision of social services, with foster carers or in residential homes, as there is a close relationship between food, nutrition and family connectedness. Following the principles of Appreciative Inquiry, the evaluation uses a case study approach to explore the learning and experiences of those involved in the intervention. The learning gained provides useful insights for practitioners and organisations who are interested in developing similar projects elsewhere.

Involvement of service users in the delivery and development of services by providing unique feedback on their own experiences is a well-established feature of continuing improvement and quality enhancement. The Friends and Family Test (FFT) is a tool that supports the fundamental principle that people who use NHS services should have the opportunity to provide feedback on their experience, however children and young people are a group of key stakeholders whose voice has not been routinely sought. This article summarises the evaluation of a pilot project which aimed to implement and test the utility of a children and young people friendly version of the FFT in general and dental practices with a view to making it more widely available in the future. One exemplar Case Study is provided and findings lead to recommendations on how to ensure the FFT is continually made accessible to children and young people.

The journey to adulthood is complex and multi-dimensional. Young people may be independent in some spheres of their lives, but dependent in others. For young people with a disability, long-term condition, or mental health problem there are additional hurdles. As they move between health and social care services, they will find significant differences in expectations, delivery, and culture. At the same time, their own needs will be evolving. Despite a great deal of guidance on effective transition support, in 2014, England's Care Quality Commission highlighted a shortfall between policy and practice. The result is confusion and frustration for young people, their families, and the staff caring for them. Seamless transition to adult services is by no means a universal experience. Here the authors offer two case studies that triangulate inter-related perspectives: those of young people, parents and carers, and the professionals involved in successful models of transition support. The case studies illustrate how the challenge of transitioning to adult services is actually experienced and how, despite some concerns held by young people, parents, and carers, well-planned and coordinated transitions can have positive outcomes for the families involved.

Numerous policy directives highlight the need for planned and well-coordinated support to enable young people with long-term conditions and disabilities to negotiate the transition to adulthood, including making the leap from children-oriented to adult- centered health services. The journey is complex and multi-dimensional. For young people with a disability, long-term condition, or mental health problem there are additional challenges when transitioning between services with differences in expectations, delivery, and culture. This article explores findings from 6 case studies of young people who have recently experienced transition to adult health and care services, triangulating inter-related perspectives: those of young people, parents, and carers, and where possible the professionals involved. One of the case studies illustrates how the challenges are actually experienced. Analysis of emerging themes across the case studies leads to key messages from families to inform strategic development of services and practice.

The National Health Service Institute for Innovation and Improvement was established to help the NHS to improve healthcare by rapidly developing and disseminating knowledge and evidence about new ways of working. One example is the Emergency and Urgent Care Pathway for Children and Young People which focused on providing high quality and safe healthcare for children and young people requiring urgent or emergency treatment for the most common illnesses and injuries. Monkey's Guide to Healthy Living and NHS Services was developed to increase awareness of acute health services in primary school-aged children. This free resource was posted to every primary school in England. A process and impact evaluation was undertaken to explore how the resource was being utilized during 2013-2014. A small number of in-depth case studies were developed involving classroom-based observations and teacher interviews along with a much larger online survey which was emailed to all primary schools in England. On the whole, the resource was viewed as useful, engaging, and informative; with children, teachers, and other professionals particularly valuing the monkey puppet, video clips, and teacher resources. The National Evaluation highlighted that most respondents integrated the materials into the curriculum, used them as a one-off lesson, or developed their own innovative and strategic approaches to make the best use of the resources; almost two-thirds of schools who responded to the survey felt the resources led to pupils knowing about the available NHS services and healthy lifestyles; over half felt pupils were now more informed about the most appropriate services to use.

A team of researchers from the Faculty of Education, Health and Community recently carried out a national evaluation project on behalf of the NHS Institute for Innovation and Improvement. Colleagues from across the faculty were involved in evaluating the impact of resources provided to every primary school in England. The resources were designed to enable teachers and health professionals to work together to help children learn about the NHS and the range of services they could access if they required acute of emergency care.

Pain is one of the most complex of all human stressors. This paper reviews the literature specific to children's pain and outlines the factors that influence how they perceive pain. The author also describes how children's pain is observed and how their needs are met in his own unit, and the importance of involving children in the management of their pain.