Background:Little is known about how interventions designed to empower youth with chronic conditions operate in natural clinical contexts during the transition from pediatric to adult care. Such interventions may contribute to social learning through discourse about the future, illness, and adolescence, thereby shaping youths' understandings of identity and empowerment. This study examined how meanings of transition are discursively constructed during Transition Preparation Consultations (TPCs), a structured intervention delivered within the AD'venir transition unit in France for youth with diverse chronic conditions. Methods:We conducted a critical discourse analysis of 26 TPCs, focusing on the discursive resources and positioning practices through which youth and physicians constructed meanings of transition. Results:TPCs framed transition as a psychological and social process, encouraging youth to develop experiential understandings of illness and identity. Consultations primarily focused on self-management, living with a chronic condition in adulthood, and health maintenance, while discussions were frequently anchored in bodily changes associated with adolescence. Although physicians often adopted pedagogical and dialogic forms of communication, interactions remained largely structured by prescriptive discourses regarding responsibility, self-management, and adult health behaviors. Conclusions:Transition programs function not only as organizational interventions but also as discursive spaces in which meanings of illness, responsibility, autonomy, and adulthood are actively produced. Recognizing these processes may support critical reflection and the ongoing refinement of transition practices.

Au cours des trois dernières décennies, l’adolescence a connu des transformations d’une intensité sans précédent. Les changements technologiques rapides, les crises sanitaires, climatiques et sociales successives, la pression scolaire croissante et l’évolution des structures familiales ont profondément influencé les déterminants de la santé des adolescents. Le Haut Conseil de la santé publique (HCSP) français a analysé ces changements et présenté un tableau contrasté : si la mortalité et certains comportements à risque ont diminué, la santé mentale n’a cessé de se détériorer, en particulier chez les filles. Cette synthèse clinique explore les grandes tendances observées sur 30 ans et discute de leurs implications pour la pratique pédiatrique et les parcours de soins. Le défi consiste désormais à adapter les approches cliniques aux réalités contemporaines de l’adolescence, en privilégiant un cadre holistique qui intègre les environnements numériques, le contexte scolaire, les inégalités sociales et les nouvelles vulnérabilités psychologiques.

Over the past thirty years, adolescence has experienced unprecedented changes. Rapid technological advancements, ongoing health, climate, and social crises, rising academic pressure, and evolving family structures have deeply influenced the factors shaping adolescent health. The French High Council for Public Health (HCSP) examined these changes and presented a mixed picture: while mortality rates and certain risk behaviors have decreased, mental health has continuously worsened, especially among girls. This clinical summary reviews the major trends observed over three decades and considers their implications for pediatric practice and care pathways. The current challenge is to adapt clinical approaches to the realities of modern adolescence, emphasizing a comprehensive framework that includes digital environments, the school setting, social inequalities, and emerging psychological vulnerabilities.

BACKGROUND:Chronic diseases affect up to 15% of adolescents, and their prevalence continues to rise. As adolescence and chronic diseases interact in complex and evolving ways, ensuring comprehensive care and facilitating a successful transition to adult services are major challenges for pediatric services. It is essential to take psychosocial aspects into account to promote autonomy and continuity of care during this vulnerable period. OBJECTIVES:To assess how psychosocial dimensions are evaluated and documented among adolescents with chronic illnesses in specialized pediatric services, and to explore healthcare professionals' views on barriers to addressing sensitive issues. METHODS AND SETTING:We conducted a retrospective analysis of paper and electronic medical records of adolescents transferred to adult care between December 2015 and February 2021 from two pediatric units (Gastroenterology and Urological & Digestive Surgery). Psychosocial data were extracted using a form. In parallel, 27 healthcare professionals (16 physicians, 11 nurses) completed a self-administered questionnaire about their practices and the perceived obstacles to discussing psychosocial issues. RESULTS:Forty-six patient records were analyzed (35% female). The median follow-up time was 19 years [IQR 10-20] in Surgery and 7 years [IQR 5-12] in Gastroenterology, with a total of 16 diagnoses. Home (96%), education (93%), and activities (87%) were the most frequently recorded domains, while substance use (26%), sexuality (30%), and mental health (32%) were rarely noted. Sexuality was documented significantly more often in girls than boys (75% vs 7%, p < 0.001). Reported barriers included lack of time (62%), privacy concerns (56%), and the assumption that another professional would address the issue (44%). CONCLUSION:Although psychosocial assessment is recognized as essential, it remains irregularly performed and documented. Implementing validated and structured tools could help standardize practice, improve multidisciplinary communication, and ultimately facilitate the transition of adolescent to adult care.

General practitioners (GPs) play a key role in ensuring continuity of care for adolescents and young adults (AYAs) with chronic conditions (CCs). However, their involvement during the transition from pediatric to adult care remains limited, contributing to unsuccessful transitions. The purpose of this study is to explore the role of GPs during transition by analyzing their involvement in the care of various CCs. The study involved GPs of 112 AYAs treated in a children’s hospital in Paris for CCs (diabetes mellitus, inflammatory bowel disease, epilepsy, sickle cell disease), transferred to adult care between 2017 and 2018. The study consisted of two parts: (1) Quantitative analysis combining retrospective data from Electronic Health Records (pathology, comorbidities, social history) and a phone survey of GPs (role in transition, factors facilitating their involvement); (2) Qualitative analysis (longer surveys with 27 GPs) exploring their experiences and expectations in communicating with hospitals about transition. Fifty percent of AYAs were registered with a GP during the transition, and fewer than 20

The transition from pediatrics to adult services represents one of the many changes experienced by adolescents with chronic illnesses between childhood and adulthood. It needs to be structured and personalized to support the young person's development and empowerment, as well as the construction of his or her overall life project. With this in mind, AD'venir offers transition preparation consultations, the details and benefits of which are described in this article.

The transition from pediatrics to adult services represents one of the many changes experienced by adolescents with chronic illnesses between childhood and adulthood. It needs to be structured and personalized to support the young person's development and empowerment, as well as the construction of his or her overall life project. With this in mind, AD'venir offers transition preparation consultations, the details and benefits of which are described in this article.

La « Mission Papillagou » (MP) est une action de prévention des conduites à risque dont le but est de développer les compétences psychosociales des collégien·ne·s. Une étude qualitative mobilisant des entretiens de groupe et des observations flottantes a été menée afin d’identifier les freins et les leviers de l’intervention pour atteindre cet objectif. Il s’agit à travers cet article de questionner les rapports sociaux qui sous-tendent la mise en oeuvre de l’intervention et d’identifier les enjeux qui en découlent. Sans prise en compte du contexte des interactions sociales asymétriques entre intervenant·e·s et élèves, la MP présente le risque de renforcer des identités stigmatisées.

To pool resources and reduce inequalities in access to transition preparation for patients, transition clinics were created in France. They are places in hospitals, independent of the usual care departments, offering multiple resources and services for adolescents and their parents. Of the 24 physicians from care departments who were surveyed, half of them do not use transition clinics. The implementation of transition clinics in hospitals did not lead to their adoption by the care departments that needed the most support for transition preparation of their patients. A strategy improving adoption is needed to allow transition clinics to reduce inequalities.

Our objective was to assess the value of transition preparation consultations (TPC) offered by the AD’venir unit (R. Debré hospital, Paris) as a new service of transitional care, from the perspective of adolescents with chronic conditions (CCs) and their referring healthcare providers (RHCPs). TPCs included a face-to-face interview with pediatricians trained in adolescent medicine, exploring the adolescent’s past (CC history), present (daily life, Treatment Burden Questionnaire, family/peer relationships, school, hobbies, sexuality, drugs), and future (global life project, transition, Good2Go questionnaire). The mixed-methods design included the following: a qualitative analysis within a multidisciplinary group (clinicians/sociologists/psychologist/public health researchers) of audio-recordings of TPCs (n = 27/girls = 56%/median age = 17.7 years) and phone interviews with adolescents 2 years post-TPC (n = 26); and a quantitative analysis of the Treatment Burden and Good2Go questionnaires and the benefits perceived by RHCPs (questionnaire 6 months post-TPC). TPCs were a form of training for adult care, adolescents meeting a practitioner alone often for the first time. Naming their CC was difficult. All complained of limitations experienced in social life (diet, fatigue, laboratory/medical appointments), but not the treatment itself; most adolescents willingly talked about sexuality. Adolescents’ feelings about transition were various, with poor representations of adult healthcare. Transfer was frequently unplanned. After TPCs, RHCPs modified their practices. Transition in the 2 years post-TPC was usually successful. Conclusion

Abstract The objective of the study was to assess the clinically relevant features of the pre-transition consultation (PTC) offered in AD’venir transition unit (R.Debré hospital, Paris) to all adolescents with a chronic condition.PTCs include a face-to-face interview with pediatricians trained in adolescent medicine, exploring the past (disease history), present (daily life, Treatment Burden Questionnaire, family/peer relationships, school, hobbies, sexuality, drugs) and future (global life project, transition, Good2Go questionnaire). Twenty-seven PTC recordings were qualitatively analyzed (girls=56%/median age=17.7yrs) within a multidisciplinary group (clinicians/sociologists/psychologist/public health researchers). Respectively 6-months and 2-years after PTC, benefits of PTC were assessed in referent healthcare providers (questionnaire) and in adolescents (phone interview). PTCs were a form of training for adult care, adolescents meeting a practitioner alone often for the first time. Naming their chronic condition was frequently difficult. All complained of limitations experienced in their social life (notably diet, tiredness, laboratory/medical appointments), but not treatment itself. Most were willing to talk about sexuality. Feelings concerning transition were various, with poor representations of adult healthcare. Transfer was often unplanned, but this did not influence transition readiness. After PTC, healthcare providers often changed their practices. Two years later, transition was successful for most of adolescents. ConclusionThe PTC is a relevant, easily implemented tool to help empower adolescents and customize their transition preparation within a holistic approach. A dedicated and long consultation, with an external/non-prescriber practitioner, including a physical examination are key factors promoting the establishment of trust, sharing of intimate issues and the assessment of potential barriers to transition.

La transition entre la pédiatrie et la médecine pour adultes est une période charnière pour les adolescents et jeunes adultes porteurs d’une maladie chronique : elle comporte un fort risque de rupture du parcours de soins et de dégradation de l’état de santé à court et long termes. Pour accompagner ce passage, plusieurs plateformes de transition ont été créées ces dernières années en France, dans des hôpitaux pédiatriques ou dans les hôpitaux pour adultes. Leur objectif commun est d’être un lieu ressource offrant un accueil physique des jeunes et de leurs parents autour des questions liées à cette transition, ainsi qu’un accès aux informations utiles à leurs besoins de santé globale. Elles travaillent en partenariat étroit avec les services de soins et les associations de patients. Une forte hétérogénéité de fonctionnement et d’offre de soins est observée dans ces structures encore récentes, qu’il convient de multiplier et de pérenniser. Le principal défi à relever dans les prochaines années est de renforcer les partenariats entre pédiatrie et hôpitaux pour adultes afin de baliser au mieux le parcours de soin des jeunes porteurs d’une maladie chronique.

The transition is a key step for adolescents with chronic illnesses, as they are at risk of a disruption in care, complications and even mortality. Accompanying this process is based on two axes: autonomization of the young person (acquisition of knowledge and know-how in a perspective of empowerment) and structuring of the care pathway (transition measures, pediatric/adult service coordination).

The transition of care between pediatric and adult care is a key-period for adolescents with chronic disease, because of the high risk of follow-up loss and of short-term and long-term poorer health. To support transition, platforms of transition have been created in France since several years, implemented in pediatric or adult care structures. Their common objective is to provide a physical reception of adolescents and their parents to share about transition issues, and to inform them about resources to enhance the adolescent's global health. They tend to work closely with the referent health care providers and the patients' associations. A large heterogeneity of functioning and health care supply is still observed in these recent structures. Supporting these structures and reinforcing the partnerships between pediatric and adults care remain a challenge.

Evaluation and diagnosis of patients with somatic symptoms and related disorders (SSRD) is often challenging and time consuming. Research suggests using a structured global approach with those patients to help them get functional again. Patients with somatic symptoms and related disorders (SSRD) are consulting in many different clinic settings: however, General Practitioners, Pediatricians, Emergency Medicine doctors, Gastroenterology, Rheumatology and Neurology specialists are often in the front line of service with those adolescent patients. The evaluation and diagnosis of SSRD are challenging, time consuming and sometimes uncomfortable for the physicians. Considering the perspective of expending existing services for SSRD in our Adolescent Medicine division, we wanted to evaluate the experience of different specialists (General Pediatricians and Pediatric Subspecialists ) working in our Pediatric University Hospital Center regarding the management of adolescents with SSRD.