What is healthcare transition, and why is it important?
In late adolescence and young adulthood (a stage called "emerging adulthood"), youth face several challenges and transitions in their path to independent adulthood. These include transitioning from high school to college, work or vocational training, forming independent friendships and romantic relationships or independent households, and transitioning from the pediatric healthcare system to the adult healthcare system.
Youth with special healthcare needs or ongoing need for health care services, face significant obstacles as they age out of highly supportive pediatric healthcare services and assume responsibility for their own health care. Youth can be at various stages of readiness to assume these responsibilities. Those youth that are not ready to assume independent responsibility for their own health and health care are at risk for failing to become integrated in the adult healthcare system, stopping needed care and potentially face deterioration in their health.
Through assessment, as well as provider and family interventions, the various stages of transition can be better measured and validated. This then helps both pediatric and adult providers (including programs specifically focused on transition) and families better understand and support the transition process.
How has the TRAQ been studied and assessed?
We have conducted three studies to revise, update, and validate the Transition Readiness Assessment Questionnaire (TRAQ). In the first study, we administered The TRAQ to 192 youth with special healthcare needs aged 16-26 years in three primary diagnostic categories, conducted factor analysis, and assessed differences in TRAQ scores by age, gender, race, and primary diagnosis type. The results of this study1 show that the TRAQ is a useful tool to assess transition readiness in youth with special healthcare needs and to guide educational interventions by providers to support transition. In the second study, we administered the TRAQ to 269 youth and used factor analysis and other methods to reduce the number of items from 29 to 202. We labeled it the TRAQ 5.0 because it was actually the 5th version of the TRAQ. See here for a copy of the TRAQ 5.0. The 20 item TRAQ 5.0 and the original 29 item TRAQ has been used in a number of studies and has been shown to be responsive to both the cognitive maturity of youth (as measured by the proxy of age) and to interventions to improve transition readiness. Please see below for references for these studies.
The most current version of the TRAQ was published in Journal of Pediatric Nursing in 2021. We believe this to be the most robust TRAQ questionnaire, one that is more sensitive to the wide range of transition readiness within 4 domains. Please click here for a copy of this current version of the TRAQ, and click here for the article we published in the Journal of Pediatric Nursing3. For the resulting 20 item TRAQ scale we conducted reliability testing by calculating the Cronbach alpha for the overall scale and for the subscales identified in the factor analysis. The overall scale Cronbach alpha was 0.930 (standardized 0.933). Cronbach alphas for each of the four subscales are as follows:
Appointment Keeping (0.89)
Tracking Health Issues (0.76)
Managing Medications (0.84)
Talking with Providers (0.90)
Our work represents the development of an instrument measuring critical skills needed for successful healthcare transition. In future studies we plan to administer the TRAQ to a larger number of youth with a diverse set of health conditions over time. Future work is also needed to assess the association of TRAQ scores on other measures of self-management, self-determination, and health and transition outcomes such as access to adult providers, completion of educational or vocational goals in young adulthood, and to conduct longitudinal analyses of the TRAQ in order to test predictive validity.
How do providers get involved?
Providers can be a part of this ongoing work by registering and providing resulting
data from your individual administered questionnaires in several ways. You can download
an Excel spreadsheet to tabulate the scores of the patients in your program or study.
Visit our page titled "How to Use the TRAQ" for details on how to implement this tool in your clinic, registration, and downloads.
1Gregory S. Sawicki, Katryne Lukens-Bull, Xiaoping Yin, Nathan Demars, I-Chan Huang,
William Livingood, John Reiss, and David Wood. Measuring the Transition Readiness
of Youth with Special Healthcare Needs: Validation of the TRAQ—Transition Readiness
Assessment Questionnaire. J. Pediatr. Psychol. (2011) 36(2): 160-171
http://jpepsy.oxfordjournals.org/content/36/2/160.full