What is the TRAQ?

Transition from adolescence to young adulthood can be a complex and challenging process.  As medical providers to this population, we developed the Transition Readiness Assessment Questionnaire (TRAQ) to be an aid to adolescents/young adults, their parents, and their providers in the transition process. The TRAQ measures key skills needed by all adolescents to manage their own health and healthcare, so they are ready to enter the adult healthcare world. 
 
The Transition Readiness Assessment Questionnaire was developed to allow self-assessment by youth 14-21 on the management of their own health and healthcare.  The questionnaire can be used in a busy clinic because it can be filled out in 3-5 minutes.  In addition, we have developed a protocol algorithm on how to use the TRAQ, how to respond to the results of the questionnaire, and resources on how to engage youth so that they can build skills of self-management, as well as improve their awareness, motivation, and self-efficacy. To find this page titled "Using the TRAQ in Clinic," click here.



 

  • Domains
    The following four domains make up the most recent version of the Transition Readiness Assessment Questionnaire (see Johnson K, Wood DL, et. al, 2021 below):
    •     Managing Medications
    •     Appointment Keeping
    •     Tracking Health Issues
    •     Talking with Providers
  • Motivation and Confidence
    There are two additional questions at the bottom of the TRAQ that assess the youth’s motivation and sense of self-efficacy or confidence to learn health and healthcare self-management skills.  If either of these are low, these should be addressed by the provider by exploring why they scored low and what they could do to help increase their motivation or confidence. 
     
    To raise motivation, we ask the youth to describe their life goals. We then reframe the TRAQ skills as skills that will help them achieve those life goals. To raise their self-efficacy or confidence, we explore what concerns they have and then we ask them to make one small goal and do one small change that will help them gain confidence in the skills areas of the TRAQ.  For example, for a youth with low confidence, we may encourage them to first practice asking questions of the doctor in a non-threatening setting, such as with their parents or friends, before they practice the skill in the clinic.
  • Skill Levels

    The Transition Readiness Assessment Questionnaire contains a series of questions about activities related to independence in health and health care self-management.  Each question has a 5-level Likert scale response using the following responses:

    ·         No, I do not know how
    ·         No, but I want to learn
    ·         No, but I am learning to do this
    ·         Yes, I have started doing this
    ·         Yes, I always do this when I need to

    These levels correspond to the 5 levels of the Stages of Change in the Trans-Theoretical model of behavior change: Pre-contemplative, Contemplative, Initiation, Action and Mastery.   

    • Pre-contemplation = No, I do not know how…
      • Implying I’m not interested or not thinking about it.
    • Contemplation Stage = No, but I want to learn…
      • I am open to trying, but I have not yet tried to do this on my own.
    • Initiation = No, but I am learning to do this.
      • The “No” is negative, and we feel this indicates that while they  may have tried, they are early into their efforts and do not feel comfortable doing this
    • Action = Yes, I have started doing this
      • The “Yes” is more affirmative, but the phrase “started doing this” indicate that they have not yet mastered the behaviors or are doing them consistently.
    • Mastery = Yes, I always do this when I need to
      • It is fairly self-explanatory.  

    These response categories are important, and it is worth explaining the response categories to the youth when you give them the questionnaire.

    In the framework of the Trans-Theoretical Model for Behavior change, Motivational Interviewing is used to approach and engage the youth to support behavior change. Each Stage of Change guides the provider in a different approach to counseling or coaching the adolescent, using a Motivational Interviewing approach. It is important to look across the whole instrument for patterns of responses and evaluating the youth’s motivation and confidence levels in engaging in these behaviors.  We recommend users consult good resources on Motivational Interviewing and use this approach with engaging youth in a manner that is appropriate for their stage of change with respect to the skills measured on the TRAQ. There are references on Motivational Interviewing in the References section below.

    For example, a youth may indicate that their overall score for each section is in the 1-2 range (“No, I do not know how” with some “No, but I want to learn”).  In talking with this youth, it would be good to help them explore their values and goals and point out the need to learn these skills in order to achieve their goals—in a sense creating discrepancy.  For example, this youth may have trouble remembering to take their medication and instead rely on a parent to remind them.  If they are resistant to taking responsibility and learning new skills, the provider must roll with resistance and encourage self-efficacy.  They may ask the youth, “I understand you want to have more freedom to go out, drive, or get a job.  Do you think it is important to make sure you take your seizure medicines, so can do these things you want to do?   How do you think we should build that skill?”  Or… “I understand you are planning to go to college.  Do you think you will need to learn to get and take your medicines on your own at college?”  By tying the youth’s own goals to the health and healthcare skills can help move someone from pre-contemplative to the next stages toward action.  To help gain these skills the provider can refer to the activities in our established goals (find under the “Transition Goals” section of this website), such as suggesting the youth download an app with reminders or setting daily alarms on their phone to prompt them to take their medicine. The provider will document this encounter and the steps they established to encourage the youth in managing their health and healthcare.

Share