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Partnering for Successful and Healthy Transitions:
Racing to Work!
Kathy Blomquist, Debbie Gilmer, Theresa Glore HRTW National Resource Center
APSE National Meeting
Louisville, KY, July 10, 2008
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Objectives of Session• Experience the power of Celebratory
Learning• Enhance understanding of transition
resources and current research• Identify best practices in transition and
health care transition planning• Practice strategies for supporting youth with
special health care needs in transition• Be re-newed, re-energized, and re-vitalized
from sharing a learning experience with your professional peers
• Have fun with us!
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Agenda
• Welcome!• Entering Charts• Bingo!• State of the State of the Research Kentucky’s Racing Form• Racing to Work! Transition Planning• Reflection and Evaluation
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Breeding…
Horses lend us the wings we lack. ~Author Unknown
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Everyone can work!
Achieving all A’s!
AspirationsAccessAccommodationsAssistive Technology
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Data: Children & Youth with Disabilities and Health Needs
Nationwide 10.2 million (13.9%) <18 Title V CYSHCN 1,418,445 ( 0-18*)
SSI Recipients 1,132,000 ( 0-17)
Sources:1. 2006 NS-CSHCN www.cshcndata.org, 2. Title V Block Grant FY 2008, www.mchb.hrsa.gov * Most State Title V CSHCN Programs end at age 183. SSA, Children Receiving SSI, April 2008, www.ssa.gov
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SSI Recipients Who Work: 18-29 (SSA 2008)
Youth & Young Adults• 304,948 All blind & disabled SSI recipients ages 18-21
- 33,863 (11.7 %) recipients work
- 1619(b) participants: 1.2% of 18-21
• 539,439 All blind & disabled SSI recipients ages 22-29
- 85,238 (15.8%) recipients work
- 1619(b) participants: 4.2% of 22-29
• Employment Among Persons 16-20 With and Without Employment Disability (2006 Census)
- With employment disability: Employed:16.8%
- Without employment disability: Employed: 41.2%
http://www.socialsecurity.gov/policy/docs/statcomps/ssi_workers/2006/sect01.html#chart1
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Transition & …No Insurance
•13.7 million young adults ages 19-29
without health insurance
•19 is critical age –
Uninsured rate jumps from 12% (18 and under)
to 30% (for ages 19-29)
SOURCE: Commonwealth Fund 2008
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NOD/Harris Survey of Americans with Disabilities (2004)
Variable People with Disabilities
People without Disabilities
Not getting needed health care
18% 7%
Health insurance not paying for service
needed
28% 7%
Income less than $15,000 per year
26% 9%
Education:
HS dropouts
21% 10%
Employment 35 % 78%
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What do Young People Want?
• To have opportunities just like all youth - fun, jobs, friends
• To be included and accepted
• To be independent
• To be educated
• To experience health and wellness
• To hear applause for their performance
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Reflection …
• What I want to remember
• Ways I’ll use this information
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Training…
No horse gets anywhere until he is harnessed. No stream or gas drives anything until it is confined. No Niagara is ever turned into light and power until it is tunneled. No life ever grows great until it is focused, dedicated, disciplined.
Harry Emerson Fosdick
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Health Impacts Performance & Productivity
Success in the classroom, within the community, and on the job requires that young people are healthy.
To stay healthy, young people need an understanding of their health and to participate in their health care decisions or identify the appropriate supports.
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Partner with Youth and Families
• Talk about health in relation to learning and employment
• Promote participation in health care and decisions
• Include the school nurse more actively in the IEP
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Partner with Health Professionals
• Everyone has the same goal: promoting optimal potential
• Think health!
• Transition is about community partners: Partner with primary physician, school nurse, etc.
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Youth are less interested in any transition organized around medical issues and more interested in a transition to financial and
social independence.
Adolescent Employment Readiness Center (AERC) Research
(Dr. Patience White):
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Measuring what youth should know and do
• Health condition• Providers• Insurance• Family and friends• Independent living• Postsecondary education and training• Employment• Recreation and leisure• Other general skills
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Reflection …
• What I want to remember
• Ways I will use this info
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Racing Form:
Kentucky Data!
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HRTW-KY Survey & Followup• Mail Surveys
– KY Commission for CSHCN 18+– SHC, Lexington
• Initial Survey: 1999-2001 N=650 (see Blomquist, 2006, Orthopaedic Nursing)
• Followup Survey 2001-2003 (see Blomquist, 2007, Orthopaedic Nursing)
N=300– 85% from KY– 94% white– 64% female– 28% independent in ADLs
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HRTW-KY Survey & FollowupN=300 DEMOGRAPHICS
Comparison: Census, BRFSS, Childtrends Databank
Variable Initial 2-years
laterComparison
Age 18-23 (21.1)
20-25 (23.1)
Live with parents 58% 43% 56% men
43% women ages 18-24
Live with spouse/
significant other
22% 30% 53%
in mid 20s
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HRTW-KY Survey & Followup (2)
N=300 DEMOGRAPHICS
Variable Initial 2-years later
Comparison
Single/
never married
85% 73% 77%
20-24 yr olds
Children 17%(49%
unwed)
25% (33%
unwed)
48% women 32% men
by mid 20s
Got help with survey 30% 23%
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HRTW-KY Survey & Followup (3)
N=300 HEALTH
Variable Initial 2-years later
Comparison
Perception of health 12% Ex
32% VG
35% G
18% F
3% P
13% Ex
30% VG
31% G
21% F
4% P
20% Ex
39% VG
33% G
7% F
1% P
Have doctor 85% 83% 73%
18-24 yr olds
Have been to ER in past year
37% 39% 25%
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HRTW-KY Survey & Followup (4)
N=300 INSURANCEVariable Initial 2-years
laterComparison
Have no insurance 24% 25% 39% of KY
18-24 yr olds
Type of Insurance *41% medicaid
*9% own job
*27% family
*10% other
*42% medicaid
*18% own job
*19% family
*13% other
*9% medicaid
*53% employment based
Offered health insurance with work
43%57% took
54%73% took
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HRTW-KY Survey & Followup (5)
N=300 WORK AND SCHOOLVariable Initial 2-years
laterComparison
Working 45%
21% FT
51%
26% FT
By age 25, 92% men and 81% women work
Receive SSI 36% 36%*21%
working
*58% use computers
*19% drive
Completed HS or higher
66% 72% 86% of
20-24 yr olds
Idle – not working, not in school, no children
23% 29%
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Issues!
Planning for YSHCN becoming adults:
• Sending System: Preparing families, youth and professionals - envisioning adulthood
• Receiving System: Different expectations, programs, rules and regulations
• ONE Plan for Collaboration across systems in the community: health, education, work, housing, transportation, technology, play
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Reflection….
• What do we do to promote work for youth with special health care needs and disabilities?
• To promote health?
• To promote access to health insurance?
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Starting Gate!
I have seen things so beautiful, that they have brought tears to my eyes. Yet, none of them can match the gracefulness and beauty of a horse running free.
Unknown
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Successful health care transition!
Youth are able to do independently or direct others:
• Access health services • See the doctor alone • Discuss their health conditions• Communicate their health care needs• Self-manage their care, and support is
available
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Youth are able to (con’t.)
• Make health care decisions (or support is in place)• Understand when their pediatric practice
expects transition, and what to expect from adult health care providers
Young adults • Have insurance and know how to use it
responsibly• Have adult health care – primary, specialty,
therapies, assistive technology• Are prepared for and have jobs and careers
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Racing to Work…Transition Planning
A horse is the projection of peoples' dreams about themselves - strong, powerful, beautiful - and it has the capability of giving us escape from our mundane existence.
Pam Brown
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Title V Leadership
Toni Wall, MPA
Kathy Blomquist, RN, PhD
Theresa Glore, MS
Federal Policy
Patti Hackett, M.Ed
Interagency Partnerships
Debbie Gilmer, M.Ed
Medical Home & Transition
Richard Antonelli, MD, MS, FAAP
Patience H. White, MD, MA, FAAP
Betty Presler, ARNP, PhD
Family, Youth & Cultural Competence
Mallory Cyr
Ceci Shapland, MSN
Trish Thomas
HRSA/MCHB Project Officers
Elizabeth McGuire/Lynda Honberg
HRTW TEAM
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Contact Us
• Kathy Blomquist: [email protected]
• Debbie Gilmer: [email protected]
• Theresa Glore: [email protected]
Healthy & Ready to Work National Resource Center
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