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How to Help Young People Transition into Adulthood
Dr Christina J. Canody discusses how to help children and teens transition into adults, how parents can prepare their children, and role they play in the transition.
Featured Speaker:
Dr. Canody earned her medical degree at West Virginia University School of Medicine and completed postgraduate training at University of South Florida School of Medicine, Department of Pediatrics. Her clinical interests are adolescent medicine, school health, pediatric mood disorders and development and behavior. She enjoys teaching and is a core faculty member of the BayCare Pediatric Residency program, a volunteer faculty member at the University of South Florida Department of Pediatrics, and a clinical preceptor for medical, PA, and APRN students.
Dr. Canody holds diverse leadership roles in both the health system, community and population heath. She is the Medical Director for the St. Joseph’s Children’s Hospital Mobile Medical Clinic and the BayCare Physician Partners CIN in addition to serving as an advisor to both local county and private school systems. Additionally, she is a presenting sponsor and coordinator of pediatric CME events for BayCare Health System.
Dr. Canody perspectives on pediatric and adolescent medicine are featured in Tampa Bay Parenting Magazine, Tampa Bay Times and broadcast on Bay News 9, WFLA News, and WTSP.
Learn more about Christina J. Canody, MD
Christina J. Canody, MD, FAAP
Christina J. Canody is a pediatric physician at BayCare Medical Group, Armenia Pediatrics in Tampa, Florida, and Pediatric Service Line Medical Director for BayCare Health System.Dr. Canody earned her medical degree at West Virginia University School of Medicine and completed postgraduate training at University of South Florida School of Medicine, Department of Pediatrics. Her clinical interests are adolescent medicine, school health, pediatric mood disorders and development and behavior. She enjoys teaching and is a core faculty member of the BayCare Pediatric Residency program, a volunteer faculty member at the University of South Florida Department of Pediatrics, and a clinical preceptor for medical, PA, and APRN students.
Dr. Canody holds diverse leadership roles in both the health system, community and population heath. She is the Medical Director for the St. Joseph’s Children’s Hospital Mobile Medical Clinic and the BayCare Physician Partners CIN in addition to serving as an advisor to both local county and private school systems. Additionally, she is a presenting sponsor and coordinator of pediatric CME events for BayCare Health System.
Dr. Canody perspectives on pediatric and adolescent medicine are featured in Tampa Bay Parenting Magazine, Tampa Bay Times and broadcast on Bay News 9, WFLA News, and WTSP.
Learn more about Christina J. Canody, MD
Transcription:
How to Help Young People Transition into Adulthood
Intro: This is BayCare HealthChat. Another podcast from BayCare Health System.
Amanda Wilde: This is BayCare HealthChat. I'm Amanda Wilde. In this episode, we'll talk about young people transitioning from pediatric to adult health care.
Dr. Christina J. Canody is Medical Director of the Pediatric Service Line for BayCare. Dr. Canody, welcome to the podcast.
Dr Christina Canody: Thank you for having me here today.
Amanda Wilde: What do we need to consider in order to set up kids for becoming successful adults in the medical system? I mean, how do we think about this?
Dr Christina Canody: I think we have to start from a young adolescent age to start preparing youth to become young adults. Especially in today's age where people have been very reluctant to go into medical offices as a result of the pandemic. We have found more and more patients have lacked getting their annual checkups, which have left chronic conditions undiagnosed and having a worse prognosis. So it's even more important to prepare our youth for becoming young adults and being proactive and taking care of their own health.
Amanda Wilde: Well, at what age do we start transitioning kids to this sort of relationship? At what time in childhood does the parent leave the room and the child have a one-on-one doctor-patient relationship, or does that happen after reaching adulthood?
Dr Christina Canody: So in general, we recommend that that start with the onset of adolescence, which is during puberty changes. So for most youth that's between the ages of 11 and 13. It's important that the patients establish a one-on-one relationship with their provider. Number one, because they want to be able to ask very sensitive questions without being scrutinized by their parents, because it's not surprising that sometimes they don't set forth the whole truth when mom or dad is in the room. And the other thing is for them to be able to ask questions and feel open and honest about them, as well as respond to our questions openly and honestly.
Amanda Wilde: Well, when the child is under 18, or I don't know if it's 21 in some states, are there legalities involved when they are not considered an adult by law when you provide one-on-one health care to minors?
Dr Christina Canody: So in general, you have to refer to each specific state. Here in Florida, where our health system is located, there are specific laws related to the delivery of health care in adolescents. For those ages 13 and up, if there's a medical emergency, obviously that is always covered. Additionally, there are provisions for behavioral health and mental health services, as well as those for substance abuse and those for pregnancy and contraceptive care. Obviously, a medical treatment with medications, should fully be disclosed to the parents, but in situations where there's a risk to the child, then those are covered under our Florida statutes to protect them so they can have the care that they need for those conditions.
Amanda Wilde: What other special needs circumstances do you run across?
Dr Christina Canody: So the other special needs circumstance that we run across are those who have special needs from a standpoint of chronic illness, where their mental capacity may not be those of an average youth, or they have a chronic condition, which has led them to need an uptake of medical services. So for a lot of these patients, it's important to prepare even more so because they're usually seeing not only their primary care provider, but also they're seeing multiple specialists. And there's a cut-off of differences in ages, some providers will go to 18, some will go to 21, some will even go to what we consider the end of adolescence, which is as old as 26.
So it's important to, number one, know where your provider stands with transferring patients out of their practice. Number two, knowing what adult providers will take care of those children and patients as they transition into adulthood. And number three, knowing if there's any special issues, such as those who can't take care of themselves or can't actually advocate on their own behalf that you're putting into place the legalities to make sure that you can actually be their guardian after they turn 18 years of age.
Amanda Wilde: For kids who don't have the special needs, but who are transitioning into adulthood and adult care, how do they focus on maintaining health or preventative medicine?
Dr Christina Canody: So, I think the biggest thing starts with a very young age when kids are just toddlers and infants in our practices. Pediatrics is the one specialty where we see children regularly. They have a set regimen of scheduled visits starting at one to two weeks of age. That goes on all the way through yearly visits starting at three to 18 years. Those are all a part of their wellness visits, their sports checkups if they're participating in athletic events, for their immunizations, as well as an assessment of their growth and development through all of those ages.
What we see is about 75% of children get regular checkups. By the time they're adolescents, it's down to about 50%. And then by the time it reaches adulthood, it's only 20%. So about one in five adults get a regular annual preventative visit. For those who are uninsured, it's probably less than 10%, which is really concerning from the standpoint of not being able to find an abnormality and treat it early or catch something before it truly becomes a problem.
Understanding that that one-on-one relationship with the provider starts at a young age is really important. So the way that we address kids and we talk to them and we ask them what their symptoms are, that even evolves further as they become adolescents and young adults. You want to earn that trust in that relationship, and that's an important part of transitioning to the adult provider relationship because you've earned the trust of somebody you've been with for 18 plus years. And now you're transitioning to a new provider where you have to earn a new trust and be on your own with not necessarily your parent there guiding you through it and understand how to be a true consumer and advocate for your own health care.
Amanda Wilde: So, how do we teach children to become educated consumers of health care?
Dr Christina Canody: I think number one, it's by parents encouraging children to talk to their providers when they're in the room and say, "Tell them how you feel." Answer the questions directly from the patient and not just from the parent. Parents always want to say, "I'm worried that Johnny has this wrong," or "Susie has this going on," but it's not until you start questioning the patient that you truly understand what's this in the context of or is there an underlying problem?
And additionally, with the rise in so many behavioral health disorders, it's important to understand is there an outside force affecting their health at this point in time? So getting that established rapport with the patient is really important because you also understand what is their affect, what is their mood. Normally, they come in here and they're very happy and they're outgoing. And today, they just looked downtrodden and sad. Or, you know, this is a patient that normally they're just easy going and everything's fine, but they're very anxious today. So it's obvious that they're under stress. So understanding that it's an integral part of the provider-patient relationship is important for parents to go, "Okay, you get to take some responsibility for this now," and that starts from a young age when you can answer questions. It moves into responsibility for remembering to take your medication and remembering to ask questions and maybe bringing up things that you've talked about.
I have a lot of parents who will look at their child and say, "Hey, we talked about this last week. What did you want to ask Dr. Canody when you were in here for your checkup?" And they'll go, "Oh, mom, I wanted to tell her about my foot." So it's important that they are having the conversation before they come to your office and even start that conversation with you because they really know what is going to be the focus of that visit when they come in.
The other thing to understand is as they get a little bit older, there are a lot of what I call the business side of medicine. So it's registering online, it's setting up your appointments, it's responding to your text message reminders, it's having a copy of your insurance card. It's knowing which pharmacy that you use. And there are a lot of older adolescents who from 16 on will come to the physician without a parent, because in a lot of cases, the parents have already signed a consent form for those visits. Or if they're 13 and older, sometimes there's a designated health care surrogate or somebody in the family such as a nanny or a grandparent who's been approved to bring that child in as well. So with children knowing the answer to those questions, it's really important and it shows that they're becoming more and more responsible and becoming a consumer of health care.
Amanda Wilde: So those are some ways parents can actually help their children take on that responsibility through the growing up years.
Dr Christina Canody: Absolutely. And understanding that at certain visits, there's a copay expected. So how are you going to be prepared to pay that? Are you using mom or dad's debit card? Are they going to pay it ahead of time? So understanding all the different responsibilities that come along with it. From the history being provided that's accurate and tells you all the details to understanding the business part of what's coming in, understanding the fiscal part of what's happening and understand that follow-up is needed. Whether it's scheduling another appointment, whether it's picking up a prescription at the pharmacy or whether it's just remembering to follow what instructions your doctor gave you, those are all part of the visit that are really important that the information gets passed along to the patient.
Amanda Wilde: And then as kids transition into seeing an adult provider, even if they've done most or all of this preparation, what other differences might they expect in either their relationship with the doctor or the approach to their care?
Dr Christina Canody: That's a great question, because what we find is change, it can always be stressful. But it's your response to stress that really determines how you do with that stress. So for some people, it's exciting. For other people, it's very difficult and anxiety-provoking. But understanding what those changes are is really important.
Number one, when most patients come into the pediatric office. It's anticipated they're going to have one or two complaints that we're going to address. But in a lot of adult wellness visits, there are so many checklists and what we call preventative screenings that need to be done that sometimes there's not chances to address those acute problems.
So for adult providers, a lot of them will say, "Okay, I understand this is causing you an issue, but we need to schedule you to come back in," or if somebody has a chronic illness such as high blood pressure, diabetes, asthma, they're going to schedule a separate visit to address that problem and not necessarily at the well visit. So that's going to require multiple visits moving through that relationship as well.
The other thing that I've noticed is in general adult providers don't offer the same kind of same-day sick services that we see in the pediatric world. I would say for 90% to 95% of our patients, they call in and we get to see them within the next 24 to 48 hours when they're ill. For adults, because of the increased need especially during the pandemic, it's been hard to manage all those acute care visits. So as we get older, we find more and more of the young adult population seeking out urgent care services or being seen in the emergency department. So making sure that they have what they need to manage their chronic illnesses is really going to help preventing those acute care visits, where they are responsible for a higher copay, higher deductibles in the urgent care and in the emergency department. So that makes them even more of an informed consumer of health care.
Amanda Wilde: Is there anything else young people should know about advocating for themselves as adults in the health system?
Dr Christina Canody: I think the biggest thing is to be proactive and understanding that you are in charge of your own health. So we can give you guidelines, we can give you recommendations. But understanding that things that you do between the ages of 18 and 25 may affect your body or your health for the rest of your life. So understanding that we can have an effect when it comes to our nutrition, when it comes to our wellness checkups, when it comes to our physical exercise, when it comes to overall managing stress and being emotionally intelligent, those are all important parts of our health and wellbeing. So it's not just coming to the doctor to listen to your heart and listen to your lungs and check your ears and throat and your abdomen, it's making sure that we have healthy minds and healthy bodies and the fuel that we're putting in and the things we're doing are really keeping our bodies healthy on a day-to-day basis.
Amanda Wilde: So really giving kids that sense of personal responsibility.
Dr Christina Canody: Absolutely. Absolutely.
Amanda Wilde: Dr. Canody, this has been really, really helpful. Thank you for your insights on how to prepare young people to successfully transition into adulthood. There's so many challenges for young people today. This part sounds like we've got this really well thought out.
Dr Christina Canody: Absolutely. I think it's a whole new world out there. So understanding that just like preparing to leave for college, we should be preparing our youth to eventually transition to an adult provider. So knowing that line of communication and what you need to do in case of an illness is important, but also maintaining a relationship with a regular primary provider and a medical home is overall going to have a tremendous impact on your health when you get older, because you're going to be able to meet those challenges of illness or of chronic illness, because you have become educated about what you need to do.
Amanda Wilde: And that transfers to other areas of life as well.
Dr Christina Canody: Absolutely.
Amanda Wilde: And that wraps up this episode of BayCare HealthChat. For more information on pediatric care at BayCare, visit BayCareKids.org. Please remember to subscribe, rate and review this podcast and be sure to check out all the other interesting podcasts in our library. For more health tips and updates, follow us on your social channels. I'm Amanda Wilde. Thanks for listening and stay well.
How to Help Young People Transition into Adulthood
Intro: This is BayCare HealthChat. Another podcast from BayCare Health System.
Amanda Wilde: This is BayCare HealthChat. I'm Amanda Wilde. In this episode, we'll talk about young people transitioning from pediatric to adult health care.
Dr. Christina J. Canody is Medical Director of the Pediatric Service Line for BayCare. Dr. Canody, welcome to the podcast.
Dr Christina Canody: Thank you for having me here today.
Amanda Wilde: What do we need to consider in order to set up kids for becoming successful adults in the medical system? I mean, how do we think about this?
Dr Christina Canody: I think we have to start from a young adolescent age to start preparing youth to become young adults. Especially in today's age where people have been very reluctant to go into medical offices as a result of the pandemic. We have found more and more patients have lacked getting their annual checkups, which have left chronic conditions undiagnosed and having a worse prognosis. So it's even more important to prepare our youth for becoming young adults and being proactive and taking care of their own health.
Amanda Wilde: Well, at what age do we start transitioning kids to this sort of relationship? At what time in childhood does the parent leave the room and the child have a one-on-one doctor-patient relationship, or does that happen after reaching adulthood?
Dr Christina Canody: So in general, we recommend that that start with the onset of adolescence, which is during puberty changes. So for most youth that's between the ages of 11 and 13. It's important that the patients establish a one-on-one relationship with their provider. Number one, because they want to be able to ask very sensitive questions without being scrutinized by their parents, because it's not surprising that sometimes they don't set forth the whole truth when mom or dad is in the room. And the other thing is for them to be able to ask questions and feel open and honest about them, as well as respond to our questions openly and honestly.
Amanda Wilde: Well, when the child is under 18, or I don't know if it's 21 in some states, are there legalities involved when they are not considered an adult by law when you provide one-on-one health care to minors?
Dr Christina Canody: So in general, you have to refer to each specific state. Here in Florida, where our health system is located, there are specific laws related to the delivery of health care in adolescents. For those ages 13 and up, if there's a medical emergency, obviously that is always covered. Additionally, there are provisions for behavioral health and mental health services, as well as those for substance abuse and those for pregnancy and contraceptive care. Obviously, a medical treatment with medications, should fully be disclosed to the parents, but in situations where there's a risk to the child, then those are covered under our Florida statutes to protect them so they can have the care that they need for those conditions.
Amanda Wilde: What other special needs circumstances do you run across?
Dr Christina Canody: So the other special needs circumstance that we run across are those who have special needs from a standpoint of chronic illness, where their mental capacity may not be those of an average youth, or they have a chronic condition, which has led them to need an uptake of medical services. So for a lot of these patients, it's important to prepare even more so because they're usually seeing not only their primary care provider, but also they're seeing multiple specialists. And there's a cut-off of differences in ages, some providers will go to 18, some will go to 21, some will even go to what we consider the end of adolescence, which is as old as 26.
So it's important to, number one, know where your provider stands with transferring patients out of their practice. Number two, knowing what adult providers will take care of those children and patients as they transition into adulthood. And number three, knowing if there's any special issues, such as those who can't take care of themselves or can't actually advocate on their own behalf that you're putting into place the legalities to make sure that you can actually be their guardian after they turn 18 years of age.
Amanda Wilde: For kids who don't have the special needs, but who are transitioning into adulthood and adult care, how do they focus on maintaining health or preventative medicine?
Dr Christina Canody: So, I think the biggest thing starts with a very young age when kids are just toddlers and infants in our practices. Pediatrics is the one specialty where we see children regularly. They have a set regimen of scheduled visits starting at one to two weeks of age. That goes on all the way through yearly visits starting at three to 18 years. Those are all a part of their wellness visits, their sports checkups if they're participating in athletic events, for their immunizations, as well as an assessment of their growth and development through all of those ages.
What we see is about 75% of children get regular checkups. By the time they're adolescents, it's down to about 50%. And then by the time it reaches adulthood, it's only 20%. So about one in five adults get a regular annual preventative visit. For those who are uninsured, it's probably less than 10%, which is really concerning from the standpoint of not being able to find an abnormality and treat it early or catch something before it truly becomes a problem.
Understanding that that one-on-one relationship with the provider starts at a young age is really important. So the way that we address kids and we talk to them and we ask them what their symptoms are, that even evolves further as they become adolescents and young adults. You want to earn that trust in that relationship, and that's an important part of transitioning to the adult provider relationship because you've earned the trust of somebody you've been with for 18 plus years. And now you're transitioning to a new provider where you have to earn a new trust and be on your own with not necessarily your parent there guiding you through it and understand how to be a true consumer and advocate for your own health care.
Amanda Wilde: So, how do we teach children to become educated consumers of health care?
Dr Christina Canody: I think number one, it's by parents encouraging children to talk to their providers when they're in the room and say, "Tell them how you feel." Answer the questions directly from the patient and not just from the parent. Parents always want to say, "I'm worried that Johnny has this wrong," or "Susie has this going on," but it's not until you start questioning the patient that you truly understand what's this in the context of or is there an underlying problem?
And additionally, with the rise in so many behavioral health disorders, it's important to understand is there an outside force affecting their health at this point in time? So getting that established rapport with the patient is really important because you also understand what is their affect, what is their mood. Normally, they come in here and they're very happy and they're outgoing. And today, they just looked downtrodden and sad. Or, you know, this is a patient that normally they're just easy going and everything's fine, but they're very anxious today. So it's obvious that they're under stress. So understanding that it's an integral part of the provider-patient relationship is important for parents to go, "Okay, you get to take some responsibility for this now," and that starts from a young age when you can answer questions. It moves into responsibility for remembering to take your medication and remembering to ask questions and maybe bringing up things that you've talked about.
I have a lot of parents who will look at their child and say, "Hey, we talked about this last week. What did you want to ask Dr. Canody when you were in here for your checkup?" And they'll go, "Oh, mom, I wanted to tell her about my foot." So it's important that they are having the conversation before they come to your office and even start that conversation with you because they really know what is going to be the focus of that visit when they come in.
The other thing to understand is as they get a little bit older, there are a lot of what I call the business side of medicine. So it's registering online, it's setting up your appointments, it's responding to your text message reminders, it's having a copy of your insurance card. It's knowing which pharmacy that you use. And there are a lot of older adolescents who from 16 on will come to the physician without a parent, because in a lot of cases, the parents have already signed a consent form for those visits. Or if they're 13 and older, sometimes there's a designated health care surrogate or somebody in the family such as a nanny or a grandparent who's been approved to bring that child in as well. So with children knowing the answer to those questions, it's really important and it shows that they're becoming more and more responsible and becoming a consumer of health care.
Amanda Wilde: So those are some ways parents can actually help their children take on that responsibility through the growing up years.
Dr Christina Canody: Absolutely. And understanding that at certain visits, there's a copay expected. So how are you going to be prepared to pay that? Are you using mom or dad's debit card? Are they going to pay it ahead of time? So understanding all the different responsibilities that come along with it. From the history being provided that's accurate and tells you all the details to understanding the business part of what's coming in, understanding the fiscal part of what's happening and understand that follow-up is needed. Whether it's scheduling another appointment, whether it's picking up a prescription at the pharmacy or whether it's just remembering to follow what instructions your doctor gave you, those are all part of the visit that are really important that the information gets passed along to the patient.
Amanda Wilde: And then as kids transition into seeing an adult provider, even if they've done most or all of this preparation, what other differences might they expect in either their relationship with the doctor or the approach to their care?
Dr Christina Canody: That's a great question, because what we find is change, it can always be stressful. But it's your response to stress that really determines how you do with that stress. So for some people, it's exciting. For other people, it's very difficult and anxiety-provoking. But understanding what those changes are is really important.
Number one, when most patients come into the pediatric office. It's anticipated they're going to have one or two complaints that we're going to address. But in a lot of adult wellness visits, there are so many checklists and what we call preventative screenings that need to be done that sometimes there's not chances to address those acute problems.
So for adult providers, a lot of them will say, "Okay, I understand this is causing you an issue, but we need to schedule you to come back in," or if somebody has a chronic illness such as high blood pressure, diabetes, asthma, they're going to schedule a separate visit to address that problem and not necessarily at the well visit. So that's going to require multiple visits moving through that relationship as well.
The other thing that I've noticed is in general adult providers don't offer the same kind of same-day sick services that we see in the pediatric world. I would say for 90% to 95% of our patients, they call in and we get to see them within the next 24 to 48 hours when they're ill. For adults, because of the increased need especially during the pandemic, it's been hard to manage all those acute care visits. So as we get older, we find more and more of the young adult population seeking out urgent care services or being seen in the emergency department. So making sure that they have what they need to manage their chronic illnesses is really going to help preventing those acute care visits, where they are responsible for a higher copay, higher deductibles in the urgent care and in the emergency department. So that makes them even more of an informed consumer of health care.
Amanda Wilde: Is there anything else young people should know about advocating for themselves as adults in the health system?
Dr Christina Canody: I think the biggest thing is to be proactive and understanding that you are in charge of your own health. So we can give you guidelines, we can give you recommendations. But understanding that things that you do between the ages of 18 and 25 may affect your body or your health for the rest of your life. So understanding that we can have an effect when it comes to our nutrition, when it comes to our wellness checkups, when it comes to our physical exercise, when it comes to overall managing stress and being emotionally intelligent, those are all important parts of our health and wellbeing. So it's not just coming to the doctor to listen to your heart and listen to your lungs and check your ears and throat and your abdomen, it's making sure that we have healthy minds and healthy bodies and the fuel that we're putting in and the things we're doing are really keeping our bodies healthy on a day-to-day basis.
Amanda Wilde: So really giving kids that sense of personal responsibility.
Dr Christina Canody: Absolutely. Absolutely.
Amanda Wilde: Dr. Canody, this has been really, really helpful. Thank you for your insights on how to prepare young people to successfully transition into adulthood. There's so many challenges for young people today. This part sounds like we've got this really well thought out.
Dr Christina Canody: Absolutely. I think it's a whole new world out there. So understanding that just like preparing to leave for college, we should be preparing our youth to eventually transition to an adult provider. So knowing that line of communication and what you need to do in case of an illness is important, but also maintaining a relationship with a regular primary provider and a medical home is overall going to have a tremendous impact on your health when you get older, because you're going to be able to meet those challenges of illness or of chronic illness, because you have become educated about what you need to do.
Amanda Wilde: And that transfers to other areas of life as well.
Dr Christina Canody: Absolutely.
Amanda Wilde: And that wraps up this episode of BayCare HealthChat. For more information on pediatric care at BayCare, visit BayCareKids.org. Please remember to subscribe, rate and review this podcast and be sure to check out all the other interesting podcasts in our library. For more health tips and updates, follow us on your social channels. I'm Amanda Wilde. Thanks for listening and stay well.