Telehealth Toolkit

for a Joint Visit with Pediatric and

Adult Health Care Clinicians and
Transferring Young Adults

Developed by
Patience H. White, MD, MA
Co-Director, Got Transition
Adam Greenberg, MSN, CRNP
Co-Director, Adult Care and Transition Team
Children’s Hospital of Philadelphia

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health
and Human Services (HHS) under grant number, U1TMC31756. The contents are those of the author(s) and do not
necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government.
About Got Transition
Got Transition® is a program of The National Alliance to Advance Adolescent Health and is
funded through a cooperative agreement from the federal Maternal and Child Health Bureau,
Health Resources and Services Administration. Its aim is to improve transition from pediatric to
adult health care through the use of innovative strategies for health care professionals and
youth, families, and caregivers. For more health care transition resources and information
about Got Transition, please visit GotTransition.org. For more information about The National
Alliance to Advance Adolescent Health, please visit TheNationalAlliance.org.

Introduction
This tip sheet offers pediatric and adult clinicians sample content that can be used to facilitate a
“warm handoff” to adult care as well as a sample resource for the transferring young adult that
explains the telehealth visit. Some young adults may need or wish to have their parent/
caregiver present for the joint telehealth visit and customizing the “Information about the Joint
Telehealth Visit for Young Adults” (page 6) to include the parent/ caregiver is suggested.

Having a shared communication between the past and future clinicians and the patient helps
to strengthen continuity of care. It also helps to improve the comfort and confidence that the
transferring young adult and their parent/caregiver has with their new clinician. It represents
an important opportunity for the transferring young adult and their parent/caregiver to convey
their preferences and ask questions. This joint telehealth visit is not intended as a substitute
for the initial adult visit, during which more time will be spent learning about the new patient
and supporting their health and wellness priorities.1

The two tip sheets are to be used as a general guide for the agenda of the joint telehealth visit.
Both can be customized to the practice and young adult and family situation (click here to
customize the sample content and click here to customize the information for young adults).
For example, more information may be added about the details of care and information
exchanged for a young adult with greater complexities. Also, the agenda could be customized
to include the young adult/caregiver in the entire virtual joint visit or just part of the visit, if the
clinicians would like some time to communicate detailed clinical information that the new
adult clinician should know in order to care for the young adult at the first visit.

Sample Content for Joint Health Care Transition Telehealth Visit……………………………..page 3

Information about the Joint Telehealth Visit for Young Adults………………………………….page 6

1The Guide to Improving Patient Safetyin Primary Care Settings by Engaging Patients and Families: Implementation Quick Start Guide Warm
Handoff. Agency for Healthcare Research and Quality. https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-
safety/patient-family-engagement/pfeprimarycare/warm-handoff-qsg-brochure.pdf

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 Sample Content for a Joint Health Care Transition
Telehealth Visit
This resource includes suggestions for the timing and content of a joint health care transition
(HCT) telehealth visit to be conducted in advance of the young adult’s initial adult health care
visit. The content should be customized for the practice’s patient population.

This joint telehealth visit can be organized into two segments:

1) Initial Segment - Communication between the young adult and the pediatric and adult
clinicians
2) Second Segment - Communication/warm handoff between the sending pediatric and
receiving adult clinicians. The young adult and clinicians will decide if the young adult
should stay on the virtual visit through the second segment.

BEFORE the Joint Visit:

• The adult clinician should share the welcome letter and the practice’s FAQs with the young adult
(click here for example).
• The pediatric clinician should share the medical summary and emergency care plan with the
young adult (click here for example).
• Be thoughtful about confidentiality for the young adult. Discuss with the young adult and parent/
caregiver about the options of having the parent/caregiver present for all, part, or none of the
joint telehealth visit.

AFTER the Joint Visit:

WHO
• Young adult
• Pediatric and adult clinicians (e.g., physician/nurse/social workers/care manager, other key team
members as needed)
• Parent/caregiver may be present, if appropriate, for some or all the visit
GOALS
1) Provide the young adult the opportunity to meet and engage with new adult clinician(s)
2) Ensure a warm handoff between pediatric and adult clinicians
3) Promote the young adult’s involvement in the conversation by providing an opportunity for them
to ask questions about the transfer to adult care
4) Clarify next steps for the first adult clinician visit (e.g., appointment time, location)
TIMING
• The length of the telehealth visit generally should be determined by the complexity of the young
adult’s medical and psychosocial issues that need to be reviewed.
• For joint telehealth visits, a 30-minute visit could be planned with the initial segment lasting 10-
15 minutes and the second lasting 15-20 minutes.

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Suggested Content/Agenda:

INITIAL SEGMENT
Communication between the young adult and the pediatric and adult clinicians.
Led by the pediatric clinician and/or care manager:
1) Share introductions (e.g., names of participants and a summary statement about the
young adult).
2) Confirm with the adult clinician that they received a copy of the medical summary and
any other needed documents (e.g., imaging, decision-making support information, if
needed) if not shared during the joint visit.
3) Ask the young adult what they want the new adult clinician to know about them that
might make the initial adult visit more comfortable (e.g., non-medical information).
4) Assure the young adult that they can and should contact their pediatric clinician for
questions (e.g., medication renewals) prior to their first adult visit and discuss when the
adult clinician will take over the responsibility of answering those questions.
5) Discuss ongoing issues that the adult clinician needs to address in the first visit.

Led by the adult clinician:

1) Confirm clinical priorities with pediatric clinician and young adult/caregiver and
determine what else they want to add.
2) Mention the adult clinician’s experience caring for young adults with similar conditions.
3) Provide an overview of the first adult visit, including what to expect and how to prepare
(e.g., logistics, what they need to bring to the appointment – see practice example below
in resources).
4) Ask the young adult what questions they have about the new practice before their first
visit.
5) Identify the best way to contact the young adult (e.g., text, call).

SECOND SEGMENT
Communication/warm handoff between the sending pediatric and receiving adult clinicians.
The young adult and clinicians will decide if the young adult should stay on the virtual
visit through the second segment.
Consider the following:
1) Questions about key aspects of the care of the young adult not conveyed in the medical
summary prepared by the pediatric clinician (e.g., social complexities facing the young adult).
Note: This may be shared on a separate call if the young adult and parent/caregiver are on
the call and the pediatric clinician feels the information is sensitive.
2) Questions about the young adult’s chronic medical/behavioral health conditions from the
adult clinician (e.g., other medical and community referrals needed, equipment needs/
referrals, reauthorization for care required in the home).
3) Clarifying questions about how the new adult clinicians can reach/consult the pediatric
clinician, if needed. Note: This may be shared in a separate call if the pediatric and adult
clinicians do not want their mobile phone numbers shared with the young adult.

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Additional Resources:
PRACTICE SCRIPT EXAMPLE
From a University of Pennsylvania adult practice nurse practitioner’s joint telehealth visit sharing
information about the first adult visit:
1. Introduction to my role as a nurse practitioner, the goal of the visit, and description of the
transition pathway.
2. Differences between pediatric and adult practices (e.g., utilization of NPs for clinic visits, who to
call for refills, how to communicate with clinicians during and after business hours).
3. What to know for first visit (e.g., records can be accessed electronically but still bring imaging on
disk to the appointment; expect to provide history of past treatments; the clinician may speak to
young adult with or without parent/caregiver present for some or all of visit).
4. Where to go (e.g., clinic location, traffic issues, arrive early, late policy).

SAMPLE CONTENT
For an adult clinician initial visit from Got Transition’s Six Core Elements of HCT (click here).

Acknowledgements:
Alexandra Bullock, MSW, LCSW: Children’s Hospital of Philadelphia
Marissa Digiovine, MD: Children’s Hospital of Philadelphia
Bethany Thomas, DNP, CNRN: Penn Medicine

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 Information about a Joint Telehealth Visit
for Young Adults
To help with your move to an adult doctor, you can be a part of a joint telehealth visit. The joint
telehealth visit will be about 15-30 minutes. Here is what you need to know before the visit:

Who will be there?

• You (the young adult)
• Your pediatric doctor/team What will happen?
• Your new adult doctor/team • You will meet your new doctor
• If appropriate, your caregiver* • You can ask questions about your new
*Note: You and your caregiver can decide if they doctor and their office
will be present for all, part, or none of the visit. Be
thoughtful about confidentiality.

What are some questions to ask about the visit?

Example questions to ask your new doctor:
• How do I get to the office? What should I bring? Is the office accessible?
• Do you have an up-to-date medical summary of my health condition?
• How do I schedule a visit?
• Who do I contact if I have an urgent health care need?
• How will you communicate with my other specialty doctor?
• How often do I need to see you?
• What telehealth platform does your office use?

Example questions to ask your new doctor if you want your caregiver to join you so they can talk with
the doctor about your health:
• Can my caregiver join for some or all of the telehealth visit?
• How will you communicate with my caregiver?
• What paperwork do you need so you can communicate with my caregiver about my health?

What do you want to tell your new After Helpful

doctor, so they know you better? the visit Resources
• Something about your medical history? Work with your • Family Voices
• Something you enjoy, like sports or drawing? pediatric doctor’s telehealth checklist
• Something you are worried about at the new office or call the (click here)
office, like blood tests? adult doctor’s • Got Transition’s
• Who else would you like to be involved in office to set up Resource Infographic
your health care? your first visit (click here)
with your new • Got Transition’s Family
adult doctor. Toolkit (click here)

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of
Health and Human Services (HHS) under grant number, U1TMC31756. The contents are those of the author(s) and do
not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government.
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