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Youth and Transition to Work A Health Perspective. Merle McPherson, MD, MPH Disability Research Institute Symposium April 2005. History. Surgeon General’s Conferences, 1982 & 1988 Title V’s Revised Legislative Mandate – OBRA 1989 Facilitate the development of community-based systems

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Youth and transition to work a health perspective

Youth and Transition to Work

A Health Perspective

Merle McPherson, MD, MPH

Disability Research Institute Symposium

April 2005


  • Surgeon General’s Conferences, 1982 & 1988

  • Title V’s Revised Legislative Mandate – OBRA 1989

    Facilitate the development of community-based systems

    of services.

  • Healthy People 2000 & 2010

  • Broad Definition of Children with Special Health Care Needs (CSHCN)

    Published in Pediatrics (1998)

History cont
History (cont.)

  • Supreme Court Decision – Olmstead v. L. C. (1999)

    Challenges governments to develop more opportunities for individuals with disabilities through more accessible system

    of cost-effective community-based services.

  • The President’s New Freedom Initiative (2001)

  • Delivering on the Promise, Report to the President (2002)

    “HRSA’s MCHB will take the lead in developing & implementing a plan to achieve appropriate community-

    based services systems for children & youth with special health care needs (CYSHCN) & their families” (pg III-39).

Mchb 6 core outcomes
MCHB 6 Core Outcomes

  • Families of CYSHCN will partner in decision making & will be satisfied with the services that they receive.

  • CYSHCN will receive coordinated, ongoing, comprehensive care within a medical home.

  • Families of CYSHCN will have adequate private and/or public insurance to pay for the services

    that they need.

Mchb 6 core outcomes cont
MCHB 6 Core Outcomes (cont.)

  • Children and youth will be screened early & continuously for SHCN.

  • Community-based service systems will be organized so that families can use them easily.

  • YSHCN will receive the services necessary to make transitions to adult life, including adult health care, work, & independence.

Consensus statement aap aafp acp 2002
Consensus StatementAAP/AAFP/ACP 2002

  • The optimal goal of health care transition is to provide health care that is family-centered, continuous, comprehensive, coordinated, compassionate, & culturally competent in a health care system that is as developmentally appropriate as it is technically sophisticated.

    Source: “A Consensus Statement on Health Care Transitions

    for Young Adults with Special Health Care Needs”

    Pediatrics. 2002 Dec; 110 (6 Pt 2): 1304-6.

Healthy ready to work hrtw initiative
Healthy & Ready To Work (HRTW) Initiative


  • 90% of CYSHCN are now living to adulthood.

  • Employment rate for adults with disabilities hovers around 30%.

  • SSI disability programs continue to grow in number of recipients.

  • Access to health insurance, health care, & utilization of services are cited as barriers.

  • The transition to adulthood, including employment & independence, is a natural progression in a lifespan approach to systems of care for CYSHCN.

Hrtw initiative cont
HRTW Initiative (cont.)

  • MCHB Launches HRTW Initiative

    Phase I: 9 Demonstration Sites & 1 National Center (1996-2001)

    Phase II: 6 State Implementation Projects (2001-2005) & HRTW National Center

    (2002 – 2006)

    From July 2001 to September 2004, the 6 Phase II Projects reported 12,182 youth & young adults served.

Hrtw initiative cont1
HRTW Initiative (cont.)

  • The importance of maintaining one’s health & wellness, & its role in allowing personal goals to be reached should not be understated.

  • Health impacts all aspects of life.

  • To stay healthy, people need an understanding of their health & to participate in their health care decisions.

  • HRTW Initiative endeavors to help develop family-centered, culturally competent systems of care.

National status by 2010
National Status By 2010

  • Wellness

    Federal, State & community-based services are organized, financed & delivered in ways that promote & sustain the well-being of YSHCN & their integration into community activities & the workforce.

  • Community-Based

    Effective community-based systems of care for all CYSHCN through private-public partnerships are in place.