Transition from pediatric to adult healthcare for migrant youth with special and/or chronic healthcare needs (e.g. asthma, diabetes, sickle cell disease, cerebral palsy, and developmental and behavioural disorders) Other
Conditions
Interventions
Participants will receive a 12-month transition-focused Patient Navigator (PN) intervention. The PN is a full-time professional with training in trauma-informed care, cultural safety, systems navigati
(2) tailored information and support
(3) co-created individualized transition plans
(4) care coordination
(5) introduction to adult services
and (6) support through transfer completion for youth aging out during the study. The PN will contact participants within 7 days of consent, then every 2–4 weeks for the first 3 months, every 3 months
Sponsors
McGill University Health Centre
Eligibility
Sex/Gender
All
Age
14 Years to 18 Years
Inclusion criteria
Inclusion criteria: Current key inclusion criteria as of 21/04/2026: 1. Primary Caregiver of youth 14 to 18 who is First- or second-generation migrant, defined as born outside of Canada or having parents born elsewhere, respectively. Migrants include immigrants, resettled refugees, refugee claimants (asylum-seekers), temporary workers or international students, and other individuals without formal immigration status (undocumented) 2. Youth with special healthcare needs aged 14-18 as defined by the CYSHCN Screener©, which identifies children who are experiencing one or more functional limitation or service use due to a physical, emotional, behavioural, developmental, or other health condition that has lasted or is expected to last at least 12 months 3. Caregiver living in Canada <15 years _____ Previous key inclusion criteria: 1. Primary Caregiver of youth 14 to 18 who is First- or second-generation migrant, defined as born outside of Canada or having parents born elsewhere, respectively. Migrants include immigrants, resettled refugees, refugee claimants (asylum-seekers), temporary workers or international students, and other individuals without formal immigration status (undocumented) 2. Youth with special healthcare needs aged 14-18 as defined by the CYSHCN Screener©, which identifies children who are experiencing one or more functional limitation or service use due to a physical, emotional, behavioural, developmental, or other health condition that has lasted or is expected to last at least 12 months 3. Followed by at least one pediatric care service expected to continue into adult care 4. Caregiver living in Canada <15 years
Exclusion criteria
Exclusion criteria: 1. Caregiver who lived in Canada for over 15 years.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Transition Readiness measured using Transition Readiness Assessment Questionnaire 6.0 (TRAQ 6.0) at baseline, 6 months and 12 months | — |
Secondary
| Measure | Time frame |
|---|---|
| Effective care coordination measured using 6 questions from the National Survey on CSHCN at baseline, 6 months and 12 months;Youth health related quality of life measured using PROMIS Pediatric Global Health 7 (PGH-7) sub-items at baseline, 6 months and 12 months;Perceived family stress measured using a Distress Thermometer at baseline, 6 months and 12 months;Family empowerment measured using the Parental Empowerment Scale - 12 item "Service System" subscale at baseline, 6 months and 12 months;Successful transition measured using a self-reported item asking youth or caregivers if the youth has had at least one appointment with an adult healthcare provider at baseline, 6 months and 12 months;Patient satisfaction with patient navigator measured using the Patient Satisfaction with Interpersonal Relationships with Navigators (PSN-I) at 6 and 12 months;Reach measured using : 1) tracking the total number of eligible participants from the multicultural clinic records; 2) collecting demographic data (e.g. age, gender, migration status, diagnosis etc.); 3) documenting reasons for participation or non-participation at baseline (upon consent) and monitored continuously throughout the recruitment period;Implementation measured using Fidelity checklists, implementation cost tracking, and tracking any adaptations to the protocol and materials at multiple time points; ongoing throughout the study;Stakeholder perceptions on reach, effectiveness, adoption, implementation and maintenance on intervention measured using semi-structured qualitative interviews at 6 and 12 months | — |
Countries
Canada
Contacts
Public ContactMelissa Tachdjian
Outcome results
None listed