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Logo of ijicareInternational Journal of Integrated Care
 
Int J Integr Care. 2010 Jan-Mar; 10: e037.
Published online 22 March 2010.
PMCID: PMC2858516

Managing transition. Support for individuals at key point of change

Reviewed by AnneLoes van Staa, RN, MD, MA

Alison Petch, editor. 2009. Bristol: The Policy Press. p. 170 ISBN: 978 1 84742 179 1.

Managing transition. Support for individuals at key point of change explores a range of transitions commonly encountered by those who receive support from health and social services. The focus of the book is on the individual experiencing these transitions, when he or she moves across organisational boundaries or from childhood to adulthood, experiences ageing or changes in health status. It aims to promote policy and practice that can enable these transitions to be achieved with the most effective outcomes for the individuals concerned. This book is unique in its broad focus on different transitions in various contexts, and its exploration of the evidence for support given to people who risk getting ‘lost in transition’. This makes this publication highly interesting to readers of the International Journal of Integrated Care. People who experience complex transitions require smooth transfers, adequate support and dedicated professionals.

The book, however, would have benefited from a more extensive review of the concept of ‘transition’. Although not new, the use of the concept ‘transition’ in health care is fairly recent and the term has been used to describe a variety of situations of change. Unfortunately, Alison Petch, the editor of this volume, does not provide a clear definition of transition in her Introduction. She stresses that transitions may be accompanied by uncertainties and a potential change of status that generates anxiety and distress, but does not refer to the origins of transition theory or to the recent reviews of this concept in nursing science [13]. Transitional definitions alter according to the disciplinary focus, but most agree that transition involves people's responses during a passage of change. Transition occurs over time and entails change and adaptation, for example, developmental, personal, relational, situational, societal or environmental change, but not all change engages transition. Reconstruction of a valued self-identity is essential to transition [3].

Nevertheless, this volume has many things to offer. Seven case studies explore the meaning of transition in different settings and from different perspectives. These case studies do not only review the existing knowledge and report on current projects in the UK to implement change in practice, but also provide key points to improve practice. Much work is being done in the field of young people in transition to adulthood, especially those with special needs or who are particularly vulnerable. Needs for transitional support are being explored for four particular groups: those leaving social care, those with learning disabilities, those with mental health care problems and those seeking asylum. These contributions provide the reader with an interesting overview of issues in highly vulnerable groups. They all run a high risk of social exclusion and lack of appropriate services after transition. In my opinion, many parallels exist with the situation of adolescents with somatic chronic conditions who need to transfer to adult care and at the same time go through a transition to adulthood. But this falls outside the scope of this volume.

Although health care professionals may find this disappointing, one could also argue that it puts our ‘problems’ with youth transitioning to adult health care into a broader perspective: there are no fundamental differences in the experiences of transition, nor in the needs for support between young people in social care and those in health care. In fact, most of us will recognize the three groups of care leavers that Mike Stein (Chapter three: Young people leaving care: transitions to adulthood) describes: those young people who are ‘moving on’ successfully; the ‘survivors’ who had mixed feelings and mixed transitions and those who ‘struggle’ and are the most disadvantaged and run most risk of unfavourable outcomes and social exclusion.

The remaining chapters of the book are focused on organisational transitions, such as the radical change in the service provision: from provider driven services to self-directed support; and on transitions to different levels of care. The last two case studies—(both by Alison Petch) focusing on the transition to supported living for older people, including people with dementia and end-of-life care; and the transition from hospital to home, focusing on the issue of discharge planning and support—are actually the best of the volume—in my opinion. The importance of the core issues in transition management, such as independence, wellbeing and choice is very well argued and demonstrated by referring to the research evidence.

The most exciting chapter is the one on synthesis ‘Taking transitions forward’. Common elements for the implementation of transitional care include: allowing time for transition; enabling individuals to access information as soon as required; supporting individuals in being involved in a meaningful way and having control; acknowledging the uniqueness of each individual and promoting their preferences. Apart from these rather straightforward recommendations, the author also promotes two strategies that I found very challenging: ‘making connections’ (stressing the importance of maintaining memories and connections) and ‘telling the stories’.

Petch rightfully notes that more is written on challenges and inadequacies around transition than about successful strategies and achievements. However, this volume is no exception, although the concept of ‘resilience’ is mentioned several times, especially in Stein's contribution. Researchers should pay more attention to resources, positive impact and long-term outcomes of transitions.

This book can be recommended to all those interested in improving practical support to people in transition. The fact that it covers several contexts is an advantage as it moves beyond one care setting or target group. However, a serious limitation is that it is strongly focused on the UK situation, drawing on policy papers, examples and situations very typical in the British social and health care system. This is a pity, as there is a serious danger now that researchers and practitioners from other countries will overlook this volume. I think it deserves a wider public, especially since it makes a strong case for integrated care (p. 162). Experiences of transition can only be enhanced by closer integration between different professionals and different agencies, the development of a relationship-centred support and an understanding of the diversity of cultural needs of service users.

References

1. Schumacher KL, Meleis AI. Transitions: a central concept in nursing. Image—the Journal of Nursing Scholarship. 1994 Summer;26(2):119–27. [PubMed]
2. Meleis AI, Sawyer LM, Im E, Messias DKH, Schumacher K. Experiencing transitions: an emerging middle-range theory. Advances in Nursing Science. 2000 Sep;23(1):12–28. [PubMed]
3. Kralik D, Visentin K, van Loon A. Transition: a literature review. Journal of Advanced Nursing. 2006 Aug;55(3):320–9. [PubMed]

Articles from International Journal of Integrated Care are provided here courtesy of Ubiquity Press