Transition from pediatric to adult care is associated with a high risk of transplant loss, increased morbidity and mortality. Frequently there is poor engagement by teenagers and young adults with adult transplant services resulting in non-adherence and up to 30% graft loss within 5 years. We established a dedicated young adult service involving a dedicated physician and nurse practitioner, with the addition of a full time youth worker in 2015; with in addition an integrated pediatric-adult transition pathway and a community-based young adult clinic for 16-25 year old transplant recipients. The youth worker catalyses peer interaction, provides 1:1 support and community outreach to enhance engagement. Over the last 12 months the youth worker has provided 700 interactions with young adults: 21% 1:1 support in the community; 14.3% 1:1 support in hospital; 64.7% communication by social media (37.5% Facebook; 37.5% Whats App; 12.5% cell phone texts; 12.5% cell phone calls). Level of youth worker support was categorised as Level 1 (Highest: immediate 1:1 support; currently non-adherent at risk of graft loss): Level 2 (Non-critical personalied regular support from youth worker); Level 3 (Low risk: in contact with young adult service (YAS); participating in peer support); Level 4 (Very low risk: seen by dedicated YAS team in standard clinics- no specialist youth worker support). Between November 2015 to November 2016 numbers of patients in YAS increased from 42 to 70; Level of risk reduced: Level 1 14/42 (33%) in 2015 to 10/70 (14%) in 2016; Level 2: 12/42 (29%) in 2015 to 9/70 (13%) in 2016. Resulting in a shift to Low risk (Levels 3 and 4) increasing from 16/42 (38%) to 51/70(73%) over 12 months from Nov 2015-16 (p=0.02). Non attendance rates at transplant outpatient clinics by young adults reduced from 32% in 2015 to 7% in 2016 by active intervention through social media co-ordinated by the youth worker.

Development of a dedicated young adult transplant service with a physician and nurse practitioner can be greatly enhanced by the addition of a youth worker who can bridge the gap between the clinical team and teenage and young adult patients resulting in improved engagement with clinical services. Incorporation of communication by social media and catalysing peer support are key components to the success of a young adult service.

CITATION INFORMATION: Cross D, Harden P. A Dedicated Young Adult Service with a Youth Worker Increases Engagement of Teenagers and Young Adults with Kidney Transplantation and Impacts Favourably on Clinical Outcomes. Am J Transplant. 2017;17 (suppl 3).

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