*Purpose: Pediatric patients coming of age face many compliance hurdles, the roots of most lying in poor coping with heir state as a transplant recipient, lack of knowledge of medications and navigation of healthcare needs, and the inability to activate appropriate socio-economic resources for support.Most of the transition efforts have so far focused on adolescent age patients, with unfortunately inconsistent success. We hypothesized that working with our transplant recipients on the pillars of compliance from a young age, will improve their success to go through transition as young adults. Secondary aims are improved compliance in the childhood years, and detecting family stressor.

*Methods: In collaboration with our child’s life specialist, we used a 14 items transition readiness checklist. Goals towards these items were developed spanning 7 age-specific tiers (3y, 5 y, 7y, 9y, 11y, 13 y, and 17y) . Age-specific education tools were picked to support the goals.We are reporting on the pilot run of this program carried out between Feb-Nov 2018. All liver transplant recipients <13y of age were eligible to enroll with the exception of patients whose English or Spanish are not their first language, and patients with deep developmental delays not expected to reach self-care. Patient were screened and enrolled by the child life specialist at their annual visits.

*Results: 31 patients were screened, 19 fell in the target ages and were enrolled. The average screening and coaching session averaged 30-60 minutes. The primary screen revealed that only 30% of patients in the 3-7 y of age and 11% of patients in the 7-13y of age met their set goals, confirming our suspected gaps in knowledge and coping. Children and families were very open and welcoming to the program and the teaching tools they were given. In the anecdotal patients who had a follow up visit during the pilot, parents noted a major improvement in children cooperation with medications.

*Conclusions: We describe a novel assessment and intervention program that targets the pillars of compliance and starts at the tender age of 3y, adopting the neuro-developmental principle of “early habits imprinting”. Tools and goals instruments were easy to use under our child life specialist supervision. Implementation was done at annual visits, as such imbedded upfront in our clinical practice for sustainability.This program is currently implemented and we are looking at compliance markers and outcomes.

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