https://doi.org/10.1177/0009922817706142 Clinical Pediatrics 2017, Vol. 56(10) 902–908 © The Author(s) 2017 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922817706142 journals.sagepub.com/home/cpj Article Introduction The American Academy of Pediatrics recommends that providers meet separately with adolescents during rou- tine care. 1-3 Beginning in early adolescence, time spent individually with patients helps build relationships between teens and their health care providers, promotes confidence in their ability to communicate their needs and concerns, allows for confidential discussions of health information, and sets the stage for increasing self- management of chronic conditions. 3,4 Early adolescence is also the recommended time to begin discussing and preparing patients, both those with and without special health care needs (SHCNs) for the eventual transition to adult-oriented health care. 5-7 Health care transition (HCT) has been called a “developmental milestone” 8 and should be part of every adolescent visit. Youth with SHCNs 9 often need additional referrals and resources as they transition care, but the same primary and preven- tive guidelines 6 apply as for youth without SHCNs. Consensus statements and recent literature about HCT from pediatric to adult-oriented care suggest that discussing future goals with the adolescent alone and with family are important steps. 5-7 Discussion of realis- tic future goals might include educational and vocational goals, 5 plans for independent living, 5 and geographic relocation and travel, all of which intertwine with plans for self-management of health conditions and health care. 4 Cogent to such discussion would be resources to assist youth in accomplishing these goals, identification of any potential limitations, or modification of plans for health-related reasons. Motivational and behavior change interventions could also be based on these mutu- ally identified goals. 10,11 Particularly for youth with SHCNs, practical, legal, and insurance ramifications of the transition to adulthood and adult-oriented care can affect the trajectory toward one’s goals. The legal 706142CPJ XX X 10.1177/0009922817706142Clinical PediatricsDavidson et al research-article 2017 1 Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA 2 Quinnipiac University, Hamden, CT, USA Corresponding Author: Lynn F. Davidson, Division of Academic General Pediatrics, Children’s Hospital at Montefiore, 3444 Kossuth Avenue, 2nd Floor, Bronx, NY 10467, USA. Email: ldavidso@montefiore.org Discussing Future Goals and Legal Aspects of Health Care: Essential Steps in Transitioning Youth to Adult- Oriented Care Lynn F. Davidson, MD 1 , Maya Doyle, LCSW-R, PhD 1,2 , and Ellen J. Silver, PhD 1 Abstract Discussing realistic future goals with the adolescent alone and with family, and reviewing legal aspects of health care transition (HCT), are essential steps in the transition from pediatric to adult-oriented care. Secondary analysis of datasets from 2 studies related to HCT assessed differences in provider practice for youth with and without special health care needs (SHCNs). Across both datasets, between 57% and 68.6% of providers reported some discussion of future goals with adolescent or with family. However, only 28.6% to 31% of providers reported discussing future goals with youth with SHCNs alone. It was rare for providers to report discussing legal aspects of HCT with any youth. Findings identify a gap in discussing future goals and legal aspects of HCT, as part of routine care for adolescents. Additional research to understand barriers and improve likelihood of these steps within HCT is needed. Keywords adolescent medicine, physician’s practice patterns, youth with special health care needs, health care transition, adolescent alone