Patients in Transition (PITS)

When your child is ready for a new doctor, we can help.

Patients in Transition Quote

The journey of changing your child’s medical care from a pediatric model of health care into an adult model of health care.

As we journey through life, we face many difficult and important decisions.Families with individuals who have disabilities have even more of these decisions to face. Some of these issues might be legal in nature and medically sensitive.Some of the issues may even address stages of independence/interdependence which could include living arrangements and work availability to name a few.

At Hennepin County Medical Center, we are committed to ensuring that everyone’s journey is a success and as seamless and smooth as possible. We recognize that transition can be scary and we have a wonderful support system which you can participate in voluntarily.

Using Our Expertise to Ensure a Smooth Transition

Marjorie Hogan Small Bio Photo

Marjorie Hogan, MD is a Pediatrician at HCMC and an expert in Adolescent Health Hennepin County Medical Center’s Department of Pediatrics is committed to the smooth transfer of care from pediatrics to adult medicine.We partner with all youth and their families to educate, plan and prepare for transition starting around at around age 14 years. By the time your child is 18 years old, when suitable, our pediatric patients will be encouraged to begin taking part in an adult model of medical care while still receiving care in our pediatric clinic.This will include taking responsibility for their own medical decision-making, scheduling appointments, consenting to medical care, and sharing their personal health information. For families with youth who need additional assistance, we encourage parents to apply for guardianship so they can continue to coordinate their child’s health care needs.

The Patients in Transition Support Mothers are Here to Help.

A group of parents who have children with disabilities and have experienced this special journey of transition have formed a support network for parents and guardians at Hennepin County Medical Center. Most have received training from the Parent to Parent program at Family voices of Minnesota. But most importantly, they have all personally experienced the challenges of traveling with a loved one on the journey from childhood to adulthood.

Patients in Transition Photos

"I live in Devonte's world. I have gone through personal care attendants like I used to go through socks," says Tyshelle Cotton, a Patients in Transition mother and champion for her child who was diagnosed at age 3 with Cerebral Palsy as well as a chromosome abnormality. Now 21 years old, his health issues continue to change and provide challenges to his family.

"I know how to listen to others who have similar problems, how to connect with them about parenting. I am someone who will understand you and help you advocate for your child."

"We aren't medical professionals," says Josephine Gibson, "but we know how to help parents make the connections they need."

Gibson's adopted daughter Nydia, born prematurely with Fetal Alcohol Syndrome, will turn 20 this year. Josephine met her when she was a nurse assigned to care for her shortly after birth. "She had people to give her basic care, but no one to hold her and comfort her. The county wanted to get her into foster care, so I changed from a nurse to a foster mother, and then eventually adopted her." Nydia is currently in vocational training and Josephine is still a tireless advocate for her future. "Everyone needs to be happy," she says, hoping Nydia gets the training for the daycare job she wants and doesn't get stuck in the laundry.

"I had a dream about Amora," says Colette Medas Bennettie, "before I met her." An ordained minister and practicing attorney, Colette met Amora almost the next day at a relative’s home. "She had just turned 4 and was wearing a size 3, crawling on her knees. I had her sit on my lap and I combed her hair, and she truly lit up. I offered to babysit for her and her teenage mom brought her over…she stayed the weekend and now we are journeying together."

"They have traveled a certain path, similar to mine and I can help them navigate through the system and work with them along their journey, hold their hand. We aren't experts but can give advice and knowledge."

Michelle Hodurski and her youngest child, Abigail, are part of the Health Care Home program in the downtown Pediatric Clinic, which helps to coordinate hervcare as a child with Down syndrome. She says HCMC stands out from other systems because, "They really listen here. The doctors know that I am with Abigail more than anyone else so they value my opinion. They take my feedback into consideration when making plans and recommendations."

Community Health Workers

Community health workers are available to act as a link between patients and the resources they need. The community health workers develop trust with patients and help guide them through their transition and beyond.

Patients in Transition Support Contacts

Collette Medas
Michelle Hodurski
Josephine Gibson – 612-208-0628

They will arrange a time to meet to help you address your concerns.

Pediatric Tips for Successful Transition

  1. Start planning the transition early
    • At least by age 14 years
    • Determine need for guardianship
    • Enroll your son or daughter in the pediatric transition registry
  2. Talk with your pediatrician or pediatric nurse practitioner about transition
    • Transition Checklist is complete every two years in pediatric clinic
    • Discuss completion of transition by age 22 years for most youth
  3. Identify how your child or teen can be involved in their health care, if possible
    • Make their own appointments
    • Manage their own medications
    • Carry an insurance card
    • Carry a care plan
  4. Enroll in the Health Care Home
  5. Sign up foryour child’s MyChart and learn how to use the information
  6. Talk to your child’s primary doctor and his pediatric specialty doctors about how to choose an adult primary doctor and adult specialty doctors
  7. Guarantee insurance coverage for your son or daughter

Additional Resources