Synopsis
Support adolescents with chronic illness to understand and manage treatment, identify practical and emotional barriers without blame, preserve safety when adherence falters, develop autonomy alongside carers, and transfer care through a coordinated, developmentally appropriate process with no loss of clinical ownership.
- Ask the young person privately and non-judgementally how treatment actually fits into each day, what is missed, what happens afterward and what makes adherence easier or harder.
- Distinguish knowledge, memory, executive function, side effects, formulation, cost, transport, pharmacy supply, stigma, family conflict, mood, eating disorder and deliberate risk because each needs a different response.
- Use objective data such as refill history, monitoring results and device downloads as a shared problem-solving aid, not as evidence in a confrontation.
- Explain the immediate and cumulative consequences of interruption in concrete language, prioritising an emergency or sick-day plan for high-risk medicines and devices.
- Begin transition planning early, revisit it regularly and adjust for development and complexity; transfer is the event within a longer process, not a birthday-based administrative discharge.
- Teach skills progressively: naming the condition and medicines, ordering supplies, booking appointments, asking questions, understanding consent and confidentiality, and knowing when and how to seek urgent help.
- Keep parents or carers involved in a role agreed with the young person while testing that safety tasks are genuinely mastered rather than withdrawing support abruptly.
- Use a named transition coordinator, joint or overlapping communication where possible, a concise health passport and confirmation that the adult service has accepted responsibility.
- After transfer, verify attendance, prescriptions, monitoring and pending actions; missed first appointments should trigger active contact rather than immediate discharge.
Key red flags
Repeated emergency attendance, unexplained biochemical deterioration, unexpected drug levels or prescription gaps may indicate non-adherence, access failure, distress, cognitive overload or safeguarding harm.
Intentional omission to change weight, cause injury, avoid school, obtain admission or express hopelessness requires direct mental-health and functional assessment rather than punishment.
A parent or partner controlling medicine, appointments, communication or benefits may compromise autonomy and can indicate neglect, coercion or exploitation.
Transfer with no named adult clinician, no accepted referral, incomplete medication supply or uncommunicated pending results creates immediate avoidable clinical risk.
Loss of competence or severe illness during transition requires renewed supported decision-making and safety planning; chronological age does not make independence automatic.
Investigation priorities
Establish actual dosing, technique, interruptions and barriers without blame.
Management branches
Critical treatment has stopped or disease control suggests imminent decompensation.
- Assess ABCDE and activate the disease-specific emergency plan, urgent tests and specialist review.
- Reconcile what was prescribed, supplied and taken and restore essential treatment safely under the relevant protocol.
- Ask privately about suicide, weight control, side effects, coercion, neglect and practical access while avoiding accusatory language.
- Discharge only with sufficient supply, a workable emergency plan, named follow-up and action on the identified barrier.