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Albert C. Hergenroeder Constance M. Wiemann

Editors

Health

Building a Program for Adolescents and Young Adults with Chronic Illness and Disability

123

Health Care Transition Albert C. Hergenroeder

Constance M.Wiemann

Editors

Health Care Transition

Building a Program for Adolescents and Young Adults with Chronic Illness and Disability

Editors

Albert C. Hergenroeder Associate Professor, Director of Research Section of Adolescent Medicine and Sports Medicine Department of Pediatrics Baylor College of Medicine Texas Children’s Hospital Houston, TX, USA
Constance M. Wiemann Professor, Chief of Adolescent Medicine Section of Adolescent Medicine and Sports Medicine Department of Pediatrics Baylor College of Medicine Texas Children’s Hospital Houston, TX, USA

  • ISBN 978-3-319-72867-4
  • ISBN 978-3-319-72868-1 (eBook)

https://doi.org/10.1007/978-3-319-72868-1

Library of Congress Control Number: 2018933347 © Springer International Publishing AG, part of Springer Nature 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Printed on acid-free paper This Springer imprint is published by the registered company Springer International PublishingAG part of Springer Nature The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Preface

Depending on the criteria used, the prevalence of chronic disease in 6–21-year-olds in the USA is 6–30%, affecting one in five families. A generation ago, many of these patients did not survive beyond childhood. Due to advances in medical treatments, 90% of individuals with chronic illness and disability survive childhood, and 750,000 young adults with special healthcare needs in the USA transition to adulthood annually. Children with special health-care needs are defined as those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally (Newacheck 1998). In this book, we focus on adolescents and young adults with special health-care needs (AYASHCN).
Health-care transition is defined as “the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented health-care systems” (Blum 1993). We include mental health conditions in this definition. For most AYASHCN who have mild conditions, characterized by no limitation of activity or cognitive impairment, the transition to adulthood appears to be successful. As the complexity of the condition increases, however, health-care transition (HCT) becomes more problematic, resulting in increased morbidity and mortality. Because poor HCT can contribute to this increased risk of morbidity and mortality, many pediatric and professional medical organizations, public health agencies, and advocacy organizations have developed statements or guidelines about the need to develop improved transition planning programs. Children’s hospitals are aware that they need formal HCT programs; adult providers recognize the need to develop methods to incorporate young adults with pediatric-onset conditions into their practices; and health-care systems are aware that the transition from pediatric to adult-based care is a particularly important one in managing the health of populations. Despite increased recognition of the importance of HCT from pediatric to adult-based care, evidenced by the number of national conferences and increased peer-reviewed publications on the topic, there has been limited progress in addressing these barriers. There is an emerging yet not established evidence base for best methods in developing HCT programs, and major issues to be answered include defining successful HCT and providing evidence for the predictive validity for actual successful HCT outcomes.
The purpose of this textbook is to provide health-care professionals caring for youth and young adults with chronic illness and disability with a state of

v

  • vi
  • Preface

the field reference, including the framework, tools, and case-based examples needed to develop and evaluate an HCT planning program that can be implemented regardless of a patient’s disease or disability. The editors of this book have been involved in developing HCT programs over the past 17 years. Drawing from their own personal experience as well as the empirical literature, the editors and invited chapter authors provide valuable perspectives on issues to consider in developing HCT programs across a range of health-care settings.
This textbook focuses on how to develop HCT programs regardless of disease or disability. As such, it does not cover condition-specific transition concerns, except as illustrated through case studies. We prefer to think of the transition process as occurring in three phases: preparation, transfer, and engagement of the AYASHCN in the adult health-care system. A process for this course from pediatric to adult-based care is presented in Chap. 1 as the 6 Core Elements of HCT. This process can be applied to any HCT model.
Wherever possible, youth/young adult, caregiver, and both pediatric and adult provider perspectives and voices are represented. The terms children with special health-care needs (CSHCN), youth with special health-care needs (YSHCN), and adolescents and young adults with special health-care needs (AYASHCN) are used throughout the book where appropriate. Many chapters contain brief case examples to illustrate key concepts or address literature gaps. As HCT is a process with overlapping components, there is some overlap among chapters. In addition, we have tried to cross-reference chapters, where appropriate.
This textbook begins with an introductory chapter (Part I) defining HCT describing the urgent need for comprehensive transition planning, the subsequent morbidity and mortality associated with poor transition outcomes, barriers to HCT, and a framework for developing and evaluating health-care transition programs. Part II focuses on the anatomic and neurochemical changes that occur in the brain during adolescence and young adulthood, the impact of these changes on cognitive function and behavior, and the ways in which cognitive function and behavior influence AYASHCN management of their illness during transition. The HCT perspectives of important participants in the HCT transition process—youth/young adults, caregivers, and both pediatric and adult providers—are presented in Part III, as well as changes in insurance and additional financial barriers experienced as youth age into young adulthood. Part IV presents ten chapters each addressing an aspect of developing HCT programs, from establishing administrative structures and processes to preparing, transferring, and tracking AYASHCN as they leave the pediatric setting to their successful acceptance into the adult health-care system. A successful transition from the perspective of five key stakeholders in the transition process—patients, caregivers, pediatric providers, adult providers, and third-party payors—is presented in Part V. Issues of HCT finance are covered in two chapters (Part VI). Part VII explores special issues in HCT, such as HCT and the medical home, the international perspective on transition, legal issues in HCT, and transitioning youth with medical complexity or cognitive/intellectual disabilities. The chapters in this section that represent relatively new topics in HCT include the hospitalist’s and

  • Preface
  • vii

dentist’s perspectives on HCT and the increased role of pharmacists and palliative care. Models of HCT programs are presented in Part VIII, including a case study of a hospital-based transition planning program and an overview of a variety of programmatic models currently operating in the field, as well as the state of the field in terms of evidence to support best practice. A single concluding chapter forms Part IX.
In all, there are 37 chapters from 63 authors representing 46 medical centers in North America and Europe.
It is important to note that as of the writing of this textbook, the infrastructure of HCT finance is currently being threatened by repeal of the ACA, with proposed dramatic reductions in Medicaid and CHIP payments upon which many AYASHCN depend for life-sustaining therapies.

Houston, TX Houston, TX
Albert C. Hergenroeder Constance M. Wiemann

Contents

Part I Introduction

  • 1
  • Introduction: Historical Perspectives,

Current Priorities, and Healthcare Transition Processes, Evidence, and Measurement . . . . . . . . . . . . . . . . . . .

Patience H. White and Margaret A. McManus

3

Part II The Adolescent and Young Adult: A Developmental
Perspective

  • 2
  • The Anatomical, Hormonal and Neurochemical

Changes that Occur During Brain Development in Adolescents and Young Adults . . . . . . . . . . . . . . . . . . . . . . . . 15

Allan Colver and Gail Dovey-Pearce

  • 3
  • The Relationships of Adolescent Behaviours

to Adolescent Brain Changes and their Relevance to the Transition of Adolescents and Young Adults

with Chronic Illness and Disability . . . . . . . . . . . . . . . . . . . . . . . 21

Allan Colver and Gail Dovey-Pearce

Part III Personal and Professional Perspectives on Healthcare
Transition

  • 4
  • Healthcare Transition from the AYASHCN’s

Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Isabel Yuriko Stenzel Byrnes

56
Healthcare Transition from the Family Perspective . . . . . . . . . 43

Laura G. Buckner

Healthcare Transition from the Pediatric Provider’s

Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Cecily L. Betz

  • 7
  • Healthcare Transition from the Adult Provider’s

Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Nathan Samras, Janet Ma, Stacey Weinstein, and Alice A. Kuo

ix

  • x
  • Contents

  • 8
  • Healthcare Insurance Changes as Youth

Become Young Adults. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Beth Sufian, James Passamano, and Amy Sopchak

Part IV Developing a Healthcare Transition Program

  • 9
  • Establishing the Administrative Structure

and Support for a Healthcare Transition Program . . . . . . . . . . 87

Mary R. Ciccarelli and Jason Woodward

10 Mobilizing Pediatric Providers . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Kathy Sanabria, James Harisiades, Rebecca Boudos, and Parag Shah

11 Developing Transition Policies, Procedures, or Guidelines. . . . 107

Roberta G. Williams and Ellen F. Iverson

12 Establishing a Method to Monitor Transition Planning and Track Patient Outcomes Following Transfer . . . . . . . . . . . 113

Gregory Sawicki

13 Incorporating Healthcare Transition Readiness

Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

Lisa A. Schwartz, Alexandra M. Psihogios, and Emily M. Fredericks

14 Employing Healthcare Transition Planning Tools. . . . . . . . . . . 129

Constance M. Wiemann and Albert C. Hergenroeder

15 Understanding the Pediatric and Adult Healthcare System:

Adapting to Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

Megumi J. Okumura, Ian S. Harris, and Mary Ellen Kleinhenz

16 Developing the Process for Transferring Care from Pediatric

to Adult Providers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149

Megumi J. Okumura and Erica Lawson

17 Preparing the Adult Practice to Accept Adolescents and Young Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

Marybeth R. Jones, Marilyn Augustine, and Brett W. Robbins

18 Establishing a System for Ensuring Transfer Completion . . . . 163

Niraj Sharma, Kitty O’Hare, and Ahmet Uluer

Part V Defining Successful Transition

19 Defining Successful Transition: Young Adult Perspective . . . . 173

Teresa Nguyen and Mallory Cyr

20 Defining Successful Transition: Parent Perspective. . . . . . . . . . 181

Rosemary Alexander and Laura J. Warren

  • Contents
  • xi

21 Defining Successful Transition: Pediatric Provider

Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191

Cynthia Fair, Sophie Rupp, Laura C. Hart, Ana Catalina Alvarez-Elias, Martha Perry, and Maria Ferris

22 Defining Successful Transition: Adult Provider

Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201

Gregg Talente

23 Defining Successful Transition: Payer Perspective . . . . . . . . . . 207

Angelo P. Giardino

Part VI Financing Healthcare Transition

  • 24 Financial Cost of Healthcare Transition
  • 223

Angelo P. Giardino

25 Payment for Healthcare Transition Services . . . . . . . . . . . . . . . 233

Margaret A. McManus, Patience H. White, and David Kanter

Part VII Special Issues in Healthcare Transition

26 Healthcare Transition and the Medical Home . . . . . . . . . . . . . . 241

Jennifer Lail

27 The Hospitalist’s Perspective on Healthcare Transition . . . . . . 255

Ryan J. Coller, Sarah Ahrens, and Debra Lotstein

28 The International Perspective on Healthcare Transition . . . . . 269

Beth E. Anderson, Swaran P. Singh, Claire Stansfield, and Kristin Liabo

29 Expanding the Role of the Pharmacist . . . . . . . . . . . . . . . . . . . . 279

Nicola J. Gray, Jonathan Burton, Roisin Campbell, and Janet E. McDonagh

30 Legal Issues: Guardianship and Supportive

Decision Making . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293

Beth Sufian, James Passamano, and Amy Sopchak

31 Transitioning Adolescents and Young Adults

with Medical Complexity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301

Mary R. Ciccarelli

32 Transitioning Youth with Intellectual

and Developmental Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . 313

Laura Pickler and Janet Hess

33 Palliative Care in Adolescents and Young Adults

with Special Healthcare Needs. . . . . . . . . . . . . . . . . . . . . . . . . . . 329

Jill Ann Jarrell, Ellen Roy Elias, and Tammy I. Kang

34 Healthcare Transitions and Dental Care . . . . . . . . . . . . . . . . . . 339

Kimberly Espinoza

  • xii
  • Contents

Part VIII Models of Healthcare Transition Programs

35 A Successful Healthcare Transition Program in a Hospital Setting � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 353

Khush Amaria and Miriam Kaufman

36 Different Healthcare Transition Models. . . . . . . . . . . . . . . . . . . 363

Cecily L. Betz

Part IX Conclusions

37 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381

Constance M. Wiemann and Albert C. Hergenroeder
Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383 Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385

Contributors

Sarah Ahrens, M�D� Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

Rosemary Alexander, Ph�D� Texas Parent to Parent, Austin, TX, USA Ana Catalina Alvarez-Elias, M�D�, M�Sc� Hospital Infantil de Mexico

Federico Gomez, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico Sick Kids, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

Khush Amaria, Ph�D�, C�Psych� Division of Adolescent Medicine and

Department of Psychology, Good 2 Go Transition Program, Hospital for Sick Children, Toronto, ON, Canada

Beth E� Anderson, Ph�D� Social Care Institute for Excellence, London, UK

Marilyn Augustine, M�D� Division of Endocrinology and Metabolism, University of Rochester Medical Center, Rochester, NY, USA

Cecily L� Betz, Ph�D�, R�N� Department of Pediatrics, University of

Southern California (USC), Keck School of Medicine, Los Angeles, CA, USA USC University Center for Excellence in Developmental Disabilities, Children’s Hospital Los Angeles, Los Angeles, CA, USA

Rebecca Boudos, L�C�S�W� Chronic Illness Transition Program, Ann and

Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

Laura G� Buckner, M�Ed�, L�P�C� Texas Center for Disability Studies, The

University of Texas, Austin, TX, USA

Jonathan Burton, B�Pharm� Right Medicine Pharmacy, University of

Stirling, Stirling, UK

Isabel Yuriko Stenzel Byrnes, L�C�S�W�, M�P�H� Social Worker and Patient

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  • Battle Ground : a Novel of the Dresden Files / Jim Butcher

    Battle Ground : a Novel of the Dresden Files / Jim Butcher

    ALSO BY JIM BUTCHER THE DRESDEN FILES STORM FRONT FOOL MOON GRAVE PERIL SUMMER KNIGHT DEATH MASKS BLOOD RITES DEAD BEAT PROVEN GUILTY WHITE NIGHT SMALL FAVOR TURN COAT CHANGES GHOST STORY COLD DAYS SKIN GAME PEACE TALKS SIDE JOBS (Anthology) BRIEF CASES (Anthology) THE CINDER SPIRES THE AERONAUT’S WINDLASS THE CODEX ALERA FURIES OF CALDERON ACADEM’S FURY CURSOR’S FURY CAPTAIN’S FURY PRINCEPS’ FURY FIRST LORD’S FURY SHADOWED SOULS (EDITED BY JIM BUTCHER AND KERRIE L. HUGHES) ACE Published by Berkley An imprint of Penguin Random House LLC penguinrandomhouse.com Copyright © 2020 by Jim Butcher “Christmas Eve” copyright © 2018 by Jim Butcher Penguin Random House supports copyright. Copyright fuels creativity, encourages diverse voices, promotes free speech, and creates a vibrant culture. Thank you for buying an authorized edition of this book and for complying with copyright laws by not reproducing, scanning, or distributing any part of it in any form without permission. You are supporting writers and allowing Penguin Random House to continue to publish books for every reader. ACE is a registered trademark and the A colophon is a trademark of Penguin Random House LLC. Library of Congress Cataloging-in-Publication Data Names: Butcher, Jim, 1971– author. Title: Battle ground : a novel of the Dresden files / Jim Butcher. Description: First Edition. | New York : Ace, [2020] | Series: The Dresden files Identifiers: LCCN 2020008653 (print) | LCCN 2020008654 (ebook) | ISBN 9780593199305 (hardcover) | ISBN 9780593199329 (ebook) Subjects: GSAFD: Fantasy fiction. Classification: LCC PS3602.U85 B88 2020 (print) | LCC PS3602.U85 (ebook) | DDC 813/.6—dc23 LC record available at https://lccn.loc.gov/2020008653 LC ebook record available at https://lccn.loc.gov/2020008654 Jacket art by Chris McGrath Jacket design by Adam Auerbach This is a work of fiction.
  • Jeanne Pedersen

    Jeanne Pedersen

    CORPORATE STRATEGIES, POWER DISTRIBUTION AND CREATIVITY WITHIN AND ACROSS THE DANISH MUSIC INDUSTRY Why different perceptions of the same song is sometimes a challenge MASTER THESIS By Jeanne Pedersen Cand.Soc.(CBP) Handed in 22.02.2016 Supervisor: Lise Skov Characters: 181.256 ABSTRACT A study of the creative processes within the Danish music industry indicates that the interactions and thereby the relationship between the record companies and the artists are experiencing frictions due to different perceptions of success. The study further states that the interactions between the two associates are affected by a lot of external factors within the legal-, economic-, political-, technological-, and social areas. The aim is thus to explore how navigation within the industry should take place, in order to avoid the clashes and gain success. The case study of the artist Francis Bowie is therefore applied to explore and understand how the clashes may affect and suppress the creativity of an artist. Data for this study is collected by qualitative interviews with representatives of the three main associates within the industry, namely artists, record companies and the radio stations. The interviews are used as foundation for examining how each of their understanding and perceptions of the industry and their role herein, influence the interactions during the processing a record undergoes before it is released. Furthermore, observations of the artist Francis Bowie has been conducted in order to obtain a full insight in the world of an artist and to examine how the behaviour is affected by external The theoretical foundation of the thesis embraces the processing of music within an industry that is so affected and dependent by environment forces.
  • Razorcake Issue #84 As A

    Razorcake Issue #84 As A

    RIP THIS PAGE OUT WHO WE ARE... Razorcake exists because of you. Whether you contributed If you wish to donate through the mail, any content that was printed in this issue, placed an ad, or are a reader: without your involvement, this magazine would not exist. We are a please rip this page out and send it to: community that defi es geographical boundaries or easy answers. Much Razorcake/Gorsky Press, Inc. of what you will fi nd here is open to interpretation, and that’s how we PO Box 42129 like it. Los Angeles, CA 90042 In mainstream culture the bottom line is profi t. In DIY punk the NAME: bottom line is a personal decision. We operate in an economy of favors amongst ethical, life-long enthusiasts. And we’re fucking serious about it. Profi tless and proud. ADDRESS: Th ere’s nothing more laughable than the general public’s perception of punk. Endlessly misrepresented and misunderstood. Exploited and patronized. Let the squares worry about “fi tting in.” We know who we are. Within these pages you’ll fi nd unwavering beliefs rooted in a EMAIL: culture that values growth and exploration over tired predictability. Th ere is a rumbling dissonance reverberating within the inner DONATION walls of our collective skull. Th ank you for contributing to it. AMOUNT: Razorcake/Gorsky Press, Inc., a California non-profit corporation, is registered as a charitable organization with the State of California’s COMPUTER STUFF: Secretary of State, and has been granted official tax exempt status (section 501(c)(3) of the Internal Revenue Code) from the United razorcake.org/donate States IRS.
  • How Will We Survive?

    How Will We Survive?

    t Parks need peoples The global movement for tribal peoples’ rights The destruction of Congo Basin tribes in the name of conservation How will we survive? Baka Cameroon 1 How will we survive? Introduction The wildlife guards beat us like The Baka and Bayaka “Pygmies,”1 like dozens of other rainforest tribes animals. We want what they’re in the Congo Basin, are being illegally evicted from their ancestral doing to end. homelands in the name of conservation. Bayaka woman, Congo, Sept. 4, 2016 National parks and other protected areas have been imposed on their lands without their consent, often with little or no consultation. Some of the world’s largest conservation organizations, principally the World Wildlife Fund (WWF) and the Wildlife Conservation Society (WCS), were the key players involved in this carve-up of indigenous lands. The Baka and Bayaka are accused of “poaching” when they hunt to feed their families, both inside and outside these areas. Together with their neighbors, they face harassment and beatings, torture and death. The anti-poaching squads that commit these atrocities are funded and equipped by the same conservation organizations. The harrowing accounts we have gathered here almost certainly represent a small fraction of the real number of such cases – the vast majority go undocumented. All these abuses should have been investigated swiftly and fairly, but almost always go unpunished, and are frequently denied. This “green colonialism” is destroying lives, and is illegal.2 It is also harming conservation. Scapegoating tribal people diverts action away from tackling the real causes of environmental destruction in the Congo Basin: logging and corruption.
  • The Most Holy Body & Blood of Christ June 14, 2020

    The Most Holy Body & Blood of Christ June 14, 2020

    Founded on June 3, 1770 St. Junipero Serra 500 Church Street Monterey, CA 93940 (831) 3732628 www.sancarloscathedral.org The Most Holy Body & Blood of Christ June 14, 2020 Parish Mission Statement Rooted in the compelling life of Jesus Christ and formed by God’s Holy Spirit, we, the diverse community of San Carlos Cathedral are passionately driven to… Pray, Live, Act, Treasure Embrace all peoples, all cultures, and all generations as witnesses to the Gospel. In person Mass celebrations will resume June 13 & 14, 2020 Daily Mass resumes June 15, 2020 *Weekend Mass Schedule: Saturday 4 p.m. & 6 p.m., Sunday at 7:30, 9 a.m., 10:30 a.m., 12 noon at 5:30 p.m. *Sunday Mass streaming will continue: www.sancarloscathedral.org *Daily Mass 7:45 a.m. *No 12:15 p.m. Mass until further notice *Safety protocols are in place. 25% capacity per Mass is permitted by our Diocese at this time. Thank you for your cooperation and patience. The Most Holy Body & Blood of Christ Feast of Corpus Christi June 14, 2020 LYRICS FOR JUNE 1314 MASSES, (4 pm, 7:30, 9 AM, 10:30, Noon, 5:30 PM) ____________________________________________ GATHERING SONG: HERE AT THIS TABLE REFRAIN: Come and be filled here at this table. Food for all who hunger and drink for all who thirst. Drink of his love, wine of salvation. You shall live forever in Jesus Christ the Lord. VERSE: You who labor for justice, you who labor for peace, you who steady the plow in the field of the Lord.
  • How Did We Survive and How Do We Remain Resilient? Aboriginal Women Sharing Their Lived Experiences And

    How Did We Survive and How Do We Remain Resilient? Aboriginal Women Sharing Their Lived Experiences And

    How did we survive and how do we remain resilient? Aboriginal women sharing their lived experiences and knowledge of lessons learned in life. Jasmine Gregory School of Public Health Faculty of Health Sciences University of Adelaide Thesis submitted in fulfilment of the requirements for the degree of Master of Philosophy August 2019 Table of Contents Table of Contents ..................................................................................................... ii Abstract .................................................................................................................... iv Declaration of Authorship ...................................................................................... vi Acknowledgements ................................................................................................ vii Chapter 1: Introduction ........................................................................................... 1 Our past ................................................................................................................... 1 Our present .............................................................................................................. 2 A way forward ........................................................................................................ 6 This research project ............................................................................................... 7 Chapter 2: Literature Review ................................................................................ 11