In the absence of a clear milestone, the decision to transfer care from the pediatric to the adult health care setting should be made by consulting with the patient and family. Successful transition will require that patients have a functional understanding of their conditions and have developed some self-care skills. Maturity, emotional stability, psychosocial development, and compliance are other factors to be considered in developing a timetable for transition. Transition should be timed to precede the inevitable attrition imposed by institutional mandates, the decrees of third-party payers, or abrupt patient or family demands. If possible, health care transition should occur at a time of relatively stable health.

The adolescent moving into the adult health care system should be offered different options, and should play an integral role in making decisions. Parents and families should be helped to understand their changing roles as the focus moves away from the family's presence at consultation and appointments, and toward health care providers speaking with the adolescent alone as much as possible.