Using the TRAQ in clinic
The TRAQ is meant to be used again and again, about every 6 months, to track a young person's progress. The key is to engage the youth, using motivational interviewing, so they choose and work on goals that matter to them.
Clinic workflow
Designed around the limited time nurses, physicians and staff have in primary care or specialty clinics. The TRAQ takes about 5 minutes before the provider sees the patient.
Start between ages 12 and 15
Begin at a well visit or any visit between ages 12 and 21. Many clinics start at 14 or 15 because of staffing, but earlier is better. Give the youth and parent a short handout on transition milestones, such as Got Transition or FloridaHATS' 10 Steps to a Successful Transition.
Administer the TRAQ
Read the instructions together and explain the five response levels before the youth fills it out on their own.
Review the results together
Confirm that answers reflect what the youth actually does, since adolescents may overestimate. Bring in the parent's view carefully. Sometimes parents need to step back and let the youth try, and sometimes fail.
Educate and set goals
For any domain under 4: teach the specific skills, use motivational interviewing to build motivation and confidence, and have the youth choose 2–3 transition goals.
Follow up
Check in by phone or patient portal at an interval set by the score, and repeat the TRAQ every 6–12 months.
Transfer
When every domain averages 4–5, finalize the transition plan, make a formal referral to adult providers, and confirm the connection after transfer.
Giving the TRAQ
Youth complete it on their own
We recommend the youth complete the TRAQ without parental input. During the review, a parent's input can be used to check or adjust the scores.
When reading or development is a barrier
The TRAQ is written at about a 6th-grade reading level. If that's too high, a parent can complete it for the youth (check the caregiver box), or staff can read each item aloud.
Motivation & confidence
The last two questions measure importance (motivation) and confidence (self-efficacy). If either is low, explore why before setting goals.
Tie transition goals to life goals
Ask the youth about their life goals, then frame TRAQ skills as steps toward them. "I want to go to college and live in an apartment" opens a conversation about going to the pharmacy alone, finding a provider, and giving a health history.
Build confidence with small steps
Explore what worries them, then pick one small change. A youth with low confidence might practice asking questions with a parent or friend first, or visit the pharmacy with a parent and talk with the pharmacist.
Coaching by score range
Use the average for each domain. Look at the whole pattern: start with the domain the youth chooses, the lowest domain, or praise their strongest domain and encourage more.
| Domain average | Where they are | Approach |
|---|---|---|
| 1–2 | Not yet doing these behaviors; may not be interested yet | Explore values and goals; create discrepancy; suggest very small first steps such as watching a video. |
| 2–3 | Interested, perhaps some first attempts | Shift into coaching. Ask what steps they'd like to take and add practical tools such as pharmacy apps. |
| 3–4 | Actively participating some of the time | Affirm progress and answer questions; take on harder topics like insurance and care at college. |
| 4–5 | Doing most behaviors consistently | Encourage full ownership; plan for transfer and next life stage. |
What the conversation sounds like
The same opening, adapted to John's score range.
Follow-up
The transition coordinator or clinic staff records the TRAQ scores, the goals chosen, and any useful notes, then follows up by phone or patient portal. Did they complete their goals? What got in the way? What would they like to try next?
Re-administer at a dedicated transition visit or at a regular visit. Youth with conditions that need frequent visits can repeat the TRAQ every 6 months.
Case examples
John · total 2.4
John is not ready to transfer yet. Asked which area he'd like to work on, he chooses Appointment Keeping, his lowest area. His goals: arrange his own ride two weeks ahead, watch the scheduling video, and book his next appointment himself. The coordinator calls him two months later to see how it went and set new goals.
Mary Jane · total 4.5
Every domain is at 4 or above. After two years of transition education, 18-year-old Mary Jane is nervous but ready. She also sees a pediatric cardiologist, so the coordinator finds an adult cardiologist who takes her insurance, involves her pediatric cardiologist in the referral, and refers her to a new primary care physician.
Transfer to adult care
Once a youth scores 4–5 in every domain, they no longer need transition education, but they still need monitoring and encouragement. The provider or coordinator should:
- Finalize the transition plan with the youth and family.
- Contact the adult provider(s) and make a formal referral, including specialists.
- Follow up after transfer to confirm the young adult connected with adult care.
Plan ahead for insurance
Insurance is often the hardest part. Youth who will lose Medicaid between 18 and 21 need early, detailed education on keeping coverage, for example through healthcare.gov. Youth heading to college need a plan for care there; see the college checklist.
The transition coordinator
Ideally a designated transition coordinator manages these steps. Otherwise a nurse and provider can share them. A coordinator gives patients more individual time and helps with the transition plan, referrals to adult primary and specialty care, and keeping insurance. For youth with intellectual disabilities, the coordinator also helps with referrals for SSI, guardianship or supported decision-making, and other services (see Youth with disabilities).
Coding
After the first encounter, add the transition counseling diagnosis code Z71.89 (other specified counseling) to the record. This lets the clinic see who has started transition, call youth back for a repeat TRAQ, and bill for time spent on transition counseling. Got Transition publishes coding and payment guidance.
References
- Johnson K, McBee M, Reiss J, Livingood W, Wood D. TRAQ Changes: Improving the Measurement of Transition Readiness by the Transition Readiness Assessment Questionnaire. J Pediatr Nurs. 2021;59:188-195. doi:10.1016/j.pedn.2021.04.019
- Gold MA, Kokotailo PK. Motivational Interviewing Strategies to Facilitate Adolescent Behavior Change. Adolescent Health Update. 2007.
- Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. 3rd ed. Guilford Press.