Special needs navigator
Continuity of care, from birth through 21
The same doctors, the same chart and the same plan across every stage, then a deliberate hand-off to adult care. For a child with special needs, continuity is what keeps hard-won progress from being lost at each transition.
NCQAPatient-Centered Medical HomeWhy it matters
Knowing the child, not just the diagnosis
Children with complex needs are often the ones who see the most different clinicians and are known well by the fewest. At Dare2Care Pediatrics the same two doctors follow a child from the newborn visit through the teen years. They know what a good day looks like, which medicines were tried and why they stopped, which specialist the family trusts, and what the school has agreed to.
That history lives in one chart with one care plan. When something changes, a new diagnosis, a hospital stay, a move to a new school, the plan is updated rather than rebuilt, and the people on the team are told.
Some of the children Dr. Viswanadham cared for two decades ago now bring their own children. Second-generation families are the clearest sign of continuity we know.
Transition to adult care
A hand-off that starts years early
Step 1: Ages 12 to 14: start the conversation
Teens begin spending part of each visit without a parent, learn their own diagnoses and medicines, and we talk about what adult care will look like.
Step 2: Ages 14 to 16: build skills
Refilling medicines, knowing when to call, carrying a summary card, understanding insurance. For a teen with developmental disabilities, we plan with the family for guardianship or supported decision-making conversations that belong to age 18.
Step 3: Ages 16 to 18: identify adult providers
Family medicine or internal medicine in your network, adult specialists who accept the child’s conditions, and, where needed, adult Medicaid pathways and waiver transfers before the 18th birthday so coverage does not lapse.
Step 4: Ages 18 to 21: the hand-off
A written medical summary, records sent, the first adult visit scheduled while we are still available, and a check-in afterwards. We keep seeing young adults until the hand-off is complete, up to age 21.
Questions
Continuity questions
Will my child always see the same doctor?
Children with complex needs are assigned a primary doctor and see that doctor for planned visits. For a same-day sick visit either doctor may see your child, and both work from the same chart and care plan.
What happens if we move or change insurance?
The chart, care plan and documentation come with you. We send records to the new practice and, if we are still in your new plan’s network, nothing needs to change at all.
Can you keep seeing my child after 18?
Yes, through age 21. For young adults with disabilities the hand-off often takes longer, and we stay involved until adult providers and coverage are in place.
Planning a transition?
Call or text (770) 615-7000 to schedule a transition planning visit, for a teen or for a young adult who is not yet set up with adult care.