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Background: The transition from pediatric to adult health care is challenging for patients with renal disease and inadequate transition can lead to increased disease-related morbidity. We developed a structured health care transition (HCT) program that includes a joint two-step transition clinic; the first step is the pediatric clinic and second step is the adult clinic. Methods: Quality improvement methodology was utilized to establish an interdisciplinary transition team and conduct a needs assessment. Lack of a standardized HCT program was identified as a primary barrier to HCT. We utilized transition team and other stakeholder input to implement a transition program that included a joint pediatric/adult two-step transition clinic. Various other components were developed, including a transition policy and patient and provider feedback surveys. A pilot group of patients with kidney disease participated in the program. Results: 27 patients completed the “first step” and 22 patients completed the “second step” of the transition clinic. Median age at the time of transition was 20 years, with kidney transplant (41 %) as the major diagnosis. All patients (100 %) received the transition policy and reported that the transition team worked with them to gain skills to manage their health and plan for the future. Pediatric and adult nephrologists reported feeling satisfied (100 %) with the transition program. Conclusion: A structured transition program was established utilizing expertise of a dedicated transition team and was well received by participants. This program is a critical first step in addressing the gap in standardized care for transition for pediatric patients with kidney disease.

The Good Behavior Game (GBG), a universal classroom management intervention, has shown clear benefits in promoting the behavioral, social-emotional, and academic development of students. However, the quality with which this intervention is delivered tends to diminish over time, which decreases the likelihood of these positive outcomes. By leveraging the benefits of technology, we built a sophisticated online platform to support teachers' fidelity of the GBG in collaboration with expert consultants and education partners. This paper details initial steps to develop and refine GBG Technology (GBG Tech). Three teacher consultants and two experts in technology-enhanced and classroom management interventions provided ongoing feedback as GBG Tech was initially developed through a rapid prototyping approach by a team of high-tech engineers. Twenty-four teachers participated in focus groups to inform subsequent revisions of the technology, and seven teachers tested the feasibility of GBG Tech in their classrooms for 6 weeks. As anticipated, teachers found GBG Tech to be acceptable, understandable, and feasible to use. Moreover, teachers reached fidelity quickly (M = 2.43 weeks), sustained fidelity for 6 weeks, and delivered the GBG at the recommended dosage. The results of this study informed a full version of GBG Tech that is ready for large-scale testing and a set of design principles intended to guide the development of other technology-delivered interventions aimed at sustaining fidelity in authentic classroom settings.