Overview

The Health Advocate for Liver Transplant (HEAL-Tx) Transition of Care Pilot is a nonrandomized, open-label intervention pilot of a health advocate intervention aimed to assess feasibility and acceptability of integrating a Health Advocate onto the transplant team to help adolescents transition their care to adult transplant teams. Across studies, health advocate roles vary, and can include coordinating medical care treatment, facilitating financial assistance (e.g., taxi vouchers), and connecting patients to community resources, which can improve self-management, mitigate social risks, and lead to better communication between the healthcare system and the family. In this pilot, the investigators will adapt this intervention for adolescent/young adult liver transplant patients and measure acceptability and feasibility according to RE-AIM.

Eligibility

Inclusion Criteria:

1. Patient has received a liver transplant >1 year ago
2. Study team has screened patient and discussed with the primary transplant practitioner that patient may benefit from the Health Advocate program.
3. Patient has an unmet social risk (e.g., food insecurity) or MLVI >/= 2.0.
4. Patient will be transferred to adult transplant team in <6 months.
5. Patient can read and write English or Spanish
6. Patient is between 18-25 years old and can provide informed consent.
7. Patient has a working phone and smart device capable of video and/or audio virtual visits via Zoom.

Exclusion Criteria:

• Patient has significant cognitive impairment.
• Does not meet age criteria
• Patient is a ward of the state.
• Non-English, non-Spanish speakers.
• Non-US residents.