While the adjustments made towards incorporating health education directed at adolescence has been an ongoing process in schools, there are still gaps in the transition from pediatric care to adult care. In a CDC study made during the timeframe of 2016–2017, it has been made apparent that most adolescents with mental, behavioral, or developmental disorders (MBDDs) did not receive the recommended support from their healthcare providers to help them transition from a parent supervised pediatric care to a more independent, patient-centered adult care. The American Academy of Pediatrics recommends transition planning for all adolescents starting at the age of 12 years, which includes the healthcare provider speaking with the adolescent separate from family members, discussing the transition to adult care, and coaching the adolescent in taking charge of their own care in preparation for when they are independently living. This transition planning is particularly important for adolescents with MBDDs to help prevent potential negative outcomes during and after a healthcare transition. Healthcare providers and parents have the opportunity to collaborate with each other to close the gaps and help adolescents with MBDDs transition to adult health care.
Findings made from Studies
Statistically, a CDC study discovered that most adolescents did not receive the recommended transition planning to get ready to move from pediatric to adult health care. However, what was interesting was that gaps in planning differed by the diagnosis given to the adolescent patient. Although adolescents with depression and anxiety were more likely than their peers without MBDDs to receive transition planning, most did not receive the recommended planning necessary in order to thrive independently. Adolescents with some developmental disorders, such as autism spectrum disorder (ASD) and developmental delay, were less likely than their peers without MBDDs to receive the recommended transition planning. Most adolescents receiving medication and/or behavioral treatment for MBDDs did not receive the recommended transition planning, putting them at risk for stopping treatment.
Here’s How We Can Close The Gap
These steps can increase the proportion of adolescents with MBDDs who receive recommended transition planning:
- Healthcare providers can learn about the recommendations and use them when providing care for adolescents starting at age 12 years, and modify the plans, goals, and timelines to meet the unique needs of each adolescent.
- Parents can ask their child’s pediatric healthcare providers about transition planning for their adolescent.
- Communities can provide transition programs outside of traditional preventive healthcare visits, such as through school-based transition programs.
- Public health can increase healthcare provider training to address the unique needs of adolescents.
Although all youth and young adults need a safe and seamless healthcare transition to adult health care, some youth with MBDDs may pose additional challenges to the transition process. These individuals often experience multiple transitions in services and support from pediatric care and special education to much less resource-rich adult systems once they enter adulthood. Youth with developmental and/or intellectual disabilities, including autism spectrum disorders, often face challenges in transitioning to self-directed care because the support for their preparation and training and accommodations in the health care delivery process is not widely available. Youth with mental or behavioral health conditions also face adversity during the transition period for several reasons. Mental health conditions often peak during young adulthood and impair one’s ability for self-care and participation in routine medical or mental health care or decision-making. Shortages of mental and/or behavioral health clinicians are pervasive, and many youths and young adults with psychiatric conditions have no access to a regular source of either mental health or medical care. Consequently, they are at higher risk of dropping out of care as well as employment, education, stable housing, and relationships. Transition planning for this special population is most helpful when the clinic incorporates active outreach and support for effective self-advocacy as well as partnerships with family members, medical and mental health clinicians, and community supports to bridge service gaps.
Works Cited
Anderson, Kristy A., et al. “Transition of Individuals With Autism to Adulthood: A Review of Qualitative Studies.” American Academy of Pediatrics, American Academy of Pediatrics, 1 Apr. 2018, pediatrics.aappublications.org/content/141/Supplement_4/S318?ijkey=dcba983f2cb06ad83e16d2d06f139ec5f818600f&keytype2=tf_ipsecsha.
“Gaps in Helping Adolescents with Mental, Behavioral, and Developmental Disorders Make the Transition to Adult Health Care.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 22 Mar. 2021, www.cdc.gov/childrensmentalhealth/features/health-care-transition-gaps.html.
Nathenson, Robert A, and Benjamin Zablotsky. “The Transition to the Adult Health Care System Among Youths With Autism Spectrum Disorder.” Psychiatric Services (Washington, D.C.), U.S. National Library of Medicine, 1 July 2017, pubmed.ncbi.nlm.nih.gov/28292222/.
Okumura, Megumi J., et al. “Physician Views on Barriers to Primary Care for Young Adults With Childhood-Onset Chronic Disease.” American Academy of Pediatrics, American Academy of Pediatrics, 1 Apr. 2010, pediatrics.aappublications.org/content/125/4/e748?ijkey=7155ffecbc7b35c6cff05a09687d10147c5e649a&keytype2=tf_ipsecsha.
Peter, Nadja G., et al. “Transition From Pediatric to Adult Care: Internists’ Perspectives.” American Academy of Pediatrics, American Academy of Pediatrics, 1 Feb. 2009, pediatrics.aappublications.org/content/123/2/417?ijkey=8cd9b48e9ee1c711ef4d49fb28f7600b78449602&keytype2=tf_ipsecsha.
Singh, Swaran P., and Helena Tuomainen. “Transition from Child to Adult Mental Health Services: Needs, Barriers, Experiences and New Models of Care.” Wiley Online Library, John Wiley & Sons, Ltd, 25 Sept. 2015, onlinelibrary.wiley.com/doi/full/10.1002/wps.20266.
Walsh, Casey, et al. “Health Care Transition Planning Among Adolescents with Autism Spectrum Disorder.” Journal of Autism and Developmental Disorders, U.S. National Library of Medicine, 4 Apr. 2017, pubmed.ncbi.nlm.nih.gov/28078534/.
White, Patience H., et al. “Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home.” American Academy of Pediatrics, American Academy of Pediatrics, 1 Nov. 2018, pediatrics.aappublications.org/content/142/5/e20182587.