Maryann Davis

Addressing the Needs of Youth in Transition to Adulthood

The appalling young-adult outcomes of youth with serious emotional disturbance who are served in public systems demonstrate a failure of standard services to address the unique needs of these youths during their transition from adolescence to adulthood. This article discusses the needs of this population and the current ability of mental health and other relevant agencies to meet those needs. The contrast between needs and system status is presented through a framework of contrasting developmental and institutional transitions. This article reviews the barriers to effective system reform, and the recommendations for changes made by national panels focused on transition and applied research.

How Are We Preparing Students With Emotional Disturbances for the Transition to Young Adulthood? Findings From the National Longitudinal Transition Study—2

The authors describe five principles they identified from the literature on exemplary practices to help students with emotional disturbances (ED) have positive secondary school experiences and successful trajectories into early adulthood.The five are relationships, rigor, relevance, attention to the whole child, and involving students and families in goal-driven transition planning.The authors evaluated implementation of these practices for middle and secondary school students with ED by using data from a nationally representative longitudinal study of students receiving special education services. The results suggest that exposure to best practices has improved since the 1980s and is similar to that for students with other disabilities, but significant opportunity for improvement remains. The authors also identify implications for school programming.

The transition to adulthood for youth who have serious emotional disturbance: developmental transition and young adult outcomes

This article reviews studies that depict the developmental transition from adolescence to young adulthood of persons who have experienced serious emotional disturbance (SED) as children or adolescents. The literature demonstrates that their plight in young adulthood is grave. Youth with SED enter the transition phase delayed in their developmental maturation and face additional challenges relative to their nondisabled peers. As a group, they are undereducated, underemployed, and have limited social supports. Homelessness, criminal activity, and drug use are prevalent. This article defines the transitional youth population, describes the developmental tasks of transition, and summarizes the results of longitudinal studies that have tracked functional outcomes of transitional youth into young adulthood. The discussion focuses on the relevance of these findings to service provision.

State child mental health efforts to support youth in transition to adulthood

The ability of state child mental health (MH) systems to facilitate the transition to adulthood of adolescents in their systems was studied by interviewing members of the Children, Youth and Families Division of the National Association of State Mental Health Program Directors (NASMHPD). Results demonstrated that transition services within the state child MH systems are sparse, nationally. Continuity of services as youth age into adulthood is hampered because of generally separate child and adult MH systems, each with separate policies defining who accesses those services, lack of clarity about procedures to access adult MH services, and lack of shared client planning between adult and child MH systems. These findings suggest that adolescents in state child MH systems have difficulty accessing services that will help them with the difficult task of learning to function as an adult. Public MH systems should examine their capacity to provide transition supports and make needed improvements.

Longitudinal patterns of offending during the transition to adulthood in youth from the mental health system

Arrest rates among the population of youth who have been served in child mental health systems are known to be high during adolescence and young adulthood, but individual longitudinal patterns have not been examined. The present study used developmental trajectory modeling, a contemporary method used widely in criminology, to examine clusters of individual criminal justice involvement patterns at ages 8 through 25, from database records of 131 individuals in public adolescent mental health services. Three groups of particular concern emerged: one with increasingly high offense rates and two with moderate to high violent offense rates that did not desist. Offense patterns in these groups indicate that early intervention should occur before age 15. Some risk factors were identified. Peak offending for most groups occurred between ages 18 and 20. Implications of these findings for mental health services during the transition to adulthood are offered.

Prevalence and Impact of Substance Use Among Emerging Adults with Serious Mental Health Conditions

TOPIC This critical review of the literature integrates findings across varied literatures and identifies areas for continued study on the prevalence, correlates, and impact of substance use (alcohol and illicit drugs) on social role functioning among emerging adults with serious mental health conditions. PURPOSE This population is of interest because of high comorbidity rates between substance use and serious mental health conditions and the added difficulties posed by their co-occurrence during the transition to adulthood. This critical review presents the epidemiology of substance use in emerging adults with serious mental health conditions compared to emerging adults without these conditions, as well as what is known about predictors and consequences of substance use in this population. SOURCES USED PsychINFO and PubMed along with relevant published literature. RESULTS This review summarizes what is known about the impact of these co-occurring problems on the transition of emerging adults from school and training environments to adult work roles. Though this group presents with unique challenges, few programs have been developed to address their specific needs. This paper synthesizes what is known empirically about approaches with this population, discussing those that might be useful for emerging adults with comorbid serious mental health conditions and substance use problems, particularly in supporting their educational and vocational development. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Emerging adults with co-occurring serious mental health conditions and substance use problems are underserved by current mental health systems. Recommendations focus on how to promote mental health and social role functioning through comprehensive intervention programs that provide continuity of care through the transition to adulthood.

The Great Divide: How Mental Health Policy Fails Young Adults

All individuals are challenged by the movement from being an adolescent living at home and attending school to being an adult typically heading a household and working to support him or herself. This period of time is called the transition to adulthood and is even more challenging for youth from vulnerable populations such as youth with disabilities, in foster care, in juvenile justice system, and the like (Osgood, Foster, Flanagan, & Ruth, 2005). The ages that transition encompasses have not gained consensus in research literature or policy. It begins at ages 14–16 in policies such as the Individuals with Disabilities Education Act (IDEA; PL101-476, 1997 and 2004 amendments) or Federal programs such as the Social Security Administrations SSI Youth Transition Demonstration Projects, which identifies ages 22 and 25, respectively, as ending transition. Recent studies on young adulthood in the general population (Settersten, Frustenberg, & Rumbaut, 2005), found that by age 30, the rapid changes of young adulthood had typically stabilized. Thus, using the broadest ages indicated by policy and research, transition to stable adulthood encompasses ages 14–30.

Increase in Untreated Cases of Psychiatric Disorders During the Transition to Adulthood

OBJECTIVE During the transition to adulthood, youths face challenges that may limit their likelihood of obtaining services for psychiatric problems. The goal of this analysis was to estimate changes in rates of service use and untreated psychiatric disorders during the transition from adolescence to adulthood. METHODS In a prospective, population-based study, participants were assessed up to four times in adolescence (ages 13-16; 3,983 observations of 1,297 participants, 1993-2000) and three times in young adulthood (ages 19, 21, and 24-26; 3,215 observations of 1,273 participants, 1999-2010). Structured diagnostic interviews were used to assess service need (participants meeting DSM-IV diagnostic criteria for a psychiatric disorder) and use of behavioral services in 21 service settings in the past three months. RESULTS During young adulthood, 28.9% of cases of psychiatric disorders were associated with some treatment, compared with a rate of 50.9% for the same participants during adolescence. This decrease included a near-complete drop in use of educational and vocational services as well as declines in use of specialty behavioral services. Young adults most frequently accessed services in specialty behavioral or general medical settings. Males, African Americans, participants with substance dependence, and participants living independently were least likely to get treatment. For cases of psychiatric disorders among young adults, insurance and poverty status were unrelated to likelihood of service use. CONCLUSIONS Young adults were much less likely to receive treatment for psychiatric problems than they were as adolescents. Public policy must address gaps in service use during the transition to adulthood.

Adapting Supported Employment for Emerging Adults with Serious Mental Health Conditions

Effective services are needed to assist young people with serious mental health conditions to successfully transition to employment or education, especially among those with intensive adolescent mental health service utilization. To meet these needs, the Individual Placement and Support (IPS) model of supported employment was adapted and its feasibility was tested in a psychiatric treatment program for early-emerging adults. Participants were 17–20 years old (mean age = 18.5 years). Most were African American, under the custody of the state, with a primary mood disorder diagnosis. Adaptations to IPS included adding the following: near age peer mentors, a supported education component, and a career development focus. This open trial feasibility study tracked the model’s development, recruitment, and retention and tracked vocational and educational outcomes for 12 months. Model refinement resulted in the development of a separate educational specialist position, greater integration of the peer mentor with the vocational team, and further specification of the role of peer mentor. There was an 80% retention rate in the feasibility evaluation. Of the 35 participants, 49% started a job and/or enrolled in an education program over the 12-month period.

Between Adolescence and Adulthood: Rehabilitation Research to Improve Services for Youth and Young adults

University of Massachusetts Medical School Learning and Working During the Transition to Adulthood Rehabilitation Research and Training Center (Transitions RTC) ENRM Veterans Hospital, Bedford, MA In what ways are current evidencebased or informed services well suited for the needs of older adolescents or young adults (i.e., 16-30 year olds) with serious mental health conditions (SMHC)? In what ways would modifications improve their efficacy? These are the questions at the heart of this Special Issue. The papers published in this Special Issue describe examples of current efforts to modify and test the effectiveness of evidence-based interventions, originally designed for other age groups, on this population. Other papers investigate elements of services that may have particular importance for this age group e.g., social media. As Guest Editors, we hope this Special Issue serves to increase the evidence base, and to invite more research on youth and young adults of transition age.