Karen T. Nakano, MD; Geoffrey B. Crawford, MD; Tatiana Zenzano, MD, MPH; Ligia Peralta, MD

Disclosures

December 14, 2011

In This Article

Transitioning From Adolescence to Adulthood

Adolescence (ages 10-19 years) and young adulthood (ages 20-24 years)[1] are periods in an individual's life highlighted by significant physical, social, behavioral, and psychological developmental changes. During these pivotal periods, adolescents and young adults establish behavioral patterns that determine current and future health outcomes.[2]Moreover, these periods are windows of opportunity for healthcare providers and parents or caregivers to teach, support, and foster healthy behaviors, encourage independence and active decision making, and usher adolescents into the adult-centered healthcare system. To appreciate the magnitude of this challenge, every year in the United States, approximately 3-4 million adolescents turn 18 years of age, meaning that roughly 1% of the entire US population will need to transition into adult healthcare every year.

Transition from pediatric to adult-centered healthcare systems ("transitioning") can be defined as "a purposeful, planned process that addresses the medical, psychosocial, and educational/vocational needs of adolescents and young adults as they move from child-centered to adult-oriented healthcare systems."[3] This article will describe the principles and practices that successfully operationalize the Society for Adolescent Health and Medicine's (SAHM) definition of transitioning, and provide resources to encourage transitioning of all adolescents to adult healthcare providers.

Models for Transitioning Adolescents

During the 1970s, discussion among pediatric and adolescent societies focused on the transition of adolescents to the adult healthcare system for 2 reasons: medical advancements made it possible for children with chronic diseases to survive into adulthood,[4]and better health outcomes were observed for adolescents with chronic conditions who received effective transitioning.[5,6] A study of teens with diabetes showed that post-transition attendance at diabetes clinics was better in teens who were introduced to their future providers before their transition.[6]

Lack of a Gold-Standard Model

Despite agreement that transitioning is necessary, no single model for transitioning has emerged as the "gold standard" or the most cost-effective method of transitioning adolescents to adult healthcare. Lack of a unified transitioning model for adolescents was highlighted by Scal and colleagues[7] when they identified 126 different interdisciplinary transition programs for young adults with a variety of chronic conditions.

Consistent observations throughout the literature demonstrate that when operationalized, successful transitioning principles enable some transitioning models to be more effective than others.[4,8,9] Studies have demonstrated that adolescents with chronic conditions who are successfully transitioned, for example, have higher rates of clinical follow-up, therapeutic adherence, and quality disease management (eg, fewer emergency care visits).[3,10]

Healthy Adolescents Overlooked

Most transitioning literature has focused on adolescents with disabilities and chronic diseases (eg, congenital heart disease, cystic fibrosis, juvenile idiopathic arthritis, pediatric kidney transplant recipients).[5,6] Healthy adolescents outnumber their peers with chronic diseases, yet a paucity of literature has examined the effect of transitioning on health outcomes for healthy adolescents and those from special populations (foster care, juvenile justice system, new immigrants, homeless, pregnant, and parenting teens).

Because healthy adolescents with chronic disease and those from special populations share many of the same concerns as healthy adolescents, especially in the areas of sexual and reproductive health,[8] it is reasonable to assume that healthy adolescents and those from special populations will also benefit from transitioned care.

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