Transitioning adolescents to adult care and adulthood

Key Points

CASE 1: You are the primary care provider for "CJ," a 19-year-old obese adolescent with a past medical history of mild intellectual disability, severe asthma, and epilepsy. He presents today after recent intensive care unit (ICU) hospitalization for status asthmaticus. CJ's health depends on whether he remembers to take his medications. He drinks alcohol excessively on the weekends and occasionally uses marijuana. He lives with his maternal aunt, who was unable to attend today. CJ is a senior in high school. He says that he would like help moving out on his own after high school, securing work in a restaurant, and becoming more independent. You want to assist him in planning his future, transferring care to adult providers, and obtaining health insurance.

Moving from childhood to adulthood involves transitioning through multiple interrelated systems, including healthcare, educational, and social services. According to a consensus statement from the American Academy of Pediatrics (AAP), the American Academy of Family Physicians, and the American College of Physicians–American Society of Internal Medicine, the goal of transition in healthcare for all youth with or without special healthcare needs is "to maximize lifelong functioning and potential through the provision of high-quality, developmentally appropriate healthcare services that continue uninterrupted as the individual moves from childhood to adulthood, as well as from pediatric to adult-oriented healthcare."¹ Pediatric providers have the opportunity and responsibility to ensure that steps toward transition have been addressed. This article discusses the role of the primary care provider in helping adolescents and young adults make the healthcare transition and provides tools that can be used to facilitate the process.

Transition planning

Qualitative research by Reiss et al² divides transition into 3 domains: "envisioning a future," "age of responsibility," and "age of transition." The first 2 stages involve developmental tasks that lay the foundation for transition-specific activities that occur during the third stage. During the "envisioning a future" stage, which may begin as soon as a condition is diagnosed, providers should talk to youth and family about long-term future plans, aspirations, or goals; establish short-term 5-year goals; and ask how providers, support staff, and the family can help make the youth's dreams a reality. Reiss et al² found that asking questions about future education, employment options, independent community living, and needed healthcare can prompt families and providers to initiate activities that promote the patient's future independence. During the "age of responsibility" stage, which begins during pre-adolescence (around 9 years of age),² providers should conduct age-appropriate teaching to youth about their health, involve youth in decision-making ("assent to consent"), give responsibility to the patient to carry out tasks of daily living and medical self-care, and help the patient advocate for himself/herself.