Transitional age youth
Transitional age youth can reference both a developmental period and be a descriptor regarding eligibility for certain services. While there are variations in definitions, the age ranges do consistently overlap and include late adolescence to early adulthood. This range is considered a critical period in human development characterized by several changes socially, environmentally, and cognitively. During this time, individuals can experience changes in their social roles and function, family and peer supports, exposure to substance use, educational and vocational programs, as well as changes in healthcare providers from pediatric to adult settings.
History
The phrase transitional aged youth originated in the foster care system but has since taken on broad applicability to other sectors. Specifically, youth “in transition” can refer to “aging out” or being ineligible for pediatric health care services after turning 18 years old, or being ineligible for children's mental health services at 18 years old in certain places. The adult outcomes for youth involved in various child-serving systems came under scrutiny in the 1980s. As a result, planning around the transition from child to adult services became a focus across many systems. In mental health systems, the term transitional aged youth has historically been associated with youth and young adults at high risk of poor transition outcomes due to complex needs, lack of a support system, and multiple challenges. Earlier studies on young adult outcomes used the term to describe individuals from 16 to 25 years old who have, or are at risk of having, Serious Mental Illness or Serious Emotional Disturbance, defined as serious emotional or behavioral difficulties that are psychological in origin, in combination with significant functional impairment, and arise by age 18 years. Terminology has since evolved, both in mental health and in federal initiatives. For example, the Substance Abuse and Mental Health Services Administration has broadened its scope to include TAY with SED and in the general public, through its Now Is The Time Healthy Transitions program. This expansion likely reflects the growing knowledge that all youth of transition age are at risk for mental health issues, substance abuse disorders, and suicide. Therefore, TAY is being used more often to refer to all individuals within an age range, regardless of presence of SED or service system involvement. Other terms which overlap with TAY include Emerging Adulthood, coined by Arnett who proposes EA as a normal discrete developmental phase for all persons 18–25; Adolescents and Young Adults, historically those with cancer but now more generally referring to all health needs of 10-25 year-olds; and Youth and Young Adults. Sometimes, the acquisition of tasks during this developmental phase has been colloquially termed, “adulting”.Developmental tasks
Like many other developmental stages, the period of transition from adolescence to early adulthood is faced with many unique challenges. TAY must consolidate and build upon the tasks that they started in adolescence, including the enrichment of their identity, independence, and relationships. During this period, their bodies begin to reach physical and sexual maturity, while cognitive and psychological development often trail behind. Physically, TAY undergo puberty mediated by sex hormones, including increases in testosterone and estrogen, and begin to develop secondary sex and traditional gender role characteristics. Cognitively, they start to form a moral code, combining aspects of societal expectations and rights as well as universal ethical principles. As they work towards independence, TAY must acquire skills for adulthood, such as learning how to manage finances, housing, and medical and legal decision-making, in order to move away from reliance upon family for basic needs. Smaller steps needed to gain success include learning how to create and maintain a budget, identifying “needs versus wants,” and opening a bank account. Legally, many youth will continue to require their guardian's consent/permission for many medical procedures, medications, and services until they reach the age of majority.Independence also involves forming and maintaining fulfilling relationships outside of the family unit. As dependence on the family lessens, relationships shift to companionship, support, and intimacy with peers. Friendships become more important as TAY further individualize and psychologically discover who they are. Intimate relationships are often more challenging to develop, and many may not find a partner during this developmental period, as TAY navigate the stresses of biological and hormonal drives, psychological wants for intimacy and acceptance, and weigh potential negatives including parental disapproval, possible pregnancy, sexually transmitted diseases, and peer rejection.
Population health
In 2020, the global population of 15-24 year olds was estimated to be 1.2 billion, accounting for about 15% of the world's total population. The health of adolescents is a critical component of a successful transition to adulthood. This period is marked by significant physical, cognitive, and psychosocial growth, and is an important time for building foundations for good health. While young people are typically seen as healthy, this period can correlate with a rise in health problems, including the emergence of mental health issues. In the last decade, depression, anxiety, and injuries were among the top ten causes of death in 10-24 year olds.Factors affecting health
There are many factors that can affect the health of this population. As part of normal development, adolescents become increasingly independent and may experiment with adult behaviors that affect future patterns of adult health. Behaviors such as driving, sexual experimentation, tobacco, alcohol, and substance use, and diet and exercise habits can impact health in the short- and long-term. Since 2014, e-cigarettes have been the most commonly used nicotine product among youth. The high level of use in this population led the U.S. Surgeon General to declare e-cigarette use an epidemic. Concerns about the negative effects of nicotine on the adolescent brain include addiction, impact on learning, memory, and attention, toxic effects on lungs from aerosol, and use of e-cigarettes for marijuana. In addition to substance use, factors that affect health in this population should be considered from a comprehensive perspective and include sexual and reproductive health, HIV and other infectious diseases, nutritional deficiencies, injury and violence, chronic physical health problems, and mental health disorders.Barriers to transition of health care
Significant barriers may impact the successful transition from pediatric to adult health care, which in turn can negatively impact health outcomes. Taking responsibility for managing one's own health care can be a struggle for young adults. As youth transition to adulthood, responsibility shifts from the family to the youth. Some youth with pre-existing illnesses might decide that treatment is no longer necessary. The myth of invulnerability and fear of being ill may reduce a young adult's motivation to seek treatment. Young adults who do seek treatment must learn how to obtain health insurance, schedule medical appointments, remember to take medication, and obtain refills. They must acquire these new skills while learning how to balance employment or increased academic demands, wellness and social activities, and with decreased support. In some countries, there are financial burdens related to the costs of high-quality healthcare. Finally, transportation issues may impact access to care, and worries about money are also widespread in the young adult population and may limit treatment options.Risk factors for mental health disorders
The transitional aged youth years coincide with the onset of many mental health conditions. Approximately 75% of serious psychiatric disorders present with symptoms before the age of 25. Studies have shown that in the “transitional aged brain”, a mismatch occurs between the early maturation of the subcortical brain regions, and the delayed maturation of the prefrontal cortex and the white matter tracts connecting them. The subcortical areas, known as the amygdala and nucleus accumbens, influence motivation, passion, pleasure, and aversive experiences, while the prefrontal cortex and connecting white matter tracts are important for attention, emotional and impulse control, flexibility, planning, and judgment. Even with external control and expectations, this group remains at very high risk for morbidity and mortality associated with suicide, substance use, psychiatric illness, and accidents. At the same time that these youth and their maturing brains need more external regulatory support and lower risk environments, they instead have easier access to alcohol and drugs, high-risk social activities, and loss of close parenting and supervision. Exposure to toxins and trauma during childhood and adolescence can also affect adult functioning. For example, adolescent exposure to marijuana may increase the risk of psychosis in vulnerable youths. A growing body of literature implicates Adverse Childhood Experiences, including physical, sexual, and emotional abuse, in a broad range of negative health consequences including depression, anxiety, suicidality, and cardiovascular and immune disease.Special subgroups
Serious mental illness
According to the NIMH, in 2019 young adults aged 18–25 years had the highest prevalence of serious mental illness compared to adults aged 26–49 years and aged 50 and older. TAY with untreated mental health disorders are at high risk for substance abuse, physical assault, and encounters with the correctional system.Foster care
Because of the early terminology applied to this population, there is a core body of research related to TAY and youth in foster care. Upwards of 80% of foster youth have developmental, behavioral, or mental health concerns. Foster care alumni have higher rates of mental health disorders than the general population, such as depression, PTSD and substance use disorders. Former foster youth with mental illness often have past trauma histories, such as being a victim of child abuse and neglect, that make it challenging for them to develop and maintain healthy adult relationships. Their mood may easily become dysregulated as a result of insecure attachments. Some researchers have shown that the more placements a child experiences, the higher risk of attachment issues which can lead to a high risk of psychiatric morbidity in adulthood.Compared to other Medicaid-eligible youth, foster youth have higher rates of behavioral health expenditures. Foster youth are prescribed psychotropic medications at 2-8 times the rate of other Medicaid-eligible youth. Foster youth are at risk for inappropriate prescribing because of limited access to youth behavioral health information and history, fragmented and/or inadequately coordinated care, insufficient time for assessment, treatment, and collaboration; un- or misdiagnosed trauma-related conditions, limited access to effective psychosocial and psychiatric treatments, and ineffective advocacy for foster youth.
The prime importance of developing treatment approaches to engage and maintain TAY in psychiatric treatment has been well documented in the literature. According to the 2014 Substance Abuse and Mental Health Services Administration study report: one-fifth of young adults of age 18 to 25 had a mental health illness in the past year, yet two-thirds of those did not receive treatment. Youth with serious mental health conditions can have significant delays in their psychosocial development that can impair their ability to function as they enter adulthood.