Policy Statement on Mental Health Care for Transition Age Youth

Background

Transition age youth (TAY) designates a developmentally discrete patient cohort (generally ages 15-26-year-olds) between adolescence and early adulthood who present with unique clinical, educational, and occupational needs at a time when they are often transitioning from child to adult healthcare systems. Approximately 75% of lifetime psychiatric disorders present before the age of 24 years old, and TAY exhibit the highest rate of onset for substance use disorders compared to other age demographics. TAY are also more likely to discontinue treatment for medical and psychiatric conditions, particularly if they are non-white, or experience mood or substance use disorders.

TAY may struggle to navigate our complex healthcare system because of changes in insurance coverage, increasing independence from their family of origin, loss of foster care, involvement with the juvenile justice system or lack access to adult services once they reach the age of majority. These difficulties are further complicated when access to care ceases, particularly for those suffering from serious mental illnesses, developmental challenges, or intellectual disabilities. Disrupted treatment and barriers to educational and vocational supports during this time may lead to poor outcomes including increased morbidity and disability in adulthood. Furthermore, screening tools, treatment algorithms, and evidence-based studies often divide TAY into two discrete cohorts, ages 15-17 (late adolescence) and ages 18 to 26. This divide creates a knowledge gap for practitioners serving TAY during this critical developmental period and can impede patient transitions between child and adult-serving systems of care including health care systems, education systems, and welfare systems.

As the leading physician authority on mental health across the lifespan, child and adolescent psychiatrists play an important role in supporting the mental health of TAY and in facilitating TAY transitions from pediatric care to adult care. Child and adolescent psychiatrists also offer expertise in research, education and advocacy to families, schools, health care, and social justice and welfare systems of care.

To promote developmentally appropriate and culturally sensitive treatment of transition age youth (TAY) with mental illness through clinical care, research, and education of practitioners caring for this population including psychiatrists, pediatricians, health care systems, and TAY serving agencies, the American Academy of Child and Adolescent Psychiatry recommends:

  1. Routine transition readiness evaluations by TAY providers that involve youth in shared decision making, self-determination, and inclusion of family or supports, when indicated, to ensure best outcomes in adulthood.
  2. Public and private funding to develop patient, caregiver, provider, and policymaker education and communication resources on TAY mental health and transition of care needs.
  3. Payment policies that recognize providers’, including child and adolescent psychiatrists, additional effort in support of TAY transitions, including consultation, referrals, and follow up, consistent with best practices.
  4. Policies that eliminate gaps in insurance coverage for TAY transitioning from pediatric to adult health insurance and/or transitioning between systems of care.

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The American Academy of Child and Adolescent Psychiatry promotes the healthy development of children, adolescents, and families through advocacy, education, and research. Child and adolescent psychiatrists are the leading physician authority on children’s mental health.

Approved by Council July 2024