Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose Weak institutional and financial linkages between child-serving and adult-serving systems jeopardize the life chances of transition-aged youth (ages 16-25 years) who need support to successfully navigate the adoption of adult roles. Grounded in developmental theory regarding stressors associated with this life stage, we use nationally representative data from the U.S. mental health service system to evaluate hypotheses regarding the mental health problems of youths at the age of legal emancipation (commonly between 18 and 21), comparing them to others in the transition period who bracket them in age. To identify youths of different ages who may be especially vulnerable to unmet service needs, we present age-based population rates. Public policy makers lack information to determine the best ways to facilitate youths' transition from adolescence to adulthood, and the results help fill this gap. Methods Data are from the Client/Patient Sample Survey, conducted by the National Institutes of Health to collect statistical information on persons receiving specialty mental health care throughout the nation. Using a two-stage sample design, 1,598 facilities were first randomly selected from the universe of specialty mental health programs in the U.S.; second, case records for clients who were admitted to or discharged from these programs during 1997 were randomly selected, with data abstracted by administrative staff at each facility. Data from the U.S. Census and admissions estimates were used to calculate utilization rates. Clinical characteristics (e.g., presenting problems of suicide and alcohol or drug use) and pathways across age groups were compared with cross-tabulations and chi-square tests. To account for the complexity of the survey design, and to produce appropriate estimates of standard errors, all analyses were conducted with SUDAAN using weighted data (n=879,512). Results There was a precipitous decline in mental health utilization at age 18: the rate of mental health utilization for youths ages 16-17 is 34 per 1,000 youth, nearly twice the rate for those ages 18-19 (19 per 1,000), and 20-21 (21 per 1,000). Compared to both older and younger youth, those ages 20-21 differ markedly, with proportionately more referrals from criminal justice and fewer from family and social services, and proportionately more Medicaid receipt. Although suicidality and substance use presenting problems did not differ significantly across ages, by age 24 substance use disorders replaced adjustment disorders as one of the most prevalent diagnoses. Implications These results demonstrate that continuity of mental health care is substantially jeopardized for legally emancipated persons, and that 20-21 year olds are especially vulnerable. Substantial shifts in referral sources indicate that case managers may need to develop strategies to maintain contact with clients who are aging out of child mental health systems and at risk of entering the adult criminal justice system. Policy makers may want to promote shared planning between child and adult systems more broadly.