Few Teens Get Help Moving From Pediatric to Adult Health Care, 2016–2017

Clinical guidelines recommend that primary care providers begin preparing adolescents for the move from pediatric to adult health care at age 12. Most teens do not get that help. It matters especially for adolescents with mental, behavioral and developmental disorders (MBDDs), who tend to drop out of care as they approach adulthood and whose conditions are linked to more illness and earlier death later in life; good transition planning may help prevent that.

CDC researchers used parents’ answers to the 2016 and 2017 National Survey of Children’s Health — a nationally representative survey run by the Health Resources and Services Administration and conducted by the Census Bureau — covering 29,286 adolescents aged 12–17.

Measuring transition planning

An adolescent counted as receiving recommended transition planning only if all three of these happened:

1. they had time alone with their primary care provider at their last preventive visit;
2. the provider worked with them to gain skills to manage their own health, or to understand the changes in health care at age 18; and
3. the provider discussed moving to an adult provider.

Disorders were grouped as behavioral (ADHD, behavioral or conduct problems, Tourette syndrome), emotional (anxiety, depression) and developmental (autism spectrum disorder, learning or intellectual disability, developmental delay, speech or language disorders).

What it found

• Overall, 14.6% of adolescents met the transition measure. 24.2% had at least one MBDD.
• The rate did not differ significantly by MBDD status: 15.8% with an MBDD against 14.2% without.
• Planning was more common among older teens. Even at ages 15–17, though, only 21.5% of those without and 19.5% of those with an MBDD received it.
• Adolescents with MBDDs were more likely to have had time alone with their provider and to have worked on health-management skills, but less likely to have discussed moving to an adult provider.

After adjusting for age, teens with anxiety were 36% and those with depression 69% more likely than peers without MBDDs to receive planning; those with autism were 35% and those with developmental delay 25% less likely. Having several disorders, or more severe ones, made no difference. Teens receiving treatment for their disorder were more likely to get planning than those who were not — yet fewer than 20% of them did.

Who is most at risk of falling through the gap

• Teens with autism and other developmental disorders, the least likely to get transition planning.
• Teens with behavioral and emotional disorders, who are at higher risk of dropping out of care — only one in five with emotional disorders and one in seven with behavioral disorders met the measure.
• Teens in treatment, for whom continuity into adulthood is critical to long-term health.

What could help

The authors suggest starting transition planning earlier, as recommended; for adolescents with MBDDs, condition-specific transition plans with longer timelines, adapted goals and shared care between pediatric and adult providers; using school-based programs and treatment visits, such as medication checks, for transition work; improving access to coordinated programs and services; and training providers in adolescents’ distinct mental and physical health needs.

Limitations

• The survey is cross-sectional and cannot show cause.
• Response rates were low, though weighting was used to correct for this.
• Parents reported the data and may not know what was discussed privately between their teen and the provider.
• Some providers may simply plan the transition later.
• Treatment may be undercounted.

Sources

Based on Leeb RT, Danielson ML, Bitsko RH, et al., "Support for Transition from Adolescent to Adult Health Care Among Adolescents With and Without Mental, Behavioral, and Developmental Disorders — United States, 2016–2017," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, as corrected by its published erratum; a work of the United States government in the public domain.