Considerations for Adolescent
and Adult Milestones
Ronna Linroth, OT, PhD, CCP
30th Annual Conference for Professionals in
Brain Injury
Thursday, April 9, 2015
Learning Objectives
O Participants will identify the four primary
areas of emerging adult milestones
O Participants will have a working definition of
Transition as a process.
O Participants will assess their program for
needed next steps for professional and
patient support during transition.
Brain development
O There is now no doubt that adolescence should
O
O
O
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be treated as a special period.
Striking changes in the white and gray matter
take place between 11 and 25 years of age.
May lead to abrupt behavioral change &
attendant risk.
Brain becomes flexible and able to respond
quickly and imaginatively.
Healthcare providers need to approach health
management within the context of transition to
adulthood.
Pediatric Head Injury
“Severe head injury in childhood may appear to be
followed by striking recovery to the developmental
stage the child had reached before injury. However,
after a number of settled years significant
behavioral, attentional and psychological problems
may then appear in the teenage years due to
underlying damage to the grey matter and the
white matter tracts being masked until the
maturation phases of adolescent brain
development begin.”
O
Colver & Longwell, (2013), pg 904
Transition
Early stage
Middle stage
Late stage
12-14
15-17
18+
Healthcare Transition
O Transition is the planned process
[preparation] and purposeful movement
into adult oriented care (Patterson, 1999).
O Transfer of care is an event or events- the
switch from pediatric oriented medical care
providers to adult oriented medical care
providers.
Components of Successful
Transition
O Self-Determination
O Person Centered Planning
O Preparation for adult health care
O Work /Independence
O Inclusion in community life
Introducing the theory of
Emerging Adulthood
Emerging Adult Milestones
Jeffrey Arnett in 2000, American Psychology
O A phase of the lifespan between late
adolescence and full-fledged adulthood
O (age 18-29)
O Applies to young adults in developed
countries who
O Do not have children
O Do not live in their own home
O Do not have sufficient income to become
fully independent
Cognitive Development during
this phase:
O Connections within the brain are still being
strengthened and unused are pruned
O Brain structures develop for
O greater processing of emotions and social
information
O greater planning and assessment of risk/rewards
O “Emerging adulthood is a critical stage for the
emergence of complex forms of thinking
required in complex societies.”
(Gisela Labouvie-Vief, 2006)
5 features of emerging adults
O Age of identity exploration.
O Age of instability.
O Age of self-focus.
O Age of feeling in between.
O Age of possibilities.
Emerging adults want a lot out
of life!
O Some struggle and some prosper
O How well an adolescent makes the transition through
young adulthood into adulthood and becomes a fully
independent person depends in large part on the right
balance of the adolescent pushing for independence
and parents and society giving the correct amount of
support--not pushing too hard or holding back too
much.
(Tanner, 2004)
Two processes occurring in
Emerging Adults
O Re-centering: Shifting from dependence on
parents to system commitments (careers,
intimate partners, children)
O Ego Development: agency, self-regulation,
impulse control, learning to stand alone,
constructing life plans
Arnett’s 4 areas of focus
O Employment
O Education
O Independent living
O Maturing relationships
Gillette’s Transition Clinic
O Designed to assist patients and families in
their transition from a pediatric care model
to an adult care model.
O Help is provided to assist in identifying skills
and knowledge needed to navigate the adult
specialty healthcare environment.
O Visit includes review of medical history,
readiness self-assessment, interview, goalsetting, referrals to services needed to
assure continuity of care.
Most frequently
identified needs
through screening
tool:
• Assistance with
transportation
• Future living
situation, i.e., group
home, remain with
family, independent
living
• Future vocation
Lessons Learned
 Patients and families present as unprepared for transition.
Parent needs for transition support are often as great as those
of patient. Discussion needs to start early
 Creation and distribution of educational tools to providers, staff,
and families is essential.
 Most transition patients do not carry any identification
 Attachments between patient/family and pediatric
providers/staff is very strong
Lessons, continued
 Pediatric primary care providers have told many
patients to find an adult primary care provider.
This is proving difficult for many patients and
families
 Difficult and often emotional when parent is
asked to leave the patient alone with provider
 Care coordination is essential for successful
transition.
Assessing for Transition
Support
Six Core Elements for Health
Care Transition
Transition supports are needed during
adolescence and early adulthood
“It is sort of unfair to
expect [teens] to have
adult levels of
organizational skills or
decision-making before
their brains are
finished being built.”
Resources
gottransition.org is the website for
the Center for Health Care Transition
References
O "Emerging Adulthood: The Winding Road From
the Late Teens Though the Twenties“, 2nd Ed.
(Oxford University Press, 2014).
O “Pediatric to Adult Transition: A Quality
Improvement Model for Primary Care”(2014)
Journal of Adolescent Health, 56, 73-78.
O Credit for images: Bing.com
http://www.bing.com/images/search?q=images+o
f+brain+development&qpvt=images+of+brain+dev
leopment&qpvt=images+of+brain+devleopment&F
ORM=IGRE
Answers are not
guaranteed but we
can have a great
discussion!
Thank you!