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Care of the Emerging Adult

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Care of Adults with Chronic Childhood Conditions

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Abstract

The period of life between 18 and 25 years represents a distinct developmental phase known as emerging adulthood. In addition to poor health outcomes, this phase is distinct in the missed opportunities and potential to alter life course health trajectories with appropriate anticipatory guidance and prevention services. The HEADDSS (home, education/employment, activities, drugs, diet, sexuality, suicide) approach to a social history, more commonly used in adolescent medicine (for children between the ages of 12 and 18 years) can and should be adapted for use with emerging adults by adult health providers. Preconception counseling, mental health, and substance use are areas of greatest impact on future health outcomes if addressed in the emerging adulthood period. For emerging or young adults with chronic childhood-onset conditions, implementing models such as the patient-centered medical home and chronic care models can improve health outcomes. Finally, adapting the Got Transition framework for use in adult patients can provide a framework for primary care practices to optimize their care of this population.

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Author information

Authors and Affiliations

  1. Medicine-Pediatrics Transition Care Program, Departments of Medicine and Pediatrics, University of California, Los Angeles, CA, USA

    Stacey Weinstein

  2. Combined Internal Medicine and Pediatrics Residency Program, University of California, Los Angeles, CA, USA

    Paul Bixenstine, Daniel Karlin, Faysal Saab, Linnaea Schuttner & Angelica Zen

  3. Departments of Medicine and Pediatrics, Health Care Transitions Research Network, University of California, Los Angeles, CA, USA

    Alice A. Kuo

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  1. Stacey Weinstein
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  2. Paul Bixenstine
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  3. Daniel Karlin
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  4. Faysal Saab
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  5. Linnaea Schuttner
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  6. Angelica Zen
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  7. Alice A. Kuo
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Corresponding author

Correspondence to Alice A. Kuo .

Editor information

Editors and Affiliations

  1. School of Medicine, Hofstra North Shore-LIJ School of Medicine, LAKE SUCCESS, New York, USA

    Mariecel Pilapil

  2. Mount Sinai School of Medicine , NEW YORK, New York, USA

    David E. DeLaet

  3. University of California Los Angeles , SANTA MONICA, California, USA

    Alice A. Kuo

  4. Baylor Clinic , HOUSTON, Texas, USA

    Cynthia Peacock

  5. Brigham and Women's Hospital , BOSTON, Massachusetts, USA

    Niraj Sharma

Appendix

Appendix

10 Steps for caring for adults with chronic childhood-onset conditions

1. Health Care Policy Statement

  • written, posted and readily available

  • developed with input of young adults and their families

  • educate and train all health care staff

  • discuss with all entering young adults

2. Tracking & Monitoring

  • data on all patients, including detailed status of each individual

  • measures of disease status and social determinants

  • use for iterative improvement

  • ideally integrate into the EHR

3. Readiness Assessment/Goal-Setting

  • use a validated questionnaire

  • address: self-care, insurance, guardianship, culture/religion, self-management, etc.

  • develop goals for functional status, employment, romantic relationships, end of life care

4. Written Health Care Plan includes:

  • creation of health care team

  • insurance

  • guardianship

  • cultural/religious beliefs

  • update process

5. Transfer of Care

  • time when appropriate

  • obtain all relevant medical info

  • obtain direct handoff

6. Team-Based Care

  • clear roles, top of license

  • empowered

  • frequent communication and reflection

7. Care Coordination

  • criteria for referral and escalation or care

  • communication, especially via EHR

  • consider case manager

8. Address Social Determinants of Health

  • screen for income, food, housing, etc.

  • connect with internal and community-based resources

9. Self-Management Support

  • Educate patients for self-care

10. Population Health Management & Quality Improvement

  • monitor performance measures on all patients

  • use quality improvement strategies to continually improve

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Weinstein, S. et al. (2016). Care of the Emerging Adult. In: Pilapil, M., DeLaet, D., Kuo, A., Peacock, C., Sharma, N. (eds) Care of Adults with Chronic Childhood Conditions. Springer, Cham. https://doi.org/10.1007/978-3-319-43827-6_2

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