Double whammy? Rural youth with serious emotional disturbance and the transition to adulthood.
BACKGROUND
All youth, especially those with serious emotional disturbances (SED), face challenges as they transition to adulthood. Little is known about rural youth at risk for transition problems.


OBJECTIVE
To examine transition-age youth who use publicly funded services in rural and urban/suburban locations in Tennessee in order to describe youth at risk for transition difficulties who need policy and service planning.


METHODS
Using Medicaid enrollment and claims/encounter data, youth at high risk for transition difficulties were identified in the following groups: SED, at risk of or in foster care/state custody, intensive or frequent mental health services users, or diagnosed with major mental disorders, behavior disorders, mental retardation, or substance use. Membership in these groups was compared between youth living in rural and urban/suburban counties. Multivariate regression was used to examine factors related to multiple group membership.


RESULTS
Rural youth were more likely to be in groups at high risk for problems transitioning to adulthood, and enrolled in Medicaid as uninsured/uninsurable, compared to their urban counterparts. The strongest factors associated with multiple risk group membership were being in state custody/foster care and receiving Supplemental Security Income (SSI).


CONCLUSIONS
Services are needed to support the transition to adulthood for youth at high risk of behavioral and adjustment problems. Systems to support coordinated planning and accountability are needed, including data on populations and services, and research on transition-age youth.
Department of Human and Organizational Development, Peabody College of Vanderbilt University, Nashville, TN 37203, USA. c.heflinger@vanderbilt.edu.
Craig Anne
CA
Heflinger
Cheri
C
Hoffman
D000293:Adolescent; D041923:Adolescent Development; D000342:Affective Symptoms / Q000523:psychology*; D005260:Female; D005581:Foster Home Care; D006801:Humans; D008297:Male; D008484:Medicaid; D020380:Needs Assessment; D012424:Rural Population; D012943:Social Security; D014481:United States; D014505:Urban Population; D055815:Young Adult