title: Health care services and the transition to young adulthood: challenges and opportunities.
abstract: OBJECTIVE
  The aim of this study was to examine the potential role of the health care system in the successful transition to young adulthood for all adolescents, with emphasis on adolescents with special health care needs (ASHCN), and to evaluate the system's status in filling that role.
  
  
  METHODS
  Research and conceptual frameworks addressing successful transitions and functioning were reviewed. A framework describing a role for health care services in the transition was presented. The health care system's status in promoting healthy transitions was evaluated, including National Survey of Children with Special Health Care Needs 2005-2006 analyses of key outcomes for ASHCN.
  
  
  RESULTS
  Although most national efforts to define skills needed for the transition have focused on career/vocational skills, a few frameworks integrate broader issues such as health, psychosocial development, and civic engagement. Adolescent transitional issues have generally received little attention; however, these have been articulated for ASHCN. Nevertheless, only 2 in 5 ASHCN receive transitional care, and ASHCN fare poorly on other core outcomes. ASHCN with mental health conditions fare worse on outcomes than those with physical health conditions. Our framework for healthy transitions includes the following: 1) adolescents can access a comprehensive health care system, 2) preventable problems are avoided, and 3) chronic problems are managed. The present health care system falls short of accomplishing these.
  
  
  CONCLUSIONS
  Health care services can potentially play a role in facilitating a healthy transition to young adulthood; however, many gaps exist. Although the health care reform act addresses some gaps, efforts that integrate adolescents' developmental needs and address mental health issues are needed.
authors.affiliation: Department of Pediatrics, University of California, San Francisco, San Francisco, California 94118, USA. jane.park@ucsf.edu
authors.forename: M Jane
authors.initials: MJ
authors.lastname: Park
authors.forename: Sally H
authors.initials: SH
authors.lastname: Adams
authors.forename: Charles E
authors.initials: CE
authors.lastname: Irwin
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration*; D019090:Case Management / Q000458:organization & administration; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D003266:Continuity of Patient Care / Q000458:organization & administration*; D019988:Children with Disabilities; D006301:Health Services Needs and Demand; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration; D011322:Primary Prevention; D011785:Quality Assurance, Health Care; D014481:United States