Transition Planning For Youth Turning 18 Years Old

The transition from adolescence to adulthood is a major one even without the presence of mental and behavioral health issues. For youth with those conditions, a knowledge of health insurance, applicable Federal and state laws, school policies, self-advocacy and support systems is necessary. There can be gaps between adolescent and adult care that result in young people losing assistance when they are least likely to proactively seek help while simultaneously facing the greatest challenges involving their mental health, risk taking and substance misuse, etc.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 can complicate parents’ access to vital medical information once their child turns 18. For example, after age 18, parents legally are not permitted to make medical, psychiatric or therapeutic appointment for their children or confirm that they have been arranged or kept unless a HIPAA release has been signed. The form allows the patient to choose the amount and type of information that can be shared with a parent while also establishing time limits. Regardless of HIPAA, parents are free to continue to provide information to their young adult children’s health care providers.

Eighteen year olds need to carry some form of picture identification (ID), which can be a driver’s license or a school ID. During a calm period before a youth’s 18th birthday (and not a time of crisis), parents should discuss decision making options. These include sharing or delegating responsibilities and having an adult (other than the 18 year old) file a petition for a court-appointed guardianship or conservatorship. (Guardianship is the most restrictive choice and should only be considered if a young adult is incapable of making meaningful decisions about his or her own life.)

If an 18 year old appoints an advocate, that person can attend meetings, obtain documents and speak up for him/her. This occurs most often in educational settings. Similarly, a health care proxy designates a “health care agent” to make medical decisions should the 18 year old become unable to do so himself or herself. (If one is completed, be sure to provide a copy to each of the young adult’s health care providers.) With regard to money, a joint bank account can permit a parent to help make financial decisions without taking complete control, while a custodial account requires the 18 year old to have the custodian present in order to deposit or withdraw money.

Before your youth turns 18, schedule an appointment with his or her therapist so you all can discuss the ongoing role he or she wishes you to have. The therapist can then explain what he or she will be able to disclose and any type of release beyond a HIPAA one that his or her practice may require. It can be difficult for an 18 year old, especially a new college student, to arrange appointments (and ask questions during them); manage diagnoses, prognoses and treatments, including medications (and their benefits, risks and potential side effects); and identify additional health concerns and track symptoms.

Serious mental health conditions typically continue into adulthood and seamless transition from adolescent mental health services to adult ones has not been the norm. Youth often feel inadequately prepared for the change, do not understand adult services and mourn the loss of familiar practitioners, while also dreading the new and unknown. Parental support can be critical to successful mental health treatment during early adulthood. For those reasons, it is vital to be aware of applicable laws and to prepare your 18 year old to access the resources he or she needs. Begin planning the transition early (a year ahead of time if possible); be sure to discuss self-management with both the youth and his or her family; include the young person’s preferences and views; and identify an adult care provider if such a change will be necessary.