Transition to Adulthood

From Entitlement to Eligibility

For an individual with special needs, transitions are dynamic processes that begin in childhood and continue through adulthood. The goal of transition planning is to maximize a child’s independence as he reaches young adulthood.

Transition planning includes:

Shifting from pediatric to adult healthcare with adequate insurance;
Leaving school for work or alternative meaningful experiences;
Moving from home to an inclusive, supportive community; and
Minimizing dependence on family as one grows into a greater degree of self-sufficiency and self-determination.

One key to successful navigation of adulthood is for your child to gain self-knowledge. By learning more about her diagnosis and medication management, and discovering her educational and vocational interests, your child will gain independence, and be better able to make informed decisions about the future.

Some young adults will continue to need assistance from their parents or legal guardian to communicate with various agencies and fill out the necessary paperwork to qualify for the adult service systems. Whether a young adult is making his own decisions or relying on the assistance of a guardian, he’ll find it helpful to prepare an accessible, portable, and up-to-date medical summary.

At 18, your child is legally an adult—a title that comes with new independence, new responsibilities, and a new system of services, resources, and support systems. As a student, your child was entitled to an education and may have received services from special education and/or a 504 plan. Some students remain in school beyond the 12th grade, and some are eligible for student services until the age of 22. Regardless of whether your young adult exits from high school after the 12th grade, or at the age of 22, when education services for individuals with disabilities end, beginning with her 18th birthday she will need to be determined eligible for services. Because this process involves various programs with different funding sources and eligibility requirements, it can be confusing and time consuming. It often includes the completion of many forms, but if you and your child begin this process ahead of time, you’ll learn what you need to know to make this transition as smoothly as possible.

One example of the type of change your child will face once he is considered an adult (age 18) is that he will now need to apply for Medicaid and SSI based on his own income and assets, instead of based on yours. Adult Medicaid may not provide all the same services that your young adult received when younger. The federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides medically necessary services to children on Medicaid until the age of 21; after that, young adults are no longer protected by EPSDT federal law. As a young person approaches his 21st birthday, he should apply for adult Medicaid to ensure he receives ongoing care.

Whenever possible, youth and young adults with special needs should be the leading voices in providing essential information and insights when planning for their own transitions, applying for programs that meet their needs, and finding ways to incorporate their strengths, hopes, and dreams into their future lives. Parents, with their unique expertise and knowledge of their children, are essential partners in the planning of transition programs. Also, professionals with knowledge of and interest in the youth may be helpful in transition planning and processes.

Local Parent Training and Information (PTI) Centers can provide families with valuable insights and resources. Utah’s PTI center, the Utah Parent Center, has put together a useful handbook about this particular transition. Along with more detailed guidance about how to help your child discover her strengths and interests, the handbook presents six key areas to help your family plan for a smooth transition from the entitlement system of schools, to the adult eligibility system:

Learn and understand the laws that govern the rights of adults with disabilities.
Understand the planning process so you can help your young adult make informed choices about his future.
Gather the information, documentation, and assessments your young adult will need when he applies for adult services.
Explore the services and programs available to your young adult.
Understand how the adult system of services works.
Learn about the appeal process and legal requirements of the various agencies with whom your young adult may work.

To learn more about each of these items, you can download the handbook, “From No Where to Know Where,” on the Utah Parent Center website.

The National Center for Transition, “Got Transition,” has many tools and resources geared toward youth and young adults with special needs and their families. You may find their website helpful as you plan for a successful transition into adulthood and adult service systems. See Got Transition?

Resources

Information & Support

For Professionals

Transitions (National Center for Medical Home Implementation)
Information for clinicians about transitioning pediatric patients to adult health care. Includes links to AAP guidance, videos, tools, and resources

Adolescent Health Transition Project, University of Washington
A resource for adolescents with special health care needs, chronic illnesses, physical or developmental disabilities. Center on Human Development and Disability (CHDD) at the University of Washington.

Transition Resources for Providers, University of Illinois
Division of Specialized Care for Children (DSCC), from the University of Illinois at Chicago, provides transition information from childhood to adulthood including fact sheets, tools, transition timelines, and other materials for providers.

Independent Living Institute
This non-profit organization in Europe provides information, educational materials and an on-line library on disability rights and independent living issues.

Kentucky Transition Resources
From the Kentucky Cabinet for Health and Family Services, Commission for Children with Special Health Care Needs, downloadable printable teaching sheets for your patients on topics such as staying healthy, managing their own healthcare, future planning, working, and more.

Kids as Self-Advocates (KASA)
KASA is a national, grassroots network of youth with special needs and friends, speaking on behalf of ourselves. We are leaders in our communities, and we help spread helpful, positive information among our peers to increase knowledge around various issues. Those issues include: living with special health care needs, health care transition issues, education, employment, and many more. We also help health care professionals, policymakers and other adults in our communities understand what it's like to live with special health care needs and we participate in discussions about how to help each other succeed.

A Guide for Health Care Providers: Transition Planning for Adolescents with Special Health Care Needs and Disabilities
Information and checklist for providers to help youth transition to adulthood. Includes the topics of health care, law, education, employment, recreation, and more. Companion manual for families and teens available; produced by the Institute for Community Inclusion at Children's Hospital, Boston 2000.

Transition Action Care Plan ( PDF Document 14 KB)
Sample action plan for youth and young adults. From the Collaborative Medical Home Project.

Transition Coalition
From the University of Kansas, Department of Special Education, this site provides information, resources, and training for providers to help them help youth transition to adulthood. Training includes best practices, cultural diversity, assessment, working with families and more.

Transition Referral Form ( PDF Document 22 KB)
Sample form to track referrals to other agencies providing transition services. From the Collaborative Medical Home Project.

Transition-Screening Tool ( PDF Document 20 KB)
Sample screening tool that addresses various transition topics including health, transportation, psychosocial, legal rights, employment, and more. From the Collaborative Medical Home Project.

Transition Timeline ( PDF Document 32 KB)
This sample timeline from the Intermountain Collaborative, for ages 2-22, provides suggestions for things that parents and providers should be teaching and checking as children transition through different age ranges and on to adulthood.

For Parents and Patients

A Parent's Guide on Puberty for Children with Disabilities ( PDF Document 7 KB)
A toolkit for parents to use as they choose, this publication was developed and written by Vanderbilt Leadership Education in Neurodevelopmental Disabilities (LEND) long-term trainees.

DSCC Transition Resources for Families
Division of Specialized Care for Children (DSCC), from the University of Illinois at Chicago, provides transition information from childhood to adulthood including fact sheets, tools, transition timelines, and other materials for families.

Full Life Ahead Foundation
Provides the "Full Life Ahead: A Workbook and Guide to Adult Life for Students and Families of Students with Disabilities." This guide was created to offer parents and students the tools and information necessary to plan for their future. Developed and written by parents and students for other parents and students, this guide can help families successfully work through the transition process.

Social Security Work Site
Promotes the employment of Social Security beneficiaries.

Got Transition?
Center for Health Care Transition Improvement, a national resource for improving health care transition supports for youth moving into the adult health care system, for health care professionals, families, youth, and state policy makers. The Six Core Elements of Health Care Transition 2.0 define the basic components of health care transition support.

State Education Contacts and Information
Contact the department of education in your state, or the adult ed, arts, child care, higher ed, humanities, libraries, PTA, special ed, tech-prep, vocational rehabilitation, vocational-technical, or other education office in your state.

Center for Parent Information and Resources (DOE)
Maintains a large resource library with information related to children with disabilities. Parent Centers in every state provide training to parents of children with disabilities and provide information about local conferences, support groups, and finding schools and other local services; Department of Education, Office of Special Education.

Keeping It Real: How to Get the Supports You Need for the Life You Want
This curriculum supports students as the transition from high school to adulthood and provides information and tools relating to transition; self-assessment; supports; employment and careers; education and training; living arrangements, recreation and leisure; and resources; from the University of Medicine and Dentistry of New Jersey.

National Center on Secondary Education and Transition
Provides information about transition during high school and to opportunities after high school including jobs, vocational education, and college. Provides links to contacts in each state for 1) State Transition Contact, 2) Regional Resource Center Contact, 3) State Director of Special Education, 4) Part B Contact, and 5) State Director or Vocational Rehabilitation.

P.R.O. Filer Personal Portfolio & Filing System ( PDF Document 160 KB)
P.R.O. filer - Personal Portfolio and Filing System (2000), an innovative tool designed by students for students that provides a way to organize important documents, keep records of school and community learning opportunities, and create a personal portfolio to showcase their accomplishments. Published by the Institute on Community Integration. See the companion Personal Portfolio Manual. For more tools, see the All Means All School-to-Work web site at http://ici.umn.edu/all/.

Personal Portfolio Manual ( PDF Document 151 KB)
P.R.O. filer - Personal Portfolio and Filing System (2000), an innovative tool designed by students for students that provides a way to organize important documents, keep records of school and community learning opportunities, and create a personal portfolio to showcase their accomplishments. Published by the Institute on Community Integration. See the companion P.R.O. Filer Personal Portfolio & Filing System.

Checklist for Transition ( PDF Document 85 KB)
From Healthy and Ready to Work, this checklist is for medical practices to determine their knowledge and skills for supporting youth transitioning to adulthood in areas including policy, medical home, family/youth involvement, insurance and screening.

Plan Your Health, Live Your Life ( PDF Document 8.1 MB)
Transitions are for everyone. This 6-page planning document has information for teens as they become adults including career goals, health, pregnancy planning, immunizations, STIs, personal safety, emotional health, finances, and more; developed by the Utah Department of Health and collaborative partners.

Autonomy Checklist ( Word Document 45 KB)
A sample checklist that includes an extenisve list of home skills; health care skills; community skills; lesisure skills; vocational options; and living arrangements; from the University of Washington.

Transition Worksheet ( PDF Document 94 KB)
A worksheet to help consider options during transition to adulthood including living arrangements, transportation, employment, education, and more.

Youth Leadership Toolkit
Guide book and DVD videos for youth/young adults, parents, medical providers, and other professionals with tips from young adults to assist in transitioning to adulthood. Includes transportation, finding adult health care, healthy relationships, employment/volunteering, self-advocacy and independent living. Developed by Independent Living Research Utilization (ILRU) in collaboration with the Center for Persons with Disabilities and the Becoming Leaders for Tomorrow Project.

Transition-Screening Tool ( Word Document 39 KB)
Sample screening tool that addresses various transition topics including health, transportation, psychosocial, legal rights, employment, and more. From the Collaborative Medical Home Project.

Waisman Center Transition
A collection of disability-related resources including links to many organizations related to transition to adulthood, carrers, independent living, employment, health, education, transportation, benefits, and more.

Answers 4 Families
From the Nebraska Transition Project, this site provides information on healthcare, employment, education, life skills, and other topics. Information includes handouts, videos, and links to other sites.

Americans with Disabilities Act ( PDF Document 64 KB)
This handout provides brief information for families about ADA from the Kentucky Commission for Children with Special Health Care Needs.

Authors & Reviewers

Initial Publication: July 2008; Last Update: September 2013

Current Authors and Reviewers (click on name for bio):

Contributing Author:	Gina Pola-Money
Reviewer:	Alfred Romeo, RN, Ph.D.

Funding: Thank you to the Utah Medical Home Young Adult Advisory Committee for reviewing this section.

Authoring history

(Limited detail is available on authoring dates before 2014.)

2005: first version: Robin Pratt^CA; Barbara Ward, RN BS^CA; Joyce Dolcourt^CA; Kristine Ferguson^CA; Teresa Such-Neibar, DO^CA; Lynn Foxx Pease^CA; Helen Post^CA; Roz Welch^CA

^AAuthor; ^CAContributing Author; ^SASenior Author; ^RReviewer