Mental Health and Secondary Transition
Evidence-Based Treatments and Mental Health Issues for Young
Adults:What They Need and What We Need to DoMaryann Davis,
Ph.D.Research Associate ProfessorDirector: Transitions Research
& Training CenterCenter for Mental Health Services
ResearchDepartment of PsychiatryUniversity of Massachusetts Medical
SchoolAcknowledgements
Major Collaborators:Charles Lidz, Ph.D., William Fisher, Ph.D.,
Lisa Mistler, MD., UMass Medical School, Center for Mental Health
Services Research, Dept. of PsychiatryAshli J. Sheidow , Ph.D.,
Michael McCart, Ph.D., Scott Henggeler, Ph.D. Medical University of
SC, Family Services Research Center, Dept of Psychiatry and
Behavioral SciencesEdward Mulvey, Ph.D., Univ. of Pittsburgh
Medical School, Dept of Psychiatry, Mary Evans, Ph.D., University
of South Florida, Dept of Nursing and Public Health
Funding from NIMH (R01 MH067862-01A1, R34-MH081303-01, R34
MH081374-01, RC1MH088542-02), and NIDRR & SAMHSA (H133B090018),
UMass Medical Schools Commonwealth Medicine
Visit us at: http://labs.umassmed.edu/TransitionsRTCThe content
of this presentation does not necessarily reflect the views of the
funding agencies, nor their endorsement
2OverviewWhy this age group needs specific Evidence Based
Treatments/Practices (EBT/Ps)EBT/Ps in developmentShared features
of EBT/PsSerious Mental Health Conditions (SMHC)Serious Emotional
Disturbance OR Serious Mental Illness OR Psychiatric DisabilityMH
diagnosis causes substantial functional impairment in family,
social, peer, school, work, community functioning, or ADLsNot
pervasive developmental disorders, substance use, LD, ID (these can
co-occur) Transitions RRTCGore, FM., Bloem, PJN, Patton, GC,
Ferguson, J, Joseph, V, Coffey, C, Sawyer, SM, & Mathers, CD
(2011). Global burden of disease in young people aged 1024 years: a
systematic analysis. Lancet, DOI:10.1016/S0140-6736(11)60512-6
15-19 Year olds20-24 Year
oldsMalesMalesFemalesFemalesAmericasEuropeHigh IncomeWorldHIV, TB,
malariaMaternal conditionsOther communicable diseasesOther
non-communicable diseasesNeuropsychiatric disordersInjuriesMajor
causes of disease burden in Disability Adjusted Life Years IN THE
WORLDLeading Neuropsychiatric Disorders causing DALYs:Unipolar
Depression* (7.9-9.9%)Schizophrenia (4.2-5.3%)Bipolar Disorder
(4/1-5.1%)Within top 6 causes of DALYs in 15-24 yr olds in the
worldOne of the reasons to focus on the MH needs of this age group
is that MH and substance use disorders are the leading causes of
disability in this age group5
Complete schooling & trainingContribute to/head
householdBecome financially self-supporting
Be a good citizenObtain/maintain rewarding work
Develop a social network
Developmental Changes Underlie Abilities to Function More
MaturelySupporting the Transition to Adulthood5/3/06Maryann Davis,
Ph.D. for MA DMH6We tend to have these expectations based more on
chronological than developmental age, particularly as our society
relies increasingly on laws to dictate social policy.Critical
Window of Development6 Paths to Adulthood (marriage, parenting,
education, residence, employment at age 24)Fast starters (12%);
high rates of marriage, parenting, school completion,
home-ownership, employment for the futureParents without Careers
(10%); living with spouse/partner, not working/poor jobs
(71%)Educated Partners (19%); living w spouse/partner, no kids,
higher education, career-step jobsOsgood, E.W., Ruth, G., Eccles,
J.S., Jacobs, J.E., & Barber,, B.L (2005). Six paths to
adulthood. In R.A. Settersten, F.F. Furstenberg, & R.G. Rumbaut
(Eds.). On the Fontier of Adulthood: Theory, Research, and Public
Policy. Univ. Chicago Press. Pp320-355. Critical Window of
Development6 Paths to Adulthood contd (marriage, parenting,
education, residence, employment)Educated Singles (37%); most
college completion, living w parents, career-step jobs, no
partner/kidsWorking Singles (7%); some college, living with parents
(some own home), in job for future, no partner/kidsSlow Starters
(14%); not well established in relationship, residence, employment
or education, 25% w kids.Osgood, E.W., Ruth, G., Eccles, J.S.,
Jacobs, J.E., & Barber,, B.L (2005). Six paths to adulthood. In
R.A. Settersten, F.F. Furstenberg, & R.G. Rumbaut (Eds.). On
the Fontier of Adulthood: Theory, Research, and Public Policy.
Univ. Chicago Press. Pp320-355. Valdes et al., 1990; Wagner et al.,
1991; Wagner et al., 1992; Wagner et al., 1993; Kutash et al.,
1995; Silver et al., 1992; Embry et al., 2000; Vander Stoep, 1992;
Vander Stoep and Taub, 1994; Vander Stoep et al., 1994; Vander
Stoep et al., 2000; Davis & Vander Stoep, 1997; Newman et al.,
2009Youth with SMHC Struggle as Young AdultsFunctioning among 18-21
yr oldsSMHC in Public ServicesGeneral Population/without
SMHCComplete High
School23-65%81-93%Employed46-51%78-80%Homeless30%7%Pregnancy (in
girls)38-50%14-17%Multiple Arrests by 25yrs44%21%9Individuals with
MH disorders struggle in main areas of functioning relative to
their peersFunctioning in Adults with Psychiatric Disorders; Young
Adults Different from Mature Adults*2 (df=1)=31.4-105.4, p