Planning the Path to Adult Care: The Findings from National Survey of Children’s Health

Background/Purpose: The transition to adult care is a critical planning process that supports adolescents in moving from pediatric to adult healthcare systems. Poorly managed transitions can lead to discontinuity of care, poorer health outcomes, and increased healthcare utilization, including greater reliance on emergency services. Transition-age youth (TAY), particularly those with adverse childhood experiences (ACEs) and complex health needs, face pronounced disparities in access to and continuity of care. Guided by Andersen’s behavioral model of health service use and the life course perspective, this study examines factors associated with receipt of services for transition to adult care among youth aged 12 to 17 years old in the United States.

Methods: This study used 2023–2024 National Survey of Children’s Health data. Among 40,357 adolescents aged 12–17, those without a medical visit in the past 12 months (n = 6,922) were excluded, yielding a final sample of 33,435. ACEs was measured by the 11 items, with the average of 1.07. Family centered care, family resilience, and frustration in efforts of getting services for the child are dichotomized variables. Complexity of healthcare needs was categorized as none, less complex, or more complex. Controlling for child gender, race/ethnicity, age, parental education, insurance status, and poverty level, stepwise logistic regression examined associations among predisposing, enabling, and need factors and receiving services for transition to adult care.

Results: In Model 1, only complexity of healthcare needs was included and children with less complex health needs (OR=1.10, p<.05) experience higher odds of having service for transition to adult care than children without health care needs. Model 2 added predisposing factors, including child gender, race/ethnicity, age, ACEs, and parental education. Females (OR=1.12, p<.001) and older youth (OR=1.35, p<.001) are associated with higher odds of receiving services for transition to adult care. However, non-white youth (Black youth: OR=.78, p<.001; Other: OR=.86, p<.001) and youth with more complex health needs (OR=.93, p<.05) are associated with lower odds of having service for transition to adult care. Model 3 further incorporated enabling factors, including insurance status, poverty level, family-centered care, and caregiver frustration in obtaining services for their child, and family resilience. Caregivers who reported having received family-centered care (OR=1.60, p<.001) and having high resilience (OR=1.31, p<.001) are associated with higher odds of receiving services to transition to adult care. Families who reported having frustration in their efforts of getting services for their children (OR=.91, p<.01) experience lower odds of receiving services for transition to adult care.

Conclusions and Implications: Findings highlight disparities in access to transition services to adult care among non-white youth and those with complex health needs. Enhancing family-centered care and strengthening family resilience may improve service access, while reducing systemic barriers that contribute to caregiver frustration is critical to promoting equitable and effective transitions to adult care.