Adult Transition

Posted on | by trex

Life is really a one-way street – Agatha Christie

Bernice Neugarten (1996*) suggests there are three “times” which, interacting simultaneously, influence the development of adults.

  1. Life time: the biological time table the chronological passage of time indicated by puberty, the graying of hair, menopause, reduced levels of strenuous activity.
  2. Social time: age grading and expectations the time to go to school, the time to raise a family, the time to retire. Many of the major shifts of the life cycle are orderly and sequential, but many are social, rather than biological in nature and their timing is socially regulated – a social time clock is superimposed on the biological clock.
  3. Historic time: political, economic, social events such as war, recession, or resurgence of religion that affects what we do and when we do it.

Growing and aging are processes that no two people experience in the same way, at the same pace, or with the same assets and limitations. Priority issues and skills needed vary across the adult life span and include: Health, Education/Skill Development, Employment, Financial Management, Social Relationships, Fun, Recreation, Meaningful Activities, Leisure, Housing, Transportation & Mobility, Legal Issues, and Support Services.

Related:

Individual Planning

On Work

  • New jobs, promotion, career changes, job loss
  • Developing new skills (i.e., learning new technology, college programs)
  • Reeducation if job change or newly acquire disability
  • Money management, bill paying, peak earning to decline in earnings, financial planning
  • Early retirement

Community Involvement

  • Being active in community: volunteering, church, clubs, concerts, adult support groups, travel, mentoring
  • Responsibility for self: self-motivation; self responsibility
  • Sense of competence and use of talents to contribute to society and make the world a better place
  • Adulthood is time of caring for others

Family roles and relationships

  • Marriage
  • Parenting
  • Divorce and remarriage
  • Renegotiating of roles of children and parents as children grow up
  • Grand-parenting
  • Death of parents, spouse, family members, and friends
  • Grieving loss of family and friends

If disabled

  • Use of SSI or SSDI and Social Security work incentives
  • Vocational rehabilitation
  • Home and community based waivers
  • Mental health services
  • Centers for Independent Living
  • Supports for Community Living
  • Transportation options
  • Housing options

On Aging

  • Retirement and related issues (decline in income, moving)
  • Staying active physically and mentally; maintaining meaning in life
  • Change from caregiver to recipient of care: negotiations with children and other caregivers regarding who helps whom and when
  • Use of adult support groups, day programs, respite services
  • Housing issues with declining abilities: Universal design, changing homes because of stairs, inability to maintain mortgage, etc.
  • Transportation – when to give up drivers’ license and car keys; alternative ways to get around

Links:

Family Involvement

Family members are involved with each other in many different ways throughout the lifespan. Stage theories of family development (Evelyn Duvall; Reuben Hill) and family career theories (Roy Rodgers; Joan Aldous) help us understand some of the social expectations at different family stages.Family members will interact differently at different ages and stages with parents and children taking various roles. Stages might include: married couples (no children), childbearing families (oldest child aged birth to 30 months), families with preschool children (oldest child aged 2½ to 6 years), families with school children (oldest child aged 6 to 13 years), families with teenagers (oldest child aged 13 to 20 years), families launching young adults (stage begins when oldest child leaves home and ends when youngest child leaves home), middle-aged parents (stage begins with empty nest and ends at start of retirement), aging family members (stage begins with spouses’ retirement and ends at their deaths).Family careers contain subcareers, such as the sibling career, the marital career, and the parental career. These, in turn, are strongly influenced by careers external to the family, such as educational and occupational careers.Theories help us understand families, remembering that stages come with fuzzy edges and some families skip over whole stages. The transitions between stages may be more important than the stages themselves. Families without children and single people will have different priorities and interactions with other family members.

Links

Health and Development

Stages of Adult Development.  

Many writers including Erik Erikson, Roger Gould, Daniel Levinson, Bernice Neugarten,  and Gail Sheehy discuss stages of adult development. In general, the stages are:

  • Young adult (18-29):  A period of exploration, leaving home, trying out possibilities for careers; a time for escaping parental domination, of substituting friends for family; and, defining oneself as an adult.
  • Thirties: Time to assess gains and ask if the gains are worth the price – do they give personal satisfaction, are there alternatives to be considered? The late 30s are a usually a time for feeling mastery, competence, and focus.
  • Middle age (40-55):  A time of mid-life transitions; for men health and job concerns may dominate; for women, more opportunities to pursue interests as childbearing and child-rearing responsibilities wane. It is a time to look at goodness-of-fit of life structure and forces within that lead to modification or a drastically changed life structure. It is a time to value wisdom over physical prowess and place greater emphasis on socializing. One needs mental and emotional flexibility.
  • Late adulthood (55-75):  Men become more nurturing; women become more assertive. Retirement is an important issue depending on finances, health, and feelings about work. May become more politically active and community oriented. May do things not possible when working.
  • Old age (beyond 75): Declining physical powers, health and loss of loved ones are issues, but many oldsters are active and make significant contributions to society.

Health Promotion – Physical, Mental, Social

  • Nutrition, vitamins, minerals and herbs
  • Exercise and fitness
  • Socially acceptable hygiene
  • Stress management – moderation and balance; time management
  • Maintaining sexual health: satisfaction, abstinence, birth control, prevention of sexually transmitted infections
  • Healthy, wanted pregnancies with prenatal care
  • Abstaining from tobacco, alcohol, street drugs
  • Oral health: prevention and treatment of caries and periodontal disease
  • Managing environmental exposures – sunlight, radiation, pollution
  • Worksite wellness – use of safety equipment; avoidance of toxic exposures, communication and teamwork skills
  • Protection of vision and hearing
  • Safety and prevention of unintentional injuries– seat belts, driving skills and prevention of motor vehicle accidents bicycle and motorcycle helmets, home safety re fires, falls
  • Knowledge of first aid and CPR
  • Protection from violence and learning conflict resolution to prevent crime, rape, homicide, suicide; avoidance of knives, guns, fighting, bullying,
  • Immunizations – influenza, pneumonia, Tetanus/Diphtheria, hepatitis B, and prevention of infectious diseases
  • Maintaining activities of daily living and physical stamina, and endurance
  • Promoting mental health, spirituality, meaning in life, nurturing potential, moderation in impulsivity, persistence and mental endurance
  • Opportunities to participate in the community – education, work, recreation and social activities; seldom lonely
  • Perceive quality of life to be good
  • Literacy – ability to read/understand
  • Preparation for work – experiences, accommodations, role models
  • Safe housing and transportation
  • Adequate income and ability to manage money
  • Developing sense of competence in some areas of life (self-efficacy)
  • Ability to dream and confidence that you can make some dreams come true (probably in small steps)
  • Ability to problem solve – find information, evaluate alternatives
  • Social competencies – verbal/nonverbal communication, teamwork, interest in others, hygiene
  • Sense of being loved and having people to love who teach, encourage and provide opportunities vs. constrain and demean
  • Having high expectations from others and of oneself
  • Resiliency – attitudes of appreciation and positive view of the future

Chronic Disease

  • Early detection and treatment of minor conditions such as sore throats, skin conditions
  • Early detection, and management of chronic diseases such as asthma
  • Knowledge of condition
  • Self-management of health regimens
  • Prevention of secondary disabilities
  • Prevention or management of decline in physical strength, energy and vitality
  • Separating normal age-related changes from treatable disease conditions
  • Coping with vision loss, hearing loss, pain,
  • Detecting and treating obesity, diabetes, hypertension, cardiovascular disease, pulmonary disease, cancer, neurological conditions/dementia, arthritis, pain
  • Detecting expression of genetic predispositions – cholesterol, dementia, etc.
  • Treatment for injuries, burns, falls, motor vehicle accidents
  • Early detection and treatment for mental health conditions (depression, suicide prevention, dementia, schizophrenia, etc.)
  • Dealing with alcoholism and other chemical dependencies
  • Smoking and tobacco use
  • Self-management of medications, awareness of polypharmacy and drug/food interaction
  • Acceptance in the community; perceived burden of condition on family/person with condition
  • Disclosure dilemmas in work, school and social situations
  • Challenge of uncertainty

Use of Health Care System

  • Access to health care – primary and specialty medical care, emergency care, dental care, mental health, therapies, assistive technology
  • Working with physicians and other health care providers
  • Care coordination/Case management services
  • Participate in decision making about health care and life activities
  • Privacy and confidentiality
  • Communication and coordination among health care providers
  • Adherence to recommendations of health care providers; keeping appointments
  • Health literacy and finding information
  • Knowledge and use of community resources
  • Reasonable use of services; cost effectiveness
  • Health insurance work benefit, self-insured, Medicaid, Medicare
  • Planning for guardianship, health surrogate.
  • Planning for death advance directives related to medical care, funerals, finances
  • Pocket Guide to Staying Healthy at 50+ and other Prevention Recommendations
  • American Academy of Family Physicians
  • American Association of Retired Persons
  • American Dental Association
  • Geriatric Mental Health Foundation
  • Health Compass
  • Healthy & Ready to Work National Center
  • Search MedLine
  • National Health Information Center
  • National Mental Health Information Center
  • National Resource Center for Safe Aging

Links:

Interagency Collaboration

Agencies involved will vary greatly depending on age, health, disability status, legal issues, needs and wants of the adults involved. Some agencies have care coordination/case management services for adults with complex needs or these services may come through health care providers.

Potential collaborators might be:

  • Statewide – Agencies and Organizations
    • Department of Education (for public schools and school to work programs)
    • Developmental Disabilities Coalition, Governor’s Council on Disabilities, etc.
    • Disability-specific organizations such as Easter Seals, Spina Bifida Association
    • Medical Associations: state Medical Society; American Academy of Pediatrics affiliate; American Academy of Family Physicians, Internal Medicine association affiliate, Physical Medicine and Rehabilitation physicians, School Nurses Association, and other related professionals
    • State Department of Health to locate local health departments
    • State Comprehensive Care Center or other mental health agency
    • State Insurance Commission Office
    • Title V Children and Youth with Special Health Care Needs: Agency leaders, Transition Coordinator or SSI Liaison
    • University Centers of Excellence for Developmental Disabilities
  • Statewide Benefit Programs
    • Medicaid office – funding for health care and Medicaid waivers, Ticket to Work, etc.
    • Social Security state and local office: SSI, SSDI, and work incentives
  • Consumer Leadership Organizations, Youth Leaders and Family Leaders
    • Centers for Independent Living
    • Disease/disability support groups: Cerebral Palsy, Diabetes Association, Spina Bifida, etc.
    • Family Voices state affiliate
    • Parent to Parent Network
    • Parent Training and Information Center (PTI) located in every state
  • Employment-Related Agencies, Organizations and State Initiatives
    • Business Organizations
    • Employers and/or an organization of employers
    • State’s workforce development agency: One Stop Shop
    • Vocational Rehabilitation leaders and anyone who may be in charge of transition-age programming, for services preparing for employment and other services (how to find a van and get it fitted for driving modifications); Programs for the blind, if separate from VR in your state
  • Disability-Related State Information Networks, Programs and Services
    • Assistive Technology Project/agency
    • Attendant Care organizations and/or adult day care programs
    • Durable medical equipment association, vendors
    • Home health agency association (good source of Waiver info and personal assistants)
    • Housing office for state: accessible housing, accommodations, and/or group homes or assisted living arrangements
    • Higher Education Information: A resource for scholarships, loans, work study, disabled student services, etc. (university, community colleges and technical schools)
    • Recreation organizations (youth): YWCA, YMCA, Scouts, 4-H, Baseball/basketball leagues
    • Transportation system (mobility training, application process, door-to-door, adapted bus routes)
Resources

Links:

Health Care Policy

  • State Approaches to Consumer Direction in Medicaid.  This issue brief, developed through a national survey of Medicaid agencies, summarizes how states are incorporating a variety of consumer directed strategies to help beneficiaries use health care dollars more efficiently.   http://www.chcs.org/usr_doc/State_Approaches_to_Consumer_Direction.pdf

Housing

  • Housing & Mortgages for People with Disabilities.  This guide has been created to help individuals living with disabilities, and their family members, in the process of buying a home of their own. Here you can learn more about the five important steps in buying a home and about financial assistance programs that are available for you living with disabilities, who want to buy a home. http://www.mortgageloan.com/disabilities

Other Organizations