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Book Review   |    
Maryann Davis
Psychiatric Services 2006; doi: 10.1176/appi.ps.57.11.1658
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edited by E. Wayne Osgood, E. Michael Foster, Constance Flanagan, and Gretchen R. Ruth; Chicago, University of Chicago Press, 2005, 432 pages, $40

Dr. Davis is assistant professor at the Center for Mental Health Services Research, Department of Psychiatry, University of Massachusetts Medical School, Worcester.

This volume describes research on adolescents in public systems, such as child welfare, juvenile justice, and mental health—vulnerable populations—as they mature into adulthood. The book couples the research with considerations of policies and programs that impact the population during the transition period. The purpose of the volume is to "spur policy makers, opinion leaders, and scholars to devote great attention to the issues facing vulnerable populations during the transition to adulthood."

The book grew out of the previous work of the organizers of this volume, the John D. and Catherine T. MacArthur Foundation Research Network on Transition to Adulthood and Public Policy, much of which was published in the companion volume On the Frontier of Adulthood: Theory, Research, and Public Policy. That book highlighted the changes in the nature of the transition period during the past 30 years in the United States. In essence, it demonstrated that the transition in the general population has become increasingly complicated, extended, and disorganized compared with the orderly progression that was commonly completed by the age of 25 years among previous generations. They found that currently adult milestones were more typically achieved by age 30 or older; the orderly progression from family home to having one's own home, starting a family, and earning income was no longer linear; marketplace pressures demanded increasingly higher levels of education; and there was greater dependence on family for a safety net and support throughout these years. Their research suggested that the vulnerable groups covered in this second volume may be at particular risk during the transition.

The book covers seven public system populations: foster care, juvenile justice, criminal justice, homeless, special education, mental health, and special health care needs and disabilities. Most populations have a chapter on research on the population and another chapter on related policies and programs. The aim of the research chapters is to describe in what areas of adult life young people are more or less successful, who fares better and who fares worse, and what accounts for those patterns. Each policy chapter aims to review programs, policies, and services that affect the population and the effectiveness, adequacy, and gaps in regard to service delivery. Readers interested in a specific population can generally read the paired chapters on that group and get a sense of what is typically needed for a successful transition; how the target population measures up; the role of family, community, and systems; how policies have shaped current services; and the strengths and weaknesses of those services.

If the editors' intent is to provide comprehensive knowledge about each group and how to improve systems to serve them better, there would be a volume on each. However, the clear intent of this volume is to demonstrate the basic point that with the recent changes in the nature of the transition period, all of these vulnerable groups are in fact struggling to achieve minimally successful adulthoods, and our policies and service systems are woefully unprepared to assist them in an effective manner. This will be a tremendous burden to our society if we do not act quickly to recognize the increasing needs for support later into adulthood for these groups.

Most authors of chapters in this book had to contend with a thin research base as a consequence of the underrecognition of the critical importance of the transition stage. Although there is often sufficient research describing adolescents in each population, there is typically little description of young adulthood or connections between adolescence and young adulthood. Authors are often left extrapolating from other populations or age groups, such as describing what is needed for any young person to assume adult roles, and factors that likely influence positive adult role assumption in the target population but without any direct evidence.

The most understudied aspect is program effectiveness. In almost every population, types of programs that successfully support the transition into adulthood, or common dimensions across different programs that are successful, have not been studied. Authors have to revert to either common sense or very broad concepts about what is needed. To this end, it is clear that in each population, and across vulnerable populations, much more research is needed to understand precisely how vulnerable young people move from adolescence to adulthood and what needs to be done and with whom to ensure greater success. That kind of research base would more richly inform needed policy change.

However, solid findings for every group in the seven public systems demonstrate that the concern by the volume organizers about these vulnerable populations was well founded. Each group generally struggles to attain adult role fulfillment: complete schooling, obtain rewarding work, have a stable domicile, maintain long-term romantic relations or marriage, and be a successful parent. Some groups struggle with some issues more than others. For example, youths in the justice systems have particularly low rates of high school completion and tremendously high rates of regular drug use, in addition to high rates of recidivism. Young people who are in foster care or homeless have particularly tenuous ties to family and therefore a highly limited safety net during young adulthood.

Out of all disability groups, youths with serious mental health conditions repeatedly fared the worst in terms of school performance and completion and trouble with the law. These are not mutually exclusive groups. The presence of mental health conditions was high across most groups, and involvement with juvenile or criminal justice and foster care was also common. Perhaps most commonly, almost every group was disproportionately from impoverished families. No chapter addressed populations served by Medicaid or Temporary Assistance for Needy Families.

The policy chapters are quite varied and largely reflect how much federal law, as opposed to state or local policies, has shaped practice. Some chapters provide general guidelines that should shape policies—for example, Phillip Lyons and Gary Melton on the mental health population—whereas others make concrete suggestions for existing policy—for example, Patience Haydock White and Leslie Gallay on young people with special health care needs. Themes that are shared include uniform difficulties posed by separate child and adult systems with disparate eligibilities and discontinuities in service provision. Because the transition age spans adult and child systems, it combines the shortcomings of both systems separately and together—noncoordinated care, competitive boundaries, and protection of resources.

Chapter highlights include the description of typical psychosocial development by He Len Chung and colleagues and their description of positive social environments that promote psychosocial maturity in preparation for adulthood. The policy chapter by Jeremy Travis and Christy Visher about prison populations consistently considers policy implications for helping younger adults in a nonrehabilitative system that is geared toward the general adult offender. The policy chapter by White and Gallay lays out the complexities of funding the health care system, considers how that impacts the transition-age population, and proposes concrete changes for federal policy.

As a researcher in this field I found the book inspiring, and it provides many cross-fertilized ideas for future research. As someone who works with practitioners and policy makers, I found that this book laid out the basic issues facing these vulnerable populations in logical and clearly compelling ways. If just a small portion of the ideas it offers were adopted, the lives of these young people and our communities would undoubtedly improve.




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