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Suggested Citation:"9 Next Steps." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
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9

Next Steps

The committee was charged with reviewing current policies and programs pertaining to the health, safety, and well-being of young adults and offering recommendations for improvement. Previous chapters have fulfilled this assignment in six specific policy domains: relationships, education and employment, civic engagement and national service, public health, health care systems, and government programs for marginalized young adults. This chapter distills our conclusions and recommendations in these specific domains into a blueprint for moving forward. It begins by drawing several overall conclusions about current policies and programs for young adults across all six domains. Based on these conclusions, we then delineate key ingredients for moving forward and offer a broad, cross-cutting recommendation. Next, we organize the recommendations from previous chapters according to the entities to which they are directed—the federal government, state and local governments, and private entities that serve many young adults. Finally, we summarize our observations regarding the research needed to provide a stronger evidence base for the development of policies and programs that better support young adults.

OVERALL CONCLUSIONS ABOUT POLICIES AND PROGRAMS THAT SERVE YOUNG ADULTS

Three overall conclusions emerged from our review of public and private policies and programs pertaining to the domains of education and employment, civic engagement and national service, public health, health care systems, and government programs for marginalized young adults.

Suggested Citation:"9 Next Steps." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

Current policies and programs serving the young adult population are often fragmented and uncoordinated.

With the exception of policies and programs that target exclusively either children and youth under 18 or older adults, young adults are among the population served by virtually every federal, state, and local program in the areas of education, employment, civic engagement and national service, and health and human services. For example, the United States currently has a wide array of policies to support higher education and workforce development services for both young and older adults at the federal, state, and local levels, as well as laws to protect the disabled. National service programs are supported and run by multiple entities, including the Corporation for National and Community Service and the U.S. Departments of Labor, Interior, and Housing and Urban Development at the federal level, and many more at the state and local levels, as well as private foundations and nonprofit organizations. Similarly, the wide range of policies and programs designed to support current members of the military serve many young adults.

In the realm of health, several major federal agencies and all state and local public health departments have programs that target many of the public health priorities for young adults identified in this report, including tobacco control, obesity prevention, injury prevention, and prevention of unprotected sexual activity. Health care coverage for young adults is fragmented across policies that guide employer-based insurance, insurance purchased through exchanges, student health coverage, and Medicaid.

Fragmentation is particularly noticeable in policies and programs aimed at supporting marginalized young adults. These include programs for young adults aging out of foster care, those in the justice system, those who are homeless, and young parents, as discussed in Chapter 8; education and employment programs for young adults neither in school nor working and those with disabilities, as discussed in Chapter 4; and policies and programs for young adults who experience particular difficulty accessing health care, as described in Chapter 7. Fragmented programs have narrow and idiosyncratic eligibility criteria that create obstacles to young people’s getting the help they need, often create gaps in help when it is provided, and too often are stigmatizing. Major entitlement programs intended to help vulnerable populations provide limited support for young adults, and discretionary programs targeting these populations, often fall far short of meeting demonstrable need. The variable categorization of marginalized young adults across multiple programs results in a lack of accountability, with multiple distinct outputs and outcomes being associated with the plethora of programs. There is no collective accountability for improving the overall health and well-being of marginalized young adults.

Suggested Citation:"9 Next Steps." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

Many states have recognized the importance of integration across different topic areas for adolescents. For example, many state public health agencies have created adolescent topic areas or have a designated state adolescent health coordinator. However, very few states have implemented a similar approach for young adults. Better coordination and, where possible, integration of services and supports and shared accountability are likely to achieve greater efficiency and effectiveness.

Policies and programs that serve young adults are often inadequately focused on their developmental needs and on specific interventions that would facilitate a successful transition to adulthood.

The majority of policies and programs that serve many young adults are not exclusively focused on this age group. A few exceptions include federal and state policies and programs that support young adults aging out of foster care and the young adult justice policies in several states. Some additional programs, such as YouthBuild, serve primarily young adults and older adolescents. However, it is much more common for young adults to be served along with all adults or, less frequently, adolescents.

Young adults cannot be treated like children because they are more mature and have more responsibilities, commitments, and expectations, as described in Chapter 2. However, general adult programs also are often inappropriate because young adults are still in the process of developing psychological and emotional maturity. Scaffolds such as mentoring, counseling, education and training, and specifically designed communication materials can help support young adults in the decisions and actions required of them as adults. Efforts to incorporate into programs for young adults parental support for their decision making and health care treatment also are worth exploring, whereas this would not be considered appropriate for general adult programs. Similarly, health care coordination approaches that are more common in pediatric than in adult systems could be helpful in supporting young adults, but with recognition of their decision-making ability and responsibilities. Although developmental research provides support for this general perspective on policies and programs for young adults, additional research and experimentation ultimately will be needed to support the development of effective interventions for young adults that appropriately strike this balance.

The evidence base on interventions, policies, programs, and service designs that are effective for young adults is limited.

Although gaps remain, much is known about the health, safety, and well-being of young adults as a group; about the factors associated with

Suggested Citation:"9 Next Steps." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

variations among them; and about trends over time. Much also is known about the changes that have occurred in the social and economic patterns that characterize the transition to adulthood. However, far less is known about the policies, programs, and service designs that will be effective in improving young adults’ health, safety, and well-being and in facilitating their successful transition to adulthood.

One barrier to expanding the evidence base is that data often are not collected or reported by age, impeding evaluation of the effectiveness of interventions, policies, programs, and service designs for young adults. Program data and clinical trials that simply include this age group (e.g., studies of adults aged 18-55) are insufficient to establish efficacy in young adults. To do so, the sample size of young adults relative to that of older or younger age groups needs to be large enough to detect an age effect.

A second barrier is that the types of data collected may not cover key issues for young adults. For example, current adult health monitoring efforts do not encompass screening and counseling for many health concerns of particular relevance to young adults, such as obesity-related issues, substance use, mental health disorders, reproductive health issues, and dental diseases. This data gap impedes efforts to monitor adherence to guidelines in preventive care for young adults. Population-based studies and government programs also often fail to capture data that would help identify the presence and well-being of marginalized populations.

Third, although evidence is emerging on effective programs and interventions for young adults, many important gaps remain. For example, there is some evidence on successful workforce programs for young and older adults and youth with relatively strong basic skills, and limited evidence on programs designed to improve success rates for disadvantaged students who enroll in college. Research suggests that integrating useful labor market information or training into such developmental efforts holds promise. However, knowledge of exactly what works cost-effectively for the most difficult-to-serve populations who are already disconnected is limited. Similarly, research is sparse on how to assist high school students with disabilities in transitioning to postsecondary education or employment. Behavioral health interventions and preventive care practices also are important research gaps for this age group.

Fourth, even in areas in which there are evidence-based or promising interventions, the ability to replicate and scale the best programs remains limited. As noted above, for example, interventions with positive impacts on completion rates and on the alignment of education and the labor market have been developed and rigorously evaluated. However, these programs need to be replicated and scaled up at the county or state level.

Finally, a key problem we identified was fragmentation and lack of coordination among the multiple policies and programs that serve margin-

Suggested Citation:"9 Next Steps." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

alized young adults. While we believe a more flexible and integrated approach to assisting these young people would ultimately be more effective than the current approach, the available evidence does not yet provide a clear path forward. Only active and ongoing partnership across all levels of government to develop and evaluate new approaches will clearly identify the policies and programs needed to reduce the marginalization of promising young adults.

A PLAN FOR MOVING FORWARD

Despite the challenges delineated above, it is important that the nation not find itself in the same position in 20 years, having failed to take advantage of opportunities to improve the trajectories of tens of millions of young adults. What is needed now is a coordinated effort by the public and private sectors to raise public awareness of the need to support and improve policies and programs focused on the needs of young adults, to engage young adults in the design and implementation of these policies and programs, and to further innovation and improvement by developing and experimentally evaluating new approaches. The key ingredients for such a concerted effort are delineated below.

Highlight Young Adulthood as a Distinct and Important Period of Development

An initial, critical ingredient for improving public policies and programs for young adults is for policy makers and program leaders to understand young adulthood as a distinct and important period of development that, under foreseeable social and economic circumstances, has significant implications for the future well-being of each cohort of young adults and of the nation as a whole. Heightened public understanding of this developmental period is needed to encourage appropriate public and private action.

Support Young Adults During the Critical Transitions They Face

A second key ingredient is public and private investment and a shared commitment to providing the training and tools needed to support young adults during the critical transitions they face, including obtaining education and entering the workforce. Investments in marginalized populations are particularly needed to reduce inequalities during the young adult years and increase the supply of skilled workers to serve the nation’s needs. Investing in public health and clinical preventive services also will be crucial because health underlies young adults’ ability to be successful in education, employment, and social relationships. Efforts to prevent and ameliorate the

Suggested Citation:"9 Next Steps." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

effects of behavioral health problems, including mood disorders, stress-related dysfunction, and substance use disorders, are particularly critical.

Engage Young Adults

The needs of young adults have been underresearched and underappreciated in policies and programs. Therefore, a third ingredient for action is to engage young adults themselves in the development of policies, programs, and services that impact them in the areas of education, social services, employment, and health care. It will be important to engage a range of young adults, not just high achievers. The powerful influence of young people with experience in foster care in developing federal and state child welfare policy over the past two decades illustrates the potential of engaging young adults in policy and program development.

Seek Developmentally Appropriate Outcomes

Government programs should identify and require outcomes that are appropriate for this age group and tailored to their developmental situation and their needs. The multiple programs serving marginalized young adults should be better coordinated, as discussed in the conclusions section above, and as part of this effort should share accountability for achieving developmentally appropriate outcomes for young adults. In an era of high-stakes accountability it is important to have program outcomes that are appropriate to the population(s) served.

Conduct Policy and Program Experimentation

While the need to invest in young adults is clear, the ideal nature of those investments is less so. As a result, we have generally avoided making recommendations for large-scale policy change. Instead, the current state of knowledge calls for coordination among federal, state, and local governments and philanthropies in policy and program experimentation to help identify the most effective approaches to improving the prospects of young adults. Promising interventions targeting the health, safety, and well-being of young adults, particularly those who have been socially excluded, should be rigorously evaluated. Government and private resources devoted to policy evaluation should be directed at learning from variations among and within states in current policies affecting young adults. In addition, demonstration projects should be developed, through coordination of government and private investments, to assess the costs and benefits of new policies intended to benefit young adults. Twenty years from now we will remain in the dark regarding how best to improve the health and well-

Suggested Citation:"9 Next Steps." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

being of young adults if we fail to make strategic investments in policy and program experimentation on their behalf.

CROSS-CUTTING RECOMMENDATION

Based on the findings and conclusions presented above, we first offer a cross-cutting recommendation that applies to all policies and programs addressing young adults, whether public or private and in all sectors of society. We then organize the specific recommendations made in previous chapters according to whether they are directed to the federal government, state and local governments, or the private sector.

Recommendation 9-1: Federal, state, and local governments and nongovernmental entities that fund programs serving young adults or research affecting the health, safety, or well-being of this population should differentiate young adults from adolescents and older adults whenever permitted by law and programmatically appropriate.

To implement this recommendation, specific actions should be taken to

  • modify reporting of data to identify young adults (aged 18-26) as a distinct age group in all reports, evaluations, and open data systems in which they are included;
  • enhance new or existing surveys or experimental research focused on either adolescents or adults to advance knowledge regarding the health and well-being of young adults and healthy transitions into young adulthood;
  • ensure that services provided to young adults are developmentally and culturally appropriate, recognizing that while adolescent or general adult services may sometimes be appropriate, modifications to existing services or entirely new approaches may be needed;
  • engage diverse young adults in designing and implementing programs and services;
  • support workforce training for health and human service providers to develop the skills and knowledge needed to work with young adults and their families;
  • seek opportunities for coordinating services and, where possible, integrating them to achieve greater effectiveness and efficiency; and
  • develop, implement, and evaluate systematic policy and program experiments to help identify the most effective approaches to improving the prospects of young adults.
Suggested Citation:"9 Next Steps." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

It is important to note that this recommendation is not intended to imply the creation of an extensive set of new programs targeted only at young adults. Such an approach would have the potential to create new silos and generate concerns about discontinuities and lack of coordination similar to those that currently characterize programs for children/adolescents and adults. Rather, the intent is to increase focus on how policies and programs are working for young adults today. We recommend the adaptation or creation of new policies, programs, and practices only when the evidence indicates that young adults’ specific needs are not being met, with an emphasis on first attempting to modify existing efforts to better suit young adults. Further, we emphasize the importance of considering the transitions into and out of young adulthood to avoid inadvertently creating new discontinuities.

ORGANIZATION OF DOMAIN-SPECIFIC RECOMMENDATIONS BY RESPONSIBLE ENTITIES

The recommendations presented in Chapters 3 through 8 of this report fall within the key domains of relationships, education and employment, civic engagement and national service, public health, health care systems, and government investments in marginalized young adults. Pursuant to the ambitious program of experimentation proposed above, these domain-specific recommendations include large-scale experimentation programs, such as demonstration projects, where initial evidence suggests promising approaches, and identify priorities for research where evidence on promising directions to pursue is currently lacking. Here we organize these recommendations according to the entities that would be responsible for their implementation. The original recommendation numbers are given in parentheses. Box 9-1 summarizes recommendations for the federal government, organized by branch and department. Box 9-2 summarizes recommendations for state and local governments; because states vary in the organization of their agencies, these recommendations are grouped by topic area and are targeted at whichever state or local agency covers that topic. Finally, Box 9-3 summarizes recommendations for various private entities, including philanthropic funders, private-sector entities such as health systems, and nonprofit organizations that serve young adults.

Suggested Citation:"9 Next Steps." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

BOX 9-1
Recommendations for the Federal Government

In addition to Recommendation 9-1, above, the committee provides the following recommendations to assist the U.S. Congress and federal agencies in developing policies and programs designed to improve the health, safety, and well-being of young adults. Although young adults are not explicitly mentioned in each recommendation below, the committee recommends that they be engaged throughout the processes described. (Please note that recommendations directed at specific agencies include Recommendation 9-1; Recommendations 8-1 through 8-5, listed under “U.S. Departments of Education, Labor, Health and Human Services, Justice, and Housing and Urban Development, and Other Agencies Serving Large Numbers of Young Adults”; and applicable recommendations under the remaining headings in this box.)

U.S. Congress

  • Amend federal laws to allow for more flexible and efficient eligibility determination and service provision across marginalized young adult populations. (8-3)

U.S. Departments of Education, Health and Human Services, Housing and Urban Development, Justice, and Labor, and Other Agencies Serving Large Numbers of Young Adults

  • Incorporate a greater focus on marginalized young adults in ongoing and new population-based cross-sectional and longitudinal studies of young adults. (8-1)
  • Implement the recent Office of Management and Budget “Guidance for Providing and Using Administrative Data for Statistical Purposes” to continue encouraging programs that serve marginalized populations to make better use of administrative data. (8-2)
  • Fund demonstration projects at the state level to support states in integrating program administrative data to better understand marginalized young adults and to evaluate programs serving them. (8-2)
  • Amend federal laws and regulations to allow for more flexible and efficient eligibility determination and service provision across marginalized young adult populations. (8-3)
  • Amend laws and regulations to create accountability for achieving improvement on a limited set of key outcomes for marginalized young adults. (8-4)
  • Emphasize evaluation of programs aimed at improving outcomes across multiple vulnerable populations while remaining sensitive to differences across subpopulations. (8-5)
  • Actively monitor the outcomes of the young parent participants in addition to early childhood outcomes in the development, implementation, and evaluation of two-generation programs. Doing so would be valuable for programs that target primarily health and well-being (such as home visiting programs), as well as those that target primarily human capital development. (3-1)
Suggested Citation:"9 Next Steps." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

U.S. Department of Education

  • Provide competitive grants and technical assistance to support state efforts to experiment with and evaluate interventions designed to improve graduation rates at high schools and colleges, as well as the rates at which high school dropouts receive their General Educational Development (GED) credential and enroll in college or job training. (4-1)
  • Provide competitive grants and technical assistance to support state efforts to implement at a medium or large scale and evaluate education and workforce development approaches that are more closely tied to high-demand economic sectors. (4-2)
  • Provide competitive grants and technical assistance to support state efforts to experiment with and evaluate providing performance-based subsidies to their public colleges and universities. (4-3)

U.S. Department of Labor

  • Provide competitive grants and technical assistance to support state efforts to implement at a medium or large scale and evaluate education and workforce development approaches that are more closely tied to high-demand economic sectors. (4-2)
  • Provide competitive grants and technical assistance to support state efforts to experiment with and evaluate providing performance-based subsidies for public colleges and universities. (4-3)
  • Expand and improve opportunities for service for all young adults, and emphasize the short- and long-term effects of service on participants’ health and well-being (in addition to community impact) in program evaluations. (5-1)

Corporation for National and Community Service

  • Expand and improve opportunities for service for all young adults, and emphasize the short- and long-term effects of service on participants’ health and well-being (in addition to community impact) in program evaluations. (5-1)

U.S. Preventive Services Task Force

  • Develop a consolidated set of standardized evidence-based recommendations for clinical preventive services such as screenings, counseling services, and preventive medications specifically for young adults. Behavioral and oral health should be included in these recommendations. (7-2)

U.S. Department of Health and Human Services

Agency for Healthcare Research and Quality

  • Develop quality performance metrics on the transition-of-care process to ensure continuity of care for young adults making the transition from pediatric to adult behavioral and medical health care. (7-1)
Suggested Citation:"9 Next Steps." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

Centers for Medicare & Medicaid Services

  • Encourage greater attention to the pediatric-to-adult transition-of-care process within the innovation models that it solicits and funds, such as those from the Center for Medicare & Medicaid Innovation. (7-1)
  • Incorporate young adult transition-of-care metrics into pay-for-performance schemes, contracting, and other provider assessments. (7-1)
  • Adopt the clinical preventive services recommended by the U.S. Preventive Services Task Force, include the delivery of those services in quality performance metrics used for pay-for-performance and other health care provider assessments, and require public reporting of compliance. (7-3)

Office of the National Coordinator for Health Information Technology

  • Ensure that meaningful use criteria enable the capture of data on the pediatric-to-adult transition-of-care process. (7-1)

Health Resources and Services Administration, Maternal and Child Health Bureau

  • Expand work on transition-of-care metrics for youth with special health care needs to include all youth and young adults, incorporate such metrics in Title V program requirements, and support related capacity development and training in states. (7-1)
  • Adopt the clinical preventive services recommended by the U.S. Preventive Services Task Force, include the delivery of those services in quality performance metrics used for pay-for-performance and other health care provider assessments, and require public reporting of compliance. (7-3)

Other Agencies That Fund or Provide Physical or Behavioral Health Services—Including the Substance Abuse and Mental Health Services Administration and the Indian Health Service

  • Adopt the clinical preventive services recommended by the U.S. Preventive Services Task Force, include the delivery of those services in quality performance metrics used for pay-for-performance and other health care provider assessments, and require public reporting of compliance. (7-3)

National Institutes of Health

  • Support research aimed at developing a set of evidence-based practices for medical and behavioral health care, including prevention, for young adults. (7-4)

U.S. Departments of Defense and Veterans Affairs

  • Adopt the clinical preventive services recommended by the U.S. Preventive Services Task Force, include the delivery of those services in quality performance metrics used for pay-for-performance and other health care provider assessments, and require public reporting of compliance. (7-3)
Suggested Citation:"9 Next Steps." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

BOX 9-2
Recommendations for State and Local Governments

In addition to Recommendation 9-1 above, the committee provides the following recommendations to assist state legislatures and state and local agencies in developing policies, programs, and services designed to improve the health, safety, and well-being of young adults.

State Legislatures and Governors

  • Amend laws and regulations to create accountability for achieving improvement on a limited set of key outcomes for marginalized young adults. (8-4)

State Agencies in the Areas of Education, Health and Human Services, Housing, Justice, and Labor, and Other Agencies Serving Large Numbers of Young Adults

  • Incorporate a greater focus on marginalized young adults in ongoing and new population-based cross-sectional and longitudinal studies of young adults. (8-1)
  • Expand on existing state and local efforts to integrate and use administrative data to better understand and serve marginalized young adults. (8-2)

State Education and Employment Agencies

  • Experiment with and evaluate a range of interventions designed to improve graduation rates at high schools and colleges, as well as the rates at which high school dropouts receive their GED credential and enroll in college or job training. (4-1)

RESEARCH NEEDS

Given that the transition to adulthood encompasses a wide range of concerns (and thus research disciplines and policy targets), different disciplines will have to collaborate to ensure that the many relevant levels of explanation and intervention (from biological to cultural) are integrated in research designed to support efforts to improve the health, safety, and well-being of young adults. It would be sensible for philanthropic organizations interested in young adults, the National Institutes of Health, and other federal research agencies to collaborate in convening a forum or some other activity for the purpose of identifying priorities and formulating a national

Suggested Citation:"9 Next Steps." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×
  • Experiment with and evaluate programs designed to reduce the enormous disparities in high school and college completion that now exist by race, family income, and geographic location (urban versus rural). (4-1)
  • Implement at a medium or large scale and evaluate education and workforce development approaches that are more closely tied to high-demand economic sectors. (4-2)
  • Experiment with and evaluate providing performance-based subsidies for public colleges and universities. (4-3)

State and Local Public Health Agencies

  • Establish an office to coordinate programs and services bearing on the health, safety, and well-being of young adults. If a separate office is not established for young adults, these responsibilities should be assigned to the adolescent health coordinator. (6-1)
  • Take the lead in convening a multistakeholder public-private coalition on “Healthy Transitions to Adulthood.” (6-2)
  • Include specific targets for young adults in plans to reach the 5-year measurable performance goals of Community Transformation Grants. (6-3)

State and Local Agencies That Fund or Provide Physical or Behavioral Health Services

  • Adopt the clinical preventive services recommended by the U.S. Preventive Services Task Force, include the delivery of those services in quality performance metrics used for pay-for-performance and other health care provider assessments, and require public reporting of compliance. (7-3)

research agenda that can meet this need. As a starting point, Table 9-1 presents a listing of key research topics identified by the committee.

CONCLUDING REMARKS

Focusing on the health, safety, and well-being of the current cohort of young adults (those becoming adults in the first third of the 21st century) is especially important because of the powerful (and perhaps transformative) economic and social forces now at work—the restructuring of the economy, widening inequality, a rapidly increasing “elder dependency ratio” (i.e., the

Suggested Citation:"9 Next Steps." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

BOX 9-3
Recommendations for Private Entities

The committee provides the following recommendations to assist private entities in developing and supporting policies, programs, and services designed to improve the health, safety, and well-being of young adults.

Philanthropic Funders and Other Entities That Fund Service Programs

  • Expand and improve opportunities for service for all young adults, and emphasize the short- and long-term effects of service on participants’ health and well-being (in addition to community impact) in program evaluations. (5-1)

Philanthropic Funders That Fund Programs for Marginalized Young Adults

  • Actively monitor the outcomes of the young parent participants in addition to early childhood outcomes in the development, implementation, and evaluation of two-generation programs. Doing so would be valuable for programs that target primarily health and well-being (such as home visiting programs), as well as those that target primarily human capital development. (3-1)
  • Emphasize evaluation of programs aimed at improving outcomes across multiple vulnerable populations while remaining sensitive to differences across subpopulations. (8-5)

ratio of the population aged 65 and older to the working-age population), a substantial increase in immigration, and the increasing diversity of the population. The future well-being of the nation rests on the investments made in all young adults today—particularly those whose background and characteristics put them at risk of experiencing the greatest struggles. Providing more of the educational, economic, social, and health supports they need will help ensure equal opportunity, erase disparities, and enable more young adults to embrace adult roles successfully as healthy workers, parents, and citizens.

Suggested Citation:"9 Next Steps." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

Colleges and Universities, Employers, Youth Organizations; Nonprofit Organizations; Medical Specialties Providing Primary Care to Young Adults; and Other Community Organizations Serving, Supporting, or Investing in Young Adults

  • Participate in a multistakeholder public-private coalition on “Healthy Transitions to Adulthood.” (6-2)

Recipients of Community Transformation Grants

  • Include specific targets for young adults in plans to reach the 5-year measurable performance goals of Community Transformation Grants. (6-3)

National Committee for Quality Assurance, National Quality Forum, and Other Quality Measurement Entities

  • Incorporate pediatric-to-adult transition-of-care performance metrics into quality measurement and reporting frameworks. (7-1)

Health Care Delivery Systems and Provider Organizations Serving Young Adults

  • Develop a coordinated pediatric-to-adult transition-of-care process within their organizations. (7-1)

Health Insurers and Purchasing Entities Such as Employer Coalitions

  • Incorporate pediatric-to-adult transition-of-care performance metrics, to be developed by the Agency for Healthcare Research and Quality, into pay-for-performance initiatives, contracting, and other health care provider assessments. (7-1)
Suggested Citation:"9 Next Steps." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×

TABLE 9-1 Research Needed to Inform Policies and Programs Designed to Improve Young Adults’ Health, Safety, and Well-Being

General Category Cross-Cutting
Specific Research Needs
  • Identify processes that underlie heterogeneity in trajectories in the health, safety, and well-being of young adults, including romantic relationships, family formation, childbearing and parenting, effective parenting of young adults, intergenerational patterns, peer relations, access to and utilization of behavioral and medical health care, involvement with social service and justice systems, and neurobiological processes.
  • Understand how social media and mobile technology influence young adults’ social relations, health, safety, and well-being to inform the design of interventions.
Relationships
  • Monitor evaluation results from ongoing two-generation programs, and extend successful programs to new implementation sites.
  • Examine the impact of the recent dramatic shift in union formation and childbearing on the health and well-being of young adults and their children.
  • Understand the ways in which social media can be used to impact young adults’ social relations, health, safety and well-being.
Education and Employment
  • Understand what works to improve success rates in higher education and the labor market for the most difficult-to-serve young adults who are already disconnected.
  • Identify effective practices for assisting high school students with disabilities in transitioning to postsecondary education or employment.
Civic Engagement and National Service
  • Identify factors that contribute to and enhance civic engagement and involvement in national service among young adults.
  • Conduct more rigorous experimental studies to determine how civic engagement and involvement in national service impact the trajectories of health, safety, and well-being of young adult participants.
  • Examine institutional supports and individual characteristics that facilitate successful transitions into education, employment, social relationships, and citizenship following national service.
Suggested Citation:"9 Next Steps." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
×
General Category Cross-Cutting
Public Health
  • Assess the effectiveness of multilevel interventions with respect to health outcomes, including how to connect with difficult-to-reach young adults.
  • Better understand the influence of social media on health outcomes.
  • Better understand how social determinants, mechanisms, and trajectories contribute to health inequalities among young adults, including within different groups.
  • Better understand the impact of advertising and promotion of alcohol, tobacco, and marijuana on the health, safety, and well-being of young adults.
Health Care Systems
  • Develop preventive care guidelines for young adults (see Recommendation 7-2).
  • Develop a set of evidence-based practices for medical and behavioral health care for young adults, including prevention and effective processes for the transition from pediatric to adult care (see Recommendations 7-1, 7-2, 7-3, and 7-4).
  • Examine the efficacy of integrating behavioral and physical health care in improving health outcomes for young adults.
  • Develop a comprehensive behavioral health screen.
Government Investments in Marginalized Young Adults
  • Gain better knowledge of how marginalized young adults fare during young adulthood (see Recommendation 8-1).
  • Integrate information across the systems serving marginalized young adults and over time to provide a more complex, longitudinal perspective on their health and well-being (see Recommendation 8-2).
Suggested Citation:"9 Next Steps." Institute of Medicine and National Research Council. 2015. Investing in the Health and Well-Being of Young Adults. Washington, DC: The National Academies Press. doi: 10.17226/18869.
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Next: Appendix A: Open Session Agendas »
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Young adulthood - ages approximately 18 to 26 - is a critical period of development with long-lasting implications for a person's economic security, health and well-being. Young adults are key contributors to the nation's workforce and military services and, since many are parents, to the healthy development of the next generation. Although 'millennials' have received attention in the popular media in recent years, young adults are too rarely treated as a distinct population in policy, programs, and research. Instead, they are often grouped with adolescents or, more often, with all adults. Currently, the nation is experiencing economic restructuring, widening inequality, a rapidly rising ratio of older adults, and an increasingly diverse population. The possible transformative effects of these features make focus on young adults especially important. A systematic approach to understanding and responding to the unique circumstances and needs of today's young adults can help to pave the way to a more productive and equitable tomorrow for young adults in particular and our society at large.

Investing in The Health and Well-Being of Young Adults describes what is meant by the term young adulthood, who young adults are, what they are doing, and what they need. This study recommends actions that nonprofit programs and federal, state, and local agencies can take to help young adults make a successful transition from adolescence to adulthood. According to this report, young adults should be considered as a separate group from adolescents and older adults. Investing in The Health and Well-Being of Young Adults makes the case that increased efforts to improve high school and college graduate rates and education and workforce development systems that are more closely tied to high-demand economic sectors will help this age group achieve greater opportunity and success. The report also discusses the health status of young adults and makes recommendations to develop evidence-based practices for young adults for medical and behavioral health, including preventions.

What happens during the young adult years has profound implications for the rest of the life course, and the stability and progress of society at large depends on how any cohort of young adults fares as a whole. Investing in The Health and Well-Being of Young Adults will provide a roadmap to improving outcomes for this age group as they transition from adolescence to adulthood.

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