University of California San Francisco
Lessons Learned
Tying it All Together
Based on a review of US state policies and programs, and interviews with Title V leadership in states that chose a young adult state measure, the Adolescent and Young Adult Health National Resource Center (AYAH-NRC) has outlined five strategies that states can adopt to advance young adult health. These strategies build on one another: states first need data to decide what issues are most pressing, then can collaborate to find the best ways to address these issues, equip staff with training to engage YAs, and so on.
The AYAH-NRC also found other lessons for Title V agencies looking to expand their work with young adults, described in this section. The following items – including facilitating factors, barriers and advice from interviewed states – enable Title V agencies to learn from what other states have found in their journeys to improve young adult health.
1. Factors Facilitating Expansion into YA Health
One of the clearest factors enabling greater focus on young adults was the establishment of strong partnerships with other state agencies, external partnerships with colleges and participation in statewide collaboratives. Through these partners, states were able to conduct outreach and provide services to young adults in schools or at work. Agencies also leveraged partnerships to conduct statewide surveys and gather actionable information, such as young adults’ perceptions and rates of substance use.
Additional facilitating factors included the development of supportive reimbursement systems (such as improved billing for family planning) and expansion of telehealth services. By operating in a context that makes services commonly used by young adults more accessible, states were able to advance their goals around young adult health more easily.
Overlap with existing Title V initiatives was another important factor, leading many YA activities to be connected to topics that were already of concern for states. Among state-level young adult health policies and programs, five topics rose to the top as areas where most YA health efforts are concentrated.
Healthcare Transition refers to young people moving on from the pediatric to adult healthcare system, and acquiring the skills and knowledge to navigate the adult healthcare system – including insurance and financing – successfully. Within Healthcare Transition, activities focused on transition to adult mental health services (e.g. counseling and residential mental health facilities) were common. Initiatives to improve young adult healthcare literacy and support former foster youth were also emphasized in the policies and programs reviewed.
Mental/Behavioral Health largely involved suicide prevention campaigns, reflecting suicide’s status as a major cause of mortality for young adults. However, among the activities found in the review, many only partially targeted YAs. For example, the review found that many pregnancy prevention programs have extended their age range to include younger YAs, but still mostly work with adolescents.
The major topics identified by this report serve as starting points for organizations to connect their work with efforts that are already taking place around the country. Both by expanding adolescent health activities to include young adults and pioneering initiatives adapted to YAs’ life context, institutions can make progress on health outcomes for this age group.
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2. Biggest Roadblocks
The challenges faced by Title V agencies include limitations in expertise, staffing and funding. Interviewees expressed that gaps in knowledge regarding how to engage young adults and address their needs posed a barrier to implementing their strategies. Closing these gaps in knowledge would require training for employees and local partners.
Additionally, staff capacity constraints meant that Title V personnel sometimes had difficulty integrating a young adult focus into their existing work. With most departments and local partners honed in on early childhood, little funding is allocated to the young adult population. This further hindered agencies’ ability to branch out into tailored programming for young adults.
Given that Title V agencies’ priorities are tied to the goals of the Maternal & Child Health Bureau, highlighting young adults through the creation of a national performance measure would encourage greater attention toward this population.
3. States’ Motivations for Adopting a YA Measure
Of the state Title V agencies interviewed for this report, most cited trends in young adult health data; a shift to a life course approach to health; or young adults’ connection to a pressing initiative as catalysts for adopting a young adult measure.
The importance of making connections to existing work is reflected in the diverse subject matter covered by each state’s young adult state performance or outcome measure. Ranging from preventive services to mental health to sexually transmitted infections, it is evident that advancing young adult health often means extending or adapting existing priorities to this age group.
Further, data trends have a major impact on if and how young adults are addressed by public health agencies. This underscores the key importance of measurement as the basis for championing the young adult population.
4. Advice for Other States
As part of each interview with states that selected a YA measure, Title V agency leaders shared their advice for other programs interested in advancing young adult health. Some of this advice was also resonant in other parts of the interview, such as the importance of highlighting young adults in the Title V Block Grant and collecting actionable data on YAs’ health status.
Beyond these factors, all interviewees stressed the importance of forming relationships with key players in young adult health in one’s state. By leveraging such relationships, states were able to gain insight into best practices for engaging young adults as well as reach groups of young adults who may not otherwise seek out public health services.
Where Do We Go from Here?
Though the field of young adult health is new, more and more entities are beginning to recognize the need to address the young adult population differently. Nationally, heightened concern over health issues that tend to worsen in young adulthood – such as substance use, mental health issues and unintended pregnancy – have drawn needed attention to this demographic. Further, public health organizations’ shift toward a life course approach requires greater consideration for the changes in legal, social and financial context that impact young adults’ health.
The Maternal and Child Health Bureau has sought to catalyze further investment in young adults through the funding of this report, technical assistance and other activities designed to help states develop YA health initiatives. With help from the strategies and resources in this document, the goal is for state Title V agencies to take action to increase their focus on young adult health.