Life After High School: My "Transition Top Ten"

We have all had many “transitions” in our lives. If one has lived long enough we likely have experienced many life transitions including new jobs, ends of jobs, marriages, break-ups, children, moves to new cities, and many other changes that nudge our lives in other directions, both planned and unplanned. Think for a minute about the feelings you had during these times. What a plethora of emotions: excitement, fear, hesitancy, confidence, vulnerability, anticipation!

Leaving high school as a new graduate or as a dropout is a first significant transition period for most young people. It is challenging for all adolescents as they move into young adulthood. It is particularly so for young people with chronic illnesses, particularly mental health conditions.

The one thing we know that consistently supports a more positive transition process is a robust plan that is driven by the young person and one in which she or he is truly invested. This plan should be based upon their interests, strengths, needs and desires for life beyond high school and provide support to get there even when things don’t go as planned. This is particularly difficult to do for a young person who is experiencing the ebb and flow of bipolar disorder as well as the more significant assaults that this illness can take.

Based on my personal experiences with my daughter’s transition and the research that I have spent my professional life reviewing and conducting, here are "top ten" thoughts on transitioning young people with mental health conditions from high school to life after.

  • Start early. Begin involving children and adolescents in their IEP meetings if they have them. Be open and honest about their diagnosis and treatment plan (age-appropriate language of course!). Develop self-determination beginning in the earliest years.
  • Be strength-based. Start with what a child or adolescent does best. Identify their interests. These may change but it is a place to begin.
  • Don’t downplay needs. Be clear about the supports needed. Develop a treatment plan that can move with them when they live independently. Develop this plan with the young person not for them.
  • Identify and develop a care team. Although parents and family are still very important to the team, include others who can support your young person if and when you are not available. Friends may agree to be available if needed. Doctors and care-givers may provide cell phone numbers or pager numbers. If the young person is living away from home it helps to meet a local treatment team and have phone numbers and contact information.
  • Assist the young person in developing a plan for the next few years after high school, but prepare to tweak or change it as needed. Identify agencies that may offer assistance (Division of Vocational Rehabilitation, Mental Health, one-stop employment programs, etc.)
  • Have a “what if” plan. Discuss and identify what to do if he or she should be away from home and become unstable. Have necessary documents photocopied and ready to go.
  • Discuss money management. Just as school assignments are affected by depressions, anxieties and manias, money management can also be subjected to the rise and fall of bipolar. This might mean that bills are not paid during a depression. Too much money might be spent in a very short time during times of high stress or manias. Talk about when assistance might be needed. Consider having checking accounts in which a trusted adult also has access.
  • Encourage and support the process's taking longer. Developmental and institutional stages can be vastly different for any young person but the differences are even more pronounced when there is a mental illness involved. Institutional transitions dictate that when a “child” turns 18 they are considered an “adult”. They can get credit cards, buy cars, and get married. Institutional stages indicate that young adults finish college in four years, perhaps five. They live independently after finishing college and perhaps in the next few years after leaving high school if working. Young people who have spent years struggling with a mental illness or have been hospitalized or unstable for any period of time have missed some of the developmental stages of maturation. They may not be on par with their peers in some areas but may be far advanced in others. It may take longer to become independent.
  • Attain a medical psychiatric directive. Parents are no longer allowed to talk to their doctors, college professors or employers without their permission once a son or daughter turns eighteen. Take the time to complete a medical psychiatric directive with your young adult. Hopefully you will never need to use it but if you do and don’t have this in place things can take a very, very bad turn. Be prepared.
  • Allow for failure but celebrate large and small victories.

 And finally, see you own therapist. It is a difficult yet so very exciting time. For parents who may have spent an exorbitant amount of time taking care of their child, assuring safety and stability and experiencing frightening situations and perhaps the fear of losing their child the transition from high school is often a very difficult time “letting go”. 

 Believe and trust your adult child. Give her or him the message that you know they can do it.

The Balanced Mind Parent Network Blogger Dr. Cinda Johnson has worked professionally in the area of transition for most of her career. She completed a doctorate in special education with her major studies and research in the transition of youth with disabilities from the K-12 school system to early employment, postsecondary education (colleges or universities), training programs, independent or not-so- independent living arrangements and to all of the many variables involved in this movement. She has spent the last twenty years working at the national and state level to assure that youth with disabilities have a transition plan for life after high school. Every year, her project follows over 6, 000 young adults after graduating or dropping out of high school to determine what they are doing and try to make sense of the information to learn how best to support adolescents to positive outcomes. (Please visit  Center for Change in Transition Services, a 15-year grant project located at Seattle University and supported by the Washington Department of Education, to learn more.)

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Thank you for the comment. My daughter would be able to take 12 - 15 credits some quarters and unable to take a "full-time" load other quarters depending on how she felt. We worked with the Disability Student Services office at the university, our psychiatrist and our insurance company to receive the accommodations necessary to assure that she not only was able to be covered by our insurance for a "full-time" student but that she received her scholarship, also for a full-time student. It is discrimination to do otherwise but it was a bit of a battle a couple of times (lots of letters and phone calls) and another time it was not. The insurance company said that as long as she was taking even one class (including on-line) she would be covered. It varies, the squeaky wheel gets attention, and it takes a huge amount of effort sometimes to make things happen. The only advice I can offer other than keep lots of documentation, work with DSS at the college, and see if you can find a patient advocate within your insurance company is to include your young adult in all of the battles. Sometimes my daughter was too overwhelmed and just wanted me to take care of it but I have had to look at it as an apprenticeship. Hopefully she will have the skills to deal with the battles to come on her own or with help from others as needed. I also suggest that students with mental health conditions have an accommodation plan through the DSS office even if they think they won't need it. Symptoms may come and go with bipolar as you know! One of the accommodations should address this in stating that when the student's symptoms prevent them from taking a full-time load of courses they can take less without losing their full time status. I have offered independent studies to a graduate student in my program who was experiencing a deep depression one quarter. She actually ended up with an "N" or incomplete grade but had a full year to make it up. But those 3 independent study credits qualified her for full time and her scholarship. Good luck and let us know how it goes! Take good care, Cinda

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Cinda Johnson

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Does anyone has experience with this situation?
If a psychiatrist writes a justification to an insurance company stating that Full Time college enrollment for THIS child is 9 credit hours (instead of 12 -15) then the student can remain on the parent's health insurance as a full time student.

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Anne, dd Casey BPDNOS, 22 yrs. old, lamictal (not sure dosage),an antidep. not sure which one, anti anxiety med, D&A abuse, Associate degree after 4 yrs of unsuccessful college attempts, employment sporadic ,dedicated Pdoc in Boston, dd has attended monthly appointments for 4 yrs., counseling weekly, dh depression, AA member 25 yrs., son 25 finished college, working, no issues. ny state.

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Yes that is definitely the key

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