Maine Behavioral Health Transition from Children's to Adult Services

Children's Behavioral Health and Adult Behavioral Health Are Different Systems

In Maine, Children's Behavioral Health Services fall under DHHS's Office of Behavioral Health (OBH). Adult behavioral health services fall under a different administrative structure. The providers, eligibility criteria, service models, and even the terminology change when a young person turns 18.

A child receiving Children's Behavioral Health Services — therapeutic case management, behavioral health professional (BHP) services, crisis stabilization — may find that the specific services they rely on don't have a direct adult equivalent. Adult behavioral health emphasizes crisis response, community mental health centers, and substance use treatment rather than the developmental and family-centered model that children's services use.

For youth with co-occurring intellectual disabilities and behavioral health needs, the transition is even more complicated because two separate adult systems — OADS (for developmental disability services) and the adult behavioral health system — both need to be engaged, and they don't automatically coordinate with each other.

The OCFS Early Notification Form

Maine has a specific mechanism for flagging youth who will need adult services: the Early Notification Form for Youth Transitioning to Adulthood, administered by OCFS. This form can be submitted starting at age 16 and serves as a voluntary heads-up to DHHS that a youth currently in the children's system will need adult developmental services.

The form itself doesn't guarantee services — it starts a planning conversation. But submitting it early gives OCFS and DHHS notice of the youth before the children's services end. Without it, the first contact with the adult system may not happen until after children's services have already terminated, creating a gap.

The IEP team or the youth's children's behavioral health provider can help the family complete and submit the form. It should be part of the age-16 IEP transition meeting, alongside DVR referrals and OADS waiver intake discussions.

What Changes at 18

At 18, the youth becomes a legal adult with the right to make their own treatment decisions. A parent who has been directing their child's behavioral health care — choosing providers, consenting to medications, communicating with therapists — no longer has automatic authority to do so.

If the young adult is unable to manage their own behavioral health decisions, the family needs a legal framework in place before the 18th birthday. Supported Decision-Making agreements can authorize a supporter to participate in treatment planning. A healthcare power of attorney can authorize a family member to make medical decisions if the person is unable to do so independently. In more complex situations, limited guardianship may be appropriate.

The transition from children's to adult behavioral health providers should be coordinated before the age cutoff. Ask the current provider: Do you have adult counterparts you can refer to? Will you provide a treatment summary and medication history to the new provider? Can you overlap care for a transition period?

Managing Dual-System Needs

Young adults who need both OADS developmental disability services and adult behavioral health services face a coordination challenge. OADS case managers focus on residential supports, employment, and community inclusion. Adult behavioral health providers focus on psychiatric treatment, therapy, and crisis intervention. Neither system is designed to manage the full picture.

Families often become the de facto coordinators — ensuring the OADS case manager knows about medication changes, the psychiatrist knows about residential placement changes, and the crisis plan is consistent across all providers. The Person-Centered Plan (PCP) developed through OADS should include behavioral health goals and provider information, but in practice this requires active advocacy from the family.

For youth exiting the juvenile justice system or foster care with behavioral health needs, the transition pathway includes additional agencies and additional complexity. The University of Maine School of Law's Youth Transition Planning Tool (2021 edition) provides a comprehensive assessment and checklist specifically for these situations.

The Maine IEP Transition to Adulthood Guide coordinates behavioral health transition milestones alongside the IEP, DVR, and OADS timelines, so families managing dual-system needs can track all deadlines in one place.

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