What does ‘recovery’ look like? What are outcomes like for teens and young adults with mental and behavioral health disorders?
At the 2013 Mental Health and Addiction Conference, Coming Together for a Healthy Ohio hosted by the Ohio Association of County Behavioral Health Authorities, Patti Fetzer, LISW-S, Manager of Service Delivery, MHRS Board of Stark County (Canton area) spoke on the TIP (Transition to Independence Process) Model. The workshop focused on practices for improving the outcomes of young people with emotional and behavioral difficulties as they transition into adult-hood. This model is evidence-supported with six research studies demonstrating improvement in real life outcomes. It comes out of the National Network on Youth Transition for Behavioral Health and the NNYT Stars Academy.
Fetzer shared with the audience that ‘emerging adulthood’ is now considered a developmental stage you’ll find in college textbooks. Support for this comes from the Jim Casey Youth Opportunity Initiative and findings that the brain is not fully developed until into the mid ‘20’s. Thus, TIP is about improving outcomes among those 14-29 years of age with EBD-emotional and behavioral difficulties. It’s also important not to rely on adult models, but on the input of like age mentors in a robust peer support program. This group faces challenges from unaffordable housing, economic disparity- some have suggested economically that a bachelor’s degree is the equivalent of a high school degree in the ‘60’s in terms of earning power.
The developmental tasks of young adult hood include completing one’s education, maintaining physical and emotional health, negotiating housing, securing employment, and learning skills of daily living. This transitional stage presents its own problems because if does not fit neatly into traditional child or adult systems across child mental health, adult mental health, child protective agencies, child welfare systems, public education, vocational rehab, juvenile justice, law enforcement, corrections or developmental disability system- all of which have different age provisions hovering around the age 18 mark. The system barriers affect youth and family and the supports and services available do not fit the needs, interests and goals of young adults. Most do not wish to be grouped with 50 and 60 year olds. Efficiency apartments do not suit a teen parent situation with an infant, and/or partner. What does a typical housing voucher buy; and what are rents today?
Studies through the CDC have found that the prevalence of suicidal ideation is higher among age 18-29 year olds than adults over age 30, and 70% of adolescents with mental health issues do not receive the care needed. Fetzer suggested some guidelines in how to involve youth age 14-29 in their own futures planning process: 1) Engage them through relational development, person-centered planning, and focus on the future from a strength-based approach. 2) Stay on top of youth culture or hire young people to help do the work. [As a sideline, look at your lobby. Is it engaging for teens and kids?] 3) Use age appropriate communications tools- text them appointment reminders; don’t do voice mails. 4) Engage the power of hope with a future focus. 5) Set goals that are important to youth, both short and long term. Consider transitional domains of: educational opportunities, employment/career, and living situation. All engage together to enhance wellbeing and personal effectiveness/functioning.
For well-being, teens need to be able to have reciprocal relationships with others, care and compassion of others, learn to speak up for themselves, manage their daily needs- including medication, manage relationship, sexual, and dating relationships, and be able to get around the community. It’s important to provide developmentally appropriate resources, to encourage problem-solving, decision-making, and for the teen to be able to evaluate the impact of those decisions on self and others. Involve parents and other community partners.
A youth system is better termed ‘discovery’ based vs. the ‘recovery’ based adult system as this is a learning process; mistakes are part of the growing process. There should be a focus on restorative justice, and, ensure a safety net. Identify informal, community, and formal supports, and understand that ‘family’ is broadly defined; peer support is a ‘net’. Identify where to go in a crisis (available via text; not necessarily telephone numbers). Track results- academic, employment, independent living skills, residential and community life functioning, and not being arrested/incarcerated. With the EBD population, modeling, coaching and practicing is important to help with moving into 1st apartment, knowing how/when to have utilities turned on, negotiating public transportation. In teaching skills which impact recovery from mental illness and helping teens learn independent living skills, one needs to be outcomes-focused. Fetzer concluded with an ancient Chinese proverb: ‘Tell me; I forget. Show me; I remember. Involve me; I understand.’
[photo credit: Scott Griessel/Dreamstime 15860041]