Transcript Slide 1

“Helping Youth with Mental Health
Issues in Transition "
Presented by:
Mark Kroner LISW-S
Trainer and Consultant
Cincinnati, Ohio
513-284-7779
[email protected]
A Practical Perspective
• Highly trained clinicians and psychiatrists often
spend 60 minutes or less time with youth with
mental health issues during a typical week; much less
than caseworkers, IL/TLP workers, foster parents and
group care staff.
• So what do we do in between the office visits?
So, what can we do to help youth with mental health
issues to move toward self-sufficiency?
 Is it even possible? Can they ever be totally self-sufficient?
 How long should it take?
 Who is responsible for making it happen?
 What will it cost?
 Who will pay for it?
 What will it cost if we don’t do it?
Transition Issues of all Youth
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Waiting for brain to finish developing
Learning from peers
Actively moving away from parents/adults
Experimentation/forming an identity
Figuring out the job thing
All about relationships/sex
Anxiety about what is next
Needs of youth with mental health issues
during their transitional years:
--------------------------------------------------__Life skills training for youth and parents
__Education about their mental health issues
__Support from parents/care providers
__Medication management
__Case-management/continuity of case-managers
__Opportunities to put life skills to use
__For some, a peer support group
__For some, mentors, tutors, job coaches
__Housing for older youth who are leaving home or aging out
__After care for unlimited time
__Many opportunities to “fail” safely and return for help
The 10 Key Elements of Effective Transition Services**
1. Education and development of entire system
2. Stable sources of funding
3. Getting entire system involved in the transition process
4. Life Skills assessments and training
5. Social support development/permanency
6. Employment and Educational support
7. Real life experience
8. Most appropriate living arrangements
9. Addressing of special needs
10. Aftercare
**And a well-paid case-manager to make it all work!
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How does Mental Health impact Transition?
• Fear of the unknown provokes anxiety and mood
swings
• Fear of success- “If I do well, they kick me out!”
• Trust issues everywhere-new “strangers” to deal
with. Forced to deal with new people and situations
• Loss of current care-providers and movement into
the “adult system”
How does MH impact Transition?
• Executive functions (planning, organizing, problem
solving) are clouded by emotions and anxiety
• Money is spent to calm emotions (ex., drugs,
shopping, binge eating, drinking)
• Time is spent more on emotions than important
tasks
• Memory and attention are blocked
• Brain is not yet fully developed to plan ahead and
pull everything together
How does mental health impact Transition? Cont’d
• Emotions cloud decision making- much energy
is spent acting to calm emotions vs. acting to
take care of business
• Anxiety leads to social isolation at a time
when youth needs to make new connections
• Forced change vs. natural changes
How does MH impact Transition? Cont’d
• Can lead to sabotage as youth feels that he is not ready
• For foster youth, transition process brings up family grief
issues again
• Youth are forced to deal with things before they are ready,
while their peers enjoy a longer adolescence.
A Key Issue:
• No one system or agency is
responsible for youth with mental
health issues transitioning into
adulthood.
What is the “normal”
transition process today?
Important questions:
• Is it mental illness or trauma?
• Is it mental illness or reaction to family chaos?
• Is the given diagnosis still true after stable
placement?
• Are medications correct?
The impact of trauma looks a lot like
mental health symptoms:
Depression
Suicide attempts
Alcoholism
Drug abuse
Promiscuity
Domestic violence
Smoking
Obesity
School problems
Work problems
Relationship problems
Crime
Eating disorders
Sleep disorders
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National Child Traumatic Stress Network
www.NCTSNet.org
Complex Developmental Trauma and its
impact on mental Health
*A
history of multiple chronic
traumatic events throughout the
life of a child or youth.
• National Child Traumatic Stress Network
www.NCTSNet.org
Complex Developmental Trauma
can lead to:
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Difficulty regulating emotions
Impulsive decision making
Risky behaviors
Feelings of low self-worth
Problems with boundaries
Inability to trust
Complex Developmental Trauma-cont’d
Can lead to:
• Problems seeing other people’s perspectives
• An inability to maintain attention
• A sense of hopelessness
• Chronic anxiety
• Emotional numbing or withdrawal
• Physical ailments
• An inability to integrate information
National Child Traumatic Stress Network
www.NCTSNet.org
Great Resource:
• National Center for Trauma-Informed Care
66 Canal Center Plaza
Suite 302
Alexandria, VA 22314
• Telephone: 866-254-4819
Fax: 703-548-9517
• [email protected]
“Trauma-informed” Programming
• Trauma informed care treats youth in a way that
is understanding of their traumatic experiences
rather than focusing on their current
“inappropriate” (possibly the most overused
word in the field of youth care work) behavior.
• It is a philosophy that involves asking youth
“What happened to you?” versus “What’s wrong
with you?” or “Why do you continue to behave
this way?”
Task Number 1: Teaching youth how and when
to ask for help
• Discuss effective ways to ask for help
• Rehearse/role-play how to ask for help
• Explore clients’ experiences of asking for help, i.e.
were people willing to help, were they rejected, etc
• Look at cultural issues/connections
Developing a System of Care
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Child Welfare
Juvenile Justice
Developmental Disabilities
Mental Health; Adolescent and Adult systems
Provider agencies
Workforce development
Education
Evidence Based practices
• Transition to independence Process (TIP)
• Assertive Community Treatment (ACT)
• Enhanced Wrap-around
• Seven Challenges
• Supported employment
Case examples
• Nick: Step down and wrap around
• Lawrence: bring him in
• Tina: overlap of CW and MH services
• Danielle: second chances/aftercare
The Basics of Working with Youth in
Transition with Mental Health Issues
1. Learn the diagnosis and its implications for you in terms of
Living arrangement, staffing, back up plans, medication,
monitoring, after hour’s involvement, other care-providers etc.
2. Increase client self-awareness about diagnosis: teach cognitive
restructuring to re-define feelings and events
3. Engage other MH system providers early: make connections with
the adult Mental Health system.
4. Expect challenges and setbacks. Develop patience, tolerance
and humor.
The Basics cont’d…
5. Expect self-sabotage
6. Increase self-awareness: Help youth know stressors and triggers.
7. Maintain a “housing first” approach-help youth maintain
housing of some sort. Develop a continuum that includes
supervised and unsupervised living arrangements.
8. Teach self-help (readings, crisis hotlines, soup kitchens/food
banks, natural supports, relaxation).
9. Let youth know limits of program and staff.
Allow natural consequences if possible
The Basics cont’d…
10. Teach follow-through strategies, planning and
documentation retention
11. Develop programming one client at a time. Avoid policies
that lead to a high early discharge rate.
12. Focus on gains and strengths.
13. Teach self-acceptance and help youth develop a sense of
humor.
14. Take a long-range approach.
The Basics cont’d...
15. Plan on spending more “processing” time with
these youth or find someone else to help.
16. Plan on increased monitoring and supervision
time.
17. Assess for suicide potential.
18. Monitor meds, teach realities of self-medicating.
19. Have back up plans in place.
20. Connect with support groups/mentors.
The Basics cont’d…
21. Seek out supervision for yourself.
22. Connect with doable jobs and educational
programs.
23. Teach life skills individually.
24. Work on social skills, hygiene and presentation issues.
25. Allow for “AWOL” youth to return.
Indicators of Success for Youth with MH Issues
This youth…
 Left the system with potential long-term living arrangement.
 Increased his/her score on written information test.
 Increased score on behavioral checklist.
 Improved communication with the adult world.
 Has better awareness of family strengths and limitations.
 Has decreased delinquent behavior.
 Has decreased substance abuse.
 Achieved an educational goal.
 Gained work experience.
Indicators of Success for Youth with MH Issues-cont’d
 Is better able to express feelings and ask for help.
 Expresses improved mental health.
 Benefited from group attendance/participation improved.
 Has better awareness of his/her strengths and limitations.
 Takes more responsibility for her/his life situation.
 Is more assertive/less passive.
 Responded to therapy-Knows that s/he can’t make it alone.
 Detaches from unhealthy peers/relatives.
Complicating Factors
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System changes
Case-worker changes
Placement/care-giver changes
Youth changes
Age
Loss of place to stay
Legal entanglements
Cultural Issues
• How do they impact the transition process?
• How do they impact a youth’s expectations about the
future?
• How do they impact housing, job, education?
• How do they impact your thinking?
• How do they impact your staff-client relationships
The “Housing First” concept
• Independent Living without housing is like
driver’s training without a real car.
• For youth with mental health issues,
maintaining stable housing can be more
important than maintaining stable treatment.
What to do when a participant is “stuck”
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Bring youth and treatment team together
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Revise treatment goals
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Change living arrangement
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Change case-managers/social workers
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Change level of involvement
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Change medications/dosages
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Change/add therapists/groups
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Add a mentor/life coach
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Make a contract
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Make specific discharge plans
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Call another meeting
Lessons learned
• Results are often delayed
• For many youth we are their first stable adults
• All American youth have a sense of entitlement that must be
challenged
• Everything works for somebody, nothing works for everybody
• Some youth will sabotage success
• Second chances can make a difference
Useful Publications
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“Transition to Adulthood: A Resource for Assisting Young People with Emotional or Behavioral
Difficulties”
Brookes Publishing Co.
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“On their Own without a Net: The Transition to Adulthood for Vulnerable Populations”
University of Chicago Press.
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“Housing Options for Independent Living Programs”
Available at or 202-662-4278 or www.CWLA.org
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“Moving In: Ten Successful IL/TL Program Models”
Available at Northwest Media 800-777-6636 or www.northwestmedia.com
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“A Future Near Me: Questions to guide a young adult’s journey to self-sufficiency”
National Resource Center for Youth Services 918-660-3700 www.nrcys.ou.edu
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“A Path Near Me: Questions to guide a young Native American journey to the future”
National Resource Center for Youth Services 918-660-3700 www.nrcys.ou.edu
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“Operation Independence: Individual and group life skills training activities”
National Resource Center 918-660-3700 www.nrcys.ou.edu
Helpful Websites
• SAMSA’s Mental Health Information Center
http://www.mentalhealth.org
• http://www.tapartnership.org/COP/transitionAgedYouth/
• National Alliance for the Mentally Ill (NAMI) Special Support
Center www.nami.org
• www.mental-health-matters.com
• www.pathprogram.samhsa.gov
• www.mentalhelp.net
• National Empowerment Center www.nec.org
• http://www.ohr.psu.edu/HealthMatters/Links.cfm#children