Nicole Deschnes

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Transition Programs for Youth with Emotional and
Behavioral Difficulties

• Nicole Deschênes
• Hewitt B. Rusty Clark
• AMCHP Annual Conference
• Mental Health promoting a New Paradigm for MCH
  Public Health Practice
• February 29, 2004Washington, DC

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Presentation Objectives

• Describe the Challenges faced by Youth in
  Transition
• Describe two Major Transition Initiatives a)
  Transition to Independence Process (TIP) system
  b) Partnerships for Youth Transition (PYT)
  Initiative
• Provide examples of application of the Transition
  to Independence Process model during the
  development and implementation of a transition
  system

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Transition to Adulthood

• A Challenging Time for Young People with
  Emotional or Behavioral Difficulties

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Prevalence of Mental Health Disorders

• 20 of Children have diagnosable Mental Health
  Disorders
• 9-13 have Serious Emotional and/or Behavior
  Disorders Can impair their development and
  functioning at home, in school or in the
  community
• Between 2 million and 6.5 million youth in
  transition in the U.S. are believed to have a
  psychiatric disorder
• Estimated 25 of adolescents are at serious risk
  of not achieving Productive Adulthood
• References
• Friedman, Katz-Leavy, et al., 1996
• National Research Council and Institute of
  Medicine, 2002.

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Comparison of Outcomes in Transition Domains
Between the General Population and Youth with EBD
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Systemic Barriers

• Institutional Boundaries/Discontinuity of
  Services
• Abrupt withdrawal of supports Often based on
  youths age or conflicting eligibility criteria
• Differing philosophies and approaches Children
  Adult Systems
• Differing Communication and Awareness issues
• Inflexibility of Systems
• Lack of coordination across support service
  systems
• Array of Services No Ones Mandated Population
  No Ones Budget
• Under-funding basis of payment for services
  lack of flex funding
• Limited access to the full range of integrated
  required community services

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Path to Adulthood - Systemic Barriers (Contd)

• Inappropriate Support Support not designated to
  meet needs of young adults
• Unfriendly hours of operation
• Waiting lists
• Families have to constantly fight for youth to
  obtain required support (e.g., financial
  assistance, SSI)
• Weak Transition Plans
• Stigma attached to accessing the Mental Health
  System undiagnosed youth segregation
• Need for cultural competency
• Need for transportation

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Major Transition Initiatives

• Transition to Independence Process (TIP) Project
• National Technical Assistance Center on Youth
  Transition

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Transition to Independence Process (TIP) system
Definition

• The Transition to Independence Process (TIP)
  system prepares and supports youth and young
  adults (14-25 years of age) with
  emotional/behavioral difficulties (EBD) in their
  movement into adult roles -- and personal
  functioning and success -- through an
  individualized, developmentally-appropriate
  process. The TIP system is operationalized
  through the TIP system guidelines at the
  practice, program, and system levels for engaging
  and working with these young people and their
  families.

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Guidelines Support the Mission
Mission
Personal Choice and Responsibility
Person- Centered Planning
Enhance Competencies
Involvement At All Levels
Individualized and Encompassing
Safety Net of Support
Outcome Focus
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TIP System Guidelines

• Engage young people through relationship
  development, person-centered planning, and a
  focus on their futures
• Use a strength-based approach
• Facilitate person-centered planning and goal
  setting
• Engage young people in positive activities of
  interest
• Respect cultural and familial values and young
  persons perspectives
• Tailor services and supports to be accessible,
  coordinated, developmentally-appropriate, and
  built on strengths to enable the young people to
  pursue their goals across all transition domains
• Facilitate young persons goal achievements
  across all transition domains
• Tailor services and supports to be
  developmentally-appropriate and built on the
  strengths of the young people
• Ensure that services and supports are accessible
  and coordinated

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Transition Domains
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TIP System Guidelines (Contd)

• Acknowledge and develop personal choice and
  social responsibility with young people
• Encourage problem-solving methods, decision
  making, and evaluation of impact on self and
  others
• Ensure that a safety-net of support is provided
  by a young persons team, parents, or other
  natural supports
• Involve parents and other natural supports
• Assist in mediating differences in the
  perspectives of young people, parents, and other
  natural and formal supports
• Facilitate the team with an unconditional
  commitment to the young person

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TIP System Guidelines (Contd)

• Enhance young persons competencies to assist
  them in achieving greater self-sufficiency and
  confidence
• Utilize assessment methods, e.g., functional
  in-situation assessment
• Teach meaningful skills relevant to the young
  people across transition domains (e.g.,
  self-advocacy, anger management, budgeting,
  self-management of emotional/behavioral
  well-being)
• Use teaching strategies in community settings
• Develop skills related to self-management,
  problem-solving, self-advocacy, and
  self-evaluation of the impact of ones choices
  and actions on self and others
• Maintain an outcome focus in the TIP system at
  the young person, program, and system levels.
•  Focus on a young persons goals and the tracking
  of his/her progress
• Evaluate the responsiveness and effectiveness of
  the TIP system
• Use process measures for continuous TIP system
  improvement

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TIP System Guidelines (Contd)

• Involve young people, parents, and other natural
  and community partners in the TIP system at the
  practice, program, and system levels
• Tap the talents of young adults as peer mentors
  and peer counselors and assist young people in
  creating peer support groups
• Partner with young people, parents, and others in
  the TIP system governance and stewardship
• Advocate for system development, expansion,
  evaluation, and policy reform to support a
  responsive, effective system for young people in
  transition and their families

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Partnerships for Youth Transition (PYT)

• Create partnerships that identify and engage
  resilient young people struggling to overcome
  difficulties
• Engage all relevant partner organizations in
  collaborative strategic planning process
  Development of Theory-Based Logic Model
• Action Plan
• Target Population
• Interventions in the model
• How services will be coordinated
• How and integrated management information system
  will be designed to track important service
  utilization, satisfaction, and outcome variables
  
• Role each partner will play in implementation
• Steps to implement the model
• How cultural competence will be assured during
  implementation
• Funding and policy barriers to overcome
• Steps to overcome policy barriers
• How the model will be funded over 5 years
• What data will be collected for quality
  assurance.

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Partnerships for Youth Transition (PYT)

• Implement the Comprehensive Youth Transition
  Program model.
• Enroll and serve young people per comprehensive
  transition model
• Train staff
• Align resources and coordinating services to
  enable youth to meet their personal, social,
  educational, and other aspirations as they enter
  adulthood
• Execute/renew needed interagency partnerships
• Enhance existing programming to fill gaps
  identified in the model Comprehensive Youth
  Transition Program
• Collect quality assurance data/track outcome data

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Transition Resources
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Please visit our websites athttp//tip.fmhi.
usf.edu http//ntacyt.fmhi.usf.edu