“ Helping Youth with Mental Health Issues in Transition "

1. “Helping Youth with Mental Health Issues in Transition " Presented by: Mark Kroner LISW-S Trainer and Consultant Cincinnati, Ohio 513-284-7779 markjkroner@yahoo.com

2. 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?

3. 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?

4. Transition Issues of all Youth • 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

5. 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

6. 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! • 2013 markjkroner

7. 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”

8. 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

9. 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

10. 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.

11. A Key Issue: • No one system or agency is responsible for youth with mental health issues transitioning into adulthood.

12. What is the “normal” transition process today?

13. 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?

14. The impact of trauma looks a lot likemental health symptoms: Depression Suicide attempts Alcoholism Drug abuse Promiscuity Domestic violence Smoking Obesity School problems Work problems Relationship problems Crime Eating disorders Sleep disorders • National Child Traumatic Stress Network www.NCTSNet.org

15. 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

16. Complex Developmental Traumacan lead to: • Difficulty regulating emotions • Impulsive decision making • Risky behaviors • Feelings of low self-worth • Problems with boundaries • Inability to trust

17. 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

18. Great Resource: • National Center for Trauma-Informed Care66 Canal Center PlazaSuite 302Alexandria, VA 22314 • Telephone: 866-254-4819Fax: 703-548-9517 • NCTIC@NASMHPD.org

19. “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?”

20. 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

21. Developing a System of Care • Child Welfare • Juvenile Justice • Developmental Disabilities • Mental Health; Adolescent and Adult systems • Provider agencies • Workforce development • Education

22. Evidence Based practices • Transition to independence Process (TIP) • Assertive Community Treatment (ACT) • Enhanced Wrap-around • Seven Challenges • Supported employment

23. Case examples • Nick: Step down and wrap around • Lawrence: bring him in • Tina: overlap of CW and MH services • Danielle: second chances/aftercare

24. 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.

25. 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

26. 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.

27. 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.

28. 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.

29. 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.

30. 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.

31. Complicating Factors • System changes • Case-worker changes • Placement/care-giver changes • Youth changes • Age • Loss of place to stay • Legal entanglements

32. 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

33. 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.

34. What to do when a participant is “stuck” • Bring youth and treatment team together • Revise treatment goals • Change living arrangement • Change case-managers/social workers • Change level of involvement • Change medications/dosages • Change/add therapists/groups • Add a mentor/life coach • Make a contract • Make specific discharge plans • Call another meeting

35. 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

36. Useful Publications • “Transition to Adulthood: A Resource for Assisting Young People with Emotional or Behavioral Difficulties” Brookes Publishing Co. • “On their Own without a Net: The Transition to Adulthood for Vulnerable Populations” University of Chicago Press. • “Housing Options for Independent Living Programs” Available at or 202-662-4278 or www.CWLA.org • “Moving In: Ten Successful IL/TL Program Models” Available at Northwest Media 800-777-6636 or www.northwestmedia.com • “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 • “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 • “Operation Independence: Individual and group life skills training activities” National Resource Center 918-660-3700 www.nrcys.ou.edu

37. 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