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Transitioning Youth with Mental Health Needs to Meaningful Employment and Independent Living
By Lindsey Woolsey and Judith Katz-Leavy, ODEP (Office of Disability Employment Policy) and NCWD/Youth (National Collaborative on Workforce and Disability for Youth)
This document was developed by the National Collaborative on Workforce and Disability for Youth, funded by a grant/contract/cooperative agreement from the U.S. Department of Labor, Office of Disability Employment Policy (Number #E-9-4-1-0070).
The opinions expressed herein do not necessarily reflect the position or policy of the U.S. Department of Labor. The mention of trade names, commercial products or organizations does not imply the endorsement by the U.S. Department of Labor. The National Collaborative on Workforce and Disability for Youth (NCWD/Youth) is composed of partners with expertise in disability, education, employment, and workforce development issues. NCWD/Youth is housed at the Institute for Educational Leadership in Washington, DC. The Collaborative is charged with assisting state and local workforce development systems in integrating youth with disabilities into their service strategies.
For information on the Collaborative, see http://www.ncwd-youth.info For information on the Office of Disability Employment Policy, see http://www.dol.gov/odep
Individuals may reproduce any part of this document. Please credit the source and support of Federal funds. Suggested citation for this guide: Woolsey, L., & Katz-Leavy, J., (2008). Transitioning Youth With Mental Health Needs to Meaningful Employment & Independent Living, Washington, DC: National Collaborative on Workforce and Disability for Youth, Institute for Educational Leadership. NCWD/Youth publications can be downloaded for free from the web at www.ncwd-youth.info. Hard copies may be purchased by contacting the Collaborative at email@example.com. ISBN 1-933493-24-0 April 2008
This research and report are the result of funding and guidance from the U.S. Department of Labor’s Office of Disability Employment Policy (ODEP). This report has also greatly benefited from the careful direction of Joan Wills and Curtis Richards at the National Collaborative on Workforce and Disability for Youth (NCWD/Youth). Both are committed to quality research and to information and tools that can be readily used by practitioners and policymakers to better serve youth with disabilities. Special thanks is extended to Dr. Maryann Davis, Assistant Professor, Department of Psychiatry, University of Massachusetts Medical School, and to Dr. Judith Cook, Professor and Director, Department of Psychiatry, University of Illinois at Chicago, for their early guidance on promising practices and potential sites for further study.
Thanks also to Mary Podmostko, Senior Project Associate at NCWD/Youth, for her work on Tunnels and Cliffs: A Guide for Workforce Development Practitioners and Policymakers Serving Youth with Mental Health Needs. Said document, co-produced by
NCWD/Youth and ODEP, served as a key source of information and guidance during research and analysis for this report. Additional thanks go to Chris Koyanagi, Policy Director at the Judge David L. Bazelon Center for Mental Health Law, and to Diane Sondheimer, Deputy Chief of the Child, Adolescent, and Family Branch, Center for Mental Health Services in the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA), for their encouragement and recommendations throughout the course of this study. Finally, gratitude must be extended to the staff members, youth, and family clients at the five contributing program sites who so generously gave their time and insights, and who share a passion for identifying (often through much trial and error), improving, and replicating practices that will help transitioning youth with mental health needs enter the workplace and lead independent and fulfilling live
The National Collaborative on Workforce and Disability for Youth (NCWD/Youth) and the researchers/authors of this report carried out its study and writing as part of a series of research activities on successful strategies for assisting youth with mental health needs as they transition to postsecondary education, employment, and independent lives.
Transitioning into adulthood is challenging for everyone. “Becoming an adult” typically demands a complex set of decisions and steps that an individual has never encountered before: leaving home; living independently; enrolling and succeeding in school; getting to and from home, school, and work; budgeting resources for basic necessities and recreation; making job and career choices; finding a place to live; and developing social and personal relationships. Every decision requires making one choice over another. For most young adults, this process relies on direction and support from family members or other caring adults, mentors, social networks, and other support systems. For the more than three million young adults diagnosed with serious mental health conditions, however, these choices can be enormously challenging.1 Many experience higher than average academic, social, and employment failure. Although the precise clinical origins of their emotional disturbances can remain complicated and enigmatic, some promising approaches to reversing these negative trends are emerging.
The National Collaborative on Workforce and Disability for Youth (NCWD/Youth) and the researchers/authors of this report carried out its study and writing as part of a series of research activities on successful strategies for assisting youth with mental health needs as they transition to postsecondary education, employment, and independent lives. Funding came from the Office of Disability Employment Policy (ODEP) in the U.S. Department of Labor. The report presents the findings from case studies of five promising program improve transition outcomes, look at young adult needs holistically, and incorporate strong career preparation and employment components sites, selected from a national scan of the field, and identifies program design features that appear to improve transition outcomes, look at young adult needs holistically, and incorporate strong career preparation and employment components.
This report uses the term “youth and young adults with mental health needs” to describe the population served by the programs highlighted in this study, in accordance with Tunnels and Cliffs: A Guide for Workforce Development Practitioners and Policymakers Serving Youth with Mental Health Needs, co-produced by NCWD/Youth and ODEP in 2006.2 This term refers broadly to youth and young adults who have been diagnosed with serious mental health conditions and those who have such needs but have no formal diagnoses. According to the Diagnostic and Statistical Manual of Mental Disorders,3 which four of the five programs use to determine eligibility for services, “psychiatric disabilities” include a wide range of diagnoses – from schizophrenia to learning disorders. Because the researchers did not want to limit the discovery of promising practices based on a narrow definition of the target population, the degree and severity of mental health conditions or needs were not criteria utilized for this study
It is the hope and intention of ODEP and NCWD/Youth that this report will add to the burgeoning body of knowledge around practices and policies that most effectively support youth and young adults with mental health conditions to leading independent and productive lives, gain access to the services and supports they need, make choices about work and career opportunities, build strong connections to their communities, and develop meaningful relationships.
…Integration into society, including the workplace, is key to the recovery process.
Many youth with diagnosed mental health needs experience poor transition outcomes. It is estimated that up to 50 percent of incarcerated youth and young adults have an emotional disturbance, up to 20 percent have a serious emotional disturbance, and at least 10 percent have a specific learning disability.4 Sixty-five percent will drop out of school before obtaining their high school diploma.5 In comparison to other youth who drop out of high school, youth with emotional disturbances are three times as likely to live in poverty.6 They experience longer delays before obtaining employment, and have higher unemployment rates than youth with other types of disabilities who overall exhibit bleak unemployment rates of over 60 percent.
Against this dreary backdrop, historical changes in the treatment of mental illness overall – including deinstitutionalization, community mental health services, and new developments in psychotropic medications – have productively informed the field in two critical ways: (1) Recovery is possible, and (2) Integration into society, including the workplace, is key to the recovery process. Promising interventions continue to emerge, resulting in the creation and implementation of recovery models that minimize and reverse negative outcomes. This includes interventions/practices that recognize youth with mental health needs are not the same as adults and, therefore, that their treatment should be youth oriented. The programs described in this report operate under this premise and have tailored their models to support youth in transition.
The researchers undertook a national scan of programs that indicated a dual focus on youth and young adults with mental health needs and on career preparation, work-based experiences, employment, and related services. The scan relied on input from knowledgeable sources in the fields of mental health intervention, education and training, and workforce development. During telephone interviews with promising program sites, five programs were selected for further study, which included site visits and structured interviews with mental health staff; education, training, and employment staff; case managers; youth and family members. These five programs are:
• The Village Integrated Service Agency’s Transitional Age Youth program in Long Beach, California;
• Options in Vancouver, Washington;
• Our Town Integrated Service Agency in Indianapolis, Indiana;
• The Transitional Community Treatment Team in Columbus, Ohio;
• YouthSource in Renton, Washington.
During these site visits, a collection of common design features emerged, which are described in detail in Part II of this report, Addressing Individual Barriers: What Works at Service Delivery. The highlighted design features address commonly cited challenges to successful transition by youth with mental health needs, including the stigma of traditional mental health therapy; feelings of low self-esteem and lack of self-worth; a lack of ownership by youth over their own life plans; low expectations by society on the ability of youth to succeed; traditional work-exposure and employment models that do not maximize individual strengths; and a lack of appropriate transitional housing in the community. The features addressing these challenges that were common across programs in the study include the following: (1) Program locations that are distinct and separate from adult service program locations; (2) Staffing choices that promote engagement of youth and young adults; (3) Individualized mental health interventions that are youth-friendly and innovative, assisting youth/young adults in managing their conditions, engaging in social relationships, identifying life goals, and understanding their choices for achieving those goals; (4) Assessment and service planning processes that facilitate the identification of individual strengths, talents, and skills that can lead to education and career goals; (5) Exposure to the world of work and career options, including individualized support by program staff to identify training, work-based experiences, and jobs that are most appropriate and rewarding for individual clients; and (6) Access to a range of transitional housing options in the community that fit the individual’s readiness to live independently.
Part III of the report, Systems Factors that Affect Program Design and Sustainability, presents systems-level factors that affect success at the service delivery and individual outcome levels. Three themes emerged from the programs in this research.
First, successful programs actively seek out partnerships with service agencies and organizations in their community to provide the comprehensive array of services needed by youth and young adults with mental health needs. These partnerships can be informal, but are most successful when formalized by memoranda of understanding and supported by formal community governance structures (e.g., advisory bodies). Formalized partnerships address service gaps, allow collaborative identification of appropriate services, and create the possibility of seamless care.
The second theme is the ability of programs to identify, access, and leverage funding streams to enhance and expand program services. This includes private funding sources and “reimagined” public funding sources from local, state, and Federal levels. Finally, the third theme that emerged is state-level capacity to promote systems change to the benefit of the population of transition-age youth with mental health needs. States have the authority to pass legislation, target funding, more effectively utilize Medicaid funding and service options, and develop statewide coordination plans that seek to improve connections to schools and other delivery systems that help prepare youth for the world of work.
Formalized partnerships address service gaps, allow collaborative identification of appropriate services, and create the possibility of seamless care.
The service delivery and systems-level themes highlighted in this report are intended to add to the growing body of knowledge about what can be done to assist transitioning youth and young adults with mental health needs in becoming self-sufficient adults who live independently and experience work and career success. Toward that goal, Part IV of the report includes recommendations for programs, staff members, and policymakers.
Recommendations for Programs and Staff
• Incorporate youth “voices” into the development and implementation of program service and policy to improve client engagement, participation, and individual ability to utilize the learning, services, and opportunities offered.
• Utilize a successful process that identifies individual strengths or “gifts” as the stepping stone to the development of education, career, and life goals, and the gateway to discovery and hope.
• Invest the time and resources required to build partnerships across relevant services and systems in the community.
• Incorporate on-site and “non-traditional” approaches to mental health interventions that work with youth and young adults at their own pace and in a highly individualized, youth friendly way.
• Train all program staff (not just the career developers) how to individualize exposure to the world of work and to incorporate activities that meet youth and young adults “where they’re at” across all phases of employment, including training and preparing for work, getting hired, retaining jobs, and advancing to better jobs and careers.
• Cultivate relationships with employers in the program’s community to assist them in seeing the benefits of hiring program clients and create open lines of communication between program staff, the client, and the employer.
• Be the mentor, family member, parent, teacher, or other positive influence that may be missing from the life of the youth/young adult client by teaching independent living skills and positive social engagement in daily activities.
• Understand the Federal and state laws and regulations that affect the program’s services and funding. It’s important to find out whether information that is accepted as “common knowledge” is an actual Federal or state requirement or simply information that’s been passed on anecdotally.
• Tailor and test Assertive Community Treatment (ACT) and Systems of Care models that target youth with mental health needs.
Recommendations for State and Federal Policy Makers
• Scale up staff capacity in workforce development, including those in the K-16 education system, to effectively work with all youth and young adults, including those with mental health needs.
• Design and fund more pilot and demonstration projects that implement and evaluate promising practices to support youth and young adults with mental health needs in their transitions into work, industry-relevant education, fulfilling careers, and independent living.
• Create a task force to explore and address the linkages between significant, but currently disconnected, policy issues impacting youth in their transition to adulthood and the world of work.
• Explore state codification of models for serving youth and young adults with mental health needs.
• Create model Medicaid waivers for states to use that will cover an array of services for youth and young adults with mental health need
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