Improving Transitional Services for Young People with Mental Health Disorders

Like many other young people his age, eighteen-year-old Michael Rowat is headed to college this fall.

Diagnosed at age 14, Michael started receiving psychiatric treatment through the Massachusetts Department of Mental Health and was placed at the Merrimack Education Collaborative, an alternative school for young people with social and emotional disorders. While these state-sponsored services may have addressed his mental health needs, they failed to focus adequately on helping Michael plan for his future.

“ Michael got very little help from the system to prepare him for college,” said Carol Rowat, Michael’s mother. “He wasn’t given college admissions tests on time, and he wasn’t given any guidance on selecting or applying for schools. They seem to assume that college is not an option for these kids. In Michael’s case, that’s not true.”

Michael is lucky to have two devoted parents who quickly learned to navigate the bureaucracy and ensure his needs were met. Many youth with serious emotional or behavioral disturbances are not so fortunate. They spend much of their adolescence in the care of public systems—foster care, residential treatment, special education, or juvenile justice—and reach adulthood without achieving critical developmental milestones that would enable them to transition into productive adult life. Outcomes are poor for this population and include high rates of high school dropout, unemployment, alcohol and drug addiction, and homelessness. At the most basic level, these youth enter adulthood not only with a serious mental illness, but also lacking such basic skills as riding the subway or managing a bank account.

What can state systems of mental health and special education do to better prepare these vulnerable young people for adulthood? In most states, young people “age out” of youth services as soon as they turn 18 and are either unprepared for adult services or are placed on lengthy waiting lists. While many state agencies offer transitional programs such as vocational training or life skills education, these services are not only too fragmented and uncoordinated to meet young people’s needs, they are also designed for older adults with more life experience.

Aware of the problem and looking for a way to solve it, the New York State Office of Mental Health (OMH) commissioned Health and Human Development Programs (HHD), a division of Education Development Center, Inc., to conduct an assessment of the state’s transition services, and to make recommendations for steps New York State could take to create a more effective system, based on research and promising programs around the country.

“We felt that we really needed to do a better job of providing our youth with vocational skills and training and facilitating the transition from adolescence to adulthood,” said Marcia Fazio, deputy director of OMH’s Bureau of Children and Families. “Systems tend to be very fragmented. In our state we serve youth up to age 18, and from there they go into the adult system. Most kids are not ready for that. We want to build a better system of transition for them so there are alternatives out there that meet their needs.”

To assist New York State, HHD conducted a literature and program review of effective transition systems. Using the Transition to Independence (TIP) model developed by Dr. Hewett (Rusty) Clark, a research professor at the University of South Florida, as well as information gathered from programs in New York and other states, HHD was able to identify critical characteristics of effective transition systems for youth. HHD then compared these criteria to New York’s existing services and developed a series of recommendations for improvement tailored to the state’s resources and infrastructure.

The final report, delivered to New York State in March 2003, highlights three areas for improvement: (1) strengthening the youth voice in transition planning; (2) improving state and local infrastructure planning; and (3) collaborating with state education, children and family services, and alcohol and substance abuse agencies on these issues.

Evelyn Frankford, senior project director at HHD and co-author of the final report, plans to conduct similar analyses for other state’s mental health transition programs. Before coming to HHD, Frankford worked extensively in New York State with state agencies and the legislature to improve mental health services for children and youth. “Each state has a different infrastructure or point of entry into mental health services,” said Frankford. “Our recommendations focus on building from what already exists. Most states already have some transitional services in place, such as vocational training, youth employment programs, or housing supports. What’s needed is better coordination. We can help states build from what they have and make important connections to begin to create a system.”

New York’s OMH has already taken action as a result of the study. “We have formed an internal work group of specialists, looking at how we can take the findings of the report and move them ahead,” said Fazio. “We are starting with our own vocational system, examining where the money is being spent and how we can free up some resources to fund localities to do planning for vocational services.”

Characteristics of Effective Transition Systems

1. Emphasize strength-based services and supports that help adolescents acquire skills in the key life domains of education, employment, community living, and managing relationships

2. Are youth-focused, embracing commitments to building personal supports around the individual youth’s needs and goals and involving youth in policy development and service system design. These systems work to help youth manage and improve relationships with families, peers, and community institutions.

3. Embed specific interventions in a comprehensive, coordinated approach that provides continuity over time.

A critical part of HHD’s assessment was listening to young people. Frankford and her team conducted youth focus groups and made site visits to talk to youth in residential facilities. “We wanted to hear from youth about their hopes and interests, and about the ways in which they believe services could be more helpful to them,” said Frankford. “One of the things they told us, for example, is that they want independent housing with supports. We were able to improve our recommendations to the state by listening to the young people’s concerns and needs.”

“Young people with emotional and behavioral disorders feel acute pain. They want to be like other people their age, and they suffer greatly over the differences,” continued Frankford.

The Rowat family concurs with the need for a strong youth voice during the transition period. “One of the main problems is that the individual child’s needs are often considered last,” said Carol Rowat. “There’s too little focus on the individual and too much focus on the system.”

The Rowats recently met with state officials to prepare for Michael’s transition out of youth mental health services. The meetings left Michael disappointed. “They hardly seemed to listen. They seem to think youth have no sense of what’s really important,” said Michael.

Voices like Michael’s may ultimately make the difference, however.

“States are waking up to the fact that there is a need for transition services. Advocates and clients have a responsibility to speak out and help states shape better services and supports for this population,” said Frankford.