Building a Developmentally Tailored Mental Health Program for Transition Age Youth Success

In Chicago, the Thresholds Young Adult Program (YAP) is designing and evaluating innovative approaches to supporting the success of young people (ages 16 to 21) with serious mental health conditions. The majority of these young adults possess histories of trauma, hospitalizations, multiple living situations (e.g., group homes, residential treatment facilities, foster families), court involvement, and poor engagement in work and school. Over half are under the custody of the state of Illinois. Most remain in YAP services until they are 21 and emancipated from the child welfare system or when they graduate from high school and are no longer funded by the Individual Care Grant program.

At YAP, young people live in 24-hour supported group homes or community apartments and receive services to develop independent living skills and manage mental health. These young people face the transition out of supported care at the same time that they are facing the transition to adulthood. Many have cited the immense disconnect between child and adult community mental health services, but research conducted by the Thresholds-Dartmouth Research Center in Chicago finds these youth face additional barriers due to fragmented social support networks, difficulty in coming to terms with mental illness, substantial financial hardship, homelessness, and continued struggles with school and work.

Focusing solely on management of mental health and stability is not sufficient in supporting the transition to adulthood. In the last 6 years, YAP has further developed its clinical, vocational, and transitional services to better address this population’s needs. YAP adopted the Transition to Independence Process (TIP) Model that focuses on empowering young people to engage in “transition” planning and goal formation with a transition coordinator and a diverse team of supportive adults (Clark, 2008). YAP employs a transition coordinator to support connections with appropriate housing and adult services before program discharge.

To support emotional and behavioral regulation (and to prevent crisis situations), staff are continually trained in Therapeutic Crisis Intervention (TCI) and an adapted-Dialectical Behavior Therapy (DBT) model. DBT is offered through weekly individual therapy sessions and skills groups, and the primary tenants of DBT (e.g. young people are doing the best that they can in this moment) are reinforced for all young people at YAP. YAP focuses on fostering relationships that will last beyond YAP by hosting quarterly events for young people and their families; training staff on family engagement; offering family and couples therapy; and including social support as an important treatment goal.

YAP implemented employment services based on the effective IPS-model for adults with serious psychiatric disabilities (Bond, Drake, & Becker, 2008) and later paired up with UMASS Center for Learning and Working During the Transition to Adulthood and the Thresholds-Dartmouth Research Center to redesign and evaluate vocational services at YAP. In addition to employment specialists, new roles of education specialists and peer mentors were developed to support young people in exploring part time jobs, taking college courses, and starting career planning. Peer mentors support young peoples’ engagement with the vocational specialists through sharing their own struggles and successes with mental illness, work, and school.

There are currently no evidence-based practices specifically for this population, but YAP continues to adapt evidence-based practices to meet the unique developmental needs of transition age youth. With the changes in YAP programming, significant changes in program culture, practice, and youth outcomes were observed. Now, treatment planning includes planning for the future beyond discharge with the goal of reaching one’s highest level of self-sufficiency. Young people “launch” into the community with YAP support before their planned discharge date, providing a chance to live independently, engage with both youth and adult mental health service providers, and build community relationships. The adapted supported employment/education model was found to positively impact employment and enrollment into post-secondary education, leading to sustained employment and education post-discharge.

Because YAP is part of Thresholds Psychiatric Rehabilitation Centers in Chicago, which serves thousands of adults each year, Thresholds has the rare opportunity to develop services to address the gap between child and adult mental health systems. Best-practices will emerge from this progressive organization’s willingness to implement, adapt, and evaluate evidence-based approaches to support the transition to adulthood for young people with serious mental health conditions.