How Young Adults with Serious Mental Health Diagnoses Navigate Poverty Post-emancipation: The Complex Roles of Community Mental Health Services & Informal Social Support.

Serious mental health diagnoses are prevalent among youth who "age out" of foster care by reaching the maximum age for child welfare service eligibility. Post-emancipation, little is known about how youth engage in community mental health services, or leverage informal social networks, to navigate independence. Twenty emancipating youth completed three interviews over 16 months. All emancipated into poverty; most lived alone and initially connected to adult community mental health teams. Four service use and informal support profiles emerged from analysis: (1) Navigators (n = 2) actively used mental health services and provided limited informal support; Treaders (n = 9) passively used mental health services and heavily exchanged informal support; Survivors (n = 5) used mental health services when in crisis and heavily provided informal support; and Strugglers (n = 4) avoided mental health services and took resources from informal connections. Findings have implications for both child and adult mental health and social service providers.

Evaluating and sustaining Coordinated Specialty Care for a recent onset of psychosis in non-academic-affiliated community mental healthcare settings.

PURPOSE: To improve sustainability of Coordinated Specialty Care (CSC) for a recent onset of psychosis, a better understanding is needed regarding how non-academic-affiliated community mental health centers blend CSC service elements and select key performance metrics to evaluate their approach. METHODS: A quality and evaluation team embedded within a large community mental health center partnered with CSC site leadership to implement CSC and design a program evaluation strategy informed by CSC research literature. Clinical, family, vocational, and psychiatry services participation, exits, key performance indicators, and standardized measures were examined for participants (n = 47) enrolled for 12-months. RESULTS: Mean service participation was 55 h (SD = 23.5) in the first 12-months (approximately 4.70 h/month). All participated in clinical; 87% in psychiatry; 67% in vocational; and 57% in family services. Sixty-one percent had planned service exits; 39% had unplanned exits. Across the 12-months, 83% were employed or in school; 72% were not psychiatric hospitalized. CONCLUSIONS: CSC participation and outcomes were similar to the limited research examining both together. Understanding service participation and provider adjustments to sustain CSC is critical in community mental healthcare settings that rely on fee-for-service billing mechanisms. Findings have implications for national CSC data harmonization and sustainability efforts.

Developing a community-based multidisciplinary service exit typology for young adults with serious mental health conditions.

Objective: Increasingly, community mental health providers are implementing multidisciplinary treatment models blending child and adult evidence-based practices to boost young adult engagement. Although promising, limited research examines how and why young adults disengage from these new models. This study examines provider documentation of treatment discharges to create a more developmentally-attuned young adult service exit typology. Method: Service records of 18-25 year-olds (n = 124) who discharged from a young adult-tailored multidisciplinary treatment team over a 5-year period were analyzed. A research team conducted a systematic content analysis of discharge forms and service notes. Planned and unplanned exits emerged as primary categories, each having distinct subcategories with noted prevalent associated experiences. Results: Participants (n = 124) were enrolled between 7 days to 3.80 years (M = 11.41 months) prior to exit. Those with "planned" exits (n = 71) were enrolled longer than those with "unplanned" exits (n = 53), means respectively 13.17 versus 9.06 months. Planned exits included: transitions either to a lower, similar or higher level of care, a return to previous provider, or insurance issues. Moving outside team geographic area contributed to planned and unplanned exits. Unplanned exits were disproportionately found among participants who were Black, had justice involvement histories, and/or experienced housing instability or homelessness. Conclusions and Implications for Practice: Young adult service exits are complex; planned exits are not always positive and unplanned exits are not always negative. Provider and research use of this new service exit typology has particular implications for identifying engagement disparities-and further tailoring models to be more attractive, culturally responsive, and impactful with young adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Meeting the Developmental Needs of Young Adults Diagnosed with Serious Mental Health Challenges: the Emerge Model.

Adult providers struggle to engage 18-25-year olds despite high rates of serious mental health challenges observed among this age group. A new model, called "Emerge," combines the intensive outreach and multidisciplinary team-based approach used in Assertive Community Treatment with Positive Youth Development principles and practices used in the Transition to Independence Process Model. Emerge bridges youth and adult services, focuses on supporting transition-to-adulthood milestone achievement, and is a sister team to Coordinated Specialty Care for recent psychosis onset. This paper describes Emerge components, practices, and findings from a feasibility pilot study using agency administrative data. Most prevalent goals were employment and social support/relationship related. The majority made progress on individual goals, engaged in employment and education, and experienced decreased psychiatric hospitalizations. Community mental health policy and practice implications are discussed, including funding blending of evidence-based practices for those transitioning to adulthood with youth-onset serious mental health conditions.

Implementing Adapted Individual Placement and Support (IPS) Supported Employment for Transition-Age Youth in Texas.

Transition-age youth (TAY, ages 14-26) diagnosed with serious mental health conditions are at high risk for vocational struggles. This paper examines the implementation and process evaluation of Individual Placement and Support (IPS) and Supported Employment enhanced to better meet developmental needs of TAY. Enhancements include the integration of a TAY development focus, engagement best-practices, Supported Education and Peer Support. Community mental health providers participated in a process evaluation to explore the feasibility of a larger scale implementation. Common organizational barriers were encountered across provider sites including: leadership support, agency structures and funding mechanisms; compounded by the complexity of bridging child and adult systems. Findings have implications for both child and adult community mental health providers as they adapt and integrate programming for TAY.

Developing quality assurance practices and measures for implementing and sustaining the Transition to Independence Process (TIP) model.

OBJECTIVE: For interventions, like the Transition to Independence Process (TIP) Model, to be implemented effectively, efficient and accessible quality assurance tools are needed. The purpose of this article is to describe the process of developing an online staff self-report quality assurance tool for a key process in the TIP Model: the TIP Solution Review (TSR) and to provide data on the acceptability and perceived impact of both the measure and the TSR process. METHOD: We used an iterative approach to pilot test and seek feedback from multidisciplinary teams trained in TIP. Initially, a team of 7 completed the online TSR Quality Assurance Scale, followed by a focus group. The tool was refined and administered to three additional TIP Model trained teams (n = 23 practitioners) in 3 different states. Team supervisors (n = 3) were then interviewed about their perceptions of the TSR process and the new tool. Thematic analyses were conducted on open-ended survey questions and interview and focus group responses. RESULTS: Findings suggest the new tool and TSR processes are acceptable and feasible. Staff feedback provided for further TSR process refinement. Conclusions and Implications for Clinical Practice: The process of developing, refining and evaluating a tool to capture the TSR (an important TIP quality improvement process) led to increased TSR process specification. Findings have implications for systematically guiding how intervention developers structure supervision and preparation of intervention planning and delivery. Future research will more rigorously test the tool to establish its empirical properties and effectiveness in assessing adherence to TSR procedures. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Adapting supported employment for emerging adults with serious mental health conditions.

Effective services are needed to assist young people with serious mental health conditions to successfully transition to employment or education, especially among those with intensive adolescent mental health service utilization. To meet these needs, the Individual Placement and Support (IPS) model of supported employment was adapted and its feasibility was tested in a psychiatric treatment program for early-emerging adults. Participants were 17-20 years old (mean age = 18.5 years). Most were African American, under the custody of the state, with a primary mood disorder diagnosis. Adaptations to IPS included adding the following: near age peer mentors, a supported education component, and a career development focus. This open trial feasibility study tracked the model's development, recruitment, and retention and tracked vocational and educational outcomes for 12 months. Model refinement resulted in the development of a separate educational specialist position, greater integration of the peer mentor with the vocational team, and further specification of the role of peer mentor. There was an 80% retention rate in the feasibility evaluation. Of the 35 participants, 49% started a job and/or enrolled in an education program over the 12-month period.

Launching into adulthood from institutional care with a serious mental health condition.

This qualitative study explores the experiences of emerging adults with serious mental health conditions (e.g., bipolar disorder, posttraumatic stress disorder) before and after they emancipate from the child welfare system and exit a transitional living program. Sixteen participants were interviewed before and 13 were interviewed after aging out. Findings suggest that transitional living programs services were appreciated for the relationships and safety net they fostered. Future plans were positive, but vague, and worries about the future were prevalent. Struggles with independence post-emancipation were common despite adult service use. Additional research is needed to understand how to best support these at-risk emerging adults.

Improving outcomes for pregnant and parenting foster care youth with severe mental illness: an evaluation of a transitional living program.

OBJECTIVE: This study provides preliminary evidence for the effectiveness of a residential program with comprehensive wrap-around services for pregnant and parenting foster care youth with severe mental illness or severe emotional disturbance who are preparing to transition to independent living. METHODS: Twenty-five females ages 18 to 21 participated. Program effectiveness was determined by tracking monthly status changes, such as education, employment, and hospitalizations, as well as by comparing scores on four bi-annually administered standardized assessments of parenting competency and stress, child maltreatment risk, and mental health symptoms. RESULTS: Assessment findings indicate that program participation is associated with positive changes in participants' familial relationships, family responsibility and care, proper parenting behavior and feelings, and parental distress and competency, but no change in mental health symptoms. Positive behavior changes associated with program participation were observed in education, employment, and low numbers of suspected and substantiated child maltreatment reports. Negative behavior changes associated with the program were frequency of AWOL incidents and subsequent pregnancies. CONCLUSIONS: This is the first study to evaluate a program designed for this very unique population and has implications for program design and policy. Future research with more rigorous experimental design is necessary in order to understand the critical ingredients of programs serving this vulnerable population.