Aging out or continuing on? Exploring strategies to prepare marginalized youth for a transition to recovery in adulthood.

OBJECTIVE: This study aimed to improve our understanding of how to best assist marginalized youth during their transition to adulthood, and how to provide them services that help them achieve independence within existing public systems of care. METHOD: Using purposive sampling methods, 17 direct service providers and supervisors of a large behavioral health organization participated in individual interviews and focus groups. RESULTS: A team of analysts identified eight primary themes: (a) the primacy of consistent and caring relationships with adults; (b) working with youth and family concurrently; (c) the complicated dance of autonomy and independence; (d) engagement of alumni and peers in service delivery; (e) transition navigator: an active not passive approach to becoming an adult; (f) youth as the drivers of treatment and recovery; (g) provider training and resources to address the unique needs of transition-age youth; and (h) broadening the definition of treatment. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Our findings have important implications for practice, including (a) adapting clinical practice to meet the unique needs of transition-age youth and young adults; (b) engaging and expanding positive support systems; and (c) shifting the mindset of transition-age youth and young adults, their caregivers, and providers from a perspective of "aging out" of the mental health system to a perspective of "continuing on" in the management of their mental health through treatment and rehabilitation as needed as young adults. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Child Trauma Exposure and Posttraumatic Stress Disorder: Identification in Community Mental Health Clinics.

We examined the identification of trauma exposure and post-traumatic stress disorder (PTSD) in help-seeking urban children (N=157) presenting for care in community mental health clinics. Children and their parents completed a standard intake assessment conducted by a community clinician followed by a structured trauma-focused assessment conducted by a study clinician. Clinicians provided ratings of child functional impairment, parents reported on internalizing/externalizing problems, and children provided self-reports of PTSD symptom severity. Although community clinicians were mandated by clinic policy to ask about exposure to physical abuse, sexual abuse, and witnessed domestic violence, they identified exposure to these at significantly lower rates than study clinicians. Rates of PTSD based on community clinician diagnosis (1.9%) were also much lower than rates obtained by study clinicians (19.1%). A review of clinical charts one year after intake revealed no change in PTSD diagnosis rate following additional clinical contacts. Clinician-rated impairment, parent-rated emotional/behavioral problems, and child-rated PTSD symptom severity measures provided support for the validity of trauma exposure and PTSD as identified by study clinicians. Trauma exposure and PTSD diagnosis among help-seeking urban youth appear to be under-identified by community clinicians, which may compromise clinicians' ability to respond to environmental risks and provide appropriate evidence-based treatments.

Sanctuary in a domestic violence shelter: a team approach to healing.

For survivors of domestic violence, the ongoing effects of trauma are compounded by the context of their abusive experience. Injury caused by a person one has loved and trusted damages beliefs about oneself, other people, and the world. Staff members of various disciplines and educational backgrounds who work in domestic violence shelters are dealing with this damage as well as the impact of trauma on shelter residents. They face the challenge of observing and responding to the effects of recent and past abuse, to traumatic reenactments within the setting, and to their own secondary trauma reactions. This paper explores the process of implementing the Sanctuary model in a domestic violence shelter as a way to address trauma and its impact on clients and staff. The Sanctuary model was chosen because of its focus on teamwork, and the guidelines for treatment it provides that are accessible to all members of the treatment community.