Guest blog post by Sally Raschick ~
HTI projects utilize a variety of evidence-based and evidence-supported practices. We were encouraged to use TIP—and had the budget stayed as projected, we would have had cross-site evaluation and been in a better position to contribute to the body of knowledge to prove or disprove the evidence based issue.
On the other hand, we use a variety of evidence-supported practices. Oklahoma and Wisconsin are both looking at implementation of Assertive Community Treatment approaches—there is research on adjusting ACT for use with first psychotic break adolescents and young adults. In Wisconsin in year 5 we will be comparing the services given in this model with what is being done in Project OYEAH, using the PACT youth practices to serve those young adults who have more severe needs than can be addressed through TIP like practices. (PACT, the original ACT program has been focused on research with youth who have experienced first psychotic breaks since 1998.)
TIP (Transition to Independence Process) is based upon wraparound, systems of care (SOC)) programs. TIP is composed basically of SOC practices that have been modified to be age appropriate for adolescents and young adults. It would be unreasonable to expect that these programs can start out as evidence based. None of today’s EBPs started as EBPs. What we are doing is utilizing evidence-based practices and applying them to people in a different developmental stage. That seems like a rational way to proceed to produce effective services with a population that has historically not been served well.
The HTI sites were expected to provide services utilizing the Transition to Independence (TIP) model. TIP is an evidence supported, youth-driven model, based upon wraparound principles and processes. It is, however, more focused on the engagement of youth and their positive personal development than most traditional, family-oriented programs are. A critical component of successful engagement of youth is changing from a family-driven system to one that becomes increasingly focused on developing experiences to support informed self-determination and self-advocacy skills as youth mature.
Dr. Jeffrey Arnett has pointed out that, at this point in history, families provide at least partial support to their transition aged “children” well into their 20s. This is true when their young adult offspring are enrolled in school, when they are pursuing the early phases of their careers, when they are “taking time out” to travel, explore who they want to be when they grow-up, etc. In providing this support, families are acknowledging the fact that in today’s complex world, the path to adulthood is a longer and more confounding process than it has been in the past.
The paths to adulthood for adolescents and young adults who have been affected by mental health and/or substance abuse issues during their youth and/or childhood are at least as long and as confounding as those of their peers without those particular issues. In fact, it is perfectly reasonable to acknowledge that the paths of these young people are, at least as challenging as the paths of others. And, that it is inappropriate to assume that the needs of young adults who have had first psychotic breaks are more worthy than those of young adults who have struggled with less dramatic challenges that had an earlier onset. Each group should receive age appropriate services that address their individual situation.
An increased understanding of the effects of childhood trauma on the health of both adults and children is one of the powerful advances in mental health in the past decade. The significant effects of these experiences often first emerge as a person emerges from childhood and is expected to function with increasing independence and breadth of responsibilities. As a result, trauma informed interventions designed for youth and young adults could result in savings of billions of dollars, much heartache and lifetimes of lost productivity.
One of the important lessons that should be learned from the experiences of all of the current projects working with adolescents and young adults is that the field needs to move away from a system of thought that says “we should fund services only for people who have the most severe and persistent of mental illnesses—and we need to wait to intervene until it has been shown that they will not get better with less intense interventions.” This perspective might have seemed useful in the past. At this point, it is appropriate to pursue the potential benefits of earlier interventions. There is no benefit to be gained by expecting young people to spend portions of their lives in dysfunctional situations when there are other options. All of these young people deserve to be supported in their transitions into adulthood.
Because youth in transition have developmental needs and characteristics that are typically not of as much concern earlier or later in their lives, applying EBP from either the children’s or adults’ systems without modification for developmental appropriateness, can result in a continuation of the minimal achievement that young people with mental health challenges typically achieve. It is important, at least when talking about mental health EBPs that it is determined that these practices are equally relevant to this age group. This can happen only when it is possible to gather data on the effects of services provided.
The public mental health system is like a neighborhood. Neighborhoods might have houses built in the 1930s, the 50s, the 70s and houses that are contemporary. Neighborhoods and the homes in them evolve. Many of the older homes have served us well. But the time comes when they need to be updated. New plumbing, more electrical capacity, modern kitchens, etc.
The equivalents exist in community-based human services. The 30s brought the development of child welfare. The 50s brought outpatient services, services for people being released from years in institutional settings and the innovations of systems of care and other wraparound programs. In the 1970s, the ACT programs were developed in response to the needs of people who had spent years in dependency and institutionalization. No one knew what “symptoms” was the inevitable result of mental illness and what “symptoms” were unfortunate outcomes of the years that were spent in dysfunction.
Today, things are evolving. We know that mental health challenges wax and wane—that people can benefit from the medications that have been developed in recent years, that brain function can actually change based upon exposure to appropriate experiences, therapies and empowerment. Today, delaying treatment to see how severe a mental illness is, or providing treatment only to people who are judged to be the most severely impacted is no longer a moral option.
HTI has provided opportunities to explore new ways to support young people with challenges. This work needs to continue. We can learn more. We can do better. And we must do better—we know that many of these young people can become increasingly independent and capable. What we don’t know yet, is how to the adult mental health system needs to evolve in order to support those who will need continued services. What we are proving is that the system will need to evolve.
This work needs to continue.
Sally Raschick, Project Director
WI Emerging Adults Initiative
A note from the CMHNetwork ~
We are encouraging all Network faithful to become educated about the benefits of the Healthy Transitions Initiative and the type of comprehensive approach necessary to effectively meet the needs of emerging adults. If you are interested in learning more, educate yourself by reading our analysis.