JUNE 1: YOUTH & YOUNG ADULTS TRANSFORMATION TEAM
Welcome to the 5 Things Digest from the NTTAC Youth and Young Adults Transformation Team!

Youth and young adults with serious mental health conditions experience some of the poorest outcomes among young people with disabilities. Better outcomes are achieved, sustained, and replicated when there are changes to both individual practice and the policies that guide these practices. Changes in services and practices, along with changes in policies and system structures, are an optimal place to start when working to improve the lives of youth and young adults. Positive outcomes are achievable!
What do we know?
#1: The developmental stage leading to adulthood is unique.
 
The developmental stage leading to adulthood is unique and fundamentally more complicated when living with a mental health condition. For young adults, many forms of transition are happening simultaneously, including individual developmental transitions, family developmental transitions, and transitions within the systems that serve them. Individual biological and developmental changes underlie a person's abilities to function more maturely and accumulate over time.

As leaders, practitioners, and advocates of young adults, it is important that we understand mental health as one aspect of the young people that we work with. We must understand the impacts that physical health, racism, inequities, social connectedness, experiences at home/school/community, as well as involvement with service systems (e.g., child welfare, justice, education, housing, social services) can have on a young adult who is navigating their mental wellness while simultaneously navigating (or preparing for) adulthood.   

The family developmental transition refers to family and community members who support young adults who will also experience challenges as they change from being in the driver's seat to being a navigational support role in the young person's life. Data supports that young adults with positive family involvement have better outcomes as they transition to adulthood.

An added layer of transition for young adults living with mental health challenges is institutional transitions, changes in young adult's lives as they move from child-serving systems to adulthood and potentially adult serving systems. These bureaucratic transitions tend to be based on rigid age criteria rather than functional capabilities.

RESOURCES

Healthy Transition Initiative Issue Briefs - These briefs highlight and summarize data collected, outcomes achieved, and lessons learned from Healthy Transition Initiatives.

Reframing Adolescence and Adolescent Development - This toolkit is a resource for communicators who want to change the narrative about adolescence and adolescent development.
#2: Service delivery must be different for young adults.

Young adults confront a variety of obstacles that can impede access to mental health services, and that contribute to low rates of utilization of the services and supports that are available. What is more, young people typically have complex needs that cannot be met within a single agency or organization or even one youth-serving system. Depending on the young person’s age, the services and support received may be provided through child systems and/or adult systems; thus, there is an additional need for coordination across the “divide” between child and adult systems. This need for coordination is key in offering services.

Adapting the System of Care approach to this population has great value added for young adults receiving service, their families, and their communities. The System of Care approach has the potential to significantly improve outcomes for this group. It is critical that communities be intentional about the elements of the service delivery model that are essential to the service approach and those which require specific enhancements for young adults--see the resource section here for more information on the needed changes.

Young adults involved in past and current system change grants have been clear about services needing to be designed for their unique circumstances. This includes providing supports that meet the holistic needs of young adults--housing and employment can be as important as mental health care. Supports should be responsive to youth culture and community context. Adapting currently available services is often necessary. Many lessons have been learned from grantee efforts across the country--these are shared in resources included in this 5 Things Digest.

RESOURCES
Image of NTTAC resource "Transformative System Design for Supporting Youth and Young Adults"
New from NTTAC! Transformative System Design Supporting Young Adults - An overview of the foundations of young adult transitions.

Young Adult Supports and Services - Online recordings and resources to supporting building transition supports. The Foundation: Transformative Systems Design for Young Adults course is a great place to start    
#3: Policy change is key.

Policy change at the local, state, and federal level is a critical tool for better outcomes. The goal is to build collaborative bridges that allow for age-appropriate and appealing services supported by strong policy. In 2005, the federal agencies working with young adults of transition age met and identified policy recommendations and these recommendations continue to be relevant to the field. Innovations in policy change are still informing change in effective supports for young adults. The central policy tenets to support better outcomes have now been expanded to include tenets around peer support and equitable systems. You can see all the unique policy considerations for supporting young people as they transition to mature adulthood here.

Central Policy Tenets
  • Provision of continuity of care from ages 14 to 29
  • Continued support of family role throughout transition
  • Provision of continuity of care across the many systems that offer relevant youth services
  • Promotion of a density of developmentally appropriate services from which individualized service and treatment plans can be constructed
  • Support of expertise to support this age group and disability population
  • Advancing an anti-racist system which is equitable and responsive to diverse young adult populations
  • Implementation of peer-delivered services

Davis, Maryann, & Koyanagi, Chris. (2005) Summary of Center for Mental Health Services Youth Transition Policy Meeting: National Experts Panel. With adaptations added by the TA Network in 2020.

Ready to pursue policy change? It is important to first assess where you and your partners are on quality services for young adults. Our new resource, Transformative System Design Supporting Young Adults, includes key discussion questions to help you identify needed policy change in the current support system. You can also assess the receiving environment as young adults begin to use adult services by answering a set of questions in the handout. Finally, look for a step-by-step policy process.

RESOURCES

CLASP (The Center for Law and Social Policy) publication Policy for Transformed Lives 
Community Toolbox Changing Policies.

Changing the Rules: A Guide for YYA with Mental Health Conditions Who Want to Change Policy - This policy guide is written for youth advocates who want to make changes in policies that affect youth and young adults of transition age.

Advice to Young Adults from Young Adults: Helpful Hints for Policy Change in the Mental Health System - this tip sheet was developed with Youth MOVE National through a series of interviews with young adult leaders from advocacy groups focused on mental health challenges or foster care.
#4: Peer-delivered services are needed and expected.

One of the key innovations in the past 15 years is the development of peer-delivered services for and by youth and young adults. In fact, the advancement of the array of youth peer services has been so great that it is essential to add this as a policy tenet in our expanded understanding of the need of the field. Youth and young adults are now receiving training and support to provide informal and formal youth peer services. In this area of support, the lived experience young people have from navigating our nation’s mental health system becomes their skilled expertise. Youth peers model recovery and resiliency journeys, offer hope, break stigma, and co-navigate mental health supports alongside youth. In 2013, CMS and SAMHSA released a co-bulletin approving youth peer services to become a Medicaid-funded service. Since this point, nearly 20 states have established some form of youth peer service delivery in Medicaid plans. And many more are piloting youth peer services and/or offering peer services via other funding mechanisms. The value of including youth voice in the design of the mental health system and System of Care efforts has naturally grown into this robust inclusion of youth voice involvement in the delivery of services.

RESOURCES

Peers Supporting Youth and Young Adult Recovery - Highlighting the value of youth peer support services.

Medicaid Funding for Family and Youth Peer Support Programs - Overview of current state by state Medicaid funding for youth and parent peer support.

Youth MOVE Peer Center - Additional resources and training opportunities for those interested in youth peer services.
#5: Cultivate a system that is anti-racist, equitable, and responsive to the holistic needs and goals of diverse young adult populations.
 
Fostering systems that celebrate diversity and inclusion, and encourage cultural authenticity, is key to engaging with young adult populations. This requires more than a statement; it requires commitment and actions that stand up against racism and marginalization. It requires bold and uncomfortable conversations and education, lifelong learning. The Society for Adolescent Health and Medicine (SAHM) developed a comprehensive Anti-Racism Toolkit that contains resources specifically for adolescent health professionals.

While race is the foundation for many inequities, we must simultaneously remain cognizant of the ways and intersections in which young adults experience racism, discrimination, microaggressions, and other forms of oppression--as well as what this looks and feels like in our organizations and among staff. This requires us to have conversations with the young adults we are working with, and engage them in conversations regarding what matters to them, what is and what is not working for them, and their thoughts regarding how we can assist. The team at CLASP developed a guide, Behind the Asterisk* | CLASP, that can assist your organization in this process. 

A system that truly values equity, knows that equity requires action and voice. It’s unacceptable to hire young adults and relegate their voices to one section of the organization. It’s also unacceptable to work with young adults, and not acknowledge them as the first experts of their lives. Equity must be interwoven into the DNA of the organization and ALL of its practices, principles, values, and programs. It includes engaging diverse young adults in board meetings, policy development, finance meetings, mentoring, senior leadership positions, and succession planning. Are you ready to take action? If so, this guide can assist: Ten Core Competencies for Youth and Young Adult Centered Mental Health Systems | CLASP.

This 5 Things Digest is a call to action for change and enhanced outcomes. We must work to ensure that our organizations and programs meet the needs of the young people they are created to assist, and not require young people to assimilate into our program molds and theories. Not sure where to begin? Interested in knowing who’s missing from the table? Look at your data. What are the demographics and characteristics of the young adults who are enrolling in services? engaged? discontinuing services? What trends do you see? Why? 
As facilitators of services for young adults and their families, it’s critical that we ensure our organizations, programs, services, and policies are fostering cultures that are engaging and amplifying the voices of young people. This requires us to not only serve as practitioners, but also as students who are excited about learning. It’s a journey that requires time, humility, self-reflection, action, and perseverance. It may sound overwhelming, but it doesn’t have to be. The great news is that you don’t have to do it alone--there are thousands of amazing and diverse young adults who are willing to share their voices and assist you along the way! Just remember, equity includes paying young adults thrivable wages for their assistance, stories, and expertise.
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Child, Youth, and Family Mental Health
 
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Disclaimer: The views, opinions, and content expressed in this email do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), or the U.S. Department of Health and Human Services (HHS).