HomeMy WebLinkAbout20121585.tiff Esther Gesick
From: Bill Bane[Bill.Bane@state.co.us]
Sent: Tuesday, June 19, 2012 5:39 PM
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Cc: Todd Merendino
Subject: Youth in Transition: Survey of Behavioral Health Service Providers
Attachments: TAY Survey Report Final.pdf
Attached is a report on a survey of Colorado behavioral health-related service providers concerning transition age youth
and young adults with, or at-risk of developing, behavioral health challenges. The survey was conducted in October
2011 with individuals in the prevention and treatment service systems.
The report points out many of the challenges we face in serving this important population. It also indicates the
creativity and resourcefulness of providers in developing resources to address the needs of young people. I hope you
find this information helpful. Thank you to everyone who completed the survey.
Bill Bane
William Bane, MSW
Manager, Child, Youth, and Family Mental Health Programs
Colorado Department of Human Services, Division of Behavioral Health
3824 W. Princeton Circle, Denver,CO 80236
303-866-7406, Fax: 303-866-7428
bill.bane@state.co.us
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•
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Youth and Young Adults in Transition:
Report on a Survey of
Behavioral Health Service Providers in Colorado
February 2012
c b Colorado Division
of Behavioral i Health
William Bane, MSW
Manager, Children, Youth, and Family Mental Health Programs
Division of Behavioral Health
3824 W. Princeton Circle
Denver, CO 80236
bill.bane@state.co.us
www.colorado.gov/CDHS/DBH
Youth and Young Adults in Transition:
Report on a Survey of Behavioral Health Service Providers in Colorado
Introduction
In recent years there has been growing interest in youth and young adults with behavioral health
challenges. In June 2008 the U.S. Government Accountability Office (GAO) reported that at least 2.4
million young adults aged 18 through 26—or 6.5 percent of the non-institutionalized young adults in that
age range had a serious mental illness in 2006, and they had lower levels of education on average than
other young adults'. The actual count would be greater than 2.4 million because it did not include young
adults who were in institutional settings, homeless, or in correctional facilities. Further, about 186,000
young adults received disability benefits in 2006 because of a mental illness that prevented them from
engaging in substantial, gainful activity.
Outcomes for this group are considerably less favorable than their peers who do not face similar
challenges. For example, young adults with behavioral health challenges are nearly 14 times less likely to
complete secondary school, with 44% of the failure to complete school attributed to their disorders; and,
have higher unemployment rates (82% compared to 34%)2. Further, 33% of adolescents discharged from
residential treatment experience homelessness; and, 69% of male and 46% of female involved in intensive
mental health services are arrested during the transition years3.
Acquisition of benefits also presents a significant challenge, as evidenced by a study indicating that
approximately one-third of youth that qualified for Supplemental Security Income (SSI) as a child lost
eligibility during the age-18 redetermination process because they did not meet the adult SSI disability
criteria or left the program for other reasons4.
Survey
In October 2011 the Colorado Division of Behavioral Health conducted an online survey (using
SurveyMonkey.com) of behavioral health prevention and treatment providers about their perspectives on
serving transition age youth and young adults ages 14-25. The survey covered 15 questions regarding
specialized services, staff training, barriers, funding, successes and challenges, youth involvement, and
ways that DBH could be helpful. For some questions, respondents were able to add comments and othcrs
were completely open-ended. hi general, open-ended responses and comments were edited for clarity.
The survey invitation was sent to executive directors and direct service staff of the following:
• Community Mental Health Centers;
• Substance use service providers licensed or funded by DBH;
• Prevention programs funded by DBH; and,
Young Adults with Serious Mental Illness: Some States and Federal Agencies Are Taking Steps to
Address Their Transition Challenges,United States Government Accountability Office,June 2008(GAO-08-678)
2 Clark,Hewitt B."Rusty". (Fall,2008). Navigating the Treacherous Pathways to Adulthood.National Council Magazine. Pp.
20-21. (www.TheNationalCouncil.org)
3 Davis,M., Sabella, K.,Smith,L.M,&Costa,A. (2011).Becoming an Adult: Challenges for Those with Mental Health
Conditions.Transitions RTC.Brief 3.Worcester,MA:UMMS,Dept.of Psychiatry,CMHSR,Transitions RTC.
°Hemmeter,J.,Kauff,J.,&Wittenburg,D. (2009).Changing circumstances: Experiences of child SSI recipients before and
after their age-18 redetermination for adult benefits.Journal of Vocational Rehabilitation. Volume 30.Number 3,pp.201-221.
• Therapeutic Residential Child Facilities (TRCCFs) licensed by the Colorado Department of
Human Services.
The email encouraged recipients to forward it to other relevant individuals in their agency and
community. In all, there were 76 individuals responses.
Survey Responses
The following summarizes responses to the survey questions, including comments and open-ended
answers.
1) Please identify the types of services your agency provides (select all that apply)
Respondents were asked to identify the types of services provided by respondent's agencies. The choices
were mental health, substance use, prevention, outpatient/community-based, and residential. As reflected
in Chart 1 below, mental health was the predominant selection (86.6%), followed by
outpatient/community-based(76.3%), substance use (71.1%), prevention (63.3%), and residential services
(43.4%).
Chart 1
86.8%
71.1% 76.3%
63.2%
43.4%
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2) To what extent is your agency equipped to provide specialized services to youth and young
adults?
Forty-two percent indicated their agency had capacity to serve transition age youth, whereas 35.5%
responded that they were either somewhat or not at all equipped to provide services to this population.
2
Chart 2
42.1%
35.5%
18.4%
3.9%
Not at all Somewhat Have Our agency has
implemented capacity to
some specialized provide transition
services services to youth
and young adults.
3) What strategies have you found to be effective for engaging youth and young adults in
transition services? Select all that apply.
Responses indicate an array of traditional and non-traditional services being used. The perceived
effectiveness of methods ranged from one-to-one counseling (75.3%) to telemedicine/video conferencing
(11%). Other strategies used significantly were youth-friendly service environments (64.4%), group
counseling/discussions (54.8%), prevention strategies (53.4%), outreach staff and mentoring (both
52.1%), and family advocates/support providers (45.2%). It is worthy of noting that less than only one-
quarter employed social networking technology. Percentages for all are found in Chart 3 below.
Chart 3
Prevention strategies 53.40%
Mentoring i 52.10%
One-to-one counseling 75.30%
Group counseling/discussions 54.80%
Youth-friendly service environments 64.40%
Telemedicine/video conferencing 11.00%
Providing access to computers 32.90%
Social networking,e.g.,Facebook 23.30%
Drop-in program 27.40%
Outreach staff 52.10%
Family advocates/support providers 45.20%
Peer specialists 39.70%
3
Open-ended responses indicated an array of other types of approaches were found to be effective:
• In-home, community-based support, advocacy and counseling.
• Employment-related assistance.
• Court-ordered treatment along with professionals using effective engagement skills.
• Comprehensive support and accountability programming with an array of intervention approaches.
• Assistance with acquiring a high school diploma or a General Educational Development (GED)
certificate.
• Transition to Independence Process (TIP).
• Trained peer counselors.
4) What proportion of your agency's staff have been trained in providing transition services?
Examples would be one-day workshops, in-service trainings, online or computer-based training,
participation in conferences on this topic,etc.
Interestingly, although responses to Question 2 indicated that 41.9% of respondent's agencies had
capacity to provide transition services, 56% reported that one-quarter or less of their agency staff had
been trained to provide services. An additional 8% reported that none of their staff had received
training.
Chart 4
_. _. . . 56%
16.00%
12°%
8% 8% IL
ja_None 1-25% 26-50% 51-75% 75-100%
5) What do you consider to be the biggest barrier to providing transition services to youth and
young adults? Please rank the following items, 1-7,with 1 being the biggest barrier.
Not surprisingly, funding was found to be the biggest bather in providing transition services, as Chart 5
below points out. Taken together, difficulty in engaging youth/young adults and families were also
significant barriers, suggesting that traditional methods of engaging young people may not be effective
4
ways to promote involvement. In this regard, evidence-informed models such as TIP which advocate for
a youth-centered approach are worthy of consideration as a means of improving outcomes.
Chart 5
7.0
6.0 ------- —no 4.7
•- 5.0 - .------ -
1°ce 7 ad 3.9 4.0
m 4.0 -- ----- ---
m
3.0 -------
a 2.0
2.0 -- -
1.0 -- --'
Funding Difficulty in Difficulty in Lack of collaboration Unique challenges lack of coordination
engaging engaging families among community faced by youth In among youth and
youth/young adults agencies out-of-home adult services in
placement your agency
l_
6) What sources of funding support your agency's transition services? Select all that apply.
Medicaid was by far the most frequently (68.2%) cited source of funding. The three others used the most
were State General Fund (40.9%), private or public grants (37.9%), and Core Services dollars (33.3%),
which are available through the child welfare system. Vocational Rehabilitation, a funding source to
assist individuals with disabilities was only used by 6.1% of respondents. Supplemental Security
Income/SSI (4.5%) was the least used to support services (it should be pointed out that SSI is an
individual benefit, not a funding source for services).
Chart 6
Supplemental Security Income(SSI) ■ 4.50%
Vocational Rehabilitation funds 5 6.10%
Chafee Foster Care Independence...i♦ 10.60%
Core Services funds(Child Welfare) 33.30%
Collaborative Management...ON 10.60%
Senate Bill 94 24.20%
Private insurance MN 15.20%
Private or public grants 37.90%
SAMHSA Block Grant 21.20%
Medicaid 68.20%
State General Fund 40.90%
5
7) What models/approaches does your agency use in providing transition services? Select all that
apply.
Nearly three-quarters indicated that Cognitive Behavioral Therapy was the most frequently used
approach. Motivational Interviewing (65.8%), Dialectical Behavior Therapy (58.9%), Evidence-Based
Prevention (42.5%), and Wellness approaches (42.5%) were the other most-used methods. Only one-
quarter indicated they used the Transition to Independence Process (TIP)5, an evidence-informed
approach specifically designed to work with youth and young adults with emotional and behavioral
challenges.
Chart 7
Wellness approaches 43.20%
Evidence-based prevention approaches 37.80%
Cognitive Behavior Therapy 71.60%
Guideposts to Success ■ 1.40%
Dialectical Behavior Therapy 58.10%
Evidence-based prevention approaches 43.20%
Functional Family Therapy 29.70%
Supported Employment 16.20%
Multisystemic Therapy 28.40%
Motivational Interviewing 66.20%
Assertive Community Treatment IMO 6.80%
Transition to Independence Process gMVIIIM 24.30%
Other models/approaches used include:
• Preventative Aftercare model used in Pennsylvania.
• Peer mentors and family support groups.
• Assertive Continuing Care(ACC).
• Strength-Based Case Management.
• Transition curriculum.
• SAIFS Model (program developed in-house and supported by research).
• Parenting with Love and Limits (PLL), an evidence-based practice (intensive in home
therapeutic/skills program) out of Savannah Family Institute.
• Evidenced-informed co-occurring substance abuse/mental health treatment.
• Adolescent Community Reinforcement Approach (ACRA), and Adolescent Continuing
Care (ACC).
8) Which of the following age groups has your agency found particular success in serving?
5 See Clark,H.B.&Deanne K.U. (2009).Transition of Youth and Young Adults with Emotional or Behavioral Difficulties:
An Evidence-Supported Handbook. Baltimore,Maryland: Brookes.
6
Sixty-percent of respondents believed they were most successful serving the 14-17 year-old age group.
To a much lesser degree, 17% and 22.9% noted success in serving 18-21 and 22-25 year olds,
respectively.
Chart 8
60.00%
22.90%
17.10%ill_ _a___
14-17 18-21 22-25
9) Which of the following age groups has your agency had the biggest challenges in serving?
Nearly fifty-seven percent felt they faced the most challenges serving the 18-21 year-old age group. If
expanded to include the 22-25 year-old age group, 71.4% felt they had the most challenges serving the
entire young adult population. This is an important finding since a 2008 Colorado study indicated young
adults ages 21-24 had the largest unmet need for behavioral health services relative to the number of years
in the group6.
Chart 9
56.90%
24.60%
AU 18.5
AL
14-17 18-21 22-25
6 Western Interstate Commission on Higher Education,Mental Health Program(2009). Colorado population in need—2009.
Boulder,CO:Author. Sponsored by the Division of Behavioral Health,Office of Behavioral Health and Housing
Colorado Department of Human Services.
7
10)Has your agency made changes to improve services focused on transitional issues for youth? If
yes,what changes have been made?
Numerous innovative change examples were given. Rather than summarizing those, the full list is
provided in the Appendix.
11)To what extent have youth been involved in developing transition services and supports
provided by your agency?
The emergence of youth involvement in the behavioral health field is a relatively recent development.
Case in point, for a number of years one of the three core values of a system of care included the phrase
"should be child centered", whereas today it is understood that the system of care should be "youth
guided." Recent developments such as the development of a national youth-run organization with state
chapters, Youth M.O.V.E. National (Motivating Others through Voices of Experience), governed by and
designed for youth with behavioral health challenges, provide evidence of the youth voice in the
behavioral health field. Only 17.3% responded that they actively involve youth in service development
and oversight.
Chart 10
36% j
28°%
18.70% 17.30%
Not at all Somewhat Have some Actively involve youth
mechanisms in place in service development
to obtain youth/young and oversight
adult input
12) How can DBH best support you and your agency in serving TAY?
The survey asked how the Division of Behavioral Health could support respondents and their agencies in
providing transition services. There were numerous responses to this; the main groupings listed in order
of their frequency are:
o Funding.
o Training and information sharing.
o Coordination and collaboration.
o Increase awareness about the population.
o Improve accessibility to services.
13)Would you be open to DBH contacting you to learn more about your agency's services for TAY.
8
Over 30 names were provided, indicating that resources exist in Colorado and that individuals are willing
to share their knowledge with others.
14)Optional: Please identify your agency and provide the email address of a contact
person.
See question 13.
15)Thank you very much for taking the time to complete this survey. Is there anything else
you would like DBH to know about your agency's implementation of services to TAY?
The following types of responses were given:
o Gaps between the youth and adult behavioral health system.
o Need to also focus on dual-diagnoses, brain-based mental health issues, and trauma.
o There is a need for a drop-in center(like the Clubhouse model in adult mental health services).
o Need continued funding and support for the community.
o The more agencies can collaborate the better.
Summary
This survey on transition services for youth and young adults behavioral health challenges is the first of
its kind sponsored by the Division of Behavioral Health. In addition to the valuable information it
provides, it also represents an important step in understanding the special circumstances of the population
and the service providers who help them address those challenges.
The survey results indicate that behavioral health service providers have accomplished much in serving
this group. Those accomplishments include service innovations and expansion, collaborative initiatives,
and working creatively within available funding. Further, the results point out the need for training,
opportunities for practitioners and agencies to exchange information on best practices, policies that guide
program development and implementation, and funding to continue and expand the important work that
has been undertaken.
The Division of Behavioral Health expresses its deep appreciation to the individuals who responded to the
survey and provided their valuable input.
Prepared by:
William Bane, MSW
Manager, Children, Youth, and Family Mental Health Programs
Colorado Department of Human Services, Division of Behavioral Health
February 2012
bill.bane@state.co.us
303-866-7406
With assistance from the Division of Behavioral Health, Work Group on Transition Age Youth and
Young Adults, and the Data and Evaluation Unit.
9
Appendix
10)Has your agency made changes to improve services focused on transitional
issues for youth? If yes,what changes have been made?
• Co-occurring group and individual sessions along with family sessions. Also, implementation of
family education sessions for family members.
• Improved communication between Child and Family and Adult Recovery Services. There is now
a path to transition youth between the programs.
• Collaborate with Preventative Aftercare, Inc. in Pennsylvania to bring this model to Colorado.
• We have two groups going, through email and in person, for parents of youth with health issues
transitioning to adulthood. We have also set up a networking group with the local Community-
Centered Board (CCB), Vocational Rehabilitation, and the Center for Independence to
communicate about issues.
• Increased program design, teen mom independent training program.
• Received extensive training in the TIP model. Promote transitional services within the agency and
in the community.
• Working with state government to clarify perimeters expanding services to 18-20 year olds.
• Adopted Facebook, home visitation, weekly email affirmations.
• Denver Cares started a youth program.
• Received grant from the Colorado Department of Education and implemented case managers
specific to transitioning youth.
• Reached out to provide services in schools.
• Applied for grants.
• Increasing the age range from 18 to 22/25 year olds.
• We have instituted and are revising our Youth Transition Services.
• Increased assistance finding employment, registering with workforce agencies, computer lab
access.
• A much greater focus on the topic and involvement of local businesses and other agencies as
support and internships.
10
• Evidence based training.
• We've tried within limited funding to create specialized programming for transition-age including
life skills and having group activities targeting that age group as they express a preference for
being with peer group and not older adults. In our supported education&employment programs
we've also targeted some specific approaches. Finally, it's a topic for our Wellness Advisory
Council which supports our Wellness programming.
• DYC has developed a broad spectrum of services to assist in transition and parole services.
• Groups,outreach,GED,independent living skills.
• Drop in center.
• More involvement with community organizations.
• Created a Transition Task Force. Our agency is represented on the Under 26 Task Force from
DBH.We have an awesome model of referring to professionals for ongoing services.Funding is
the issue.
• It's not been through our agency but other agencies we work with.
• We extensively trained staff and have worked with referral sources to be aware of these programs.
• Increased online content,resources,and assessment tools via web pages and social media outlets;
increased peer training on key topics.
• New treatment models,attempts to secure grant funding.
• Specifically implementing TIP.
• Developing an intensive adolescent outpatient program in conjunction with other services for the
13-17 year olds.
• We have made changes to make transition from child to adult services more effective.
• More emphasis on co-occurring disorders.
• Convened monthly meeting between adult/child services to discuss needs of specific youth.
11
Hello