HAVING & BEING SOMEONE TO LEAN ON:

Transcription

1 HAVING & BEING SOMEONE TO LEAN ON: UNDERSTANDING THE NECESSARY SHIFT IN SOCIAL SUPPORT PARTICIPATION AS YOUTH AGE OUT OF CARE Vanessa V. Klodnick, Ph.D., LCSW & Marc Fagan, Psy,D. Thresholds Youth Services, Chicago, IL

2 WHO WE ARE Vanessa V. Klodnick, PhD, LCSW Marc Fagan, PsyD Clipart credit:

3 BIG THANKS! The Fahs Beck Fund for Dissertation Research The University of Chicago + other Key Academics Thresholds Youth Services

4 OUR GOALS - THRESHOLDS YOUTH SERVICES Develop treatment models that effectively engage & impact older youth & young adults with serious mental health challenges & the systems they are embedded in Conduct clinically-informed research in partnership with transition age youth experts in order to generate best-practice Share our findings in ways that are accessible to multiple audiences

5 OUR GOALS FOR TODAY! Describe the unique challenges facing older youth with serious mental health conditions who are in residential &/or transitional living programs Share findings from a study that systematically examined social support among youth aging out of care all who had spent lengthy amounts of time in residential care as children Discuss the challenges related to building social support among youth in residential care & identify potential practice & policy solutions

6 OVERVIEW Theory & research Study context Research questions Study design Study findings Making meaning of the findings

7 THEORY & RESEARCH INFORMING THE PROJECT

8 Autonomy vs. Shame & Doubt Early Childhood Ages Initiative vs. Guilt Preschool/Play Ages 3-5 Identity vs. Role Confusion Adolescence Ages ERIKSON S THEORY OF DEVELOPMENT Generativity vs. Stagnation Middle Adulthood Ages Trust vs. Mistrust Infancy Industry vs. Inferiority School Age Ages 5-13 Intimacy vs. Isolation Early Adulthood Ages Ego Integrity vs. Despair Late Adulthood Ages 65 +

9 WHY THE TRANSITION TO ADULTHOOD IS SO CHALLENGING 14 y/o.30 y/o This transition is supposed to be slow/gradual But due to the often stark division between our child & adult systems, sometimes there are abrupt changes And in reality, the support & demands looks like...

10 THEORY OF EMERGING ADULTHOOD Early EA Middle EA Late EA Brain development still happening! Pre-frontal cortex not fully functioning until mid-20s Official Adulthood 1. Taking responsibility for yourself 2. Making independent decisions 3. Becoming financially independent

11 (Arnett, 2004) Central Experiences in Emerging Adulthood Identity Exploration Age of Possibilities Instability Self-focused experiences Feeling inbetween Making choices about life, work, & relationships Taking advantage of opportunities to try out different vocations, relationships, living locations & situations Possibility for Dramatic change is the greatest Least oversight from parents & not settled down yet Most instability in work, school, living situation, relationships compared to any other age group Fewest daily role obligations & greatest scope for independent decision making Millennials will not settle for work that is not fulfilling The bucket list! y/o s are most likely to respond to do you feel you have reach adulthood with Yes & No

12 SOCIAL SUPPORT IN EMERGING ADULTHOOD Family renegotiation Exploration of possibilities & selffocus Romantic relationships & friendships Boomerang trend

13 ADOLESCENT BRAIN & EXECUTIVE FUNCTIONING Nimble Limbic Captain of the Brain-Ship Working Memory Initiation Meta-cognition & Emotional Control Self-Monitoring

14 A UNIQUE AGING OUT POPULATION 1 in 3 who age out have a mental health condition Sudden support loss is more critical for those with SMHC Aging out independent of progress made on selfsufficiency or recovery Little research despite the existence of unique programs

15 The Cliff Corrections Adult Mental Health Medicaid Young Person in Charge Criminal Justice System Adult Mental Health Adult Supported Housing Vocational Rehabilitation SSI & Medicaid Parent in Charge Child Mental Health System Systems of Care Residential Care Individual Care Grants & Medicaid Child Welfare & Juvenile Justice Public Education System

16 FOSTERING CONNECTIONS FOCUS Support youth in connecting & reconnecting with families of origin Identification of at least 1 supportive adult in a young person s life by emancipation Increase social support in general and connection to community Provide opportunities for connection to formal & natural mentors Fantastic in theory, but very complicated in practice.

17 SOCIAL SUPPORT A BREAKDOWN Types: Emotional Instrumental/tangible Informational Appraisal/esteem Processes: Seeking Acquiring Utilizing Reciprocation Important Elements Characteristics of those involved in exchange Conditions under which exchange occurs

18 STUDY CONTEXT Artwork by Kenneth Williams - Thresholds South Artists

19 THE STATE OF ILLINOIS Child MH system Adult Community MH system Thresholds history

20 WHO DO WE ENGAGE? Age range Serious mental health challenges Delayed vocational development History &/or current system-involvement

21 THRESHOLDS YOUTH SERVICES Thresholds Programs Young Adult Program Mothers Project Structure & Services TLP & Residential Psychiatric treatment Vocational Development Transition Focus

22 WHAT IS THE TRANSITION TO INDEPENDENCE PROCESS (TIP)? Engagement/Strength Discovery Self-Determination Balance of choice & support Experiential learning Futures Planning Capitalizing on Competencies

23 TIP TRANSITION DOMAINS Employment & Career Educational Opportunity Personal Effectiveness & Wellbeing Functioning Living Situation

24 KEY COMPONENTS OF THE THRESHOLDS APPROACH With vs. For Involvement in treatment planning Partnership Empowerment Youth-defined family

25 RESEARCH QUESTIONS 1. How does social support shift at emancipation? 2. What are the social support processes observed post-emancipation? 3. What are the key components that define these social support processes?

26 METHOD QUALITATIVE LONGITUDINAL GROUNDED THEORY STUDY Interview 1 Interview 2 Interview Emancipation Dimensional analysis Attrition prevention Monthly contact Building a relationship Facebook & contact person

27 SAMPLE CHARACTERISTICS (N=20) Gender Female (10) Male (6) Transgender (4) Race/Ethnicity African American (12) White (4) Latino (4) Vocational Emancipation High School Graduate (14) Some College or Certificate Program (6) Work Experience (12) Employed Part-Time at Exit (7) Income Minimum wage PT or FT SSI - $721/month at the time

28 QUESTIONS FOR AUDIENCE: What do you think social support experiences were like like for the young people in this study before emancipation? Who was primarily providing guidance, support, & monitoring before emancipation? What kinds of characteristics did individuals in participant support networks before emancipation?

29 FINDINGS

30 PRE-EMANCIPATION: SOCIAL SUPPORT EXPERIENCES Passive formal (child) system receiver System largely responsible for providing both instrumental & emotional support Instrumental support rarely accessed through informal network connections prior to emancipation Reciprocity largely missing from social support experience

31 PRE-EMANCIPATION SUPPORT STRUCTURE Child Welfare System Mental Health Service Provider 20 year old with SMHC who is under the custody of the state

32 QUESTIONS FOR AUDIENCE: What do you think social support experiences were like like for the young people in this study AFTER emancipation? Who was primarily providing guidance, support, & monitoring AFTER emancipation? What kinds of characteristics did individuals in participant support networks AFTER emancipation?

33 SOCIAL SUPPORT SHIFTS AT EMANCIPATION With emancipation, there is a major shift in: Available support Sources of support Expectations in acquiring & receiving support Desire not to access informal support & instead to utilize formal financial support first

34 POST-EMANCIPATION: ACTIVE IN SOCIAL SUPPORT PROCESSES Active role in seeking, acquiring, avoiding, using, reciprocating support Unique combinations of formal and informal support use (some voluntary, some involuntary) New behavior expectations & reciprocity Provider role within informal network

35 POST-EMANCIPATION SOCIAL SUPPORT STRUCTURE Voluntary Formal Connections Involuntary Formal Connections 21 year old with SMHC who emancipated Informal Instrumental Support Informal Emotional Support

36 SOCIAL SUPPORT PROCESS PROFILES (POST-EMANCIPATION) 4 Profiles Navigators (n=2) Treaders (n=9) Survivors (n=5) Avoiders (n=4) Defined thru: Formal support interaction style Formal support utilization purpose Informal support characteristics Informal support interaction style

37 SUPPORT PROCESS PROFILE PRODUCTION Relational Boundaries with Informal Support Network Open Closed Avoids Formal System Support? Avoids Formal System Support? Yes, uses only in crisis No, but use is passive Yes, but forced to receive No. Utilizes actively Survivors: Support Use Aim: Overcome hardship Treaders: Support Use Aim: Maintain status-quo Avoiders: Support Use Aim: To not use any support Navigators: Support Use Aim: Selfimprovement

38 NAVIGATORS: SELF-IMPROVEMENT Formal Support Interaction Style Purpose of Formal Support Use Informal Support Characteristics Relational Boundaries with Informal Network Actively seeks support Actively utilizes support Selfimprovemen t Uses support to reach personal vocational, housing, & family goals Mixed resources Network provides time-limited instrumental support & has moderate demands for participant support Primarily closed boundaries Provides limited emotional & instrumental support to select individuals "I use all the supports I can get to better myself." I m proud of myself! I m excited about the future. I don t ask my family for support because it causes problems. I have enough support through the adult service system. I like helping when I can, but I need to focus on myself. I provide only to really important people in my life.

39 TREADERS: MAINTAINING STATUS-QUO Formal Support Interaction Style Purpose of Formal Support Use Informal Support Characteristics Boundaries with Informal Network Actively seeks support Passively utilizes support Survival Uses support to meet personal basic needs, avoid homelessness, & manage SSI Low resources Network provides time-limited instrumental support Network excessively demanding for participant support Primarily open boundaries Provides substantial emotional & instrumental support to many individuals I receive support to meet my basic needs." I m an expert budgeter. I know how to find support, but I don t like being monitored or told what to do. I sometimes need to ask for support, but my family & friends have little to offer. Providing support makes me feel good & important. My family needs me and my resources. If I don t provide support, they might not support me in the future.

40 SURVIVORS: OVERCOMING HARDSHIP Formal Support Interaction Style Purpose of Formal Support Use Informal Support Characteristics Boundaries with Informal Network Avoidant of support Receives support in crisis Overcome hardship or crisis Uses support to meet personal & loved ones basic needs when exhausted other options Low resources Network provides time-limited support Network excessively demanding for participant instrumental support Primarily open boundaries Provides substantial emotional & instrumental support when has resources I m independent. I only need support when I have no other options. Services only help me to get back on my feet, then I don t need them anymore. I sometimes am forced to ask for support, but it comes with stipulations that I don t like. I am a primary support provider in my social network.

41 AVOIDERS: TO NOT USE SUPPORT. Formal Support Interaction Style Purpose of Formal Support Utilization Informal Support Characteristics Boundaries with Informal Support Network Avoidant of support Involuntary support To not use formal support Forced to use support to regulate mental health or behavior Mixed or unknown resources Network provides time-limited support Network has moderate demands for participant instrumental support Primarily closed boundaries Provides limited or no support to network I do not need support. I am forced to receive support in jail or the hospital. My family and friends are forced/coerced into helping me out. I look out for myself, not others.

42 DISCUSSION

43 LIMITATIONS Small urban sample in one state in unique service setting Only young people interviewed (not others) Use of Interviews Certain points in time

44 TAKE AWAY MESSAGE General sense that if we just increased social support that these young people will have better transitions & improved outcomes. This study reveals the complicated social support processes that vary based on a number of factors. We need to incorporate this messiness into our transition practice models.

45 IMPLICATIONS FOR RESIDENTIAL PROVIDERS Policies & practices in residential care tend to be the same for older youth as they are for any child or adolescent. Young adults do NOT get opportunities to explore life outside (& negotiating social support/being an active participant in exchanges) until they actually are outside & have no safety net. Need to have practices & policies that allow for more relationship exploration while they re still in care (with a safety net).

46 MORE PRACTICE IMPLICATIONS Social support is dynamic. On-going assessment of social support is necessary. Social support a series of interactions that have meaning. Ensure practices provide real opportunities for social resource exchange prior to emancipation. Engagement takes time. Connecting with new providers needs to start well before emancipation. Explore mutuality in formal practice. Near Age Peer Mentors can share their experiences with navigating formal & informal support.

47 YOUTH & YOUNG ADULT PEER MENTORS Growing interest in peer support in Transition Age Youth Mental Health despite limited research Youth voice & partnership focus = key for developing successful programs for transition age youth Many challenges to doing YA Peer mentoring well. Need to: define peer clarify YA peer mentor role provide administrative & clinical supervision Peer mentors may be key in supporting natural relationships

48 Circle of Support Map Circle of Exchange Circle of Participation Circle of Friendship Circle of Intimacy

49 QUESTIONS? COMMENTS? CONTACT US! Vanessa V. Klodnick Marc Fagan