Addressing the Mental Health Needs of THP+

ParticipantsTracy Davis, ASW

Shawna Lauer, MFTRebecca Hathorn, ASW

About our programsSupported Housing Program (THP+), Bay

Area Youth CentersScattered site model providing individualized support

to youthSocial workers assist in creating goals around

relationships and self-awareness, education, employment, mental health and housing and community development

Foster Youth Development Program, WestCoast Children’s ClinicFlexible, community-based, wraparound mental

health services ~ a relational approach

Healthy Development vs. Disrupted Attachment

NURTURING & CONSISTENCY = confidence, joy, problem solving skills, playfulness & curiosity

TRAUMA + LACK of NURTURING & CONSISTENCY = interruption of the development of initiative, autonomy, self-esteem, social awareness, ability to learn, physical health, emotion regulation & interpersonal relatedness

Relationship problems

Emotion regulation difficulties

Substance abuse

Irritability

Sleep difficulties

Hopelessness & helplessness

“Spacing out”

Oppositional behavior & aggression

Academic problems

High risk behaviors

Problems with daily living activities

Paranoia, bizarre behaviors, delusions, hallucinations

Signs and Symptoms of Mental Health Problems in Adolescents & Young Adults

Identity development

Separation from family of origin

Exploring educational and vocational opportunities & goals

Desiring and achieving responsible social behavior

Developmental Tasks of

Adolescents & Young Adults

Accessing Mental Health Services

• Former foster youth are entitled to FULL SCOPE Medi-Cal until their 21st birthday

• After the age of 21…• Build a relationship with a Medi-Cal specialist, or

Transition Age Youth Liaison, who can support the young person to navigate the system

To Make a ReferralCall Medi-Cal to get a list of providers in your

area

Contact those providers and ask questionsWhat services do you provide?What is the referral process? Waitlist?What are grounds for discontinuing services?What model/approach do you use?

Use your own judgment. Would you feel comfortable with this person? How do you imagine the youth might respond to this provider and his/her approach?

Encouraging Mental Health Services

Building the youth’s interest and willingness to participate in therapy is a process…

Educate YourselfSeek out trainings for yourself and your staff

Familiarity = ComfortabilityTrainings should be culturally relevant and specific

to this age group. Recommended topics include:Trauma & AttachmentDepression in adolescentsAnxiety, PTSD, Complex PTSDNeuropsychology and brain developmentSubstance Abuse ~ Harm reduction & Motivational

interviewingCrisis de-escalation

“I don’t need therapy, I’m not crazy!!”

Resistance & ambivalence about therapy is normal and understandableCultural implicationsGrowing up in a systemPast experiences with mental health services

Speak to the Ambivalence“A part of you might really want help with

this…”

“Another part of you might be worried about…”What other people might thinkWhat your family might say or thinkThat people think you’re crazyThat you might have to talk about things you don’t

want to

NormalizeSymptoms & behaviors are a normal, adaptable,

and functional response to an abnormal situation“This really worked for you before. But, now I

wonder if it might get in your way sometimes?”“Everyone needs help now and then” “It seems like the more support and different

perspectives you can get, the better.”

Wouldn’t it be nice to talk to someone who…

Is unbiased and neutral

Can offer an outside perspective

Keeps things confidential

Doesn’t have the authority to…

Curiosity, A Powerful Tool

Help the youth to become curious about his/her behaviors and symptoms

Wondering aloudNaming the symptoms/patternsExternalizeDe-stigmatize ~ good? Bad? Or just is?

Use your relationship‘I know a guy/gal…”

“I know that it’s really hard for you to trust people, it took a long time for you to trust me. I imagine it’s hard to think about opening up to someone new.”

“I really think this might be good for you…”

“Do you know how much those people charge? I’d love the chance to go for free!”

Speak to the hopeful part…

We don’t have to start with the biggest problem here…What is resolvable?What matters to you?What are you willing to let others help you with?

Empower the youth to take action on his/her own behalf

Therapy is voluntary“You can interview the therapist and decide for yourself.”“You can go at your own pace, quit if you need to…”“What kind of person would be a good fit for you?”“Let’s think about what questions you might want to

ask.”“What have your past experiences in therapy been like?” “What would you want to be different?”“Maybe I can help you find someone who would be a

better fit.”

Fight, Flight, or FreezeTherapy can stir up anxiety and anxiety can

trigger the desire to…Fight

“I hate my therapist”Flee

“I’m never going back there”Freeze

“I don’t know when my next appointment is” “Oh, I forgot”

Opening a dialogue“You might want to quit sometimes, or get mad at

the person you’re working with. Let’s talk about it if you start to feel that way.”

“It seems like maybe you’re feeling overwhelmed (scared). That’s understandable.”

“Wow. Therapy is hard, huh.”

Encourage the youth to bring these problems back to the provider and let him/her know what the he/she needs or wants Remind the youth that this is a safe place to try new

ways of resolving interpersonal problems A corrective emotional experience

Effective collaborations ~ How do we get there?

Define roles from the beginning and be ready to redefine as neededBuild upon each other’s strengths, resources, and

expertise

Effective collaborations ~ How do we get there?

Communicate, communicate, communicate!Be responsive to phone calls and follow through on

tasksSchedule regular face to face meetingsDefine how confidentiality will be handled and

share this with every member of the team, most importantly, with the clientOpen communication amongst team members Respecting the client’s privacyHow to describe this to the youth

Effective collaborations ~ How do we get there?

Problems and differences of opinion will arise ~ work it outBe prepared for splittingCheck yourself. Are you feeling territorial? Is your ego

getting in the way?Work with the youth to help him/her work through

difficulties that arise in his/her relationship with other team members

“It takes a village…”

For us too!Have fun. Share successes and funny storiesCELEBRATE when things go wellSupport each other when they don’t

Be honest when you’re feeling hopeless or frustratedAttend trainings and events together and get to

know your “team” outside of the office

An Example…

These symptoms were many years in the making and will take many years to heal…

Experiencing long-term relationships that are consistent, predictable, and safe…a valuable and necessary intervention to improve the emotional functioning of Transition Aged Youth