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Strengthening Family Support for Young People with Mental Health Needs in the Transition to Adulthood: a Tip Sheet for Service Providers

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Strengthening Family Support for Young People with Mental Health Needs in the Transition to Adulthood: a Tip Sheet for Service Providers Strengthening Family Support for Young People with Mental Health Needs in the Transition to Adulthood: A Tip Sheet for Service Providers By: Pauline Jivanjee, Eileen Brennan, and Claudia Sellmaier in September consultation with the Pathways Transition Training Collaborative, mental health consumers, families, and service providers 2012 o strengthen family support in the transition to adulthood, T service providers need to be able to: • Articulate the value to young people of having family members involved in services • Involve families of all diversities in supporting their young adult children to achieve their goals • Navigate the legal and policy contexts that affect families’ involvement in the transition years • Call upon Family Support Organizations and Parent Advocates to support families in the transition years. Consider the experiences Service providers need to be reported by many families during familiar with federal, state, and the transition years: local legal and policy issues: • A shared sense of losing control with • Individual and family developmental changes the natural pulling apart of adult family happen gradually but institutional transitions members and youth as youth become more occur abruptly according to bureaucratic and independent. legal rules. • Initially parents may feel confident, although • There are different definitions of serious worried, but feel less adequate when service emotional disturbance in special education providers undermine their expertise and versus mental health in the adult system. judgment by questioning and marginalizing • Youth with mental health disabilities have them. entitlements in the education system • The treatment system often forces young but when they have reached the age of adults and families to disconnect. adulthood there is only eligibility for adult • Families care for youth in a context of services, no entitlement. inadequate resources, and little support in • Consent: Refers to the age-related shift of the community. legal responsibility from parent to young • Systems do not necessarily support person which varies by state. collaboration with families. • Confidentiality: According to HIPAA – Health Insurance Portability & Accountability Act of 1 1996 (PL 104-191), providers cannot discuss health information with a parent unless the youth specifically grants permission – need to explore possible benefits and concerns with young people. • Competency: When a young adult is clearly not competent to make independent health care decisions, a parent may petition the court to become the guardian, generally before age 18. • Guardianship: A guardian is appointed to arrange care of a person who is incapacitated: • Ask family members questions to find out • Requires an attorney, filing for a petition, about the challenges they face. having a court visitor interview the young • Recognize isolation, fear, and loss of control adult to be sure it is in that person’s best in parents. interest. • Ask questions about the important systems • The protected person must be willing that affect the family’s ability to support their to sign the consent, or be served to young person (e.g. school, transportation, appear in court to show cause. There employment, family support). is no universally accepted definition of • Recognize the practical assistance families competence and terms and conditions provide: financial help (housing, bills, access vary state-to-state. to health care); treatment; education. • Conservator: A conservator is appointed by • Avoid jargon and talk clearly to families. court to make decisions about property and • Support families finding a balance between wanting to protect their children and assets. needing to let them make mistakes. Relationships with families • Support families to encourage their children to take responsibility for their own care in • Some young people may be grateful new environments (college, first apartment, for support that family members offer supported housing). them as they work toward recovery and • Offer assistance to families to get their young independence (Preyde, Cameron, Frensch, & people ready to make their own decisions Adams, 2011). and to advocate for themselves. • Other young people may want to strike out • Avoid blaming families if their children make on their own and not want other family mistakes. members in their business (Arnett, 2000). • Help families to get connected with Family • Families are a resource and generally want Support Organizations and link them with to be helpful. Youth in crisis may not see Family/Parent Advocates. what families have to offer; providers should be prepared to speak about the value of The following questions about involving families. mental health issues could be Providers are encouraged to: useful for family discussion: • Recognize social and emotional supports, • Is the young person able to discuss her/his including siblings. condition with significant people? 2 • Can the young adult articulate her/his development of positive cultural identity, mental health and other needs? Does s/he and encourage families to draw from know how to access health/mental health traditional culture and spiritual teachings information? to guide their relationships with young • Does the young person know how to access people (Cross et al., 2007). community resources and agencies? » Emphasize health promotion involving • Does the young person understand when to family, friends, peer supports, and other discuss her/his condition? community supports that young people • Can the young person advocate for her/ trust (Garcia & Saewyc, 2007). himself? (Holmbeck et al, 2010) » Seek ways to facilitate youth-family communication to build understanding New service approaches are and appreciation of strengths (Chapman & needed with diverse families and Pereira, 2005). communities: » Reach out to community resources and engage in advocacy on behalf of • Young people live in many different family vulnerable families. structures, so it is important to: » Use asset-based approaches to promote » Ask young people who they define as LGBTQIQ2-S resiliency through building family and what are their preferences for positive identity, reducing stigma, and family involvement in services. promoting strong relationships with peers, » Seek information and advice about the supportive families, positive role models, racial and ethnic diversity of families and adult allies (Gamache & Lazear, 2009). you are serving and seek opportunities » Know about policies and supports in all to develop skills in providing culturally areas of living, obstacles to success, and responsive services. strategies for young people to achieve » Reach out to the families of youth their goals. of color who are over-represented in more restrictive settings and who face additional challenges in trying to participate in their children’s treatment. » For effective work with immigrant families, think about protective factors such as respect, loyalty to family, and the development of biculturalism. » Focus interventions on promoting a strong sense of positive cultural identity to reduce the depressive effects of discrimination. » Involvement of community supports such as churches can be valuable, although not all families want this (Lindsey et al., 2006). Self-assessment of preparedness » Seek to connect Native American youth to work with diverse families: and families to culturally-specific agencies • Do I understand and respect those whom that use holistic approaches rooted young people define as family? in traditional teachings, promote the • Am I aware of families’ different cultural 3 beliefs about mental health and have I clarified their expectations of treatment National Family Support outcomes? Organizations • Do I respond with humility and reflection and seek clarity where I don’t understand? • Do I know where to seek culturally relevant National Federation of Families and specific services and supports? for Children’s Mental Health– • Am I working to support the development of positive ethnic and cultural identity as a also check for state/local protective factor? chapters • Have I sought mentors to bring knowledge of http://www.ffcmh.org/ youth culture to adult family members? • Do I know how to connect families with National Alliance on Mental Family Support Organizations, family support Illness (NAMI) – also check for and advocacy groups, and parent advocates state/local chapters who can: http://www.nami.org/ • Help parents navigate the system and access traditional and non-traditional PACER center services? • Translate the content and process of http://pacer.org meetings with service providers into Parents, Families and Friends understandable language (Munson et al., of Lesbians and Gays (PFLAG) 2009)? • Work to empower parents and youth has over 500 chapters so that their voices are heard in service nationwide and provides systems? community-based support and • Serve as networking agents to link parents advocacy for families with others with similar experiences? • Bring their valuable personal experiences http://community.pflag.org/ to bear, and offer hope (Hoagwood, 2005; Munson et al., 2009, Robbins et al, 2008)? Please visit our project web page at: www.pathwaysrtc.pdx.edu/proj-trainingcollaborative.shtml Tipsheet produced by Pathways Project funded by National Institute Transition Training Collaborative, of Disability and Rehabilitation Re- Research and Training Center for search, United States Department Pathways to Positive Futures, Port- of Education, and the Center for land State University, Portland, OR. Mental Health Services Substance Abuse and Mental Health Services Administration, United States De- partment of Health and Human Ser- www.pathwaysrtc.pdx.edu vices (NIDRR grant H133B090019). 4.
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