In order to effectively address the needs of EA transitioning to, or requiring access to, adult mental health and addiction services, a principle-based, integrated, accessible, and responsive system needs to be in place, embedded in provincial policy.
“I just needed to talk to somebody about everything that was going on. And there just isn’t appropriate access to psychologists, in my opinion, here. But, yeah, and like I said, I was talking to a psych nurse, and I said, ‘Is my doctor just going to shove pills down my throat?’ and she said, ‘Yes,’ and I said, ‘Well, thank you for your services’ and then I walked out and never went back.”
— Aaron Goodwin, Youth Participant (Cappelli et al., 2012)
Guiding Principles
Despite the lack of explicit empirical support, promising transitional programs, like the headspace program in Australia and the US’s Transition to Independence approach (TIP) being implemented across North America, ascribe to a well-articulated set of principles that are the foundation for effective practice (Clark, Pschorr, Wells, Curtis, &
Tighe, 2004; Haber et al., 2008; Hagner, Cheney, & Malloy, 1999; Koroloff, Pullmann,
& Gordon, 2008; Muir et al., 2009). These principles underline the requirement for working differently with this cohort.
At the October 2012 Summit, An International Focus on Youth in Transition:
Development and Evaluation of a Mental Health Transition Service Model (Cappelli et al., 2012), a collective vision statement was developed by participants that increased the scope of the project beyond “effective transitioning across the chasm.” It was at this think tank session that the systemic framework and the need for a broadened view was articulated and received consensus support from a group of close to 50 international experts (see Appendix 2 for List of Participants).
In addition, key principles were developed that should be reflected in any
transitional services policy and service model. Grounding any service planning and implementation in collaboratively developed guiding principles is a starting place, especially in the absence of service guidelines, standards, and performance metrics.
These key principles fall under five distinct themes and are “cohort specific”:
1. Responsive
Services are responsive to the needs of youth and EA, and;
• are built around individual needs and strengths;
• honour and promote self-determined goals;
• acknowledge the importance of cultural and individual variables in peoples’ lives;
• cross transitional domains;
• reflect the ability of systems (e.g. child and adolescent mental health and addictions services /adult mental health and addictions services , hospital/community), researchers, and care providers to work collaboratively to deliver services;
• are proactive;
• are fluid, coordinated, seamless, and invested; and,
• help people flourish.
2. Developmentally Appropriate and Family Connected
The transition between adolescence and adulthood is a complicated developmental period and happens at different rates for different people. As a result, responsive services are:
• flexible;
• appropriate to an individual’s developmental age;
• based on a youth’s readiness to progress;
• made in the context of the broader understanding of the individual, their relationship with themselves, their peers, and their level of family/
community involvement;
• focused on education and skill development, titrated to developmental milestone; and,
• informed by a collaborative spirit that encourages family engagement when possible and appropriate.
“Our goal is to foster confidence and self-determination
throughout transitions to help young people and emerging adults move toward their visions of success. Mental health and addictions care will be resiliency focused and propelled by the needs AND strengths of young people, families, and communities.”
— (Cappelli et al., 2012)
3. Youth Engaging and Peer Driven
All transitional services, EA specialist services, and CAMHAS/AMHAS that treat, serve, and/or support EA:
• reflect the voices of EA;
• provide EA with choices and help empower them in their decision-making processes;
• mobilize supportive networks present in the lives of young people (e.g. friends, teachers, parents, peer ambassadors, and mentors) when it is in the best interest of the young person (health professionals can facilitate this process);
• are communicated in youth friendly ways using youth preferred communication modes; and,
• include opportunities for EA to offer and receive support to and from their peers.
Research and innovation should be driven with the help of youth voices.
Professionals should develop appropriate knowledge exchange strategies that are accessible to young people and that use available and developing technologies to support engagement, learning, and continuity of service.
4. Informed
All transition protocols, services, EA specialist services, and CAMHAS/AMHAS that treat, serve, and/or support EA:
• include enhanced education, training, and research capacities to support effective transitional care;
• improve training and education for professionals regarding the developmental needs of EA and factors that promote readiness for transition;
• promote educational and training needs of peer ambassadors, mentors, and coaches;
• include a dimension of accountability on the part of researchers and administrators;
• strive to identify critical research questions and appropriate outcome variables, encourage collegial interactions and collaborations between research groups, evaluate our programs, and identify best practices;
• allow for the participation in knowledge exchange activities that identify both the strengths and weaknesses of our practices; and,
• are anchored in best practice guidelines and oriented around identifying evidence-based practices.
5. Recovery-oriented
All transitional services, EA specialist services, and CAMHAS/AMHAS that treat, serve, and/or support EA:
• are resiliency-building, recovery-based, and peer-inclusive;
• consider wellness, health, and meaningful role outcomes, rather than being limited to service engagement and symptom management/relief;
• commit to and demonstrate EA-driven individual and program practices;
• offer opportunities for youth to be involved in community building with their peers; and,
• advocate for and support EA in self-advocacy to ensure their needs are understood, and self-identified outcomes are achieved, within a framework of hope, meaningful roles, and recovery.
The concept of recovery refers to living a satisfying, hopeful and contributing life, even when there are on-going limitations caused by mental health problems and illnesses.
(MHCC, 2012)
The Continuum Concept
The World Health Organization (WHO) articulates the need for continuum of care as a response to fragmented service delivery across the lifespan (WHO, 2003).
A continuum framework, however, will also require “an investment of financial resources and the training of professionals to utilize the spectrum of services included in a continuum” as well as system capacity enhancements, based on epidemiological data (WHO, 2003). WHO also identifies the importance of incorporating practice guidelines or practice parameters within a full continuum of services.
The Mental Health Commission of Canada’s (MHCC) former Child and Youth Advisory Committee and international experts on youth mental health align in the unequivocal message that specific services that are responsive to the emerging adult age cohort are a key requirement of an effective system.
The MHCC recommends a tiered approach to the continuum of services (referred to in Changing Directions, Changing Lives: The Mental Health Strategy for Canada, 2012).
This tiered approach is also clearly articulated in A Systems Approach to Substance Use in Canada – Recommendations for a National Treatment Strategy (National Treatment Strategy Working Group, 2008), Saskatchewan’s Mental Health and Alcohol and Drug Misuse Services: Framework for Service Delivery (Saskatchewan Ministry of Health, 2012), Creating Connections: Alberta’s Addiction and Mental Health Strategy (Alberta Health Services, 2011), and The Action Plan for Mental Health in New Brunswick 2011-18 (Government of New Brunswick, 2011).
The concept of a tiered framework has been included in many provincial mental health and addiction service strategy documents (Saskatchewan Ministry of Health [2012]; Alberta Health Services [2011]; Government of New Brunswick [2011, 2013];
National Treatment Strategy Working Group [2008]; British Columbia Ministry of Health Services [2004]). These frameworks are built to accommodate the needs of any individual age 16 or older when accessing services for the first time. As those 16 and over are often dealing with the emergence of major adult disorders, it is appropriate that these EA should be served by organizations funded within the AMHAS envelope, as they will need access to the full spectrum of services. These organizations, however, need to be EA competent and, as indicated, EA-specific services need to be included at each tier of the continuum.