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Report focuses
on 'aging out' of adolescents
(May 2003
Issue)
By Meredith Fine
The Massachusetts Department of Mental Health is revamping its
approach to teenage clients, bolstered by a recent report that detailed
the "shock and helplessness" many of these young people feel when
they reach 18 or 19 and lose the services to which they are accustomed.
Consumer Quality Initiatives issued its report in December in which
24 past and current DMH clients were interviewed in depth about
their experiences.
Consumer Quality Initiatives is a private, non-profit agency based
in Dorchester, Mass. that is run by consumers of mental health services.
The report entitled "Voices of Our Youth in Transition," addresses
people ages 18-21 who "age out" of state programs for adolescents.
Many of those clients find themselves discharged from group homes
or intensive residential treatment programs with little emotional
or practical preparation and no longer under anyone's legal guardianship,
according to the report. And adult mental health programs usually
are not designed for people who have spent much of their lives in
state care.
"One-half of the respondents said that the aging out process felt
'unstable,' as if the ground were moving out from under them. Several
had little notice before being moved to their adult treatment setting,
… (they) didn't have a chance to visit that setting or meet staff,
and at times found themselves in environments they did not like.
Others, already uncertain as to how they might support themselves,
found themselves homeless and sometimes in prison," the report says.
Consumer Quality Initiatives listed seven recommendations: transitional
planning should begin no later than age 16; the needs of clients
should drive state programming, rather than trying to fit young
people into available programs; young people should be given training
in basic living skills before and after they age out of state programs;
group homes should be available for youths in transition; a peer
mentoring system would be useful to provide support and access to
resources; a "Youth in Transition Citizenship" Web site should be
created to help young people find resources; and young clients should
be trained to become their own advocates.
The report points to a program in Quincy called Super Employable
People as a model. Super Employable People offers six weeks of job
and life skills training to young adults between ages 16 and 22.
Following graduation, clients can continue to receive job coaching
and peer support.
Jonathan Delman, executive director of Consumer Quality Initiatives
and an author of the report, said the Parent Professional Advocacy
League brought the issue to his attention. "There is not a lot known
about this topic," he says.
Assistant State Commissioner for Child and Adolescent Services
Joan Mikula says, "What drives change in a system is external advocacy.
Parents who were really passionate about their children are now
equally passionate about their adolescents. In addition, the whole
consumer empowerment movement has created a newly confident, outspoken
consumer. This has helped surface this issue in a way it hadn't
before."
She calls the report "compelling," and adds, "it has spread the
belief that action needs to be taken."
Even before the report was written, a Mental Health Planning Council
had been created to help allocate resources from the federal mental
health block grant. In early 2002, Mikula says, council members
"raised a number of concerns about the lack of attention for people
aging out of the child system."
An ad hoc committee was created, chaired by two clients in their
20s. "It's a terrific group that has really hit the ground running,"
says Mikula.
The state has already created what Mikula calls a "flexible, wraparound"
program for children, in which a child receives an individualized
plan of services. Mikula wants to take that same approach for adolescents
and adults. "You can't cookie-cutter it," she says.
"We have to carve out a special program focus for adolescents,"
she adds. "It doesn't require more money, just retooling the system."
Programs for adolescents will be a focus in fiscal year 2005, which
begins in July 2004, when the state goes out to bid for mental health
vendors. She concludes, "We need more hands-on, practical interventions
and solutions for people so they can be as much a part of the community
as possible."
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