While transition age youth and young adults ages 16 to 25 with serious mental health conditions (TAYYA) face many challenges and risk factors, not graduating from high school is possibly the single biggest one, predictive of multiple future problems including unemployment, homelessness, and incarceration, and of foreclosed opportunities to live a satisfying life in the community, something most young adults want.
Dimensions of the Problem
More than 50% of students aged 14 or older with a mental health condition drop out of high school, which is the highest dropout rate of any disability group. Such students also experience low grade point averages, poor attendance, and the highest expulsion/suspension rates among all students with disabilities.1 Disruptions in relationships and social isolation result from and contribute to these problems.
Examining data from the National Longitudinal Transition Study about the lives of high school youth with disabilities, researchers confirmed these poor indicators: They found that students with a primary disability category of emotional disturbance (ED) demonstrated a pattern of “disconnectedness from school, academic failure, poor social adjustment, and criminal justice system involvement.”2
Researchers carrying out a large longitudinal study of adolescent offenders found that having a mental health disorder is not independently linked to poor employment outcomes; rather, lack of educational achievement, specifically lack of a high school diploma, carries the weight.3
Student mobility is a barrier to education: the more often the student moves, as many TAYYA do, whether because of placement decisions or changes in residence, the more difficult her/his academic and social situation becomes. In Massachusetts in 2009, students who attended only one public high school graduated at a rate of 85.9% while students who attended three schools graduated at a rate of 39.8% and those who attended four schools graduated at a rate of 24.9%.4 Other factors that disrupt schooling for TAYYA include:
- Functional limitations that impact educational performance such as sustaining concentration, screening out stimuli, maintaining stamina, handling time pressure, interacting with others, and test anxiety5
- Returning to school after an absence for a mental health or substance use disorder, during which the student will have missed academic work and been disconnected from social networks
- School disciplinary practices that result in disproportionate suspensions and expulsions for students with a mental illness
What is to be Done?
Mental health providers that want to promote good outcomes in teen patients with serious mental health conditions are in a strategic position to use emerging best practices to work with youth on strategies that help them attend school regularly, stay in school through graduation, and access vocational resources to reach a desired work life.
The range of possibilities for action is considerable: individual engagement using a positive youth development model to solve problems that push TAYYA out of school; programmatic interventions to re-integrate students into school after an absence; and systems changes to implement a Multi-Tier System of Supports (MTSS) that reduces suspensions and expulsions by improving school climate and reserves intensive clinical services for those most in need.
Interventions that Work
Effective interventions for TAYYA build on positive youth development and person-centered planning that engages the young person around her/his strengths and interests.
Positive youth development is characterized by adaptive or mutually beneficial relationships between an individual and her/his life context, so that the individual contributes to the contacts that support her/him. The clinical element enters the framework when the goal of positive developmental interventions is to restore or enhance developmental processes that have been compromised by high levels of risk and challenge.6
Positive youth development approaches are useful for improving TAYYA education outcomes, for example by promoting positive perceptions of school which then leads to better school attendance, which is essential for academic achievement and graduation.7 The ideal model will use mental health agency staff skills and knowledge of human development to engage a disconnected young person and strengthen their connections with school and long-term vocational goals.
Mental health providers can also collaborate with schools in program development, for example, by introducing mentoring programs that help the young person concentrate and handle pressures.
Providers can create “bridge” programs, such as BRYT (Bridge for Resilient Youth in Transition) developed by the Brookline Center for Community Mental Health for the local high school and now being tested in diverse districts across Massachusetts. BRYT helps students who have been absent due to behavioral health challenges to reintegrate with school. It places mental health staff in the school to provide clinical supports for returning students, academic case management on their behalf with school personnel, and liaison with families for students in both special and general education.8
Finally, systems change is an option for assisting TAYYA: Partnerships between schools and community agencies have often created a three-tier model, called a Multi-Tier System of Supports (MTSS) that invests in universal supports for all young people (Tier 1) to improve school climate and modify disciplinary practices that too often result in suspension or expulsion for students with behavioral health challenges. This model reserves Tier 3, the most clinical tier, for the minority of students with more intensive care requirements.
Reinforcing the Imperative to Focus on Education Issues
Serious mental health problems represent the largest burden of disease in young people. Yet, TAYYA between the ages of 16 or 18 and 21 with serious mental health conditions, who may have received services as children, discontinue services – either by dropping out or being forced out. Policy and funding barriers, unpleasant school experiences, lack of attractive treatment models, stigma and a desire to “be done” with mental health services, and poor coordination between mental health services and community institutions such as schools all contribute to this phenomenon.9
To reverse the trajectory leading to poor outcomes, states and localities are increasing their focus on building infrastructure and services for TAYYA. Among the central areas of focus must be their education and how the mental health service system can improve education outcomes for this population. Connection with school – vs. disconnection – can mean the difference between a successful life in the community or one bouncing around on society’s margins.
Evelyn Frankford, MSW, is an independent Consultant who has worked on issues pertaining to Transition Age Youth and Young Adults for the Massachusetts Departments of Mental Health and Public Health/School-Based Health Center Program, the Georgetown University National Technical Assistance Center for Children’s Mental Health on a SAMHSA grant, and the New York State Office of Mental Health. She can be reached at email@example.com and on the web at www.frankfordconsulting.com.
- Alikhan, S., Logan D., Ellison, M., & Biebel, K. (2016). Supported education (SEd): State of the practice. Psychiatry Information in Brief, 13(9). Worcester, MA: University of Massachusetts Medical School, Department of Psychiatry, Systems and Psychosocial Advances Research Center.
- Wagner, M., & Davis, M., How Are We Preparing Students with Emotional Disturbances for Transition to Young Adulthood: Findings from the National Longitudinal Study-2,” Summer 2006. J. of Emotional and Behavioral Disorders.
- Schubert, Carol & Mulvey, Edward, The Influence of Mental Health Disorders on Education and Employment Outcomes for Serious Adolescent Offenders Transitioning to Adulthood. http://www.pathwaysstudy.pitt.edu/index.html and http://www.umassmed.edu/TransitionsACR.
- Evelyn Frankford for Massachusetts Department of Mental Health (DMH), Learning and Working Hubs, 2011.
- Souma, A. et.al., cited in Ellison, M.L. et al, Supporting the Education Goals of Young Adults with Psychiatric Conditions, Transition RTC State of the Science Paper, September 2013.
- Walker, Janet, A Theory of Change for Positive Developmental Approaches to Improving Outcomes Among Emerging Adults with Serious Mental Health Conditions, J of Behavioral Health Services & Research. Feb. 19. 2015.
- Brennan, Eileen, Nygren, Peggy, Stephens, Robert, & Croskey, Adrienne, Predicting Positive Education Outcomes for Emerging Adults in Mental Health Systems of Care. J or Behavioral Health Services & Research, 2015.
- For more information, see: https://www.brooklinecenter.org/services/school-based-support/bryt-program/