the role of vocation and community engagement in recovery for transition age youth

The Role of Vocation and Community Engagement in Recovery for Transition Age Youth

Model of Care at Goldsmith

Psychiatric residential treatment for 50 adolescent males with a primary mental health diagnosis

Residents receive education, therapy, health services, recreation and vocational training from trained staff

Admission to the RTF is voluntary and is approximately 3-9 months.

RTF Care

Sanctuary Model

Sanctuary is a treatment and organizational change model that integrates trauma theory with the creation of therapeutic communities to provide safety for both clients and the staff

who work with them

Nonviolence Emotional

Intelligence Social Learning Open Communication Social Responsibility Democracy Growth & Change

The Seven Commitments of Sanctuary

Safety: Physical, Psychological, Social, Moral

Emotions: Handling feelings without becoming self/other destructive

Loss: Feeling grief and dealing with personal losses, preparing for change

Future: Re-establishing the capacity for choice

S.E.L.F

Twice Daily Community Meetings

Psychoeducation Groups Safety Planning Comfort Room Red Flag Meetings Staff Self-Care Plans Treatment Team

Conferences

Sanctuary in Practice at Goldsmith

Transition Age Youth Program

(TAY)

Increased number of older children in RTF care

HRA emphasis on adult housing

OMH involvement

Discussion began almost 10 years ago with building bridges initiative.

Negative outcomes of youth transitions from RTF to adult systems.

Impetus for a TAY Program

Preparedness for transition to adult housing

Development of independence and competence in daily activities (ADL’s)

Development of vocational skills

Focus on successful reintegration into communities as an Adult

The Goal

Typical Resident Profile Primary Psychiatric Diagnosis Multiple Psychiatric Hospitalizations Trauma History Extensive History of Foster Care/ Residential

Placement Maladaptive Coping Skills Poor Confidence/ Self Esteem Dependence/ Institutional Mentality

The Challenge

The Solution

On Campus Recreational and Vocational Programming

Creating Community Opportunities for Social and Vocational Participation

Clinical Interventions to Support Positive Social and Vocational Engagement

3 Tiered Vocational and Community Programming at Goldsmith

On Campus Recreation and

Vocational Programming

To allow for the initial fostering of social and vocational skills in a more protected and controlled environment

Goal

A large percentage of our youth come into our care with little to

no vocational skills!!!

This can largely be attributed to a lack of a sense of future for

themselves.

Tragic Truth

What are your plans when you leave? What do you want to do with your life? What kind of job do you want to have? Do you want to go to college or learn a

trade? If yes, what do you want to learn?

WHAT ARE SOME OF THE ANSWERS YOU GET??

Questions to Instill Future Vision

What type of residents / clients are in your program?

What is their psychiatric level of functioning?

Are they able to work in a setting with or without supervision?

Can they function off grounds independently?

How does their trauma or symptoms impact their ability to participate in the vocational program?

VOCATIONAL PROGRAM ASSESSMENT

Client / Residents go through an interview process.

They must first get approval from their respective treatment team.

Employment is used as a therapeutic tool, not a tool used to punish.

Jobs include building maintenance, grounds maintenance,culinary work in kitchen.

On Grounds Vocational Programming

Increased sense of future Development of practical work skills Sense of responsibility and punctuality Increased sense of self-confidence Prompts thought around future work/ career Increases interest in pursuing off-campus

work

Visible Results of On-Campus Vocational Programming

On-campus events Family engagement/ inclusion Sports Teams Inter-program collaboration Off campus trips Educational experiences Camping

Goldsmith Recreational Programming

Compliments Vocational Programming in a Number of Ways Social skill development Exposure to new hobbies/ interests Increased knowledge/ education Improved self confidence interacting in

public/ with strangers.

Benefits of Recreational Programming

Creating Community

Opportunities and

Relationships

To allow youth the opportunity to engage vocationally and

recreationally in the community, in a supported manner, while still in

RTF placement

Goal

Love is Ageless Pets Alive! Animal Shelter Walgreens Soup Kitchen BOCES

Previous partnerships

Ittleson Volunteering

Project

Ongoing challenge to identify new partnerships for Goldsmith residents

Programs consistently benefit from volunteers who enhance programming

Why not utilize residents as volunteers at other programs within the agency?

Impetus for Program

Confidentiality/HIPAA Frequency Guidelines for engagement Supervision Role of peer volunteers

Logistical Considerations

Elijah & Mykle Pre-existing independent skills Well liked by peers Enjoy helping others Travel Independently Excited by the idea of working with children

Identifying Appropriate Youth

Discussion with agency volunteer coordinator

Helped youth identify reason for wanting to volunteer

Completion of volunteer application Resume Preparation Interview prep Clothes shopping

Initial Steps

Emulated professional job interview Group and individual format interviews Met and spoke with agency CEO David Rivel Given tour of headquarters Met staff from multiple departments Relationship developed with graphic

designer

Interview at Headquarters

Onsite interview at Ittleson RTF with Program Director and AOD

Onsite orientation Travel Training Scheduling of supervision with volunteer

coordinator

Next Steps

Attending for about 5 months Attend weekly for about three hours, travel

independently Weekly supervision with volunteer

coordinator Call ahead to report tardiness or absence

for valid excuse Consistent positive feedback from boys and

program

Ittleson Volunteering Project Now

Portable skill set #1 Improved self-confidence and esteem (outward appearance reflect emotions)

Portable skill set #2: Real interview skills, dress for success, non-verbal communication

Portable skill set #3: Resume development/ enhancement

Portable skill set #4: Responsibility, consistency, punctuality

Portable skill set #5: Boundaries, team work, accepting feedback, personal improvment

Skill Sets Developed

Clinical Interventions and Support

To provide youth with the skills and tools needed to

be successful and confident in social and vocational engagement

in the community

Goal

Psychoeducation around symptoms and impact on functioning

Development grounding skills to promote independent self-regulation

Address negative thinking patterns and low self-esteem

Address motivation/ ambivalence towards change and independence

Development of social skills appropriate for work-place and other professional and social interactions

Therapeutic Tasks for Vocational Prep

Psychosocial Psychiatric CANS Phase Specific Treatment Team Conference

reviews UCLA-RI OMH Substance Use/Addictive Behaviors

Addendum

Assessments to Guide Interventions

Mental Illness-What is it?

Symptom Identification◦ Functional impact

Need for ongoing treatment◦ Medication compliance

Reconciliation between symptoms/illness, and social/workplace demands

Concurrent psychoeducation with families and/or collateral agencies/around youth’s needs

Psychoeducation

Identifying feelings Identifying triggers Identifying coping skills/

grounding techniques◦ Emphasis on independent and

portable skills Deep breathing, PMR, physical

grounding, mental grounding, etc… Development of Situation

Specific Safety Plans◦ Community safety plan◦ Job safety plan

Mobilization of Comfort Room

Self Regulation/ Grounding

Cognitive Behavioral TherapyGoal:To identify, reduce, and replace a resident’s dysfunctional/distorted thinking

Common thought distortions among TAY youth:

◦ Personalization and blame

◦ Labeling/ poor self-image◦ “Should”/ “must”

statements in relation to future/ work

◦ Overgeneralization◦ Projection of negative

thoughts

CBT Interventions ◦ Connecting thoughts, feelings, and behaviors

(CBT Triangles)◦ Thought/ Feelings Record◦ Activity Scheduling◦ Cognitive Coping◦ TF-CBT◦ Corrective Experiences

Cognitive Behavioral Therapy

Motivational InterviewingGoal: To have residents look at both sides of their ambivalence about change, make a statement of commitment to change, and make a change in behavior.

Common ambivalence/ problematic behaviors related to vocational engagement

◦ Substance use/ abuse◦ Fighting/ Aggression◦ Autonomy vs.

Dependence/ Learned helplessness

◦ Isolation vs. Engagement

MI Interventions◦ OARS

Open-ended questions Affirmations Reflective Listening Summaries

◦ Change Talk/ DARN Desire “I want to…” Ability “I can…” Reason “It’s important…” Need “I should…”

◦ Commitment Statements

◦ Realistic Action Plans

Motivational Interviewing

Social Skill Development/PracticeGoal: To learn and rehearse social skills appropriate for the work place and other settings.

Common barriers to appropriate social engagement

◦ Poor self-confidence◦ Difficulty understanding

social cues◦ Lack of “vocational

vocab”◦ Lack of experience/ role-

modeling

Rehearsal and Role-Play Greetings Introductions Conflict resolution Asking for help Giving directions/ Instructions Coping with unpleasant exchanges Understanding and setting boundaries

Social Skill Development/ Practice

Curriculum developed by NYS OMH, NYU McSilver Institute, and The Urban Institute for Behavioral Health.

Weekly group focused on relevant topics for transition age youth ie. Relationships, drug use, negative thinking, physical and mental health etc.

Allows for open conversation and exploration of topics in a way that gives youth ownership

Knowledge Empowers You (KEY)Group

The Benefits of

Vocational and Community

Programming

Youth Experience/ Testimonies

Mykle Personal Appearance Self Confidence Ability to identify strengths Corrective experience related to distorted thinkingElijah Accountability/ Responsibility Feeling of self-worth Sense of future/accomplishment Increased motivation to engage in own treatment

Role in Recovery

Program Logo designed by Mykle and Agency Graphic Designer

Continue Ittleson Volunteering Project and possibly increase number of participants Ongoing development of relationships both at RTF

and in community More community based activities and relationships

◦ Volunteering & vocational New facilities

◦ more independent living style/ teaching kitchen Additional assessments/ implementation of

evidence based practice Re-engagement of previous TAY residents as

mentors

Looking Towards the Future

Questions Antwan Cook

Team Leader / Vocational/ Recreation DirectorACook@jbfcs.org

914-773-7402

Ingrid McKenzieTransition Coordinator/ Supervisor

IMcKenzie@jbfcs.org914-773-7452

Andrew Dillenbeck, LMSWSocial Worker

Adillenbeck@jbfcs.org914-773-7428