Making the Most of Transitions: The Challenges for Children & Adolescents with Mental Health Difficulties
 Transition events, such as starting school, changing school, changing jobs, and moving home are an integral part of family life. A transition is defined as “a passage from one state, stage, subject, or place to another." Transition is often a gradual process that includes both new opportunities and the loss of familiar relationships, places, and ways of solving problems. Individuals may have mixed responses as they experience both a desire to hold on to that which is familiar, and a desire to move ahead.
The stress and uncertainty associated with transitions may be particularly challenging for children with emotional and behavioral disorders and their families. The integration of transition planning into services is critical to promoting children’s successful development and adjustment to new experiences and environments.
Best Practices in Transition: What Do We Know?
Some research-based information is already available to guide the design and delivery of effective transition services. Examples of the resources available for early childhood transitions are the National Center for Early Development and Learning and the National Early Childhood Transition Center. Resources for youth transition are available from the National Technical Center on youth transition.
Key principles for transition practice already identified through research include the following:
- Person-centered planning
- Attention to the child or young person’s strengths, interests, values, and culture
- Consideration of the community context of individual families and children
- Individually-tailored services across multiple domains that are flexible and responsive
- Involvement of a range of stakeholders
- Coordination and collaboration among agencies
- Presence of a safety net
- Opportunities to support appropriate development and enhance levels of independence
- Evaluation and continuous improvement
Additional research on specific aspects of transition and the evaluation of transition interventions is being conducted to build on this knowledge base. For example, current research projects at the Research & Training Center include Transition to Kindergarten, Youth Transition, and Career Transitions.
Transition Policies and Programs: How Can They Be Improved?
Since age is a common criterion for service eligibility, it is often a crucial marker of transition for families receiving services. The vulnerability of families during such transitions is borne out by recent research. A 2005 study of early intervention programs for infants and toddlers (Part C of the Individuals with Disabilities Education Act) identified significant challenges in services for young children during the transition to Part B services at three years of age. This, combined with the failure to routinely track emotional disorders among young children, contributes to lost opportunities to prepare children and their families for successful transition to school.
Research on youth recipients of mental health services also indicates that there is substantial room for improvement. For example, although eligibility for child mental health services ends at age 18 years in 31 states, 12 state child mental health systems offered no transition services. A recent survey of members of the National Association of State Mental Health Program Directors found that no states had the same definition of eligibility criteria for adult and children’s mental health services, and that access to adult services is typically more restrictive. Although the Bazelon Center recently identified as many as 57 programs in nine departments of the federal government that can address the needs of youth with mental health difficulties transitioning to adulthood, families are not receiving the services they need. The situation may be even more acute for children from diverse families. Consequently children are at higher risk of exclusion from school, school failure, unemployment, substance use, and involvement in the juvenile justice system.
Please share your views and experiences of transition below. Here are some questions you may wish to consider:
- Have you experienced a successful transition? Please share your success and what you feel made it a successful experience.
- Are you involved in supporting or facilitating transitions? What are the challenges and what strategies can be used to overcome them?
- How can transition services for children with emotional and behavioral challenges and their families be improved?
- What changes are required to make transition support more relevant and responsive to the needs of different families?
Thank you for taking the time to share your thoughts. As always, we appreciate your views.
Your thoughts…
Comments:
 In Seattle as we began our SAMHSA grant we held a series of focus groups looking for strengths and gaps for youth transitioning into adulthood. While there were challenges in all domains and essentially no communication between children's and adult programs, there was one extreme "gap" that rose to the top of our list as the most pervasive and challenging; that of housing for youth with very severe mental health problems. Housing issues for this group were not addressed by our Congregate Care, or adult residential treatment facilites designed to serve those with severe and persistent mental illness. They typically housed adults between 35 and 65 who were in variable states of recovery from mostly psychotic illnesses. That population was adversely impacted by youth who were more prone to behavioral problems, drug and alcohol use and ambivalence towards their own mental health problems.
Youth rejected these facilities as they were horrified with what they perceived as burned out adults for who they held strong negative feelings as they were unable to overcome the stigma of mental illness themselves. Youth rejected the rules of these facilities and preferred to take their chances on the street homeless. Many of them had fantasies of leading more free lives after 18 (or 21) that would include drinking, doing drugs, persuing sexual relationships and rejecting medications. Engaging these emerging young adults was challenging enough, but would be possible if facilities existed designed to meet their unique needs.
We attempted several unique and creative means of funding such programs and failed due to the mismatch between a competent program design that emphasized creative and rich staffing rather then rules and the funding available. There was a great deal of resistance on the part of adult programs run by contract agencies in our system to take on what they felt to be a population that would place their agencies at high risk. Other housing funding streams such as Independent Living Program funds served only less ill and less disruptive youth who were tied into the social service system by at least two days in foster care. We found that when families were not available, adult corrections became the primary housing program for those with severe mental illness over 18 by default.
Charley Huffine, Seattle Posted Thursday, March 23, 2006 at 07:49 AM
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