Charles Burgess, BSMason Haber PhDMason Haber, PhD
UNC Charlotte
Transition Age Youth Youth with mental health conditions face resource related challenges in the transition to adulthood Essential areas in adult role functioning include: Essential areas in adult role functioning include:
Educational attainment EmploymentH i Housing
Finances Positive outcomes in these domains are strongly g yassociated with positive outcomes in later adult life
Role of informal or “natural” supports in providing resources and other assistance with these areas is crucialresources and other assistance with these areas is crucial
Clark & Unruh, 2009; Schoeni & Ross, 2005
Supportive Adults Formal versus informal support
Formal – paid professionals Informal/natural family friends etc Informal/natural – family, friends, etc.
Assistance can take many forms (e.g. material or emotional)
The receipt of informal support during transition is a normative experience for the majority of youth
H th ith t l h lth h ll However, many youth with mental health challenges may have lost or never had dependable informal support
Developing this support may be critical to improving their outcomes
Davis & Vander Stoep, 1997; Munson & McMillen, 2006; Samuels, 2008
The RENEW Model Rehabilitation for Empowerment, Natural Supports, Education, and Work A promising practice p o s g p act ce The RENEW model focuses on assisting transition rather than treating specific mental health symptoms
RENEW components include: RENEW components include: Futures Planning – helping youth envision and work toward a future through a future focused planT D l t t i h i th ’ Team Development – restoring or enhancing youths’ connections to supportive others
Informal support involvement in futures planning and i h i d d d teams is emphasized as a means and an end
Study Objectives This study seeks to examine:
Whether or not youth enrolled in a RENEW program i dditi l t t d i f l tacquire additional trusted informal supports
Whether or not increases in numbers of supports are associated with better outcomes over time
Sample Participants were youth enrolled in a RENEW program in Charlotte, 45
50
program in Charlotte, NC Total sample was 46 youth
25
30
35
40
Female
Maleyouth 48% Female Age ranged from 15 to 21 0
5
10
15
20 Male
g g 5 Average age at baseline
was 17.4 years (SD=1.24) Number of observations
01 2 3 4 5 6
ranged from 1 to 6
Assessment of Support andAssessment of Support and Outcome Variables Procedure:
Data was collected using the specialist‐rated Transition to Adulthood Program Information System Progress Tracker (TAPIS) (TAPIS)
Completed at enrollment and quarterly follow‐ups Outcome measures:
l d “ bl ” h employment, education, engagement, “stable” housing, income
Support: Wh d h h i “ d hi /h i Who does the youth view as a “trusted mentor to him/her in the last 30 days, individuals who provide substantial tangible, informational, and/or emotional support”?
# formal # informal # overall # formal, # informal, # overall
Haber & Clark, 2008
Hypotheses1) Time in RENEW program will be associated with
increased numbers of supports) i b f ill b i d 2) Increases in numbers of supports will be associated
with increased likelihood of… School Enrollment School Enrollment Employment Engagementg g Stable Housing Income
Analytic Approach Multilevel Modeling (MLM) for longitudinal data is ideal to use with this type of data
M l i l b i f b f h d Multiple observations for a subset of youth, and uneven numbers of observations across youth
Separate models were run to assess:Separate models were run to assess: Change in predictor and outcome variables across time Prediction of change on outcome variables as a function of
b f tnumber of supports
Singer & Willet, 2003
Descriptives
Frequency by Time
Examining Change in Support andExamining Change in Support and Outcome Status Over Time Do supports and outcomes change over time? OutcomeTimetime? Gender and age at baseline are entered as time invariant AgeGender
L1
L2
time invariant covariates
Time is the sole time‐i di
g
varying predictor Separate models for each support variable ppand outcome
Support and Outcome by Time
Predicted Probabilities by Time
%
90%
100%
* ** **
60%
70%
80%
1
40%
50%2
3
4
5
10%
20%
30%5
0%
Overall Informal Formal
Predicted Probabilities by Time
%
90%
100%
* * *
60%
70%
80%
1
40%
50%2
3
4
5
10%
20%
30%5
0%
Employment Enrollment Engagement Housing Income
Examining the Impact of SupportsExamining the Impact of Supports on Outcome Variables Does having more support predict better status on outcomes?
OutcomeTime
Support
status on outcomes? Gender and age at baseline remain time‐ Age
Time
GenderL2
L1
invariant controls Time and number of
t t d
g
supports are entered simultaneously as time‐varying predictors
Overall Support
Predicted Probabilities by NumberPredicted Probabilities by Number of Overall Supports
90%
100%
*
60%
70%
80%
40%
50%
0
1
2
3
10%
20%
30%
0%
Employment Enrollment Engagement Housing Income
Formal Support
Predicted Probabilities by NumberPredicted Probabilities by Number of Formal Supports
90%
100%
60%
70%
80%
40%
50%
0
1
2
3
10%
20%
30%
0%
Employment Enrollment Engagement Housing Income
Informal Support
Predicted Probabilities by NumberPredicted Probabilities by Number of Informal Supports
80%
90%
100%
* *
60%
70%
80%
40%
50%0
1
2
3
10%
20%
30%
0%
Employment Enrollment Engagement Housing Income
Summary Youth engaged in the RENEW program gain formal and informal supports over time
Likelihood of school enrollment stable housing and Likelihood of school enrollment, stable housing, and having income improves over time
Having more support was associated with more favorable toutcomes
Stronger, more robust relationships with informal support Much of this improvement was attributable to strengthened connections with family members
Relatively few significant findings, but consistent pattern of results and rather large effect sizes suggest more g ggrelationships will be found in larger sample
Program Staff Reactions andProgram Staff Reactions and Feedback These findings were presented to program staff They were initially skeptical
They believed that youth were generally disconnected from any t d i d ft ll tsupports and remained so after enrollment
The discussion shifted when one of the staff there pointed out that this might be due to focusing on youth with more severe problems
Staff may spend more time with youth that are more disconnected Staff may spend more time with youth that are more disconnected or less able to build their informal support networks
Thus, they may weight these youth disproportionately in their overall impressions of the population
Thi l d t di i f ibl b d t ti f This led to a discussion of possible subgroups and targeting of efforts to needs of youth who are particularly disconnected at enrollment or who remain so.
In the end staff perceptions of the importance of enhancing In the end, staff perceptions of the importance of enhancing youth supports seemed to shift significantly
Future Directions Examining distinct subgroups of youth
Reactions of staff and some paradoxical findings suggest possible subgroups:p g p Some youth improve quickly and leave the program Other youth do not improve as much and remain in the program for
longer periods of time Latent trajectory or growth mixture modeling could be used to
examine these possibilities in a larger sample Efforts are underway to extend use of tools to other programs
Ri l d t l h lth d b t bl Rigorously measured mental health and substance use problems might show similar relationships
Changes in support could also be related to program i l t tiimplementation
Conclusions Increases in trusted support network members were common among youth in this RENEW program
These increases particularly those in informal support These increases, particularly those in informal support, were shown to be linked with outcomes
These findings support the “N” in the RENEW theory of g pp ychange – the crucial role of enhancing natural (i.e., informal) support in specialists’ efforts with youth Note that it is likely this frequently involved reconnecting Note that it is likely this frequently involved reconnecting youth (e.g., with family) rather than finding new supports
Findings also show the importance of measuring social support in transition programs