the role of vocation and community engagement in recovery for transition age youth
TRANSCRIPT
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 [email protected]
914-773-7402
Ingrid McKenzieTransition Coordinator/ Supervisor
Andrew Dillenbeck, LMSWSocial Worker