How Mental Healthcare Providers Can Be Trauma-Informed When Engaging Transition-Age Youth

Posted: 7/1/2020 8:00:00 AM by Zsofia Duarte

Transition-Age Youth (TAY) are young people who are transitioning out of the child mental health system and into the adult mental health system. It can be a hard transition that requires strong engagement on the part of providers.  This transition period requires strong trauma-informed approach.  Trauma-informed care is an approach to practice that raises awareness of the impact of psychological trauma and how common it is in society.  Trauma-informed engagement is particularly crucial during the transition period because many young people with histories of mental healthcare needs have been exposed to trauma, adversity, or toxic stress in childhood that directly contributed to their mental health conditions, but they’ve also experienced much adversity a result of their mental healthcare needs through such experiences as suicide attempts, harsh discipline, seclusion, homelessness, and domestic violence.

Despite being critically important, engagement with transition-age youth has not been consistently defined in research or practice.  Engagement is the process through which TAY are actively engaged in their treatment and services at two moments: (1) initial engagement with the youth, the first contact or early contacts between the youth and mental healthcare providers and (2) ongoing engagement with the youth, maintaining the ongoing collaborative relationship between the youth and healthcare provider and having the young person actively involved in their care planning. In this post, I will briefly discuss four ways healthcare providers can practice trauma-informed engagement with TAY and best engage with TAY with histories of trauma or adversity.  
 
(1) Understanding Young People through the Ecological Model
Youth do not exist in isolation from their environment, or from the multiple systems that they play a role in their lives. In the early 2000s there was a significant shift in thinking about service utilization from a focus on the belief that individuals make rational and voluntary choices about health care to highlighting that the health care consumers are actually navigating their health through a social process informed by many different systems and networks, such as the individual, family, community, and agency.  This view is often called the ecological point of view, or the ecological model that encourages providers to create space to consider a youth’s past traumatic exposure and current related experiences across multiple levels as critical to treatment and service engagement. In doing so, providers will then validate the complex factors interacting with the youth and validate that the youth’s engagement is not simply a matter of the motivation of the young person alone, but a combination of various factors, engaging the whole youth including the youth’s experiences with adversity
 
(2) Understanding the Youth’s Perceptions of Mental Healthcare
            When young people move into the adult mental healthcare system they enter with thoughts and feelings about treatment and providers, much of which has been informed by their earlier experiences with the system. It is vital that providers take the time with youth to explore their past experiences with service systems and providers and their beliefs about mental healthcare. In many ways it’s equivalent to developing a cultural formulation of the young person’s health beliefs. Cultural formulation is a process through which an individual’s perceptions and beliefs about care, elements of the provider relationship, and the overall impact of culture on diagnosis and care are explored. Providers must give great attention to whether the youth believes in their diagnoses, and if so, what does the youth believe is the source of their diagnoses? What’s more, does the youth believe in treatment, and if so, what sort of treatment? Through understanding that young people’s beliefs of mental health and healthcare are culturally informed, providers will create space for engagement that considers past adversity and how trauma informs their relationship to mental healthcare. In this same vein, trauma-informed engagement with TAY also means exploring with youth how the stigma of mental illness can contribute to their experiences that can exacerbate symptoms and expose youth to chronic and sometimes toxic stress.
 
(3) Providing Consistency, Especially Consistent Relationships
Providing consistency is an especially important element of practicing trauma-informed engagement with TAY. The transition period can contain a great deal of inconsistency, which can be particularly difficult for TAY with past traumatic exposure. Providing a source of stability for youth can be of great help. More specifically, consistency in the form of consistent relationships is key, as it will also provide a sense of safety and reliability. One relationship of focus is the relationship between the provider and the youth. Cultivating a relationship between provider and youth that is defined by consistent practices can build trust and promote engagement. Examples include consistent style and modes of communication between the youth and the provider outside of and during meetings, and meeting consistently and at the same time and place as often as possible. Beyond the relationship with the provider and the youth, is the importance of consistent peer relationships, which providers can help facilitate and cultivate when working with the youth. Additionally, it has been shown that for both provider-to-youth and peer-to-peer relationships, these relationships are most beneficial for the youth when mutuality and empathy compliment the consistency. Through creating and routinizing sources of mutual and empathetic stability, providers can more effectively engage young people.
 
(4) Meeting Basic Needs
Finally, while it is important for providers to engage with youth to address mental health challenges, including past or current traumatic exposure, it is also important to address basic needs. As both research and practice suggest, treatment cannot happen without first meeting the people’s basic needs. Working together to stabilize or enrich housing, food, work, and school must happen while other work occurs so that there is attention to both meeting basic needs and critical treatment goals.  Youth have shared that providers often want to jump into trauma treatment, however youth often strongly feel that they are more than their mental health or trauma history and want to be engaged with as such.  Put differently, practitioners often want to jump right into symptom reduction when the youth actually has other, potentially more important, needs that they want to address. Paying attention to those needs is not only crucial for strong engagement, but also a way of practicing trauma-informed care, as it is a way of engaging with the entire youth and meeting them wherever they are. It is important to remember that trauma-informed care is not only about addressing traumatic events but also about addressing life stressors and securing immediate needs to mitigate or prevent adversity.
 
Trauma-informed engagement can greatly enhance a therapeutic relationship and experience with TAY. Young people who are thoughtfully engaged in services are more likely to bond with service providers, participate in treatment planning, direct treatment goals, remain in service longer, and report higher levels of satisfaction.
 
To learn more about TAY engagement from the *consumer* perspective, please access The Community Technical Assistance Center (CTAC) of New York State’s webinar, “Transition Age Youth (TAY) Engagement: Best Practices & Personal Experiences”.
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