by Wayne Munchel, LCSW   0 Comments

I caught up to Early Psychosis services expert, change agent extraordinaire and overall interesting person, Nev Jones, after her return from Milan, Italy where she participated in the International Early Psychosis Association (IEPA) conference. Nev is the Director of Research at Felton Institute CCOR (Client Centered Outcomes Research in Public Mental Health).

So Nev, what were some of the more interesting trends you saw at IEPA?

It’s never possible to attend everything you want to with multiple concurrent sessions, but there was a strong undercurrent of research focused on adverse childhood experiences (ACEs), including both individual trauma and structural adversity (for instance, growing up in a disadvantaged neighborhood). Many of these presentations focused on the contributions of ACEs and other social factors, including migration, to later development of psychosis. (While still relatively under-acknowledged in the US, the relationship between early trauma and psychosis is now empirically well established and it’s critical that US clinicians start building trauma-informed approaches and trauma work into psychosis treatment programs. See a brief and accessible overview of the trauma-early psychosis research literature here).

In terms of contributing factors to the development of psychosis, there were definitely the more conventional presentations focused on biology. However, Mark van der Gaag and his lab (Amsterdam), presented a series of studies concerning repeated social stressors. By creating a “virtual café” they exposed subjects to an environment where everyone is a different race, and appear unfriendly or hostile. I also saw a great presentation on Melbourne-based researcher Sarah Bendall’s important work developing and evaluating TRIPP (trauma informed psychotherapy for psychosis), one of the first attempts to develop therapeutic interventions focused on trauma within the context of recent onset psychosis.)

Sounds interesting. What else did you learn?

This may at least partly be due to the fact that early psychosis services are much newer in the US than in countries like Canada and Australia, but I saw a range of innovative, outside-the-box projects that one just doesn’t see here in the States. For instance, an early psychosis intervention revolving around participation in adventure sports (e.g. rock climbing, white water rafting), and a martial arts intervention for at-risk youth. What I like about these sorts of projects is that they help move us away from the conventional symptoms focus of most early psychosis services, and reorient to the reality that most young people are probably far more interested in navigating a series of Class 4 rapids with a group of peers, than sitting around in a circle at a mental health center in group therapy discussing their coping strategies. A lot of processing, and a lot of healing, happens indirectly, by forging new relationships, tackling new challenges, and collaboratively engaging in activities that are actually legitimately cool.

Very cool. Did you present on anything?

I did two presentations as well as a poster. The poster focused on young people’s experiences of sexuality and the sex- or gender-driven themes so often present in voices or belief systems. My own research has found that around 50% of service users experience some sort of sexual content, including voices that talk about sex, unusual (positive and negative) erotic experiences, and/or themes related to past sexual trauma. It’s critical that these experiences are validated, discussed and explored, but often these sorts of themes leave clinicians feeling uncomfortable and so they simply avoid the subject. I also presented on a pair of twin SAMHSA-funded higher ed toolkits that we developed at the Felton Institute (“Supporting the full inclusion of students with early psychosis in higher education”) with extensive student and family input. The toolkits themselves are helpful (actually long overdue!) but still really just a first step in addressing the substantial educational disparities and barriers that students with early psychosis face. We’re now meeting with city and community college staff and trying to take this to the next level in terms of resources, trainings, and program development.

Thanks, Nev!

Nev is the director of research at Felton Institute CCOR (Client Centered Outcomes Research in Public Mental Health) and an active early psychosis services researcher and change agent. For more on Nev’s work on peer leadership in early psychosis see an archived webinar here.

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by Wayne Munchel, LCSW   1 Comment

TAY Employed

I was lost. I was stressed. Everyone was rushing me to grow up and I just…I didn’t even begin to understand how that was to be done. I felt like a clock was ticking…time was running out. I needed to find work, become an adult, make a life for myself, but everything pushed against me doing that. In this world I found myself in, I was given a task, yet given a coming storm of obstacles to prevent me from achieving that, with no tools to work within assisting me. I had so many questions and no one had any answers. It broke me.

Derek’s plight was exactly what the Kern County stakeholders had in mind when they convened in 2013 to identify the needs of Transition Age Youth. Twenty system-involved youth, along with representatives from Kern County Mental Health, Kern County Department of Human Services Independent Living Program (ILP), and representatives from community housing programs, participated in a series of meetings to vote on service priorities for this vulnerable population. A clear consensus emerged; jobs and education were identified as the greatest needs facing youth and young adults living in Bakersfield.

This stakeholder collaboration followed an extensive training in the Transition to Independence Process (TIP) Model™, an evidence supported practice designed to improve the outcomes of youth and young adults with emotional and behavioral difficulties. One of the TIP system guidelines recommends “involving young people, parents, and other community partners in planning and guiding transition services”. The Kern County stakeholders recognized that effectively supporting youth like Derek, and the many others aging out of foster care, probation and children’s mental health in furthering their education and getting jobs would require significant collaboration – no one provider could do it alone.

The Kern County TAY Career Development program was launched. The Kern County Mental Health Department took the lead in busting out of the usual service silos, and reached out to Employer’s Training Resource to join the project and provide their vital expertise in vocational training and job coaching. Kern High School District also signed on as a sub-contractor to offer job development and placement services.

In order for the collaboration with multiple agencies to be successful, the Transition Age Youth team wanted to ensure that all planning partners spoke the same language. Therefore, the team invited all key players who may be involved in the transition process to learn the TIP Model. Partnering agencies and staff from Employer’s Training Resource, Kern High School District, social workers, probation officers, Independent Living Program (ILP) staff, and group home staff all participated in the TIP trainings.

Derek enrolled in the new program and picks up his story:

At first I was confused and didn’t really understand where things were going, but that’s just the way I am. But still…never before have I had so much support in my life. And then the four week program started, training us in job hunting and…I was making progress. I was making real, visible progress and that made me feel better about my life than I had in a very long time.

Participants work twenty hours per week for eight weeks at their “externship” sites. The available externship sites are varied and placement is tailored to meet each person’s individual strengths and interests, as well as how close their homes are to the sites. Examples of externships include daycare centers, the Garden Spot, Pac-Sun, Footlocker, CVS, and maintenance work at apartment complexes. Once an externship has ended, their employers have the opportunity to hire them as permanent employees. For the youth who do not get hired, an Employer’s Training Resource job developer continues to work with them one-on-one to find permanent employment.

Derek continues:

Now I’ve started my externship in which I’m on my second week, and the experience is invaluable. There’s direction in my life…it’s hard to believe it sometimes!

TAY programs can do much to either serve as on-ramps to futures of higher education, career opportunities and valued roles, or be pathways to life-times of poverty, disability and marginalization. Kern County is demonstrating that when youth and young adults like Derek, are supported by effective partnerships between mental health practitioners, business leaders, educators and job trainers, they can go far.

Update:

After completing his externship, Derek applied and was hired by an insurance firm as a Data Entry Clerk and was paid $15 an hour. He has since moved out of his mother’s home, and got an apartment in another state, where he works for a well known insurance company.

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