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“Treatment as usual” (TAU) is a term used in research to denote the comparison group that does not get exposed to a new intervention or experimental practice. TAU describes the typical, usual services that are provided for a given condition. For far too many youth and young adults with serious mental health conditions in the US, TAU is the only option. What might “unusual”, optimal treatment and supports look like for TAY? This post will describe some of the key elements of an ideal TAY System of Care.
- ROBUST SUPPORTED EDUCATION AND EMPLOYMENT
In order to overcome the “soft bigotry of low expectations,” these critical life domains must be robustly and insistently supported. When emerging youth become disconnected from these life domains they lose contact with key resiliency factors and are often relegated to lifetimes of disability and poverty.
- ACCESSIBLE SUPPORTED HOUSING CONTINUUM
Ongoing housing instability often undermines progress in other domains. Flexible, titrated supports delivered across a range of housing options are optimum, from the most supervised and structured to independent living arrangements.
- UBIQUITOUS TRAUMA INFORMED CARE
A large percentage of TAY have been exposed to significant trauma. The “What Happened to You?” approach greatly enhances engagement and facilitates the process of healing and recovery.
- GONZO PEER SUPPORT
The strong presence of youth peer mentors brings vibrancy, cultural competence (youth culture), social media savvy and hope to the mix. Peer Supporters can also add and support creative arts (music, art, drama, etc…) as a means to engage, have fun, and heal.
- ENHANCED SUBSTANCE ABUSE TREATMENT CAPACITY
Integrated with Trauma Informed Care, addressing prevalent substance abuse issues is imperative. Promoting and teaching safer coping skills and harm reduction strategies is a critical element of an effective TAY System of Care. Motivational Interviewing guides TAY practitioners in providing a collaborative, empowering approach.
- DEVELOPMENTALLY ATTUNED SERVICES
The transition from childhood to adulthood is mediated by individual differences in maturation and culture, availability of social supports, and impacted by challenges such as trauma, illness, and poverty. The provider’s adjustable ability to deliver a level of culturally-sensitive support and structure matched to widely differing levels of need and ability to be self-directed is recommended.
- STAGES OF CHANGE FRAMEWORK
Applying Prochaska and DiClemente’s Stages of Change guides providers in matching the appropriate interventions to the TAY’s stage of change and to “meet them where they’re at.” This stage-specific approach is not only applicable to substance abuse issues, but can be productively utilized with other key developmental goals such as education, employment, and self-care.
- HOPE-FULL INTERVENTIONS FOR YOUTH EXPERIENCING PSYCHOSIS
Embedding this component into the TAY System of Care requires staff to develop the capacity to normalize and decatastrophize psychosis and offers practical ways to enhance coping and reduce distress. Being proficient in “high yield” elements of Cognitive Behavioral Therapy for Psychosis (CBTp) is a definite plus.