Area of Focus
Youth and Young Adults (YYA) of Transitional Age with, or at Risk for, Serious Mental Illness (SMI)
The Pacific Southwest MHTTC provides training, technical assistance (TTA), and resource development to the mental health field in the Pacific Southwest region (HHS-designated Region 9). In addition, we offer support at a national level on our areas of specialty, including working with YYA of transitional age with, or at risk for, SMI.
Overview of YYA Mental Health
Youth and young adults (YYA) of transition age (16-25 years of age) are an important population of focus for mental health services and supports. This period involves significant changes, new responsibilities, and decision-making related to school, career, family, personal relationships, finances, and other areas of life. For most YYA, these transitions are both exciting and challenging. However, for YYA who experience (or are at risk for) serious mental illness, the transition to adulthood presents unique risks and difficulties that can impact lifelong outcomes.
One of the risks of the transition age is that it coincides with the age of onset for most mental and behavioral health challenges. Most mental health challenges emerge in the late teens to early 20s, with roughly 75% of mental health challenges beginning by the early 20s.1,2,3 Serious mental illness, or diagnosable mental health challenges that substantially interfere with or limit major life activities, are more prevalent during the transition age than at any other period.4,5 Recent National Survey on Drug Use and Health (NSDUH) data show increasing rates of SMI, major depression, and suicidality for YYA of transition age.6
Young adulthood also involves the transition from child-serving systems (foster care, juvenile justice, special education, pediatric care, etc.) to adult-serving systems. Eligibility requirements vary across programs, with youth services terminating at ages ranging from 16 to 22, and usually do not take into account the developmental needs and strengths of the specific YYA who receive services. Rather than a streamlined system of care, many YYA experience a series of transition tunnels and cliffs that can lead to their falling through the cracks between systems.7
The resources provided on this page are intended to assist a wide array of stakeholders involved in creating better outcomes for YYA with mental health challenges and SMI. These resources uphold the research-based concept that systems and services should be youth driven, developmentally and culturally appropriate, and trauma informed.
Pacific Southwest MHTTC Youth of Transition Age Webinar Series
Low-Barrier Access to Mental Health Service for Youth and Young Adults: What Works with What We've Got
Tuesday, April 30
6:00-7:15 p.m. ET / 3:00-4:15 p.m. PT / 1:00-2:15 p.m. HT / 9:00-10:15 a.m. ChT
This webinar will explore low-barrier services for young adults of transition age experiencing or at risk for behavioral health challenges. Presenters will discuss how low-barrier services can improve engagement and will identify strategies for integrating low-barrier policies and practices into organizational standards. Throughout the discussion, presenters will provide examples of promising approaches that have been adopted by local communities, including the development of drop-in centers and peer-to-peer programs. Presented by Kristin Thorp, BSW, Youth Engagement Specialist at Youth M.O.V.E. National, and guest presenter.
Ethical Considerations and Strategies for Improving Shared Decision Making in Civil Commitment and Involuntary Hospitalization
Tuesday, May 28
6:00-7:15 p.m. ET / 3:00-4:15 p.m. PT / 1:00-2:15 p.m. HT / 9:00-10:15 a.m. ChT
Though the practice of civil commitment and involuntary hospitalization has markedly changed since the middle of the 20th century, it remains one of the most controversial procedures in behavioral healthcare. This webinar will explore civil commitment law through the lens of civil liberties for young adults of transition age. We will consider the ethical tensions between a provider or family member's desire to help a young person experiencing serious mental illness and the young person's autonomy. Presenters will discuss the importance of shared decision making and will provide strategies for improving the process of civil commitments for youth and their families. Presented by Kristin Thorp, BSW, Youth Engagement Specialist at Youth M.O.V.E. National, and guest presenter.
Tuesday, July 9
6:00-7:15 p.m. ET / 3:00-4:15 p.m. PT / 1:00-2:15 p.m. HT / 9:00-10:15 a.m. ChT
Young adults of transition age have elevated rates of mental health challenges, yet they often do not receive services. Few mental health interventions have been designed with this population in mind, and even fewer have been found to be effective. This puts young adults of transition age at greater risk for homelessness, justice involvement, and education and employment challenges. These challenges are even more acute for youth from vulnerable populations. This webinar will focus on strategic practices that health departments and mental health agencies can take to begin eliminating health disparities by advancing mental health equity. Presented by Kristin Thorp, BSW, Youth Engagement Specialist at Youth M.O.V.E. National, and guest presenter.
Resources for Agencies, Clinicians, and Providers
WEBSITES OR CENTERS
RTC for Pathways to Positive Futures at Portland State University aims to improve the lives of YYA with serious mental health conditions through rigorous research and effective training and dissemination. Sample resources include:
- Focal Point is a research review which covers a topic related to YYA mental health and the transition to adulthood annually.
- The Integration of Early Psychosis Services in a System of Care Framework: Opportunities, Issues, and Recommendations provides recommendations for state and local jurisdictions with and without systems of care.
- Housing and Transition: Meeting the Needs of Young Adults with Mental Health Conditions: this report is written for administrators, policymakers, and individuals planning to develop or modify housing supports for YYA of transition age with mental health conditions.
The mission of Transitions ACR at University of Massachusetts Medical School is to promote the full participation in socially valued roles of YYA of transition age (age 14-30) with serious mental health conditions. Sign up for the Transitions ACR newsletter. Relevant resources include:
- Helping Youth on the Path to Employment (HYPE) is a manual-based intervention for Supported Employment (SE) programs that wish to better assist YYA of transition age develop their careers.
- Transitions ACR hosts quarterly webinars on topics such as preventing disability at a systems level, behavioral health for YYA involved in the justice system, and employment strategies.
BRSS TACS helps programs, systems, states, territories, and tribes as they implement effective recovery supports and services for people with mental or substance use disorders. Sample topics include peer support, shared decision-making, and crisis. Visit their Youth and Young Adults page for technical assistance and video trainings.
Youth MOVE National is a youth-driven, chapter-based organization dedicated to improving services and systems that support positive growth and development by uniting the voices of individuals who have lived experience in various systems. Key resources include:
- #Things2Consider tipsheet series: Community Youth Resource Mapping, Strategic Sharing, Stipending Youth & Young Adults (Español), Measuring Success (Español), and Creating a Youth Advisory Board
- Language in the Youth MOVEment: A Compilation of Terms explains terms such as “transition aged youth,” “youth driven,” and “youth advocate,” and provides considerations from the perspective of YYA.
- Youth Peer-to-Peer Support: A Review of the Literature describes the history of YYA peer support and the research supporting it.
BBI is dedicated to improving lives by advancing partnerships among residential and community-based service providers, youth, and families. Visit their website for tip sheets, tools, and more resources on evaluating service outcomes; increasing cultural competency of services; promoting child welfare permanency; and understanding residential services (for youth and families).
The National Association of State Mental Health Program Directors (NASMHPD) developed these factsheets, videos, and training guides for clinicians, schools, YYA, families, and communities to support individuals experiencing early psychosis. Topics include trauma, family involvement in coordinated specialty care services, transitioning out of services, and more. NASMHPD also has an Early Intervention in Psychosis Virtual Resource Center.
SMI Adviser is an initiative from SAMHSA and the American Psychiatric Association. The section for Clinicians provides links to online courses; events; and a Knowledge Base with answers to frequently asked questions on topics such as manualized treatments, medications, family involvement, and more.
Got Transition/Center for Health Care Transition Improvement aims to improve transition from pediatric to adult health care through the use of new and innovative strategies for health professionals and youth and families. Resources focus on research and policy around health care transition. Sample resources include:
- The Youth & Families page provides frequently asked questions about every stage of transition, from discovering to completing.
- Incorporating Health Care Transition Services into Preventive Care for Adolescents and Young Adults: A Toolkit for Clinicians (Español): this toolkit provides suggested questions and guidance for clinicians to introduce health care transition during preventive visits with early (11-14), middle (15-17), and late adolescents (18-21) and young adults (22-25).
- Got Transition Newsletters share new resources, clinical guidance, and research on transition.
NTTAC provides states, tribes, and communities with training and technical assistance (TTA) on children’s behavioral health, with a focus on systems of care. The NTTAC is operated by the TA Network. View the TA Network’s YouTube page for videos about YYA systems of care, addressing topics such as early psychosis, wraparound supports, and career pathways.
KSOC-TV is SAMHSA web-based technical assistance television program featuring behavioral health and lived-experience experts discussing cutting edge issues in children's and youth mental health. Relevant webisodes include:
- Diverting to Treatment: Community Policing and Supporting Youth with Mental Health Needs
- Altering the Course: First Episode Psychosis Intervention
- Supporting Families with LGBTQ Youth
- Supporting Young Veterans and Young Parents
The SAMHSA-funded Now Is The Time Technical Assistance (NITT-TA) Center supported states and tribes funded through the Healthy Transitions grant program to improve systems and services for 16- to 25-year-olds with, or at risk for, SMI. Relevant webinars include:
- Early Intervention in Psychosis: From Foundational Principles to Innovation
- Developing Healthy Supportive Adult Relationships
- The Importance of Engaging Families of YYA with Behavioral Health Challenges
- Mental Health: A Key to Positive Futures for Youth in Foster Care
Windows of Opportunity in Early Psychosis Care: Navigating Cultural Dilemmas
This cultural competence series from the National Association of State Mental Health Program Directors (NASMHPD) includes a training guide and three brief (8-minute) training videos for providers:
- Navigating Cultural Dilemmas about Religion and Spirituality
- Navigating Cultural Dilemmas about Family Relationships
- Navigating Cultural Dilemmas about Masculinity and Gender Constructs
TOOLS AND PUBLICATIONS
This toolkit from the Learning & Working Center at Transitions RTC is written for provider organizations that employ or want to employ YYA peer supporters.
Back to School: Toolkits to Support the Full Inclusion of Students with Early Psychosis in Higher Education – Campus Staff and Administrator Version
This toolkit from the National Association of State Mental Health Program Directors (NASMHPD) is written for campus administrators; staff; faculty; and other members of the campus community, such as student advocates. Topics include recognizing and responding to signs of early psychosis, providing accommodations, increasing awareness and decreasing stigma, and more.
The Way Forward: Federal Action for a System That Works for All People Living with SMI and SED and Their Families and Caregivers is a 2017 report that identifies five major ISMICC areas of focus to advance systems and services for people with serious mental illness (SMI) or serious emotional disturbance (SED) and their families. It includes discussion of the specific needs of YYA of transition age.
The Guideposts for Success are a framework to assist the multiple organizations that need to be involved to meet the needs and improve the transition outcomes of YYA. Developed by the National Collaborative on Workforce and Disability, the Guideposts provide a detailed outline of the transition needs of all YYA, and specifically YYA with mental health needs and disabilities.
Resources for YYA, Families, and Community Members
SAMHSA’s ESMI Treatment Locator is a confidential and anonymous search tool for individuals and their families seeking treatment facilities in the U.S. states or Pacific Islands.
The mission of Transitions to Adulthood Center for Research (Transitions ACR) is to promote the full participation in socially valued roles of YYA of transition age (14-30) with serious mental health conditions. Recent and relevant resources for YYA include:
- Outside-the-Box College Accommodations: Real Support for Real Students assists YYA with mental health conditions with identifying accommodations unique to their needs
- Voices 4 Hope is a website that was created and is maintained by YYA with mental health conditions at Transitions ACR. It provides resources and information for other YYA.
- Comeback TV is a web-based TV series made by YYA to help YYA with mental health conditions on their path to successful independent lives. Episode topics include peer mentoring, applying to and receiving accommodations in college, applying to and interviewing for jobs, and more.
The National Alliance on Mental Illness (NAMI) developed this guide and video series in partnership with The Jed Foundation. It was created for college students and their caregivers and families. Topics include mental health conversation starters, campus services, and health information privacy.
Back to School: Toolkits to Support the Full Inclusion of Students with Early Psychosis in Higher Education – Student and Family Version
This toolkit from the National Association of State Mental Health Program Directors (NASMHPD) is written to support college students who have experienced first episode psychosis and their families. Topics include working with campus mental health services, receiving accommodations, navigating campus disciplinary actions and stigma, and more.
SAMHSA’s “Get the Facts” Factsheets
This series of short, recovery-oriented factsheets is written for young adults who have received a diagnosis of a mental health challenge, and their families or caregivers. Each factsheet provides an overview of the mental health challenge, discusses treatment approaches, and provides links to more support.
- Understanding Attention Deficit/Hyperactivity Disorder: Get the Facts (Young Adult) (Caregiver)
- Understanding Anxiety Disorders: Get the Facts (Young Adult) (Caregiver)
- Understanding Bipolar Disorder: Get the Facts (Young Adult) (Caregiver)
- Understanding Depression: Get the Facts (Young Adult) (Caregiver)
- Understanding a First Episode of Psychosis: Get the Facts (Young Adult) (Caregiver)
- Understanding Obsessive Compulsive Disorder: Get the Facts (Young Adult) (Caregiver)
- Your Life Your Future: Inside Info on Residential Programs from Youth Who Have Been There (English brief/expanded) (Español brief/expanded)
- Tip Sheet for Families Considering a Residential Program (English brief/expanded) (Español brief/expanded)
- Supporting Siblings When a Brother or Sister is Receiving Residential Interventions
This factsheet from National Association of State Mental Health Program Directors (NASMHPD) is written to help families understand and advocate for their role in a coordinated specialty care (CSC) program for a family member with early serious mental illness. (The companion tip sheet, Family Involvement in Programming for Early Serious Mental Illness, is written to help clinicians work with families.)
SMI Adviser is an initiative from SAMHSA and the American Psychiatric Association. The Patients & Families page links to SAMHSA-supported programs to advance mental health care.
This workbook was written for YYA (and their adult allies) who have experienced traumatic life experiences, such as serious mental illness and involvement in various systems, and who want to share their stories to advocate for change.
Youth MOVE National in partnership with the RTC for Pathways to Positive Futures developed this guide for YYA who have chosen to use their lived experience with systems (including the mental health system) to advocate for change.
RTC for Pathways to Positive Futures – Policy Change Resources
The RTC for Pathways to Positive Futures’ work is guided by the perspectives of YYA and their families, and based in a positive development framework. They have developed multiple tools to support YYA advocacy in the mental health system, including:
- Changing the Rules: A Guide for YYA with Mental Health Conditions Who Want to Change Policy: this policy guide is written for youth- and young adult-led groups and organizations that want to make changes in policies that affect them and other YYA of transition age.
- Advice to Young Adults from Young Adults: Helpful Hints for Policy Change in the Mental Health System: this tip sheet was developed with Youth MOVE National through a series of interviews with young adult leaders from advocacy groups focused on mental health challenges or foster care.
Topic in Focus: Trauma
This guide from Youth MOVE National is designed to help youth make a connection between stressful events and the potential lasting impacts. Understanding trauma and having a framework to talk about past experiences can help in processing and asking for help.
Complex Trauma Fact Sheets
The National Child Traumatic Stress Network (NCTSN) describes complex trauma, provides recommendations on how to support youth, and suggests specific evidence-based interventions.
- Complex Trauma: Facts for Directors, Administrators, and Staff in Residential Settings
- Complex Trauma: Facts for Treatment Staff in Residential Settings
- Complex Trauma: In Urban African-American Children, Youth, and Families
- Complex Trauma: In Juvenile Justice-System Involved Youth
This film was developed by National Child Traumatic Stress Network (NCTSN) featuring seven diverse YYA who examine the shared and unique challenges and growth they experienced from their developmental trauma.
This chart from the Family & Youth Services Bureau Runaway & Homeless Youth Program features low-cost or public domain screening tools for YYA, many of them focused on mental health, wellbeing, and trauma.
This National Association of State Mental Health Program Directors (NASMHPD) report describes what a trauma-informed FEP program looks like, with a focus on screening, assessment, and treatment for co-occurring trauma and psychosis.
1Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6),593–602.
2Insel TR, Fenton WS. Psychiatric epidemiology: it’s not just about counting anymore. Arch Gen Psychiatry. 2005;62:590–592.
3Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustun TB. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry. 2007;20:359–364.
4Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18-5068, NSDUH Series H-53). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
5Zajac, K., Sheidow, A. J., & Davis, M. (September 2013). Transitional Youth with Mental Health Challenges in the Juvenile Justice System. Juvenile Justice Resource Series. Retrieved from https://www.umassmed.edu/contentassets/15113f8a672840fca8b783ca95a800af/taywithmentalhealthchallengesjj.pdf
6McCance-Katz, E. F. (Sept. 14 2018). SAMHSA’s National Survey on Drug Use and Health – Recorded Presentation Retrieved from https://www.youtube.com/watch?v=M3s8laShPNU
7Podmostko, M. (2007). Tunnels and cliffs: A guide for workforce development practitioners and policymakers serving youth with mental health needs. Washington, DC: National Collaborative on Workforce and Disability for Youth, Institute for Educational Leadership.