The proposed project, Transitioning Lives Collaborative (TLC), will foster the mental health, behavioral health, and long-term outcomes of youth and young adults by implementing best practices within an array of services and support for youth and young adults. TLC will streamline, improve, and increase the availability and quality of comprehensive behavioral/mental health services to meet the needs of transition-age youth (TAY)/young adults (age 16-25) with serious emotional disturbance (SED), serious mental illness (SMI), co-occurring mental and substance use disorders (COD), and intellectual and developmental disabilities and their families receiving services at MHMR. The project will effectively respond to the needs of this population by providing a vast array of comprehensive, evidence-based practices and services to youth and young adults aged 16-25 who are at risk of failing to transition successfully to adult services. The population of focus for this project will include transition-age youth/young adults (TAY) (age 16-25) with SED, SMI, IDD, or COD.
The following service gaps will be address through TLC: (1) Bridging the gap between two distinct service systems by assigning a TAY transitional specialized provider to help in the transition to adult services; (2) Providing staff and specialized services to serve TAY to ensure the likelihood of a successful continuity of care with needed services; (3) Reduce the lack of awareness, education, and coordination of services for transition-age youth/young adults by implementing a continuum of services through appropriate navigation/collaboration of servicing agencies (i.e., employment, vocational, housing, education, medical benefits); (4) Reducing discontinuity of services, disengagement from services, and poorer clinical outcomes for transition-age youth; and (5) Assisting TAY with SMI, SED, COD, and IDD in their transition to employment, supported employment, and vocational services.
The TLC project will utilize 5 FTEs who will provide direct services to TAY. These positions include a Family Interventionist (2.0 FTE) who will provide case management services and a liaison to TAY and will serve as a liaison with Adult Services for the TAY population; a Family Advocate (2.0 FTE) who will provide support and resources to youth receiving case management services; a Navigator (1.0 FTE) who will provide access and referral service coordination to TAY that calls into MHMR; a Youth Engagement Program Director (.15 FTE) who oversees and facilitates youth voice across programs and community systems of Child and Family Services (CFS); an Advanced Practice Registered Nurse (.1 FTE) who will assist clients with medication management; and a Support Specialist (.5 FTE) who is responsible for the data fidelity for all data collection systems.
The Research Division of MHMRTC will evaluate this project. Following the individuals' consent to participate, the evaluator will complete a series of instruments. Individuals will be followed up at 3-months post intake with these measures. At the time of discharge, only the NOMS will also be administered.