By Todd Williams, Agency Liaison, and
Angela Wessell Ph.D., Project Director for
Missouri Show-Me Kids

The Missouri Show-Me Kids System of Care (SOC) community focuses on providing a variety of high-quality transitional services to our youth with co-occurring mental health disorders and developmental disabilities and their families. We have identified four critical components to help these youth transition from child to adult services and from school to work. The four components are: 1) youth and family voices, 2) specialized care management, 3) natural supports within the community, and 4) interagency partnerships.

Youth and Family Voices

As we reflect over lessons learned in our efforts to provide these youth smooth transitions into adulthood, we realize the necessity for building our transitional services around the voice of the youth and their families. When a transitional plan is not sensitive to the needs and wants of youths and their families, they are not only at risk of terminating the plan, but also the planning team is not seen as valuable or helpful by the family. For this reason, we are beginning to form small focus groups in which youths will have a chance to discuss what they need and want from transitional services. We hope to use the discussions and ideas from the groups in our policy teams so that we can better tailor our transition services.

Specialized Care Management

Specialized care management refers to a care manager who has worked with both the youth and adult populations and has the skills and knowledge base to help transition the youth to access adult services, including mental health services, housing, vocational development, social security disability, etc. It involves attention to the needs and wants of youths and their families from Day One. Transitional services in our SOC community begin long before the youth reaches the age of 18. For example, if a child enters our program at 12 years of age with a co-occurring disorder of depression and Down's Syndrome, we will encourage and work with parents to give their child more responsibilities as he or she continues in his or her mental health treatment. The goal of giving youth more responsibilities in their treatment plans is to prepare them for real life. When parents or caregivers assume complete ownership over these tasks, the youth have a difficult time understanding why it is important for them to continue with their services once they turn 18 years old.

We often ask our youth and families to consider what the youth's world will look like in 6 years. Parents are often dealing with immediate concerns, such as a behavioral issue at school or how they are going to get their child to therapy. Our care managers are aware of the overriding issues that our families face and use their time with families to remind them of the importance of preparing for their child's transition to adulthood. For instance, when a youth turns 18, he or she often needs to fill out the Supplemental Security Income (SSI) form, which asks them where they have been treated, what treatments they have received, and when they received the treatments. These questions can be challenging to answer after 3 or 4 years of treatment. For this reason, we encourage parents and youth to keep their appointment cards and put them in an envelope as a record of their treatment. While this may appear to be a simple task, it can eliminate a lot of confusion and frustration in the transition from child to adult services.

Our specialized care managers also help to prepare youth and families for the changes in Medicaid laws from children to adult services. For example, childhood diagnoses of reactive attachment disorder or separation anxiety typically do not qualify for services within the adult system. Therefore, the young adult would have to be re-evaluated to determine if they had a qualifying diagnosis when they grew out of the child/youth mental health services. Each youth's care manager will take the time to explain the services that the youth will be entitled to under adult Medicaid laws.

Natural Supports within the Community

Care managers also help to link youths to employment services. In order to create these linkages, we have focused on building relationships with natural supports in the community. We approach organizations, such as the Missouri Mentoring Partnership and the Missouri Career Center, which have been a part of our community for a long time, but have been underutilized by the system of care. Our collaboration with these organizations has demonstrated the necessity for education around mental health. In talking with individuals from job training and employment centers in our state, we have encountered some misconceptions about mental health. Some workers unfamiliar with mental health issues assumed that our kids would be unable to work or present too many difficulties to make it through their program. For our part, we did not understand fully what their programs could offer. However, with a modest amount of education, communication, and explanation of the supports we can offer, misconceptions quickly where changed for everyone. The end result is that there are kids who will be working this summer in supportive settings around the community and who will have similar opportunities as other youth.

In order to replace the myths about mental health with facts, and to ensure our youth a supportive environment in their transition from school to work, we give presentations and provide trainings for staff from the Missouri Mentoring Partnership and other natural community support organizations. The presentations and trainings also help to clarify the intentions of our System of Care community. Organizations often assume that when someone approaches them, all they want is financial support or funding. In our case, we do not want anything monetary; instead, we want to make access to their services easier for our youth. Through phone calls, emails, and visits, we make sure that things are going well for the organization and our youth.

Interagency Partnerships

Our goal in partnering with these organizations is not only to make access to services easier for our youth, but also to make it harder for them to be dropped. An important step in reaching this goal is explaining to the staff in community organizations the challenges that each youth faces and the role that the care manager plays in the life of the youth. For example, after forming an alliance with the Show-Me Kids SOC, the Ozarks Area Community Action Corporation (OACAC), an organization that provides youth, family, and housing services ( http://www.oacac-caa.org/ ), has been successful in retaining our youth in their summer work program. We have worked with the OACAC staff to allow care managers to visit their youth from time to time at the work site versus at home. We explained that we were not there to supervise the youth or to intervene with their work schedule, but rather to offer extra support to the youth and to complement the program in place. With the additional support and understanding from both the care managers and the community supports, our youth have a better chance of success in their transition to adulthood.

Sustainability of Transition Services

By helping our youth to access existing services, we do not have to recreate the wheel. We are simply linking our System of Care community to services that are already in place. Our growing interagency partnerships also help to ensure that the transitional services we are offering to our youth will continue to serve them after the funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) grant has ended. All agencies involved, i.e., child welfare, Department of Mental Health, Division of Mental Retardation Developmental Disabilities (MRDD), are taking more ownership in the sustainability of services. For example, the MRDD has attended three different meetings with the youth and their families in the past several weeks. In the past, a staff member from the Department of Mental Health would relay the information to a staff member from MRDD who in turn would send a message back to the youth and their families through the staff member from the Department. Now, the client has the opportunity to work directly with all partners involved in their transitional process. As a cohesive and working unit, we are able to problem-solve more efficiently and to more respectfully honor the voices of our youth across multiple domains. Our partnership has permitted a more open relationship where our communication with other agencies is no longer an exception to the rule.

In collaborating and partnering with natural community supports and other child-serving agencies, we have helped bridge a gap between our youth and existing underutilized transitional services. We have learned that the focal point for our work must be the voice of the youth and family. Without their investment, we have nothing. We—the professionals, teachers, coaches, and community supports—are the steps in the staircase to adult services and job opportunities for our youth in transition. Their families are the handrails that will be there to support them every step of the way. The youth have the choice to go up or down the steps, and it becomes our mission to empower these young people to keep walking up the staircase. It is our hope that as we continue to identify natural supports and provide opportunities for professionals to hear the youth and family voice. We will keep our youth in transition motivated until they reach the top.