During their transition period, all youth and young adults face decisions about new social situations and responsibilities, future career and educational goals, self-management of behavior and substance use, and development and maintenance of supportive and intimate relationships (Arnett, 2004). For these emerging adults, this is a period of "discovery." Young people with EBD are particularly challenged during this transition period, and as a group, experience some of the poorest secondary school and postsecondary school outcomes among any disability group (Clark & Unruh, 2009; Pleis, Ward, & Lucas, 2010; Wagner, Newman, Cameto, & Levine, 2005; Vander Stoep, Beresford, Weiss, McKnight, Cauce, & Cohen, 2000; Vander Stoep, Weiss, Kuo, Cheney, & Cohen, 2003).
Fragmented services and limited access across different programs (e.g., mental health, education, vocational rehabilitation, juvenile justice, child welfare, housing) and funding mechanisms (e.g., Social Security, state and local appropriations, Medicaid, and federal block grants) further complicate this transition arena for young people with EBD and their families. For the most part, each of these program components has entirely different eligibility requirements, and the child-serving and adult-serving programs often operate under different philosophies. While each program may provide some essential services individually, it is often next to impossible for young people, parents, and professionals to navigate across them due to the complexities and fragmentation within and between programs/systems (Clark & Davis, 2000; Davis & Koroloff, 2006; Hoffman, Heflinger, Athay, & Davis, 2009; Unruh & Clark, 2009).
The TIP model prepares youth and young adults with EBD for their movement into adult roles through an individualized process, engaging them in their own futures planning process, as well as providing developmentally-appropriate and appealing supports and services (Clark & Hart, 2009). The TIP model involves youth and young adults (ages 14-29) in a process that facilitates their movement towards greater self-sufficiency and successful achievement of their goals. Young people are encouraged to explore their interests and futures as related to each of the transition domains: employment and career, education, living situation, personal effectiveness and wellbeing, and community-life functioning. The TIP system also supports and involves family members and other informal key players (e.g., parents, foster parents, an older sister, girlfriend, roommate) as relevant in meeting their needs and those of the young person.
The TIP model is operationalized through seven guidelines that drive practice-level activities with young people to provide the delivery of coordinated, non-stigmatizing, trauma-informed, developmentally-appropriate, appealing supports and services to them. The guidelines also provide a framework for program and community systems to support, facilitate, and sustain this effort (Clark, Deschênes, & Jones, 2000; Clark & Hart, 2009; Dresser, Clark, Deschênes, in press). (Please refer to Table 1 that follows this TIP Model Overview for a listing of these TIP model guidelines).
The TIP guidelines were synthesize from the literature on transition facilitation and then evaluated further with youth and young adults with EBD and their families (Dresser, Clark, Deschênes, in press; Walker & Gowen, 2011). The TIP model is a “practice model,” meaning that it can be delivered by personnel within different “service delivery” platforms, such as a case management platform or from a team platform (e.g., Assertive Community Treatment [ACT]).
At the heart of the TIP practice model are “proactive case managers” with small caseloads (i.e., transition facilitators, aka: life coaches, transition specialists, or coaches, serving 15 or fewer youth/young adults). The TIP transition facilitators use the guidelines and core practices (e.g., problem solving, in-vivo teaching, prevention planning of high-risk behaviors) in their work with young people to facilitate youth making better decisions, as well as improving their progress and outcomes. The TIP model also provides for the use of other evidence-based interventions (e.g., CBT, SPARCS/DBT) or other clinical interventions to address a critical need of a particular young person.
The following brief description of Kendra illustrates the TIP model approach as is has been applied with her at one of our sites. See how many of the TIP guidelines you can identify being applied in this work with Kendra.
Kendra, a 17 year-old-girl, was diagnosed with bipolar disorder and was refusing to take her prescribed medications. Her use of street drugs was possibly her way of self-medicating. Although she was in high school, her attendance, disciplinary record, and grades were all on the edge. Kendra’s transition facilitator, Ronda, began meeting with her in settings such as Starbucks and neighborhood parks. While taking walks together Ronda began conducting informal Strength Discovery assessments and person-centered planning. Over the first six weeks, Ronda was earning Kendra’s trust and learning about her interests, strengths, needs, resources, challenges, dreams, preferences, and social connections from Kendra, as well as from other conversations with her mother and an older sister who also lived at home. During this period, Ronda was also prompting, cajoling, and supporting school attendance, as well as teaching Kendra to manage her anger when someone would get “in her face” or tease her.
School continued to be a major challenge and Kendra continued to use drugs on occasion, as well as experiencing episodes of severe depression. Although she seemed to be developing more of a trusting relationship with Ronda, she continued to refuse to attend any therapy or medication reviews. Ronda continued to reach out to her and after about two-and-a-half months, Kendra revealed that the loss of her grandmother a year ago was devastating to her, since she was the only family member who Kendra found to ever show that she loved her. Ronda also learned through the informal Strength Discovery conversations that Kendra dreamed of being a nurse as her grandmother had been.
Based on this new information, Ronda worked with Kendra to explore how she might be able to improve her sense of family with her mother and older sister, and also to get a sense of what options Kendra would have in the nursing profession. Ronda arranged for Kendra to visit the community college program for nursing and to meet with the program coordinator. She gave Kendra a tour, discussed program options, and arranged for Kendra to sit in on a class on several occasions to see what was being studied and to meet some of the students. Kendra was very inspired by what she experienced and learned about the AA Degree program option.
Concurrently, Ronda and Kendra also met with a mental health therapist to see if Kendra would be willing to engage in individual therapy and try a new type of medication that might not have the side effects that she had experienced previously. She reluctantly began attending individual therapy twice a week, often wanting Ronda to attend with her. Over the course of the next month, Kendra was stabilized on a new medication and decided to expand her therapy to include her mother and sister in an attempt to create a sense of family.
Ronda worked with Kendra on developing a resume and teaching her interview skills so that she might interview more successfully for a reception position at a doctor’s office for the summer. Ronda had also learned from conversations with Kendra and her mother and sister that Kendra and her sister used to do a lot of roller-skating when they were younger. Ronda explored with Kendra and her sister if they might want to do some rollerblading at the local rink. Ronda was able to get a couple of passes to cover rink costs for a few months. Kendra and her sister really enjoyed their time together on the rink, made some new friends, and began to do more things together.
Now in her senior year of high school, Kendra is working, making good progress in completing high school, taking one class at the community college, making some new friends there, and living with a better sense of family. Ronda facilitated this through informal strength assessments and person-centered planning that engaged Kendra, and revealed her strengths, needs, and dreams. Ronda then provided tailored supports and services to assist Kendra in addressing her needs and achieving her goals. This process has allowed Kendra to find a new trajectory for her life and future.
The TIP model is an evidence-supported practice that has been demonstrated to be effective in improving the outcomes of youth and young adults with EBD. To learn more about our program development and research efforts and how they have been guided by the voice and perspectives of young people, parents, and practitioners in the field, as well as science; please refer to the TIP Theory and Research section of our website www.TIPstars.org.
In order to achieve these outcomes with youth and young adults, the SBHG TIP Model Consultants provide competency-based training and technical assistance to agencies, community collaboratives, counties, and states. The transition facilitators and the supervisory personnel at transition sites are taught and coached in the application of the TIP model guidelines and provided competency training in the use of TIP model core practices such as: Futures Planning, In-vivo Teaching, Problem Solving, Prevention Planning on High Risk Behaviors, and Mediation with Young People and Other Key Players. (Please see Tables that follow this TIP Model Overview for more information related to the guidelines, core practices, and transition domains).
The TIP Consultants and Assessors also assist sites with sustainability through technical assistance and mentoring on processes and building site capacity on topics such as: a) establishing peer support and leadership; b) conducting TIP Solutions Reviews for ongoing competency enhancement of all transition personnel; c) mentoring of supervisory personnel in coaching methods for working more effectively with their transition team; d) providing technical assistance on tracking of progress and outcome indicators for youth and young adults; e) establishing TIP Model Site-Based Trainers through mentoring; f) conducting and building site capacity for TIP Model Fidelity Quality Improvement Assessments; and g) certification of sites. It is our goal to ensure that the TIP model is implemented and sustained so as to improve the outcomes for transition-age youth and young adults with EBD (Dresser, Clark, Deschênes, in press).
FILE: Website TIP Model Overview WORD 092714
Copyright © 2010 by Stars Behavioral Health Group