The Role of Vocation and Community Engagement in

The Role of Vocation and Community Engagement in Recovery for Transition Age Youth

Model of Care at Goldsmith

RTF Care � Psychiatric residential treatment for 50 adolescent males with a primary mental health diagnosis � Residents receive education, therapy, health services, recreation and vocational training from trained staff � Admission to the RTF is voluntary and is approximately 3 -9 months.

Sanctuary Model Sanctuary is a treatment and organizational change model that integrates trauma theory with the creation of therapeutic communities to provide safety for both clients and the staff who work with them

The Seven Commitments of Sanctuary � Nonviolence � Emotional Intelligence � Social Learning � Open Communication � Social Responsibility � Democracy � Growth & Change

Safety: S. E. L. F Physical, Psychological, Social, Moral Emotions: Handling feelings without becoming self/other destructive Loss: Feeling grief and dealing with personal losses, preparing for change Future: Re-establishing the capacity for choice

Sanctuary in Practice at Goldsmith � Twice Daily Community Meetings � Psychoeducation Groups � Safety Planning � Comfort Room � Red Flag Meetings � Staff Self-Care Plans � Treatment Team Conferences

Transition Age Youth Program (TAY)

Impetus for a TAY Program � Increased � HRA � OMH number of older children in RTF care emphasis on adult housing involvement � Discussion began almost 10 years ago with building bridges initiative. � Negative outcomes of youth transitions from RTF to adult systems.

The Goal � Preparedness for transition to adult housing � Development of independence and competence in daily activities (ADL’s) � Development � Focus of vocational skills on successful reintegration into communities as an Adult

The Challenge Typical Resident Profile � Primary Psychiatric Diagnosis � Multiple Psychiatric Hospitalizations � Trauma History � Extensive History of Foster Care/ Residential Placement � Maladaptive Coping Skills � Poor Confidence/ Self Esteem � Dependence/ Institutional Mentality

The Solution

3 Tiered Vocational and Community Programming at Goldsmith � On Campus Recreational and Vocational Programming � Creating Community Opportunities for Social and Vocational Participation � Clinical Interventions to Support Positive Social and Vocational Engagement

On Campus Recreation and Vocational Programming

Goal To allow for the initial fostering of social and vocational skills in a more protected and controlled environment

Tragic Truth �A large percentage of our youth come into our care with little to no vocational skills!!! �This can largely be attributed to a lack of a sense of future for themselves.

Questions to Instill Future Vision � What are your plans when you leave? � What do you want to do with your life? � What kind of job do you want to have? � Do you want to go to college or learn a trade? � If yes, what do you want to learn? WHAT ARE SOME OF THE ANSWERS YOU GET? ?

VOCATIONAL PROGRAM ASSESSMENT � What type of residents / clients are in your program? � What is their psychiatric level of functioning? � Are they able to work in a setting with or without supervision? � Can they function off grounds independently? � How does their trauma or symptoms impact their ability to participate in the vocational program?

On Grounds Vocational Programming � Client / Residents go through an interview process. � They must first get approval from their respective treatment team. � Employment is used as a therapeutic tool, not a tool used to punish. � Jobs include building maintenance, grounds maintenance, culinary work in kitchen.

Visible Results of On-Campus Vocational Programming � Increased sense of future � Development of practical work skills � Sense of responsibility and punctuality � Increased sense of self-confidence � Prompts thought around future work/ career � Increases interest in pursuing off-campus work

Goldsmith Recreational Programming � On-campus events � Family engagement/ inclusion � Sports Teams � Inter-program collaboration � Off campus trips � Educational experiences � Camping

Benefits of Recreational Programming Compliments Vocational Programming in a Number of Ways � Social skill development � Exposure to new hobbies/ interests � Increased knowledge/ education � Improved self confidence interacting in public/ with strangers.

Creating Community Opportunities and Relationships

Goal To allow youth the opportunity to engage vocationally and recreationally in the community, in a supported manner, while still in RTF placement

Previous partnerships � Love is Ageless � Pets Alive! Animal Shelter � Walgreens � Soup Kitchen � BOCES

Ittleson Volunteering Project

Impetus for Program � Ongoing challenge to identify new partnerships for Goldsmith residents � Programs consistently benefit from volunteers who enhance programming � Why not utilize residents as volunteers at other programs within the agency?

Logistical Considerations � Confidentiality/HIPAA � Frequency � Guidelines for engagement � Supervision � Role of peer volunteers

Identifying Appropriate Youth Elijah & Mykle � Pre-existing independent skills � Well liked by peers � Enjoy helping others � Travel Independently � Excited by the idea of working with children

Initial Steps � Discussion with agency volunteer coordinator � Helped youth identify reason for wanting to volunteer � Completion of volunteer application � Resume Preparation � Interview prep � Clothes shopping

Interview at Headquarters � Emulated professional job interview � Group and individual format interviews � Met and spoke with agency CEO David Rivel � Given tour of headquarters � Met staff from multiple departments � Relationship developed with graphic designer

Next Steps � Onsite interview at Ittleson RTF with Program Director and AOD � Onsite orientation � Travel Training � Scheduling of supervision with volunteer coordinator

Ittleson Volunteering Project Now � Attending for about 5 months � Attend weekly for about three hours, travel independently � Weekly supervision with volunteer coordinator � Call ahead to report tardiness or absence for valid excuse � Consistent positive feedback from boys and program

Skill Sets Developed � Portable skill set #1 Improved self-confidence and esteem (outward appearance reflect emotions) � Portable skill set #2: Real interview skills, dress for success, non-verbal communication � Portable skill set #3: Resume development/ enhancement � Portable skill set #4: Responsibility, consistency, punctuality � Portable skill set #5: Boundaries, team work, accepting feedback, personal improvment

Clinical Interventions and Support

Goal To provide youth with the skills and tools needed to be successful and confident in social and vocational engagement in the community

Therapeutic Tasks for Vocational Prep � Psychoeducation around symptoms and impact on functioning � Development grounding skills to promote independent self-regulation � Address negative thinking patterns and low selfesteem � Address motivation/ ambivalence towards change and independence � Development of social skills appropriate for work -place and other professional and social interactions

Assessments to Guide Interventions � Psychosocial � Psychiatric � CANS � Phase Specific Treatment Team Conference reviews � UCLA-RI � OMH Substance Use/Addictive Behaviors Addendum

Psychoeducation � Mental Illness-What is it? � Symptom Identification ◦ Functional impact � Need for ongoing treatment ◦ Medication compliance � Reconciliation between symptoms/illness, and social/workplace demands � Concurrent psychoeducation with families and/or collateral agencies/around youth’s needs

Self Regulation/ Grounding � Identifying feelings � Identifying triggers � Identifying coping skills/ grounding techniques ◦ Emphasis on independent and portable skills �Deep breathing, PMR, physical grounding, mental grounding, etc… � Development of Situation Specific Safety Plans ◦ Community safety plan ◦ Job safety plan � Mobilization of Comfort Room

Cognitive Behavioral Therapy Goal: To identify, reduce, and replace a resident’s dysfunctional/distorted thinking Common thought distortions among TAY youth: ◦ Personalization and blame ◦ Labeling/ poor self-image ◦ “Should”/ “must” statements in relation to future/ work ◦ Overgeneralization ◦ Projection of negative thoughts

Cognitive Behavioral Therapy � CBT Interventions ◦ Connecting thoughts, feelings, and behaviors (CBT Triangles) ◦ Thought/ Feelings Record ◦ Activity Scheduling ◦ Cognitive Coping ◦ TF-CBT ◦ Corrective Experiences

Motivational Interviewing Goal: To have residents look at both sides of their ambivalence about change, make a statement of commitment to change, and make a change in behavior. Common ambivalence/ problematic behaviors related to vocational engagement ◦ Substance use/ abuse ◦ Fighting/ Aggression ◦ Autonomy vs. Dependence/ Learned helplessness ◦ Isolation vs. Engagement

Motivational Interviewing � MI Interventions ◦ OARS �Open-ended questions �Affirmations �Reflective Listening �Summaries ◦ Change Talk/ DARN �Desire “I want to…” �Ability “I can…” �Reason “It’s important…” �Need “I should…” ◦ Commitment Statements ◦ Realistic Action Plans

Social Skill Development/Practice Goal: To learn and rehearse social skills appropriate for the work place and other settings. Common barriers to appropriate social engagement ◦ Poor self-confidence ◦ Difficulty understanding social cues ◦ Lack of “vocational vocab” ◦ Lack of experience/ rolemodeling

Social Skill Development/ Practice Rehearsal and Role-Play � Greetings � Introductions � Conflict resolution � Asking for help � Giving directions/ Instructions � Coping with unpleasant exchanges � Understanding and setting boundaries

Knowledge Empowers You (KEY) Group � Curriculum developed by NYS OMH, NYU Mc. Silver Institute, and The Urban Institute for Behavioral Health. � Weekly group focused on relevant topics for transition age youth ie. Relationships, drug use, negative thinking, physical and mental health etc. � Allows for open conversation and exploration of topics in a way that gives youth ownership

The Benefits of Vocational and Community Programming

Youth Experience/ Testimonies

Role in Recovery Mykle � Personal Appearance � Self Confidence � Ability to identify strengths � Corrective experience related to distorted thinking Elijah � Accountability/ Responsibility � Feeling of self-worth � Sense of future/accomplishment � Increased motivation to engage in own treatment

Program Logo designed by Mykle and Agency Graphic Designer

Looking Towards the Future Continue Ittleson Volunteering Project and possibly increase number of participants � Ongoing development of relationships both at RTF and in community � More community based activities and relationships � ◦ � � Volunteering & vocational New facilities more independent living style/ teaching kitchen Additional assessments/ implementation of evidence based practice Re-engagement of previous TAY residents as mentors

Questions Antwan Cook Team Leader / Vocational/ Recreation Director ACook@jbfcs. org 914 -773 -7402 Ingrid Mc. Kenzie Transition Coordinator/ Supervisor IMc. Kenzie@jbfcs. org 914 -773 -7452 Andrew Dillenbeck, LMSW Social Worker Adillenbeck@jbfcs. org 914 -773 -7428