Work Bridgeable

Transforming the mental health experiences of Transitional Aged Youth

Problem

For youth receiving community mental health care in Ontario, approaching adulthood means transitioning to adult mental health services. The lack of integration between these two systems disrupts continuity of care and can result in Transitional Aged Youth (TAY) losing access to services altogether.

Solution

We brought together sector leaders and service providers to co-design two tools: a journey map that builds awareness around the key challenges TAY face today and a strategic roadmap outlining next steps to drive sector-level impact.

Impact

The outputs of this work were presented at the 2024 CMHO Conference, growing momentum for this change by connecting relevant stakeholders and initiating next steps on 3 identified priority areas to improve the experiences of TAY in Ontario.

Mental health services in Ontario: a complex landscape

In Ontario, youth approaching adulthood, or Transitional Aged Youth (TAY), are required to shift from child and youth mental health services to adult services in order to maintain access to care. During this transition, TAY face a number of complex challenges that disrupt continuity of care or result in service loss altogether, with up to 60% of TAY losing access to treatment during this transitional period1. The stage of emerging adulthood is a critical period in which mental health challenges can emerge or increase in severity and complexity, making this challenge especially pressing. A lack of support and intervention during these formative years can have profound long-term impacts on an individual’s life outcomes, such as underemployment, justice involvement, substance use, physical health, and increased burden of mental health illnesses.

We partnered with Capitalize for Kids (C4K), a non-profit impact consulting firm that works collaboratively with community mental health stakeholders, to better understand the experiences of TAY in Ontario and to drive momentum for sector-level change. This topic has received a significant amount of attention in recent years through research and youth engagement. Service providers and leaders across Ontario have been working to respond to the needs of TAY by developing innovative programming and best practice approaches to care, such as Youth in Transition Worker programs, Youth Wellness Hubs Ontario (YWHOs), and transition navigation support for TAY and their caregivers. However, because Ontario is geographically large with uneven service provision, implementing and sharing solutions across regions and sectors is difficult.

While progress has been made, the volume of partners, initiatives, and policy recommendations has created a complex landscape without clarity on where the sector stands today, or a clear consensus on where the largest impact can be made next. Alongside C4K, we set out to support collective action and decision-making by bringing together stakeholders and clarifying the complexity of this cross-sectoral challenge. Over a 3-month period, we convened a working group of sector leaders, service providers, and TAY stakeholders from across the child and youth mental health sector in a number of engagements.

Facilitated

2

co-creation sessions

Conducted

7

in-depth interviews

Engaged

21

sector stakeholders and leaders

Together, we sought to build consensus and define:

  1. The most pressing challenges TAY face today
  2. What actions are needed to support meaningful progress

Given the cross-sectoral nature of this challenge, we set out to capture our findings in an easily digestible format that could be used to build awareness and to support a common understanding of the TAY experience and how they might be improved into the future.

1: Understanding the most pressing challenges facing TAY today

To start, we designed a TAY Journey Map depicting the current experience of moving from child and youth mental health services to the adult system. At Bridgeable, we commonly present the current state experiences of service users through journey mapping, which visualizes experiences in a compelling, empathy-based way that can be easily understood. To develop the TAY Journey Map, we reviewed existing youth engagement research to understand the experiences and perspectives of TAY in Ontario. We conducted in-depth interviews with front-line TAY service providers across a variety of settings, and convened a working group of sector leaders through an interactive working session focused on the TAY experience.

Based on this input, we designed a TAY Journey Map depicting the current experience of moving from child and youth mental health services to the adult system. The experiences of youth transitioning to adult services are unique to every individual. To help build consensus and drive action, we synthesized these many experiences to capture 5 of the most common and critical challenges that impact transition success in Ontario today.

C4K Journey Map | Bridgeable
Current state TAY Journey Map. Click for a larger view.

Key Challenges:

  1. TAY are often not developmentally ready, or not prepared in advance to transition to adult services. Many TAY may not yet have the confidence or life skills to be successful in adult services, and may experience a ‘culture shock’ during this transitional period. Since cognitive development is experienced differently across individuals, some TAY may not be ready for adult services despite their age.
  2. TAY encounter a large administrative burden when trying to match with adult services. The challenge of information sharing between providers means that TAY may be expected to complete duplicative forms and assessments, and share their mental health history again and again. At the same time, resource scarcity and the complexity of the service landscape results in TAY having to try multiple times to connect with services. Over time, this burden can negatively impact navigational confidence and can result in fatigue or disengagement from services.
  3. TAY attending postsecondary schools often encounter limited pathways between postsecondary and community mental health supports. While students often have to balance their mental health needs against the demands of the classroom, postsecondary schools increasingly offer mental health and wellness services, providing students with another point of entry to mental health services. However, postsecondary mental health services are essentially a siloed private system, creating challenges when TAY seek to maintain services upon leaving school.
  4. A lack of preventative care and unclear pathways from crisis treatment to community support can lead to preventable cycles of crisis. For many TAY, a mental health crisis will be a first point of contact with the mental health system. Lack of awareness, stigma, and high thresholds for qualifying for preventative care can mean that early symptoms of poor mental health may go unrecognized or untreated. Unclear service pathways from crisis treatment to community support can be further challenged by the stigma and isolation that can be experienced post-crisis.
  5. There is no clear service pathway connecting the child and youth and adult mental health sectors. Services for adults are less comprehensive and less available than those in the child and youth system. They are also fundamentally different in approach, and providers are often less familiar working with TAY and their unique challenges. The scarcity of community mental health services means many youth will need to pay for private services in order to maintain care.

To provide further context for the TAY Journey Map, we also developed a set of Case Studies that showcase some of the innovative solutions currently being used by service providers to address challenges on local and regional levels across Ontario.

C4K Case Study | Bridgeable
Example of a TAY Case Study.

2: Identifying what is needed to make meaningful progress for TAY

The TAY Journey Map and accompanying Case Studies provide a snapshot of the current state of TAY experiences. With the working group, we also set out to co-create a Roadmap to Impact that would articulate a path forward through which the Ontario mental health sectors can improve pathways for TAY. In a second collaborative working session, the working group identified and prioritized initiatives that would improve the experiences of TAY as well as next steps that could be taken to achieve these. Our Roadmap to Impact outlines three key priority areas and recommendations on next steps:

Priority Area 1: Recognize developmental readiness

To recognize that the age of transition is marked by profound physical and cognitive changes which are experienced differently across individual youth, TAY developmental readiness should be prioritized through flexible age cutoffs and a province-wide transition protocol, rather than a one-size-fits-all chronological age of transition

Priority Area 2: Connect systems and stakeholders involved in TAY care

To support continuity of care and reduce the administrative burden for TAY, the sector should undertake initiatives that strengthen bridging between providers and across systems, including protocols for warm handoffs between providers, a provincial front door to services, and a provincial TAY data capture and sharing protocol.

Priority Area 3: Enhance awareness, access, and knowledge translation

Awareness of and access to available mental health services continues to be a major challenge for many TAY, their families, and health care providers. The Ontario mental health sector should support initiatives that address educational gaps for targeted groups and support these stakeholders to navigate complicated service pathways through TAY mental health awareness education, and expanded navigation services.

The roadmap also includes 3 recommendations for how the Ontario Mental Health sector can come together to take the next steps toward implementing the three priority areas, including:

  1. Implement: Strike a TAY special task force of mental health leaders to lead implementation of initiatives
  2. Engage: Create a TAY advisory council to ensure youth and caregiver engagement in all initiatives
  3. Scale: Found a Provincial TAY Centre of Excellence (CoE) to feature regional successes and scale efforts

In the report, we outline who might be involved in these next steps as well as a potential mandate for the TAY task force, advisory council, and CoE. These next steps should enable stakeholders to continue to come together around the many great solutions that are being implemented and drive them forward to continue improving TAY experiences.

Taken together, the TAY Journey Map, Case Studies and Roadmap to Impact provide a snapshot of some of the key challenges faced by TAY today and how the sector can take action tomorrow.

 

The full report can be viewed here.

 


Follow Capitalize for Kids on LinkedIn and Instagram or visit capitalizeforkids.org to learn more about how they support the child and youth mental health sector across Canada. You can read more about this project on their website.


References

1 —Harpaz-Rotem, I., D. Leslie, R.A. Rosenheck. 2004, Treatment retention among children entering a new episode of mental health care. Psychiatric Services, 55:1022-1028.


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