Engagement in Mental Health Treatment Among Adolescents and Young Adults: A Systematic Review

The purpose of the present study is to review empirical evidence of the effects of interventions designed to improve engagement in mental health services among adolescents, young adults and their families. Investigators searched relevant databases, prior reviews, and conducted hand searches for intervention studies that met the following criteria: (1) examined engagement in mental health services; (2) included a comparison condition; and (3) focused on adolescents and/or young adults. Effect sizes for all reported outcomes were calculated. Thirteen studies met inclusion criteria. Conceptualizations of engagement and measurement approaches varied throughout studies. Approaches to improving engagement varied in effectiveness based on level of intervention. Individual level approaches improved attendance during the initial stage of treatment. While family level engagement interventions increased initial attendance rates, the impact did not extend to the ongoing use of services, whereas service delivery level interventions were more effective at improving ongoing engagement. The review illuminated that engagement interventions framed in an ecological model may be most effective at facilitating engagement. Implications for future research and practice are discussed.     

Keeley's journey: From service user to service provider

Background: This paper presents the vocational journey of a young British woman, Keeley, who changed her career aspirations to become a mental health worker following an episode of significant mental health difficulties. Keeley's story illustrates the application of the locally developed WORKS framework in conceptualising and supporting Keeley's vocational recovery. Approach: A narrative approach highlights the partnerships that developed between Keeley, the Occupational Therapist, Sally, and the User Support and Employment Service. Findings: The WORKS framework supported Keeley and Sally to collaboratively develop a successful employment pathway. Strategies, including attention to Keeley's view of her capabilities and aspirations, volunteer placements, support of peers, employer engagement and planning for sustainable employment, assisted Keeley to establish her chosen career. Keeley's journey highlights the leadership role that mental health services can assume by providing paid work for people with experience of mental health difficulties.     

In their own words: Overcoming barriers during the transition to adulthood for youth with disabilities who experienced foster care

The transition to adulthood can be especially challenging for youth who experience the foster care system. These challenges are magnified for youth with disabilities, who account for at least 40–47% of all children in foster care (Powers et al., 2012). In order to move from a deficit-based to a strength-based approach, this qualitative study focused on understanding the lived experience of transitioning to adulthood for alumni of foster care with disabilities. Semi-structured interviews were conducted with seven young adults who had exited care over a six-month time period. Participants described their journeys from foster care to independence and articulated a vision for a successful adulthood. Key themes that emerged included a desire for stability and personal fulfillment in adult life. Participants also identified common barriers encountered including unmet mental health needs and lack of disability awareness or the implications of mental health diagnosis. Personal strengths that helped overcome those barriers included resilience, advocacy, and self-determination.     

Using Values‐Based Webinar Interventions to Facilitate Career‐Life Exploration and Planning

Using a quasi‐experimental design, the authors examined whether career indecision could be reduced by participation in a values‐based career webinar designed to translate various types of psychological data (e.g., Holland‐type themes) into values‐based language. Participants (N = 67; 36 women, 31 men; mean age = 36 years) were divided into 1 control and 2 treatment groups. The 1st treatment group received an interest‐based intervention. The 2nd received a values‐based intervention. Both interventions consisted of 1 additional webinar spanning 1 hour in length. This study demonstrated a statistical significance of career indecision decrease through use of the values‐based, process‐oriented webinar intervention, which is particularly helpful to career counselors working with adults. The study also illustrated the effective application of online technology as a service delivery tool. Future research might examine the efficacy of this intervention in a variety of settings (e.g., K–12, postsecondary, agency, mental health, corporate).     

Connecting and Strengthening Young Aboriginal Men: A Family Wellbeing Pilot Study

A significant proportion of young people in Australia are currently not being engaged in school and other social systems. This article presents the results of a mixed-methods study of a pilot Family Wellbeing intervention designed to enhance the social and emotional wellbeing (SEWB) of young Aboriginal men and improve engagement in education, employment, and other social participation. A questionnaire incorporating the Kessler Psychological Distress Scale and respondent self-assessment SEWB questions was administered to program participants pre and post intervention (N = 30) and qualitative data were collected from program organisers (N = 6). The results suggest that the Family Wellbeing intervention has the capacity to make a marked contribution to the SEWB of young Aboriginal men; participants experienced strong improvement in capacity to manage relationships, engagement in education and employment, and mental and physical health. The factors that enabled the program to be adapted to the target group and setting are documented.     

Vocational Identity Resources in Emerging Adulthood: Associations With Facets of Dispositional Mindfulness

The processes of career development and forming a crystallized identity can be fraught with emotional turmoil. One multidimensional construct known to reduce emotional reactivity is dispositional mindfulness (DM). We used canonical correlation analysis to examine relationships involving measures of resources for establishing a vocational identity (Hirschi, 2012a) and facets of DM in emerging adults (134 women, 38 men). Observing, describing, and nonreactivity to inner experiences contributed uniquely to the first canonical function with career agency and occupational engagement. Observing, describing, and nonjudging contributed uniquely to the second function with occupational engagement and negative career outlook. These results shed light on key facets of DM that help emerging adults to effectively utilize emotion within the context of career‐life planning. Future research should examine relationships between DM facets and additional constructs subsumed within the career resources model. Counselors may find utility in understanding how clients conceptualize conscious emotional experience and use it in career‐life planning.     

A bit more understanding: Young adults' views of mental health services in care in Ireland

Children and young people in the care system typically experience very high levels of mental health difficulties, yet their views of these difficulties and of mental health services have rarely been explored. For this qualitative study we spoke with eight young adults aged 18 to 27 years with experience of the care system in Ireland about mental health challenges, service experiences, and how they felt mental health services needed to improve. Themes from the interviews illuminated young adults' views of their emotional well-being while in care, and the double stigma of being in care and mental health difficulties. In terms of services, young adults wanted these to be flexible and sensitive to level of need; to offer choice and more congenial environments; to provide more creative routes to engaging young people; and to offer honest, reciprocal, caring communication — treating children in care as one would any child. Recommendations highlight three key needs: an ethic of care in services as well as an ethic of justice; mental health training for all professionals in contact with children in care; and the need to listen, hear and act on what children and young people say.     

No one is listening: Members of the Deaf community share their depression narratives

This exploratory case study conducted in Manitoba, Canada examined a unique social justice issue in the field of mental health, namely, how Deaf adults, all American Sign Language first-language users who were diagnosed with Depression, manage their symptoms in a mental health system that is based on spoken, not signed communication. Using in-depth individual interviews, and a hand-drawn Person and Environment Map, this study offers rich in-depth narratives of the experiences and challenges faced by members of the Deaf community seeking mental health assessment and intervention.     

Child welfare caseworkers' perspectives on the challenges of addressing mental health problems in early childhood

Although nearly half of child maltreatment victims are under the age of five and at high risk for developing serious emotional or behavioral problems, few young children involved in the child welfare system receive treatment. As the first point of service contact, child welfare caseworkers can play a key role in quickly identifying children with mental health problems and linking them to services. This study examines caseworkers' perspectives on the challenges of addressing mental health problems in early childhood. Based on five focus groups conducted with 50 caseworkers from an urban, public child welfare agency, results suggest that although workers acknowledge the importance of early intervention, difficulty identifying mental health needs in early childhood and workplace barriers impede linkage to services. Given the lasting impacts of early experiences on children's development, it is imperative that these challenges be addressed. Implications for systematic mental health screening and caseworker training are discussed.     

Communal invalidation of young adults with co-occurring substance abuse and mental health issues

This study explores how young adults with co-occurring substance abuse and mental health issues experience the challenges of belonging to their local communities. The data were generated through qualitative in-depth interviews with seven young adult service users, six of whom were interviewed twice. The qualitative data analysis resulted in three overarching themes: the need to accept one’s own life and the structures surrounding it; being caught between conflicting social worlds; and moral fumbling in choices and actions. Using an empirical study, we suggest that a process of ‘communal invalidation’ operates through which young adults in the community are socially defined as inadequate. This invalidation serves as a formidable barrier to their recovery.     

Managing moods and parenting: Perspectives of former system youth who struggle with emotional challenges

Young adults who were served in public systems of care as children are much more likely than their peers to be parenting in adolescence and young adulthood. They are also more likely than their counterparts to have a history of mental health problems. This study examined the perspectives of young adult parents with mood problems who had been involved in public systems of care before age 18. Qualitative interviews with twenty-eight participants were analyzed to examine the experience of managing moods and parenting. Young parents described how their symptoms impact their parenting and how parenting impacts their coping. They also described the strengths and challenges of using mental health services while parenting. Findings highlight the need to provide interventions that include supports for both parenting and symptom management and for providers to include both tangible and emotional support in their interventions.     

Development and piloting of a mother and child intervention to promote resilience in young children of HIV-infected mothers in South Africa

This paper describes the process of developing a parallel intervention for HIV-positive mothers and their young children (6-10 years) with a view to strengthening the relationship between them. Strong mother-child relationships can contribute to enhanced psychological resilience in children. The intervention was developed through action research, involving a situation analysis based on focus group discussions; intervention planning, piloting the intervention and a formative evaluation of the intervention. Participants supplied feedback regarding the value of the intervention in mother-child relationships. The findings obtained from the formative evaluation were used to refine the intervention. Two parallel programmes for mothers and children (15 sessions each) were followed by 10 joint sessions. The intervention for mothers focused on maternal mental health and the strengthening of their capacity to protect and care for their young children. The intervention for children addressed the development of their self-esteem, interpersonal relationships and survival skills. The formative evaluation provided evidence of good participation, support and group cohesion. Qualitative feedback indicated that the activities stimulated mother-child interaction. A similar intervention can easily be applied elsewhere using the detailed manual. The insights gained and lessons learnt related to mother and child interaction within an HIV-context that emerged from this research, can be valuable in other settings, both in Sub-Saharan Africa and elsewhere.     

Development and piloting of a mother and child intervention to promote resilience in young children of HIV-infected mothers in South Africa

This paper describes the process of developing a parallel intervention for HIV-positive mothers and their young children (6–10 years) with a view to strengthening the relationship between them. Strong mother–child relationships can contribute to enhanced psychological resilience in children. The intervention was developed through action research, involving a situation analysis based on focus group discussions; intervention planning, piloting the intervention and a formative evaluation of the intervention. Participants supplied feedback regarding the value of the intervention in mother–child relationships. The findings obtained from the formative evaluation were used to refine the intervention. Two parallel programmes for mothers and children (15 sessions each) were followed by 10 joint sessions. The intervention for mothers focused on maternal mental health and the strengthening of their capacity to protect and care for their young children. The intervention for children addressed the development of their self-esteem, interpersonal relationships and survival skills. The formative evaluation provided evidence of good participation, support and group cohesion. Qualitative feedback indicated that the activities stimulated mother–child interaction. A similar intervention can easily be applied elsewhere using the detailed manual. The insights gained and lessons learnt related to mother and child interaction within an HIV-context that emerged from this research, can be valuable in other settings, both in Sub-Saharan Africa and elsewhere.     

Mental health interventions for children in foster care: A systematic review

Children in foster care have high rates of adverse childhood experiences and are at risk for mental health problems. These problems can be difficult to ameliorate, creating a need for rigorous intervention research. Previous research suggests that intervening with children in foster care can be challenging for several reasons, including the severity and complexity of their mental health problems, and challenges engaging this often transitory population in mental health services. The goal of this article was to systematically review the intervention research that has been conducted with children in foster care, and to identify future research directions. This review was conducted on mental health interventions for children, ages 0 to 12, in foster care, using ERIC, CINAHL, PsycINFO, PubMed, ProQuest's Dissertation and Theses Database, Social Services Abstracts, and Social Work Abstracts. It was restricted to interventions that are at least “possibly efficacious” (i.e., supported by evidence from at least one randomized controlled trial). Studies were evaluated for risk of bias. Ten interventions were identified, with diverse outcomes, including mental health and physiological. Six interventions were developed for children in foster care. Interventions not developed for children in foster care were typically adapted to the foster context. Most interventions have yet to be rigorously evaluated in community-based settings with children in foster care. Little research has been conducted on child and family engagement within these interventions, and there is a need for more research on moderators of intervention outcomes and subgroups that benefit most from these interventions. In addition, there is no consensus regarding how to adapt interventions to this population. Future research should focus on developing and testing more interventions with this population, rigorously evaluating their effectiveness in community-based settings, determining necessary adaptations, and identifying which interventions work best for whom.     

Online Mental Health Information Seeking in Young Adults with Mental Health Challenges

Barriers such as stigmatization and access to health care may lead young adults with mental health conditions (YAMHC) to try to find alternatives to more traditional means of obtaining care. One possible alternative is to seek information online. The purpose of this article is to better understand how YAMHC use the Internet to access information about mental health, and the challenges they face when trying to access that information. Semistructured focus groups were conducted to investigate how YAMHC use the Internet for information and support regarding their mental health. Three major themes about mental health information seeking emerged from the data: (a) Topics searched, (b) Motivations for going online to search for information, and (c) Barriers to successful searching. Findings indicate that YAMHC look up information related to their mental health for a variety of reasons that are unique to the online experience, and use that information to help them with their care, despite at times feeling overwhelmed by, and not always trusting of, the information available.     

It's good to know that you got somebody that's not going anywhere: Attitudes and beliefs of older youth in foster care about child welfare-based natural mentoring

This exploratory study is the first to investigate the attitudes and beliefs of older adolescents in foster care toward the implementation of a child welfare-based natural mentoring intervention designed to promote enduring, growth-fostering relationships between youth at risk of emancipation and caring, supportive nonparental adults from within the youth's existing social network. Six focus groups were conducted with 17 older youth in foster care attending a specialized charter high school for young people in out-of-home care in a large, urban city in the Northeast United States. Focus group data were transcribed and analyzed using a conventional content analysis approach. The following significant themes emerged related to natural mentoring for older foster youth emancipating from care: (1) need for permanent relationships with caring adults, (2) youth conceptions of natural mentoring, (3) unique challenges related to natural mentoring for youth in foster care, (4) role of a natural mentoring intervention in child welfare, and (5) challenges for implementing a child welfare-based natural mentoring intervention. Overall, our findings suggest that these young people are cautiously optimistic about the potential of a child welfare-based natural mentoring intervention to promote their social and emotional wellbeing. Future studies are needed to better understand the experiences of older foster youth with an actual natural mentoring intervention, including challenges, opportunities, and outcomes.     

Better Futures: A validated model for increasing postsecondary preparation and participation of youth in foster care with mental health challenges

Higher education participation rates of young people in foster care are dramatically lower than their level of postsecondary education aspiration. Increasing attention to this disparity has stimulated policy and practice enhancements, however rigorously validated models for promoting postsecondary preparation and participation have not existed for young people in foster care, including those with mental health conditions. This article describes Better Futures, which is the first such model to be experimentally validated as effective for increasing the higher education participation and other related outcomes of young people in foster care with mental health challenges. Better Futures features a four day on-campus Summer Institute, coaching provided to youth by older peers who are in college and have shared experiences around foster care and/or mental health, and workshops that bring together youth, coaches and guest speakers for information sharing and mutual support. This article includes the theoretical and component features of the Better Futures model, findings related to intervention fidelity, participants' evaluation of the program, and discussion of implications for future model refinement and research.     

Applying Social Learning Theory of Career Decision Making to Gay,Lesbian, Bisexual,Transgender, and Questioning Young Adults

Incorporating J. D. Krumboltz's (1979) social learning theory of career decision making, the author explores career development issues for gay, lesbian, bisexual, transgender, and questioning (GLBTQ) adolescents and young adults. Unique challenges for the GLBTQ population are discussed, specific recommendations for effective career counseling with this population are outlined, and suggestions for future research are presented.