Mind youth services framework

The Mind youth services framework describes the guiding principles behind Mind’s provision of youth services. It aims to:

• build organisational capacity and to support all Mind staff to deliver best-practice approaches to working with young people living with mental ill-health, their families and carers
• be a source of information for young people, their families and carers.

The importance of youth oriented services

Research shows that approximately 75% of all forms of mental illness emerge in people before the age of 25 years (Kim-Cohen et al. 2003; Kessler et al. 2005), and that adolescence and young adulthood are periods that significantly influence the course and severity of such ill-health (McGorry & Purcell 2009). Over the past 25 years there has been a notable rise in emotional and behavioural difficulties in young people (Collishaw, Maughan Goodman & Pickles 2004).

Access to – and utilisation of – health and support services by people aged 12–25 years is poor (Booth et al. 2004; Samargia, Saewyc & Elliot 2006; Mission Australia 2014), which illustrates the challenge of identifying and providing effective service models for young people.

Mind is committed to meeting that challenge. As one of the largest specialist providers of community managed mental health services in Australia, we have an important leadership role. We aim to be at the forefront of youth service provision and are committed to advocating for system-wide service improvement and to inspiring all relevant organisations – including our own – to make youth services more effective.

At any one time, between 15 – 20% of Mind’s service users, across all programs and areas are young people. The diversity of needs among this age range represents a unique challenge to ensure services are developmentally appropriate and responsive to their immediate needs.

Practice guided by principles

Mind runs a range of programs that specifically target people aged 12–25 years, including youth residential services, youth prevention and recovery care (PARC) facilities, headspace centres and adventure-based programs.

All Mind youth services work to the key principles of the International Association for Youth Mental Health and our own approach to recovery oriented practice, as below.

International Association for Youth Mental Health principles:

• Every young person has a meaningful life and can fulfil their hopes and dreams.
• All young people are respected, valued and supported by their families, friends and communities.
• Young people feel empowered to exercise their right to participate in decisions that affect them.
• Young people living with mental ill-health get the support and care they need when and where they need it.
• No young person with mental ill-health has to endure stigma, prejudice and discrimination.
• The role of family and friends in supporting young people is valued and encouraged.

The principles underpinning Mind’s approach to recovery oriented practice:

• Supporting personal recovery and personal wellbeing.
• Delivering services informed by evidence and consistent with a social model of health.
• Proactive and purposeful engagement to build trusting relationships.
• Ensuring our practice is sensitive to the needs of families and carers.
• Working in partnership and collaborating with other organisations.

Mind’s focus for young people is about improving their state of wellbeing, which emphasises positive relationships, economic participation and being a proactive member of their community.

Mind’s youth services framework

Mind’s framework for the provision of youth mental health services is supported by two key approaches.

1. Provide effective, evidence-based services

Mind youth services are developed from research that illustrates the unique needs of young people and presents evidence about effective interventions. Mind has identified specific approaches to practice that are effective in working with young people. They are as follows.

1.1 Be flexible and person-centred

Mind recognises the importance of working flexibly with young people. International models of practice have indicated a range of intervention strategies that work for young people, and we apply these as appropriate to the individual, taking into account their particular circumstances and requirements.

1.2 Be strengths-based

Strengths-based approaches focus on what is going right in the young person’s life and build on their skills and available resources to help them address challenges. There are six standards for what constitutes a strengths-based approach. They are that it should:

• Be goal oriented – The central element of any approach is the extent to which young people themselves set goals they would like to achieve in their lives.
• Include a strengths assessment – The primary focus is not on problems or deficits, and the young person is supported to recognise the inherent resources they have at their disposal to counteract challenges. 
• Incorporate resources from the environment – In every environment there are individuals, associations, groups and institutions who have something to give that others may find useful.
• Use explicit methods for identifying individual and environmental strengths for goal attainment – These methods will be different for each of the strengths-based approaches. For example, in solution focused therapy, people are helped to set goals before they are helped to identify their strengths.
• Involve a relationship that increases hope – A strengths-based approach aims to increase the level of hope felt by the client. Hope can be increased through strengthened relationships with people (families in particular) and communities.
• Meaningful choice – Each person is the expert in their own life, and the worker’s role is to increase and explain choices and encourage people to make their own decisions and informed choices (Rapp, Saleebey & Sullivan 2008).

1.3 Apply trauma-informed practice

Many of our young clients have a background involving significant trauma, including physical and sexual assault. Early-onset trauma can have a significant impact on the developing brain, requiring it to shift from being a ‘learning’ brain to a ‘survival’ brain and disrupting neural integration, which is necessary for responding flexibly to daily challenges (Courtois and Ford 2009). The adverse effects of complex trauma on individual functioning are pervasive and deeply disruptive of key developmental processes (Kezelman & Stavropoulos 2012; Siegel & Hartzell 2004).

Mind has adopted trauma informed practice across all its youth oriented programs. This involves understanding the possible effects of trauma, as well as the practices or interventions that may facilitate healing. This knowledge better enables staff to engage young people who have been impacted upon by traumatic life events and more effectively assist them to make positive life changes. Mind has integrated into its practice the eight principles that are widely accepted as being at the core of trauma-informed practice:

1. Provide a physically and emotionally safe environment.
2. Work in partnership with the young people who engage with our services to maximise their choice and control.
3. Provide training and education for Mind staff about the impacts of trauma and the importance of developing safety and crisis plans.
4. Provide ongoing supervision and support for staff to mitigate the impacts of vicarious trauma.
5. Provide a culturally safe and gender-sensitive service.
6. Ensure communication is open and respectful.
7. Support young people’s goals and interests.
8. Refer young people to trauma-specific services (Hopper et al. 2010; Cusack et al. 2008).

1.4 Offer adventure-based challenges for their therapeutic value

Mind offers outdoor and adventure-based activities to many of its young clients, providing therapeutic opportunities beyond that which can be provided through more traditional therapies. Learning and self-discovery through experiences is key to this approach, as are interaction with nature, meaningful engagement with a group of peers and an ethic of care and support (Bowen & Neil 2013).

Outdoor and adventure therapy programs are developed to address specific problematic areas in the young person’s daily life through a number of challenging physical and mental tasks that require problem solving skills. Mastering the skills to complete these tasks provides young people with a sense of accomplishment.

Ensure effective engagement and participation

In order to produce the best outcomes for our clients, Mind seeks to achieve the most effective engagement of young people and to maximise the potential of their participation in our services.

2.1. Promote active participation 

Young people have a voice in Mind services. We support their active participation in decisions that affect them and we work to maintain their engagement in the service. We provide a range of options for young people to participate in ways that are appropriate to their interests and skills (current or potential).

We are committed to monitoring the effectiveness of participatory mechanisms. Our commitment to youth participation remains flexible and accommodates young people’s ideas, capacities and emerging needs. The following represents the different levels of participation.

Level 1 - Low-level engagement

• Event participant
• Writer/contributor
• Reviewer of youth-specific information
• Social media participant

Level 2 - Mid-level engagement

• Community participant
• Training participant
• Quality assurance of youth programs

Level 3 - High-level engagement (requires training)

• Youth Advisory Council member
• Youth peer worker
• Youth educator
• Youth intern

Core principles that underpin Mind’s approach to youth participation include:

• Partnership – Young people are seen as essential partners in developing world-class youth mental health services, balancing their own skills and experience with the perspective of professionals.
• Organisational culture – A culture that values the perspectives of young people and promotes their active participation in all elements of the organisation.
• Diversity – Young people are engaged from diverse backgrounds that incorporate those with a lived experience, emerging professionals, culturally diverse young people and disadvantaged young people who are not usually represented in mainstream services.
• Flexibility – Young people’s journey through life will impact on the level at which they are able to participate. Our flexible approach ensures that their participation is both meaningful and rewarding.
• Communication – Keeping young people informed about opportunities, developments and progress in different program areas will manage expectations and ensure they remain engaged and committed. We will actively promote the use of technology and social media as ways of engaging and connecting young people.
• Support – Young people are supported by appropriate resources that enable them to fully participate in a range of activities across the organisation. Young people have a choice with regard to the types of activities they can engage in. We will support young people into highl evel engagement such as training them for roles as peer worker, youth educator, advisory council member and intern.

2.2 Provide individualised, person-centred care

Current youth-focused models of care take a holistic approach to the young person (McGorry et al. 2007; McGorry, Parker & Purcell 2007; Patton, Hetrick & McGorry 2007). The developmental needs of young people vary significantly and are influenced by environment, family, education and natural supports. As a result, Mind believes that person-centred care is fundamental to any service provided to young people.

We see beyond the young person’s diagnosis, to view them as a whole person who operates in multiple contexts and roles. We recognise there is great diversity in the youth population and acknowledge each person’s unique perspectives, strengths, skills and needs. We are committed to implementing effective practices and interventions that respond to the needs of individuals, groups and families.

2.3 Apply family-sensitive practice

Families, friends and carers are critical to a young person’s wellbeing. They provide formal and informal protective supports, understand mental ill-health and have a role to play in mental health promotion and psychoeducation. They also have a vital role to play in a person’s recovery journey, and may undertake their own parallel personal recovery journey. We understand that they may experience their own mental health issues as a result of the stress of supporting a person who is ill or navigating a complex service system.

We seek to ensure that the needs of the families, friends and carers of clients are adequately addressed. In our services and practice we focus on three areas:

1. Promoting family-sensitive practice to ensure families, friends and carers are included as part of our services to clients
2. Providing short-term, targeted services for families, friends and carers
3. Providing specialist family services

Mind is committed to helping families and carers engage young people with informal support networks locally. (We recognise that not all young people may benefit from family being closely involved, particularly when family dysfunction or trauma has been a key factor in the development of their mental ill-health. In such circumstances, we seek to engage natural supports outside the immediate family.)

2.4 Work in partnership with a range of stakeholders

Mind acknowledges that young people have a range of needs that cannot be met by a single approach or intervention. Other organisations, groups and individuals can provide useful resources and input to a young person’s mental health recovery and we strive to connect the young person with them, working in partnership wherever relevant.

Mind has established a broad network of partnerships and collaborations with stakeholders who include:

• Employment, education and vocational services – These can play a critical role in young people’s recovery
• National Disability Insurance Agency (NDIA) – The National Disability Insurance Scheme (NDIS) will help people living with a co-occurring mental illness and disability to access the care best suited to their needs
• Specialist services – Organisations such as the Child and Adolescent Mental Health Service (CAHMS)
• Alcohol and other drug services – Many young people living with mental ill-health also manage co-occurring substance use issues
• Families and carers – These are critical partners in a young person’s journey to wellbeing

Demonstrating our commitment to providing young people with tailored mental health services

Mind’s commitment to youth mental health is demonstrated in four key areas.

The following section illustrate the ways in which Mind addresses each of these key areas, each area broken down into elements of knowing, being, doing and outcomes.

Commitment 1 – Implement youth oriented practice

Mind is committed to implementing effective practices and interventions that respond to the needs of individuals, groups and families.

Mind staff know:

• principles by which services are provided to ensure ongoing engagement with the young person
• theoretical frameworks that lend themselves to good practice relating to young people living with mental ill-health
• a developmental approach that reflects age-appropriate service responses
• the importance of social connections for young people, which include family, peers and the community.

Mind staff are:

• open to continuous improvement and learning through practice with young people
• capable of learning from peers and practice wisdom in their work with young
• able to reflect on their own practice and its effect on the individual
• committed to valuing diversity and the perspectives that young people present with.

Mind staff do:

• challenge their own assumptions, biases and preconceived ideas
• clarify their own values, attitudes and expectations
• acknowledge their own skills and knowledge in their work with young people
• recognise and utilise support, guidance and supervision to enhance practice
• use strengths-based approaches to facilitate youth oriented practice
• use evidence-based practices and interventions that are effective with young people
• use reflective practice to influence decisions and actions.

Outcome:

Mind staff will achieve clarity about their own cultural and personal beliefs, assumptions, values, attitudes and expectations. They will actively reflect on working with young people living with mental ill-health.

Young people experience a range of mental health and wellbeing services that are respectful and place them at the centre of their own decision-making.

Young people are valued by their family and community.

Commitment 2 – Foster inclusive engagement

Mind provides young people with opportunities to actively engage at an organisational level in the decisions which affect the programs that target them.

Mind staff know:

• engagement and participation principles and practice
• young people’s preferences
• to monitor the effectiveness of participatory mechanisms
• to use technology as an enabler in promoting connection and wellbeing for young people’s mental health,

Mind staff are:

• approachable and open to feedback
• trustworthy
• honest and open with young people
• able to listen and act
• flexible
• consumer oriented.

Mind staff do:

• assure confidentiality
• develop insights from a young person’s perspective
• learn the most effective ways to engage with young people from young people themselves
• collaborate with young people
• foster ongoing and effective two-way communication
• embrace new technologies and use of social media
• manage relationships between young people and the organisation.

Outcome:

Active engagement of young people in collaborative and inclusive decision making in areas that affect them.

Young people participate in planning, monitoring and evaluation of programs that are relevant to them.

Young people feel respected, included and listened to at Mind, and have the capacity to input into the decisions that affect them.

Commitment 3 – Promote family and carer inclusiveness

Mind will include families and carers in its engagement of young people as we acknowledge the value and importance of the formal and informal support they provide.

Mind staff know:

• the role that families and natural supports play as a protective factor for young people living with mental ill-health
• to help families and carers engage young people with informal support networks locally
• the capacity of family members and carers to understand mental ill-health and their role in mental health promotion and psycho-education
• how young people prefer to connect with their communities (virtual or otherwise).

Mind staff are:

• committed to inclusive practice that actively promotes the role of family and carers in the life of a young person
• guided by good community development principles and practices
• realistic about the limitations that can apply to family and community supports

Mind staff do:

• embrace family-sensitive practice across all program areas
• involve families in decisions that affect them and their relatives
• actively engage young people in community networks that support their recovery
• involve families at an organisational level in systems change that improves mental health supports and services for all.

Outcome

Evidence-based approaches and actions that lead to the active engagement of families and carers in the care of a young person, where appropriate.

Young people who are connected to their local community (virtual or real) in a way that improves their chance of achieving wellbeing.

Commitment 4 – Demonstrate leadership in youth mental health service provision

Mind will lead and inspire other organisations in transforming mental health services for young people, their families and the community to become more responsive, effective and capable.

Mind staff know:

• to lead by example through which all staff demonstrate their capacity to provide high-quality youth services
• to achieve improved outcomes for young people by working in partnership to enhance service provision
• to take a leadership role in working with young people
• to listen to consumer voices and advocating on their behalf for system-wide service improvement and reform.

Mind staff are:

• clear about personal and organisational values
• leaders in working with young people
• committed to achieving the organisation’s vision for working with young people
• honest and have integrity.

Mind staff do:

• lead by example and model best practice
• have a clear vision for the organisation’s work with young people, families and the community
• support and develop partner organisations’ practice and service provision
• acknowledge and promote success in working with young people, their families and the community
• demonstrate leadership regarding inclusivity of all young people who are affected by mental ill-health
• utilise strengths-based approaches to develop a positive agenda for working with young people.

Outcome:

An increasing number of individuals and organisations who are passionate and committed to creating accessible and acceptable mental health services that deliver the right outcomes for young people.

Young people are active community advocates for what mental health responses are required for themselves, their peers and their families.

 

Glossary

• Client - Person who uses Mind’s services.
• Consumer - Broad descriptive term for people who use or have used mental health services.
• Mental ill-health - A term covering a wide spectrum, from the challenges and anxieties one experiences in everyday life to more serious forms of ill-health such as depression, anxiety or psychosis.
• Partnership - A cross-sector alliance in which individuals, groups and organisations agree to work together to fulfil an obligation or undertake a specific task, sharing the burdens and the benefits and reviewing the relationship regularly.
• Wellbeing - Mental wellbeing is a dynamic state in which the individual is able to develop to their potential, work productively and creatively, build strong and positive relationships with others and contribute to the community (Foresight Mental Capital and Wellbeing Project 2008).
• Recovery - Recovery does not mean ‘cure’. Recovery involves living a full and satisfying life in the presence or absence of symptoms.
• Young people - Refers to all people aged between 12 and 25. Those aged between 18 and 25 can be referred to as ‘young adults’.
• Youth participation - Recognising and nurturing the strengths, interests and abilities of young people through the provision of real opportunities for them to become involved in decisions that affect them at individual and systemic levels.

References

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Bowen, D.J. and. Neill, J.T. (2013). A Meta-Analysis of Adventure Therapy Outcomes and Moderators. The Open Psychology Journal, 6: p. 28-53.

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Kezelman, C. & Stavropoulos, P. (2012). The Last Frontier. Practice Guidelines for Treatment Of Complex Trauma and Trauma Informed Care And Service Delivery. ASCA: Sydney.

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McGorry, P.D., & Purcell, R. (2009). Youth mental health reform and early intervention: Encouraging early signs. Early Intervention in Psychiatry, 3, 161-162.

McGorry, P.D. (2007). The specialist youth mental health model: Strengthening the weakest link in the public mental health system. Medical Journal of Australia, 187 (7 Suppl.), S53-6.

McGorry, P.D., Tanti, C., Stokes, R., Hickie, I., Carnell, K., Littlefield, L., & Moran, J. (2007). Headspace: Australia’s National Youth Mental Health Foundation – where young minds come first. Medical Journal of Australia, 187(7), 68-70.

McGorry, P.D., Parker, A., Purcell, R. (2007). Youth mental health: A new stream of mental health care for adolescents and young adults. In G. Meadows, B. Singh, & M. Grigg (Eds.), Mental Health in Australia: Collaborative community practice (2nd edn., pp. 438-449). South Melbourne: Oxford University Press.