Moving Research into Coordinated Programs
Work is nature’s best physician and is essential to human happiness: the Greek physician Galen[1]
Who Are We Talking About?
We are talking about youth and young adults with Serious Mental Health Conditions (SMHCs), for whom we want to see success in the transition from adolescence to adulthood. It has been estimated that 6 to 12% of US adolescents and young adults experience these conditions, representing over 2 million young people.
We are talking here about youth who have struggled in school and have often been referred to special education because of behavioral or discipline challenges. They are disproportionately suspended or expelled, which completely undermines success. They may have spent their adolescence in public systems such as mental health and substance abuse, or in foster care or juvenile justice, often resulting in residential mobility, a factor in poor school outcomes. Disproportionately, these are youth of color and their families may have experienced inter-generational poverty, trauma, and racism.
Getting employment is their most prevalent personal goal:
…Employment with a purpose plays the central role in identify formation for young adults. Everyone wants to BE something when they grow up. Young adults came to Tempo (a Massachusetts agency) looking for work far more than for any other resource. Those who found meaningful work became stable and successful in other ways, such as keeping their housing, staying clean and sober, and starting college. Employment is a powerful springboard for physical, emotional and mental health. Young adults know this and meaningful employment inspires them.[2]
“What brings young adults with SMHCs to services is not psychological distress but employment, school, and housing/homelessness issues.”[3]
Overcoming Barriers and Hurdles to Employment
Accomplishing this goal requires overcoming hurdles; the pathway is often not clear or easy for these youth:
- While one in seven of all youth (14%) do not graduate from high school, more than 50% of students aged 14 or older with a mental health condition drop out of high school, which is the highest dropout rate of any disability group. Such students also experience low grade point averages, poor attendance, and the highest expulsion/suspension rates among all students with disabilities.[4]
- One-third of individuals receiving SSI (Supplemental Security Income) under age 65 are young adults and 24% of those have SMHCs. Less than 1% exit from SSI rolls. “Prolonged SSI receipt can result in a lifetime of low employment and poverty.” Fewer than 5% of such SSI recipients were employed and over half had no income other than SSI payments.[5]
- Black young adults with mental illness are less likely than white counterparts to be gainfully employed, a trend that “is particularly concerning because Black people are noted to be disproportionately represented among young adults with emotional disturbances.” As well, experiences of day-to-day racial discrimination are common and a barrier to vocational and educational growth.[6]
- Even among those who graduate, a sizable number of all students who enter postsecondary education with the intention of earning a certificate or degree never achieve that goal. Among students who entered college in 2011-12 and had intended to earn an associate degree, nearly half (45.7 percent) were no longer enrolled and had no education credential to show for their time, effort, and expense.[7]
The contemporary K-12 mantra is “college for all” but nearly two-thirds (65%) of the US labor force don’t have college degrees.[8] High school graduation is essential but an alternate pathway of preparation for careers is possible for students with SMHCs.
An Alternate Pathway
This alternate pathway involves a conscious linking of work- and career-oriented learning in high school, especially in special education, to post-secondary career preparation for good middle-skill jobs in high-demand industries, largely through apprenticeships. Such new initiatives emphasize diversity, equity, and inclusion and seek to remedy identified barriers.
Research supports strategies to help students with disabilities complete high school. For many students with SMHCs (in special education, called Emotional Disturbance or ED),[9] hands-on learning is a better strategy than sitting at a desk.
- Promote Career and Technical Education (CTE) for high school students with SMHCs
Major changes have occurred in what was once vocational education. Perkins V legislation,[10] enacted in 2018, allocates substantial funding to states and school districts for high-quality CTE programs that offer combined rigorous academic content and technical courses in specific occupations.[11]
A concentration of CTE courses along a career pathway is a strong predictor of high school graduation and of postsecondary employment for students with disabilities, particularly those with emotional disturbance. The guide Translating Evidence to Support Transitions in Career and Technical Education (TEST-CTE) helps special educators and transition specialists to assist students in exploring careers, formulate a career goal in an in-demand industry, develop an Individualized Education Program (IEP) with at least 4 credits of CTE, obtain work-based learning experiences, and mitigate challenges. [12],[13],[14]
- Coordinate with Workforce Innovation and Opportunity Act (WIOA) and vocational programs
WIOA is responsible for monitoring and reporting labor market information for Perkins V planning. Both Perkins V and WIOA encourage states to leverage various programs to help such students attain recognized postsecondary credentials that enable them to get jobs they want.[15]
The researchers on vocational development cited above found that, while there is a need to improve vocational development, particularly for populations of color, participants in the NARIC study thought that vocational counselors were “open minded, relatable, and provided service options that accounted for the clients’ personal preferences.” Furthermore, the presence of Black people in positions of authority and as peers added to participants’ growth at school and in the workplace.[16]
- Access new youth apprenticeship programs
The “big new thing” of the moment is youth apprenticeships, designed to create a pathway to good careers through “learn and earn” strategies for careers in in-demand industries. These are an important opportunity for young people with SMHCs.
National legislation on youth apprenticeships passed the House in January 2021,[17] and has now been incorporated in the Administration’s Bi-partisan Infrastructure legislation (enacted) and its Build Back Better legislation, which appears to be on track to be enacted. These emphasize coordinating and “stacking” diverse programs and services. The Build Back Better (BBB) legislation provides investments to expand registered apprenticeships, pre-apprenticeships, and youth apprenticeships. Funding will go toward serving people with barriers to employment, people with disabilities, and populations underrepresented in apprenticeships.[18]
BBB would also invest in sector-based training programs, which are comprehensive training programs that include wraparound services, paired with high-quality training and effective partnerships between educational institutions, unions, and employers — guaranteeing placement in a good quality, in-demand job. The sector-based training investments will provide millions of workers –particularly young workers, women and workers of color –with pathways into high job-quality sectors including clean energy, manufacturing and infrastructure. This will ensure these underserved groups have greater access to new infrastructure jobs.[19]
Some youth with SMHCs who are not in school and not employed may need preparation and support to succeed in the first stage of the apprenticeship continuum, particularly for Registered Apprenticeships, because entrance qualifications and standards are high and typically require a high school diploma as well as high basic skills. Youth who have gotten into the justice system will require supports. “The journey from pre-apprenticeship through apprenticeship is long and requires persistence.”[20]
Learning and Working Hubs: Make Connections for Youth with SMHCs
Learning and Working Hubs anchored in community-based comprehensive, mental health, and/or social service organizations could build local capacity in the now-neglected space at the intersection of secondary education, particularly special education, jobs for youth and young adults with SMHCs and emerging opportunities on a pathway from CTE to youth apprenticeships.
Focusing special educators and workforce officials on helping such students would achieve a dual goal: guiding credentialled high school graduates into the paid workforce rather than consigning them to a lifetime in poverty on SSI disability payments, and providing a skilled workforce for in-demand jobs.
Young adults with SMHCs —in particular, those who are not in school or employed—can have personal needs that interfere with retention in youth apprenticeships, such as child care, transportation, stable housing, emotional safety, and physical well-being, not to mention access to behavioral health services should these prove necessary. According to Jobs for the Future (JFF), providing access to wrap-around supports can remove very real barriers and help youth and young adults to meet and balance training requirements with the complex and challenging demands they may face outside the program.
A common finding across service providers and researchers: youth and young adults with experience of public systems and services do not want to continue being “in treatment.” This phenomenon underpins disengagement. They fear an identity of patient. If they engage with services, these young people want to focus on building a life in the community.
Emphasizing school and work as opposed to symptom management is strengths-based and developmentally appropriate and a powerful engagement tool for young adults.[21] The key is engaging young people through relationship development, person-centered planning, and a focus on their futures.[22]
Hubs could serve as on-the-ground laboratories to build applied knowledge from the array of available pertinent research that shows how vocational preparation serves youth and young adults with SMHCs.
In Sum
In a letter to the Biden Administration’s newly appointed Secretaries of Education (Cardona) and Labor (Walsh), Obed Louissaint, Senior Vice President for Transformation and Culture at IBM Corporate Headquarters in Armonk, N.Y., wrote: “we coined the term ‘new collar jobs’ to refer to a surging number of careers that don’t necessarily require a traditional bachelor’s degree but instead need a specific set of in-demand skills…Creating new pathways to careers means investing in programs that provide in-demand skills…, including “earn and learn” programs like apprenticeships, new hybrid education models, partnerships between community colleges and the private sector…” (January 28, 2021)
Learning and Working Hubs operating in a now-neglected space between special education and apprenticeships can provide access to a world of opportunity for youth and young adults with serious mental illnesses who choose such paths.
November 2021
[1]The Greek physician Galen, Cited by Courtney Harding, Center for Rehabilitation and Recovery at the NYC Coalition of Behavioral Health Agencies, April 2010.
[2] Consumer Quality Initiatives (CQI), Inc., Tempo Qualitative Evaluation: Participant interview report, September 2008. My bolding.
[3] Statement of Researchers, SAMHSA’s Healthy Transitions National Evaluation: Preliminary Process, System and Client Outcomes, Tampa Conference, March 6, 2018. Ringeisen, Heather, SAMHSA’s Healthy Transitions National Evaluation: Preliminary Process, System and Client Outcomes, Presentation at the 31th Annual Research & Policy Conference on Child, Adolescent, and Young Adult Behavioral Health, March 6, 2018.
[4] Alikhan, S., Logan D., Ellison, M., & Biebel, K. (2016). Supported education (SEd): State of the practice. Psychiatry Information in Brief, 13(9). Worcester, MA: University of Massachusetts Medical School, Department of Psychiatry, Systems and Psychosocial Advances Research Center.
[5] McKay, Colleen and Ellison, Marsha Langer, “Career and Technical Education for Students with Emotional Disturbance, SSI Solutions, April 30, 2021. (https://www.dol.gov/sites/dolgov/files/ODEP/pdf/SSI_Youth_McKay_Final_Proposal.pdf)
[6] Delman, J. & Adams, L.B., “Barriers to and Facilitators of Vocational Development for Black Young Adults with Serious Mental Illnesses, 2021. https://naric.com/?q=en/rif/Black%20Young%20Adults%20with%20Serious%20Mental%20Illness%20Experience%20Barriers%20to%20Vocational%20Growth%2C%20Find%20Support%20from%20Vocational%20Counselors%20Who%20Seek%20to%20Understand%20Their%20Needs
[7] US Department of Education, Institute of Education Sciences, What Works Clearinghouse, Request for Information, Federal Register, Nov. 8, 2021. https://www.federalregister.gov/documents/2021/11/08/2021-24382/request-for-information-on-rigorous-research-on-interventions-that-promote-postsecondary-success
[8] Manno, Bruno, “High School and Beyond: Creating Pathways to Opportunity,” June 23, 2021. https://americancompass.org/the-commons/high-school-and-beyond-creating-pathways-to-opportunity/
[9] The term emotional disturbance, used in Special Education (Individuals with Disabilities Act or IDEA), is a subset of SMHC. (McKay, Colleen and Ellison, Marsha Langer, Career and Technical Education for Students with ED, 2021.)
[10] US Department of Education, Office of Career, Technical, and Adult Education, Request for Information on Successful Approaches for Expanding Work-Based Learning Opportunities for Youth, December 2, 2020. “Since 2000, there has been a precipitous drop in participation in the job market by adolescents ages 16 to 19 of all major races and ethnicities.”
[11] Smith, Ryan, “Advancing Racial Equity in Career and Technical Education,” Center for American Progress, August 28, 2018.
[12] Ellison, M. L., Huckabee, S., Golden, L., & Biebel, K. (2020). “Incorporating Career and Technical Education in Transition Planning for Students with Emotional Disturbance.” Translating Evidence to Support Transitions. University of Massachusetts Medical School, Department of Psychiatry, Implementation Science and Practice Advances Research Center (iSPARC), Transitions to Adulthood Center for Research: Worcester, MA.
[13] McKay, Colleen and Ellison, Marsha Langer, “Career and Technical Education for Students with Emotional Disturbance, SSI Solutions, April 30, 2021. (https://www.dol.gov/sites/dolgov/files/ODEP/pdf/SSI_Youth_McKay_Final_Proposal.pdf)
[14] McKay, Colleen, Ellison, Marsha Langer, and Markewicz, Emma L., “Promoting and Maintaining Career and Technical Education for Students with Disabilities,” CAPE-Youth, October 2021.
[15] Ibid.
[16] Delman, J. & Adams, L.B., “Barriers to and Facilitators of Vocational Development for Black Young Adults with Serious Mental Illnesses, 2021. https://naric.com/?q=en/rif/Black%20Young%20Adults%20with%20Serious%20Mental%20Illness%20Experience%20Barriers%20to%20Vocational%20Growth%2C%20Find%20Support%20from%20Vocational%20Counselors%20Who%20Seek%20to%20Understand%20Their%20Needs
[17] https://bobbyscott.house.gov/media-center/press-releases/scott-praises-passage-of-the-national-apprenticeship-act-of-2021
[18] https://www.newamerica.org/education-policy/edcentral/key-provisions-in-the-build-back-better-act/
[19] https://www.whitehouse.gov/briefing-room/statements-releases/2021/07/22/fact-sheet-how-the-build-back-better-plan-will-create-a-better-future-for-young-americans/
[20] Jobs for the Future (www.jff.org).
[21] Lucksted et al, 2015, cited in Cohen, D.A. et al, Implementing Adapted individual Placement and Support (IPS) Supported Employment for Transition-Age Youth, Community Mental Health Journal, November, 2019.
[22] Clark, Hewitt B. “Rusty” & Hart, Karen, Navigating the Obstacle Course: An Evidence-Supported Community Transition System, in Clark, Hewitt B. & Unruh, Deanne (Eds), Transition of Youth and Young Adults with Emotional or Behavioral Difficulties: An Evidence-Supported Handbook. 2009. Baltimore: Paul H. Brookes Publishing Co. For more information, see also the TIP website: http://tip.fmhi.usf.edu/.
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