RYE'S VISION
What is the "Transition Age"?
Society's recognition of expanding needs in the life-stage
called "adolescence" has evoked a new term--
the "Transition Age."
What are transition services?
Transition Services as defined in the federal
Individuals with Disabilities Education Act (IDEA) are:
"...a coordinated set of activities for a student, which promotes movement
from school to post-school activities:
° Post-secondary education
° Vocational training
° Integrated employment
° Supported employment
° Continuing and adult education
° Adult services
° Independent living
° Community participation
"...based upon the individual student's needs, preferences
and interests, and shall include:
° Instruction
° Community experiences
° The development of employment and other post-school adult living objectives
° Acquisition of daily living skills
° Functional vocational evaluation."
The ultimate goal of transition planning is meaningful employment
and a quality adult life for all individuals with disabilities."
* * *
The Final Report of the Presidential Task Force on Employment
of Adults with Disabilities, July 2002, estimates that only one-third
of youth and young adults with disabilities receive appropriate job
training and assistance. Some of the barriers to autonomy and
achievement encountered by youth and young adults with disabilities
include uncoordinated approaches to transition across service systems,
discontinuity between schools and adult disability services, poor
preparation of teens for adult life, lack of incentives or supports for
early transition planning, and lack of school and community supports.
For transitioning youth and young adults with disabilities, developing
positive self-confidence, resilience, and an expectation for
achievement in a competitive, high-quality career must take place
early in their academic career. Mentors or role models with whom
students can identify, and who have shared interests, can have a
positive impact that will last a lifetime. These individuals can play
a vital role in eliminating barriers to autonomy, community integration,
and achievement by motivating youth and young adults with
disabilities to develop social competence, academic motivation,
career awareness, and other appropriate skills needed for employment
and independent living.
[Federal Register: September 30, 2003 (Volume 68, Number 189)]
[Notices]
[Page 56471-56475]
"Where are Bridges Needed?
Relationships Between Youth and Adult Services
Before Strengthening the Transition System"
And . . .
In California: A Report of the Public Hearings of the Joint Committee on Mental Health Reform and Findings and Recommendations as Adopted by the Senate Select Committee on Developmental Disabilities and Mental Health."●The JCMHR recommends the development of specialized, integrated and targeted services for youth, including foster youth, transitioning into the adult system."
(Prepared for: American Institutes for Research under contract to the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.)
More examples of attempts to enhance the much-needed supports for these youth can be found in the links below:
Rye Hospital Center has long-recognized the arbitrariness of "aging-in" and "aging-out" distinctions when government devised services for adolescent youth--healthy or disabled. More sinister, is the bureaucratic segregation taking place when funding from general revenue or philanthropy is made to communities or agencies responsible for service provision, and limitations are placed on maturation.
In 1999, the U.S. Supreme Court reviewed these issues through the eyes of Congress in enacting the Americans With Disabilities Act of 1990, and decreed that reasonable modifications of services must take place "through institutionalization" into the communities. No longer can rigid, inflexible age demarcations take place without causing unlawful discrimination against disabled young people.
Below, and in other sections of our website, you will share some of Rye Hospital Center's experience with treatment, habilitation and growth for this population--to fill the maturational and developmental void that may occur when youth are segregated in hospital or other institutions for the disabled solely because they are young and sick.
Children and Adolescents
They Need Help To Move On!
Often finding it difficult to locate and keep jobs, young people with mental illnesses require support from special programs and skilled mental health service providers in order to achieve successful transition across the domains of employment, education, living situation, and community-life adjustment. Unfortunately, due to differing eligibility criteria, many transitioning youth lose their access to these supports when they turn 18. This is a policy issue that may be considered discriminatory, and Rye Hospital Center is determined to prevent this institutionalized discrimination.
The 1999 US Supreme Court ruling in L.C. & E.W. vs. Olmstead, interpreted the Americans with Disabilities Act (ADA) to require that states must provide services in the most integrated setting appropriate to the needs of qualified individuals with disabilities. The ruling directs states to make "reasonable modifications" in programs and activities.
Link to: THE STATES' RESPONSE TO THE OLMSTEAD DECISION A Work in Progress
The May 2006 report above signals the work being performed by the states over the past five years. Unfortunately the pattern is is more like a "crazy quilt" than not. Historically, federal "remedial" legislation--Medicare, Medicaid, ADA, Rehabilitation Act, ERISA [the federal pension law]--was enacted to end the crazy-quilt of variegated state laws related to medical care, education, job security and pensions, which revealed their problems when people increasingly moved across state lines.
Reading the report is both enlightening because it is there, and disappointing because it seems unpiloted from above. The High Court ruled, orders were followed and the situation seems to have settled into a sea of silence. Ponderously moving commissions, torpid task forces, doleful recounting about funding problems, and public-relations reticence rear their 50-plus heads from the activities in most of the states and the territories.
The report, from the National Conference of State Legislators, demonstrates that to date, New York State remains far behind 80 percent of the country in fulfilling the Supreme Court's findings, exemplified by the President's 2001:
New Freedom Initiative Executive Order 13217 Section 1.:
(c) Unjustified isolation or segregation of qualified individuals with disabilities through institutionalization is a form of disability-based discrimination prohibited by Title II of the Americans With Disabilities Act of 1990 (ADA), 42 U.S.C. 12101 et. seq. States must avoid disability-based discrimination unless doing so would fundamentally alter the nature of the service, program, or activity provided by the State.
Note: Since Rye Hospital Center's programs do not need to be "fundamentally altered," having successfully contributed non-discriminatory, "integrated services" for over thirty-five years, segregating appropriately supervised adults from youth would be historically and legally regressive.
Our staff attended the conference described below:
--"Some Remedies . . ." --by Maryann Davis, Ph.D., Center for Mental Health Services Research, University of Massachusetts Medical School. Presentation at Boston University Rehabilitation Research and Training Center, May 8, 2006.
Dr. Davis points out that "No state had the same policy for child and adolescent mental health [and that there were ] "arbitrary barrier[s] of access to adult services based on a change in age, not on a change in need." She indicates that states must "change policies that define disability by age," to conform to new federal expectations.
Part of the problem results from states having "Two separate service systems: adult and child."
"The Central Policy Tenet [is] Provision of Continuity of Care from 14 or 16 through 25 or 30."
Foster Leadership that Holds the Vision
° All 15-30 year olds with serious mental health conditions share the tasks of maturation and adult role fulfillment
° The service system needs to be continuous and on task throughout this developmental stage
° Youth voice required and foremost, family voice also needed
° Constant vigilance for recognizing and creating opportunities for change
"Some Remedies . . ."
Engage ownership of this developmental stage within the adult system
° This is not an 'aging out' issue, it is an issue of providing developmentally appropriate services to all clients
° Build on strengths of each system
° Collect outcome data
Confusion!
° The sheer number of programs makes it difficult for providers and policymakers to be aware of, much less fully understand all programs
° No specific attempt has been made by the federal government to align programs with each other
° Typically, there are rules unique to each program
° Eligibility differences result in individual youth being eligible for some programs but not others, or being eligible at one age but not consistently eligible through age 25
* * *
Article:
Because it is the third leading cause of death in children over 15, here is a review article updated by: David Taylor, M.D., Department of Psychiatry, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.
SUICIDE
(the ninth leading cause of death in the U.S.)
Definition
Suicide is the act of deliberately taking one's own life. Suicidal behavior
is any deliberate action with potentially life-threatening consequences, such
as taking a drug overdose or deliberately crashing a car.
Causes, incidence, and risk factors
Suicidal behaviors can accompany many emotional disturbances, including depression,
bipolar disorder, and schizophrenia. More than 90% of all suicides are related
to a mood disorder or other psychiatric illness. Suicidal behaviors often occur
as a response to a situation that the person views as overwhelming, such as
social isolation, death of a loved one, emotional trauma, serious physical illness,
growing old, unemployment or financial problems, guilt feelings, and alcohol
or other drug dependence. In the U.S., suicide accounts for about 1% of all
deaths each year. The highest rate is among the elderly, but there has been
a steady increase in the rate among adolescents. Suicide is now the third leading
cause of death for those 15 to 19 years old, after accidents and homicide.
Suicide attempts that do not result in death far outnumber completed suicides.
Many unsuccessful suicide attempts are carried out in a manner that makes rescue
possible. They often represent a desperate cry for help.
The method of suicide varies from
relatively nonviolent methods (such as poisoning or overdose) to violent methods
(such as shooting oneself). Males are more likely to choose violent methods,
which probably accounts for the fact that suicide attempts by males are more
likely to be completed.
Suicide attempts should always be taken seriously and mental health care should
be sought immediately. Dismissing them as "attention seeking"
can have devastating consequences.
Relatives of people who seriously attempt or complete suicide often blame themselves
or become extremely angry, seeing the attempt or act as selfish. However, when
people are suicidal, they often mistakenly believe that they are doing their
friends and relatives a favor by taking themselves out of the world and these
irrational beliefs often drive their behavior.
Symptoms
Early signs:
· depression
· statements or expressions of guilt feelings
· tension or anxiety
· nervousness
· impulsiveness
Critical signs:
· sudden change in behavior (especially calmness after a period of anxiety)
· giving away belongings, attempts to "get one's affairs in order"
· direct or indirect threats to commit suicide
· direct attempts to commit suicide
Treatment
Emergency measures may be necessary
after a person has attempted suicide. First aid, CPR or mouth-to-mouth resuscitation
may be required.
Hospitalization is often needed, both to treat the recent actions and to prevent
future attempts. Psychiatric intervention is one of the most important aspects
of treatment.
Expectations (prognosis)
All suicide threats and attempts should be taken seriously. About one-third
of people who attempt suicide will repeat the attempt within one year, and about
10% of those who threaten or attempt suicide eventually do kill themselves.
Complications
Complications vary depending on the type of suicide attempt.
Call your health care provider.
A person who threatens or attempts suicide MUST be evaluated by a mental health
professional promptly. NEVER IGNORE A SUICIDE THREAT OR ATTEMPT!
Prevention
Many people who attempt suicide talk about it before making the attempt. Often,
the ability to talk to a sympathetic, nonjudgmental listener is enough to prevent
the person from attempting suicide. For this reason suicide prevention centers
have telephone "hotline" services. Again, do not ignore a suicide
threat or attempted suicide.
As with any other type of emergency,
it is best to immediately call the local emergency number (such as 911). Do
not leave the person alone even after phone contact with an appropriate professional
has been made.
Update Date: 1/25/2003