Primary Sources: Integrated Employment and Mental Health Services -- How Well Do They Work For Homeless Youth?

Using the Social Enterprise Intervention and Individual Placement and Support Models to Improve Employment and Clinical Outcomes of Homeless Youth With Mental Illness” (abstract). Kristin M. Ferguson. Social Work in Mental Health, Vol. 11, No. 5 (2013).

What it’s about: Author Kristin M. Ferguson worked with two social services agencies in Los Angeles that work with homeless youth who also suffer from mental illness. Together, Ferguson and agency staff studied the effect on young people of two programs that combine employment and mental health services.

About three dozen youth participated in each of the two studies. In each case, Ferguson involved staff, clients, community members, board members and others in conducting the research, an approach called community-based participatory research. Both studies had an "intervention group" that took part in the program being studied and a "control group" that got regular support services.

Why read it: Homeless youth face many barriers to employment. Other researchers have estimated that the unemployment rate among homeless young people may be as high as 75 percent. At the same time, Ferguson writes, many homeless youth make money through nontraditional and sometimes through illegal means, like selling blood, dealing drugs, panhandling and survival sex. Programs that empower homeless youth, including those struggling with mental illness, to gain job skills and get and keep jobs may also help them to afford stable housing and stay off the streets.

Biggest takeaways for family and youth workers: One of the two models Ferguson studied is Social Enterprise Intervention, an evidence-informed 20-month program with four stages through which youth gain vocational skills and small-business skills, start their own cooperative business, and get clinical mental health services.

Youth in the intervention group felt better about their lives and about the support they received from family and peers at the end of the program. Their symptoms of depression had decreased, as well. In focus groups, they said the program boosted their self-esteem, motivation and employability.

The second model that Ferguson studied is Individual Placement and Support, an evidence-based program designed to help people with mental illnesses get employed and stay employed. The program uses eight principles, including integrated clinical and vocational services, rapid placement in jobs, and continuing, individualized support for participants.

Youth in the study group had higher employment rates throughout the months of the study than did youth in the control group, who were receiving less intensive employment services separate from mental health services. Between 45-70 percent of youth in the study group were working in any given month, compared to 19-31 percent of control-group youth.

Ferguson also makes a case for the practical effects of the community-based participatory research approach she used for both studies. She argues that using this method of research to pilot a new program can make it easier to integrate services that are typically kept separate, such as mental health and employment.

Additional references: Look for more articles about youth employment and mental health in NCFY’s research library.

Previously, we wrote about research into whether mental health and housing services can help homeless youth hold down a job.

Bright Idea: Four Ways to Engage At-Risk Youth in Community Service

If you’ve ever cleaned up a park or planned a fundraiser with a group of young people, you know volunteering makes them feel good and helps them develop leadership skills. They learn how to share ideas with a group, motivate others to succeed and see a project through to the end. These skills, and the confidence that comes with them, can translate to the classroom and the workplace. 

In fact, there’s quite a bit of research exploring the benefits young people get when they do community service. And giving back may be particularly beneficial for youth from underserved communities.

“There’s nothing more empowering for youth coming from an at-risk background than to hear that someone needs their help,” says David Battey, president and founder of Youth Volunteer Corps in Kansas, MO. “Those are powerful words to say to anyone, but they’re even more meaningful for teens who feel they’re usually the ones in need.”

Connecting Youth to Community Service Opportunities

Unfortunately, Battey says, young people with the most to gain from community service often don’t know about ways to get involved. Plus, many of the opportunities available to teens lack the guidance and structure needed to make them rewarding, says Battey, whose organization works with nonprofits across the country to create high-quality service projects for teens—including those not traditionally asked to serve.

We asked Battey and Karen Daniel, vice president of engagement at Youth Service America, which sponsors Global Youth Service Day each April, to offer advice on engaging young people from at-risk backgrounds in community service. Here’s what they said:

  1. Ask youth the right questions. Asking “do you want to volunteer” can get kids motivated, but it isn’t always enough. Make sure to include follow-up questions, Daniel says, like “what would you do in a perfect day” to see what types of activities they enjoy most. Youth Service America encourages young people to become leaders by creating and administering their own service projects that “fire them up.” A young person who loves to dance might create a free dance program for low-income students, for example, while an aspiring musician might organize a concert to raise money for charity.
  2. Vet community service programs. Help young people learn about ongoing service projects in your community such as park beautification projects and mentorship programs—and the organizations running them. You want to gauge whether the experience will be meaningful for the young person. Look for programs that are structured and include adult guidance. Will young people have a designated project leader they can seek out if they have questions? Will they be left alone in a room to complete their work, or will they have opportunities to collaborate and brainstorm with others? For at-risk youth in particular, Battey says, working in a team environment adds a level of accountability that might not exist if they were to volunteer alone. A teammate may text  someone who doesn’t show up on time, for example, or speak up if they think someone is acting disrespectfully.
  3. Think through logistics. Once teens have chosen a project to join or begun to design their own project, help them consider what they might need to volunteer and how you can support those needs. Will they need help getting to their service project, for example? Does the task require special clothes or supplies? Family and youth workers can also help young people think through the skills they might need to succeed in a certain role, and the homework they can do to prepare. YSA’s “Youth Changing the World: A Service Project Toolkit” can walk them through all the right steps.
  4. Be a sounding board. Give young volunteers opportunities to talk through challenges that come up and to decide whether it makes sense to overcome them or move on.  This can involve regular meetings, or simply being available if a young person wants to talk.

A last word: Don’t be surprised or disappointed, Daniel says, if teens change their minds about what they want to do. Instead, offer support and walk them through the pros and cons of starting a new project.

“Right now, a young person might be really excited about recycling and in six weeks, they’re really interested in literacy,” she says. “That’s just part of the [discovery] process.”

Bright Idea: Dallas High Schools Open Early as Drop-In Centers

Once a week, a few dozen students at North Dallas High School arrive before the first bell. They receive a free breakfast, as well as supplies like socks and hygiene products, all of which have been donated by local businesses and a church across the street. Some of the young people take a donut or Egg McMuffin and go on their way, though others stick around to talk to volunteers like Mark Pierce, homeless liaison for the Dallas Independent School District, or representatives from local youth-serving agencies like Promise House.

Don’t call it a program for homeless youth: a variety of students show up, says Pierce, and the school doesn’t advertise it as homeless assistance. But this weekly drop-in center—and two others that Pierce has opened in other Dallas-area schools—has brought services, supplies and mentorship directly to some of the local kids who need it most, for whatever reason. The weekly event also has given youth- and family- serving programs a whole new way to interact with the city’s youth.

“It’s a win-win for both,” says Kerri Stitt, clinical services manager for Promise House. “The kids get resources, and we get to start relationships with them.”

Pierce and Stitt spoke to NCFY about how other communities can implement a similar program.

Step 1: Talk to your homeless liaison & local school

The McKinney-Vento Act requires that each school district employ a liaison for homeless youth. Pierce recommends calling them to talk about the possibility of weekly drop-ins at local schools. Or, he says, "Go directly to the high school and talk about opening something that doesn’t disrupt teaching time." Many schools have community outreach coordinators who can help bring this kind of idea to fruition.

Step 2: Bring in Local Partners

At the weekly Dallas drop-ins, case managers from youth-serving programs help young people fill out benefit forms and job applications. The case managers also generally inform young people of what services they’re entitled to. The biggest need that most youth convey is transportation, so Pierce has arranged for the Dallas Area Rapid Transport system to come by the school and hand out weekly passes so that youth might get around more easily.

Step 3: Give Youth a Reason to Come

Kerri Stitt says that those transportation passes, and other incentives, play a double role: they meet a need and they get young people in the door consistently.

“We also do a punch card system,” she says. “Every time [youth] come and talk to one of our case managers, they get a punch. After four times, we give them a $5 gift card [to a local business], then after eight it’s $20.”

Pierce says that he’s offered jobs to some of the more consistently engaged visitors to the program. They will get paid to help come in and set up for the drop-in center each week. Anything to improve these young people’s attendance in school, he says. “If they come [to our program], they will do better in school. They’ll have more of their needs meet, and they won’t have to wonder where to go for it.”


Primary Sources: How Setbacks in Youth-Led Projects Promote Strategic Thinking

Adolescents’ Development of Skills for Agency in Youth Programs: Learning to Think Strategically” (abstract). Reed W. Larson and Rachel M. Angus. Child Development, Vol. 82, Number 1 (2011).

What it’s about: Larson and Angus wanted to see if youth development programs help young people learn to set and achieve goals—a set of skills known as agency.

The University of Illinois researchers interviewed 108 youth ages 13 to 21. Participants were enrolled in a local arts or leadership program, which engaged them in projects like staging a local musical, advocating for better school policies or planning a day camp for fourth graders.

Interviewers talked to participants every two weeks or so, to discuss their experiences and look for common themes. More than half of participants completed a follow-up interview two or three years after their projects ended.

Why read it: Being able to establish and pursue goals is valuable for young people approaching adulthood, yet the part of the brain responsible for reasoning and problem-solving is often still developing in adolescents. Research on the impact of youth development programs on skills like strategic thinking and goal setting may help family and youth workers develop more effective programming.

Biggest takeaways for family and youth workers: In the interviews at the time of the projects, many participants talked about "working hard" or "doing what it takes" to meet their project demands and deadlines. But teens who were aware of exactly what it would take to finish their projects didn't necessarily follow through or develop an independent ability to set goals.

Participants who ran into unexpected challenges, on the other hand, learned to think strategically as they walked through what caused the problem and how they might solve it and move forward. Youth also showed gains in strategic thinking when their advisors took a hands-off approach instead of telling them what to do. Larson and Angus theorize that those young people knew they could reach out for advice even if they would be making a final decision. That feeling of being supported may have helped them to grow.

In their follow-up interviews several years later, the authors found that many participants had held onto the skills they picked up as teens. One college student said campaigning to improve school policies taught her always to have a backup plan in case a situation doesn't work out as expected. Another participant said that recognizing the impact of his decisions has motivated him to avoid gang life and enroll in college.

Larson and Angus say further research is needed to develop program models that expose youth to real-world challenges while making sure they are connected to caring adults. They add that such programs--whatever they look like--will help youth develop strategic tools that can smooth their path to adulthood.

Additional references: Find abstracts of other literature on Positive Youth Development in our digital library.

We also offer two online guides related to this topic, "Positive Youth Development: An Introduction" and "Putting Positive Youth Development into Practice."

Publications discussed here do not necessarily reflect the views of NCFY, FYSB or the Administration for Children and Families.

Small-Picture Teen Pregnancy Prevention: Four Things to Do When Teen Birth Rates Don’t Decline

On the U.S. teen pregnancy prevention front, good news seems to be all around. From 1991 to 2012, the national rate of teen births plummeted by more than 50 percent, and most individual states followed suit. But as anyone in the field knows, progress is sometimes bumpy and rates can be affected by many factors. Especially in small communities, an extra few births can mar year-to-year statistical improvement.

A small increase in teen births from one year to the next doesn’t constitute a failure. Setbacks do happen, and teen pregnancy prevention programs can weather them by building a community-wide culture of adolescent health that doesn’t hinge on fluctuations in percentages or funding.

“When the numbers come out, we share them and keep talking,” says Michelle Nimmons of the Bamberg County School/Community Sexual Risk Reduction Project in Denmark, SC. “But I never allow [the greater community] to think it’s just my job. You have to remind them that it’s their responsibility too.”

Despite the Bamberg County project’s long-term achievements, Bamberg is one of 19 South Carolina counties to experience a slight uptick in teen birth rates from 2011 to 2012, despite a statewide 47 percent decline in the rate over the last 20 years. Here are four things some local programs in those counties do to keep up the positive momentum:

1. Keep young people involved. One of the Bamberg County School/Community Sexual Risk Reduction Project’s most important partners is its group of 14 “teen ambassadors.” The ambassadors are volunteer peer educators who serve as liaisons between the project and local teens. When birth rates recently went up, Nimmons and her colleagues asked the ambassadors, “Tell us what’s happening. Where do we need to reinforce this message?” The young people have an ear to what obstacles their peers are facing, and what might work to help them make healthier choices.

2. Find new partners. When local rates go up, it's often because of the loss of an important local resources. For example, Nimmons' teen ambassodors told her that their peers had trouble getting contraception after a local health clinic closed. Nimmons needed to find new partners, places that young people would be comfortable visiting. She and her colleagues found a few willing barber and beauty shops that now offer free condoms supplied by the project.

3. Recognize what you can do with limited resources. Like the shuttering of a local partner, a sudden loss of funding can certainly increase the teen-pregnancy rate in any area. Pam Rush, director of prevention services for Axis 1, a teen pregnancy prevention agency in Barnwell County, SC, says her community saw a small uptick in teen births over the last two years of available data, in part due to a tight state budget. With less funding, Rush and her colleagues cut back on the school-based curriculum they offered to middle schoolers and high schoolers, and are focusing on maintaining as much face-time as possible with the 9th-grade and 10th-grade students they are still able to serve.

“For us, consistency is the thing,” says Rush. “The rates improved because we were there. When we’re not there, the influence they get from TV, from music, becomes the norm.”

4. Broaden the discussion. Rush finds that putting teen pregnancy into the bigger context of teen health and wellbeing helps keep parents and local leaders from losing hope when rates increase year-to-year.

“We’re no longer talking only about pregnancy, it’s HIV prevention and STDs [too],” says Rush. She and her colleagues also try to spend less time talking about rates and percentages, because they don’t want the community to think those are the only things that constitutes success. Particularly in a small community, Rush says, “big-picture talk about rates doesn’t tell the whole story.”

The real work of teen pregnancy prevention, she says, happens through a gradual change in community values that numbers can't always capture.

Learn How You Can Help Families Support Their LGBTQ Children

We’ve written before about the groundbreaking research from San Francisco State University’s Family Acceptance Project, and interviewed the project’s director, Caitlin Ryan about the difference supportive families can make for lesbian, gay, bisexual and transgender youth.

Now a new publication from the Substance Abuse and Mental Health Services Administration, "A Practitioner's Resource Guide: Helping Families to Support Their LGBT Children," aims to help health and social service professionals put the project’s “family intervention” approach into practice.

Research by Ryan and others has shown that youth who are rejected by their families because of sexual orientation have higher risks of suicide and depression and are more likely than their peers to use illegal drugs and have unprotected sex. Researchers have also learned that different levels of rejection have varying effects on young people’s well-being. That means helping families become even a little more accepting can make a difference for LGBTQ teens.

Family Intervention Framework

With that in mind, the family intervention framework views families and caregivers as potential allies in reducing risk, promoting well-being, and creating a healthy future for LGBTQ youth. The approach also sees a family’s cultural values – including deeply-held beliefs –as strengths.

“Many parents and families whose children end up out of home (e.g., homeless or in custodial care) want to reconnect and to have an ongoing relationship with their LGBT children despite assumptions by others that they do not want to have any involvement with their LGBT children’s lives,” the authors of the SAMHSA guide write.

Key Steps for Service Providers

Based on Family Acceptance Project research, the SAMHSA guide suggests key steps service providers can take when they work with families, including:

  1. Meet caregivers “where they are.”
  2. Give families respectful language to talk about sexual orientation and gender identity.
  3. Let parents and caregivers talk about their experiences and their hopes and fears for their LGBTQ children.
  4. Educate families on how family rejecting behaviors affect their LGBTQ children.
  5. Educate families on how supportive and accepting behaviors affect their LGBTQ children.

Using the advice in the guide, service professionals can help parents and caregivers separate their personal reactions to having an LGBTQ child from their child’s need for love, safety and support.

Read “A Practitioner's Resource Guide: Helping Families to Support Their LGBT Children" (PDF 1MB).

Publications discussed here do not necessarily reflect the views of NCFY, FYSB or the Administration for Children & Families.

Nominate Your Volunteers for Our Thank You Campaign

Global Youth Service Day and National Volunteer Week are both observed in April. So this month, we want to show our gratitude to the amazing volunteers who promote the missions of youth- and family-serving organizations.

We call it the Thank-a-Volunteer campaign.

Here’s how it will work: You nominate a volunteer. We’ll choose from among the nominees and feature outstanding stories on our website and in our social media channels. The featured volunteers will feel thanked and appreciated.

You can nominate up to three people, ages 18 and up, who have volunteered for your organization in the past year. Send us a short description of how amazing they are and what they have done to support your organization’s mission by April 17. Send the description in one of these ways:

  1. By email to
  2. By following us on Twitter and tweeting a message to @ncfy
  3. By liking us on Facebook and commenting on a post about our Thank-a-Volunteer campaign.
  4. By clicking the live chat button at the top of this page.

We’d especially love to hear about volunteers from organizations that receive funding from the Family & Youth Services Bureau, but any family and youth services organization can nominate someone.

We look forward to hearing from you!

Help Youth Explore Careers and Gain Skills

Two new resources from the Department of Labor can help you point youth down the right career path and prepare them to succeed.

"What’s My Next Move” is a printable guide that helps youth learn how to use the My Next Move and CareerOneStop websites to learn about occupations that match their interests and skills. The seven-step guide is interactive and easy to follow as it gives youth practical guidance about how to gain employment in many occupations. We like the "Job Zones" section of the guide, which walks users through the amount of education, training, and experience needed in particular fields.

"Skills to Pay the Bills: Mastering Soft Skills for Workplace Success" is a curriculum developed by Office of Disability Employment Policy to teach young people, including those with disabilities, the "soft" skills they need to get and stay employed. The interactive lessons cover six key skill areas: communication, enthusiasm and attitude, teamwork, networking, problem solving and critical thinking, and professionalism. You'll find role play scenarios and conversation starters that can help you give youth practical and tangible examples of each skills.

Use either of these tools as part of lifeskills education for teens and young adults or in one-on-one career counseling sessions.

Publications discussed here do not necessarily reflect the views of NCFY, FYSB or the Administration for Children & Families.

Bright Idea: Everything You Need to Know About Helping Homeless Youth Apply for Medicaid

In recent months, you may have seen a federal or grassroots campaign to sign young people up for health care coverage under the Affordable Care Act. Although open enrollment for paid insurance plans ends on March 31, eligible youth can still sign up for Medicaid—the government health care program for low-income individuals and families—past that deadline.

Graham Bowman, an Equal Justice Works fellow at The Law Project of the Chicago Coalition for the Homeless, has spent the last five months helping eligible runaway and homeless youth apply for Medicaid. Here’s what he told us about getting them signed up:

Motivate youth to get covered. You’ve likely encountered young people who aren’t convinced they need health care coverage. For example, some young people are more worried about their next meal than thinking about future medical needs. Bowman finds he can motivate some youth to apply for health care coverage by explaining that as Illinois residents, they can apply for the Supplemental Nutrition Assistance Program at the same time.

Bowman says it's easier to convince youth to get covered if they’ve dealt with long waits or racked up big medical bills at the emergency room. For those young people, learning that Illinois will pay most medical debt incurred up to three months before Medicaid enrollment provides an additional incentive.      

Find your state’s Medicaid agency to learn about local resources and provisions that might resonate with youth.

Explain rules that affect eligibility. Youth may be eligible for Medicaid coverage, but they don’t always know it. The Affordable Care Act allows many youth who have been in the child welfare system to retain Medicaid coverage until they turn 26. But Bowman says some youth don’t realize they qualify if they lived with a relative or in another situation they didn’t call foster care. Asking young people where they grew up can help you determine if the provision applies.

On the other hand, young people may be denied coverage because a family member claims them as a dependent on their tax returns—even if the young person hasn’t seen them for years. Bowman recommends asking youth if they know someone claims them as a dependent and then explaining how filing their own tax returns might eliminate the problem.

Sign youth up by phone, rather than online. On the phone, the Medicaid caseworker can take a youth step-by-step through the process, get a sense of the young person’s situation more clearly and rule out irrelevant questions listed on the online form, Bowman says.

That personal touch increases the likelihood youths’ applications are complete and accurate. Using the phone, Bowman says, also lets youth “sign” the application orally and without sending personal documents.

In his experience in Illinois, “Nine times out of 10, young people are immediately approved over the phone just by giving their name, social security number and mailing address,” Bowman says.

Rehearse the call. Before making the call with a young person, Bowman runs through typical questions the caseworker will ask, like whether the youth receives any income and knows their social security number. This initial conversation makes young people less nervous about the process, he says, and reduces the odds that the caseworker will find any discrepancies in their applications.

Let them use your mailing address. Youth will be asked to provide an address where their medical cards can be sent. Bowman encourages programs to receive mail on an applicant’s behalf, and to remind youth they can seek medical attention without a card.

A Federal Website Helps Teens Understand the Real Cost of Smoking

A new anti-smoking campaign from the Food and Drug Administration's Center for Tobacco Products targets youth ages 12-17 who are open to smoking or already experimenting with cigarettes. Launched last month, The Real Cost was developed using evidence-based best practices and is designed to reach youth who do not consider themselves smokers. 

Tailored to teens, campaign messages highlight not just the long-term health effects of smoking, but also more short-term costs of getting hooked, like bad breath and stained teeth, and the difficulty of quitting once you start.

Youth can take the "Are You Hooked?" quiz to find out if they have a problem with smoking. There's also practical advice on quitting.

Publications discussed here do not necessarily reflect the views of NCFY, FYSB or the Administration for Children & Families.


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