Treatment

At a glance: youth engagement openings in treatment  

A youth engagement approach to care is holistic, recovery-oriented, strength-based and collaborative; young people and service providers develop strong relationships and work together to identify goals, supports and services according to the young person’s individual needs and preferences.

Some youth may require additional skill-building, supports, and services to fully benefit from youth engagement opportunities. A youth engagement approach to treatment strengthens the role of positive youth development and creates opportunities for young people to work with their service provider to adjust services to meet their individual needs. The following considerations have been shown to increase engagement in treatment:

Youth receive accurate and thorough information about services and supports

 By addressing stigma and providing young people with choice within the therapeutic setting, service providers can enhance treatment engagement. 2 Service providers are tasked with explaining (in accessible language) information about the treatment process; more specifically, what youth can expect, what the different treatment options are and how supports are supposed to help. Service providers also go over the young person’s rights and responsibilities (e.g., confidentiality, what they can do if they believe they are receiving poor services) as well as potential benefits and risks. 3^,4^,5^,6

Treatment is holistic and recovery-oriented

The principles of youth engagement are aligned with a recovery-oriented approach to mental health care. SAMHSA (2012) defines recovery as “a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. 7 Engagement in meaningful activities, empowering relationships and connection to the community are major dimension that support a life in recovery. 7 While the elimination of symptoms may be an important goal, symptoms are only one facet of the person’s experience. Recovery considers quality of life and the wellness of the whole person. 8

Treatment goals and planning are set collaboratively to meet the needs and preferences of the young person

Shared decision-making invites youth to be active participants in their treatment and to have a better understanding of, and increased commitment to the treatment process. 9 Evidence suggests that therapists’ use of collaborative behaviours, including presenting treatment as a team effort, working together to establish goals, promoting participation and involvement, encouraging feedback, predict better quality alliance scores, 10 which is linked to positive treatment outcomes in youth. 11 To promote active involvement, planning meetings are scheduled at times that work for the young person and do not happen without them present.

Treatment builds on the young person’s strengths, skills, resilience and resources

Treatment has traditionally focused on addressing a young person’s pathology, deficits, or problems. Working from a positive youth development approach, service providers focus on the relationship and the young person’s strengths, skills and resources as protective factors against mental health problems. 12 Given its demonstrated benefits, youth engagement is a promising intervention in itself, leading to improved clinical outcomes. Hawke, Hennen, Gallione (2005) demonstrated that youth engagement in meaningful activities increases the development of key recovery skills such as self-regulation, effective coping and understanding of self-factors related to recovery. Lloyd and King (2003) maintain that engagement activities may act as a protective factor against the negative effects of stigma by building capacity, confidence and skills for sound decision-making. For more, see the evidence summary Youth engagement and clinical outcomes.

Mechanisms are in place for youth to provide feedback on how treatment is working for them; that feedback is built into treatment planning

Service providers work to create opportunities for young people to provide honest feedback about their treatment and they are supported in ensuring that treatment fits the young person’s individual needs 13^,6. Measures exist to invite feedback and assess therapeutic alliance.

Treatment plans emphasize the roles of family and natural supports

“Families need to be supported in a way that enables access to the right information at the right time to help them help their children make informed choices, and to advocate for services that best meet their unique needs. 14 Working from an ecological framework to therapy, service providers attend to various alliances in the young person’s psychosocial network. 15^,16^,17 Natural supports can be valuable sources of support and engaging parents and caregiver in treatment can have a positive effect on treatment retention and outcome. 18^,5

Peer support is recognized as an essential component of mental health services

Peer support can happen informally between young people who connect around a shared issue. Peer support can also involve more formal roles where young people in recovery are selected and prepared to provide support to others utilizing clinical services. Peer supporters generally have lived experience of a mental health issue, and can relate to the challenges along the way. This often inspires hope, demonstrating that recovery is possible. 8

In Making the Case for Peer Support, 19 the Mental Health Commission of Canada recognized peer support as an essential component of mental health services. While there is little research evidence specific to peer support in youth mental health, a best practices publication by Health Canada (2008) for youth with substance use problems includes a recommendation to include peer helpers in outreach activities. Outreach services involve former clients alongside outreach staff or other workers, and act as peer educators or helpers. As a best practice, it is suggested that using peers has several potential advantages:

• Peers may address barriers associated with mistrust of adults or professional service providers
• Peers may have knowledge of existing youth networks and social norms
• Peers with lived experience and street knowledge are more relatable to youth seeking help
• Peers might have innovative insights into the design and implementation of outreach activities, operations, and evaluation elements

Health Canada does warn there is risk that former clients reinitiate problem substance use, and if they are engaged as peer helpers it could delay their transition into mainstream community life. It is essential that outreach initiatives, which incorporate peer workers or volunteers, have ongoing support and supervision available.

• 1. Walker, 2008, p.4
• 2. Oetzel & Scerer, 2003
• 3. Karver & Caporino, 2010
• 4. Sommers-Flanagan & Bequette, 2013
• 5. a. b. Karver, Handelsman, Fields & Bickman, 2006
• 6. a. b. Henkelman & Everall, 2011
• 7. a. b. https://www.samhsa.gov/find-help/recovery
• 8. a. b. Mental Health Commission of Canada, 2013
• 9. Schuer, Everett, & del Veccio, 2007
• 10. Creed & Kendall, 2005
• 11. Martin, Garske & Davis, 2000
• 12. Schwartz & Suyemoto, 2013
• 13. Walker, Thorne, Powers & Gaonkar, 2009
• 14. Manion & Smith, 2011, p.3
• 15. Feinstein, 2009
• 16. Thompson, Bender, Lantry &Flynn, 2007
• 17. Hawley & Garland, 2008
• 18. Hawley & Weisz, 2005
• 19. Mental Health Commission of Canada, 2010