The Relationship between Trauma, Behavioral and Life Functioning Needs, and Mental Illness in a Community Sample of Transition Age Youth

Background and Purpose: There is a growing body of research around the effects of psychosocial stressors from early trauma exposure on the likelihood and severity of the subsequent onset of severe mental illness (SMI) for those with biological SMI vulnerability. This study seeks to better understand the scope of needs and connection between trauma and SMI for Transitional Age Youth (TAY) in an applied service setting. This population is particularly vulnerable; all are low-income, and the majority (88%) have a history of foster-care involvement.

Methods: This descriptive study examined the clinical profile, behavioral and emotional needs, and improvement during treatment for a community-based sample of transition age youth (age 16-25) with serious mental illness, including mood and psychotic disorders. Youth in the study are receiving services to support their transition from residential treatment programs to independent living in the community. Program staff collect Child Adolescent Needs and Strengths (CANS) and Adult Needs and Strengths (ANSA) data at intake, throughout treatment, and at discharge, for assessment and treatment-planning purposes. Youth in the sample are equally male and female and the majority (87%) are youth of color. We examine diagnosis, trauma exposure, symptomology, and other needs at baseline and at the end of treatment to examine what areas of functioning show greatest improvement in the short (6-month) and medium (1.5 years) term, and what areas require additional services to support stable living for these young people.

Results:  Data analysis is consistent with literature on trauma-prevalence for individuals with SMI. Among youth in the study, 55% had experienced interpersonal trauma at baseline; 42% had exposure to both nonviolent and violent traumas at baseline, with some experiencing as many as 4 different types of traumas. Young women were significantly more likely to experience interpersonal and violent trauma (p<. 05) than young men. Those who experienced more traumatic exposures had a higher number of traumatic symptoms. Needs most likely to be met by the end of treatment include improved symptoms related to anxiety, impulse control, and adjustment to trauma, and improved life functioning skills, including independent living and self care. Residential stability and employment continued to be ongoing needs for most youth.

Conclusion and Implications: These findings underscore the particular difficulties of meeting the trauma-related needs of this population, given intermittent and abrupt destabilizing factors, such as psychiatric hospitalizations and losing stable housing, which can be experienced as traumatic in and of themselves. Mental health service providers experience high programmatic expectations to address the intensive and long-term needs of youth, often without enough resources or time to address them. Additionally, waiting to provide services until children and youth experience a crisis (such as a psychiatric hospitalization) misses key opportunities to intervene at crucial points in their lives. Earlier assessment and treatment of trauma-related symptoms could significantly reduce the severity and even the onset of SMI, and potentially increase the stability and positive life experiences for these youth.