Creating Natural Supports and Engaging Youth and Workers in an Innovative Practice Change for Transition-Age Youth

Background: The State of Maryland has implemented an Enhanced Youth Transitional Planning (E-YTP) model for youth ages 14-21 in five rural counties. E-YTP is an individualized, youth-driven, comprehensive, team-based transition planning process using the Achieve My Plan (AMP) model, developed by Portland State University. The goals of the E-YTP model are to increase the effectiveness of youth transition plans and life skills of transition-aged youth, and to increase natural supports by increasing youth involvement in their transition planning as well as providing specific training for the child welfare workforce around transition age youth planning and engagement.

Methods: A mixed-methods design was used to evaluate the implementation of the model and outcomes for the E-YTP model, for both the youth and the workforce. Youth and child welfare workers were given a pretest in Spring 2017 and a posttest in January 2020. Measures for youth included an assessment of substance use, well-being, trauma, natural supports, and perceived independent living abilities. Pretests and posttests for the workforce involved a demographic questionnaire, Professional Quality of Life Scale, and the Maslach Burnout Inventory. Additionally, focus groups assessing the overall model experience for youth and workers occurred in January 2019 and Spring 2020. A continuous quality improvement (CQI) process was established to provide a feedback loop to the workforce and to inform coaching needs.

Results: Substance findings for youth at pretest and posttest indicate they were drinking below the national average, but for youth who were drinking, there were binge drinking implications. Well-being findings at both timepoints suggest that youth perceive a high level of well-being and meet the criteria for PTSD. Workers showed an increased level of burnout and secondary traumatic stress as well as an increase in emotional exhaustion, depersonalization, and personal accomplishment from pretest to posttest. This was to be expected as workers changed their practice and engaged with youth in a different and more personal manner. The increase in sense of personal accomplishment likely reflects an increase in understanding and implementing E-YTP. Regarding natural supports, both youth and their workers indicated the youth had developed more natural supports as part of the E-YTP process. Focus group findings suggest that youth are supportive of the E-YTP model and felt the model helped them prepare to leave care. Workers reported that the model added time and tasks to their workweek but were supportive of the model. Workers did not feel the model was influencing youth well-being or preparation to leave care, but felt the model helped youth to learn to advocate for their needs. The CQI process illustrated what E-YTP elements were essential for reporting to the workforce, the need for data dissemination, as well as the need for frequent and intense coaching.

Conclusion: The E-YTP model is a culture and practice shift for the workforce with findings suggesting positive outcomes for both youth and the workforce. Findings from this study suggest that this specific, youth-driven intervention can be successfully implemented in rural counties, with implementation support and coaching.