The definition of serious mental health conditions in youth and young adults crosses two age-delimited, conceptually related, diagnostic categories. The term “serious emotional disturbance” (SED), applied to people under the age of 18, refers to a diagnosable mental, behavioral or emotional disorder that substantially interferes with or limits a child’s role in family, school, or community activities (Interdepartmental Serious Mental Illness Coordinating Committee, 2017; ISMICC). Similarly, the term “serious mental illness” (SMI), typically applied to adults (18 and older), refers to a diagnosable mental, behavioral, or emotional disorder that results in functional impairment that substantially interferes with or limits one or more major life activities (Interdepartmental Serious Mental Illness Coordinating Committee, 2017). For this priority, the population of interest, youth and young adults with serious mental health conditions (SMHC), includes individuals between the ages of 14 and 30 who have been diagnosed with either SED or SMI, according to these definitions.
SED in youth and SMI in young adults have similar population prevalence estimates. SED in youth ages 13 to 17 has an estimated prevalence of 8% (Kessler et. al., 2012). The prevalence of SMI in young adults ages 18 to 25 is 7.5% and has been increasing since 2013 (Substance Abuse and Mental Health Services Administration [SAMHSA], 2018). Risk factors for mental health conditions, such as poverty, food insecurity, and exposure to violence, disproportionately affect youth and young adults of color, (Alegria, Vallas & Pumariega, 2010); and, persistently low socioeconomic status is strongly related to higher rates of mental health problems among adolescents (Reiss, 2013). Additionally, some youth and young adults are at particularly high risk for adverse outcomes related to their SMHC, including youth with multiple diagnoses, involvement in foster care, involvement in the justice system, and those who experience psychosis (Burke et al., 2015; Institute of Medicine and National Research Council, 2013).
Youth and young adults with serious mental health conditions face significant barriers to successful employment. Data from the National Longitudinal Study-2 (NLTS2) revealed that 50% of young adults previously diagnosed with emotional disturbance (the NLTS2 diagnostic term comparable to the term “serious mental illness” for the children included in the sample; SRI International, 2011) were employed, as compared to 66% of the general population. (Wagner & Newman, 2012). One of the predictors of successful employment outcomes for individuals with disabilities is higher educational attainment (U.S. ­­­Bureau of Labor Statistics, 2017). However, students with serious mental health conditions also face barriers to successful completion of postsecondary education programs, for which postsecondary institutions are frequently unprepared to provide appropriate services (Kupferman & Schultz, 2015; Ringeisen et al., 2017).
Adults with serious mental illness are highly likely to report positive employment goals and expectations (Livermore & Baldos, 2017). Similarly, young adults with SMHC positively value employment, reporting that work improves social engagement and feelings of contributions to society, and also can enhance self-esteem and self-confidence (Torres Stone et al., 2018). Improving employment outcomes for youth and young adults with SMHC is also consistent with the ISMICC’s recommendations for this group (Interdepartmental Serious Mental Illness Coordinating Committee, 2017).
Recent research has begun to investigate the effects of providing developmentally appropriate employment services for youth and young adults with SMHC. Some models being studied have begun to provide adaptations of supported employment, particularly Individual Placement and Supports, for this age group (Ellison et al., 2015). Some models have also integrated supported employment with supported postsecondary education, including interventions for individuals experiencing their first episodes of psychosis (Kane et al., 2016). Other research has emphasized training youth and young adults in competencies (e.g. self-determination, goal-setting, planning) that can improve their employment outcomes (Dresser et al., 2015; Shogren et al, 2015; Sowers & Swank, 2017).
In sum, youth and young adults with SMHC frequently experience challenges in employment. There is a need for more evidence-based and effective interventions, systems change and coordination, and policies to improve employment outcomes for these individuals, particularly those who face the greatest challenges.
Alegria, M., Vallas, M., & Pumariega, A. (2010). Racial and ethnic disparities in pediatric mental health. Child and Adolescent Psychiatric Clinics of North America, 19(4), 759.
Burke, J. D., Mulvey, E. P., & Schubert, C. A. (2015). Prevalence of mental health problems and service use among first-time juvenile offenders. Journal of child and family studies, 24(12), 3774-3781.
Dresser, Karyn, Hewitt B. Clark, and Nicole Deschênes. "Implementation of a positive development, evidence-supported practice for emerging adults with serious mental health conditions: The Transition to Independence Process (TIP) Model." The journal of behavioral health services & research 42.2 (2015): 223-237.
Ellison, M. L., Klodnick, V. V., Bond, G. R., Krzos, I. M., Kaiser, S. M., Fagan, M. A., & Davis, M. (2015). Adapting supported employment for emerging adults with serious mental health conditions. The journal of behavioral health services & research, 42(2), 206-222.
Institute of Medicine and National Research Council. 2013. Improving the Health, Safety, and Well-Being of Young Adults: Workshop Summary. Washington, DC: The National Academies Press. https://doi.org/10.17226/18340.
Interdepartmental Serious Mental Illness Coordinating Committee (2017). The Way Forward: Federal Action for a System That Works for All People Living With SMI and SED and Their Families and Caregivers. Retrieved from https://www.samhsa.gov/sites/default/files/programs_campaigns/ismicc_20….
Kane, J. M., Robinson, D. G., Schooler, N. R., Mueser, K. T., Penn, D. L.,Rosenheck, R. A., Addington, J., Brunette M. F., Correll, C. U., Estroff, S. E., Marcy, P., Robinson, J., Meyer-Kalos, P. S., Gottlieb, J. D., Glynn, S. M., Lynde, D. W., Pipes, R., Kurian, B. T., Miller, A. L., Azrin, S. T., Goldstein, A. B., Severe, J. B., Lin, H., Sint, K . J., John, M., & Heinssen, R. K. (2016). Comprehensive versus usual community care for first-episode psychosis: 2-year outcomes from the NIMH RAISE early treatment program. The American Journal of Psychiatry, 173, 362–372.
Kessler, R. C., Avenevoli, S., Costello, J., Green, J. G., Gruber, M. J., McLaughlin, K. A., Petukova, M., Sampson, N. A., Zaslavsky, A. M., & Merikangas, K. R. (2012). Severity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Archives of General Psychiatry, 69, 381-389.
Kupferman, S.I., & Schultz, J. (2015). Supporting students with psychiatric disabilities in postsecondary education: Important knowledge, skills, and attitudes. Journal of Postsecondary Education and Disability, 28(1), 25-40.
Livermore, G. A., & Bardos, M. (2017). Characteristics of adults with psychiatric disabilities participating in the federal disability programs. Psychiatric rehabilitation journal, 40(2), 153.
Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Social science & medicine, 90, 24-31.
Shogren, K. A., Wehmeyer, M. L., Palmer, S. B., Rifenbark, G. G., & Little, T. D. (2015). Relationships between self-determination and postschool outcomes for youth with disabilities. The Journal of Special Education, 48(4), 256-267.
Sowers, J-A., & Swank, P. (2017). Enhancing the career planning self-determination of young adults with mental health challenges. Journal of Social Work in Disability & Rehabilitation, 16(2), 161-179.
SRI International (2011). NLTS2 database overview. Menlo Park, CA.
Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. (2018). Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health. Retrieved from: https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report.
Torres Stone, R. A., Sabella, K., Lidz, C. W., McKay, C., & Smith, L. M. (2018). The meaning of work for young adults diagnosed with serious mental health conditions. Psychiatric Rehabilitation Journal, 41, 290-298.
U.S. Bureau of Labor Statistics (2017). Persons with a disability: Labor force characteristics summary. Retrieved from https://www.bls.gov/news.release/disabl.nr0.htm.
Wagner, M., & Newman, L. (2012). Longitudinal transition outcomes of youth with emotional disturbances. Psychiatric Rehabilitation Journal, 35, 199–208.
The Administrator of the Administration for Community Living establishes a priority for an RRTC on Transition to Employment for Youth and Young Adults with Serious Mental Health Conditions (SMHC). This RRTC will also conduct activities funded by the Center for Mental Health Services, of the Substance Abuse and Mental Health Services Administration. The RRTC must conduct research or evaluative studies designed to improve employment outcomes of youth and young adults with serious mental health conditions (SMHC). Evaluative studies conducted by this RRTC will focus on assessing the effectiveness of existing programs or services; research studies will generate new knowledge, generalizable to the relevant target populations.
For the purposes of this priority, the term “youth and young adults with SMHC” refers to individuals between the ages of 14 and 30, inclusive, who have been assessed as having either a serious emotional disturbance (for individuals under the age of 18 years) or a serious mental illness (for those 18 years of age or older). Under this priority, the RRTC must contribute to improved employment outcomes for youth and young adults with SMHC by:
(a) Conducting research or evaluation activities that generate new knowledge regarding the effectiveness of developmentally appropriate interventions that are designed to improve employment outcomes for youth and young adults with serious mental health conditions. These research activities must:
(i) Identify or develop, and then evaluate and test, innovative employment interventions that meet the needs of youth and young adults with SMHC. Interventions include any strategy, practice, program, policy, or tool that, is designed and implemented to contribute to improvements in employment outcomes for youth and young adults with SMHC. These interventions may include, but are not limited to supported employment, supported postsecondary education, career development, or training in relevant social competencies and skills (e.g., self-determination, goal-setting), for youth and young adults with SMHC.
(ii) Include in the activities in (a)(i) above youth and young adults with SMHC who are at particular risk for less favorable education/training and employment outcomes (e.g., unemployment, school dropout and difficulty maintaining employment) than other youth and young adults with SMHC. This may also include individuals who are in early stages of psychosis. Applicants must identify the specific at-risk group or groups of youth and young adults with SMHC they propose to study, provide evidence that the selected population or populations are at risk for less favorable employment outcomes, and explain how the proposed practices are expected to address the needs of the identified population.
(b) Conducting research or evaluation activities to generate new knowledge about how key systems and policy issues affect employment outcomes for youth and young adults with SMHC. If generating this new knowledge by conducting research, applicants should conduct research in one or more specific stages of research. If the RRTC plans to conduct research that can be categorized under more than one of the research stages, or research that progresses from one stage to another, those stages must be clearly specified. These stages and their definitions are provided in this notice;
(c) Increasing capacity of educators, organizations, employers, State agencies, and service providers for youth and young adults with SMHC to improve the employment outcomes for youth and young adults with SMHC. The RRTC will provide training and technical assistance to these entities who work with youth and young adults with SMHC.
(d) Serving as a national resource center on employment for youth and young adults with SMHC, by:
(i) Providing information and technical assistance to youth and young adults with SMHC, their representatives, and other key stakeholders;
(ii) Providing training (including graduate, pre-service, and in-service training) and technical assistance to facilitate more effective delivery of employment-related services to youth and young adults with SMHC. This training may be provided through conferences, workshops, public education programs, in-service training programs, and similar activities. These trainings should increase the capacity of organizations, employers, State agencies, and service providers for youth and young adults with SMHC to improve their educational, career development, and employment outcomes.
(iii) Disseminating research-based information and materials related to employment of youth and young adults with SMHC. The applicant must describe how it will involve youth and young adults with SMHC in its dissemination and outreach activities; and
(iv) Involving youth and young adults with SMHC, as well as other key stakeholder groups (e.g., family members or family surrogates, employers, educators, state agencies, service providers, peer mentors) in the activities conducted under paragraphs (a) and (b) in order to maximize the relevance and usability of the new knowledge generated by the RRTC.
General Rehabilitation Research and Training Center Requirements
The effectiveness of any RRTC depends on, among other things, how well the RRTC coordinates its research efforts with the research of other NIDILRR-funded projects, and involves individuals with disabilities in its activities. Accordingly, the RRTC must:
(a) Coordinate on research projects of mutual interest with relevant NIDILRR-funded projects as identified by the NIDILRR Project Officer.
(b) Involve individuals with disabilities, including individuals with disabilities from minority backgrounds, in planning and implementing its research, training, and dissemination activities, and in evaluating the RRTC.
(c) Coordinate with the appropriate NIDILRR-funded Knowledge Translation Centers and professional and consumer organizations to provide scientific results and information to policymakers, service providers, researchers, and others, including employers, vocational rehabilitation providers, and independent living centers.
Definitions - Stages of Research:
Exploration and discovery means the stage of research that generates hypotheses or theories through new and refined analyses of data, producing observational findings and creating other sources of research-based information. This research stage may include identifying or describing the barriers to and facilitators of improved outcomes of individuals with disabilities, as well as identifying or describing existing practices, programs, or policies that are associated with important aspects of the lives of individuals with disabilities. Results achieved under this stage of research may inform the development of interventions or lead to evaluations of interventions or policies. The results of the exploration and discovery stage of research may also be used to inform decisions or priorities.
Intervention development means the stage of research that focuses on generating and testing interventions that have the potential to improve outcomes for individuals with disabilities. Intervention development involves determining the active components of possible interventions, developing measures that would be required to illustrate outcomes, specifying target populations, conducting field tests, and assessing the feasibility of conducting a well-designed intervention study. Results from this stage of research may be used to inform the design of a study to test the efficacy of an intervention.
Intervention efficacy means the stage of research during which a project evaluates and tests whether an intervention is feasible, practical, and has the potential to yield positive outcomes for individuals with disabilities. Efficacy research may assess the strength of the relationships between an intervention and outcomes and may identify factors or individual characteristics that affect the relationship between the intervention and outcomes. Efficacy research can inform decisions about whether there is sufficient evidence to support “scaling-up” an intervention to other sites and contexts. This stage of research may include assessing the training needed for wide-scale implementation of the intervention and approaches to evaluation of the intervention in real-world applications.
Scale-up evaluation means the stage of research during which a project analyzes whether an intervention is effective in producing improved outcomes for individuals with disabilities when implemented in a real-world setting. During this stage of research, a project tests the outcomes of an evidence-based intervention in different settings. The project examines the challenges to successful replication of the intervention and the circumstances and activities that contribute to successful adoption of the intervention in real-world settings. This stage of research may also include well-designed studies of an intervention that has been widely adopted in practice, but lacks a sufficient evidence base to demonstrate its effectiveness.