Research partners: The research team includes Beth Flanzbaum, MSW, LICSW, Assistant Director of Outpatient Services and MSW Internship Coordinator at Youth Opportunities Upheld (Y.O.U.), Inc. and Elspeth Slayter, MSW, PhD, Assistant Professor at Salem State College School of Social Work (SSC SSW). Y.O.U., Inc. is a behavioral health organization providing a range of social, psychological, and preventive programs for at-risk youth with developmental disabilities and their families in Worcester, Massachusetts. In 2007, Y.O.U., Inc. served 1,428 clients aged 15-22, comprising 76 percent of their total client population. Nineteen percent of the agency’s client population are Latino/a, with another 25 percent of other diverse ethnicities that represent an increasing immigrant population in Worcester, including a large population of African immigrants. As a social service agency, Y.O.U., Inc. is concerned with the need for graduate mental health practitioners who, upon entering its workforce, are optimally skilled at assessing and addressing risk and promoting resilience among youth with developmental disabilities. As a regional leader in Massachusetts’ new court-mandated systems-of-care initiative, the Children’s Behavioral Health Initiative, for low-income youth, Y.O.U., Inc. recognizes that its future access to a competent workforce is dependent on developing and evaluating practice-relevant field-based education for mental health professionals in the present. As a School of Social Work, SSC SSW is committed to efforts to increase academic and field-based content on practice with a range of people with disabilities.
Brief description of partnership: Through their ongoing partnership, Y.O.U., Inc. and SSC SSW share the goal of risk prevention and resiliency promotion among youth with developmental disabilities who are at risk of psychological and personal distress (including suicidality), youth violence and family turmoil. Together, the entities have a long-standing partnership that includes both the training of master’s level social workers and the ongoing conduct of collaborative research and evaluation on suicidality among Latino/a clients and clinical practice with populations with disabilities. Recently, this team has identified the agency’s need to development better clinical practice approaches for the range of work engaged in with youth with developmental disabilities in a multi-service setting.
Research Context: Over the past year, youth with developmental disabilities have been identified as an under-served population within the Worcester, Massachusetts community, and within Y.O.U., Inc. in particular. Despite the nascent development of clinical practice approaches for people (mostly adults) with developmental disabilities, much less is known about the application of existing best practices to this population (Beail, 2003). For youth who are eligible for services through state-funded mental retardation agencies, some specialized services are available. However, for youth with developmental disabilities who fall between the cracks, community-based service agencies are the option – yet they rarely have the expertise to conduct this work in a way that will promote client resilience and prevent risk. Given the prevalence of developmental disabilities, especially among youth served by the agency through their involvement with Massachusetts’ Children’s Behavioral Health Initiative, and given the agency’s particular role in service provision to a range of ethnically diverse communities in Worcester, Massachusetts, development of better approaches to clinical services provision for this population is a significant need.
Research Aims: The study to be advanced via participation in the Institute has three aims. First, to develop culturally-competent and developmentally appropriate set of clinical practice protocols for youth with developmental disabilities aged 15-22 in partnership with community partners. Second, to assess the implementation of these clinical practice protocols in a multiservice agency serving ethnically diverse youth with developmental disabilities aged 15-22. Third, to evaluate the effectiveness of these clinical practice protocols in fostering resilience and reducing risk among youth with developmental disabilities aged 15-22.
Study Design: The study is designed to assess the development and use of clinical practice models with at-risk youth with developmental disabilities aged 15-22. Focusing both on the collection of qualitative and quantitative process and outcome data, this prospective, longitudinal study will include two overlapping phases over a two-year period. First, after using a literature-informed process in the development of culturally-competent and developmentally appropriate clinical practice models for this population, the implementation of these models will be studied. The implementation study will qualitatively and quantitatively track the experiences of Y.O.U., Inc. graduate interns, their supervisors and all of the agency’s clinical staff in order to create a continuous quality improvement process about the models in application to client work. Second, client process and outcome measures related to risk prevention and resiliency promotion will be tracked via both the use of case record review and qualitative interviews with clinicians. While the clients themselves will not be interviewed as part of this study, measures related to psychological and personal distress (including suicidality), youth violence and family turmoil will be tracked through use of data from the Treatment Outcome Package (TOP) – a behavioral health outcome measurement tool used by Y.O.U., Inc. (Kraus, Seligman, & Jordan, 2005; Behavioral Health Laboratories, 2008).
Study Population: The proposed study will involve two study populations. First, Y.O.U., Inc. graduate interns, their supervisors and all of the agency’s clinical staff will be part of both the implementation study and the client process and outcomes study. Second, youth with developmental disabilities aged 15-22 will comprise the second study population through the use of the secondary data sources discussed above. At present the agency provides services and supports to youth aged 10-22 years receive services in outpatient, home-based, residential, and school-based services as well as therapeutic day treatment – including a range of youth with developmental disabilities.
Expertise of the Research Team: Beth Flanzbaum, MSW, LICSW, has been Assistant Director of Outpatient Services at and MSW Internship Coordinator at Y.O.U., Inc since 1998 and holds academic affiliations with four MSW programs. She has chaired several of the agency’s quality management committees and been directly involved in teaching and supervising the agency’s interns. She is skilled in the use and application of TOP as an assessment and utilization review instrument. Ms. Flanzbaum is a licensed clinical social worker and has over 25 years of direct practice experience with children and families. Elspeth Slayter, MSW, Ph.D., is an Assistant Professors at Salem State College School of Social Work. Dr. Slayter conducts behavioral health services research focused on people with disabilities (Slayter, 2010a; Slayter, 2010b; Slayter, 2009, Slayter and Steenrod, 2009, Slayter, 2008 and Slayter, 2007). Additionally, Dr. Slayter holds particular expertise in both partnering with social service agencies in applied research design and data collection approaches, but also in working with secondary data from administrative records to investigate challenges to creating and sustaining effective behavioral health service delivery systems. Dr. Slayter’s 7 years of direct practice experience with at-risk youth with developmental disabilities involved in child welfare, juvenile or criminal court proceedings in New York City also inform this study. Ms. Flanzbaum and Dr. Slayter are currently conducting a needs assessment related to clinical practice with youth with developmental disabilities who are involved with Y.O.U., Inc.
Expected public health and policy relevance: Given increasing community participation among youth with developmental disabilities (a central disability policy goal), it is particularly important to prepare mental health clinicians who are able to both prevent risk and promote resilience among this population – a population often excluded from empirical studies in an effort to obtain an ideal sample (Humphries and Weisner 2000). Focusing on the development of these clinical skills for use among at-risk youth with developmental disabilities of diverse ethnicities in a clinical setting, this project will advance clinical knowledge for practice focused on an underserved population. Additionally, this study will forward a model for increasing the preparedness of graduate-level mental health clinicians to engage in resilience promotion and risk prevention with this vulnerable population of youth with developmental disabilities.
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