Jesse Viner, MD

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What's Emerging About Emerging Adults?

Jesse Viner, MD
Founder and Executive Medical Director

 

Treatment Systems: What we have; What works.

Treatment systems are not sufficiently organized or funded for the seriously troubled emerging adult population who, with effective treatment, are capable of becoming independent successful adults. College health services are not able to offer intensive or extended services. Community hospitals are already hard pressed to operate acute care psychiatric units with short term symptom stabilization aftercare day programs. The emerging adult’s needs are approached from an episode of illness perspective and a syndrome specific focus rather than a longitudinal developmental model combining traditional treatments, extended strength based initiatives and knowledge form research in the field of neurobiology.  Recurrent and persistent emotional or behavioral difficulties often extend into partial disability or explode in crisis resulting in referral to residential treatment centers.

National specialty residential treatment centers often provide excellent intervention for the acute episode of illness and build psychological and interpersonal skills necessary for successful young adult functioning. However, this population is the most vulnerable to separations and transitions in their support system and many cannot sustain their progress upon return to their community. Problems in self-regulation are stabilized, supported and healed within emotionally resonant intimate attachments which take time to develop and are not readily transferable to new therapeutic relationships. Residential treatment centers continue to function on an outdated asylum model of treatment; Go away to  get better.  The asylum model of treatment does not offer the concurrent experience and opportunity to build internal strengths and an anchored life in the community while receiving necessary professional support and skilled services. The emerging adult is then at risk for stalled development, misunderstanding continued suffering as demoralizing personal failure and experiencing shameful estrangement from needed family and friends.

Vander Stoep notes that families with psychiatrically ill children also tend to withdraw from their community despite increased needs for support. Continued living at home by troubled emerging adults distorts individual developmental needs and strains family bonds already weary from the turmoil and pain of psychiatric illness. Families are additionally burdened with having to cope not only with their child’s illness but with functioning as case managers for a fragmented delivery system which collaborates poorly among professionals and families, and lacks accountability for outcome and economic value.

The Annenberg Foundation Trust Report on Mental Health in Adolescence (2005) has reviewed the literature on program evaluation for this population and has concluded that programs are apt to be successful-increasing positive outcomes and reducing negative outcomes if they have the following features:

  • a guiding philosophy of young adult difficulties and how to effect change;
  • more intensive over more time;
  • broad based affecting multiple interacting systems within the individual and their milieu;
  • utilize a “person in context” approach assisting “in real time” with hands on active engagement;
  • provide multiple opportunities for modeling and mentoring relationships with adults and peers;
  • Program self-reflective questioning and monitoring of process and outcome.