[State of practice: a profile of the practices adopted in Quebec to facilitate the transition to adulthood of young people who reside in an alternative living facility]

Bernard S
Record ID 32018001013
Original Title: État des pratiques: portrait des pratiques visant la transition à la vie adulte des jeunes résidant en milieu de vie substitut au Québec
Authors' objectives: The transition to adulthood presents many challenges for young people and can be particularly difficult for those more vulnerable, including the youths who reside in an alternative living facility. Many of them have a complex clinical profile with various issues related to mental health, behavior, and use of psychoactive substances. This situation is alarming for the various professionals involved with these young people. The latter can quickly find themselves in a climate of insecurity due to numerous social and professional integration challenges they confront on their road to adulthood. They have to develop their autonomy while sometimes being deprived of the required capacities or of the resources to satisfy their needs; nor do they receive support to handle these issues. Within the framework of its three-year plan of activities 2016-2019, and based on scientific, contextual and experiential data, the National Institute of Excellence in Health and Social Services (INESSS) and the Ministry of Health and Social Services (MSSS) have agreed to develop a practice guide on the transition to adulthood of young people residing in an alternative living facility. The resulting recommendations will focus more specifically on the transition between youth services and adult services, as well as on the practices addressing the autonomy and the social and professional integration of these young people.
Authors' results and conclusions: RESULTS: The organizational practices identified and deployed by the institutions are intended to facilitate the transition to adulthood of young people residing in alternative living facilities by supporting the growth of their potential for empowerment. Some of them are more specifically aimed to ensure the smoothness and consistency of services for young people who are in transition from youth services to those intended for adults. They also aim at coordinating the procedures to guide youth towards community resources. These practices can be in the form of agreements, step-by-step guides, access mechanisms, personalized recommendations or designated accommodation resources. Cooperation with the partners is essential to optimize the offerings of these different services through a better alignment between them. For this purpose, the institutions have created municipal, school, community and business partnerships. The cooperative work can also be supported by the professionals involved with these young people through their participation in round-tables, committees and meeting days dedicated to this subject. Such meetings make it possible to discuss specific issues and suggest ways to improve access to services and facilitate young people's transition to adulthood. In addition, some CISSS and CIUSSS organize youth meeting days to provide young people with an opportunity to learn about the available resources. The clinical practices identified through the survey are conceived in the form of rehabilitation, reintegration, employability and schooling programs, as well as in the form of therapeutic activities and training or group workshops. Supervised or semi-autonomous apartment housing programs are also available in some areas. The administration of clinical tools, for its part, provides an opportunity to evaluate the degree of autonomy and the needs of young people in order to adjust the support they require. Through the different clinical practices, young people are led to acquire and develop skills and abilities to improve their functional independence, to create a network of social contacts, to take the steps required to find and retain a job or to continue their studies. Some practices also aim at acquisition of personal and interpersonal abilities to assist young people in taking care of their health and well-being, as well as in more efficient managing of their emotions and behaviors. The mobilization and involvement of young people are important since they are at the core of their empowerment process. In order to support them in their learning, the forms of actions that are proposed to them are diverse and oriented according to their needs and interests, their capacities, their desires, their evolution and their life project. Some programs, workshops or activities target young people who require more specialized support due mental health issues or serious behavioral disorders. Assessment and research activities are carried out by CISSS and CIUSSS in cooperation with a large number of partners, researchers, institutions and organizations. The purpose of this work is to optimize the services facilitating the transition to adulthood of young people who reside in an alternative living facility. These services address organizational practices and step-by-step guides as well as the clinical practices, continuous training and supervision of the professionals involved with this clientele. The synthesis of the elements identified by the stakeholders reveals common characteristics and concerns, which are reflected in some of the practices deployed in the province by the CISSS and CIUSSS. They are categorized here in five aspects. • A sequence of interventions adjusted according to the level of development of young people and to their progress in the acquisition of autonomy. o Preparing for independent living makes it possible to target the learning priorities and to offer the appropriate support in a way that fosters a gradual and continuous progression in the acquisition of autonomy, which is consistent with the fact that the transition to adulthood is a developmental process. However, there is no uniformity in all of Québec's regions as to the most opportune moment to initiate this intervention, nor as to the related strategies. Furthermore, some of the identified practices advance the continuation of support by youth services beyond the age of 18 years. • Varied and evolving interventions for a comprehensive response to the needs of transition to adulthood. o In the last years, a diversification of the means of intervention with the young people is observed. However, many goals are focused more on learning the functional skills and abilities than on the personal and interpersonal abilities, which are nevertheless necessary for the development of autonomy. In order to ensure the acquisition of this type of abilities, certain identified practices provide for interventions in several spheres of the young person's life. • Taking into consideration the complex needs of young people in terms of appropriate and individualized interventions. o The introduction of specialized services that support the transition to adulthood allows young people to benefit from interventions that are better suited to their needs. Some of the identified practices pay particular attention to those with serious mental health problems and behavioral disorders. Despite the efforts to set up cooperation with adult mental health services, the accessibility and consistency continue to be a challenge in some regions. • Engagement of young people, an essential factor in the transition to adulthood. o Everyone agrees on the importance of encouraging young people to engage and to act, so that they take power over their lives, assume their responsibilities and become independent. Thereupon, several clinical practices advocate empowerment as a principle of intervention. In the process of transition to adulthood, the mobilization of some young people remains a challenge, which becomes even more complex once they have reached adulthood since the services are then supplied to them on a voluntary basis. • The ongoing cooperation of all the professionals involved with these young people: a shared responsibility. o This cooperation allows to improve the response to the needs of young people and support them in developing their autonomy by focusing on greater diversity and consistency of the interventions. According to CISSS and CIUSSS respondents, it varies depending on the resources available and the agreements established between the partners. CONCLUSION: Although the identified organizational and clinical practices are aimed at empowering and supporting young people in their independence and transition to adulthood, challenges remain, particularly for young people with mental health problems. These young people, once they become adults, find themselves in precarious living conditions; they may even be experiencing social exclusion and homelessness or they may be at risk of becoming homeless. It is with a view to supporting, and even enhancing, the Québec practices aimed at these young people, that INESSS is pursuing its research, which will lead to the publication of a practice guide, an essential outcome of this profile.
Authors' methods: In order to contextualize the elements of this guide, a profile of the organizational and clinical practices within the institutions of the Quebec health and social services network was first produced. To support its project at various stages, INESSS has set up a working committee composed of representatives from different fields of activity and expertise and from a range of administrative areas. To produce the profile, a questionnaire was developed and sent to all the directors of youth program of the integrated health and social services centers (CISSS) and the integrated university health and social services centers (CIUSSS) as well as to the directors of youth protection. Data collection took place from July to November 2016 within the establishments concerned. This profile identifies the main characteristics of the practices reported by respondents. For ease of distribution, the data tables of clinical practices have been incorporated into the report in Appendix C. However, the method used for this review does not allow to conclude that all existing practices or initiatives have been identified.
Project Status: Completed
Year Published: 2018
English language abstract: An English language summary is available
Publication Type: Other
Country: Canada
Province: Quebec
MeSH Terms
  • Mental Health Services
  • Transition to Adult Care
  • Mental Disorders
  • Adolescent
  • Adolescent, Institutionalized
  • Young Adult
  • Adolescent Development
  • Social Welfare
  • Social Support
  • Foster Home Care
  • Children in institutional care
Organisation Name: Institut national d'excellence en sante et en services sociaux
Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name: demande@inesss.qc.ca
Contact Email: demande@inesss.qc.ca
Copyright: Gouvernement du Québec
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.