HRTW-OR CONTACT & ABSTRACT

OVERVIEW:
The Community Solutions Project aims to build the capacities of schools, health providers and community organizations in the Portland Area to promote the health and transition success of minority teenagers with special health needs. The project is a 4 year model demonstration and systems development initiative that includes transition-focused support and advocacy for youth and families, youth leadership, an inter-agency policy task force, and interdisciplinary training for health professionals in transition and cultural competence.

PROBLEM:
In the 5 years following high school, youth with special health care needs lag behind their peers in the general population in terms of rates of employment, wages earned, access to post-secondary education, and residential independence (Blackorby & Wagner, 1996). Specifically, youth who experience health conditions, multiple disabilities, orthopedic impairments, and mental retardation continue to demonstrate poor transition outcomes, particularly minority youth.
Findings from a needs assessment with African American, Native American and Hispanic youth suggest a number of barriers that must be address to promote youth transition success. These barriers include (a) cultural insensitivity, (b) lack of awareness by professionals and employers of the obstacles imposed by health problems and accommodations that can be provided to assist youth, (c) isolation of youth and families from transition and health care supports, and (d) poor coordination between discrete school programs that support youth with diverse conditions, and between schools, community organizations and disability or health-focused programs. If we are to improve the transition outcomes of culturally diverse youth, it is essential that family-centered, culturally-responsive, community-driven strategies be developed to reduce these barriers.

GOALS AND OBJECTIVES:
The purpose of the Community Solutions Project is to build the capacities of schools, health providers and community organizations in the Portland Area to promote the health and transition success of minority teenagers with special health needs through a 4 year model demonstration and systems development initiative. Community Solutions is accomplishing 4 major goals:

• Transition-Focused Family Support. A transition-focused family-support program has been established for teenagers and families in the African American, Hispanic and Native American communities. Transition Support Liaisons provide outreach to youth and their families, and assist them to conduct person-centered transition planning, to identify and access supports and to negotiate transition barriers. Liaisons are based in the school district and in organizations that provide health/disability, employment and cultural supports to youth and their families.
• Leadership Development. We have established a leadership development program that facilitates mentorship and intra-generational peer support for youth and educational and advocacy activities to promote cultural responsiveness and health awareness among educators, employers, health professionals, and community organizations.
• Interdisciplinary Professional Development. We are establishing a training focus in culture and transition supports within the OHSU Maternal and Child Health Training Program. Maternal and Child Health trainees and OHSU medical school and nursing students participate in instructional and practicum experiences focused on enhancing their cultural responsiveness and their transition support skill. Curricula is being developed to support trainee participation in instructional and practicum activities.
• Systems Development. An inter-organizational Policy Team meets quarterly to consider the system barriers to transition success that are being identified through the Project and to develop specific objectives and strategies to address the barriers. The Policy Team includes representatives of key State health, education and employment agencies, youth and family Project participants and representatives from community organizations.

METHODOLOGY:
Community Solutions is committed to work with youth with SHCN, their families and leaders from communities with ethnic and cultural richness in every step of the process. Methods include a review of extant data, surveys, focus groups, self-assessments of transition-focused cultural competence by organizations poised to address the employment needs of youth with SHCN, and inter-organizational strategic planning.

COORDINATION:
The Center on Self-Determination at Oregon Health Sciences University, a program of the Child Development and Rehabilitation Center (CDRC), is collaborating with schools and community programs in Portland, Oregon to address the needs of minority youth in transition from high school to adult life. CDRC is the Title V. agency in Oregon and it’s leaders, Dr. Jerry Sells and Charles Carter, are actively involved in the project.

EVALUATION:
The central outcome of the Project is the development of comprehensive approaches to address the identified employment and health needs of youth with SHCN within and across the target communities. Formative and summative strategies address administrative and methodological monitoring for: 1) Fidelity to the plan; 2) Social Validity of activities and products; and 3) Efficacy of the activities. The Community Solutions Project is being systematically evaluated to determine it's impact on adolescent, family, employer, and health provider participants as well as it's impact on systems development. The findings, strategies and products from the Project will be comprehensively disseminated to promote the design and delivery of transition supports to culturally diverse youth with health conditions and disabilities across the nation.

KEY WORDS:
SCSHN, Adolescent, Transition, Employment, Culture

ANNOTATION:
The Community Solutions Project aims to build the capacities of schools, health providers and community organizations in the Portland Area to promote the health and transition success of minority teenagers with special health needs. The project is a 4 year model demonstration and systems development initiative that includes transition-focused support and advocacy for youth and families, youth leadership, an inter-agency policy task force, and interdisciplinary training for health professionals in transition and cultural competence.

[SUMMARY]

HRTW – OR Summary of Project Activities

Project: HRTW-OR Community Solutions
Coordinator: Maria Mendez
State: Oregon

Year four of HRTW projects. Ytd = February 1, 2001 to May 31, 2001
Cum. = October 1, 1997 to May 31, 2001

1. How many adolescents with special health care needs/disabilities have received training and/or support to promote self-determination and/or leadership skills? 39; 130

What types of training, support, or leadership skills were provided?

• ongoing participation in youth leadership group = 27 students
• 18 students working one on one with Project Liaisons
• 4 youth participating in the College Club.
• Youth leadership newsletter published every month by youth and staff.
• 14 youth participated in special event team building/leadership activities such as :
  1) the Teen Solutions float, which was built by youth members and presented in the Portland Starlight Parade
  2) Recording of the Teen Solutions Rap CD entitled “We’re Here to Tell Ya” created in collaboration with 95.5 radio station.

Note 1: As the project is preparing to end in October, no new youth have been enrolled in the project since mid-March. However, we are continuing to work with youth who are already members of Teen Solutions.
Note 2: Several youth participated in more than one activity (thus, number does not total 39).

What were the outcomes or effectiveness of this training?

• Youth identify, work towards and achieve goals around health, employment, independent living and college. Youth experienced increased feelings of empowerment. Youth demonstrate increased involvement in their schools and communities. Youth remain in school.

• An evaluation package is completed at intake, when a youth exiting the program and periodic intervals in between. The evaluation package includes an empowerment scale and items to assess changes in status (e.g. employment) and the degree to which youth have achieved their goals.

• Liaisons worked with 18 parents on an ongoing basis around supporting the transition and self-determination of youth.
• More time limited information and referral services were provided to 23 families.

• Increased connection of parents to services, programs and school. Parents are more aware of transition issues and how to address youth’s transition needs in a developmentally appropriate way. Youth and parents are able to work together more effectively to achieve the youth’s goals.

3.How many health care professionals, teachers, vocational rehabilitation counselors and other human service professionals have received training/support related to planning and providing effective services/supports to adolescents with special health care needs and their families. 174; 1210

In what manner has this training/support been delivered?

• 14 separate training/information meetings within Portland Public Schools =a total of 72 professionals participated. Training meetings were conducted primarily with staff from Indian Education, ESL and Migrant Education around transition and the needs of minority students with disabilities.
• Approximately 60 professionals have received support from liaisons around supporting Teen Solution youth and families.
• An all-day district-wide workshop was conducted with staff from Portland Public Schools around diversity, disability and transition issues: 24 professionals attended.
• 4 sessions were conducted as the 17th Annual Pacific Rim Conference on Disabilities in Hawaii (total of 18 professionals)
• Has there been follow-up?
  Information from the training meetings and the intensive workshop with PPS has been helpful in generating recommendations for the school district’s strategic plan. Following the workshop, a smaller PPS workgroup has been established by project staff to further the goals and activities identified by workshop participants. In addition, the Liaisons provide follow-up technical assistance to PPS staff around their work with individual students.

• Increased awareness of transition issues facing minority youth. Increased connection between disability, cultural and health related programs within PPS (e.g. increased communication between ESL, Special Education and Nursing).

• We have established a partnership with the Oregon Youth Employment Institute. The Institute identifies and pays for employment opportunities that are consistent with youth interests, and provides year round job training and tutoring. In return, Liaisons provide technical assistance to the Institute and employers around working with youth who are culturally diverse and have disabilities. An emphasis on identifying employment opportunities that are aligned with youth interests has resulted in high levels of youth satisfaction.

• Youth receive ongoing training through the Oregon Youth Employment Institute, School to Work programs and through individualized support from Project Liaisons. In addition to employment, the Community Solutions Project emphasizes college as a strong option for youth. For example, several of the youth are participating in the Project’s College Club. Students in this Club meet with a Lend student once a week to research and visit colleges, fill-out applications and identify scholarships.

• Almost all of the youth directly served by the project have had a medical home when they entered the program.

• 9 youth have transitioned from pediatric to adult health care. Project liaisons are working with all youth around helping them get ready for this transition (e.g. managing their medication, learning about their health condition, making doctor appointments, etc.)

• Because Oregon has the Oregon Health Plan, there have been only a few instances in which a youth participating in the project have not had health insurance. In these cases, Liaisons have assisted youth in filling out paper necessary for the OHP and in identifying a provider. Documentation of citizenship can be a barrier in obtaining health insurance for youth who have immigrated to this country.

9.Have there been any changes in policies at the state or local levels that have occurred as a result of project activities? If yes, please describe briefly.

• In collaboration with Portland Public Schools, a district wide, all day training around diversity and disability was implemented on April 6th. In addition to providing valuable information, the training resulted in a smaller PPS work group being established to further advance the goals and objectives identified by training participants. Another outcome of the training was a strong mandate that diversity and disability be incorporated into the Superintendent’s Strategic Plan for PPS.

10. What has been accomplished (established, done) to increase the extent to which service systems are comprehensive, coordinated, family-centered, community-based, and culturally competent?

• The Community Solutions Project has focused on multiple levels in bringing about systems change (e.g. youth and families, technical assistance for individual or small groups of direct service providers, district wide training). An emphasis has been placed on building ownership for the project within PPS so implementation will continue beyond the life of the project.

• The Youth leadership group and the work of the Liaisons;
• Our collaboration with Oregon’s Title V program
.

12. Are there any other significant project activities or outcomes that have not been addressed?

• Teen Solutions has been very effective in helping youth stay in or return to school.
• In addition to employment, the project has focused on helping youth apply and be successful at college.
• Teen Solutions has received considerable local media coverage in the past few months. This includes two television news spots on the youth group (03/2001: KPDX Channel 49 & 06/2001 Channel 12); a Radio Interview with a Teen Solutions youth member (05/2001 KWJJ radio 99.5); a news article about the group in the Oregonian Newspaper (04/2001); an article in the Oregon Health Magazine (Spring, 2001); an article in the Portland Parent Magazine (May, 2001) and participation of the Teen Solutions youth group in the Starlight Parade.