Program Goals

The goals of the Transition to Independence Process (TIP) Model are:

• Increasing engagement and progress in high school, postsecondary education, and/or technical/vocational training
• Increasing exploration, placement, and progress in employment and careers
• Improving stability in living situation in safe, home-like settings
• Learning relevant life skills for functioning in home, school, work, and community settings, including problem solving & decision making
• Improving emotional coping and self-management skills
• Decreasing interference from mental health and/or substance use problems with their functioning in their school, work, community, and/or relationships
• Improving interpersonal skills and expanding relevant social supports
• Decreasing crisis placements, restrictive residential facilities, homelessness, and involvement with the criminal system and incarceration
• Increasing competence and confidence in continuing to advance their life and future

Logic Model

View the Logic Model for Transition to Independence Process (TIP) Model.

Essential Components

Note: The Logic Model above can be tailored to the implementing community and program – adjusting it to reflect community needs, resources, target population, and program focus.

The essential components of Transition to Independence Process (TIP) Model include:

• Essential Personnel in the TIP Model
• The TIP Model is implemented directly by Transition Facilitators (TFs) who work with the young people and, as relevant, with their families and other informal and formal support people.
• Sites are encouraged to hire young adults as Peer Support Specialists (a.k.a. Peer Provider or Peer Associate) to assist young people as they engage them, explore their perspectives, and assist them in setting and accomplishing their goals.
• Some Transition Teams also have Supported Employment/Education (Emp/Edu) Specialists, First Episode Psychosis Specialists, and therapists.
• The TFs and other personnel are competency-based trained to use the following TIP Model Guidelines (principles) to guide their moment-to-moment, day-to-day, and week-to-week work with the young people and their key support players in their lives.
• These principles underscore the essence of the TIP Model — that the process is driven by the young person with the TF guiding and teaching them in setting and achieving their own goals.
• TIP Model Guidelines
• Engage young people through relationship development, person-centered planning, and a focus on their futures.
• Tailor services and supports to be accessible, coordinated, appealing, nonstigmatizing, culturally competent, trauma-informed, and developmentally appropriate — and building on strengths to enable the young people to pursue their goals across relevant TIP Transition Domains.
• Acknowledge and develop personal choice and social responsibility with young people.
• Ensure a safety-net of support by involving a young person's parents, family members, and other informal and formal key players (as relevant to the young person).
• Enhance young persons' competencies to assist them in achieving greater self-sufficiency and confidence.
• Maintain an outcome focus in the TIP Model at the young person, program, and community levels.
• Involve young people, parents, and other community partners in the TIP system at the practice, program, and community levels.
• The TFs and Peer Associates are also trained to competency in the application of TIP Model Core Practices to further advance the young people.
• Strength Discovery and Needs Assessment
• Futures Planning
• Rationales
• In-vivo Teaching
• SODAS: Problem Solving & Decision Making Method
• WHAT'S UP?: Prevention Planning for High-Risk Behaviors & Risky Situations
• SCORA: Mediation with Young People and Other Key Players
• Special Module: Trauma-Informed TIP
• Transition Domains: To maximize engagement and minimize stigma, the youth and young adults are approached using the Transition Domains and Subdomains listed below. These domains encompass areas that the young people can relate to versus being approached about another therapy or feeling like another treatment is being imposed on them.
• Employment & Career
• Educational Opportunities
• Living Situations
• Personal Effectiveness & Well-being (e.g., Friends & Family, Emotional & Behavioral Well-being, and Physical Health & Well-being)
• Community Life Functioning (e.g., Daily Living Skill, Leisure-Time Skills)
• Individually Tailored Services and Supports
• The TFs work with youth and/or young adults on an individualized basis to maximize engagement, teach them meaningful skills, and facilitate the achievement of their own individualized goals across relevant Transition Domains.
• As a young person is pursuing their own goals, the TF works with the young person in:
• Applying their strengths and resources to advance progress and build a natural support network (e.g., having an older sibling helping the youth with their homework), and
• Overcoming barriers and difficulties that emerge from the pursuit of a goal (e.g., teaching coping skills to manage their anxiety in the workplace; learning social skills to build and maintain friendships and other relevant social supports; conducting mediation between a young person and their mother or significant other; teaching problem solving & decision making).
• The TF and young person involve family members, other natural supports, and professionals as relevant to the young person's current goal or issue.
• Service Platform Options for the TIP Model
• The TIP Model is typically provided using a "case management" platform with each TF having no more than 15 youth and/or young adults at a time.
• The TIP Model is also used as the "practice model" for some Assertive Community Treatment (ACT) Teams. The ACT platform has different TFs serving different young adults across the days and weeks depending on the needs of each young adult. The ACT platform has some advantages (e.g., young adult learning to interact with different people), however, the stable relationship of having one TF may be important for engaging and advancing some young people. Thus, most ACT Teams arrange for a "primary" TF for every young person.
• Group Activities and Functions: Group activities can be used for socializing or for particular activities.
• These might be initiated by the Peers, or the TFs, but are always based on the interest of some of the young people. Some examples include:
• Monthly dinner meetings to encourage and celebrate employment, educational, and career accomplishments
• Special group sessions by therapists for young ladies wanting to explore relationship issues between women/men and women/women, coping with possible past trauma issues, and formation of healthy relationships
• Group meetings on exploring "supportive connections" involving advancing social competence and confidence in building and understanding healthy reciprocal relationships
• Independence and Interdependence: As the title of the TIP Model suggests, it is designed to assist youth and young adults achieve greater self-sufficiency and independence. However, the concept of interdependence is central to working effectively with young people. This concept nests the focus of independent functioning (e.g., maintaining a job, managing money, eating well, and keeping fit) within the framework of young people learning that there is a healthy, reciprocal role of supporting others and receiving support from others (e.g., social support network for emotional, spiritual, and physical well-being).

Program Delivery

Child/Adolescent Services

Transition to Independence Process (TIP) Model directly provides services to children/adolescents and addresses the following:

• Youth and young adults who are transitioning to adulthood with, or at risk of, emotional/behavioral difficulties (EBD) [e.g., severe mental health conditions and related challenges]

Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: A parent/caregiver is involved in the process as relevant to the progress of the individual youth or young adult. In most states, for a youth under 18, a parent or other legal guardian has legal authority. Therefore, the Transition Facilitator does, at times, have to mediate between differing youth and parent/guardian perspectives in order to achieve youth engagement and progress. The TF and young person involve family members, other natural supports, and professionals in individualized planning and services as relevant to the young person's current goals or issues.

Recommended Intensity:

The program is highly individualized for each young person. The Transition Facilitator (TF) adjusts the coaching and supports to match the needs of the young person as they progress or have setbacks along the way. Therefore, the TF must individually tailor the frequency, intensity, and types of supports and services to each young person and their current circumstances. The types of contacts between a TF and a young person involve meeting in-person in a community setting or at a young person's home or apartment, frequent texting, and phone calls. The frequency of contacts varies across Phases of Coaching, with very frequent and intensive service being required during the Active Intensive Coaching Phase and less frequent in-person contact during the Maintenance Coaching Phase and Follow-Along Phase. For example, under the Active Intensive Coaching Phase, a TF may be with a young person 3 times a week on average for a total of 3-6 hours (plus texting and telephone contacts); whereas under the Maintenance Coaching Phase the TF may have 2-4 face-to-face contacts and 4-12 other types of contacts (texting, telephone) with the young person per month. The types of interactions can be tailored in the event of health and safety concerns (e.g., the COVID pandemic). Walking outside in a park, meeting over coffee with both the TF and young person wearing masks, or Zoom calls used in place of meeting over lunch or some other in-person meeting.

Recommended Duration:

The duration of the program services and supports for a young person averages about 18 months, but may vary greatly for a given individual, based on their needs and goals.

Delivery Settings

This program is typically conducted in a(n):

• Adoptive Home
• Birth Family Home
• Community Daily Living Setting
• Foster / Kinship Care
• Outpatient Clinic
• Community-based Agency / Organization / Provider
• Group or Residential Care
• Justice Setting (Juvenile Detention, Jail, Prison, Courtroom, etc.)
• Other
• School Setting (Including: Day Care, Day Treatment Programs, etc.)
• Virtual (Online, Telephone, Video, Zoom, etc.)

Homework

Transition to Independence Process (TIP) Model includes a homework component:

The Transition Facilitators actively work with youth and young adults on their Futures Planning and related skill development to assist them in achievement of their short-term and long-term goals. Of course, the only way any of this is going to assist the young people is if they are taking the action steps to advance their goals and applying these new skills in their everyday life and settings. Thus, most of the TF meetings with young people have a homework component that the TFs follow up with through texts, calls, and/or at the next meeting.

Resources Needed to Run Program

The typical resources for implementing the program are:

• TF's automobile for ease of meeting with youth and other supports, and for transporting young people when necessary.
• Laptops or iPads for TFs (preferable with internet connection, Zoom or Facetime capability, and signature pads for youth and parents to sign transition plans, etc.)
• Cell phones with texting and calling capabilities for the staff and the young people
• Meeting space available for small meetings and access to larger room space for periodic meetings
• Optional funds available to help the young people with unexpected expenses (e.g., occasional meals, special events, security deposits/first and last month rent)

Manuals and Training

Prerequisite/Minimum Provider Qualifications

• The TIP Model Consultants provide guidelines and sample position descriptions that site leadership can use as they are planning for positioning and hiring of personnel for their Transition Teams.
• An example of the types of qualifications for each of three positions is provided here.
• Transition Facilitator: Typically have the following combination of minimum education and work experience: a) a bachelor's degree in the social science or educational fields and at least four years of experience working with children, adolescents, young adults, their families, and/or adults as a resource coordinator, case manager, applied behavior analyst, counselor, therapist, guidance counselor, social worker, or other similar position; or b) a master's degree in the social science or educational fields and at least one year of work experience. Preference for these positions will be given to candidates who also have a social services license and/or have experience in: 1) working with adolescents and young adults with emotional and/or behavioral difficulties; 2) preparing these individuals for living independently, obtaining employment, or functioning in the community more effectively; and/or 3) conducting home-based, school-based, or field-based service delivery. Candidates can be hired based on extensive relevant experience (e.g., high school degree and 8 years of experience in working with youth and young adults with EBD).
• Peer Support Specialist (a.k.a. Peer Provider or Peer Associate): Should be an individual who has had direct experience with mental health services (and/or foster care or multi-system involvement) and will utilize those experiences to collaborate with, coach, and challenge the young person to view their situation as an opportunity for growth and change within each individual's recovery and discovery. The Peer Support Specialists must have a level of recovery and maturity that will enable them to collaboratively aid the TFs in working with the youth/young adults in their move toward self-advocacy in the attainment of their own, culturally specific life goals.
• Transition Program Supervisor: Must have at minimum the following education and work experience: a) a Master's degree in social science or educational fields; and b) four years of experience working with children, adolescents, young adults, their families, and/or adults as a resource coordinator, case manager, applied behavior analyst, counselor, therapist, guidance counselor, social worker, or other similar position. Preference will be given to qualifying candidates who have experience working with adolescents and young adults with emotional/behavioral difficulties and supervising field-based service personnel, hold an active social services license; and/or have demonstrated professionalism (e.g., interact respectfully toward all clientele, staff members, community stakeholders, and other supervisory personnel; ability to accept corrective feedback)

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual Information:

• Clark, H. B., & Huntsman, C. (2017). TIP Model manual - Part one & Part two. Stars Behavioral Health Group.

Ask Training Contact below for more information.

Training Information

There is training available for this program.

Training Contact:

• Joseph Solomita, LCSW, Managing Director
  SBHG Stars Training Academy
  www.TIPstars.org
  jsolomita@starsinc.com
  phone: (310) 221-6336 x109 or (714) 336-8363

Training Type/Location:

TIP Model Consultants provide competency-based training and technical assistance to personnel (e.g., TFs, Peer Support Specialists, Emp./Edu. Specialists, Therapists) who provide direct services and their supervisors and program managers. The TIP Model training and implementation services are provided on-site and virtually, with periodic, interactive teleconference consultation services. A proportion of these services can now be provided through a sophisticated Zoom platform. The focus of the training and technical assistance services is to ensure a site is advancing with TIP Model implementation and sustainability through the following activities:

• TIP Model Cross-Site Forums provide intensive training and practice of the TIP Model principles and core practices.
• Supervisors are mentored in Supervisory Coaching Methods so they can support and guide their personnel in the application of the required personnel competencies.
• Build site capacity for sustainability by guiding the leadership in:
• Building a TIP Model Community of Practice and establishing relevant community partnerships (e.g., community college, housing, community career center)
• Mentoring supervisors in field-based coaching and group supervision (e.g., TIP Solutions Review process)
• Mentoring and certifying Site-Based Trainers
• Possibly conducting TIP Model Fidelity Quality Improvement (QI) Assessments and establishing and certifying Regional Fidelity QI Assessors

Number of days/hours:

The TIP Model training and implementation services are provided on-site usually with three site visits per year over a 2-year period [typically 3-days for each site visit], with periodic, interactive teleconference consultation services. However, the training/implementation plans are tailored to match the needs of the agency/collaborative for TIP Model sustainability. Consultants are also able to use a sophisticated Zoom platform to assist Transition Team Supervisors and TFs in as proficient a way possible to advance their TIP Model implementation and sustainability.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Transition to Independence Process (TIP) Model as listed below:

Agency and collaborative leadership who are considering implementing the TIP Model need to address, up front, many critical factors that will have a significant impact on the eventual success or failure of implementing the TIP Model. To help assess an agency's and/or the collaborative's readiness to implement the program, TIP Model Consultants utilize various planning and readiness tools. One tool is the Hexagon Tool for Assessing Readiness/Progress (adapted from the National Implementation Research Network [NIRN]). The Hexagon Tool assists providers, agency managers, and other relevant stakeholders in assessing an agency's or collaborative's capacity, need, resources, and "fit" in relation to the TIP Model and provides a framework for discussions and planning for implementation considerations.

Other tools include:

• Site Readiness for TIP Model Implementation
• TIP Implementation Site-Assessment Organizational Action Planning
• TIP Model Implementation Planning for Next Steps

Formal Support for Implementation

There is formal support available for implementation of Transition to Independence Process (TIP) Model as listed below:

The TIP Model Consultants collaborate with an agency or a community coalition of agencies to maximize implementation and sustainability.

• The Consultants provide competency-based training through TIP Model Cross-Site Forums and technical assistance to agencies in communities, counties, and regions. The Transition Facilitators (TFs), other frontline team personnel, and the supervisors at transition sites are taught and coached in the application of the TIP Model Guidelines and Core Practices (e.g., In-vivo Teaching, SODAS Problem Solving, Prevention Planning on High Risk Behaviors & Situations).
• The TIP Model Consultants and Assessors also assist sites with sustainability through technical assistance and mentoring on processes and building site capacity on topics such as:
• Establishing peer support and peer leadership
• Conducting TIP Solutions Review sessions for ongoing competency enhancement of all transition personnel
• Mentoring supervisory personnel in coaching methods for working more effectively with their transition team
• Providing technical assistance on tracking of progress and outcome indicators for youth and young adults (e.g., TAPIS Progress Tracker & Goal Achiever)
• Establishing TIP Model Site-Based Trainers through mentoring and certification
• Conducting TIP Model Fidelity Quality Improvement Assessments and building site capacity through mentoring and certifying Regional Fidelity QI Assessors
• Accreditation of sites based on meeting TIP Model fidelity standards

The following chapter describes the implementation process, using a region in Canada as a site example.

• Clark, H. B, Jaouich, A., & Baker, K. (2015). The Transition to Independence Process: Implementation of the TIP Model for improving the outcomes of youth and young adults with emotional/behavioral difficulties. In B. G. Cook, M. Tankersley, & T. J. Landrum (Eds.), Transition of youth and young adults: Advances in learning and behavioural disabilities (Vol. 28, pp. 135–171). Emerald Group Publishing Limited.

Fidelity Measures

There are fidelity measures for Transition to Independence Process (TIP) Model as listed below:

The TIP Model Fidelity QI Assessment is used for: a) providing ongoing quality improvement to a Transition Team; b) tracking TIP Model implementation and sustainability; and c) providing the basis for being accredited as a TIP Model Site. A complete Fidelity QI Assessment typically takes 2 days with a Transition Team and is composed of the following four Tools.

• Fidelity QI TF Interviews on TIP Model Practice Implementation — The purpose of the TF Interviews is to understand the extent to which the TFs are:
• Knowledgeable of the young people they are serving
• Applying the principles and practices of the TIP Model with integrity
• Documenting their practice activities in ways that illustrate its relevance to working effectively with the young people and making it likely that the service episodes are billable
• Fidelity QI Young Person Focus Group -- The Focus Group typically involves four to six youth and young adults. The purpose of this Focus Group with young people is to assess the extent to which:
• The TIP Model Guidelines and Core Practices are reaching the young people being served in this Transition Program
• The young people find the transition system to be helpful, relevant, and impactful in their lives and futures
• Fidelity QI Survey/Interview on TIP Model Organizational Implementation — The Organizational Survey/Interview examines the extent to which TIP Model organizational features are present in the transition system and the organizational and community structure around it. This Tool provides implementation ratings across categories such as accessibility of services, continuity of services and supports, staff management/supervision, tracking of the progress of the young people, organizational commitment, and sustainability.
• Fidelity QI TIP Solutions Review (TSR) Online Survey -- The TIP Solutions Review (TSR) process is to provide a Transition Team an opportunity to collaboratively problem-solve ways to improve its Team's effectiveness in working with young people, their natural supports, and other formal key players. The TIP Model fidelity requires that the entire Transition Team review at least two young people in-depth each month using the YP Descriptive Outline form. Fidelity to this process is assessed by the TSR Survey, which is an online SurveyMonkey to assess the extent to which the Transition Team is: a) applying the TSR process; and b) the Team Members are benefiting from it for improving their work with their young people.

TIP Model Assessors also work with sites to assist the leadership so that they are utilizing other relevant qualitative and quantitative data as part of their continuing quality improvement effort. For example:

• Service/support utilization data that illustrate the application of supports and services to facilitate a young person's progress across relevant Transition Domains.
• Survey on the "helpfulness of supports & services" from the perspective of young people. (Satisfaction surveys can also be conducted from parents' perspectives or the perspectives of other supportive key players in the lives of the young people).
• Progress on the young person's own goals (e.g., TIP Model Futures Planning; aka TAPIS Goal Achiever in an electronic version).
• Tracking of progress and outcomes across the Transition Domains (e.g., TAPIS Progress Tracker).

Some sites are interested in establishing capacity for ongoing TIP Model quality improvement. A process has been developed by which a Certified TIP Model Fidelity QI Assessor can conduct a Fidelity QI Assessment on a Transition Team and concurrently mentor up to two Assessor Candidates from the region to learn this assessment process. It typically requires two or three pairing with a Candidate for them to be signed off where they can then apply to the TIP Model Board for certification.

Established Psychometrics:

Dresser, K., Clark, H. B., & Deschênes, N. (2015). 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), 223-237. https://doi.org/10.1007/s11414-014-9438-3

Implementation Guides or Manuals

There are implementation guides or manuals for Transition to Independence Process (TIP) Model as listed below:

The faculty and Consultants of the Stars Training Academy and NNYT have created numerous implementation materials and guides. Listed below are a few of the implementation guides that Consultants use with sites as relevant to their needs and progression with implementation and sustainability:

• Supervisory Methods for Personnel Coaching
• Supervisory Field-Based Coaching Form
• TIP Tool Kits
• TIP Solutions Review Monitoring and Mentoring Checklist
• TIP Model Implementation Planning for Next Steps

Implementation Cost

There have been studies of the costs of implementing Transition to Independence Process (TIP) Model which are listed below:

Clark, H. B., Pschorr, O., Wells, P., Curtis, M., & Tighe, T. (2004). Transition into community roles for young people with emotional behavioral difficulties: Collaborative systems and program outcomes. In D. Cheney (Ed.), Transition of secondary approaches for positive outcomes (pp. 201–226). The Council for Children with Behavioral Disorders.

Research on How to Implement the Program

Research has been conducted on how to implement Transition to Independence Process (TIP) Model as listed below:

• Dresser, K., Clark, H. B., & Deschênes, N. (2015). 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), 223–237. https://doi.org/10.1007/s11414-014-9438-3
• Klodnick, V. V., Clark, H. B. "R.," Johnson, R. P., & Fagan, M. A. (2018). Developing quality assurance practices and measures for implementing and sustaining the Transition to Independence Process (TIP) Model. Psychiatric Rehabilitation Journal, 42(1), 71–78. https://doi.org/10.1037/prj0000324

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Additional References