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The Story of a Standard: Youth Psychosocial Rehabilitation Standards

The Story of a Standard: Youth Psychosocial Rehabilitation Standards

 

The Story of a Standard is a new blog series following the development of new or updated COA standards. COA staff leading the development of specific standards sections will take the reader through their journey as they identify needs, conduct research, and collaborate with subject matter experts to determine best practices and establish standards that COA’s community must implement to achieve accreditation.  

First up: Isabelle Leventhal, COA Standards Associate, and lead on the development of new standards for Youth Psychosocial Rehabilitation services released last month. 


 

In early June when COA’s Youth Psychosocial Rehabilitation Standards (YPS) were released, I excitedly texted my friends and family a link to the standards. “They’re up! They’re published! Now you can finally see what I do!” And their general consensus was, “I still don’t understand.” 

Writing standards is a weird gig and an even weirder one to explain. My go-to line when asked the dreaded “so what do you do for a living” question is “I write rules and regulations that organizations have to meet to be accredited.” This is followed by a litany of questions: “Do you like it?” “Yes.” “Can you explain what it is you do exactly?” “Kind of?” But in whatever context in which the what-do-you-do-for-a-living question comes up, there’s no good way to clearly describe my role. My explanation inevitably comes out dry, and doesn’t amount to much more than “I type on a computer all day,” which doesn’t do the job justice. 

The most visceral way to explain standards development is, it’s about breathing life into a concept and then making it concrete and tangible. Which, to someone like me who finds policy exhilarating, is a little bit like magic. If magic were overly concerned with procedures. Now let’s walk-through the evolution of the YPS standards. 
 


Where does a standard come from?

Simply put-- a need. Usually, the need is simple and clear. A standard needs to be updated to reflect current best practices or perhaps the language isn’t quite as clear and organizations have reported confusion around it. Even an ill-defined “is” or inappropriately placed Oxford Comma can weaken the structure of an otherwise strong standard. But sometimes the need is bigger, the gap between what we have and what organizations need is too big to be bridged with a simple standards update. It is then, with great consideration, that we decide to create a new standards section.

Where do we begin?

Putting together a standard is like building a plane in midair, somehow managing to be both a top-down and bottom-up process. We start with a vague idea of what it is we are trying to accomplish, in this case designing Youth Psychosocial Rehabilitation Programs standards. What is that? What does that mean? How do we define it? Well, fortunately, we don’t have to define it. For that we look to organizations, regulations, and thought leaders to set up the parameters of these programs for us. This allows for us to begin with a vision of what it is we are trying to accomplish while simultaneously getting a feel for the skeleton of the beast.

As I am reviewing that preliminary information, I try to look for the commonalities between all the different organizations that I look to. What are some themes that I see trending? What defines these programs as unique from others? I also look for what seems to be specific to particular organizations versus what are we seeing across the board. It is the former that sets the framework, the latter sets the language. When looking into Youth Psychosocial programs, some important factors I found were a commitment to connecting youth to the community , allowing the youth to be in the least restrictive setting, and creating service plans that were communicative across service sectors at least, if not singular.

 

How do we flesh out these concepts? 

If we are going to continue with the skeleton metaphor, then we all know all a skeleton is bones without any of the meat (muscles, tendons, organs, etc.) to make it come alive. This is where working on a standard gets fun. How do we push forward standards that support best practices and set up our organizations for success? What is best practice? How do we define that without becoming overly prescriptive? Where is the meat?

This is where research comes in and the standards development process becomes less like a jigsaw puzzle and more like a painting. You have the skeleton. You have an idea of what it is you want to accomplish. Now you have to fill it in. Give it color and meaning. During the YPS development, I found myself asking questions like: How should we focus our standards? What should we emphasize in order to support our organizations in helping to give youth the best chance? What concepts do I see coming up again and again? What is the underlying mission that all of these successful programs seem to have in common? How does one set youth up for success?

Resilience became a theme I saw again and again as I delved into the literature. If you want to help a youth achieve their goals, create sustainable change in their lives, and really permeate all of the mitigating factors that contribute to a youth’s psychosocial development, then you need to create programs that facilitate resiliency in youth.

So how do you take the flesh and the bones and get them to move together?

Good question. And one that plagued me through months as I worked on these standards. Was I being clear with my intention? Promoting resiliency isn’t as simple as saying make sure the youth are resilient. You have to operationalize it, make it concrete. I began by unpacking resilience and defining it: “protective factors that may be especially important under conditions of risk” (Greenberg, 2006)

So what are these protective factors? Well, to begin with, some of these factors I had already identified; they’re the same factors that I pulled out from successful youth psychosocial programs I had turned to in the beginning (community, least restrictive setting, singular plans). However, protective factors work better the more of them that you have, so while three factors was a good way to start, I knew that it was not enough. I would have to inundate the standards so that they promoted as many protective factors as possible. I included giving the youth agency through voice and choice, supporting them in their decision-making, and above all ensuring that everything is done with a focus on the individual’s strengths, not their deficits. 

An example of how this is reflected in the standards is YPS 7: Social and Community Connection. Natural supports and developing an informal support network are considered to be an important factor in supporting youth, building resiliency, and successful treatment outcomes by providing the following protective factors: provides a large support network, connects the youth with individuals, helps engage them in prosocial recreational activities, and stabilizes them within a community. To name a few. 

No matter how I explain the intricacies of my day-to-day work one of the most gratifying aspects is connecting the standards back to the clients. During the development process it is crucial to circle back to the overall purpose of the standards which is to offer community-based services that facilitate childhood development and resiliency, using a holistic approach that improves family functioning and increases child well-being and safety.  

 
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