When Helping a Young Person Means Changing the System Around Them
By Dr. Bob Carey
There is a point in many conversations about a young person's mental health when someone says, quite reasonably, that the child needs help. Perhaps a teenager has stopped attending school regularly, seems increasingly withdrawn, or no longer enjoys the things that once mattered to them. Parents become concerned, teachers notice changes, and a referral is made. We tend to think of that referral as the beginning of a solution. Yet for some families, it is the beginning of another difficult journey, involving waiting lists, unfamiliar services, unanswered questions and a young person who is not convinced that talking to another adult will make any difference.
This is one of the reasons I was interested in Julio Sabater's recent article, A Multilevel Model for Expanding Youth Mental Health Access in Clinical Practice, published in the Journal of Health Service Psychology. Sabater asks us to think more carefully about what access to care actually means. A service can exist, and a referral can be appropriate, without a young person ever becoming meaningfully connected to that service. His model examines how assessment, relationships, family involvement and coordination across systems can work together to make help more accessible and sustainable.
For me, this has a clear connection with the Positive Systems Approach. Behaviour does not occur in isolation, and neither does the process of seeking help. A young person's willingness to participate in treatment is influenced by their experiences, their relationships, the expectations placed upon them and the way services respond. Sabater is not describing PSA, and the two approaches should not be treated as interchangeable. However, his model offers a useful example of why understanding the individual and understanding the surrounding system belong in the same conversation.
The article begins with a clinical vignette involving a 14-year-old Latino adolescent whose teachers have noticed withdrawal, declining academic performance and frequent absences. He appears tired and disengaged, and he tells a school counsellor about persistent sadness, low motivation and difficulty concentrating. At the same time, he minimizes his distress and questions whether counselling will help. He feels misunderstood by adults and more comfortable speaking with peers or people closer to his age, but has no consistent support network at school or in the community.
His mother, who primarily speaks Spanish, works multiple jobs and cares for him and his two younger siblings. She wants to support her son but finds school and healthcare systems difficult to navigate. Language barriers and time constraints make participation challenging, while stigma and uncertainty about mental-health services contribute to her hesitation. Previous efforts to obtain care have encountered long waiting lists, insurance complications and a shortage of culturally and linguistically appropriate providers. School staff are concerned and willing to help, but their capacity to provide ongoing intervention is limited.
It would be easy to describe this as a teenager who is reluctant to accept help, or a family that has not followed through. Reading the fuller account, however, changes that interpretation. The mother's concern is evident, and the adolescent's hesitation occurs within a history of disconnection and unsuccessful access. Before concluding that either needs to become more motivated, we need to consider how much effort the system requires from people who are already struggling, and whether the help being offered feels understandable, trustworthy and relevant to their lives.
Sabater organizes his model around six interconnected levels: Individual, Family/Caregiver, School/Educational, Community, Clinical System, and Workforce/Systemic. At the individual level, access is affected by recognition of symptoms, emotional readiness, trust and stigma. At the family level, cultural beliefs, language, transportation and stress become important. Schools contribute through identification, referral pathways and available supports, while communities contribute through relationships, outreach and local trust. Clinical services influence availability and continuity, and workforce capacity determines whether appropriate providers and supervision are available. What happens at one level can change what becomes possible at another.
The practical implications begin with the first conversation. Sabater recommends developmentally appropriate, nonjudgmental engagement alongside assessment, allowing the adolescent to express concerns in a way that feels safe. Screening may address depression, anxiety, suicidality, trauma-related symptoms and school functioning, while assessment also explores family circumstances, previous experiences of care and the young person's perceptions of support. Building rapport should accompany this work. An adolescent who does not trust the process may reveal very little, even when the clinician is asking all the technically appropriate questions.
This connects closely with the PSA Individual Factor of Identification. We need to identify what is happening, what may be contributing, and what strengths and supports are already present. A change in attendance, for example, is an observation that requires explanation, rather than an explanation in itself. Relationship/Rapport is equally relevant because trust influences what a young person is prepared to share and whether they return. Communication extends that process by helping the adolescent express needs and helping the family understand what assessment and treatment involve, in language they can comfortably use.
Sabater's emphasis on culturally responsive care goes further than translating information. Clinicians are encouraged to explore caregiver beliefs, hopes, concerns and previous experiences, and to adapt communication and engagement to the family's circumstances. Bilingual providers or trained interpreters can support meaningful participation; relying on the adolescent to interpret for a caregiver can create ethical and relational difficulties. A parent who understands the words may still be uncertain about confidentiality, worried about labelling, or unable to attend during working hours. Those concerns deserve a conversation rather than an assumption about the parent's commitment.
Another important feature is the structured involvement of trained, supervised non-clinical support personnel. Depending on the service, these may include students, trainees, engagement specialists or community support staff. Sabater proposes that relatable, sometimes near-peer relationships can help adolescents become more comfortable with care, while support personnel assist with outreach, appointments, psychoeducation and connections across settings. They may also reinforce coping and emotional-regulation strategies introduced or overseen by clinicians. Assessment, diagnosis, risk management and treatment planning remain the responsibility of licensed clinicians, with clear boundaries, supervision and escalation procedures protecting the young person.
From a PSA perspective, this gives practical expression to the Individual factors I have labelled as: “Coping” and “Reinforcement:. A strategy introduced in a clinical appointment becomes more useful when the young person has supported opportunities to practise it in daily life. Reinforcement involves attending to what makes a helpful response more likely to happen again, including encouragement and experiences of success. My extension of this idea would be to notice a teenager's small efforts to reconnect, ask for assistance or attempt a difficult task, rather than allowing every conversation to revolve around what they have failed to do.
The remaining Individual Factors, Re-Direction and Stimulation, also offer useful questions, although these are my PSA connections rather than Sabater's terminology. Re-Direction can involve calmly helping a young person move from an unhelpful response toward an achievable alternative, such as finding a manageable first step when a conversation becomes overwhelming. Stimulation asks us to consider both excessive demands and insufficient meaningful engagement. A teenager may need relief from noise and social pressure, while also needing opportunities for activity, interest and belonging. These questions broaden support without assuming that environmental changes alone will resolve depression or other mental-health difficulties.
The seven System Factors help us examine whether those individual supports can actually work. Flexibility is evident when a service adjusts communication, appointment arrangements or the setting in which engagement begins. For the mother in Sabater's vignette, an accessible conversation in Spanish at a workable time may make participation more possible. Perseverance/Tolerance reminds us that engagement can develop gradually, particularly after disappointing experiences. A missed appointment or hesitant response should prompt us to investigate the barrier and reconsider the approach, while continuing to attend to the young person's needs and safety.
The System Factors in PSA of Consistency and Portability become especially important when several settings are involved. Sabater recommends communication across home, school, community and clinical services within appropriate consent and confidentiality arrangements. In PSA, Consistency means that important supports are sufficiently predictable and coordinated. Portability asks whether the young person can use the communication or coping skills they have learned beyond the setting where they were taught. A strategy practised in counselling may need an agreed cue, an opportunity to use it at school, and a response from adults that makes asking for help worthwhile.
The PSA System factor of Intensity concerns whether the support is sufficient for the person's current needs. Some adolescents require more active assistance with engagement and follow-through than a referral and an appointment reminder can provide. Sabater's supervised support roles offer one possible way to extend that assistance while retaining clinical responsibility. The PSA System factor of Change asks us to review and adapt the plan as circumstances evolve. If attendance improves but isolation remains, or a family's work arrangements change, the response needs to change too. Support should remain responsive to what is happening rather than continue unchanged because it was appropriate at the beginning.
The PSA System factor of Team Health brings us back to the people expected to sustain the intervention. The mother in the vignette is already carrying considerable responsibility, and the school staff are trying to help within limited capacity. From a PSA perspective, we need to ask whether the adults have the resources, clarity and emotional support required to work together. Coordination can reduce some of the burden, especially when responsibility for follow-through is clear. Giving a family another list of tasks may achieve little if no one has considered how those tasks will fit into the family's day.
Sabater also recommends accessible programming and interdisciplinary training that bring psychological and educational expertise together. This includes appropriate accommodations for different learning and communication needs, alongside culturally responsive preparation for support personnel. His broader argument is that service delivery and workforce development can be considered together: supervised learning opportunities may help extend current support while preparing people for future roles. The article presents a proposed clinical model illustrated through a vignette, however, rather than a controlled evaluation demonstrating its effectiveness. Its suggested benefits are possibilities to develop and evaluate, not established outcomes for the adolescent described.
For parents, the value of this discussion lies partly in the questions it opens up. When a young person seems reluctant to receive help, what do they understand about the service, and what are they worried might happen? When a family cannot follow through, which practical barriers have been explored? When a child learns a useful skill in treatment, who will help make that skill generalizable and usable at home or school? Asking these questions allows us to be more precise about what needs to change, rather than interpreting every difficulty as a failure of effort.
This is also the perspective I bring to my latest book (Oct. 2026) which is currently being published through Amazon: “What if it's Not Just the Behaviour? A Parent's Companion”. Understanding the child remains essential, but that understanding becomes much more useful when we examine the conditions in which the child is expected to cope, communicate and participate. Sabater's article extends that conversation to the way mental-health care itself is organized. A young person may need effective treatment, a trusted relationship and practical assistance reaching that treatment. The adults may need support working together. When we take those needs seriously, we begin creating a system in which accepting help becomes more possible.
Reference
Sabater, J. (2026). A multilevel model for expanding youth mental health access in clinical practice. Journal of Health Service Psychology, 52(2), 57–64. https://doi.org/10.1007/s42843-026-00155-9
“What if it's Not Just the Behaviour? A Parent's Companion” – currently available in Kindle on Amazon; paperback version coming soon:
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