Beyond the Ivy Walls

By the time she graduated from Ivy Street School, Mary* had conquered social anxiety so severe she couldn’t leave her house. The school, in Brookline, Mass., helps teens and young adults like Mary who have autism, brain injuries, and behavioral health issues develop the skills they need to successfully transition to adult life. But at age 22, with no concrete steps for what to do next and a well-meaning family whose concern made it hard for her to pursue independence, Mary soon became depressed and her anxiety returned.

Ivy Street occupational therapist and transition coordinator Brooke Howard (’05) had seen this happen before. As students make gains at school, many struggle with their burgeoning autonomy at home. Howard asked herself, “How can we help the whole family move forward in a way that honors the goals and dreams” of the young person? In May 2016, she launched a solution: Skills for Life, a client-centered, community-based occupational therapy intervention, helps young adults aged 16 to 26 take the skills they learned at Ivy Street to the outside world.

Family dynamics can be a significant barrier to a smooth transition. Young people like Mary are “coming into adulthood in their family home,” says Howard. And because of their diagnosis, they often don’t go through the typical teenage rebellion. Instead, youth and parents continue “entrenched patterns,” even though change could benefit them all.

“After 20 years of making breakfast for their child, parents aren’t just going to stop,” says Howard, clinical director of Skills for Life. Families burn out trying to meet their children’s needs, while the young adults crave more independence.

“How can we help the whole family move forward in a way that honors the goals and dreams [of the young person]?”

—Brooke Howard (’05)

Skills for Life pairs clients with an occupational therapist for weekly two-hour sessions to help them develop functional daily living skills. The treatment is framed around a client’s goals, which can range from the everyday (clean the bathroom) to less commonplace pursuits (travel to Japan), and the therapist tailors all services to the client’s functional ability. Rather than simulating a client’s daily experience in a clinical setting, the therapist provides treatment in the family’s home or in the community, at the moment it’s needed. “We don’t sit and talk about your routine,” says Howard. “We do it.”

After graduating with a BS in neuroscience, Howard worked with kids recovering from brain injuries at the Franciscan Children’s hospital. Although impressed with their progress, Howard often wondered if the young patients would get the support they needed outside the hospital.

“We talk about having a clinical itch,” says Howard’s mentor, Ellen Cohn, a Sargent clinical professor of occupational therapy. “If you see something in practice that’s bothering you, you’re challenged to ask, ‘How can I provide more effective service?’”

Now at the end of its first year, Skills for Life has served 25 clients. Howard, who earned a master’s in occupational therapy, has begun to expand the program outside Ivy Street School, working to bring its services to supported group living communities in the Boston area. While she initially envisioned a short-term intervention, clients can continue with the program indefinitely. Several have already achieved their initial goals and set new ones. Mary, now 26, has once again overcome her social anxiety and is working with Skills for Life on finding a job. Her ultimate goal? “Learn to live on my own.”

*Name changed to protect client confidentiality

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