Table 2.

Rights-based framework applied to the three pillars of structurally safe transitions of care

	Mental health care	Multisectoral integration	Transition readiness with an intersectional lens	Rights-based methods (examples from cases)
Participation	Patients, families, and communities defining what “optimal mental health care” looks like	Community- and patient-driven responses to care (including traditional, religious, and spiritual healers) with regard to how they are integrated within care teams	Dynamic praxis cycle gathering information from youth with a variety of non- dominant identities and their experience with transition	Case 1: Asking Rose to describe what would make her feel most supported in terms of her mental well-being and her physical health Case 2: Including the participation of traditional healers in the transition process
Accountability	Metrics for health systems evaluating the provision of community-driven mental health care	Metrics and enforcement of intersectoral collaboration (e.g., % of clinical providers collaborating with non- Western healers, school- systems, employers, etc.)	Metrics to ensure that different identities are supported and captured (e.g., multiple ways of communication for neurodiverse individuals, social and financial support)	Documentation in patients’ medical records explicitly stating structural vulnerabilities and how they are being addressed, and asking future providers to address each in the same way they would address “clinical” issues
Nondiscrimination and equality	Supporting and promoting “last- mile” mental health care for the most vulnerable	“Opt-out” age- appropriate mental and physical health screening (across disciplines) to ensure holistic care	Promotion of active identification of non- dominant identities with tiered support across sectors	In both cases, specifically naming multiply marginalized identities and how they interact with the health system; for example, “Rose self-identifies as Haitian-American, Black and female, and it is important to view her perceptions of health and wellbeing from these perspectives”
Empowerment	Normalizing and validating mental health care for this population in a way that promotes self- advocacy and self- and community- efficacy	Adolescents and young adults feel empowered to ask for and engage in multidisciplinary care peri- and post- transition	Transition-age youth with non-dominant identities whose identities are not being met by the health system are empowered to mention this to providers	In case 2, asking caregivers to design or articulate the transition process in a way that feels most approachable for them and their family; documentation of that method and use of accountability structures to promote a patient- and family- centered response
Legality	Enforceable, measurable laws and policies that support equal access to affordable, quality mental health care	Cross-sectoral policies promoting and allowing for communication and collaboration	Political accountability for accessibility (e.g., allowing for multiple modes of engagement, physical accessibility for hospitals, etc.)	In both cases, advocating for policies that do not allow abrupt insurance or financial transitions at vulnerable developmental periods (adolescence and early adulthood)