Purpose. Transition-age youth (TAY) who have experienced or are experiencing complex trauma, system involvement and homelessness are at increased risk for serious mental health needs and related challenges. However, these vulnerable and historically marginalized TAY typically have low rates of mental health service engagement. This study examines how and why TAY experiencing system involvement, homelessness, and serious mental health and substance use symptoms engage in mental health services, and what facilitates and/or hinders their engagement in services. Methods. Twenty-one TAY completed a virtual interview about their previous and current mental health service experiences, and why they did or did not engage with mental health services. A modified grounded theory qualitative analysis approach was used to understand how participants’ personal sense of meaning interacted with programmatic factors to construct participant experiences with mental health services. Results. Most participants (81%, n = 17) received mental health services, namely psychiatry (76%, n = 16) and counseling/therapy (48%, n = 10), and peer support (10%, n = 2). Participants described their mental health service experiences along three interpersonal and relational continuums between themselves and their providers: feeling (mis)understood, being treated with (dis)respect, and experiencing (dis)trust. Discussion. Study findings reveal that for these particularly vulnerable and marginalized TAY, relational and interpersonal factors significantly influenced their engagement in mental health services. Study findings call for providers to re-imagine their working alliance with highly vulnerable TAY through culturally-attuned practices that promote understanding, respect, and trust. Findings also call for TAY-serving programs and policies to re-imagine peer support as a mental health service option for this highly vulnerable population.

目的。经历过或正在经历复杂创伤、系统受累和无家可归的过渡年龄青年 (TAY) 面临严重心理健康需求和相关挑战的风险增加。然而，这些弱势和历史上被边缘化的 TAY 通常具有较低的心理健康服务参与率。本研究调查了 TAY 如何以及为何经历系统参与、无家可归、严重的心理健康和物质使用症状而参与心理健康服务，以及是什么促进和/或阻碍了他们参与服务。方法。21 名 TAY 完成了关于他们以前和现在的心理健康服务经历的虚拟访谈，以及他们参与或不参与心理健康服务的原因。使用修改后的扎根理论定性分析方法来了解参与者的个人意义感如何与计划因素相互作用，以构建参与者的心理健康服务体验。结果。大多数参与者（81%，n  = 17）接受了心理健康服务，即精神病学（76%，n  = 16）和咨询/治疗（48%，n  = 10），以及同伴支持（10%，n = 2). 参与者描述了他们在自己与提供者之间的三个人际关系和关系连续体中的心理健康服务体验：感觉（误解）理解、受到（不）尊重和体验（不）信任。讨论。研究结果表明，对于这些特别脆弱和边缘化的 TAY，关系和人际因素显着影响他们参与心理健康服务。研究结果呼吁提供者通过促进理解、尊重和信任的文化适应实践，重新构想他们与高度脆弱的 TAY 的工作联盟。调查结果还呼吁 TAY 服务计划和政策重新设想同伴支持作为这一高度脆弱人群的心理健康服务选择。