Barriers and solutions discussed at Youth Mental Health Collaborative

Three out of four children and adolescents in California with mental health needs do not receive treatment. Of those who do, up to 80% receive it in a school setting.

Mental health specialists and staff members from L.A. Unified and The Los Angeles Trust for Children’s Health met November 18, 2021, at the third virtual Youth Mental Health Collaborative. Their goal: Address the crisis in student mental health and remove barriers to youth mental healthcare for L.A. Unified students.

The Collaborative is part of a two-year investment by Ballmer Group to increase education and prevention efforts, and to identify and resolve obstacles to mental healthcare among L.A. Unified youth. Participants discussed challenges and solutions to the current crisis and heard subcommittee updates on funding, data, youth voice and the referral process. (See meeting agenda and PowerPoint.)

Tanya Mercado, organization facilitator for L.A. Unified School Mental Health, said, “There is a lot of funding for student mental health, but it’s complicated.” It will take several years to apply for and receive grants from the hundreds of millions of dollars allocated to address the youth mental health crisis. We must move from a “reactionary system to a proactive system,” she said.

Jaime Ducreux, LAUSD organization facilitator, said providers are currently “maxed out.” Other participants agreed there was a shortage of social workers, clinicians and psychologists. Marsha Ellis, director of programs for The L.A. Trust and co-chair of the meeting, emphasized, “We want to remove any barriers that may result in youth waiting for services.” With increased need comes the need for prioritizing those seeking services, several participants said.

The voice of youth

Robert Renteria and Noe Rivera, senior program managers with The L.A. Trust, discussed ways to enlist youth voice in the process. The L.A. Trust’s growing network of Student Advisory Boards (SABs) is one platform for youth to participate. The Community Ambassador Network (CAN) is another.

Funded by the California Mental Health Services Authority, CAN will activate 8 to 10 students at five six different L.A. Unified campuses, eventually expanding to 10 sites in 2022. The program started in May 2021 and will continue through June 2023. 

Student CAN ambassadors are being been trained in youth mental awareness, participating in two or three mental health awareness activities per school year, joining SAB engagement efforts and community needs assessments, and conducting outreach to peers, families and teachers in the school community.

“If you give students the data, they know how to communicate it to their peers,” said Renteria. He and other members of The L.A. Trust staff have been working with students and L.A. Unified staff on campaigns this fall, covering topics like Suicide Prevention Awareness, Healthy Relationships and Self-Care.

Referral and treatment

Aimee Phillips from L.A. Unified School Mental Health (SMH) discussed clinic services and the referral process. The district provides both individual and family therapy for children and students ages 2 and older who are uninsured or covered by Medi-Cal.

Evidence-based practices focus on family stress, dysfunction or poor communication; depression and anxiety; trauma; and disruptive behaviors. Students who are likely to meet any diagnosis listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) can avail themselves of SMH clinic services, except for certain diagnoses such as autism. A referral to L.A. Unified School Mental Health does not replace the need to follow district procedures regarding child abuse or potentially suicidal students, Phillips added.

Addressing student mental health issues is often a family matter. SMH is actively recruiting parents and caregivers in Parent Child Interactive Therapy (PCIT) to improve family relationships and address severe behavior problems.

Most affected

According to the report, “Every Young Heart and Mind: Schools as Centers of Wellness”, 1 in 6 high school students in California has considered suicide in the past year, and 1 in 3 report feeling chronically sad.

“Some students fare even worse,” the report says. “LGBTQ students experience victimization at school, persistent sadness and suicide ideation at more than twice the rate of their non-LGBTQ peers. Students of color disproportionately carry to school the burden of poverty, racism and discrimination, parental incarceration, exposure to violence and intergenerational trauma.”

“We must address this crisis,” Maryjane Puffer, executive director of The L.A. Trust. “Our students and communities are not getting the mental health support they need. That’s what makes L.A. Trust Student Mental Health Initiative and the work of our collaborative partners so important.”

The need is urgent

Attendees were told L.A. Unified Student and Family Wellness Hotline at (213) 241-3840 received 27,000 calls in the first month following students’ return to school. In a recent L.A. Barometer Survey — reported in the paper School-Age Children’s Wellbeing and School-Related Needs in Los Angeles County (Dudovitz et al.) — 62% of L.A. County parents cited the need for mental health supports – the share was higher in communities of color.

According to research cited by L.A. Unified School Mental Health, “21% of youth ages 13-18 have a mental illness that causes significant impairment in their daily life, and half of all mental illnesses begin by age 14. In California, three out of four children with mental health needs do not receive treatment despite having health care coverage. Of those receiving care, up to 80% receive it in a school setting.”

Wellness Centers confer on impact and inclusion

Senior LAUSD Physician Dr. Rosina Franco provided an update on the District’s coronavirus response at The L.A. Trust Wellness Network Learning Collaborative.

Representatives from Los Angeles Unified and its Wellness Centers discussed how to reach and treat students during the COVID-19 pandemic at The L.A. Trust’s online Learning Collaborative October 14.

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Maryjane Puffer, executive director of The Los Angeles Trust for Children’s Health, welcomed the participants. Noting that inclusion was the theme of the gathering, she quoted Dr. Martin Luther King, Jr., who said, “Injustice anywhere is a threat to justice everywhere.”

Report card

Gloria Velasquez, an organization facilitator for L.A. Unified’s Student Health and Human Services, presented a Wellness Network Report Card for academic year 2019-2020. She reminded the attendees that the purpose of the Wellness Network was to help students and families “where there is a gap in healthcare” and thanked The L.A. Trust Data xChange “for gathering and presenting these metrics so they could be shared in so many different ways.”

Velasquez noted that student patients comprised more than 28% of all patients seen by the Wellness Clinics and they averaged 2.1 visits per year. More female than male students visited the clinics (55.6% vs. 44.4%) and the overwhelming number of student patients were teens 14-19. The top services provided to students were well child exams, overweight and obesity concerns, contraceptive management and vaccinations and pre-exposure prophylaxis (PrEP).

Return plan

Senior LAUSD Physician Dr. Rosina Franco provided an update on the District’s coronavirus response and prospects for school reopening. She noted that Los Angeles County was still in Tier 1, reflecting widespread case and positivity rates, and outlined the state’s requirements for re-opening. As of October 13, Los Angeles County had 9.0 new COVID cases per 100,000 population — the county’s positivity rate was 3.7% and rising.

Franco said L.A. Unified was laying the groundwork for a safe return to in-person instruction. LAUSD is currently testing teachers, staff and children in childcare to establish an initial COVID-19 baseline. The second phase of initial baseline testing will include all staff working from home. The third phase will include all students.

The District will do another return to school baseline test and periodic testing thereafter. Contacts of students and staff who test positive will be notified by the District as part of its robust Community Engagement effort.

Inclusive engagement

Two representatives from the Carson Wellness Center presented ideas on how to engage students and community members and drive visits to Wellness Centers.

Kristie Garrison of Healthy Start and Suzanne Markey of LAUSD School Mental Health offered marketing and communications tactics, including virtual clinic tours media to be shared on classroom Zoom meetings and social media. The team is focused on promoting clinic services to students, especially sexually transmitted infection and HIV prevention education.

Rosario Rico and Robert Renteria of The L.A. Trust gave a brief presentation on inclusive strategies to increase student use of LAUSD Wellness Centers.

They emphasized “location, location, location,” which includes virtual environments like Schoology, Zoom and social media, and more traditional methods like putting printed fliers in places where students are still checking in. They said messaging should include Wellness Center hours, available services, minor consent services and how to make an appointment.

The two-hour event concluded with breakout rooms discussing “How to expand outreach efforts in a more inclusive manner?” Suggestions included involving parents and past student clients as ambassadors; engaging teachers; and utilizing ConnectEd, Schoology and other platforms.

Conference attendees committed to exploring the techniques and increasing clinic visits next semester.

Students find a healthcare home at LAUSD Wellness Centers

LAUSD’s network of Wellness Centers, like this one operated by South Central Family Health Center, are on the front lines of student and community health.

When a Delta 777 passenger plane dumped a load of aviation fuel over the Cudahy area last month, students at six LAUSD schools were affected—and the Wellness Center at Elizabeth Learning Center sprung into action.

The clinic, operated by South Central Family Health Center, offered free screenings to everyone in the community, regardless of insurance, immigration status or ability to pay. The clinic is part of Los Angeles Unified School District’s network of Student and Family Wellness Centers, which provide a healthcare home for students and community members in the district’s most underserved neighborhoods. Tens of thousands of students and community members rely on the clinics each year.

“When there’s an environmental emergency, a flu outbreak or a spike in STDs, the Wellness Centers often see it first,” said Maryjane Puffer, executive director of The Los Angeles Trust for Children’s Health. “They are on the front lines of student and community health, and the services they provide are indispensable. Nothing is more important to The L.A. Trust than supporting these clinics.”

Partners in health

The L.A. Trust provided direct financial support to the six original LAUSD school-based health clinics between 1994 and 2002. Since then it has worked closely with LAUSD Health and Human Services to support the development of 15 (soon to be 19) new school-based Wellness Centers, focusing on strategies to make them self-sufficient and sustainable. 

“Our Wellness Center support mission today includes a broad range of prevention programs, best practices and research,” Puffer said. She cited The L.A. Trust’s groundbreaking Data xChange initiative, student engagement efforts and Wellness Network Learning Collaborative workshops as examples of how The L.A. Trust supports the clinics.

The Wellness Center Network is overseen by LAUSD Health and Human Services, headed by Executive Director Pia V. Escudero. Professional services are provided by these Federally qualified health centers: Asian Pacific Healthcare Venture at Belmont; Eisner Health at Santee Education Complex; Kaiser Permanente, LAUSD Student Medical Services and Planned Parenthood Los Angeles at Hollywood High; Mission City Community Network at Maywood Center for Enriched Studies; Northeast Community Clinics at Gage Middle School; St. John’s Well Child and Family Center at Manual Arts High and Washington Prep; South Central Family Health Center at Elizabeth Learning Center and Jefferson High; South Bay Family Health Center at Carson High; T.H.E. (To Help Everyone) Health and Wellness Centers at Crenshaw High; UMMA Community Clinic at Fremont High; Valley Community Healthcare at North Hills-Monroe High; Via Care at Garfield High; and Watts Health at Jordan High and Locke Early Education Center. 

Primary care plus

In addition to primary and dental care, most LAUSD Wellness Centers provide mental health services to students and community members. LAUSD School Mental Health provides intervention, care and referral at the Belmont, Carson, Crenshaw, Elizabeth, Gage, Locke, Maywood and Washington Prep Wellness Centers.

Other mental health services providers include Aviva Family and Children’s Services at Hollywood High; Child and Family Guidance Center at North Hills-Monroe; Children’s Institute at Jordan; Los Angeles Child Guidance Clinic at Manual Arts; and Weber Community Center at Fremont.

“Our kids hold all the promise in the world,” Puffer said. “Helping support them with access to care—whether it’s asthma, anxiety, depression or substance use—is part of the holistic wellness mission of The L.A. Trust. ”