It takes a whole village to solve the youth mental health crisis

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Carolina Serna, Care Coordinator for Clifford Beers, helps children and families get the clinical care they need. In her work, she often connects families to services to improve their overall well-being. Credit: Melanie Stengel photo / C-HIT.org

Carolina Serna’s work as Care Coordinator for the Clifford Beers, a behavioral health care provider based in New Haven, places her at the heart of the current mental health crisis for children, adolescents and their families. When Clifford Beers receives referrals for cases, Serna and other care coordinators become the face of the organization, helping children and families get the clinical care they need. But Serna and his colleagues do much more than that. In a sense, they are the bridge between struggling families and the rest of society.

Consider one of the many difficult situations Serna handled during the COVID-19 crisis: a young Hispanic mother from New Haven had just lost her job. Her husband is gone. She was pregnant. Her son had behavioral health and disability issues. And she was kicked out of her apartment. The first thing Serna did was find a lawyer for the mother. Then she contacted the school and social service agencies for help. “The mother didn’t know how to connect, so I put the family in touch with the help they needed,” says Serna, who is bilingual.

The story has a happy ending, at least so far. During the six months that Serna worked with the family, the eviction was stopped, the mother enrolled in a program for people re-entering the labor market and the son was placed in a school for children with special needs. specials and received the necessary advice.

Across the country, the number of teens reporting poor mental health is increasing. A 2021 survey from the US Centers for Disease Control and Prevention released in March showed that 37% of high school students had poor mental health during the pandemic and 44% said they felt constantly sad or hopeless during of the previous year.

Separation from school and friends, the threat of becoming seriously ill and family tensions – including loss of jobs and income – have sent children to hospital emergency rooms in record numbers. Other social stresses fuel crises, including domestic violence, gun violence and racism. The pain is more acute in disadvantaged communities.

“Many of my patients were at home doing virtual schooling, but they were also tasked with caring for the younger ones because their parents are essential workers. The children were overjoyed. »

—Dr. Deepa Camengaassociate professor of emergency medicine at the Yale School of Medicine.

The country’s disparate healthcare system is not designed to handle this kind of crisis. There are not enough caregivers and behavioral health facilities to meet the demands for services, especially for the poor, says Dr. Andre Ulrich, who is in charge of emergency services at Yale New Haven Health hospitals in New Haven. What’s more, says Alice M. Forrester, CEO of Clifford Beers, Medicaid reimbursement levels don’t even cover basic costs for healthcare organizations like hers, leaving them to depend on philanthropy to make ends meet.

The Connecticut General Assembly paid a down payment on addressing some of those issues this session when it passed bills, which the governor recently signed into law, that expand mobile crisis programs statewide and create grant programs to hire more school counsellors.

Despite the depth of the crisis and the lack of funding, there is a glimmer of hope. In communities across the state, groups are collaborating and experimenting with innovative approaches to improving health and wellness. An example is how Serna of Clifford Beers helped the New Haven wife and children. The idea is that when the social determinants of health are addressed and community resources are coordinated, the well-being of individuals and entire communities can improve. The approach also involves families and neighborhood organizations in decisions that affect them.

Ultimately, these experiences could change the way our society views and delivers health care. According to this model, health care and social service organizations do not compete or operate in isolation, but work together to achieve common goals. “We are moving from short-term self-interest to long-term common interest,” says Rick Brush, CEO of Wellvillea nonprofit national health advisory group that helps local collaborations in five U.S. communities, including North Hartford neighborhoods.

The idea of ​​community-health-collaboration has its roots in Connecticut. Just before the pandemic, Connecticut Office of Health Strategy (OHS) launched its Health Enhancement Community (HEC) initiative. So far, nine HECs have been established across the state. All are focused on community-led collaborations aimed at improving social, economic and physical conditions to improve overall well-being. The OHS is also encouraging HECs to change incentives in the health care system from fee-for-service to pay-for-health outcomes. “Our strategy is to lead community-led and community-led initiatives to meet the specific needs of each community, reduce disparities and ensure that communities are engaged for the long term,” said Victoria Veltri, Director OHS Executive.

Rick Brush, CEO of Wellville, supports the work being done in North Hartford neighborhoods to bring residents and community organizations together to improve their quality of life. Credit: Photo by Steve Hamm/C-HIT.org

In Hartford, for example, an HEC was organized under the auspices of the North Hartford Triple Aim Collaborative, whose goal is to improve individual and community health while reducing health care costs. The group includes representatives from the City of Hartford, United Way, Trinity Health, Connecticut Children’s and Hartford Hospital, but also invites community organizations and individuals to the table.

Additionally, Connecticut Children’s has partnered with the City of Hartford, Hartford Public Schools and other organizations to develop a new landmark project, the North Hartford Ascend Pipeline. They have landed a $30 million federal grant to be matched by local contributions that will fund a range of interrelated services to improve the well-being of young people from the prenatal period through young adulthood. “The key is to reach children and support families early,” says Dr. Paul H. Dworkin, director of the Connecticut Children’s Office for Community Child Health. “That way we can get much better outcomes for these kids as they grow into teenagers and adults.”

Connecticut’s community health innovators aren’t shy about adopting and adapting approaches that have been tested elsewhere. For example, Clifford Beers’ community outreach program is based on the Wrap-Around Milwaukee model for coordinating health care and social services.

Clifford Beers plans to take his community involvement to another level with a resilience center he hopes to set up in the Newhallville neighborhood of New Haven, offering early childhood services, mental health programs, after-school programs and activities. community health and disease prevention.

Health experts say the closer these coordinated service programs get to neighborhoods and families — truly listening to what people want rather than dictate to them — the more likely they are to have positive effects.

When Cynthia Cruz, a bilingual coordinator serving communities in northwest Connecticut during Wellmore Behavioral Health, is assigned to a new case of behavioral health in a youth, the first thing she does is visit the family at their home.

They discuss what is happening and what they would like to change. Her program only lasts six months, so she also reaches out to other members of the community to see if they can help longer term, including pastors, sports coaches and extended family members. Wellmore refers to these human networks as “natural resources.”

The north end of Hartford. Credit: Photo by Steve Hamm/C-HIT.org

Cruz recalls a situation involving a boy and his family in the far northwest of the state. Earlier in the COVID crisis, the boy had retired to his bedroom and spent much of his time playing video games. He withdrew from his family, barely speaking to his mother. During interviews with the family, Cruz learned that the boy loved watching football on television, but did not play in it. So, in addition to finding him a counselor, she recruited her uncle to throw a soccer ball with him once a week. It broke the ice. She offered the family a membership in the local YMCA. The boy began to socialize with other people. He and his mother reconciled. “You know what they say,” Cruz says. “It takes a village to raise a child.”

A program launched by a team of Yale Children’s Study Center, Supportive Parenting for Anxious Childhood Emotions (SPACE), places parents at the center of the care of their offspring. Clinicians train parents to deal directly with children who suffer from anxiety disorders, rather than relying on professional therapy sessions.

“There are young people who cannot or do not want to engage in cognitive therapy, so we had to find another tool,” explains Eli R. Lebowitz, an associate professor at the Child Study Center whose team developed the technique. Their approach has been embraced by therapists around the world and really took off after Lebowitz published a bestselling book in 2021 about it, “Freeing from anxiety and OCD in children.”

In one of Lebowitz’s cases, a 12-year-old girl from Milford had developed such severe anxiety that she didn’t speak to anyone outside her home. Lebowitz helped parents understand that they were hindering her recovery by speaking up for her in such situations. They changed their behavior, which gradually led their daughter to regain her self-confidence and to speak again.

COVID has sparked the youth behavioral health crisis, but it has also spurred innovative approaches that could help address issues young people face in the future.

“It’s been a profound two years, and for the clinic it’s been groundbreaking in some ways,” says Forrester of Clifford Beers. “We have emphasized outreach work in the communities. Now we see the aftermath and we know what to do.

To connect with the Yale Child Study Center Mood and Anxiety Disorders Program, where free care is available under certain circumstances, call (203) 737-4644.

Information about Wellmore is available here.

You can join Clifford Beers, which is changing its name to Clifford Beers Community Care Center on July 1 here.

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