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Tag Archive: children’s mental health

  1. 9-8-8 is Just One Step Towards a Comprehensive Crisis Services System

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    This blog is the second post in a two-part series that takes a deeper look into Virginia’s efforts to integrate the 9-8-8 hotline with the behavioral health crisis services continuum. Read the first blog post in the series here.

    For years, communities have advocated for diverting mental and behavioral health calls away from law enforcement and for states to adopt a comprehensive crisis response system. Now, that dream is beginning to come to fruition. On July 16, the National Suicide Prevention Lifeline transitioned to the three-digit number 9-8-8. While this transition was initiated by legislation at the federal level, states are responsible for the rollout and linkages to their crisis response systems when the caller’s needs cannot be resolved over the phone. Virginia has been working on a rollout behind the scenes to link the lifeline to crisis response services that are currently being designed and implemented by state agencies and stakeholders.

    The commonwealth’s plan for minimizing emergency room visits for mental health crises and providing an alternative to calling 9-1-1 is to link the crisis call centers with regionally focused resources by integrating mobile crisis response alongside the Marcus Alert protocols. However, at this moment, this is simply the goal and not the reality. The development and implementation of Virginia’s behavioral health crisis system has been a piecemeal approach, and is not yet fully prepared to deliver comprehensive, trauma-informed, and culturally responsive services to meet individuals’ mental health needs—specifically the needs of young people

    The Surgeon General sounded the alarm in December 2021 by issuing an advisory on the youth mental health crisis. Despite widespread awareness, young people’s mental and behavioral health needs are often an afterthought or part of “phase two” when developing programs and services. Current resources dedicated to young people’s behavioral health make up less than 10% of Virginia’s overall behavioral health agency budget. The lack of sufficient funding and resources further the disparities that historically marginalized communities face in accessing support and services.

    Due to the inconsistent mental health crisis services across regions, law enforcement is often the first point of “care” for mental health emergencies, especially for Black, Latinx, Indigenous, and LGBTQIA+ youth. While most calls to 9-8-8 can be resolved during the call, some crises will require an in-person response based on a four-level call matrix.

    four level call matrix

    This new entry point for mental health support is supposed to be an alternative to law enforcement response, but a new law allows 89 of Virginia’s 133 localities with 40,000 or less residents to opt out of two protocols under the Marcus Alert System. This means that for those living in one of the 89 localities that are not required to implement all Marcus Alert protocols, an attempt to get in-person crisis support may still result in law enforcement, with or without Crisis Intervention Training, responding to your call. The criminalization of youth crises often results in further traumatization. This experience can intensify their crisis, compromise their treatment, and make them and their families less willing to call for help if another crisis occurs. Far too often children and families are met with a response that is not suited to meet their immediate or long-term needs.

    At a time when young people need support the most—while their worlds have been turned upside down by COVID-19—we must ensure there are providers and services in place to provide access to timely, culturally responsive services, and address social determinants of health to support children and families’ overall wellbeing. This requires investments from lawmakers and interagency collaboration.

    For 9-8-8 to be truly transformative, investments are needed now.

    While all these recommendations are not immediate and some are considerations for future policy, Voices for Virginia’s Children suggests the following key recommendations:

    • Mobile Crisis services need to be fully funded across all regions, with an emphasis on providing services in underserved and rural communities. Voices also suggests separate mobile crisis protocols designed specifically for youth, as the intervention points at which young people receive support may include schools, parental consent, developmental appropriateness, or specifically trained professionals;
    • Mobile Crisis and Community Care teams should include a peer specialist, interpreter, community advocate, and child-serving mental health professional;
    • More small-scale children’s Crisis Stabilization Units should be placed in communities across the state;
    • Establish an infrastructure for language access and a culturally diverse and appropriate workforce;
    • Mandatory trainings should include equity-centered concepts, including implicit bias training, trauma-informed care, child and adolescent development, and training specific to special populations (i.e., LGBTQIA+ youth and youth with intellectual and/or developmental disabilities);
    • Stakeholders involved in implementation should include those most impacted, such as youth with lived experience and communities of color;
    • Ensure that crisis response protocols and services are equipped to support systems-involved youth and their family members. Protocols should be designed to avoid future involvement in the child welfare system or juvenile justice system.

    Voices will continue to advocate for increased access and improved coordination of quality mental health services for all children in Virginia, regardless of where they live or at what point they seek mental health services. The future wellbeing of our state depends on how we support and invest in the next generation.

    To learn more about Virginia’s plan for crisis system transformation, visit these resources: Virginia’s Crisis System Transformation and Marcus Alert and STEP-VA.

  2. Youth Mental Health Crisis

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    Written by Voices’ intern Abby Aquije

    Increasing mental health resources and access to behavioral health services is a necessary step to mend our youth mental health crisis. If we are truly committed to ending this crisis, we must also consider what factors lead to the situation getting this bad. What is different about our youth today? What has gotten us to this crisis point?

    Youth are feeling alone and disconnected

    Our youth are facing an unprecedented number of stressors that can explain rising rates of depression and anxiety among children and adolescents. Gen Z youth are experiencing stress from sources ranging from school demands to family issues, and even “eco anxiety.” Though these statistics tell us that most youth are struggling with similar hardships, those that work closest to them assure us that this is not how they see it. Recent conversations with Virginia youth directors have made it clear that a key element in this crisis is that youth are feeling alone and disconnected from those around them.

    Most of us have been there, feeling as if we are the only ones stressing about school, social image, or family issues, when in reality the majority of us go through similar issues. As a society, we are becoming more open about mental health issues, yet, there is more to be done. If youth do not feel comfortable talking about their struggles, they will continue to feel alone. Think of a student falling behind in a class. On top of feeling the academic stress, they may also feel shame, which could lead to feelings of isolation and then more serious mental health issues. Even in the Netherlands – whose COVID-19 response included short lockdowns, equitable funding, and high rates of broadband access – student test results revealed a learning loss. How can a student blame themselves for something that is happening globally, even in “best case” scenarios? Why is it that they feel shame rather than solidarity?

    The COVID-19 pandemic has worsened the already concerning rates of loneliness

    Loneliness is being described as an epidemic, with over 60% of young adults feeling it. They are unable to connect with those around them and have to tackle their challenges alone. This all makes the perfect recipe for deteriorating physical and mental health issues that must be addressed.

    High rates of youth loneliness can easily be attributed to the COVID-19 pandemic: the nationwide lockdowns, social distancing, and virtual schooling all caused disconnection. Efforts to boost human connection were admirable, but the damage is done. No amount of virtual connection can make up for the formative middle school years, high school celebrations, and other important in-person experiences youth missed. While it is easy to point fingers at the pandemic, we cannot forget that these rates were rising prior to it. Social media and changing family structures also play a role in limiting the connections youth build with one another.

    Program Response: Employ connectedness strategies

    As we move forward, we have to be more intentional about forming and maintaining connections. Those that work with youth should prioritize creating spaces for youth to meet and truly connect with one another. Youth thrive when they feel they belong, they need to know that people hear and care about them.

    Most parents and caregivers know the importance of forming secure attachment in early childhood and actively work toward developing it. Attachment building paves the way for healthy and independent children, however, as they grow up there is less of an emphasis on developing and maintaining these sorts of connections. It is important for kids to learn independence, but no one can survive on their own, not physically or mentally. It is no surprise that youth connectedness is a protective factor for negative mental health outcomes and that the CDC supports the implementation of connectedness strategies, policies, and activities. As we move forward, we must value building youth connections just as much as we do infant attachment building.

    Policymakers should push for Peer Support Services before crises arise

    Peer support is an evidence-based practice used to help individuals cope with mental health challenges and improve quality of life. In addition to being cost-saving, it has been shown to be more effective than usual care for treating depression, and is especially engaging for “difficult to reach” individuals. Virginia already has qualified peer support providers that use their lived experience with mental health and substance use disorders to help others with their recovery. These providers are important for recovery once mental health challenges arise; however, their experience can also be beneficial for preventative measures before the issues arise. Programs like Hoos Connected, at the University of Virginia, use a form of peer support by having upperclassmen facilitators bring students together to develop meaningful connections with one another.  Students that participate in these programs report feeling significantly less depressed and as a former facilitator, I can attest to the difference the 9-week program makes. Despite its limitations – mainly the challenge of enrolling youth into a “feelings” class – there is a lot of promise to programs like these.

    Combating the loneliness epidemic will take time as it requires youth buy-in and societal shifting. Working alongside young people as we continue to research and develop solutions will be essential as we move forward in an effort to improve the overall mental health of our youth.

  3. How the 988 Hotline Can Break Down Systemic Barriers to Health Care

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    This blog is the first of two posts that will take a deeper look into Virginia’s efforts to integrate the 988 hotline with the behavioral health crisis services continuum.

    **This blog contains information and statistics on suicide and mental health. If you or a loved one are experiencing a crisis or need mental health resources, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (en Español: 1-888-628-9454; deaf and hard of hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741-741.

    On July 16, a new three-digit national hotline–988–will launch to connect callers with trained counselors through the National Suicide Prevention Lifeline to provide 24/7 call or text support for anyone experiencing a mental health crisis or in need of suicide prevention services. Though the hotline is administered through the national Lifeline, calls to 988 will be routed based on area code to regional crisis call centers that can connect individuals with crisis and emergency services that are available in their local communities.

    Virginia is utilizing the national 988 hotline implementation as an opportunity to link the three-digit dialing to the broader behavioral health crisis services continuum that is being developed across the state. Eventually, this will mean that more young people and their families will have access to mental health professionals responding to a crisis instead of law enforcement. This is especially important given the compounding traumatic effects of the COVID-19 pandemic, systemic racism, LGBTQIA+ discrimination, and gun violence in this country.

    The Need for a Lifesaving Hotline

    Suicide is the second-leading cause of death among young people aged 10 to 24. However, deaths from suicide are only part of the problem. Each year, approximately 157,000 youth between the ages of 10 and 24 receive medical care for self-inflicted injuries at emergency departments across the U.S.

    The Centers for Disease Control reported that during 2020, mental health–related emergency department visits among youth aged 12 to 17 increased 31% compared to 2019. Specifically, emergency department visits for suspected suicide attempts among 12 to 17-year-old girls were 50.6% higher in February to March 2021 than during the same period in 2019; among boys aged 12 to 17, such emergency department visits increased 3.7%.

    In Virginia, the percentage of students who experienced feeling sad for two weeks or more increased significantly from 2011 (25.5%) through 2019 (32.4%). And among those who reported feeling sad for two weeks or more, 39.1% reported that they considered attempting suicide, 29.5% made a suicide plan, 18.0% attempted suicide and 4.9% made an injurious suicide attempt.

    The pandemic is deteriorating children’s mental health to new lows, with more than 25% of high school students nationally having reported worsened emotional and cognitive health.

    Figure 1: Percentage of Students who felt sad or hopeless almost every day for 2 weeks or more, VYS, 2011-2019

     

    Figure 1. ED visits related to suicidal thoughts, self-harm, and suicide attempts among Virginia youth aged 9-18 years, 2016-2021

     

    Figure 2: ED visits rates for suicidal thoughts, self-harm, or suicide attempts among Virginia youth aged 9-18 years, by sex, 2016-2021

    Barriers to Accessing Mental Health Services

    Although rates of mental health problems are not statistically different by race, the rate at which children of color receive mental health care is much different than white children. A National Center for Health Statistics data brief reported that non-Hispanic white children (17.7%) were more likely than Hispanic (9.2%) or non-Hispanic Black (8.7%) children to have received any mental health treatment in the past 12 months.

    As noted in Voices’ Children’s Mental Health Discussion Paper, “systemic barriers such as eligibility criteria for health insurance and accessibility of services contribute to lower participation among Black and Latinx children. A history of racism and disinvestment in communities of color have made mental health services less accessible for children of color by geography, cultural fit, and language.”

    LGBTQIA+ youth also often lack access to affirming spaces, which include health care and mental health care services. The Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health reported that 60% of LGBTQIA+ youth who wanted mental health care in the past year were not able to get it. Some of the reasons youth cited for wanting care but not having access include fear of discussing mental health concerns (48%), concerns with obtaining parent/caregiver permission (45%), fear of not being taken seriously (43%), and lack of affordability (41%).

    LGBTQ youth who wanted mental health care but where unable to get it cited the following top ten reasons.

    Of the LGBTQIA+ youth aged 13 to 17 that were surveyed, 73% reported symptoms of anxiety and 67% reported symptoms of depressive disorder in 2020. Almost half of those youth surveyed seriously considered attempting suicide in the past year.

    These statistics demonstrate the clear need for appropriate and effective mental health services for young people. Lack of access can lead to serious and lasting impacts across all areas of a child’s life. Ensuring that emergency services are accessible, unintimidating, and culturally competent will take creating programs like the 988 hotline and implementing them with full funding and public support.

    As lawmakers work to streamline Virginia’s mental health and behavioral health system, Voices is focused on opening these services to all our communities and addressing past harms in the way of healing.

    Stay tuned for more on the 988 hotline and children’s mental health.

  4. General Assembly 2022: Mental Health Wrap-Up

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    The momentum was in place for children’s mental health in Virginia. The US Surgeon General and key advocates declared a national emergency to confront a decade-long decline in children’s mental health. Despite widespread concern, Governor Northam’s original budget proposal did not fund new programs in schools for children’s mental health. To meet the moment, a bipartisan group of legislators and advocates from various communities lobbied for investments in psychological services and counseling. Additional resources of $1.4 million per year will expand the Virginia Mental Health Access Program to integrate services in health care settings. Noted below are other new investments integrating mental health in school settings, increasing reimbursement rates, and supporting the workforce.

    A First Step for School-Based Mental Health Integration 

    Over the last three years, the General Assembly has focused on improving school-based mental health by funding specialized student support positions—counselors, social workers, and psychologists. While students have benefited from better relationships with faculty, COVID presented unanticipated disruptions, rapidly increasing needs, and barriers to vital care. School divisions have responded by allocating federal recovery funds into training, coaching, and even bringing community-based mental health professionals into schools.

    However, federal support during this emergency is impermanent and mental health threats are ongoing. School divisions need resources to continue to support these efforts. Voices led advocacy for additional state general fund resources supporting school-based mental health in flexible ways to assist school divisions in identifying key partnerships and resources. The General Assembly allocated $2.5 million in FY23 to begin supporting school-based mental health services and included language asking the newly established Behavioral Health Commission to study how schools can better integrate mental health services with sustainable funding streams such as Medicaid.

    The General Assembly also approved funding to establish a regional Recovery High School based in Chesterfield where substance abuse recovery is incorporated into the school day. The proposal by Delegate Carrie Coyner was finally approved after the 2020 COVID response cut funding. Other high schools will be able to look toward this model to support health needs in the classroom.

    Senator Jennifer McClellan has been a significant leader on school based mental health and increasing resources for school-based professionals. Read more in her Op/Ed in the Fredericksburg FreeLance Star.

    Addressing Workforce Shortages

    The lynchpin to support the social and emotional well-being of students is having an appropriate workforce. We are excited about two changes that will help address pressing workforce challenges.

    The House and Senate approved HB829, proposed by Del. Tony Wilt, that will provide flexibility on a provisional basis for licensed mental health professionals without certification to work in school-settings. This flexibility will ensure that school divisions can hire more mental health staff.

    The budget adopted by the General Assembly includes funding for a new initiative to help mental health professionals seeking licensure when they must pay for their supervision time out-of-pocket. The new initiative, Boost200, will provide resources to cover out-of-pocket expenses for licensure and match them with approved supervisors. This initiative is poised to make a significant impact on removing barriers towards licensure and diversifying the mental health field. Learn more about participating to address licensure costs or to work as a supervisor.

    Improving Medicaid Reimbursement Rates

    The third area that the legislature improved on mental health services was improving Medicaid reimbursement rates for several mental health services. Federal funds from the current “public health emergency” have increased payment rates for community-based services by 12.5%. The General Assembly approved resources to continue financing those services. The General Assembly also improved rates for psychiatric residential treatment facilities. Many facilities served children from other states and lacked placements for children in Virginia, leading to greater instability for the hardest to place children, who are the focus of the Safe and Sound Task Force. The increased rates should help caregivers meet immediate needs, but challenges remain to ensure that children are not placed in inappropriate and lengthy stays in congregate settings. While increasing Medicaid rates is a positive step, adequate reimbursement is essential to looking after the mental health of economically disadvantaged children and vulnerable children in the foster care system.

  5. General Assembly 2022: Health and Wellness Wrap-Up

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    Understanding the social determinants of health (SDOH) that impact children’s lives informs how we advocate for policies that improve the health and well-being of all children, especially children of color and economically disadvantaged children. During the 2022 General Assembly Session, Voices joined partners, advocates, and youth in asking lawmakers to invest in equity and provide access to language services across state agencies, healthy and nutritious foods, and comprehensive health care.

    After months of negotiation, the legislature has reached an agreement on the state budget, including many of these initiatives. Policy changes in legislation and budget language have made progress towards holistically addressing the inequities and disparities faced by Virginia’s children and families.

    Creating an Equitable Health Care System

    • HB 987, sponsored by Delegate Tran, was signed into law and requires the Board of Medical Assistance Services to ensure that all medical assistance program information provided to applicants is made available in a manner that is timely and accessible to individuals with limited English proficiency through language access services. This includes oral interpretation, written translations, and auxiliary aids and services for individuals with disabilities as a reasonable step to provide meaningful access to health care coverage.
    • HB 229, sponsored by Delegate Coyner, was signed into law and requires the Department of Health to collect and analyze information, including demographic data, regarding social determinants of health and their impact on health risks and health outcomes of Virginians.
    • To address Medicaid enrollment, language is included in the budget directing the Secretary of Health and Human Resources to establish a Task Force on Eligibility Redetermination. This task force will help plan and advise the Department of Medical Assistance Services on the unwinding process to ensure Virginians do not lose healthcare coverage. The language also adds American Rescue Plan Act (ARPA) funding to be used for operational challenges linked to eligibility redetermination, such as technology needs and paying staff overtime at local DSS agencies.
    • The legislature has directed $2.5 million in FY23 to continue the contract for an integrated e-referral system for one year. It is expected that the e-referral system will continue beyond FY23 with user fees supporting its operations. The purpose of the system is to connect government agencies, health care providers, and community-based partners to enable participants in the system to refer patients to public health and social services.

    Increasing Language Access and Equity

    • While the funding amount was reduced from the original budget, $2.5 million per fiscal year remains in the current budget to be provided to state agencies for facilitating and improving language access. This funding will allow each state agency to designate a language access coordinator who will be responsible for making sure that agency materials and communications are accessible to all Virginians, especially those who have limited English proficiency.

    Increasing Food Access and Nutrition Security

    • To ensure access to healthy and nutritious foods and boost the buying power of the Supplemental Nutrition Assistance Program (SNAP) benefit for fruits and vegetables at farmers markets and food stores, $1 million per fiscal year will be directed to Virginia Fresh Match.
    • HB 582, sponsored by Delegate Roem, was signed into law and requires public institutions of higher education to ensure that young people in college have access to information on SNAP benefits, including eligibility and how to apply. The bill also requires each institution to advertise information on the SNAP benefit process on their website and in orientation materials distributed to students.
    • HB 587, sponsored by Delegate Roem, was signed into law and requires every public elementary or secondary school to process web-based or paper-based applications for participation in the School Breakfast Program or the National School Lunch Program, administered by the U.S. Department of Agriculture, within five working days after the date of receipt of the application.

    Creating a future where Virginia’s children can thrive will require intersectional approaches, including equitable, healing-centered policies that dismantle systemic barriers so that all young people can lead long, healthy, and successful lives. While the budget takes important steps forward, we must continue uplifting youth voices to improve policies impacting their health and well-being.

  6. 2022 General Assembly Budget Passes with Bipartisan Progress for Kids

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    Click here to register for our upcoming Zoom webinar on June 14 as we discuss General Assembly results and what they mean for children and families in Virginia.

    After several months of negotiations and discussions among key decision makers, the General Assembly has reached an agreement on the budget. This year’s budget had notable investments in early education, foster care, and children’s mental health through bipartisan support. Since budgets are a reflection of priorities, we believe there are improvements Virginia can make to demonstrate its commitment to young people in the commonwealth.

    Notable investments in the final budget compromise include:

    • Expanding affordable, accessible early childhood education for young children around the state. The budget builds on Governor Northam’s vision to expand early childhood programming and provides funding for regional initiatives in Southwest Virginia and early intervention services for infants and toddlers with developmental delays.
    • State funding for school-based mental health integration projects linking mental health services into schools. The legislature approved $2.5 million for school-based mental health projects as well as the first regional recovery high school in Virginia.
    • New initiatives to address long-standing challenges in the child welfare system include replacing the outdated child welfare data tracking system and the iFoster web-based portal for youth, expanded regional collaboration for foster placements, and additional support for foster youth seeking associate’s degrees to participate in Great Expectations.
    • $1 million each year to boost the buying power of SNAP benefits to purchase fruits and vegetables at farmers markets and community retailers.

    We are proud to stand by the youth and young adults who advocated with us for these investments. And we will continue to speak up for policy changes designed to meet their needs.

    As one of our youth advocates said,

    “Mental health is the same thing as your physical health. It’s just as important, if not more important, so we really need to prioritize that and make it so that everybody has equal opportunities.”

    – (Aaliyana, 16 years old).

    While these initiatives will continue to create new opportunities for young children to grow and thrive, the foundation of their success is economic stability. The rate of children experiencing poverty has remained consistent for decades in Virginia with persistent racial disparities in the percentage of Black and Latino children living in poverty than their White peers. A solid foundation for child well-being rests on a solid financial foundation for their families.

    As a significant commitment to families, the General Assembly approved a partially refundable Earned Income Tax Credit (EITC):

    • Low-income working families who have a higher-than-average tax burden will see 15% of the value of their federal refund returned as a state tax credit.
    • In addition, this summer, taxpayers will receive one-time rebates of $250 for single families and $500 for married couples.

    The refundable EITC for families demonstrates that lawmakers can take necessary action to address long-standing challenges for families that were exacerbated by the pandemic. There will be more work to do to ensure that families receive economic support and stability that will address decades-long trends in child poverty and ever-increasing material hardship experienced by families across the state.

  7. A National State of Emergency in Children’s Mental Health

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    Advocates, school personnel, mental health clinicians, and families have been saying for years – even before the pandemic –  that children’s mental health access is in a state of emergency. Over the summer, we heard from outpatient treatment clinicians who had months-long waiting lists and emergency departments that were filling up with children in mental health crisis without other options. As school returned, more reports of mental health and behavioral disruptions resonated across the Commonwealth. Now, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association are declaring a “National Emergency” in children’s mental health.

    Virginia lawmakers are paying attention too. During a discussion about education funding in a Senate Finance Committee meeting, Senator Jennifer McClellan stated, “the kids are not okay.” The compounded effect of the pandemic, racial trauma, and individual traumatic experiences are causing anxiety, depression, and more severe mental health issues in students. It was evident to Senator McClellan as a parent that mental health is causing major distress and barriers to learning.

    Young people are ready for policymakers and leaders to address this emergency.

    Justice, a young adult in Richmond told us this week, “I believe that if we can put more free mental health services out there for young people to turn to if they don’t have somebody to talk to they won’t just keep things in and one day just explode… It’s okay to not be okay.”

    Children’s Mental Health Discussion Paper: October 2021

    Children’s mental health needs touch all systems and all aspects of life. To fully address children’s mental health issues, we need an “all-hands-on-deck” approach.  There are no easy solutions to address a “state of emergency” but there are many points to begin trying.

    Voices has released a discussion paper for lawmakers to tackle children’s mental health issues from the perspective of the child-student and outside any one silo. This paper is relevant for lawmakers serving on the education funding committee, health and human resources funding committees, and the newly formed Behavioral Health Commission. It also creates a framework for the incoming governor to tackle a pressing issue and create some opportunities to continue collaborative efforts such as the Children’s Cabinet.

    button image download

    The most important steps lawmakers must take to address the current emergency include:

    • Addressing workforce shortages. Children’s clinical workforce shortages existed even before the pandemic, but overall workforce shortages are contributing to even longer waits for care. We need to retain the current workforce, attract a future workforce, and align the current workforce to opportunities for licensure and appropriate reimbursement. We support a proposal in front of the Behavioral Health Committee and consideration for the governor’s budget to assist clinicians in paying for supervision towards licensure to help meet immediate needs. Additionally, retention bonuses proposed for providers in the public mental health system and loan repayment programs are critical. In the longer term, stakeholders and leaders should spend time defining the best fit for certain roles, particularly the roles that can be filled by Qualified Mental Health Professionals (QMHPs) in schools and community settings.
    • Building out the capacity of health providers to address mental health issues. Continuing efforts to expand the Virginia Mental Health Access Program to reach more health providers, such as emergency department staff, and enhancing awareness of early childhood mental health issues are necessary. Additional recruitment and professional development for the health care workforce to identify and address mental health needs can help children who might not have robust school-based services.
    • Facilitating connections between schools and community providers. School have gotten very creative at finding ways to meet mental health needs during the pandemic. And thanks to investments from state lawmakers, many have been able to add additional school counselors and specialized support staff. For these new initiatives to meet increased demand and increased severity of need, the schools will need support to implement trauma-informed and multi-tier support from the state Department of Education and from their school divisions.

    Additional federal resources and Medicaid reimbursement will be critical to supporting school-initiated services in the long-term. There are several opportunities to create strong support systems for student mental health with American Recovery Act funds, the recalibration of Medicaid-funded mental health services through Project BRAVO and the ability for schools to bill for health and mental health needs outside a students’ IEP through the “free care” rule. Stakeholders, students, providers and schools should come together on some ideal plans and programs to implement at the school and child care level to meet student needs.

    Read the paper in its entirety and continue to follow Voices on social media for updates.

  8. Talking to Youth After Violence

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    It is an unfortunate truth in this country that we must have difficult and scary conversations that follow acts of violence, including school shootings. These events stir up confusion, fear, and unease for ourselves as caregivers or parents who are witnessing our worst nightmare, and also alarm the young people in our lives. It is during these difficult moments that children and youth look to trusted adults to understand how to react, cope and how to trust the world around them again. As you embark on these challenging conversations, consider the guidance below:

    • Name emotions together. Anxiety. Hypervigilance. Name the things that are coming up and be open about what comes up for you as a parent/caregiver. Sharing like this demonstrates that a) emotions are acceptable and b) gives them an opportunity to model their coping styles after you. Reserve processing more intense emotions with other supportive adults. While it is good to be open about emotions, you do not want children to think they must care for you too, or that they are somehow at fault. Phrases like, “I’m upset about what I saw, it’s not you,” can also help ease heightened and worried young minds.
    • Consider what is developmentally appropriate. You are the expert in your child. For any child or youth, approaching the conversation with curiosity and playfulness will be most helpful, but there are some things to keep in mind depending on age.
      • Remember that younger children (up to Elementary School age) tend to think in more linear, concrete terms, so keeping things simple, clear and concise will be important in addressing their anxious behaviors. Accept and hold the full range of their emotions. Phrases like, “A scary thing happened here, and grown-ups are working hard to try to fix it and keep everyone safe.”
      • Older children (Middle to High school) are keenly aware of when they are being condescended to and already have access to so much information on their own. Begin by being curious about what they already know. Anchor your conversation in facts. Invite a check-in later, if needed. “This scary thing happened and it’s making me think about safety. We can talk whenever you’re ready.”
    • Reassure safety. School is supposed to be a safe place. Help the young people you are connecting with understand that school is still a safe place to learn and connect with friends and trusted adults. You can approach this practically by helping to identify the things that keep them safe day-to-day, like talking to trusted adults when they are feeling afraid or unsure. Reiterate their safety by reminding them that you are always there for them and that authorities are investigating. “It’s okay to feel scared, but know that your teacher(s) works with me and other helpers to keep you safe.”
    • Keep the news and any violent or potentially triggering media away. If you as an adult are eager for the information, practice discretion, or try distracting your child to shift their focus. For older youth, filter the news for optimal times of day (avoiding close to bedtime) and/or watch together. Consider youth-centered news resources as well, such as Xzya: News for Kids.
    • Maintain routines. Keep it as “normal” a day as possible. Regular schedules are reassuring and can reduce anxiety. Ensure plenty of sleep, regular meals, and movement. Encourage academics and extracurriculars, but if your child is overwhelmed, take those cues and suggest a more emotionally accessible activity to do.

    Navigating these conversations is not an exact science. You and the child you are supporting may have different needs depending on aspects like age, race and ethnicity, where you live, and the resources available to you for support. Let these talking points and recommendations guide you, but recognize when to ask for help.

    Sign up to receive emails from Voices. We’ll be sending out resources to support these conversations, and youth, via email and social media in the coming weeks.

  9. The Impact of Having Clinicians of Color

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    This is a guest blog post written by Olivya Wilson, MSW, LCSW, the Parent Engagement Coordinator for Greater Richmond SCAN. This is part one on the impact of having clinicians of color.

    We want to raise awareness about the importance of having mental health professionals of color and why children in particular need clinicians who present and reflect their same racial and ethnic experiences.

    Tamika’s Story

    I want to do this by first introducing you to Tamika. Tamika is a Black/African American mother of four. She has three boys and one girl. Her oldest son was diagnosed with Autism as a child, something she knew nothing about as a new mom several years ago. This diagnosis led her on a winding path of trying to learn all she could about the diagnosis and how to find the right kind of resources and supports for her son. She fought many battles trying to advocate for her son’s needs. He was completely non-verbal at the onset of his diagnosis and struggled with aggressive behaviors, among other challenges. Additionally, he was in a school system with personnel that didn’t know how to appropriately respond to his needs, especially with him being a tall Black adolescent and later, a teenage boy with Autism.

    When her son began receiving intensive in-home counseling services, she requested a Black male counselor, but for the first three to four years, her son was assigned mostly White female counselors. He received a Black female counselor once, but shortly after was switched back to a White female counselor. Tamika persisted with this request until her son was finally assigned a Black male counselor, who she said has made all the difference in her son’s progress.

    If you asked Tamika, she would tell you that the reason it took so long to get a Black counselor for her son is because there aren’t enough Black mental health providers to meet the ever-growing need and demand. Black male mental health providers are even more scarce. Tamika shared her story with me and continues to share it every opportunity she gets about why it was so important for her to find a Black male counselor for her son. She went to these lengths because she knew it was important for her Black son to be connected with someone who looked like him and who could identify with him and relate to him in a real way. She wanted someone for him who shared similar, or even the same, ethnic and cultural values.

    Why Children of Color Need Clinicians of Color

    I’m always reminded of Tamika’s story whenever I engage in conversation about the need for more Black and Brown mental health professionals. Her story is just one of many that helps convey why having clinicians of color is so important. When we consider the needs of children of color, we must consider their unique backgrounds and experiences as well. We have to take into account what it means for them to have mental health professionals that represent and reflect their identities, as well as have spaces to share and process their experiences without the added stress of having to explain themselves or feeling fearful of being misunderstood, judged, invalidated, or further marginalized by their therapists.

    In season 4 of the award-winning drama series This Is Us, Randall Pearson, played by Sterling K. Brown, finally acquiesces to seeking therapy for his past traumas and history of mental health challenges. He begins working with a White female therapist, who Randall appears to develop a positive rapport with and who seems to help with his first breakthrough. However, with COVID-19, the resurgence of violence against Black people, increased racial and political tensions happening, he comes to realize he needs to find a therapist that could help him show up more authentically in a therapeutic space and he finds that with a Black male therapist.

    When I think about the mental health of children of color, I think about how the history of racism and systems of oppression are in many ways connected to their presenting circumstances. Just like we advocate for more representation of Black and Brown people in other professional arenas such as the medical field, politics, mass media and sports that have been dominated and run by White people and white supremacist systems for so long, the advocacy is desperately needed in the mental health field as well.

    According to the American Psychological Association’s Center for Workforce Studies, 86% of psychologists are white, and other mental health professions are similarly homogeneous. Already at a disadvantage owing to structural disparities, people from underrepresented communities are often unable to find providers who look like them or share their cultural experiences. (Source: https://www.apa.org/monitor/2020/09/increasing-providers-color)

    Raising awareness about the racial-ethnic disparities in the mental health field doesn’t dismiss or deny the ability of some White mental health professionals to work with Black and Brown children and their families. However, it does remind us how neglectful the mental health field has been to Black and Brown individuals and communities. For me, not acknowledging the importance of having and needing more mental health clinicians of color keeps us at risk, whether consciously or unconsciously, of perpetuating the “White Savior” complex.

    From Sachs to Kristof to Invisible Children to TED, the fastest growth industry in the US is the White Savior Industrial Complex. This world exists simply to satisfy the needs—including, importantly, the sentimental needs—of white people… The White Savior Industrial Complex is not about justice. It is about having a big emotional experience that validates privilege,” according to a piece in The Atlantictitled “The White Savior Industrial Complex”. (Source: https://www.theatlantic.com/international/archive/2012/03/the-white-savior-industrial-complex/254843/)

    I’ve come to recognize more than ever that Black, Indigenous, Latino and Asian people, especially our children, need to see more people like themselves participating in the healing process. Attending cultural competency or cultural sensitivity trainings are helpful and necessary, but it’s not enough. We must start to recognize how important the lived experiences of Brown and Black mental health professionals are to the practice. In these Trauma Basics or Intro to Trauma Informed Care trainings, we learn that trauma doesn’t discriminate, it has no respect of person, it crosses color lines, class, socioeconomic lines, etc. This is true, trauma can and has impacted all kinds of peoples and communities. I’ve also learned in my Urban Trauma training courses that there is a history of trauma, cultural biases, mistrust, and stigmas that are unique to Black and Brown people that White clinicians will never truly be able to understand, with regards to the importance and relevance of these experiences to their identities.

    Egette Indelele is the founder and CEO of Safe Haven Space and a recent graduate of George Mason University. Egette and her family were refugees from Tanzania some years ago. Her experience of being a refugee and realizing the impacts of that experience on her and her family’s mental health, along with understanding the cultural stigmas around mental health led her to founding Safe Haven Space. They offer mental health and well-being programs to refugee and immigrant students and their families, helping them to succeed in American life and culture through programs in schools and community organizations. This delivery of services most likely wouldn’t have the same impact if someone without the experiences of being a refugee or immigrant was leading this work.

    Learn more about Safe Haven Space.

    These are just a few examples and reasons of why we encourage more Black and Brown providers to work in mental health and why children in particular need clinicians who represent and reflect that same racial and ethnic or cultural experiences.

    In part two of Olivya’s guest blog post, she’ll be discussing the recruitment of clinicians of color, including barriers, retainment, and how you can help.

  10. 2021 General Assembly Session: Mental Health Priorities

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    Children’s mental health is facing a critical system change moment right now. There has never been a moment when mental health needs were more prevalent or more normalized. There are few moments when all children and parents experience a collective trauma. There is more awareness and understanding of how racial and historical trauma is connected to mental health and wellness. We must take this opportunity to build a new approach to mental health services and supports for children. The first steps for this new approach start with the investments that the governor, state agencies and legislature will make in the early days of 2021.

    Pre-pandemic, one in four children in Virginia experienced a mental health issue ranging from ADD to depression/anxiety.  A look at the report from Mental Health America on their online screening tool found a 93 percent increase over the previous year of individuals seeking help through the online screening during the pandemicThere was a 9 percent increase among youth 11-17 taking the screening by September 2020 compared to 2019.

    We know from previous research that community disasters or traumas can produce high levels of mental health issues in children with as many as half of children in a community experiencing mental health issues after a disaster. In 2018-19 data from the National Survey of Children’s Health, nearly 61 percent of Black or Latino children in VA experienced trauma. In the future, our systems must respond to this disproportionate impact and the context of racial & historical trauma.

    Because we know that mental health concerns will increase for children in their prevalence and severity we must plan now to build systems to support mental health and meet kids where they are—in child care settings, virtual classrooms, online peer groups and more acute treatment methods.   

    To cast a wide net for mental health services and to help children and families recover from the trauma of the pandemic and years of economic hardship and unjust systems, policymakers must ask this question in every legislative meeting and in every discussion with agencies and advocates: “Where are we addressing mental health needs in this system?”  

    Some ideas about how policymakers can begin:

    • Support parents: One in five parents reports feeling stressed or depressed during the pandemic. Parents’ mental health and wellness directly impacts their children. Parents who are stressed financially or by grief, loss and anxiety cannot provide the optimal supportive environment for kids to grow and thrive. We need policies that support parents such as home visiting and paid leave expansion.
    • Start early: Begin in early education and elementary schools by training educators to support social-emotional wellness and to identify and address mental health issues appropriatelyA team of advocates and state agency leaders put together a report about how to build mental health supports in early education systems. State agencies must work towards implementing those plans and the legislature must support additional mental health services.
    • Medicaid is an opportunity: More than 700,000 or one in three children in Virginia is insured by Medicaid/FAMIS. These children are the most economically at-risk in the state and also experience a lack of access to resources in their communities. Knowing that we can reach a large group of our most vulnerable children through Medicaid, what tools for screening, care coordination, and innovative or incentive funds can be leveraged even before kids fully return to classrooms and child care is vital.
    • Build the continuum: Because this year has disrupted the way we deliver services and efforts, such as the Family First Prevention Services Act and Behavioral Health Enhancement reforming how services are delivered, another look at the continuum is warranted. We know right now that services and a trained workforce will need to be built at every level and in every geography for a fully articulated continuum.
    • Apply an equity lensThis is the most important step and what we must have in place to build our systems of support back. Workforce and training initiatives need to be better prepared to meet the needs of children of color and respond to racial and historical trauma. We need training in implicit bias and the intersection of racial and cultural trauma for all of our child-serving professionals and to recruit a diverse set of professionals more reflective of the kids they serve.

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