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Tag Archive: mental health

  1. 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.

  2. 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.

  3. 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.

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    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.

  4. 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.

  5. Intentional Recruitment of 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 two of a two-part series. Read 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. This post focuses on the recruitment of clinicians of color, barriers to recruitment and how you can be an advocate.

    Intentional Recruitment of Clinicians of Color

    As mentioned in the first part of this series, there is a shortage of Black and Brown mental health providers and those that do exist can be difficult to access, especially depending on where you live. So, in addition to raising awareness about the need for more mental health professionals of color, we have to speak to why there is a shortage. One of the reasons is recruitment and retention. The mental health arena consists of many types of job settings and positions and for a long time, the field has not been intentional about recruiting Black and Brown people. While better efforts have been made with the help of increased conversations about diversity, inclusion and equity, we still have some ways to go to close the gap.

    Barriers to Recruiting and Retaining Mental Health Professionals of Color

    The Reach of Job Postings

    I have benefited from recruitment efforts that involved being personally referred for a job opening by an inside person. This is a common practice in the mental health field especially in the non-profit world. I don’t knock this kind of recruitment effort, however I do have a problem with it being providers’ primary or sole recruitment strategy especially if the organization or agency’s staff is predominately white and have little or no connections to other professionals of color. This will not help reach more clinicians of color. Intentional recruitment of clinicians of color requires diversifying the places/platforms where job opportunities are posted. Posting jobs in places that attract the same pool of applicants every time and then simply concluding that Black and Brown clinicians don’t apply for whatever biased reason is a barrier.

    Fair and Equitable Pay

    Traditionally, the mental health care field has been known to have low to average paying positions. Though we are beginning to see increases in pay, we still need to consider the equity implications for why White mental health clinicians generally would be more likely to accept a lower paying job than clinician of colors. Funding for Black and Brown mental health providers to start businesses of their own is also a barrier.

    Discrimination

    We cannot deny that workplace discrimination continues to occur and when it does, the discrimination is mostly based on race and sexual orientation, which is reflected in a 2017 Report from the Behavioral Health Workforce. This report highlights that discrimination against the client population also deters mental health clinicians of color from working with particular employers or is a factor that leads to them leaving their job.

     Call to Action

    What you can do? Mental health providers of color can connect with/join area chapters of organizations like the National Association of Black Social Workers, National Association of Black Psychologists, and National Association of Black Counselors. Membership benefits can include networking, educational opportunities, mentorship, greater access to job referrals/job postings, and other community resources, just to name a few. These associations often have directories and other resources that can help community members of color find Black and Brown mental health providers in their areas. Additionally, the aforementioned associations oftentimes have student chapters at various colleges and universities that allow students of color to get connected to strong professional networks which helps prepare them for the workforce post-graduation.

    We can create pipeline structures for future mental health professionals of color by increasing exposure about employment opportunities in the mental health field to Black and Brown youth as early as possible. Increased positive experiences between Black and Brown clients and mental health providers who reflect their ethnicity and cultural norms can lead to increased interest and desire for people of color to enter the field. White providers working toward intentional recruitment of clinicians of color can reach out to local Historically Black Colleges and Universities and connect with their Department of Field Education and Career Centers to share job/internship opportunities. Go to these places and participate in their job fairs, build relationships with the Schools of Psychology, Social Work, Counseling, etc.

    Last, but not least, keep addressing systemic racism and its impacts on Black and Brown people. Invest in more trainings for administrators and employees that address biases, structural racism and other barriers to achieving equity, inclusion and diversity in the workplace. Advocate for more equitable funders/funding sources so Black and Brown mental health providers don’t have to continue struggling to effectively meet the needs of their communities.

     

    Referenced Articles/Websites

    https://www.apa.org/monitor/2020/09/increasing-providers-color

    https://behavioralhealthworkforce.org/wp-content/uploads/2017/05/FA2P1_Workforce-Diversity_Final-Report.pdf

    https://www.healthline.com/health-news/access-to-mental-healthcare-is-harder-for-black-americans-heres-why

    https://safehavenspace.com/

  6. 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.

  7. Studying Workforce Outcomes for Youth in Foster Care

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    When looking at the numerous challenges that face youth aging out of foster care, workforce outcomes are a key issue, but one in which we have a limited understanding. We know that 20% of youth in foster care are aging out and only 50% of those youth will have steady employment by 24. With estimates of 650 youth aging out of care in Virginia each year (this number only continues to rise), this would mean roughly 325 youth per year being unemployed or underemployed. Many barriers contribute to the employment struggles of these youth including homelessness and mental health concerns which can create exponential challenges to obtaining or maintaining employment.

    What is Being Requested?

    To best identify possible solutions that will help support our youth, a study has been requested from the Commission on Youth. The request is for the Commission to dive deep into what barriers exist in preventing youth aging out of care from obtaining and maintaining steady employment. After understanding these barriers, the study would hopefully provide recommendations for policy changes or programs that would offer prevention for youth still in foster care and intervention for those who have already aged out.

    Who is Involved?

    Currently, Children’s Home Society has taken the lead on working with the Commission on Youth to propose this study along with contacting legislators from both the House and the Senate for their support. After the study is approved, the Commission on Youth will identify a variety of stakeholders to be involved. This will likely include the Department of Social Services, Voices for Virginia’s Children, and other agencies who work in foster care, adoption, and independent living.

    What is the Timeline?

    The next Commission on Youth meeting has not yet been set, so the date for when they would vote on whether to take on this study is likely to occur after session is over. Based on prior study timelines, if approved, the study would likely be completed by November 2021. This would then allow advocates and legislators to take the recommendations under consideration for proposing policy changes in the 2022 General Assembly session.

    What are the Expectations?

    From this study, we expect the Commission would begin by looking at what other states are doing to get an initial idea of current methods of prevention and intervention. Afterwards, there would be a process for hearing from stakeholders and the youth themselves. Part of the process may also include some engagement with the workforce to gain the employers’ perspectives as well. There is a significant opportunity for this study to highlight the need for employers to better understand what youth aging out of foster care require in terms of support and the value that they bring to the workforce. Employers need significant education to understand the barriers and provide better support to their employees.

    Youth Involvement?

    Prior to proposing this study, Children’s Home Society had created a panel with several stakeholders, including youth, to identify policy recommendations. The recommendation for the study came out of this panel and all recommendations were approved and endorsed by the youth in their program. As an organization, they are currently talking to their youth about what was supportive and what helped provide successful employment, as well as, what supports would have been needed to better support employment. Additionally, we anticipate the youth voice being involved in the study and from an equity perspective, it is critical that their voices are incorporated. The experiences of youth aging out of foster care are unique and their perspective on solutions, that will or will not work, is priceless. We want to be sure that if we implement a recommendation the youth will buy into it. Otherwise, the impact we seek is unlikely to be realized.

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  8. 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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  9. 2021 General Assembly Session: Early Care and Education Priorities

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    There is no question that 2020 has dramatically changed the early learning sector in Virginia. As of late November, one-third of the licensed child care capacity in the state were still closedMost of our public preschool programs are offering virtual instruction for students. The impact of this year will have long-term implications for children as well as the child care sector.  

    We must recognize that our child care sector has only achieved stability at this level through additional federal resources. Nearly $170 million in response funds have been directed to child care and public preschool by the legislature and the Northam administration. This level of investment has been essential to keeping many providers open and allowing educators to offer care and instruction for the last nine months.

    We know that, due to the economic impact of COVID-19 on the state, additional state funds may be hard to come by this year. Our talking points for the 2021 legislative session will focus on two themes: 

    1. Improving compensation for early educators who have worked on the front lines.
    2. Building social-emotional supports into every aspect of our early learning systems.

    Improving Compensation for Early Educator Frontline Heroes

    recent UVA study of the racial composition and compensation of the early childhood workforce found that two out of five early educators in child care centers reported household incomes under $25,000. 35 percent of early educators reported decreased earnings back in May due to COVID-19 closuresBefore the pandemic, the median wage in child care was $10-14 an hour across the country. Educators in the private child care sector tend to usually be women of color—lead teachers in private programs were three times more likely to be Black than teachers in public preschool programs.

    In order for young children to continue to have loving and prepared caregivers and for parents to find child care, we must ensure there is a workforce to support children and support the sector. For the many child care programs that have remained open, early educators have put themselves at-risk of exposure to love and nurture our babies. These heroes deserve to be compensated in line with their importance in our society and in children’s lives.

    Incentive Payments: The Northam Administration has offered $1,500 incentive payments to some educators in PDG B-5 pilot communities. In FY20, about $3 mil distributed to 2,000 teachers as $1,500 recognition payments and another $3 mil is set to be distributed this year. UVA study comparing those who received an incentive and those who did not showed that the recognition payment reduced teacher turnover in child care centersWe will support additional incentive payments for educators and efforts that seek to increase minimum wages in child care settings by offering additional financial support.

    Building in Social-Emotional Supports into Every Aspect

    We don’t yet know the full impact that the pandemic will have on young children, but we do know that the stressors of the pandemic can produce a long-term impact on quickly growing and developing young brains. For children of color, the economic and emotional impact of the pandemic is layered on top of racial and historical trauma for their families and their communities.  

    Recent Census Household Pulse data shows that more than one in five parents in Virginia reported feeling hopeless or depressed. We know that when parents struggle with their mental health their children are also likely to struggle. We have heard directly from early educators who feel the toll of being on the front lines and who worry about their own health and serving children who are facing months of trauma and disruption. We must do better to support children and their caregivers in response to the pandemic.

    VDOE and state partners conducted a study on implementing mental health consultation models in child care this fall and found a few opportunities to start building up our systems. We believe that agency administrators and program leaders from Education, Social Services, Mental Health and Health agencies should review their professional development and program support plans to support services for social-emotional health into every program plan. This would include efforts such as additional social-emotional screening tools for children, implicit bias and equity training for educators, service linkages and workforce development efforts. To ensure a statewide system of support for children and caregivers there must be a multi-pronged and multi-faceted response with support from the legislature and administration creating a foundation of solid social-emotional wellness.

    Long Term Big, Bold Vision for ECE

    As we look to the long-term of the future of early education, we know we have to address a long standing problem— parents can’t afford to pay any more for child care and early educators can’t afford to earn any less. As we seek long-term solutions to rebuild this sector, we will keep these dual goals in mind to identify and support public investments and tools that can provide better pay for teachers and supports for the overall system to keep costs down for parents. We cannot go back to a system that requires parents to pay more than college tuition for their child care. And we cannot go back to a system that is based on paying low wages to teachers and caregivers. The recognition that child care is essential for our workforce should change the positioning and prominence of child care on any state and federal policy agenda in the future. It is critical to have your advocacy to continue to support it.

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  10. Prioritizing Children’s Mental Health During Special Session

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    COVID-19 isn’t just affecting our physical health and daily life—it’s also wrecking havoc on the mental health of our children and families. Whether it’s a lack of access to mental health treatment, loneliness and depression from isolation, fear of contracting COVID, stress and anxiety from racism, or despair from job loss—our country is in pain and our emotional well-being has been compromised.

     

    Mental health experts are becoming increasingly concerned about an emerging mental health crisis that our current system isn’t prepared to handle. While Virginia has made significant strides towards creating a more equitable behavioral health system, disparities in access and quality exist. Now, more than ever, policymakers must recommit to building a comprehensive continuum of behavioral health services for our children and families.

     

    On August 18, policymakers will gather once again to make tough decisions about the state budget and which funding priorities they will “reallot” or “unfreeze.” Policymakers have an opportunity to mitigate the negative impact this pandemic has on our children’s mental health by reinvesting in the following behavioral health priorities:

     

    Make permanent or otherwise extend telehealth flexibilities granted during the pandemic. A bright spot during the public health crisis has been the widespread use of telehealth services across the Commonwealth. As compared to primary care services, behavioral health service utilization remained relatively stable during the pandemic due to new telehealth allowances. To ensure equitable access to telehealth services moving forward, broadband capacity issues and telehealth flexibilities must be addressed. Telehealth flexibilities should:

    • Telehealth reimbursement parity
    • Allow for home and school to be considered an “originating site”
    • Permit phone-based care
    • Increase minutes available on Medicaid phones

     

    Re-allot funding that invests in behavioral health systems and supports that improve equitable access to quality services. These services include:

    • Medicaid Redesign: $13.6 million. Efforts to transform our behavioral health system includes implementation of evidence-based services that have demonstrated impact and value to children and adults and provides alternatives to and step-down from psychiatric admissions. In response to feedback from stakeholders, Virginia’s Medicaid office has now added a racial equity workgroup, a critical first step to addressing racial inequities in our behavioral health system.

     

    • Continue implementation of STEP-VA: $54 million. STEP-VA services improve access, increase quality, build consistency, and strengthen accountability across Virginia’s public mental health system.

     

    • Virginia Mental Health Access Program (VMAP): $8.4 million. Often times, concerns about a child’s mental health are first discussed with the families’ pediatrician. VMAP supports the integration of behavioral and physical health and builds the capacity of pediatricians to identify, diagnose, and treat mental health concerns through consultation, training, and referral support. The pandemic has and will continue to have an impact on the behavioral health of children in Virginia and Pediatricians need support to effectively address this need.

     

    Re-allot funding to support behavioral health workforce development and retention efforts. The behavioral health workforce shortage crisis is well documented. Our community services boards (CSBs) lack sufficient workforce capacity to address challenges in workforce recruitment and retention. CSBs often have difficulty hiring and retaining licensed clinical staff because salaries are often not competitive and reimbursement levels are low. As we build out a better mental health system, intentional efforts to support and develop an equitable workforce is paramount. These efforts include:

    • Fund the Behavioral Health Loan Repayment Program: $3.4 million
    • Increased Medicaid mental health provider rates to 110% of Medicare: $4.9 million
    • Fund additional clinical staff at the Commonwealth Center for Children and Adolescents (CCCA): $1.5 million.
      • While admissions at CCCA dropped to 50 percent capacity during the pandemic, ongoing mental health needs will likely cause a surge in admissions to the state’s only inpatient psychiatric hospital for children in the following months. To date, CCCA has incurred $115,333 in COVID-19 related expenses that remain unmet. To maintain a safe and therapeutic environment at CCCA, additional clinical staff is needed.

    For too long, the stigma of mental health needs has influenced both policy, funding and practice in Virginia, leading to unnecessary and unfair suffering. While our battle against COVID requires all our collective will, we hope lawmakers will prioritize the mental health needs of children and families as they make tough decisions about our state budget.