The Center for Care Innovations works to support the “health care safety net,” a patchwork of organizations working in low-income neighborhoods across the United States. Below are excerpts from their July 12, 2022 article – read the full version here.
When the Community Health Centers of the Central Coast (CHCCC) teamed up with the local nonprofit Fighting Back – Santa Maria Valley, its providers expected to focus on intervention and preventive mental health services for teens – in particular, those experiencing adverse childhood experiences (ACES) and domestic or intimate partner violence. Then the pandemic hit. It quickly became apparent that the new alliance formed by the two organizations, known as the Peace Network, would need to switch to crisis management mode.
This was crucial to help preserve youths’ physical, psychological, emotional, and spiritual health during an unprecedented time. With so many teens suffering from isolation, disruption, loneliness, and grief, the Peace Network – short for Positive, Equitable and Affirming Childhood Experiences – would focus on expanding mental health services in the high schools. With a pandemic-related uptick in anxiety, depression, substance use, and ER visits linked to domestic violence, along with lockdowns, remote learning, and job loss, the partnership had to pivot fast.
Rather than seeing COVID-19 as an insurmountable obstacle, this coastal California partnership viewed it as a situation that accelerated the pace of innovation. To better meet the needs of the community, says Magdalena Sunshine Serrano, CHCCC’s Director of Behavioral Health department, “we had to go beyond brick and mortar to ‘click and mortar.’”
As with all health clinics, CHCCC quickly shifted to virtual care not long after the pandemic emerged. That included reaching its adolescent patients remotely, too. Fighting Back referred students to clinic counselors, who also receive referrals from pediatricians.
During the peak of the pandemic, the demand for mental health treatment for youth proved enormous, even overwhelming at times. The center saw a 300% jump in referrals, according to Serrano. Their switch to a digital delivery of services—telehealth and telephone appointments and referrals—proved more effective and efficient than clinic visits, she says. It also eliminated barriers for adolescent participation, such as transportation and distance, and gave teens the ability to access culturally relevant and language accessible counseling that may have been out of reach prior to the pandemic.
Serrano, currently a fellow with the California Health Care Foundation Health Care Leadership Program, sees the benefit of combining telehealth and behavioral (aka mental health) services reflected both in data and anecdotal evidence. In the leadership program, Serrano is focusing on the state-wide development of a telehealth-based behavioral health model. From her perspective, digital equity and health equity are intertwined, and the pandemic only magnified that reality. Starting early on in the COVID-19 outbreak, the clinic went the extra mile to ensure that patients with less access to tech—in particular vulnerable Indigenous and Latinx clients—got the assistance they needed for healthcare, vaccine clinics, and mental health counseling.
“The whole partnership process has taught me that it’s not enough to be of the community, you need to be in the community,”
LGBTQ students have been particularly vulnerable during the pandemic, when in-person support systems in the school and greater community were more difficult to access or unavailable, notes Serrano. That’s particularly tough for LGBTQ students who don’t have support at home, she adds. It’s also crucial because LGBTQ youth experience mental health challenges and suicidality at higher rates than their heterosexual peers. Transgender youth are two times more likely than their cisgender peers to experience depression, consider suicide, or attempt suicide. Approximately 17% of youth (ages 6-17 years) live with a mental health disorder. Half of all mental health illnesses begins by age 14, with 75% of such illnesses emerging by age 24.
live with some form of mental illness
of all lifetime mental illness begins by age 14
of all lifetime mental illness starts by age 24
Health centers like CHCCC see evidence of that crisis in their clinics on a daily basis. Partnering with other like-minded organizations in the area can be crucial to ensuring that youth get the behavioral healthcare services they need in a timely fashion. “The whole partnership process has taught me that it’s not enough to be of the community, you need to be in the community,” says Serrano. “It’s helped me have a better understanding of the issues beyond healthcare, and helped me understand different systems—such as schools, which are vital partners as they give us access to the most vulnerable adolescents.” That includes students who may be witnessing domestic violence in their homes, at risk for intimate partner violence themselves, or screen positive for mental health concerns.
For Serrano and her counseling team, there is no turning back. “This program is here to stay. We have created an intentional and inclusive framework with partnerships that help create pathways for us to care for the community — in this case, the physical, psychological, emotional, mental, and spiritual health of our adolescent youth. We are meeting the moment and the movement of what it really means to be a community healthcare center.” But Serrano, who was named Trauma Resource Institute ambassador of 2021, knows there is more to do. “Now we have to start looking at the entire family system and how we can support our community doing the upstream work of early intervention and prevention… so we can move the needle here on these cycles of intergenerational trauma.”