BY REED CONNELL

“Although the COVID-19 crisis is, in the first instance, a physical health crisis, it has the seeds of a major mental health crisis as well, if action is not taken.”

So begins the United Nations’ Policy Brief: COVID-19 and the Need for Action on Mental Health, released May 13, 2020. A similar U.N. brief, released the previous month, addressed the specific threat of COVID-19 to children’s mental health.

On May 27, 2020, the World Economic Forum (WEF) released its report, “A Global Framework for Youth Mental Health,” which followed the release the day before of a similar WEF call to action: This Is Why We Need to Change Our Approach to Young People’s Mental Health.

The message from these international bodies is clear. There is a real threat of a “plague of mental illness” in children.And the pandemic will only exacerbate a problem that already existed: U.N. Secretary-General António Guterres recently said, “Mental health problems, including depression and anxiety, are some of the greatest causes of misery in our world.”

The WEF calls out:

• 75% of mental illnesses begin before the age of 25; 50% begin before the age of 15.
• At least one in four people experience mental health problems.
• Most mental health systems are split between children and adults, leaving many young people struggling with different approaches at their most vulnerable moment.

Existing mental health services, according to the WEF, are “poorly integrated with the wider service system addressing the diverse needs experienced by young people with mental illness, such as the education system, welfare, housing and other supports. This is clearly a situation that needs to change.”

The American response to the pandemic has resulted in the highest number of cases and deaths in the world. Terrible inequities shaping our nation’s collective experience — shocking disparities in illness and mortality across race and socioeconomic status — have been brought to light like never before.

Given current consensus on the long-term impacts of poor mental health, we must mobilize policymakers, professionals, parents and communities to build a new era of proactive support for children. Doing so is even more urgent now that our nation is gripped by sweeping protests against the trauma of police brutality and entrenched unchecked structural inequity in the wake of the killing of George Floyd by police officers in Minneapolis.

Before COVID-19 there was already a mental health crisis in the lives of children and youth. The pandemic is gasoline on the fire.

America’s kids do not experience the pandemic or the mental health crisis equally. Nationally, while 11% of youth have been diagnosed with a mental illness, two-thirds of youth who have a condition are not identified and do not receive mental health service. (Medicaid.gov); In California, only 5% of youth on Medi-Cal receive a behavioral health service.

Founded three years ago in response to overwhelming evidence of this crisis, The California Children’s Trust is a coalition-supported initiative to reinvent how California defines, finances, administers and delivers children’s mental health supports and services.

Equity + Justice is at the center of our beliefs, actions and strategy for change. In the time since the pandemic began, we see hope in the unprecedented public dialogue about the need to address the crisis and support children over the long term.

The U.N. brief provides many actionable recommendations that the Trust supports and believes are possible.Several key points resonate with the principles we’ve advanced and the conversations we have been having with partners and stakeholders:

• “Investing in mental health interventions that can be delivered remotely, for example quality-assured tele-counseling for frontline health-care workers and people at home with depression and anxiety;”
• “Using the current momentum of interest in mental health to catalyze mental health reforms, for example by developing and funding the implementation of national services re-organization strategies that shift care away from institutions to community services;”
• “Building human resource capacity to deliver mental health and social care … and organizing community-based services that protect and promote people’s human rights, for example by involving people with lived experience in the design, implementation and monitoring of services.”

The nation must proliferate innovative approaches that are responsive to the distinct needs of young people. One size does not fit all. Interventions and services need to be grounded in research on the impacts of trauma and adversity.

Delivery models should not be centered solely on a 50-minute counseling session. They should recognize the value of frequent brief contact and diverse modalities, delivered in community settings. And every step of the way, we should engage the voices of children, youth and parents, and ensure they see their input and preferences reflected in policy, practice and financing.

As the WEF rightly notes, “young people are not interested in a prescribed model imposed on them. They are keen to have guidance, but equally willing to contribute a local viewpoint about how the guidance should be interpreted and implemented.”

We must take this global call to action to every zip code in the USA.Now is the time to strengthen the nation’s safety net for children.To increase federal Medicaid mental health financing.To augment in-person services with thoughtful and effective technology-driven modalities, which are equitable and accessible to youth.To move schools to the heart of our nation’s children’s mental health infrastructure. To train and transform the mental health workforce and prepare it to meet the challenges ahead as young people emerge and begin to grapple with unprecedented levels of trauma from COVID-19 while confronting relentless racial injustice and systemic inequity.

The federal government has a role to play in answering the WEF and U.N. calls to action. Congress and the administration can empower states to make the necessary structural changes and can recognize that additional federal funding for mental health care is an essential element of all pandemic response legislation.

But states and localities know the true needs of their children and families, and they are leading the response. It is in communities that innovation and effective responses will take hold and have an impact.

As the pandemic and national despair about inequity and injustice touch all of us, our shared experience can align us around an unprecedented effort to support America’s children and youth. Now is the time to advocate together, to demand action from federal, state and local policymakers to leverage what is needed to save a generation.

Reed Connell is the director for external affairs for The California Children’s Trustand Claudia Page is a healthcare consultant in California.

We are so proud to have her as a long-standing member of our board!

It may be surprising that Donna Hitchens M.A., J.D. ’77—who became the first openly lesbian judge elected to the bench in the United States and spent 20 years of her career on the California Superior Court bench—never dreamed of becoming a lawyer, nevermind a judge.

Saralyn Ruff, our Clinical Consultant, collected responses from young adults in foster care to learn about their experiences and needs during COVID-19. Please review her Preliminary Report here, and contact her with any questions.

This national survey assessed the needs, concerns, and strengths of young adults (ages 18-26) with a history of foster care in response to COVID-19. Participants (n = 127) completed the survey in May and June, reporting their physical, financial, social, psychological, relational level of concern, as well as their confidence in existing professional goals and pride in strengths and accomplishments. Participants were asked to assess all domains before, during, and in the year following Shelter in Place (SIP) due to COVID-19, to identify the immediate impact and perceived impact over time. Participants offered recommendations for present and future resources.

On a recent Monday evening, a young man strummed a guitar as he performed an original song for his peers—physically scattered around Oregon but gathered virtually in a video conference room. Listening intently, the other youth waved their fingers in the “sparkle gesture” to show their appreciation for the powerful piece.

The youth on the call were all members of Our Children Oregon’s Oregon Foster Youth Connection (OFYC), an advocacy program led by former and current foster youth ages 14 through 25. After the shelter-in-place directive was instituted in their state in late March, many young people in the program shared with Lisa McMahon, OFYC program director, that they were struggling and felt the need for connection and support.

“They were talking about their mental health, and acknowledging their need for connection and support,” says McMahon. “They weren’t saying, ‘I really need to talk to a therapist,’ but all the things they typically do for self-care, like getting together with their peers, now weren’t possible, and that was creating a problem for their mental health.”

Describing their experience of the pandemic, more than one young person said “foster care prepared me for this,” referring to the way it prevented them from spending time with people they love and doing things they enjoy doing. Connections and self-care are particularly important for people healing from the traumatic experience of foster care and the events in their life that led to it. McMahon asked the youth if they’d like to form a support group with help from therapists. “And they thought it would be a great opportunity for connection,” she says.

So, McMahon contacted Laura Orgel, the local clinical director for A Home Within (AHW), a national organization providing free one-to-one therapy to current and former foster youth. Each AHW therapist commits to providing therapy at no cost—and for as long as it takes— to a young person who has experienced foster care. A Home Within has been providing therapy to OFYC members for years.

“Often young people who have experienced foster care have a negative impression of therapy because they were required to see a therapist when they were younger and did not have a positive experience,” says McMahon. “A support group, as opposed to ‘group therapy,’ seemed like the perfect opportunity for the OFYC youth to experience a positive interaction with a therapist. It normalizes it.”

Orgel was delighted to facilitate the group in partnership with McMahon and OFYC and contacted Judy Herzberg, a member of the local AHW team, who agreed to co-lead it.

Starting in early April, the group began meeting by video conference every Monday evening. Six young people showed up for the first session. In keeping with OFYC’s model of youth leadership, the young people decided how the group would run and what the group agreements would be.

For instance, the youth decided the group would be open—meaning participants could come and go as they liked, showing up one week and missing the next. It would be open not only to OFYC members but also to any former foster youth who expressed interest in joining.

Perhaps most importantly for the group, they could participate however they were comfortable: visible on the video or not; speaking directly to the group or through a private chat with McMahon; taking a break, doodling, and fidgeting as needed. The youth also wanted a place to share their creative work and other things important to them. They agreed to reserve time each week for a showcase. Youth have shared poetry, drawing, songs, paintings, constructions, and even a kitten!

“As the early weeks went along,” says Orgel, “the participants saw that they had the power to create the kind of group they could really benefit from. For young people who have not always had control over their environments, this has been a powerful experience.”

The youth let their peers know what kind of support they’d like to receive from those on the call, and their peers respond in kind, offering emotional and/or practical support, or whatever type of support each youth is looking for.

“It’s a place where I can go and speak about what is happening in my life and also hear others’ stories,” said one young participant. “Hearing others helps remind me that I’m not alone through all of this and there are others also struggling. It also shows me that there is hope on the other side when positive events get brought up.”

When a young person shares their struggles such as rent coming due while they’re not working, the other youth show empathy and understanding, echoing their experience and expressing appreciation to them for sharing. Sometimes, practical support is needed, as when one young woman shared that she was running out of diapers for her baby. She was connected to a source for free diapers via a link added to the chatbox on the video call.

When feelings of loss or even despair have surfaced, participants have offered words and gestures of understanding and caring. They’ve shared strategies for staying safe, taking care of themselves, and maintaining their connections.

“The group means a lot,” said one participant, “because I don’t have much access to counseling and support groups that are related to having experienced childhood in care. I was in foster care for 11 years and there’s not a lot of mental health professionals that have experience working with people like me. I definitely like that our input is valued because I feel like I can say when I am uncomfortable in session.”

One thing these young people can count on during this unsettling time is that every Monday evening, they can click a link to be virtually transported to a roomful of peers and supportive adults— a place where they can share their feelings and concerns, and openly discuss whatever is on their mind without fear of judgment.

As the pandemic continues, so does the group, evolving to meet the shifting challenges, and providing, in the midst of much struggle, a creative, collaborative, and supportive haven.

Identifying details have been changed to protect the privacy of the support group participants.

By David Brooks

This article was originally published by The New York Times.

Being a kid can be hard. Being a foster kid can be even harder. Being an LGBTQ foster kid can sometimes be so hard that kids end up on the streets instead of protected by the agency that is responsible for their care. The child welfare system is charged—first and foremost—with providing for the physical safety of children whose parents are unable to care for them. This means that they need a roof over their heads and food in their bellies. Those are the basics; the rest follows.

Sadly, when the system is unable to meet even these basic needs vulnerable young people have little choice other than to join the ranks of the homeless and learn to fend for themselves on the streets. Unfortunately, those who work in and around the foster care system are seldom surprised to learn that LBGTQ youth are over represented in the homeless population and are likely to be on the streets longer than their peers. They are also likely to have more serious physical and emotional health problems. True Colors Fund Study

Of course, a tragic story accompanies all homeless young people—regardless of race, religion, gender, or sexual orientation. Trauma doesn’t discriminate, but the lives of homeless LBGTQ youth often have a particular poignancy. Frequently, they have suffered quietly in their families and communities, struggling to come to terms with feeling different from those around them who so easily fit into the straight world. Despite decreases in homophobia in some communities, fear, distrust, and dislike of anyone who is not straight or whose gender brings into question the validity of a world that admits of only two genders remains rampant in many quarters of this country.

When these young people do eventually find the courage to tell family and friends about the ways in which their sexual orientation or gender expression sets them apart, too often their families feel threatened, turn against them, and send them into foster care or onto the street. Regrettably, for many, foster care is merely a detour on the way to homelessness—a space where homophobia and lack of appreciation for gender non-conformity continue to a much greater degree than they should.

Although the picture is grim and young people continue to suffer while harmful attitudes and behavior toward those who are different from the norm change far too slowly, there are some bright spots in and around the foster care system. Through the Center for the Study of Social Policy, the Get R.E.A.L. campaign www.cssp.org has brought together over eighty individuals, organizations, and government agencies to address the issues facing LGBTQ foster youth. The group has created powerful materials to help caseworkers, foster parents, other staff, and volunteers recognize both blatant and subtle forms of mistreatment of the LGBTQ community. On another front, RaiseAChild actively recruits and supports gay and lesbian couples through the foster and adoption process.

We need more efforts like these so that our gay and transgender family members and friends will feel loved, and respected throughout the year. They must be honored, not just during the days of PRIDE month, but every day of every year.

By Toni Heineman

Valentine’s Day: Beyond Romance

Particularly this year, it is important to reach beyond flowers, chocolates, and heart-shaped gifts to the love that binds us to family, friends, and community. Too many among us now live in fear of losing those they hold most dear. Parents worry that they will be sent back to a country that they left for the promise of safety and freedom. Children worry that they will come home to an empty house, with no clue about how to even begin looking for the parents or siblings they hugged when they left for school.

College students, brought to the United States as infants, fear that they will be torn away from the only country they have ever known. They want to stay and learn so that they can work, pay their taxes, and raise their children to do the same.

Today, as we celebrate romance, whether the excited joy of new love or the contentment of love smoothed by years, we also remember that the capacity to love fully begins in the safety of home and family. We learn to love from being loved. We learn how to care by being well cared for. We learn to listen by being heard, to look after by being watched over. Strong families build strong communities with the capacity, interest, and skills to care for their citizens. We protect and strengthen our country by protecting and strengthening families. This means not only honoring individual families, but also attending to the institutions promoting the well-being of children. We at A Home Within are particularly concerned about the foster care community. We worry that an influx of children left behind in the wake of wide-spread deportations will swell the already growing child welfare rolls, beyond the system’s capacity to provide even minimally adequate care. We need to remind those in power that refugee and immigrant children must be able to count on their community and country for protection, safety, and security.

Children do not have a voice in the policies that govern their lives, so we need to speak for them. In return, they will develop their voices as they grow. We will benefit every day from the fierceness of their love for community and their loyalty to country.

I hope that today will find you celebrating with those you love. Perhaps you will enjoy a romantic evening, a meal around the family table, or an outing with friends. If you are fortunate to have any of these special moments in your life, I hope that you will also remember to hold those who are separated from friends and family in your hearts and minds.

Warmly,

By Toni Heineman

What’s So Hard about Hope?

Our sense of optimism and the capacity to hope are rooted in the first months of life. When infants are fed when they are hungry, comforted when they are distressed, changed when they are wet or soiled, gently rocked to sleep when they are tired, and greeted with a smile when they awaken, they learn that the world is a pretty good place. Fortunately, the world just needs to be “good enough,” because, of course, not every day or night is smooth, there are no perfect parents, and babies are not equally responsive.

When babies’ needs are met day after day, month after month, they get progressively better at letting people know what they want or need. In turn, their parents and other caregivers become better at reading their increasingly subtle signals.

Optimistic children have a sense of confidence about the future. Because they trust that the world will treat them well, they are not afraid to hope and dream. They are also not afraid to work hard to get what they want. When their plans fail—when their hopes are dashed—they have the confidence to pick themselves up and try again.
When life does not begin so well, babies do not learn to hope. If their needs and wants are ignored or their care is misguided, they do not develop a sense of confidence that the world will care well for them. They become pessimistic about the future. They have no reason to hope that things will improve or that tomorrow or next week will be brighter. Without the expectation that their efforts will be rewarded, children do not learn to plan for ways to get their needs met and to work hard for what they want and need.

Sadly, life often does not begin well for children in the foster care system. For many complicated reasons—some stemming from the environment, such as poverty, or homelessness; some arising from the individual, such as mental and physical illness, or addiction—their parents are unable to care for them. Some infants are placed with a family who will eventually adopt them and give them the kind of consistent loving care that allows them to build confidence and learn to hope. Others are not so lucky; they are moved from one home to another, often with periodic stays with their biological parents, in the futile hope that the family can be permanently reunited.

When children’s earliest lives are filled with uncertainty and inconsistent care, they shut down, withdrawing into themselves rather than exploring the world or reaching out for help. They become emotionally numb and fearful of relationships. After all, what is the point of hoping if you are certain that you will be disappointed?

So many of the foster youth who are referred to A Home Within for psychotherapy enter their therapists’ offices too scared to hope that this relationship might be different. Some children approach therapy angrily, actually or virtually challenging their therapists to leave them alone. This anger usually masks fear—better to push someone away than to hope for help and be left behind once again. Others don’t engage because they are convinced that this therapist will leave just like all the rest; others are silent because they are afraid to believe that this therapist might really listen.

Human beings are fundamentally social animals who, at the deepest level, crave relationships, even if it takes a very long time to transform fear into hope. One of our therapists told us about her beginning work with “Rosa,” who came regularly to her weekly sessions, even though it took nearly ten months before she found the courage to make steady eye contact and begin meaningful conversations. Fortunately for Rosa, her therapist ignored a colleague who suggested that she should end treatment after a few weeks because Rosa wasn’t making progress. Instead she followed the original mission statement of A Home Within, determined to be available “for as long as it takes.”

The therapists who volunteer their time through A Home Within are wonderful and generous people who offer many things to foster youth—patience, thoughtful listening, caring, stability, and kindness, just to begin the list. They also know how very, very frightening it can be to trust enough to begin to hope. They keep hope alive for children who are too scared to hold hope for themselves.

I hope that you will help the therapists who offer so much to our most vulnerable children.

By Toni Heineman

by Toni Heineman

Monday morning brought news of another mass shooting. I was startled when I realized that I had silently sighed, “Well, only two dead this time.” Only two real people—teenagers with families, friends, neighbors, teachers, coaches, and scores of people who will never have a chance to know them—gone forever, for reasons that are apparently yet unknown. My reaction made me feel ashamed that I had allowed myself to become hardened to the premature and senseless loss of any life.

This is one of the very troubling consequences of our being inundated with horrific stories and images of trauma and death. Even if we are not in immediate danger, we can become numb as a way of protecting ourselves from being emotionally overwhelmed. Sometimes we defend ourselves by not watching the news and sometimes we watch or listen without feeling.

Some of us have the luxury of turning away from violence by simply ignoring the multiple media channels ready to bring us news of the world. But many are not so fortunate. The Associated Press reported that the Florida shooting, following an event that was supposed to bring some summer fun to teenagers, happened in a neighborhood where gunfire is not uncommon. See LA Times article here.

We know that community violence has profound and lasting negative consequences on children’s emotional well-being, physical health, social relationships, and ability to learn. See more here. Not only are they subjected to continual and unpredictable dangers, the adults who are supposed to care for them are also traumatized by the lack of safety, making it difficult for them to attend and respond to the needs of children, who as a means of self-protection, may not be able to ask for, or even know, what they feel or need.

Many of our most vulnerable children live in impoverished neighborhoods beset with community violence. Already the story of the tragic deaths of Sean Archilles and Stef’an Strawder is fading from the news. Sadly, because we know that another incident will again make headlines for a short time, we are tempted not to attend fully to the story of each loss. Perhaps we cannot help the grieving families and friends directly, but we can hold ourselves accountable for knowing. We can refuse to pretend that turning away or learning not to care is a solution to the problem of human suffering.