The HOPE Coalition Mental Health Model
The HOPE Mental Health Model fills a critical gap in Worcester. The roughly 30,000 young people between the ages of 11 and 24 living in Worcester are exposed to a number of community-level risk factors associated poor mental health outcomes and are at risk of becoming “disconnected” as young adults due to poverty, school dropout, inability to access jobs, involvement in the juvenile justice system, substance abuse, and early pregnancy. Mental health problems and limited positive coping skills excacerbate many of these problems.
Nationwide, one out of five young people are affected by a mental health problem. Two thirds of youth who have mental health problems are not getting the help they need; youth of color and low-income youth are least likely to get mental health care (Kataoka, S. et al. 2002; NIMH 2002; Yeh, et al, 2003). In Massachusetts, “70% of the children who need mental health services do not receive them” (MSPCC 2006). Nearly 50% of students with a mental health disorder drop out of school, the highest drop out rate of any disability group (An Act Relative to Children’s Mental Health, 2007). Despite enormous need, there are many problems in the children’s mental health system, including a lack of culturally competent, linguistically appropriate early identification and prevention services (Children’s Mental Health in the Commonwealth: The Time is Now, 2006). A growing body of evidence indicates that blending mental health into settings such as school, primary care, and into the community helps to overcome some of these problems; yet this is happening only to a limited extent
In Worcester, there are many challenges for youth to access supportive mental health counseling. For example, Worcester has numerous school-based and community-based programs that serve young people; yet, few address their mental health needs. In 2007, the Youth Opportunities Office assessed 56 organizations offering 87 different youth programs in Worcester. This assessment demonstrated that there was abundant recreation, education and leadership development programming but limited programming accessible to youth in the areas of gang violence reduction, domestic violence, emergency services, truancy, runaway/homelessness services, and health related programs (including physical health, mental health, and substance use).
Our Plan to Address that Need
Given Worcester’s demographics, the growing number of ‘disconnected’ young people, trends in the unmet mental health needs of youth, the lower number of programs that provide mental health support and emergency services, and the problems identified through the HOPE Peer Leaders’ needs assessment, we believe that the HOPE Mental Health Model is a greatly needed problem prevention, crisis intervention, and organizational capacity building strategy in Worcester. The HOPE Model provides mental health supports and crisis intervention in the places that at-risk young people attend. Our model to integrate supportive mental health counseling into community-based youth organizations directly addresses the barriers youth face to receiving the help that they need. This model, developed through a youth-adult partnership has operated for nine years and has served over 1,500 young people who otherwise would not have had access to this type of mental health support. In 2011-2012 alone, close to 600 different young people were served through one-on-one counseling, in innovative therapeutic groups such as ‘Photovoice’, case management, and through crisis interventions.
The Model integrates mental health counselors into the staff of the Boys and Girls Club, the Worcester Youth Center, Girls, Inc., and YouthNet. The counselors provide mental health services and interventions while incorporating a holistic, positive youth development approach. They are hired and receive clinical supervision by the Massachusetts Society for the Prevention of Cruelty to Children (MSPCC). The primary role of the counselor is to build relationships with youth and staff in the organizations. Counselors provide individual and group counseling and skill building to teens, and training and guidance to staff on how to identify and address mental health problems.
The HOPE Model includes six main components. 1) Informal, milieu support. Roughly half of the counselor’s time is spent “on the floor” getting to know the youth, identifying potential problems, providing staff support, and performing crisis intervention. 2) Group support. Roughly a quarter of the counselor’s time is spent running support groups and positive coping skill trainings for the youth, such as the Photo-voice group described below. 3) Intensive Counseling. Roughly one-quarter of the counselor’s time is spent seeing youth with more significant mental health issues one-on-one. 4) Case management. Several hours a month are spent off-site, connecting with the youth’s families, schools, and assisting youth at court. 5) Referrals. If the counselor determines that the mental health needs of a particular youth are too serious to address on-site, he/she will refer the youth to MSPCC or other agencies for more intensive services. 6) Staff training and one-on-one staff consultation. The counselors conduct formal staff trainings on how to identify signs of mental health problems, how to address youth crises, and how to do early intervention and effective referrals. Additionally, the counselors provide countless hours of individual support and coaching with staff on how to address challenging youth behaviors.
An example of an innovative program we use to emphasize positive mental health and to educate the community on youth strengths and struggles is called Photo-voice (Lopez, Eng, Robinson, and Wang, 2005). Photo-voice is a participatory and empowering program meant to give voice to marginalized groups in a community. The HOPE Mental Health counselor at the Boys and Girls Club used Photo-voice in a group she called, “Slides of our Lives” as a way to engage high risk youth who would otherwise not be interested in a therapeutic group. Photo-voice had them taking photographs of the places and things that represent difficult emotions to talk about, such as hope, love, success, loss, respect, and pride. The photos offered a window into the teen’s lives and became a catalyst for group discussions about difficult topics. Photo-voice also gave the youth the opportunity to display their work at an exhibit at Worcester’s Nu Café restaurant. The youth were extremely enthusiastic about the program and have raised $200 on their own initiative to purchase cameras to run the program again this year.
By locating mental health support at the Boys and Girls Club, the Worcester Youth Center, Girls Inc.,and YouthNet where 90% of the youth are low-income and over 75% are Latino or African American, the HOPE model directs service to low-income youth of color—unquestionably a vulnerable population facing barriers to accessing professional mental health support. The Model is primarily a prevention and early identification strategy, which fills a gap in local services. In summary, the HOPE Model:
- Increases access. It reaches young people in the places that they ‘hang-out’, rather than making them come to a clinical environment that may not be teen friendly.
- Reduces stigma. The young people who designed the program felt that by integrating qualified counselors into the staff of the places teens hang out, young people would feel more comfortable accessing services. The counselor isn’t seen as the person you go to when you are bad, depressed, or acting ‘crazy’, but rather as a supportive member of the staff.
- Builds capacity. The counselor works with staff to develop their ability to identify and address the problems young people exhibit. As a result, the organization becomes a healthier place for all young people, ultimately preventing serious problems from occurring.
WorcesterBoys and Girls Club