[Pictured: Dr. William Martinez, UCSF Director of Pediatric Mental Health for the UCSF Health and Human Rights Initiative, is the principal investigator of the Fuerte program, a school-based group prevention program targeting newcomer immigrant youth at risk of behavioral health concerns. Photo: Anna Hoch-Kenney]
Approximately 500 new migrants enroll in public high schools in San Francisco each year, according to district data. Of those 500, more than half come from Honduras, El Salvador, and Guatemala. An additional 8 percent comes from Mexico.
Linguistics, scholarship, society, economy, and now pandemic stress are common among immigrants these days. New Latin young people are at increased risk of traumatic stress and behavioral disorders, according to a study conducted by the William T. Grant Foundation. They are also less likely to access and use mental health care services than whites.
Fuerte, a one-semester mental health education program for new Spanish-speaking Latin immigrants from the San Francisco Unified School District (SFUSD), is trying to change that. Since its inception in 2015, it has served more than 350 young people and has survived the pandemic. Current iterations are being evaluated by UCSF researchers for their impact on mental health literacy, links and access to mental health services, and social connectivity.
According to Principal Investigator Dr. William Martinez, this study is an opportunity to demonstrate the concrete impact of mental health programs such as Fuerte on migrant youth. “If we can demonstrate that this program is beneficial to this population, we can get the money to sustain it. [and] Spread it elsewhere around California, “he explained. Currently, the San Francisco program is guaranteed funding for at least another two years, thanks to the Mental Health Services Act Innovation Fund, which has been covered by a 1% income tax on annual personal income of over $ 1 million since 2004. I am. ..
Fuerte is groundbreaking in recognizing the specific mental health needs of freshman immigrants and emphasizing the importance of preventive care. Martinez and his fellow clinicians first recognized the need for a preventive mental health program in 2013. [Central American] Children coming in [to the UCSF clinic] I have a lot of trauma, “he said. “Newcomers have arrived … when they were already more sensitive [with] More behavioral health problems. U.S. inhumane family segregation policies and the psychological consequences of detention centers on immigrants, criminalization of immigrants, and racist rhetoric at both national and interpersonal levels should be underestimated here. You can not.
Therefore, part of Fuerte’s programming is screening aimed at identifying mental health care needs and linking students to services faster. However, structural barriers to access remain. Conversations with newcomers of Latin descent in the program revealed that most young people are not available outside of class hours. “Most of our kids work after school and many of them work more than 20 hours a week,” Martinez said. Elte Corote.. “We have a labor turnover … for the same reason-it’s very expensive,” he said. The shortage of Spanish-speaking mental health clinicians in San Francisco means that care for patients in need of bilingual services is often delayed.
Erik Martinez, SFUSD’s focal services supervisor, said that new students “have a great need for mental health. [support].. There is a waiting list to make it accessible to people. Some of those waiting lists are closed …[some are] It means that no one has been seen for at least a month. I think Fuerte will help — I think school-based support will help, but I think you should also keep in mind that schools are closed during the summer. ”
The greatness of Fuerte, which is easily accessible during the free period of school, also reminds us of the limits of the program. Ensuring access to freshman mental health resources is a challenge that goes far beyond the limits of Fuerte and extends to local and state health policies and priorities. Children should not wait months for treatment appointments. Not addressing the proven need of Spanish clinicians in the city urgently is to ignore the Latin community.
In addition, Fuerte’s programming addresses the needs of literacy and linkage, but it also exposes new ones. For example, newcomers of Latin descent who speak Portuguese or indigenous languages have two language barriers: not speaking English and not speaking Spanish. “Many Portuguese-speaking people have been introduced to us. [or] “Mom,” Martinez said. One year, five Brazilian newcomers were introduced to Fuerte, and the program kept them away rather than trying to accept them.
A few years ago, San Francisco International High School, one of the three high schools offering Fuerte programming, approached a research team demanding adaptation to new students in Syria and Yemen. Deployment of the modified curriculum began in early 2020, but collapsed shortly after the pandemic occurred. However, the move to Zoom and Telehealth did not interfere with the more established Spanish program. In fact, in fact, the program was able to foster a sense of social connection among students. A young participant said in a focus group:Fuerte It’s a great group because we share ideas and dreams for our future, and other things about ourselves, and share them with the group … I learned a lot. [the other youth participants], And they also learned about me. ”
The effectiveness of the program over telemedicine is especially important from a scale-up and scale-out perspective to reach more new entrants. In more rural areas, such as the Central Valley, where there are not enough Spanish-speaking providers but there is considerable need, mental health education and prevention programs are effectively implemented and can have a significant impact. I know.
Regarding other future directions, the Fuerte team is discussing whether and how to involve parents in programming. Many newcomers are “reunified with families they have never met. [or that] They haven’t seen it for a long time, and now they need to learn to get along, “Martinez said. But again, there are similar barriers to implementation and access. Like children, parents often do multiple jobs and take care of their children. The waiting list is long. “We have to be creative,” Martinez said.
