County, Stanford hope to open clinics in San Jose, Palo
Alto area
Elena Kadvany: Thu, Aug 23, 2018, 4:52 pm
A
yearslong effort to launch an open-to-all, one-stop-shop youth mental health
clinic in Santa Clara County took a critical step forward on Thursday, securing
$15 million in funding from the state's Mental Health Services Oversight and
Accountability Commission.
The
clinic is the product of a partnership between Santa Clara County and Stanford
University's Center for Youth Mental Health and Wellbeing. Together, they plan
to open two clinics — one in San Jose and one in Palo Alto or Mountain View —
to make mental health services more accessible to young people ages 12 to 25
years old. The clinics plan to focus on early prevention and intervention for
young people with mild to moderate mental health issues, but with close
relationships to services for youth with more severe mental illness. Services
will be provided at no cost and regardless of health insurance status.
The
clinic, which has yet to be named, is inspired by a model in Australia
called headspace, which provides early-intervention services — from physical
and mental health to alcohol and other drugs, work and academic issues — to
young people at low or no cost. There are similar youth mental health centers
in Canada and Ireland, but none yet in the United States.
The
team behind the local project hopes, ambitiously, that Santa Clara County's
would be the first of many such centers across the state and even the country.
"We're
in the innovation capital of the world," Toni Tullys, the county's
Behavioral Health Services director, told the mental health commission in
Sacramento. "What we're trying to do right now with Stanford and the
community is to be just as innovative in mental health as we are in tech. It
requires some bold, bold moves."
The
state funding is specifically for "innovative" projects that evaluate
"new best practices in mental health services" and have a defined
time period. The commission approved four years of funding for this project.
All
of the nine commissioners present on Thursday voted to approve the funding.
They expressed their support for the project but some questioned logistics,
from building two sites at once to how the centers will be sustained financially
after the state funding expires.
Commissioner
Gladys Mitchell, who represents the Sacramento area, asked whether the team has
considered starting with one center before expanding.
"I
like your big picture thinking," she said. "My question is because you
are thinking so big ... have you considered maybe just doing one site to start
with so it's not so big to scale?
"It's
kind of like purchasing two homes at one time and moving into both at the same
time," she added.
Tullys
said that they decided to open two sites to serve two distinct populations in
Santa Clara County — primarily youth of color on MediCal in San Jose and
commercially insured young people in North County. They also wanted to respond
to a "high level of need" in Palo Alto, Tullys said.
Working
with different demographics will also provide "richer" data and
lessons learned for implementing this model in other counties, noted Steven
Adelsheim, director of the Center for Youth Mental Health and Wellbeing. Other
California counties as well as sites in New York, Michigan, Illinois and
others, have expressed interest in creating a headspace-like model, according
to a lengthy project plan description
submitted to the state.
State
Sen. Jim Beall, D-San Jose, who serves on the Mental Health Services Oversight
and Accountability Commission, said members of a state mental health caucus are
also interested in pursuing legislation to promote such clinics in their
communities.
"There
is a lot of interest in this," Beall said.
The
question of the centers’ long-term sustainability remains unanswered, but the
group said there is "high interest" in pursuing public-private
partnerships. The Stanford Center for Youth Mental Health and Wellbeing has
received "multiple requests" from foundations who are interested in
supporting the clinics, the plan description states. They will also likely rely
on Mental Health Services and Supports funding from the state.
Santa
Clara County is allocating $8.7 million to cover its own personnel and
operating costs as well as evaluation of the centers. The county is paying the
Stanford Center for Youth Mental Health and Wellbeing $1.7 million for the
part-time clinical staff who will work at the sites and $1.4 million for a
technical assistance team (which includes a medical director,
education/employment specialist and evaluation implementation scientist).
A 'first of a kind' model
The
Santa Clara County centers will bring mental health and primary health care
services, substance use treatment, education and employment under one roof. The
project plan describes this model as "'one-stop-shopping,' which helps to
prevent stigma when accessing mental health services for young people."
The
staff will be made up of psychiatrists, psychologists, physicians, substance
use treatment counselors and others. The Stanford psychiatrists and
psychologists will be part-time, according to the project budget.
The
team envisions the clinics as culturally and linguistically inclusive and
making an effort to reach vulnerable and marginalized young people, including
LGBTQ, homeless and indigenous youth. They will not turn anyone away, Tullys
said, and are working to develop a blended model that accepts both private and
public insurance.
Stanford
and Santa Clara County's Behavioral Health Services Department will primarily
provide the direct psychiatric and psychological services, while community
organizations will provide peer support and case management. Partnerships with
community organizations will also allow for other services to be provided
directly to young people at the clinics and to make it easier to refer teens
out to other programs.
A
youth advisory group, made up of
27 diverse teenagers from throughout the county, is providing feedback on
everything from specific services to hours the centers should be open to what
the physical spaces should look like. The teens are working with Palo Alto
design firm IDEO on branding and design. The youth group will continue to
advise and evaluate the centers after they open.
The
county is also working with a vendor to collect data and evaluate the centers.
Derek
Zhou, a senior at Palo Alto High School, described to the commissioners the
difficulty of accessing mental health care locally. He said he went through an
"endless spiral" trying to find a therapist that would accept his
family's insurance and that he connected with. And as a young Asian-American
man, open conversations about mental health still feel "taboo."
"I
think of someone walking into the center and I feel instantly hopeful,"
Zhou said. "No one would have to go through the trial-and-error method I
went through because a diverse group of therapists would be available. Kids
wouldn't be afraid of familial or financial consequences because our services
would be confidential and free."
The
team hopes to identify a physical site for contract negotiations by November.
They are setting aside $5 million in the project budget to cover rent for two
locations.
They
hope to serve at least 1,000 young people in Santa Clara County in the centers'
first year.
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