Equity & Diversity

Mental-Health Aid for Immigrant Children Lags

By Mary Ann Zehr — May 01, 2007 8 min read
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As educators and experts assess the quality of student mental-health services in light of the deadly shootings last month at Virginia Tech, the gunman’s immigrant background is focusing attention on what those who work with immigrants say is a lack of services tailored to such groups.

There was no information as of last week about whether Seung Hui Cho, the university senior who killed 32 others and himself on April 16, had received school-based or other mental-health care as a child after his family immigrated to the United States from South Korea.

But mental-health professionals say that, in general, even school districts with programs that specialize in helping students from immigrant families are hard-pressed to keep up with the demand from the nation’s growing immigrant population.

“We’re overwhelmed,” said Rick Saneda, the director of the intensive-services division of the Los Angeles Child Guidance Clinic, which provides mental-health care in the Los Angeles Unified School District. “We don’t have enough staff to cover all the referrals or all the schools.”

For the population as a whole, about one child in six receives some kind of mental-health services. Of those, the vast majority—70 percent to 80 percent—get that care in a school setting, according to Sharon Hoover Stephan, the director of research and analysis for the University of Maryland’s Center for School Mental Health.

When it comes to immigrant children, the sheer number in U.S. schools—about 13 million between the ages of 5 and 18 as of 2006, or 23 percent of the overall enrollment nationally—has created a demand for care that is adapted for different cultures or for those coping with particular experiences, mental-health experts say.

For example, post-traumatic stress disorder, or PTSD, is found among some African children who have seen family members killed in wars in their home countries and among some Central American or Mexican youths who were beaten, raped, or subjected to other violence during their journeys to this country.

Symptoms of the same disorder can show up in immigrants who live in high-crime neighborhoods in the United States, where they may witness or become victims of violence, health practitioners say. In addition, they say, many immigrant children become anxious or depressed after they have left behind grandparents or other relatives who raised them while the children’s parents came to this country to get established.

The Princeton, N.J.-based Robert Wood Johnson Foundation has emerged as a key funder in this area of mental-health care. In March, the foundation awarded $4.5 million to 15 school-based mental-health programs designed for immigrants or refugees. The foundation had received applications from 355 school-based partnerships seeking the funding.

“There is a lack of funding for school-based mental-health-care services, no matter what age group or population,” said Wendy Yallowitz, a program officer for the foundation.

Point of Contact

Many who work with immigrant communities say that public schools are an ideal access point for mental-health services.

Offering Specialized Care

The Robert Wood Johnson Foundation’s Caring Across Communities initiative has awarded grants to local institutions and organizations to create or expand mental-health-care services for particular populations, to be delivered through schools.

Asian American Recovery Services
Santa Clara, Calif.
Population: Vietnamese

Children’s Hospital Boston
Boston
Population: Somali

Children’s Crisis Treatment Center for Health and Health Care in Schools
Philadelphia
Populations: West African (Liberia, Sierra Leone, Guinea, Ivory Coast)

Duke University
Durham, N.C.
Population: Mexican

Family Service Association of Bucks County
Warminster, Pa.
Populations: Liberian, Indian, Caribbean, Mexican

Imperial County Office of Education
Imperial City, Calif.
Population: Mexican

Los Angeles Child Guidance Clinic
Los Angeles
Population: Mexican

Los Angeles Unified School District
Los Angeles
Populations: Mexican, El Salvadorian, Central American, Korean

Minneapolis Public Schools
Minneapolis
Populations: Somali, Liberian, Oromo, Latino

New York University School of Medicine
New York City
Population: Afro-Caribbean

Portland Public Schools
Portland, Maine
Populations: Acholi, Arabic, Khmer, Nuer, Serbo-Croation, Somali, Vietnamese

Santa Cruz Community Center for Health and Health Care in Schools
Santa Cruz, Calif.
Population: Mexican migrant workers

University of North Carolina, Chapel Hill
Chapel Hill, N.C.
Population: Mexican

Village Family Services
Fargo, N.D.
Populations: Somali, Sudanese, Bosnian, Liberian

World Relief Chicago
Chicago
Populations: Vietnamese, Cambodian, Hmong, Somali, Bosnian, Liberian, Mexican

SOURCE: Robert Wood Johnson Foundation

“We see a lot of children in our schools who come from different countries,” said Marlene Wong, the director of crisis counseling and intervention for the Los Angeles district, which has 708,000 students. “Often we see them at the first point of entry, where they may not come to the attention of traditional mental-health services.”

Others say a school setting simply may be more approachable for some immigrant parents.

“Culturally, different populations recognize or don’t recognize mental-health issues in different ways,” said Deborah B. Berndt, a program officer for the Hogg Foundation for Mental Health in Austin, Texas. “It’s less stigmatizing to go up to a school for help than to go to a specialty mental-health clinic.”

Lien H. Cao, the associate director for the Santa Clara County office of the Asian American Recovery Services in San Jose, Calif., said the news that the killer at Virginia Polytechnic Institute and State University was a Korean immigrant had caused her staff to talk about how they could better reach children of Asian heritage who may have mental-health difficulties.

“It’s been hard to get ethnic referrals, particularly Asian,” said Ms. Cao, an immigrant from Vietnam. “Usually, teachers make referrals when they see the kids acting out, using drugs, or fighting. Asian kids do not act out. They are under the radar. They don’t tell on each other, either.”

The picture of Mr. Cho, 23, that emerged after the slayings showed him as an uncommunicative loner who had alarmed professors with the violent themes of his class writings. They had referred him for counseling. He had also been the subject of harassment complaints by two female students, authorities said, and had briefly been placed in a mental-health facility. (“College Rampage Renews School Safety Concerns,” April 25, 2007.)

Ms. Cao has designed a program, financed by the Robert Wood Johnson Foundation, to reach out to children from Vietnamese immigrant families at Morrill Middle School in the 8,300-student Berryessa Union School District in San Jose.

There is no such specialized program in the Fairfax County school district in Virginia, where Mr. Cho attended middle and high school. The 164,000-student school district isn’t releasing information to the news media about whether he received school-based mental-health care.

But the district provided a description of the mental-health services that have been in place in all its schools for at least the past seven years. Every school has a psychologist and a social worker. In addition, a mental-health worker is responsible for students in no more than three schools at a time.

Some of the programs funded by the Johnson foundation focus on a wide range of mental illnesses. A grant to the University of North Carolina at Chapel Hill, for example, connects a mental-health-care provider that serves Latinos with the teachers and staff of a middle and a high school in Siler City, N.C., part of the 7,500-student Chatham County district. It also will pay for a bilingual social worker to serve those schools, said Mary Lee Moore, the director of federal programs and English-language learners for the school district. Ms. Moore said that all teachers and staff members in the district will take diversity training to better understand the school’s immigrant students, who are mostly Latinos.

Some of the 15 groups that got the Johnson grants, which are for $300,000 each over three years, have considerable experience in serving immigrant families; others have put together such programs for the first time.

Strategies being used by the grant recipients include connecting school personnel with immigrant-run organizations, co-facilitating therapy groups with members of the ethnic group being served, using ethnic media to communicate about mental-health issues, and training school social workers to be culturally sensitive.

Treating Trauma

Several of the projects focus on treating children with PTSD, symptoms of which can include not being able to concentrate, having recurrent bad mental images, and having difficulty sleeping, which leads to irritability.

Ms. Wong, of the Los Angeles school district, has been a leader in piloting treatment for children of immigrant families with the disorder. She has conducted surveys of children from immigrant families who say they have been “hit, kicked, punched, threatened with a gun or knife, or witnessed it,” she said.

In 2003, she teamed up with researchers to pilot a 10-session group-counseling program developed by experts to treat 6th graders in Los Angeles with PTSD who were primarily Latino. The program—the subject of an article in the Journal of the American Medical Association on Aug. 6, 2003—is a rare example of an “evidence-based program” for mental-health care in schools, according to Ms. Wong.

In Philadelphia, the Children’s Crisis Treatment Center four years ago started a school-based program to treat the same disorder among immigrants from Liberia, Sierra Leone, and Guinea. That program includes treatment groups facilitated by both a trauma clinician and someone from the West African community who has experience with mental-health care.

Julie O. Campbell, the coordinator of trauma-focused projects for the Philadelphia center, said the center got involved in tailoring care for West Africans after a West African child who was a student at Tilden Middle School was beaten up by African-American children and hospitalized. A teacher at the school begged the center staff to provide mental-health care not only for that child but also for other West African children at the school—and for their parents.

Initially, the program—which also provides case managers for parents and training for teachers to understand the effects of trauma—was funded by a federal grant. It’s now financed in part by the Johnson foundation.

But such school-based programs remain exceptions. In an era when schools are focused so heavily on raising student test scores, providing mental-health care at school can be a hard sell, said Andrea Kuebbeler, the clinical director for Alternatives Inc. in Chicago.

Her organization specializes in providing such services to immigrant youths and is a partner in a Johnson grant with World Relief Chicago and with two Chicago public schools.

“If we can’t see a kid during their lunch break, and have to pull them out of class, that isn’t often allowed, even if the child is in crisis,” Ms. Kuebbeler said. “But if they are in class and can’t concentrate, they aren’t going to learn what they have to learn.”

A version of this article appeared in the May 02, 2007 edition of Education Week as Mental-Health Aid for Immigrant Children Lags

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