[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]
Each year, about 500 newly arrived immigrants enroll in San Francisco’s public high schools, according to district data. Of those 500, more than half come from Honduras, El Salvador and Guatemala. Another eight percent comes from Mexico.
Among recent immigrants, linguistic, academic, social, financial, and now pandemic stress is common. Newly arrived Latino youth are at higher risk for traumatic stress and behavioral disorders, according to research conducted by the William T. Grant Foundation. They are also less likely than their white counterparts to access and use mental health services.
Fuerte, a semester-long mental health education program for Spanish-speaking Latino Latino immigrants in the San Francisco Unified School District (SFUSD), seeks to change that. It has served more than 350 youth since its inception in 2015, has survived the pandemic, and UCSF researchers are evaluating its current iteration for impact on mental health literacy, engagement, and access to health services. mental and social connection.
According to Dr. William Martinez, the principal investigator, the study is an opportunity to demonstrate the tangible impacts of mental health programs like Fuerte on immigrant youth. “If we can show that this program is beneficial to this population, we can get funding to keep it going. [and] spread it to other places in California,” he explained. As of now, the San Francisco program is guaranteed funding for at least two more years, thanks to the Mental Health Services Act Innovation fund, which has been funded by a one percent income tax on annual personal income of more than one million dollars since 2004. .
In addition to recognizing the unique mental health needs of recently arrived immigrant students, Fuerte is innovative in that it emphasizes the importance of preventive care. Martinez and his medical colleagues first recognized the need for a preventative mental health program in 2013, when they began seeing “many [Central American] children entering [to the UCSF clinic] with a lot of trauma,” he said. “Newcomers entered… when they were already much sharper, [with] many more behavioral health problems.” The psychological impact on immigrants of the United States’ inhumane family separation policies and detention centers, its criminalization of immigration, and its nationally and interpersonally racist rhetoric cannot be underestimated here.
Therefore, part of Fuerte’s programming is an assessment intended to identify mental health care needs and link students to services sooner. However, structural barriers to access remain. Conversations with Latino newcomers to the program revealed that most youth were not available outside of school hours. “Most of our kids work after school and many of them work more than 20 hours a week,” Martinez said. The owl. “We have staff turnover … for the same reason: It’s very expensive,” he said. A shortage of Spanish-speaking mental health doctors in San Francisco means care is frequently delayed for patients who need bilingual services.
Erik Martinez, supervisor of focal services for SFUSD, said that for newly arrived students “there is a critical need for mental health. [support]. There are waiting lists for people to have access. Some of those waiting lists are closed…[some are] minimum one month, which means that someone will not be seen for a month. I think Strong helps, I think school supports help, but I think we also need to remember that schools are closed for the summer.”
What makes Fuerte great, that it is easily accessible during free periods at school, is also a reminder of the limits of the program. Ensuring access to mental health resources for newly arrived students is a task that extends far beyond the boundaries of Fuerte and into state and local health policies and priorities. No child should have to wait months for a therapy appointment. To fail to urgently address the city’s demonstrated need for Spanish-speaking physicians is to neglect Latino communities.
Additionally, while Fuerte’s programming addresses literacy and bonding needs, it has also exposed new ones. For newly arrived Latinos who speak Portuguese or indigenous languages, for example, there is a double language barrier: not speaking English and not speaking Spanish. “We had a lot of people refer us who spoke Portuguese [or] Mom,” Martinez said. One year, five Brazilian newcomers were referred to Fuerte and the program turned them away rather than trying to accommodate them.
A few years ago, San Francisco International High School, one of three high schools to offer Fuerte programming, approached the research team to request an accommodation for Syrian and Yemeni newcomers. Implementation of the modified curriculum began in early 2020, but fell apart soon after when the pandemic hit. However, the transition to Zoom and Telehealth did not inhibit the more established Spanish-language program. In fact, even virtually, the program was able to develop students’ sense of social connection. One young participant said in a focus group: “strong it’s a great group because we share our ideas and dreams for our future, and other things about ourselves, and we share them with the group… I learned a lot about [the other youth participants]and they also learned about me.”
That the program is effective over Telehealth is particularly important in terms of scaling up and expanding to reach more newcomer populations. In more rural areas without enough Spanish-speaking providers but with substantial need, like the Central Valley, we now know that mental health education and prevention programs can occur virtually and have substantial impact.
Regarding other future directions, the Fuerte team is discussing whether and how to involve parents in its programming. Many new arrivals “are now being reunited with family members they have never met before, [or that] they haven’t seen each other in 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 their children, parents often work multiple jobs and/or care for children. Waiting lists are long. “We have to be creative,” Martinez said.