With the public mental health care system strained by the pandemic, a new Northern California program aims to serve children least likely to get the help they need — foster youth who are struggling emotionally but not in an apparent crisis.
The teletherapy program is a joint project of court-appointed special advocates in Contra Costa County and a San Francisco-based nonprofit that has long provided pro bono therapy to foster youth, A Home Within.
The two groups have teamed up to provide free weekly sessions to young Californians aged 12 through 18 who aren’t able to access mental health care through other means. Program manager Elliott Night said many participants have struggled to access therapy benefits because their symptoms aren’t severe enough to qualify for the services provided in foster care.
“They were being assessed and deemed to be doing OK,” Night said. “They’re doing OK in school, they’re not acting out. So these were the youth who were kind of falling through the cracks.”
Foster children in California receive health care through Medi-Cal, the state’s Medicaid program. But in order to receive mental health treatment, they must have a clinical diagnosis. For all services, demand far outpaces supply, with children who do qualify often left on waiting lists.
More than 6 in 10 foster youth have at least one mental health diagnosis, but nearly all have suffered trauma, according to research from the Casey Family Programs.
Still, emotional pain and even psychiatric disorders can be hard to identify in some children — such as kids with low-level depression or those keeping anxiety and panic attacks a well-kept secret. The Bay Area teletherapy project serves those patients, as well as children for whom no available therapists can be found. Virtual sessions make it possible for foster youth to keep working with the same therapist even if they move or don’t have reliable transportation.
Participants are matched with volunteer therapists who they meet with for weekly hourlong sessions. Each therapist is vetted and interviewed by program staff, and those who don’t work with foster youth in their regular practice receive additional training. Clients are encouraged to stick with the often-uncomfortable therapeutic process with Visa gift cards they receive after the third and 10th sessions.
Survey responses from youth participating in the teletherapy program reveal their gratitude:
“In these trying times everyone is struggling, everyone needs someone to talk to,” one client wrote. “The life of a foster youth is often filled with strife, trauma, and depression. The program gives us a chance to have a release.”
Another said the program motivated them to continue therapy after an interruption, increasing their capacity for self-love, communication and coping with anxiety. A third said simply: “It’s good to know someone cares.”
Licensed clinical social worker RaQuel Neal, who trains child welfare social workers for Alameda County in addition to her private therapy practice, has volunteered with the project since it launched in 2020. She said even if mental health challenges aren’t impairing day-to-day life, young people in foster care — especially older youth preparing to age out — need support to process the trauma they’ve experienced and learn coping skills.
“They still do need to understand why they feel the way they feel, how to better respond as opposed to react,” Neal said, adding that these skills are essential to helping teens and young adults build a social support system.
This need has been exacerbated by the crushing emotional and social toll the pandemic has taken on everyone, Neal said. The longtime child welfare worker said she’s seeing increased anxiety, depression and excessive worrying among youth in foster care who feel they have little control over their lives and may be in fear of the people they’ve been stuck with at home. A May 2021 survey from the nonprofit John Burton Advocates for Youth found that 50% of foster youth feel “down, hopeless or depressed” a majority of the time — up 26% from the year prior.
In Contra Costa County, court-appointed special advocates, known as CASAs, noticed the children they worked with had unmet mental health needs. To get them support, they approached A Home Within, which has a decadeslong history of providing free therapy to current and former foster youth.
The joint program launched last year as an 18-month pilot in Contra Costa County funded by Kaiser Permanente and the women’s philanthropy group Impact 100. Earlier this year, it received a $900,000 three-year grant generated by California’s cannabis tax to expand statewide.
Since its 2020 rollout, the program has served more than 100 young people. Night said they’re working toward a goal of serving 600 children during the grant term but that it’s challenging to recruit enough therapists — especially with the group’s commitment to building a diverse volunteer force reflective of the clients they’re serving, who are overwhelmingly children of color. More than 60% of the volunteer therapists are either Black, Latino or mixed race, according to a program flyer.
“There are not a lot of therapists of color,” said Neal, who is Black. “That’s an important consideration when you think about cultural dynamics and just level of comfort.”