There are days when Lisa Xiong and her colleagues barely recognize a boy they’ve known since he was in kindergarten.
“He’s a sixth-grader now,” said Xiong, a clinical director a Change Inc., a nonprofit providing mental health professionals to more than 30 schools around the Twin Cities. When the boy first began seeing a therapist based at his school, his family — six children headed by a single father with significant mental health issues — was struggling.
“There was CPS (child protection services) involvement,” Xiong explained. “The kids had been removed from their home multiple times. There was a lot of trauma that came with that separation.”
A team of therapists based at the siblings’ school scheduled sessions with the boy, his siblings and their father. Slowly, progress was made.
“In the last five years,” Xiong said, “there’s been no CPS involvement. That’s wonderful. Just last week a staff member said about this boy, ‘I’m so proud of him. He knows himself. He has self-esteem. He’s a totally different kid.’” For a sixth-grader to have made this much progress is, she added, “just amazing. I wonder what his life would be like if he didn’t have people like the school staff and therapists who’ve been on this journey with him.”
Xiong can’t relive the past, but she does believe that if they had needed to seek out mental health support on their own rather than seeing therapists at their school, this boy and his family would never have been able to make it work. The hurdles would have been too high.
Change Inc. sends therapists to schools where the majority of families qualify for free or reduced lunch, explained Clinical Director Jennifer Garrido Santos. This means that most families struggle to meet basic needs, and that “extras” like therapy can feel out of reach.
“Unlike a suburban middle-class white family who says, ‘We’re struggling. Let’s call a therapist,’” Santos said, “that won’t be the case with the families in our schools.” Like families everywhere, she added, “our families sometimes need mental health support, but without school-based therapy, it would be out of reach.”
Funding for programs like those provided by Change Inc. could increase this legislative session. Gov. Tim Walz and Lt. Gov. Peggy Flanagan are asking the Minnesota Senate to expand school-linked mental health support through passage of their summer learning package in the state’s COVID-19 recovery budget. The package would provide $7 million to expand school-linked mental health services during the school year and also provide access for students to well-being support in summer learning programs.
For many kids and their families, school-linked mental health services are a great equalizer, said Jody Nelson, Change Inc. executive director. Basing mental health care in a place that is familiar and easy to access makes it that much easier for families to get the support they need. Kids from middle- and upper-middle-class families shouldn’t be the only ones who get mental health support, Nelson said; school-linked programs help level the playing field, making accessing psychological support convenient for everyone.
Change Inc. therapists are independent professionals who form strong relationships with school staff because they see kids every day and work together to meet their needs, Nelson explained. Therapy services are covered by health insurance as well as state and national grants.
“We’re embedding professional mental health support people in the school, standing side by side with other specialists like nurses, classroom teachers and social workers, supporting young people to become successful in school and in life,” Nelson said. “When these things are working with kids and their families, amazing things can happen.”
‘We’ll make it work’
Until she began working at Change Inc., Xiong didn’t know that it was possible for kids to see a therapist at school.
“I didn’t know school-based mental health existed,” she said. But when she started working at Change Inc.’s school-linked program at Edison High School in Minneapolis, the pieces fell into place for her. “I fell in love with the work. It made sense. I quickly realized that mental health for kids and their families should be provided in a school-based setting, rather than a medical clinic where there are a lot more stereotypes.”
A child of Hmong immigrants, Xiong knew many families that struggled mightily to find their place in a new country. Many of the children in these families would have benefited from mental health support, she said, but the idea of seeing a therapist never entered their parents’ minds. Not only did it seem expensive and inconvenient, talking to a stranger about your problems was out of the question.
As she grew, Xiong saw the powerful benefits of mental health support. That key care shouldn’t be limited to privileged families with time and money to spare, she believed, so when she earned a degree in family social science, she did so with a commitment to work with “kids and families, in particular with marginalized communities that were least likely to access services.”
Beyond the general feeling in her community that mental health care was intended for other people, Xiong said there were other issues that made this kind of care feel out of reach.
“Not everybody has a car available or has money to take a bus or an Uber to an appointment,” she said. “Then there are also families with lots of kids. To take one child to an outpatient clinic for therapy, the parent has to figure out who will watch the rest of the kids. Those kinds of barriers can feel impossible.”
Early on in her career at Change Inc., Xiong realized that school-linked therapy could surmount many of those common barriers. Because therapists are based in the schools, appointments can happen during the school day. And if parents are part of the sessions, they can bring younger siblings along.
In school-linked therapy, flexibility is key, Xiong explained: “We can say, ‘Bring everyone. We’ll make it work.’”
In many communities, having a therapist in the school helps children normalize the experience of seeking mental health care, Xiong added.
“Some kids start to think it is cool to go to therapy. When a kid sees their friend leave class for their meeting with me, sometimes they’ll say ‘Hey Miss Lisa: Why don’t you come get me? I need to go to therapy, too.’”
Establishing the idea that it’s normal to talk to a mental health professional about your feelings helps spread acceptance from children to their families.
“Most of us who work in pre-K-to-8 schools have play therapy experience,” Xiong said. “Using that approach helps destigmatize seeking help. Kids hear about what their friend is doing and they tell me, ‘I need to talk to you, too.’”
To gain the trust and acceptance of students and families, Santos said, school-linked therapists are committed to accessibility. It also helps to get other education professionals like teachers and social workers on board, explaining what therapists do and how they can help kids and families.
“If we have a student who’s struggling, staff can say to the child and their parents, ‘Would you be interested in talking to this person?’ Then we would do what it takes to build a relationship with the kid and their family by going by their house, meeting them at school or calling and just reaching out until we can establish a relationship. We’re all about removing barriers and meeting them right where they’re at.”
Santos believes that if you want a therapeutic relationship to work, it has to be a partnership. Many of the children and families in her schools say they feel that people in positions of authority too often tell them what to do or make decisions for them. She wants people to be in control of their own treatment.
When a young person is reluctant to see her, Santos said, “I work by coming alongside them. My attitude is, ‘I’m going to build a relationship with you first before we officially make this therapy.’”
Once, Santos said, she had a struggling student who did not want to meet with her. His parent wanted him to be seen. Instead of forcing the relationship, she explained, “I worked with him to make an agreement. I was like, ‘Let’s try this six times. If you hate it, we’ll stop.’” The boy eventually agreed to see Santos for therapy, she said: “I try to work all the angles to facilitate and navigate a partnership so I can engage kids and families from different cultures.”
Recently, Santos began consulting with an agency based in the Somali community. “I’m learning so much about the best way to engage Somali kids and their families,” she said. “It takes a different approach. It’s not just waiting for someone to come in to your office.”
With Somali families, Santos has learned, it’s important to emphasize the key role of mothers. “Somali moms are the experts. They know what their kids need. They know what’s going on.”
Too often, the only time parents hear from the school is when their child is in trouble, Santos explained. “I always emphasize the strengths and the unique qualities of a kid after I meet them. A lot of times, with Black and brown kids in general, parents get a lot of calls about what is not going right. They are exhausted by that. To have a provider call and say, ‘Your kid is amazing. This is what I’m seeing in him. He’s not a bad kid. Maybe he’s even gifted and he’s bored,’ makes all the difference. Shifting the gaze helps parents to buy in more.”
Santos said she takes a “strength-based, collaborative approach,” to her work. “We treat parents or caregivers as experts, putting them almost in the co-therapist’s seat. My attitude is, ‘You’re driving the bus. I work for you.’ I’m trying to empower them in the process so they feel like they are part of it, that it’s not something that’s being done to them.”
Access is equality
Change Inc. was built on the belief that all children, regardless of their place of birth or economic resources, should be able to succeed in school and grow to their full potential, Nelson said. The nonprofit began by operating alternative schools in Minneapolis and St. Paul, and eventually expanded to include school-linked mental health, providing clinical supervision for clinical trainees and professionals serving children and families. The organization’s focus is on young people of color and members of marginalized communities.
“We work with a lot of programs and bring in graduate-level interns who have to do practicums and get trained in schools,” Nelson explained. The organization works mainly with licensed marriage and family therapists, she added: “Our training is in systemic and relational work. We approach school-linked mental health from a relational and systemic lens.”
School-linked therapy can build community within the school building and help kids be more successful and connected at school, Nelson said. “The school is our client. We want to do everything we can to better the relationships in the building and promote positive environments so that schools are places where kids can thrive.”
That approach means that Change Inc. staff see their practice from an active, flexible perspective.
“When you are school-based, you are not just a therapist,” Xiong said. “You have to think outside of just, ‘I’m going to wait in my office for kids to come to me.’ You have to go out and look for students. It is your role to provide culturally responsive and engaging services. You have to be an advocate, a support person. You’re wearing multiple hats.”
This work is done through an equity lens, Nelson said. Because not all children and families have equal access to mental health care, Change Inc. staff works on the principle that all young people, no matter their background, deserve the care they need to thrive. That goes beyond free meals at school, Nelson added: Mental health care should be considered a right — and a priority.
“I think it is a social justice issue,” Nelson said. “ All young people should have access to mental health providers. If a young person can access mental health support during the school day, it much more likely that they are going to get the support they need in life.”