With local youth and families sheltering at home, counseling sessions and support groups that used to take place face-to-face in school wellness centers, clinics and private offices across Santa Clara and San Mateo counties have gone completely virtual.
Seeing the writing on the wall several weeks ago, local youth mental health organizations started preparing for the transition to telehealth services and say it went smoothly, for the most part. They informed families, negotiated new contracts with school districts, trained their therapists on strategies for video and phone and turned to platforms like Zoom, Skype and Google Meet to hold virtual therapy sessions.
For many nonprofits, demand for their services — and attendance — is higher than usual while young people are out of school and experiencing increased anxiety, isolation and family stressors.
"It might be easy for the community to put mental health on the back burner right now with so many pressing, competing needs," said Ramsey Khasho, chief clinical officer of Children's Health Council in Palo Alto. "We want to make sure while people are physically isolating, they're not socially and emotionally isolating."
At Children's Health Council, which provides mental health support to youth and families, plans had already been underway to expand existing telehealth services. The nonprofit had started sending laptops home with therapists and making sure they have personal Zoom links that are compliant with the Health Insurance Portability and Accountability Act, or HIPAA, which protects clients' privacy. (Due to the coronavirus, the federal government waived last month some HIPAA restrictions, including the requirement to obtain a patient's agreement to speak with family members or friends involved in the patient's care.)
Children's Health Council (CHC) is offering its full range of services online, from individual therapy to support groups for parents of children with learning disabilities and anxiety to free, 30-minute consultations for potential clients. Even the nonprofit's 12-week intensive outpatient program for teenagers struggling with self-harm and suicidal thoughts has moved online — not a population that remote support would usually be appropriate for, but "given the fact this is a unique situation, telehealth services are better than no services," Khasho said. (CHC is accepting new patients for this program right now, and is conducting intakes for a middle school family skills group starting May 19.)
Mental health services are considered "essential" under Santa Clara County's stay-at-home order, so in the event a teen is actively suicidal and needs to be assessed by a clinician in person at Children's Health Council, the nonprofit can do that, he said.
Working remotely with potentially suicidal youth poses its own set of challenges. Service providers are requesting these clients, when in a session, disclose their location and have two emergency phone numbers available.
For any telehealth session, both therapists and youth alike have to find a quiet, safe place to talk, which can be challenging with more people sharing households at this time. Therapists are also working to include parents in sessions when appropriate to address family dynamics.
Research has shown that telehealth counseling can be as effective as in-person therapy, Khasho said, and what clinicians are observing among youth and families during an unprecedented disruption of daily life makes continuing mental health support all the more necessary.
"Our phones have been ringing off the hook," said Philippe Rey, executive director of Adolescent Counseling Services in Redwood City. "Anxiety and isolation is what we hear the most from our youth and concern about the economy from parents and loss of jobs that's creating tension in the home."
For teens, a disorienting disruption of social lives
Some high school students are also struggling with the disruption of their routines and social lives, much of which happens at school, nonprofit staff noted. They're disappointed by the cancellation of significant events like prom and, potentially, graduation.
"Socializing is such an important part of being a teenager — separating from a parent, becoming their own self and making choices," said Elena Cacace, clinical director at Counseling and Support Services for Youth, which provides services to schools in Palo Alto and East Palo Alto. "Having that taken away, even with social media, is definitely affecting our kids."
Savannah Flock, a junior at Design Tech High School who works with teen mental health advocacy nonprofit SafeSpace in Menlo Park, said she's struggling with the loss of her normal routines.
"Every aspect of my life and what I am passionate about has been canceled," she said. "I feel very stuck and sad often since I cannot see my friends and participate in the things that I love, like going to SafeSpace meetings."
Menlo-Atherton High School junior Kai Doran, also a SafeSpace participant, said he's felt too anxious to reach out to friends during the shutdown and is struggling to "maintain relationships solely through digital spaces."
"A lot of people are in the situation where they want to reach out but aren't sure who they can talk to," he said. "A simple phone call or genuine text message can make a big difference to someone who hasn't spoken to peers in days."
For teens who are part of SafeSpace in Menlo Park, their in-person work with the nonprofit — school presentations on mental health, collaborations with community organizations and an annual walk to raise awareness about teen wellbeing — has been canceled or postponed. The students are now meeting — and connecting socially — via Zoom. They've started a virtual book club, are cooking together over video and are developing a podcast on mental health.
Adolescent Counseling Services, which provides community counseling as well as at local school districts, is using Google Meet for remote therapy and support groups, all of which are continuing online. Attendance is up, Rey said, whereas before youth would often cancel appointments or not show up.
Teens, both ones who were already working with Adolescent Counseling Services and new clients, are reporting more fights between parents, Rey said. Some youth also say they're self-medicating to cope with increased anxiety, so staff are reminding parents to watch their medicine cabinet.
They're also advising parents to be honest about their own feelings about this time with their children.
"Don't avoid the conversation about mental wellness. It's so easy for all of us to go into denial about what is going on already in terms of COVID-19, but it's even easier for all of us to go into denial about what we're all feeling and going through," Rey said. "Open up the conversation. Ask the questions."
Lena Kalotihos, a Menlo-Atherton High School senior, said that the coronavirus temporarily disrupted her mental health treatment while her providers figured out how to move to HIPAA compliant telehealth services and had to cancel appointments.
"Now that I have all this time on my hands, I am pretty vulnerable to anxiety and depression's tricks. I try and combat this by making a schedule for myself and keeping myself engaged outside of the four walls of my room," Kalotihos said. "As long as I keep myself busy (with schoolwork, projects, running, etc.), I am able to stay present and take things day by day."
Mental health nonprofits are working to reach low-income and more vulnerable youth and families who are likely to be disproportionately impacted by the shutdown. Many provide their counseling services at no or a low cost.
Adolescent Counseling Services serves students at East Palo Alto charter high school Oxford Day Academy, which has arranged times for very small groups of teens to use computers on campus for counseling sessions. They've also used computers at the Boys & Girls Club in East Palo Alto, Rey said.
Lyn Balistreri, development director at Community Health Awareness Council (CHAC) in Mountain View, said the nonprofit has run into challenges accommodating clients without a cellphone or internet connection.
Community Health Awareness Council, which offers counseling through local schools and its own clinic, saw an initial spike in cancellations — as many as 50% of sessions — which Balistreri attributed to people feeling they had to avoid person-to-person contact. Since then, clinicians have been working with clients to let them know therapy is still available remotely, she said, adding that many of those appointments have been rescheduled.
Certain vulnerable populations the Community Health Awareness Council serves, including people who are homeless and living in RVs, domestic violence victims and those coping with abusive relationships who are partway through the immigration process, are the most difficult to not to be able to see in person.
"We are concerned for our clients because they are vulnerable, so we're trying to balance giving them what they need while in a less-than-ideal therapeutic setting," Balistreri said.
The coronavirus has forced a major shift onto the mental health field as a whole — but one that could have benefits that extend beyond this crisis.
"The silver lining we're realizing (is) this might be a way for us to reach more youth, local and outside of our geographic boundaries, especially with the stigma associated with driving to an office," Rey said.
How school districts are providing mental health support
As local educators work to ramp up their distance learning offerings, school mental health staff are doing the same to build remote emotional support for students. Below is what several Midpeninsula districts are offering students and families at this time.
Palo Alto Unified School District
In Palo Alto Unified, staff are checking in with students who were receiving support at their schools before the closures. Counselors and psychologists are working with outside providers to "plan for the safety" of at-risk middle and high school students, said Miriam Stevenson, student services director in the wellness and support department. Staff are watching high school Confessions pages on Facebook and responding to any concerning reports about students' wellbeing.
Students and families can schedule time to connect virtually with school counselors, psychologists and therapists from 8:30 a.m. to 3:30 p.m. on what would usually be school days. High schoolers can also now set up remote drop-in sessions with their campuses' wellness centers.
To help families find community providers, if needed, the district is directing them to Care Solace, a free online service. The district plans to resume all school-based student mental health services through telehealth after spring break, Stevenson said.
"Students, families and staff are continuing to reach out for support, which is great in terms of the work the community has done around stigma," she said. "Not being able to walk in and get support is creating a new barrier and delay in access. Telehealth has advantages in terms of being able to access from anywhere but can present a different set of challenges, especially when people do not have frequent physical connection or access to private spaces or reliable technology and phone service/wifi."
The district recently launched a webpage for families that lists local and county resources related to mental health, housing, financial support, technology and more.
Sequoia Union High School District
In the Sequoia Union High School District, staff members are offering students mental health services through Google Hangouts Meet (with video and screen sharing), Google Hangouts Chat, Google Voice, by phone and by other means, according to the district website.
Staff is prioritizing, and reaching out to, the highest need students, including students receiving crisis care.
Students can contact mental health coordinators at their individual schools to make counseling appointments.
More information on mental services in the district can be found here.
Menlo Park City School District
Student services teachers and staff in the Menlo Park City School District are offering personalized virtual learning plans to students who receive mental health services as part of Individualized Education Plans (IEPs), said Parke Treadway, the district's public information officer.
"With support from our community, we are able to have full-time counselors and school psychologists at every school, and they continue to work remotely during the closure," she said. "Students who access mental health services from our school counselors and psychologists are still served by those same professionals, either individually or through the virtual education that our counselors and psychologists are providing."
Hillview Middle School counselors created a support page for families with information on managing stress, recommendations for meditation apps and more.
Elementary school counselors are creating virtual social-and-emotional-learning curriculum and personally checking in with students through the district's lunch deliveries, Treadway said.
Last week, the district offered parents small-group support from Karen Junker, an expert on techniques for speaking, listening and asking questions to build healthy relationships and de-escalate conflict with their children. Many school counselors and psychologists joined those calls to provide additional tips and support, Treadway said.
Mountain View-Los Altos High School and Mountain View Whisman districts
The Mountain View-Los Altos High School District will continue to provide counseling support for students who were already receiving services on a check-in basis between 9 a.m. and noon and 1-3 p.m. through Zoom. The district will contact students who receive counseling on-campus, but may not be able to match each student with his or her current therapist. School therapists will also be contacting students who receive therapeutic services through an IEP. For more information, click here.
At the Mountain View Whisman School District, students who receive mental health support from CHAC will be contacted to schedule telehealth sessions. The district also works with Campbell-based Uplift Family Services, which will be providing telehealth support to students and families. New clients should contact school community-engagement facilitators and counselors to enroll. More information is available here.
Embarcadero Media reporters Angela Swartz, Kate Bradshaw and Kevin Forestieri contributed reporting to this story.
In distress over COVID-19? There is help.
Anyone who is experiencing depression or heightened anxiety because of the public health crisis can find help through local resources:
In Santa Clara County:
• 24/7 Behavioral Health Services Department Call Center: 800-704-0900.
• Crisis Text Line: Text RENEW to 741741.
• 24/7 Suicide and Crisis Hotline: 855-278-4204.
• If you are experiencing an emergency, call 911 immediately.
In San Mateo County:
• Behavioral Health Services & Resources - 24/7
• Access Call Center - Toll-free number: 800-686-0101 | For the hearing impaired: 800-943-2833.
• If you are experiencing an emergency, call 911 immediately.
For seniors, people with disabilities: The Institute on Aging has a Friendship Line for people ages 60 and older and adults with disabilities who feel isolated: 800-971-0016.
For youth: A list of local resources for young people who need mental health support, as well as their family and friends, can be found here.
California Department of Education's new "Help for Students in Crisis" website.
Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.