[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 new immigrants attend public high schools in San Francisco, according to area data. Of those 500, more than half come from Honduras, El Salvador and Guatemala. Another eight percent come from Mexico.
Among recent immigrants, linguistic, academic, social, financial and now, epidemiological stress is common. according to Research by the William T. Grant Foundation. They are also less likely than their white counterparts to access and use mental health care services.
Fuerte, a semester-long mental health education program for newcomer Spanish-speaking immigrants in the San Francisco Consolidated District (SFUSD), seeks to change that. Serving more than 350 young adults since its inception in 2015, it has survived the epidemic, and UCSF researchers are evaluating its current frequency for the impact on mental health literacy, connectivity and access to mental health services, and social connectedness.
According to Dr. William Martinez, principal investigator, the study is an opportunity to demonstrate the tangible effects of mental health programs like Fuerte on immigrant youth. “If we can demonstrate that this program is beneficial to this population, we can get funding to sustain it. [and] Posted in other places around California, he explained. As of now, funding for the San Francisco program is guaranteed for at least another two years, thanks to the Mental Health Services Act Innovation Fund, which has been funded through a 1% income tax on annual personal income of more than $1 million since 2004.
In addition to recognizing the unique mental health needs of incoming immigrant students, the city of Fuerte is a leader in that it emphasizes the importance of preventive care. Martinez and his fellow clinicians first recognized the need for a preventative mental health program in 2013, when they began seeing “a lot of [Central American] children come [to the UCSF clinic] With so much shock.” “The newcomers were coming… when they were already more severe, [with] Lots of behavioral health problems.” The psychological impact on immigrants of the inhumane segregation of families and detention centers in the United States, its criminalization of immigration, and its racist rhetoric on both national and personal levels cannot be understated here.
Thus, part of Fuerte’s programming is an examination aimed at identifying mental health care needs and connecting students to services sooner. However, structural barriers to access remain. Conversations with the latent newcomers in the program revealed that most of the youth were not present outside school hours. “Most of our children work after school and many of them work more than 20 hours a week,” Martinez said. El Tecolote. “We have workforce turnover… for the same reason – it is very expensive,” he said. The shortage of Spanish-speaking mental health doctors in San Francisco means that care is often delayed for patients who need bilingual services.
For incoming students, “there is a dire need for mental health,” said Eric Martinez, the focus services supervisor for San Francisco Unified District. [support]. There are waiting lists for people to access. Some of these queues are closed…[some are] At least 1 month, which means no one will be seen for a month. I think Fuerte helps – I think school support helps, but I think we also have to remember that schools are closed in the summer.”
What makes Fuerte so great – that it’s so easily accessible during the free periods at school – is also a reminder of the program’s limitations. Ensuring access to mental health resources for international students is a task that extends well beyond Fuerte and into local and state health care policies and priorities. No child should wait months for a treatment appointment. Not having the obvious need for Spanish-language doctors in the city urgently met is the neglect of the Latin communities.
Moreover, even as Fuerte programming addresses literacy and connectivity needs, it has also revealed new ones. For Latin newcomers 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 referred to us who spoke Portuguese [or] Martinez said. One year, five new Brazilians 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 offering Fuerte programs, contacted the research team to request an amendment for Syrian and Yemeni new arrivals. Publication of the revised syllabus began in early 2020, but collapsed shortly after the pandemic. The move to Zoom and Telehealth didn’t stop the more established Spanish language program. In fact, even by default, the program was Able to develop students’ sense of social cohesion. One young participant in a focus group said, “Fuerte A great group because we share our thoughts and dreams for our future, and other things about ourselves, and we share with the group… I learned a lot of things about [the other youth participants]And they learned about me, too.”
The effectiveness of the program via telehealth is particularly important in terms of expanding and reaching more new arrivals. In more rural areas that don’t have enough Spanish-speaking providers but still have a great need, like Central Valley, we now know that mental health education and prevention programs can really happen and have a huge impact.
Regarding other future directions, the Fuerte team is discussing whether and how parents will be included in their programs. Many of the newcomers are now being reunited with family members they have never met before, [or that] “They haven’t seen in a long time, and now they have to learn to live,” Martinez said. But again, similar barriers to implementation and access exist. Like their children, parents often work multiple jobs and/or look after children. The queues are long. “We have to be creative,” Martinez said.