Sacramento County is seeing success adding mental health clinicians to schools, but progress is slow

Souchoy Saechou’s fourth grade class at Ethel I. Baker Elementary School in south Sacramento begins their day with a community circle. On this day, they’re completing Martin Luther King Jr.’s most memorable line.

“I have a dream that everyone around the world will understand that girls can like soccer and boys can wear dresses,” one student says.

She hands the talking feather to the next student who quietly shares, “I have a dream that everyone from other countries can have a green card so they can come to California,” and passes the feather.

The fourth grader next to him thinks a little and follows up with, “I have a dream that everybody passes college.” 

Silence fills the classroom as their fellow students confide their worries and their desires for the future. 

This circle is part of the school’s focus to have mental health support services embedded in the classroom, along with more specialized services on school sites for prevention and intervention. Ethel Baker Elementary, whose students are 97% English language learners or qualify for reduced lunch, was one of the first to develop and pilot a school-based mental health program.

After COVID-19 exacerbated the youth mental health crisis, the Sacramento County Office of Education began grappling with the shortage of mental health clinicians in its 300 schools and took a bilateral approach: partnering with Medi-Cal, California’s Medicaid program, to hire clinicians for school-based wellness centers and investing in a high school recruitment-to-licensed therapist pipeline. 

As Sacramento schools try to address the mental health crisis, vulnerable students suffer

The Office of Education aspires to have a clinician in every school, but progress stalled at 40 clinicians in 2022, and the current projection indicates that it might not be achieved until 2050. However, schools such as Ethel Baker Elementary demonstrate promising potential. 

In the interim, efforts are being made to supplement the need by collaborating with local, culturally responsive mental health programs such as the Q-Spot — focusing on LGBTQ+ youth — and Roberts Family Development Center’s Girl’s Club — focusing on girls of color.

“It's a startup,” explained Dave Gordon, the superintendent for the Office of Education. He attributes the sluggish pace of service rollout to the mental health professional shortage and inadequate funding. Instead, Gordon and his team are perfecting the support network for school-based wellness centers which is contingent on teamwork.  

“It promotes the concept of wellness and it focuses on prevention,” Gordon says. 

Modeling a sustainable approach

Chris Williams, the county’s director of school-based mental health and wellness, said sustainable and long-term mental health solutions in schools are being built “brick by brick” and require time. 

“We want to create systems that are not dependent on a person,” Williams detailed on the Office of Education’s outlook. “If for whatever reason individuals move on, the system is in place that can continue irrespective of personnel.” 

Improving school-based mental health services became a county priority in 2022 after they released a report showing nearly 40% of all students were feeling sad and hopeless. Those percentages were even higher for students at the intersections of race, gender, sexuality and housing insecurity.

The Office of Education began to chip away at creative solutions, which resulted in the collaboration with Medi-Cal. 

“Roughly 65% of students in Sacramento County are on Medi-Cal,” said Williams. “We're accessing the pot of money that has been set aside for these students, and that then sustains and reimburses us for the salary of a clinician.” 

Despite the need, only 6% of young people access services in the county, he finds. 

“Data suggests that 20% of school-aged kids have been diagnosed with a mental health disorder,” Williams said. “So, there’s a huge disparity.”

Benefits of School-Based Sites

Ethel Baker Elementary has been successful in implementing the county’s tiered mental health program: 

• Tier 1 incorporates social and emotional learning into the classroom
• Tier 2 identifies students’ needs and provides a space for them to regroup and return to learning
• Tier 3 is for students with a pronounced need for individualized clinician help

Principal Nathan McGill, assistant principal Cristina Kosakowski, clinician Elizabeth Kirby and office manager Eva Gomez are just a fraction of the team at Ethel Baker Elementary that has advocated for and enacted change to make school-based mental health services effective.

Ethel I. Baker Elementary School Principal Nathan McGill and Assistant Principal Cristina Kosakowski discuss the school's Center of Wellness at a news conference Jan. 18, 2024.Seth Patterson / The Sacramento Observer

Changing the culture around mental health at the school was a challenge and wasn’t a success initially, relayed McGill. COVID-19 broke the line of trust that the school staff would’ve normally had with the community.

“The sell for mental health and trusting your child with a person that you don't know to then get therapy was a big lift,” he said. 

It took buy-in from the entire school staff and the district to reframe the cultural stigma associated with mental health and students of color. 

“We created conditions in each classroom that were a lot safer and had teachers talking about wellness,” said McGill, exemplified by the community circle in Saechou’s fourth-grade class. “We know that folks of color and folks who have less money are disproportionately affected by a traumatic experience and that has an effect on their health, well-being and then we also see it in terms of educational outcomes in schools.” 

By the time Kirby joined the team in 2022, two years after it started, as the only on-site clinician for 650 students, she said mental health language in classrooms was seamlessly built into the framework of the school.  

“The administration was so invested in that work, that it existed even before I walked on campus,” said Kirby. “It's hard for me to even imagine what it would be like without that.”

Notably, compared to the current county environment where there are around 1,300 students to every school psychologist, Kirby finds the school’s caseload is manageable. She said because she is “operating as part of a team” and preventative practices are in place, most students don’t require her specialized help.

“There are a number of adults and the students know that they can go to a teacher or a yard supervisor,” noted Kirby. “If I was the only caring adult in the school that would never be enough, but it's not meant to be that way.”

Latrenna Conner, a parent at Ethel Baker Elementary, says intervention services have been helpful as her family goes through a tough time. All three of her children have accessed the wellness space on-site and have developed a trusting relationship with Kirby. 

“It's questions that she may be able to ask that I might not know to ask,” said Conner. “It's a very rewarding experience and I appreciate all the help because I have seen a drastic change in my kids' behavior and their communication.” 

Parent Latrenna Conner and her daughter La’anadii Gillett have fostered positive relationships with Ethel I. Baker Elementary staff.Seth Patterson / The Sacramento Observer

Her daughter, sixth-grader La’anadii Gillett, finds that she is regularly frustrated and it can distract her from learning. 

“Last time I was irritated, I couldn't focus on the math problem,” she explained. But with the skills developed with Kirby, she knows to take a step back. “I could either color and draw or we have a Zen Zone where I can go play with some toys and read books.”

Ethel Baker Elementary is just one of 40 school-based wellness centers in the county. And through these efforts, the Office of Education provided mental health services to 389 students across 18 school sites last year, according to the Sacramento County Department of Health Services. 

Still, Behavioral Health Services, independent of the Office of Education, had nearly 10,000 youth require their assistance, highlighting the discrepancy between the need and accessibility at schools. 

For McGill, there is more to be done at Ethel Baker Elementary: “I would love it to become more integrated into the community.” 

Representative support

McGill is not alone in his desire for community-focused mental health interventions. Districts and schools have independently partnered with local organizations centered on culturally responsive verbiage and tactics, providing some mental health support for students even before the county can provide a clinician in every school. 

Roberts Family Development Center has pushed to get their mental health services Girls Club and Boys Club into after-school programs on sites with majority students of color to provide representative support. 

At Martin Luther King Jr. Technology Academy, they meet every Wednesday. They sit at a circular table and talk over one another, excitedly sharing what they love about Girls Club.

“We’re cooking and we’re bonding with each other,” said eighth grader Malaysia Howell. 

Her friend Delecia Castro laughed and chimed in, “When we're around each other, we're able to talk to each other about certain things even if we don't know the person … telling them stuff about crushes, periods and puberty.” 

MLK Technology Academy students Arianna Alarcon, Delecia Castro, Malaysia Howell, Annahbella Sevilla prepare their no-bake cookies at Girls Club Jan. 24, 2024.Srishti Prabha/CapRadio

As the girls delve into their interest in attending Girls Club, the need for a space that acknowledges the identity of its students becomes more apparent. 

Mikaela Lo, a seventh grader, recounted a mental wellness activity led by the two facilitators which aimed to nurture essential skills for the mental well-being of young girls.

“We did this thing [where] you go outside and then you feel, you smell, you see,” she said. “I felt the sun and the cold air. I felt free.”

Destiny Robbins, a licensed clinical social worker and program lead, highlights the significance of Girls Club in the Del Paso neighborhood. 

“They represent resilience. They represent those that can thrive given the right tools, given the right resources, given the right support,” said Robbins. “These young ladies, they've been through adversity. As a Black woman myself, I know what that feels like to be the only one in the room. So culturally sensitive programming is crucial – it can make or break someone's chances to thrive.

And Girls Club data collected by the facilitator Alissa Fernandez reports the positive outcome of students attending the program.

“The more self-concept has gone up, we've seen less descriptive behavior,” she reported. Her study used self-concept, or a student’s self-esteem, as a measure for better mental health. “We've seen positive results across all the measures — a decrease in anger, anxiety and depression, as well as disruptive behavior.”

Similarly, Q-Spot, under the Sacramento LGBT Community Center, targets LGBTQ+ youth — a group that is likely to feel isolated or be subject to housing instability. Andy Cha, who goes by he/she/they, is the mental health program manager for Q-Spot and spends time advocating for queer youth in school settings. 

“I organized a field trip [to Q-Spot] for an LGBT Club at Rancho Cordova High School and gave them a workshop where they were able to make some pronoun buttons and it was just so cute because they were finally in a space where they could be themselves,” said Cha. “Some things that they would mention about school are, ‘teachers misgender me’ and ‘the locker rooms feel unsafe’ if they are a transgender girl.”

Cha spends time ensuring policies change at school for youth who, because of their identity, feel isolated on campus. It takes more outreach to work with the schools, said Cha, because the resources can be a far distance for many young people. And not being embedded into the network of the school system poses challenges. 

“We have to take the extra mile to reach them, offer the resources and let them know that we have a community here for you,” said Cha.

Looking at the long-term sustainability of the program, the Office of Education is looking to bring more students of color into the mental health care profession. They’re leading a cultural competence initiative establishing a professional pipeline from high school recruitment to clinical licensing, ensuring representation of the diverse student population. 

The program, now in its second year, has attracted a more diverse cohort than its inaugural year, said Williams, offering opportunities for peer mentoring to high school students and stipends to Sacramento State University students looking to join the mental health profession in the county.  

Srishti Prabha is an education reporter and Report For America corps member in collaboration with CapRadio and The Sacramento Observer. Their focus is K-12 education in Sacramento’s Black communities.