When Julia (they/them), a 14-year-old who had been in therapy for three years, crushed up a bottle of antidepressants and ibuprofen with the intention of ingesting them, their mom, Lisa, knew it was time for a new approach to her child’s mental health care.
“This was one of the scariest nights of my life,” said Lisa, who asked to be identified only by her first name to protect her minor child, in an email. “Julia and I stayed up so late that night while they shared their feelings with me. I tried my very best to stay calm, ask questions, and listen, but it is not easy when you see your kid losing the battle to their depression.”
After Lisa and her husband locked up all potential threats to their child’s life, she spent the next few days exploring her options. She found three group therapy programs, and after interviewing with all of them, Lisa believed El Camino Health’s After-School Program Interventions and Resiliency Education (ASPIRE) program would offer Julia the best support. She felt relief for the first time in months and supported by the team.
Julia, on the other hand, was skeptical.
“They were not really too keen on signing up for it,” Lisa said of Julia. “We explained to them that we were running out of options to keep them safe, and our only other option was to go to the ER and start down the path of a possible in-patient stay. This suddenly became more appealing to them, and once Julia started the program, they began to warm up, participate, and enjoy the group process.”
Dr. Jennifer Zumarraga, childhood and adolescent psychiatrist and medical director of ASPIRE, said the program launched in 2009 after a cluster of teen suicides in the area.
A community task force comprising school representatives, therapists,
counselors, students and health providers emerged, and members discussed how to address the crises many students were
“At the time, there were very few programs for adolescent mental health,” Zumarraga said. “We began to research higher levels of care with different forms of therapy, and we launched the ASPIRE program.”
The program implements the use of dialectical behavioral therapy (DBT), which helps participants develop resiliency skills. Five modules are taught in the program, addressing the topics of distress tolerance, interpersonal effectiveness, emotion regulation, mindfulness and walking
the middle path.
“Each DBT module is taught over a period of weeks,” Zumarraga said. “They learn specific skills and practice them throughout these weeks, fill out daily diary cards and discuss what specific skills they have used each day while they are at home and school or social situations when they have come across stressors.”
ASPIRE was initially tailored to high school students, but as the need for mental health care for middle schoolers and other age groups spread, staff updated the program.
“As demand grew and additional need became evident, staff developed additional targeted tracks for middle school students, transition-age youth (18-25) and youth with habitual behaviors, including substance use and excessive screen time,” Zumarraga said.
ASPIRE is offered in four categories, divided by age and grade: middle school, high school, transition-age youth and the QUEST intensive outpatient program, designed for those ages 13-18 with identified substance use disorders and habitual behaviors, such as excessive gaming or screen use, who also experience a mental health condition.
“The ASPIRE program is a higher level of care,” Zumarraga said. “It is an (intensive outpatient program) that is three hours
per day, three to five days per week. It is helpful to those already struggling with mental health issues. We deal with current crises and struggles, and the skills that are taught and practiced help with preventing further crises.”
Teaching life skills
Over the course of eight to 10 weeks, participants take
part in individual, group and family counseling sessions.
Zumarraga said group therapy allows teens not to feel alone in their struggles and experiences. It also provides them crucial social skills and a better understanding of others’ perspectives.
“In my opinion, having a community of kids who are going through similar struggles was very validating for Julia,” Lisa said. “We are social beings, and teens these days are finding themselves more and more isolated with their phones, which can be reinforcing the isolation and anxiety, so being with a group of kids who were not distracted by their phones for three hours at a time, and working on skills to
manage your feelings that come up without that crutch, was huge.”
Lisa said Julia, who loves theater, enjoyed role-playing skill training and expressive art therapy they experienced in the ASPIRE program.
“Julia proudly displays some of their projects around the house as a reminder of their hard work,” Lisa added.
The ultimate goal of the program, according to Zumarraga, is to teach skills that help participants deal with life’s inevitable crises, increase their self-confidence and decrease any suicidal or self-harm thoughts.
Lisa said the program gave Julia concrete actions they can take when they are distressed and need to cope with stressors. Julia’s preferred skill, TIPP (Temperature, Intense Exercise, Paced breathing and Paired muscle relaxation), helps when they are feeling distressed.
“This one is Julia’s favorite skill, and works very effectively when they are about to enter a panic attack,” Lisa said. “I can also say that their interpersonal skills have improved, and they are much less reactive in their communication with parents.”
Zumarraga emphasized how important it is for parents to support their children’s mental health by setting boundaries with them when they are younger but encouraging them to feel independent as they age, being more active in their lives, knowing their friends and interests, and connecting and listening to them. Parent self-care is also key, as they are their children’s role models.
Lisa depended on school counselors, therapists, Julia’s pediatrician, parents who had similar experiences with their children and the ASPIRE care team to bolster her child’s mental well-being.
“Their advice was invaluable, and having a team like ASPIRE’s (intensive outpatient program) at the ready was exactly what we needed,” Lisa said.
She advised parents who see their children struggling with their mental health to take it seriously and reach out for help, noting that sometimes the first reaction is to minimize or pretend the problem doesn’t exist.
“I know for my husband and I, it was very difficult to accept that our child was struggling with depression, self-harm and suicidal ideation,” Lisa said. “There is such a stigma around mental illness in our country, and it gets in the way of people seeking the help that they really need.”
For more information on the ASPIRE program, call (650) 988-8468 or visit tinyurl.com/aspireprogramech.
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