Your Health

Addressing ongoing need, ECH expands program for teen mental health

A singular message reverberated across social media Sept.10, World Suicide Prevention Day: Youth suicide rates will not change until each community takes action.

Directors of El Camino Hospital’s After-School Program for Interventions and Resiliency Education (ASPIRE) last week announced the expansion of the program with new replications in Southern California at CHOC Children’s Hospital, Hoag Memorial Hospital Presbyterian and Mission Hospital.

Daniel Becker, M.D., chief medical director of Mental Health and Addiction Services at El Camino, said that while the hospital jump-started ASPIRE after the wave of suicides at Gunn High School in Palo Alto in 2010, the program works with youth of all ages struggling with a range of mental health problems. Local residents may associate the launch of ASPIRE with the mental health crisis that precipitated it, but program representatives stand ready to serve any child, teen or young adult waging a mental battle long before it becomes that severe.

“Undeniably, those events did add urgency (to start ASPIRE),” Becker said of the local cluster of teen suicides. “But there have been many other kids with other behaviors. … It’s a great choice for kids who have the ability to make use of a fairly rigorous curriculum to help with their anxiety, depression, substance abuse, mood or personality disorder.”

Another tip widely shared on the internet on World Suicide Prevention Day: Pay attention to the words and behaviors of friends and loved ones. That advice directly correlates to how ASPIRE identifies youth who need care and teaches them how to cope with stress.

“I’ve worked in the Bay Area for over 25 years now, with other hospitals, too, and I have referred many to ASPIRE,” Becker said. “People get referred to ASPIRE and all of El Camino Hospital’s programs through many routes: school personnel or counselors, parents who read about the program or clinicians who have seen a kid in evaluation and determine right now they need more treatment than in a typical doctor’s office situation.”

Individualized care

According to Becker, during the eight-week, after-school outpatient program, participants meet with a psychiatrist who specializes in child-adolescent behavior, who conducts an ongoing evaluation and/or prescribes safe medication if appropriate. The program also incorporates group and family intervention. ASPIRE’s commitment to addressing and customizing care for each individual’s mental health struggle has made the program especially effective and worth replicating.

The group and family therapy aspect of ASPIRE is key to treatment and recovery, Becker said, because of the large amount of trust and emphasis teens place on what their peers and family members think.

“We try to help parents understand what approach we are using with their kids in hopes they can encourage healthier behavior and thinking,” he added. “They can only do that if they understand.”

Becker noted that he has never seen group treatment work better than with the middle school, high school and college/postgraduate individuals that ASPIRE serves. The program employs a model that enables participants who enter at different times and must assimilate new information to adjust to their new environment by receiving encouragement and mentoring from those who have been in the program longer who can genuinely say they know how the newcomers feel.

“It’s very common in psychiatric treatment, but especially powerful in teens for reasons that are developmentally normal, or even good,” the medical director said of the peer-to-peer aspect of the program. “They pay more attention to their peers than grownups in their lives. They are beginning to step outside of their parents’ shadows to form complex, meaningful connections (with those their age.)”

Model program

To Becker’s knowledge, ASPIRE’s model is the first of its kind. Modified from the experience of those who attended therapy sessions once a week for six months, they compressed the program into eight weeks for efficiency. Directors also attempted to make ASPIRE accessible to all who need it, working to ensure that insurance companies don’t refuse to cover the service for a child or teen considered stable enough to discontinue his or her therapy.

All who start the eight weeks are eligible complete it, and graduates pass along advice for the next group coming in after they have completed the program.

Michael Fitzgerald, El Camino’s executive director of Mental Health and Addiction Services, stressed that ASPIRE offers treatment for a wide spectrum of mental health challenges.

“Kids are not just discharged if they don’t have suicidal tendencies,” he said.

The need has never been greater for youth mental health resources, largely because of how much social stress today’s youth endure, Becker said, adding that the pressure to get into a good college alone is enough to send a teenager over the edge.

“Adults are better at stress management because it is a part of their growth,” he said. “We sense this in ourselves probably through trial and error, and now have a bunch of strategies to reduce these stresses, like saying ‘no,’ taking time off and exercising. Teens have not yet gotten to the point where they can identify and reduce stress like grownups do.”

The program began with a task force of psychiatrists, parents, school personnel and community members who identified ongoing resources for ASPIRE participants after discharge, filling in the so-called missing gap. Middle school and transitional age (ages 18-25) programs were added as need arose.

For participants nervous about starting ASPIRE, a two-week preparation program aims to ease anxiety and, build cooperation and commitment, Fitzgerald said.

“None of this is intended to be definitive treatment,” he said. “It’s frontloading treatment with decades of potential ahead of (those in the program) … in hopes they’ll work with a therapist in the community in the future to practice these tools then and throughout their lives.”

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