Mental health, substance abuse clinic in St. Paul's east side looks to serve youth of color

INTERVIEWER: It's no surprise to many of us, children and teens have been reporting mental health struggles at higher rates than in the past in recent years. Nationwide, only about half of those with a mental health condition get treatment. That's according to the CDC.

A St. Paul organization is working to reach more kids with a new clinic that today starts its first full week of operation. The Wilder Foundation's new site in St. Paul's east side claims to close gaps in care for young people, especially young people of color, with providers who work in multiple languages and other services. Joining me for more details on those services is Wilder's vice president of community mental health and wellness, Pahoua Yang. Thank you very much for your time this afternoon.

PAHOUA YANG: Yes, thank you for having me on.

INTERVIEWER: As I said from the top, we've all been talking, especially since the start of the COVID pandemic, about just what young people are going through in this day and age. Can you start by telling us a little bit about just the need for this type of clinic?

PAHOUA YANG: Absolutely. I think during the pandemic, our country and many of our communities went through so much, both concrete and ambiguous losses. And the experience for many of our children and adolescents was very different during the pandemic. And so coming out on this side of things, we are seeing a lot higher need for mental health and substance use services, both in our adult and child population.

But particularly, we know that the waitlists have been incredibly long for children and adolescents. And we know that the need has grown this side of the pandemic. People are still grappling with what we've gone through as a nation, as a world, the last five years.

In addition, we also saw many organizations, particularly locally, many organizations that were youth serving or youth oriented go away during the pandemic. And so you have this very high need. And we have less resources.

INTERVIEWER: So when you talk about-- people use the term "culturally specific care." And, I mentioned at the top, there are people working in multiple languages. Not only have some organizations gone away, but there are also a lot of questions that are being posed now about, why focus on youth of color or people of color? Can you explain for people why you all felt it was critical to focus in on populations of young children and young people of color, and how you're able to specifically cater to any needs that might be there?

PAHOUA YANG: Absolutely. So let me clarify. Our main focus is on kids and adolescents and really working to match the needs of our community and the people we serve. And so we have a whole team of people who serve very young children age 0 to 5. They have to understand what the world looks like from a child that age and what the world looks like for their caretakers.

It's the same thing for many of our children and adolescents, who may be Black, Indigenous, or from other communities of color or who may speak a different language. It's incredibly important, when we are working in this kind of context with families, that we really understand their worldview and provide services that take that into consideration. And that includes understanding their cultural context. That includes understanding language. That includes understanding many aspects of who they are on this planet.

INTERVIEWER: What are some of the most prominent mental health and substance use challenges that you are hearing and seeing about in this time? I think we talk about the problem at large. But are there any specific trends in things you're really able to identify?

PAHOUA YANG: Yes. I mean, we see, again, a lot of loss, a lot of trauma, both direct experiences with trauma, but also, just being in environments where a lot is happening in a way that kids can't always absorb. It's hard for adults to absorb, and so it's hard to expect kids to absorb. We see a lot of anxiety, especially during this time, where as a nation, we are experiencing a lot of changes.

INTERVIEWER: Oh, excuse me.

PAHOUA YANG: Are you still there?

INTERVIEWER: Yep, I'm here.

PAHOUA YANG: Sorry.

INTERVIEWER: That's OK.

PAHOUA YANG: Just a lot of changes, a lot of unknowns-- what my team is reporting is they are experiencing kiddos who have anxiety about a lot of things in ways that we haven't seen before, as a result of just all of the changes happening nationally and what they're seeing on both the local and national news. In some subsets of our populations, we're seeing earlier and earlier use of drugs and alcohol, often as a way for kids to cope, and so just a whole collection of different things that really have to do with kids trying to make sense of their world and trying to do the best that they can.

INTERVIEWER: Sure. Can you describe a little bit about what the process looks like for how a child would end up receiving these services?

PAHOUA YANG: Absolutely. So of course, any caretaker can give us a call and consult with one of our providers, one of our staff, to talk through their specific situation before deciding whether we're the right place or not. But once people do decide that they want to come to Wilder, every child or adult goes through an assessment process with one of our providers, really talking through what's been going on, what they're looking for. And through that process, we will work with families to decide what the right pathway to treatment and support might be. And so it's really starting with that assessment with a mental health provider.

INTERVIEWER: And does this clinic have inpatient services, or is it mostly outpatient? How many people do you feel you'll be able to serve?

PAHOUA YANG: Sure. We do not provide any inpatient services. So we work with lots of our colleagues who have inpatient treatment. So if we ever come across someone who would be better served in an inpatient situation, then we work with them to get them to one of our colleagues that provides that. So we provide all outpatient services.

We have our two clinics now. And people can come to a clinic and receive services there. We also have a number of school, home, and community-based services. And so if we determine with the family that one of those services might be better or would be of support to them, then we would work to make sure that people are connected internally to our teams, who then would work together with the family to coordinate those kind of services.

INTERVIEWER: Sure. And are there other types of-- it sounds like you're coordinating with schools and other places. Are there other obstacles that you foresee being able to help families with? Sometimes, funds can be short, or even transportation can be hard to come by. What about some of those types, that holistic approach to helping?

PAHOUA YANG: Absolutely. And those are all things that we go through with families when they come in, just to look at what could be a barrier for them. So the first and foremost important for everyone to know is we see everyone, regardless of ability to pay. And if insurance is something that they desire, we have someone on staff who can help them access health insurance. Otherwise, we work with families to look at, in addition to the mental health or substance use needs, what other needs might exist that we could support or that we could help them connect to one of our partner organizations with?

And so we're really looking at all of that. I think a lot of times, people aren't sure how to reach out or how to even get services started. And so connecting with us is a great way to at least say, how do I get to your clinic? Or how do I make an appointment? Or can I talk to someone even about what's happening?

INTERVIEWER: Sure, it's good to reach out and ask those questions. Before I let you go, I do wonder if from your perspective-- we know that stigma around mental health needs can vary among cultures, but the stigma is everywhere. Do you feel that it's been improving in recent years and maybe specific to young people and children?

PAHOUA YANG: That Is a complicated question. So, I do think this side of the pandemic, there has been a little bit more attention and for some of our young folks and in some of our adults, a little bit more openness to say, I need help, or I need support.

But the stigma is still pretty powerful. And so sometimes, we may have a young person who reaches out and says, I really, really need to talk to somebody, and who may have a caretaker who has a lot of feelings about that. And so part of our work is to talk to everybody who is important in this young person's life to help support them, so that it's OK for this young person to get what they need.

INTERVIEWER: That makes sense. Pahoua Yang, thank you so much for your time this afternoon.

PAHOUA YANG: Thank you for having me on.

INTERVIEWER: Pahoua Yang is vice president of community mental health and wellness for the Wilder Foundation.