Mental health issues among children, teens and young adults — specifically, depression, anxiety, substance abuse disorders and an alarming trend toward suicide — represent a growing problem across the country and, in recent years, have increased significantly. Creating access for youth to appropriate mental health services is particularly challenging in areas such as Fresno County, due to its large size and the make-up of its communities. Fresno County is over 6,000 square miles and is home to a high percentage of farming and agricultural communities in rural and remote regions with limited resources. Many families in these areas, as well as metro areas, face challenges related to poverty, trauma, food insecurity and lack of access to health care. All these factors contribute to mental health challenges.

The Office of the Fresno County Superintendent of Schools (FCSS) and the Fresno County Department of Behavioral Health (FDBH) have a long-standing relationship and mutual understanding of the challenges their schools face in accessing appropriate mental health services. In 2016, FCSS and FDBH began a conversation about reimagining a mental health service delivery model that reduces barriers and increases access to mental health services for Fresno County youth. They knew that school is where youth spend a majority of their time, and FCSS worked with its districts to help place clinicians and case managers on school campuses. Reimagining mental health services required collaboration and coordination between multiple organizations and stakeholders to provide better services for Fresno’s students.

Through a five-year, $111 million contract, the All 4 Youth program (all4youth.fcoe.org) was established in 2018 to provide a mental health clinician or access to a clinician in every school within Fresno County. The program uses the allotted funding and insurance billing practices to remove financial barriers to services for all youth, and medical cross-systems billing strategies to maximize cost-effectiveness. All 4 Youth provides specialty mental health and prevention and early intervention services to youth ages birth to 22 who are experiencing behavioral health difficulties. Psychiatric services are also provided as needed. Any student can be referred and provided with long- or short-term treatment or connected with appropriate services.

All 4 Youth is focused on addressing mental health as an essential part of learning success and overall wellness. FCSS and FDBH felt it was critical to include the birth to 5-year-old population in its program to prioritize early identification for those at risk and provide the support they need to prevent serious mental health issues from developing, as well as increasing school readiness and maximizing future school success. In this service delivery model, mental health clinicians are integrated into the school system and culture, becoming part of the team within the schoolwide, multi-tiered support system. The program meets youth and families where they are by providing mental health services at school, in the community and in the home.

All 4 Youth is in its fourth year and employs 115 clinicians and case managers who are assigned to school sites, as well as over 30 support staff to assist with delivering quality services. Last year, All 4 Youth served approximately 4,000 youth and families in Fresno County.

One of the most impactful components of the program is a training series schools are required to participate in as a condition for having a clinician or case manager placed at their sites. The series of three, two-hour trainings are focused on trauma and resilience with an emphasis on understanding the impact trauma has on the developing brain, an individual’s ability to regulate their emotions and behavior, the impact of toxic stress, and strategies for staff to respond to students with a trauma-informed approach.

Training is provided to all school staff, including teachers, paraprofessionals, custodians, bus drivers, front office staff and administration, with the goal of helping school staff view students’ behavior from an empathetic, supportive lens. The trainings are also designed to help school staff understand mental health challenges, to be better equipped to identify behavioral health issues, and to know when to refer a student for mental health services.

FCSS staff say they deeply value their partnership with the FDPH and encourage other school districts and county offices of education to explore similar partnerships in their communities. Successful partnerships utilize the power of collaboration in supporting youth through mental health services, including the expansion of integrated supports and the development of innovative strategies. The ultimate goal is to remove barriers to meet the increasing needs of youth in order to help them thrive.