Credit: Pexels / RDNE Stock project
Born and raised in the agricultural foothills of Tulare County in California’s Central Valley, Greg Salcedo attended the only K-8 school and high school serving his rural town of about 3,000 people, where everything seemed out of reach — backpacks and notebooks, teachers and administrators and, in particular, school counselors and social workers.
Friends and family, Salcedo said, never spoke about adolescent depression, anxiety, post-traumatic stress or suicide, issues that have, for decades, disproportionately affected rural, high-poverty communities in the United States.
But after the Covid-19 pandemic exacerbated a decades-long mental health problem in Tulare County — with psychiatric hospitalization rates for students 9 to 13 years old climbing 23% during the first year of the pandemic — Salcedo decided to pursue a master’s degree in social work. In his first year as a graduate student, he helped shape the county’s emergency response through Rural Access to Mental Health Professionals, a program that placed him as a student mental health support worker in schools serving his community.
“I was able to talk to students and set them up with resources, call parents to set them up for therapy referrals or services with outside agencies [and] do a lot of outreach to promote mental health,” Salcedo said. “Being in this community for so long has helped me have a better sense of empathy and understanding of these kids and what they’re going through.”
The program places early-career mental health workers in 33 of Tulare County’s high-poverty school districts. Through the program, Salcedo served a one-year unpaid internship at an elementary and high school in Tulare, after which he was hired full time as a social worker at a high school in the Tulare Joint Union High School District.
Participants are first- and second-year graduate students in social work who provide education-related services such as interim therapy and student group services, according to Marvin Lopez, executive director at the California Center on Teaching Careers, which helps coordinate the program. Since 2019, the center has supported 50 candidates through a $2.5 million grant from the U.S. Department of Education.
“In our district alone, we started out with three social workers last year, and now, we have seven new social workers that came on through the grant,” Salcedo said.
In 2019, Tulare County had a student-to-counselor ratio of about 870:1 — one of the highest in the state and well exceeding the recommended ratio of 250:1.
Since then, the state has embarked on a historic, five-year, $4.6 billion initiative to expand school-based mental health support through programs such as the Certified Wellness Coach workforce and the CalHOPE Student Support and Schools Initiative.
Districts in Tulare County have improved shortages of mental health providers using funds from the state. Tulare Joint Union High School District, for example, reported that the district’s student-to-counselor ratio improved significantly from 300 students per counselor in 2019 to 268 students per counselor in 2021.
But, few participants could afford to stay in the school-based mental health field after completing their unpaid placements, said Lopez.
“It became evident that we needed to support candidates to make sure we retain them,” Lopez said. “We began looking at resources like clinical supervision and additional training, but also financial incentives that can allow them to continue working at school sites.”
Last year, the center secured a $15 million federal grant to develop Preparing Rural Inclusive Mental Health Educators, a program that pays final-year graduate students a $45,000 stipend for a yearlong internship and a three-year commitment to remain in the field of school-based mental health care. To date, the center has sponsored 23 interns.
According to Lopez, these candidates are able to offer more long-term, advanced care, such as individual student therapy, group therapy, parent and family consultation and school faculty support. The center intentionally recruits from partner universities closest to Tulare County, such as California State University Bakersfield and Fresno State, whose students largely come from the rural communities they will serve.
Jeovany Martin, who completed his master’s in social work at CSU Bakersfield, was an intern in the program at a local elementary school. Martin was raised in neighboring Kings County by his Mexican immigrant parents, and he applied for the program to serve families whose needs have been shortchanged by language barriers.
“I’m able to relate to these students. I speak their language, and I’m able to communicate with parents in their language, which goes a very long way in creating a working relationship with them,” Martin said.
Martin said that the program was also his most realistic path to the field of education-based mental health care. Most providers are overworked and underpaid — with nearly 59% of school counselors leaving their positions in their first two years — and non-white, low-income candidates have much less financial and professional support to enter the field.
Nationally, most school counselors are overwhelmingly white, and they do not represent the backgrounds of the students they serve. For Tulare County’s student population — where nearly 80% of students are Latino — the two programs address a shortage of cultural competence in mental health support available to students, according to program supervisor Rosie Hernandez.
“We’re also having folks who are bilingual be part of our program because it allows families to be a bit more open to services because of that simple fact that they speak their native tongue,” Hernandez said.
Most children living in rural, low-income households, Lopez said, are also more likely to experience higher rates of anxiety, depression and behavioral problems, often due to stressors such as food insecurity, parental job loss and geographic isolation.
“We’re recruiting, preparing and supporting candidates from our own communities who represent our student population,” Lopez said. “That, in itself, allows our students to connect at a much higher level with our interns to bring them comfort, a space where they can interact and feel safe.”
A legacy of bias and neglect
Martin and Salcedo’s internships in Tulare County also provided the opportunity to tackle a decades-long legacy of mistrust between social workers and immigrant families.
“A lot of our families, especially from the Hispanic culture, think of social workers as ‘the people that take away my kids,’” Salcedo said. In his first year, Salcedo felt stifled by the number of permission slips that would have allowed him to help more students, but were returned unsigned. “Our job is also about breaking down that barrier and [explaining] our role for them to understand, ‘This person is here to help my kid with anxiety. They’re not here to judge me as a parent.’”
The National Center for Youth Law found that across the country’s child welfare, education and mental health systems, providers and educators have routinely over-referred Latino students for behavioral issues and subjected them to harsher disciplinary measures than white children. Black and Latino children were also found to be removed from their families and into out-of-home care at higher rates, while receiving fewer mental health services, such as psychotherapy and counseling, than white children.
Families that include at least one undocumented or non-citizen — 14.3% of Tulare County’s overall population — are also less likely to opt into care if they rely on citizen children to receive basic benefits like food stamps and housing subsidies, which can be jeopardized by family separation. In a county where more than a quarter of residents receive SNAP food assistance, and two-thirds of these recipients are children, signing a permission slip could come down to what some parents feel is a calculation between their child’s mental health and access to basic services.
To address fears of bias and neglect, which remain the highest barrier for underserved communities to access to mental health care, program interns adapt a traditionally siloed approach in school counseling to work more directly with parents, caretakers and community support systems.
Salcedo, for example, partnered with the local Boys and Girls Club to run a regular backpack drive for students in the neighborhood. He also helped set up a resource closet at his school, where students frequently stop by for necessities such as food, school supplies and personal hygiene products. Most recently, he partnered with a local church to serve boxed meals to students at the end of the school day and to parents on back-to-school nights.
“We have this daily check-in routine with our students, where we say, ‘Whether you’re needing to talk to a counselor, or you just need some deodorant, a snack, or pencils, we can provide it,’” Salcedo said. “‘If you’re looking for housing, or babysitting, or transportation to get to an appointment, we can try to help.’”
Broader post-pandemic challenges
Martin, who was hired as a social worker after completing his placement, said that the need for broader support has especially spiked for K-8 students in Tulare County, many of whom lost crucial social and cognitive development to remote learning during the Covid-19 pandemic. Many of Salcedo’s high school students, he said, withdrew from their counseling sessions online — some did not have reliable Wi-Fi or could not turn on microphones due to chaotic environments at home, for example.
Many also experienced life-altering trauma as a result of the pandemic. They grieved family members, experienced debilitating illness and lost access to basic needs like shelter and food.
“That’s why it’s important for us to take a holistic approach,” Martin said. “We might be doing an intervention here at the school for the student, but there might be something going on at home that the family needs extra resources for. We’re able to help bridge those gaps, wherever they might be, for the students and their families.”
