In New Orleans, Community Mental Health Workers Staff Youth Workforce Development Programs
Innovations in Youth Mental Health
By Nia West-Bey
Our nation has a well-documented shortage of clinical mental health providers. The truth is that we will never have enough mental health clinicians to meet young people’s mental health needs, nor are they the kinds of providers that young people prefer. CLASP’s mental health work has consistently shown that young people strongly prefer to receive support from peers and to receive support in trusted community-based settings, including youth workforce development programs. Research has also shown that youth workforce system leaders and providers feel their programs are unprepared to meet the mental health needs of their participants, who have disproportionately experienced trauma because of community violence, financial strain, racism, discrimination, and/or histories of child welfare and criminal legal system involvement.
In this post, I highlight an example of a promising program aimed at young adults in New Orleans. It creates a new model of mental health service drawing on the strengths of youth peer support and community health work to meet the needs of youth in workforce development programs.
The New Orleans Children’s Bureau leveraged a philanthropic research grant to develop a new model of service designed to meet the mental health needs of young adults ages 18-24 engaged in the city’s youth workforce development programs. Community mental health workers (CMHWs) are a new career pathway that brings together the mental health focus of traditional peer support programs and the public health strategy traditionally associated with community health workers. CHMWs participate in a month-long training that includes a two-week peer support training module along with shadowing clinical professionals. They are then matched with a youth workforce provider agency as permanent, salaried, full-time employees.
CHMWs provide a range of supports to youth workforce program participants, including mental health education (stress management, mental health awareness), outreach to program participants, connections to care, and support for young people already receiving clinical services. These workers serve as a part of a clinical team and can take on community-based education and activities in support of therapeutic goals.
Several key features make the CHMW model effective. Community mental health work is not a “stepping stone” to another career. It is a career in its own right, offering a salary and benefits. Program organizers emphasize that for CHMWs to succeed, youth workforce program sites must show they are “organizationally ready” to incorporate mental health workers. They can demonstrate this by their ability to prioritize mental health education and tier 1 supports, provide on-site clinical supervision of mental health workers, and promote mental health in the program broadly.
The CMHW model holds much promise for supporting the mental health needs of opportunity youth in New Orleans. The program is seeing more than 20 applicants for each opening, a significant increase compared to clinical roles that struggle to draw applicants. As the program looks to continue to grow and achieve sustainability, the policy context in New Orleans and in Louisiana includes both strengths and challenges:
Youth-Led Narrative Shifts: The city of New Orleans has experienced an increase in youth voice and engagement in local advocacy and policymaking. For example, New Orleans youth led the development of the city’s Youth Master Plan, a comprehensive roadmap for creating and sustaining a positive, youth-development-focused, results-oriented New Orleans that works for all young people. Because young people in the city have consistently elevated mental health as a primary need, their perspective pushed both the investment in youth mental health and thinking beyond clinical levels of care.
State-level Medicaid Reimbursement Choices: A major challenge to sustaining and scaling the CHMW model is Louisiana’s Medicaid policy context. Medicaid is a public health insurance program that covers millions of people with low incomes including children, parents and other adults, seniors, and people with disabilities. States have significant discretion in what services to cover, how much to reimburse providers for services, and who to consider a provider. Louisiana’s definition of peer support providers is narrower than many other states. For example, Louisiana requires that peer support providers must have had a substance abuse or serious mental illness diagnosis, which limits eligibility for the role, especially for youth. Louisiana also has some of the lowest Medicaid reimbursement rates in the nation, making it difficult to sustain typical clinical mental health work through Medicaid reimbursement, never mind a new provider type. The state is considering expanding reimbursement for evidence-based practices, which could include CHMWs, but state-level policy change would be required.
In an effort to highlight transformative solutions aligned with our core principles to reframe mental health, we seek to elevate the innovative ways communities are addressing youth mental health. New Orleans’ CHMW program provides an example of how youth voice can change the trajectory of mental health care, lead to innovations in provider types, and increase access to care for opportunity youth by partnering with workforce provider agencies.