Season 2: Episode 10 - A Community-Centered Approach to Behavioral Health

It's no secret that mental, social, and emotional health is a hot topic for society right now. And yet there continue to be far too many barriers to access when it comes to behavioral healthcare. As Director of Emotional Well-Being for the Boys & Girls Clubs of St. Joseph County, Erica Kelsey is working to remove those barriers. 

In the final episode of Season 2 of our Staffing, Safety, Society podcast, we talk to Erica about her efforts. 

Whether it's through Club-wide mental health screening and education services, staff-focused counseling and support, or targeted early interventions for youth most at risk, Erica's work offers pathways and insights for how community-based nonprofits can offer an innovative, proactive alternative to traditional healthcare settings. 

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Transcript

00:01 - Erica Kelsey (Guest)
The shortage of mental health providers is nationwide. This is the direction that we need to go in for our kids. It's worth it to invest in them. They're the future generation of leaders in our communities. 

00:12 - Kevin Trapani (Host)
Welcome everybody to season two, episode 10 of Staffing Safety Society, our last episode of the season. I'm Kevin Trapani. 

00:21 - Paige Bagwell (Co-host)
And I'm Paige Bagwell. Cue the tears. 

00:23 - Kevin Trapani (Host)
What are we going to do? We have nothing to do, paige. I know what will we do. Our topic today is another part in a theme of what we've been working on a really broad conversation around behavioral health, and that's really been a common thread for a bunch of our recent episodes, because it's a hot topic in society and it's really important for ensuring safety of communities, especially as we work post-pandemic. Today, we're specifically talking about the integration of behavioral health services within community-based organizations, both as an alternative and also complementary to more traditional healthcare settings. While our guest today already has an advanced and deeply integrated model at Her Boys and Girls Club, what's really important is that there are a whole bunch of ways that all of us can take smaller steps to get there. Paige, how about introducing Erika? 

01:06 - Paige Bagwell (Co-host)
We have Erika Kelsey with us, and she has served as the director of emotional well-being for the Boys and Girls Club of St Joseph County for the past year and a half. Shout out to that club. What a fantastic role to have inside your club. She's also a licensed clinical psychologist. She earned her master's and her PhD in clinical psychology from the University of Southern Mississippi and completed her training as a pre-doctoral resident at Indiana University School of Medicine. She is a certified integrated behavioral health psychologist. Prior to being with this club, she served as director of behavioral health at the South Bend Clinic, started the integrated emotional well-being program at the club, where she had hopes of creating this preventative mental health program that just kind of fosters resilience in the youth and also reduces access barriers to exceptional mental health services that, like so desperately, is needed. And so I'm just so excited not just that Erika's with us, but that clubs are thinking in this way. Erika, we are so happy to have you Welcome. 

02:05 - Erica Kelsey (Guest)
Thank you, I'm excited to be here. 

02:08 - Paige Bagwell (Co-host)
This is a huge focus in our society today. I hear it all the time in the news, you hear it around school systems and community programs. You being a medical professional and also hearing this a lot, can you talk a little bit about the behavioral changes that you've seen in the youth over the past few years? 

02:22 - Erica Kelsey (Guest)
An easy marker for me is to think about pre-pandemic and then since the pandemic. 

02:27
What's changed? We've noticed nationwide that there's a lot more health illness going around with adults, kids, really everybody. There's a lot more anxiety and depression. School-aged kids were seeing more oppositional behavior, outburst and defiance and also some gaps in social skill development because of the extended amount of time where they were asked to be at home only around their immediate family. And then even in that area, you have to think about the academic struggles that occurred for many who were e-learning during the pandemic, especially if they had working parent and they were fairly young, they might not have had the assistance and support to keep up with their online learning. Falling behind academically is understandably going to result in some stress and some anxiety and even some defiant behavior when they're back into the school setting. Because when kids are upset, that might be their natural response is to act out or refuse to do something, and not because they don't want to do it, it's maybe they don't know how and they're afraid to ask or they don't know how to ask. 

03:22
So we are seeing a lot more of that in our schools and then, of course, in our clubs. 

03:27 - Kevin Trapani (Host)
I know you have a concern with the way our access to our healthcare system is set up. The way you built this integrative approach is meant really to address some access issues. Can you help us understand traditionally how mental healthcare might have been accessed, what some of the more recent developments are and how specifically y'all's approach is addressing that? 

03:46 - Erica Kelsey (Guest)
This is probably the thing I'm most excited about, with the opportunity to work in this nonprofit organization. Traditionally, I think you can think of mental health providers as either working in a community space, a mental health clinic, a medical center or in a private practice. The common trend between those three settings is that more than likely they're going to bill health insurance. The health insurance requires the individual who's receiving the services to have a diagnosis for them to justify coverage. That's a barrier because if you're a mental health provider and you want to treat symptoms early, before they get to be so big that they're really interfering with someone's functioning, the insurance isn't going to cover it. Or you're stuck in an ethical dilemma on whether you should diagnose something that's not fully there. There's a shortage to get in, even if you have mental health providers in the community. Here in St Joe County it's anywhere from three to six months to get in. Once a referral is made. It's even longer for assessments. A lot of times there's specialty areas like autism and spectrum disorder. In our area that's closer to 12 months for a weight. There's a lot of reasons for that. 

04:45
I think integrating behavioral health isn't a brand new thing that I decided to do. It's something that's been around for several years, but it started off in medical centers. I've worked in integrated models at Indiana University School of Medicine and then most recently at a medical center here in South Bend. The goal there is to improve access. I was in an office with pediatricians and they could say to a patient if you're having anxiety, we have my colleague over here could see you today. That's really nice to eliminate that wait time, but there were still access barriers there, like insurance, just the need and the capacity. 

05:18
Also, you have to think about those kids who don't see a primary care doctor. There's a lot of families who maybe only go in when they need to for a sports physical. If you do have a pediatrician, how often do you see them If you're healthy? Once a year. A year is not really a great frequency to pick up on early signs of mental health concerns. But where could we pick up on it early? Somewhere where the kids are going every day A school, a club, another organization in the community, you bet, yeah, the coolest part about the access barriers we're eliminating is not just the ones I mentioned with. We don't bill insurance. Our services are free, we go to our site, so there's no extra appointment or transportation need for the family, then normalizing the setting. So you're at the Boys and Girls Club. That's a trusted community space. There's no stigma behind being there. It's a very nice way to destigmatize anything behind receiving mental health treatment the early access so we can get in as soon as we see signs and get some interventions in place. 

06:11 - Kevin Trapani (Host)
It is really, really a brilliant model. 

06:13 - Erica Kelsey (Guest)
It is. 

06:14 - Kevin Trapani (Host)
That's why you're doing it right. It's just the idea. In so many levels you've articulated so many different barriers. This is as if we wait until after somebody has a heart attack to decide to prescribe Lipitor. The idea is to get out ahead of this stuff, and our system doesn't do a great job at that. Talk to us a little bit about in the club. How does this model look? 

06:32 - Erica Kelsey (Guest)
Our model has two main tracks. One is our youth facing and the other is our staff facing. We think of our front line staff the ones that are in the club site as one of the number one protective factors for recognizing the early signs and developing resiliency skills and coping tools and things like that, and just that trusted relationship is so important. So we invest in our staff's mental health and well-being by offering drop-in wellness workshops. That are different themes that the staff have voiced they want to learn more about. Might be something like sleep hygiene or healthy boundaries at work or whatever. 

07:06
Then we also have an in-house mental health provider who will do free therapy for any staff member who reaches out and for those who may not want to see a staff therapist on our team, so have telehealth and there's free mental health access that way as well. We have a community partner who is a private practice that offers free services for our staff and our club families at no cost. So we've developed a really great option-based system for our staff and so I think that then pretty well received and well utilized, even just being here for a little under a year and a half. And then on our youth-facing side, we follow a three-tiered model. The first tier is our universal level. This is where we want to target the biggest number of kids. So 80% of our kids who may have mental health concerns or behavioral concerns emerge eventually should be managed well with tier one. So it's universal and everybody gets it. 

07:54
That means that all of our club site kids are getting weekly social and emotional learning curriculum. So they're learning things like healthy expression of emotions, coping tools, relationship strategies, social skill building and things like that. And we also do a lot of staff training around areas of trauma-informed care and best practices for using redirection and praise and de-escalation Really like equipping our staff with preventative tools so that when they see something going on at club. They know how to intervene properly and they feel well prepared and well equipped, which is going to help them be more satisfied in their work. We do a universal screening. Families get the choice to opt in or opt out. Most of our families opt in. I don't have an exact percentage, but I want to say probably 85 to 90% opt in and we do this twice a year and it's a mental health screener that's not used to diagnose, but it's used to give us a picture of children who may show early warning signs of developing a mental health disorder. 

08:44
Oh, wow we do it twice a year. With the results of that, we make recommendations. I have a whole team that works under me who helps to kind of sift through and do follow-ups with the parents to get more information and then make recommendations, which might be something we could do in-house. Which brings us to our tier two level of intervention, which would be like a group therapy, so we can offer that in-house. There's a lot of really cool things at our tier two level we have. For the past six months we've been using Mightier, which is a kids biofeedback program where they get to play video games while they're connected to a heart sensor. Oh, wow. 

09:16
And it teaches them how to regulate their emotions and regulate their body's physiology. Wow, so that's out at all of our club sites. It's a really cool program. That is awesome. 

09:23 - Kevin Trapani (Host)
It's amazing. 

09:24 - Erica Kelsey (Guest)
And we have several other programs and resources that are kind of at that early intervention phase for our club kids. 

09:30
It might be like a family outreach, it might be resources that we send home, Just depends on the unique reason for the elevation. Generally we allow any of our club directors to send referrals to us if there's a child who they think might need mental health support or some resources from our team, and we have a way of triaging that and figuring out which level, different ways of like not letting anyone slip through the cracks. And then tier three would be our ballast area because we're hoping that with effective use of universal and targeted intervention, not very many kids need tier three, which is our most intensive. So that would be individual therapy, family therapy, some that we do internally. Sometimes we do refer to our community partners because it might be something that we think needs a little bit more comprehensive care where they need wraparound services or psychiatry or a specialty area that we don't serve. But we have a great relationship with our community partners. So that's in a nutshell what we're doing here. 

10:22 - Paige Bagwell (Co-host)
That's a lot in a nutshell, it really is, because it's just so intentional Even ways to engage with kids. Let's just think y'all've gotten really creative. And the fact that you didn't leave your staff out, that is just huge. That trauma, informed care, that prevention I used to work in a nonprofit and we talked a lot about they can't care for others, they don't know how to care for themselves, right, and so just having that understanding and providing those wellness technique and workshops and all of that for them speaks volumes of that integrated model and how intentional you are. All our beings Just kudos Really meeting people where they are making it easy for people. It's amazing, amazing work, I guarantee you. There are other nonprofit leaders that are saying like gosh, I would love to do all of these things, but I don't know where to start. 

11:07 - Erica Kelsey (Guest)
Yeah, I think if it's an organization who's at the very starting level, they don't have any mental health providers on their team. 

11:13
What I usually recommend is reaching out to their local community mental health centers and learning about what resources the community mental health center might have to offer Even a lot of times at no cost to other nonprofits. There's community mental health centers that will provide trainings for staff on trauma informed practices. They'll come to your site and do trainings. Prior to me starting, I know the Boys and Girls Club of St Joseph County was contracting with community mental health partners to bring therapists into the clubs on like a contract as needed basis, and I think that's a common thing when someone's just putting their toes in to see if it's something that they would like or need at their site. There's universities around that have masters or doctoral level mental health programs. That's another good area to reach out because a lot of times same thing they might be willing to do trainings. You might be able to establish a internship or a practicum placement. Those are other like really low cost ways of getting some mental health services and some trainings into your staff. 

12:06 - Kevin Trapani (Host)
Eric, this has been an enlightening and engaging, wonderful conversation. The work you're doing I agree with Paige the intentionality of the work, the design of the work, frankly, is reflective of the kinds of social initiatives that scale. You've addressed the barriers in a very intentional way, surpassed the barriers and now you're providing care to kids before they know they need care. What should we have asked you that we didn't? What do you want to, as you think about all of our hundreds of thousands, or no, I guess? 

12:36
it's millions of people, millions of people, millions of listeners. 

12:39 - Erica Kelsey (Guest)
Something that I often say when I'm doing trainings is when you're able to shift your mindset to stop thinking of mental health and well-being as a silo that only mental health professionals can manage or can work with, and start thinking of it as a community responsibility. I think the sky's the limit for the number of opportunities and things that you can do to be preventative, and the shortage of mental health providers is nationwide, and so this is the direction that we need to go in for our kids. It's worth it to invest in them. They're the future generation of our leaders in our communities. 

13:13 - Kevin Trapani (Host)
What a great way to say that. I mean, the fact is that we've got armies of caring, selfless people in relationship with young people all day, every day, across this country, so they've already passed the first barrier of do you have the capacity to care? Now, what we're trying to do is equip them when they encounter a child in crisis or they are working with kids that have the skills that are necessary. It's a fantastic idea. Instead of thinking of scarcity, we think of the abundance of the embedded resource. Erica, this has been wonderful. Paige, we're going to wrap this up. What are your final thoughts here? 

13:44 - Paige Bagwell (Co-host)
Erica could have dropped the mic on that last comment of hers, like this is not just for that mental health silo. 

13:49
This is a community thing that everybody needs to wrap their arms around, and so that is my big takeaway, because I think what we did today which is fitting that it's the last episode of this season Dream, You're looking at a community that needs help and that especially a community of children, and so dream big, make phone calls. I mean, that's really what Erica called people to do just make the right phone calls in your community to say how can we just show up? And I just think that y'all are doing that so well. I just am really really excited to keep watching and learning from you all, because you're doing some really great things. 

14:22 - Kevin Trapani (Host)
You know it's so fitting that this is our last conversation of this season. We've talked to some of your colleagues in the Boys and Girls Club community who have gone out and put dogs on their staff Literally, because they break down barriers and create a warm environment and they did that for kids and they found that it was most helpful for staff. They saw staff that needed something that they probably would not have noticed before. We've talked to people about conscious and unconscious bias. 

14:50
We've talked a lot about the demands on staff coming out of the pandemic, all the deficits that exist from having kids in asocial environments for such a long period of time at such an important developmental stage. And it all delivers every afternoon and a lot of mornings to all the Boys and Girls Clubs around the country and YMCA's and camps and all kinds of Jewish community centers, and what you did today was you gave all of them a place to start. I think you've said most of your work is grant funded anyway. Is that right? 

15:17 - Erica Kelsey (Guest)
Yes, most of our work is grant funded and because mental health is such a hot topic and such a primary concern, there's grant funding out there and they're waiting for people to apply. 

15:27 - Kevin Trapani (Host)
So I want to make sure we talk about that, because you've given everybody a lot of opportunities to do things that maybe are at no cost and a great place to start and begin to ramp up immediately. But don't be hopeless, because we will have the opportunity to tell a narrative to people who care, and there's money available. Well, y'all, thank you for this conversation. Erica, thank you for your work. It is really the good Lord doing the best work. 

15:49 - Paige Bagwell (Co-host)
Amazing. 

15:50 - Kevin Trapani (Host)
Let me read us out. Staffing Safety Society is created by the Redwoods Group. It's produced by Steven Dosher, melanie Young, sammy Grover, paige Bagwell, piper Kessler and a little bit by me. If you like the show, tell a friend, leave us a review if you can. It means a lot to us. If you have a topic suggestion or any kind of feedback, we'd love to hear it, particularly here at the end of this season. If there are things you really want us to dig into next season, let us know. Who knows what that will look like, but we're certainly open to your ideas and just click on the link that's in the show notes, or you send an email to us at communityatredwoodsgroupcom again communityatredwoodsgroupcom, and we'll get back to you. Staffing Safety Society is recorded weekly in North Carolina. I'm Kevin Trapani and I'm Paige Bagwell. 

16:32
Thanks y'all for being with us. Take care.