CHARLESTON, W. Va. – Federal funds could help pay for badly needed behavioral-health support services in public schools, advocates say.

Young people from families caught in the drug crisis desperately need the support of counselors and social workers, said Kathleen "Kat" Stoll, director of West Virginians Together for Medicaid and policy director for West Virginians for Affordable Health Care.

She said most people agree schools are the best place to provide that help but often don't have the money.

The good news, Stoll said, is that other states now have started to take advantage of a change in Medicaid rules that allows use of those funds.

"The federal rules have changed and opened the door wide for some additional services, particularly around behavioral health services," she said. "So, we need to take advantage of that."

For every $1 the state spends under Medicaid, the feds put in nearly $3.

More than 40% of West Virginians younger than age 18 qualify, but Medicaid billing is complex, as is most health insurance, and the state's agreement with the program also is very complicated.

Stoll said the state will have to decide how best to do this. For example, would it be better to have the schools bill Medicaid? Or should students get the services through the state's well-established network of school-based community health clinics?

Either way, Stoll said, it's well worth it for West Virginia to work through the questions.

"Our Legislature should say to the Department of Health and Human Resources, 'Let's look into this. Let's make sure we're maximizing our Medicaid dollars to get the kids the services they need in our schools,'" she said.

During the intense debate over this year's education omnibus bill, one of the few areas of broad agreement was the need for expanded wrap-around services in public schools. However, many lawmakers pointed out those services might be difficult to pay for.


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By Deanna Pistono for MinnPost.
Broadcast version by Mike Moen for Minnesota News Connection reporting for the Rural News Network-Public News Service Collaboration

If Minneapolis therapist Emily Abeln could wave a magic wand, the political rhetoric flooding the airwaves this election season would likely look a lot different. 

“I would just have every single human mind on the planet actually humanize each other. If we see everyone as human, then we don’t tend to do all this hate, violence, discrimination and restriction,” said Abeln, MA, LP, who co-founded Transcend Psychotherapy with spouse Max Abeln, MA, LMFT.

For many in America, this year’s election rhetoric has felt dehumanizing as parts of their identity are being discussed, often negatively, as political talking points. 

“Anytime that we have people who have to justify their own existence, (we’re) creating an environment for mental health problems and mental illness to form and be sustained,” said Shonda Craft PhD, LMFT, who runs Craft Psychotherapy and Consultation in the Twin Cities. 

Abeln and Craft are among the many providers with clients in Minnesota and across the U.S. who have had their identities – race, gender, or immigration status – invoked in various ways during the election. How they are impacted, however, can vary greatly. 

“Some people are desensitized to what’s happening. The constant exposure has caused them to emotionally disconnect and experience emotional fatigue, which can be a good coping mechanism (and) buffer for psychological distress,” said Fathi Kofiro, MSW, LICSW, who owns and practices at Daryeel Therapy in the Twin Cities. “For others, they’re terrified. They’re afraid for their lives. They’re afraid for their family’s lives. They’re afraid for the people that they care about.” 

Mental health providers use therapeutic techniques and practices while validating clients’ emotions and giving them a space to share their feelings. Providers working with clients from these communities also emphasize the importance of connection with a community that affirms their client’s identity and supports them.

“The gap between (a person’s ideal life and the life they live right now) is oftentimes where mental illness lives. That gap between what I expect life to be and what I experience life (to) actually (be) can be filled in with depression. It can be filled in with anxiety, it can be filled in with hopelessness (and) loneliness,” Craft said, adding that she works with clients to close the gap. “How can we build connections with people who are affirming of who you are? How can we help you to understand your own value and identify what makes you unique, and how that uniqueness is actually very needed in this world?” 

In addition to individual therapy, some providers host support groups for members of targeted communities. But providers also acknowledge their own limitations: While they can help clients deal with their identities being part of political discussion, they cannot stop these identities from being part of the conversation.

“We can support people in gaining insight and we can support people in restructuring the way that they’re thinking. But we cannot get rid of the fact that (stress and trauma) continue to happen over and over and over,” said Candace Hanson, LPCC, and executive director of Canopy Mental Health & Counseling in Minnesota.

Ghazel Tellawi, who has therapy clients in Minnesota, Kentucky and Wisconsin, hopes those whose identities are not subject to political attacks will understand that “the things that are said have a real-life impact on people’s lives and people’s wellbeing. It’s not just locker room talk.” 

Here are three examples of political rhetoric affecting marginalized communities this election:

Mental health providers working with the Black community and other communities of color have noticed how right-wing backlash against diversity, equity and inclusion initiatives has been used to question Vice President Harris’s competency.

“When you add in this political environment, where we’re labeling certain types of people as inherently not qualified for a job that they hold, that starts being something that plays out in workplaces. It reinforces that pressure to perform that a lot of BIPOC folks have in the workplace (and) dials up the pressure and the stress,” Hanson, of Canopy Mental Health & Counseling, said. 

This stress can go on to negatively impact a person’s mental health, leading to a loss of self-confidence, along with signs of anxiety and depression. All the microaggressions in the workplace, along with “DEI hire” rhetoric, said Hanson, builds up to a “cumulative effect that can amount to racial trauma.”

Adriana Ines Quiñones Peña, a mental health practitioner and advocate based in Minnesota, also referenced a statement by Trump that immigrants were stealing “Black jobs” as something that was evocative of a history of colonization and racist perceptions of Black people. 

“There’s Black people in tech, there’s Black people in STEM, there’s Black doctors (and) there’s black people that are artists, so when it comes to (the) idea (of) ‘Black people jobs,’ it feels as (if) we are supposed to go back to those days when we (were) doing hard labor (and were) severely underpaid or not getting paid,” she said. 

Having one’s identity othered can also lead to distrust and isolation. 

“There is this withdrawal that happens (in communities of color) because they don’t know who they can trust and they don’t know who’s safe,” said Hanson, who noted that even while former President Barack Obama was running, clients would indicate that they were unsure of what their white neighbors were saying about them when they weren’t around, or what they thought of racist rhetoric. 

“It is sort of like this daily reminder that this hostility against who you are as a person exists and there’s nothing you can do about it.”

What has also been concerning and harmful to communities of color, specifically mixed-race people, has been the periodic questioning of Harris’ racial identity. Harris is multiracial, a group that comprises the fastest growing part of the U.S. population, according to the most recent U.S. census in 2020. But just because the numbers of mixed-race people are growing does not mean that there is a greater understanding of mixed identities. 

The struggle for determining one’s identity as a mixed-race person remains “a really complicated dynamic,” said Hanson, who noted that people from different groups may not “claim” individuals who are mixed race as part of their group. 

“Having that become this public and ugly kind of discussion and criticism can be very difficult to cope with for some folks,” Hanson added. 

Craft said the rhetoric “does cause some anxiety because it’s almost like telling them, ‘You’re not allowed to know who you think you are.”

When speaking about the mental toll on the trans community during the election cycle, Christine Kerno, LICSW, a trans mental health provider who also serves trans clients, referenced the quote above, noting that it was clearly a reference to trans and nonbinary people using they/them pronouns. 

“There’s a lot of fear of what will happen if Trump wins the presidency,” Kerno said, adding there’s also concern about what a Republican-controlled Congress would do. State legislation in Minnesota protecting trans rights, “will help, but it won’t protect us completely,” Kerno said.

“The rights of trans folks are very much being used as this political tool (and) talking point to sway certain people,” Tellawi said. “(They) use fear-based tactics to make people afraid of trans people.”

While coping with anxiety, fear and depression ahead of the election, some members of the trans community are trying to prepare for how the election results could affect them, Max Abeln of Transcend Psychotherapy said. 

“I definitely hear about the specifics of people getting legal documents in order and making sure they have their passports for fear of what might happen, or hurrying up their gender-affirming care, making sure they’re getting on hormones or stockpiling hormones,” they said.

For undocumented immigrants, being the subject of election discourse is nothing new. According to mental health provider Mayra Barragan-O’Brien, the mental health senior manager at Immigrants Rising, however, things are different from “the first time around,” during the 2016 election.

“The way that the past president was talking about the communities that we are a part of, the way he described our communities, described who we are was very violent,” Barragan-O’Brien said. “There is still a lot of fear, a lot of anxiety, a lot of sadness, frustration, rage that comes along (with) this election. But there’s also a lot of feeling numb – feeling like it’s the same thing, just a different year.” 

While some have become numb, others are afraid. 

For undocumented immigrants, talk of deportation “has definitely increased a fear and maybe some distrust in the system,” Quiñones Peña said. “They’re coming here thinking that they’re searching for that American dream – that they’re going to have a better quality of life for themselves and their family. And then when they come here, they have this reality check that not everyone’s going to be welcoming of them. That not everyone’s going to be accepting of them. And (even) if they’re accepted here, that doesn’t mean that they belong here.” 

An undocumented immigrant in Minnesota, who asked to be referenced using only their last name, Flores, said that they were, for their own mental health, trying to avoid hearing about the election cycle as much as possible while still keeping up to date. 

“(Growing up, the perception was that undocumented immigrants were) only older folks or folks who were smuggled in (and) they (were) here to take your jobs or get handouts or all these other things. That’s not the reality. Sometimes it just feels like we’re like still in the shadows because even if we did speak about coming out with our stories and sharing our experiences, I just feel so scared about people calling ICE, or feeling justified to let local authorities know my whereabouts,” said Flores, who described their life as one of “uncertainty.” 

Though Trump has often been criticized for his rhetoric regarding undocumented immigrants, Flores added that Harris’ response has also been lacking.

“Although (Harris) is receptive to listening to people’s stories and does hear them out, she just comes back to stricter borders. It’s disheartening to hear, but it’s nothing new,” Flores said. 

While they have coping mechanisms, such as nature walks, journaling and finding community with other undocumented immigrants online through Immigrant Risings’ wellness support groups, “sometimes I feel I’m drowning in the stress,” Flores said.

Barragan-O’Brien said she hopes more non-immigrants would empathize with those fleeing to the United States. 

“There’s this poem that says, ‘Nobody puts their children on the boat unless the water is safer than the land,’” she said. “I wish people could hear that and take it in and understand that if they were in a similar situation (as undocumented immigrants) they would try to survive (and do) whatever would be possible for themselves and for their children and their loved ones.”


This story was originally produced by Deanna Pistono of MinnPost as part of the Rural News Network, an initiative of the Institute for Nonprofit News (INN), supporting more than 475 independent, nonprofit news organizations.


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New data from the Centers for Disease Control and Prevention show three of every four high school students nationwide said they have experienced at least one adverse childhood experience, including witnessing domestic violence in the home, parental separation or physical and sexual abuse, among others.

Research has shown the experiences, called ACEs, can alter a child's brain chemistry and produce a prolonged, sometimes lifelong, toxic stress response.

Joe Bargione, a certified school psychologist and executive committee member of the Bounce Coalition, a Kentucky ACEs advocacy group, said the national data support the trends among youth in the Commonwealth.

"We're seeing some of the same kinds of patterns," Bargione outlined. "That increased sense of loneliness, isolation in our youth, increased levels of suicidal ideation, exposure to violence, exposure to other adverse childhood experiences."

Experiencing at least one ACE as a child is linked to having alcohol and substance use problems as an adult, as well as chronic diseases such as diabetes and obesity. Childhood trauma costs states. According to the National Governor's Associations, adults with ACEs can lead to billions of dollars in health care costs and lost productivity.

Bargione added schools can help address the youth mental health crisis by cultivating a sense of belonging and connectedness, as well as increasing suicide prevention programs.

"Promoting mental health awareness in schools," Bargione urged. "Teaching kids around social emotional learning and dealing with their emotions in an effective way, increased mental health services."

He pointed out recent changes to state law now require school districts to create trauma-informed plans.

"Creating those trauma-informed care plans and then reviewing those annually by the Kentucky Department of Education and also the General Assembly is really, I think, a great way to see what's working, what's not working," Bargione explained.

Statewide, one in five children has already experienced at least two ACEs, according to Kentucky Youth Advocates.


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The growing crisis in Ohio's child welfare system is drawing attention, particularly for its impact on children's mental health.

Across the state, children with complex behavioral needs are struggling as placement options shrink and demand for specialized care reaches an all-time high.

Lindsay Sparks, protective services administrator for the South Central Ohio Job and Family Services, Children's Division & Adult Protective Services, noted that despite efforts with mental-health providers, many agencies lack the resources to handle severe cases.

"We have had a young child, under the age of 10, who we have about 45 denials across the state, they feel that they cannot meet that child's needs," she said. "Children have had to spend the night at our agency. That is not ideal for our children, for our staff, for anyone - but it has happened."

In some cases, Sparks added, agencies are forced to seek out-of-state placements - which can further complicate care for children already facing significant challenges. Recruitment efforts for foster families are ongoing, but the gap remains wide.

The crisis extends beyond placement shortages to escalating mental health concerns. Jody Walker, executive director of South Central Ohio Job and Family Services, highlighted how these issues have worsened over the past decade.

"The types of children that we're seeing coming into care, that have more severe behavioral mental health issues, and our system really hasn't been able to keep up with types of placements that benefit these kids the most," he said. "The cost for those placements went up, at the tune of 300% in the last 10 years."

As Ohio faces rising costs and limited resources, the County Commissioners Association has made child welfare a top priority in the upcoming biennial budget. The association is applauding Governor Mike DeWine's commitment to children, and stresses that counties play a vital role in protecting them.