By Dr. Helen Horvath
ECM interviewed Krysta Esquivel, Executive Director for YMCA Youth & Family Services, and Brittany Villarino Vetter, Associate Director in part II of our series on mental health services
July 30, 2020 (San Diego) -- COVID-19 has impacted our communities in so many ways. Divorce filings have gone up; domestic violence has increased and people have lost jobs, and insurance. Key to these losses are our community’s sense of fear and anxiety of what will happen next.
Anxiety, fear, and depression are side impacts of the sense of unknown, creating at times serious mental health and lifestyle concerns. Losing health insurance is a loss of a safety net tied to employment. The question becomes how to afford mental health and lifestyle coaching services on a limited income? The YMCA has an answer for that through the YMCA’s Youth and Family Services department the social service arm of the YMCA.
Photo, right: Krysta Esquivel, Executive Director
YMCA behavior health program offers affordable services
The YMCA operates an entire social services department to holistically offer integrative whole health programs and services. These programs are designed to feed the mind, body, and spirit through family and individual therapy, transitional living services for youth, foster care therapeutic interventions and other programs within the YMCA’s Y&FS programs.
The mental health services at the YMCA, according to Vetter, include individual, group, family, and couples therapy. The treatment plans are individualized to the needs of the client/patient and interests.
Photo, right: Brittany Vetter
OZ San Diego helps teens and their families
The YMCA has a unique mental health inpatient 28-day program that has been in existence for 50 years known as “OZ San Diego”. The program is for 12-17 year old clients and their families. These clients are admitted to either the intensive outpatient program or partial hospitalization program.
The partial hospitalization program requirements are ever changing due to COVID-19. The OZ San Diego program, under COVID-19 County protocols, currently has been adapted to operate utilizing teletherapy for families and teens. The service is a CARF-accredited program. CARF-accreditation is an oversight program for mental health and human service providers.
Teens with more serious mental health or substance use issues are referred to Sharp Mesa Vista, Aurora Behavioral Health, and Rady Children’s Hospital. The OZ San Diego program works with a variety of community partners and insurance providers. Currently, OZ accepts Tricare, Kaiser, and United Behavioral Health insurance. In addition, the YMCA accepts Medi-Cal.
For outpatient care, the YMCA does not accept insurance, with the exception of Medi-Cal for foster youth and eligible beneficiaries. The primary payment method outside of Medi-Cal is a sliding scale fee that is based upon annual household income. Payment is based upon a percentage of the household income. The annual household income is that starting point for payment; yet, at times the YMCA will make accommodations due to unusual circumstances.
During the interview, Vetter stated, “2-1-1 San Diego, referrals transition into providing services, breaking barriers. We try to build programs for whatever help may look like. We have our behavioral health department; yet, we also have coaching, case management, family crisis intervention, transitional housing that includes an array of programs and services. We really hope to find YMCA programs that can support the specific needs. We work to provide an integrative service process that is a holistic approach to support family.”
Esquivel interjected that all Y&FS clients in the mental health and other youth programs—thousands a year, have access to free membership at the branch of their choice. She added, “The YMCA staff gets to see the entire holistic results…and has an amazing opportunity to impact youth and families in our community in a way that no organization can.” Vetter and Esquivel agreed that this unique opportunity to serve the community creates excitement in the ability to positively impact all areas of family and youth services.
Transitional housing for young people
YMCA also operates a transitional housing program for youth. The program offers furnished housing, onsite case management and support, education and employment assistance, development of independent living skills, relational wellness and counseling services, financial education, personal budgeting assistance, and after care support.
This program is an extension of the overall social services programs offered to the community through the YMCA’s Y&FS department.
Community Mental Health and Illness: A Snapshot from the YMCA’s behavioral health program
Asked what drew her to the Social Work industry, Esquivel indicated that she has learned a lot in the social work arena. “Brittany and I are not only interested in the individual; we are interested in the environment and social system” that the client lives in, she said, adding that the social system can be the family, or external influences. “There is so, so, so much that is related to connections in the community to human beings, family, and larger social systems. The way that all those things interact can be the difference between a healthy thriving life and a life filled with barriers filled with chronic stress. When we begin to understand how those systems interact and what we can do to intervene or prevent these fractured systems (at home, work, or elsewhere) we can be impactful.”
She added that as social workers, “We focus upon those factors that can support the health and wellbeing of the entire family.” Some community-based programs provide a band-aid approach of fixing single or multiple issues in the family; the YMCA takes a whole system that examines each element that is impacting the client or entire family.
Esquivel continued, “One person’s mental health can impact other people’s mental health” in the family or community. “The idea that we can help our youth build social capital, social networks, and help create increased wellbeing that persists long after the person is gone (no longer in therapy), this is what draws me to this work.” She added, “The ability to do this type of work has me over the moon.”
Brittany Vetter is the Program Director for the YMCA Youth and Family Services. Asked what prepared her for her role at the YMCA she said, “I’m an East County born and raised individual. I grew up in Santee and live in El Cajon; I really have not gone that far. My mother was a school counselor in an underserved school. I went into social work with the idea that I would go into working with Child Protective Services by working with vulnerable populations as social workers try to do.
She observed that the irony was that “no one wanted to meet with me (as a social worker) and I did not feel helpful. I saw a true need working on core issues, so I transitioned into mental health counseling. I worked as a case manager as I gained the experience and learned new skills.” She has continued to learn about the complexity of issues that impact families, with each new employment level leading new information.
As a result, she reflected, “I learned the root causes that need to be addressed in our community. “For us, particularly with the population we serve, we can trace a lot back to chronic stress and adverse child experiences. Cycles of poverty and abuse.”
She has become extremely interested in how the brain functions under stress, understanding that “the results of extreme poverty, extreme trauma, and abuse play a role” by putting “an extreme amount of stress on the brain that cannot be handled” at times. “A developing brain of an adolescent is impacted by this stress, not permitting the brain to develop self-regulation skills for lifelong functioning. The pathologies we see are a manifestation of those underpinning issues. When folks are faced with some of these stressors they cannot cope and find healthy ways to cope because the issues are never ending,” Vetter observed.
Esquivel said the best thing that the YMCA can do is to “meet basic needs to remove stressors,” providing essentials such as food, clothing, and shelter. Clients “cannot attend a video therapy session if they do not have access to technology or if they do not know if they will have food that night. The amount of relief required to focus upon our own self-care and brain is pretty immense. We take this for granted. People with chronic stress have difficulty focusing and may have a toxic stress response,” she noted, adding that when this happens, the clients “cannot organize life or processes.”
Part of the therapeutic process is understanding diagnoses versus chronic stress. “We work to remove those barriers so that clients can maximize their own internal abilities to create coping mechanisms,” she said.
Chronic stress is like a spin bike, you get on wanting to get your exercise done; yet as you ride 10 or 20 miles, but you are really not going anywhere. You are stuck on the bike with nowhere to go. Similarly, with chronic stress, there is so much external noise that you cannot hear yourself or find peace in simple solutions, Esquivel noted.
When asked what tools the YMCA uses to continue client engagement, Vetter replied, “YMCA’s Youth & Family Services is trying to be a unicorn in the social service field. I have worked in the social service field for a long time. I know a lot of things are not working…for the vulnerable populations.” She said it’s critical to be accessing the most vulnerable population while keeping them “engaged, doing, and completing treatment… intervening in ways that are meaningful and impactful.”
She explained, “Being a unicorn means that we are doing things differently. We are finding ways to access youth and family in a more natural setting, such as schools.” By doing this, the YMCA “offers a less scary environment that is predictable and comfortable,” she added.”We work with clients based upon mutual self-interest – what can we offer families that will cause the family to interact with the YMCA’s behavioral health programs.” The YMCA works to coexist with families, youth, child welfare, and schools, through flexibility of services.
COVID-19 impacts on mental health services and access
We asked what services, prior to COVID-19, were utilized by the community. Esquivel replied, “Individual therapy across youth and family services, based upon how we interact with our clients.: She referenced a lack of a traditional clinical approach to treatment. “This is primarily as a result of our client population such as foster care youth. We work to organize treatment in such a way that meets the needs of the clientele. Brittany and her team, prior to COVID-19, did a lot of couples therapy.” In addition, “For the youth we do age-appropriate therapy. We use gaming therapy that we do quite a bit. to have a very organic conversation.”
During the pandemic, there has been an increase in the number of clients typically served when compared to pre-COVID-19 client participation. Vetter said, “Depending on the program, we have seen more engagement during COVID-19. Some of it may be tied to less responsibility (ie.,due to unemployment) and easier access to services. There has been more engagement” with the YMCA mental health unit since COVID-19 began,” she said.
Vetter believes that people may still have stress and chaos; yet now they have more time to access mental health. “With the use of video therapy, people have an easier time to schedule mental health therapy sessions,”Vetter said. “People are seeking therapy, yet they are also seeking low cost therapy, which we offer.”
During the national COVID-19 crisis, the YMCA had to make a business decision on how to address the critical needs of providing mental health services. The YMCA chose to provide services that are affordable and accessible to the community.
Esquivel said, “The YMCA has seen an increase in anxiety amongst clients.” She noted that a blog article about anxiety written by Vetter “has been the most accessed article on our website for the last 30-60 days.” She called it a “quick, great article,” adding, “Anxiety is the most reported mental health issue in the United States, especially during the pandemic. The consequences and lack of opportunity to address the anxiety (through physical exercise) leaves gaps in ways to deal with anxiety. Then you have people at home who are not used to spending all this time at home together. This creates additional anxiety and unintended consequences when families and people are forced to interact differently” due to interdependences between mental health illnesses and actions, she said.
As for dealing with prior childhood trauma, ECM asked if the YMCA Behavioral Health unit noticed a trend in the population for a diagnosis of Post Traumatic Stress Disorder in children and adolescent clients. Esquivel stated, “Actually, foster youth who have experienced the foster care system experience PTSD at a greater rate than veterans.”
How you can get help or support the YMCA’s efforts
The YMCA has a primary mission to provide social services to the community. The organization has more than 138 years of providing those services. Mental health services to the community began in 1970. Now, 50 years later. these services are expanding and helping the community through COVID-19 and the related mental health stressors associated with individuals and families.
You can contact the YMCA for individual, family, couples, and children’s therapies, to access counseling and well-being support. To learn more about the YMCA’s program and services, visit their website.
The YMCA, just like many other non-profit organizations, has experienced financial challenges as a result of COVID-19. If you would like to help out, please contact the YMCA by clicking the YMCA image to the right to make a donation.
Dr. Helen Horvath is a psychologist, organizational development consultant and published author on a variety of psychology and business topics. As a speaker, she has presented at the American Psychological Association Annual Conference, Society of Industrial and Organizational Psychology, and other key professional organizations. She is a former marriage and family therapist and published a relationship book entitled “Put a Period to IT: When Divorce is the Option”. Dr. Horvath writes for East County Magazine relating to COVID-19 topics.
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