In 2020 California will renew its Medicaid waiver and this revision has the potential to impact the provision of mental and behavioral health services for years to come. A Medicaid Waiver is a provision in Section 1115 of the federal Social Securities Act that allows states to provide services to residents who may not be eligible under the basic Medicaid rules.  Because of this provision, states can use Medicaid funds for new or innovative programs and increase access to care for underserved groups. The current debate will define the criteria for these expanded programs and set the foundation for many of the regulations that impact practice. 

There are a number of critical points being debated as a part of this reform effort, but one that is of particular interest, given its direct alignment with Unconditional Education is the discussion related to just how children can gain access to mental and behavioral health care. Under the current system, a client must receive a diagnosis of a mental health disorder in order to be “opened” or receive ongoing sessions with a therapist funded through MediCal. A diagnosis, representing a cluster of symptoms, indicates that treatment is medically necessary. While this determination of “medical necessity” seems like a clear-cut distinction, how it plays out in practice is substantially more nuanced, complex, and can have problematic consequences for both individuals and our larger system of care. Loosening the restrictions around this provision and allowing therapists to serve clients without first providing a formal diagnosis would provide an opportunity to:

Stop problems before they start. 
For far too many children who have faced multiple stressors in under-resourced systems the point of diagnosis comes only after a critical level of challenge has been reached. Children are referred to care only once they are already presenting acute symptoms impacting their daily functioning and success at school. Increasing the flexibility with which therapeutic services can be provided would open new opportunities to focus on prevention and early intervention and increase access to care for families who utilize MediCal.  

Reduce the stigmatization of mental health care. 
Currently, diagnosis must occur early in the relationship between the client, caregiver and therapist and requires that early discussions focus on about what’s “wrong” with the child. This required entry point stands in deep contrast to what is otherwise a belief in providing a strengths-based approach to care. While sometimes the establishment of a diagnosis is a useful tool for determining course of treatment, it can also be barrier that prevents families from accessing services for fear of being labeled as “mentally ill”. Further, the criteria of a diagnosis requires a clinician to pathologize many of the normal ups and downs of wellbeing and responses to stress that families experience over time in order to provide needed support. Increased flexibility in accessing MediCal has the potential to reduce the stigmatization that can come with receiving mental health services and support the cultivation of a client’s strengths and protective factors from the start of care. 

Promote equity. 
Beyond the issues of accessing care above, there are problematic challenges with the establishment of a diagnosis in and of itself. There’s a growing body of research to demonstrate that poor children of color are more likely to receive diagnosis of Oppositional Defiant Disorder (ODD) and less likely to receive diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) than their more affluent white peers, even when other factors, such as the prevalence of trauma, were accounted for. While similar in symptomology, these two diagnoses carry vastly different social meanings and can indicate largely different trajectories for a client’s care.  Patterns of diagnosis that follow predictable and disproportionate lines across race and class indicate the ways in which unmitigated bias continue reinforce the oppressive systems that impact Medicare recipients. Reducing the emphasis on diagnosis, and instead focusing on client wellbeing, would promote a more equitable approach.

While there is still much to be determined in the development of California’s proposed waiver it is exciting to engage on this important discussion. To follow this discussion and the others that are a part of the Waiver debate follow along at MediCal: A Healthier California for All.

There is a huge sign in front of the school announcing its “sesquicentennial” celebration.  That means this school has served the Oakland school children, families, and the community for over 150 years!  The Prescott Elementary school was founded in 1869.  Ida Louise Jackson, Oakland’s first African American teacher, taught at Prescott in 1925-- 13 years before any other school hired a black teacher.  The school served the historic West Oakland community and for years, had an enrollment of predominantly African American students.  The spirit of Black pride is woven into the make-up of the school.  With the shifting times, the school has gone through transitions but remains firmly committed to serving the community through education and community building.  During the 2005-2006 school year, the school was re-envisioned with a new name of PLACE @ Prescott (Preparatory Literary Academy of Cultural Excellence).  Check out this video that captures the breadth and legacy of teachers and students at Prescott:

​This is our first year in partnership with this notable school.  Helmed by a seasoned principal who embodies the values of the school, we jumped into a busy school year with a full team made up of Danee Black (UE Coach), Kaycee Hasan (Clinical Intervention Specialist), Ronni Pelley (Mental Health Counselor, Associate), and Alithu Manrique (Mental Health Counselor) working along side the school with the Intensive Counseling Enriched Classroom (ICEC).  Our Seneca representatives on the school campus also embody the values of the school, bringing a strong sense of pride in culture and education.

As with any new partnership, this Seneca team worked tirelessly to figure out systems, build alliances with the school, and flex the strengths of the Seneca All In models of inclusion.  Through their tenacity and dedication this team has forged a strong relationship with the special education teacher within the ICEC class and has opened the pathways to connecting with the wider campus staff and leaders.  Their creativity in managing challenges is unparalleled!  From impromptu classroom activities to ongoing space issues to holding consistent expectations for their students amidst intense, daunting behaviors, the team perseveres towards living out a disconfirming stance that the students can and shall have access to the education they deserve.  As one member said, “…this is a team where all members give 110%!”  Team members have created inventive calming spaces on the campus, helped manage contentious meetings with families with the Department of Transportation, won over the families of our ICEC students with phone calls that convey respect and collaboration (with other agencies asking for tips on how this team did this!), and stepped into the community/client’s homes/school bus to provide the service where it is needed.  They have given and received feedback with each other through this process.  They have laughed, they have cried, and they have talked and talked and talked (this is a very talkative group).

Their students in the ICEC program have acknowledged the team’s care and importance in their young lives in subtle ways and in memorable overt ways, like the time the students made superlative awards for each Seneca team member in secret to surprise the group.  The best teacher, the best counselor, the most nicest person – these are the attributes that the students could see in their classroom team.  This simple expression can be uncomfortable for these students and it shows great trust that they were able to engage with the team in a vulnerably sweet way.
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I’m proud of this team at Prescott.  They are embodying the shared values of the school and laying the groundwork for an even stronger partnership in the years to come.  Maybe for the next 150 years??

Yes, it is meaningful and important work: We change lives and systems.  However, in order to remain healthy and sustain in the work, it is important that we proactively take care of ourselves.

Portia Jackson-Preston's Ted Talk (linked below) discusses a shift from the individualistic self-care approach, which emphasizes on self-reliance to communal care practices.  This shift recognizes that self-care practices reflect individual needs and preferences while also identifying the importance of having these practices supported by resources.  Portia discusses the social-ecological model as a means to develop an effective long-lasting self-care practice for ourselves and others in our community.
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When you are finished watching the TedTalk, click HERE to take a Self-Care Assessment to determine how to best facilitate your self-care practices.  What shifts will you make in your self-care practice?

Name: Karla Aguirre
​Position: School Psychologist Intern
What led you to your current position? During my first year at All-In! Toshia Mears passionately shared why she thought being a school psychologist was a career I should consider. With Toshia’s and Meka Tull’s input I became interested in the role. I was able to shadow a bilingual psychologist my first year at Seneca and decided that I was highly interested in pursuing the career. Now, I’m in my last year of graduate school, while completing my internship at Seneca.
Fun Fact/Quote: As a graduation gift to myself, I booked a trip to Thailand this summer J
What does your average day look like? My day depends on what site I’m at. A typical day of counseling is typically back to back sessions of counseling and documenting my services. A typical day of assessments could look like me observing, pulling and reviewing files, interviewing parents/teachers, and report writing (a lot of writing).
Why do you do this work? ​As a school psychologist I am able to hold many hats. The flexibility of role allows me to work with parents, students and school staff members. I enjoy supporting marginalized populations because they remind me of my family and community from southern California. 

Name: Roxas Tumaneng
​Position: Classroom Therapist at Think College Now (TCN) Elementary in Oakland
What led you to your current position? Since I was a kid, getting into psychology was my goal because I needed a structured way to understand people. It wasn’t until I had a niece that I really wanted to focus on understanding children and youth within their social and ecological environment. I hoped that what I learned at work would also teach me to be a better uncle. Since working with Seneca (2015), I was familiar with the counseling enriched classroom setting and wanted to continue that as a therapist. So with the support of my supervisor, I worked towards getting into the Seneca MSW @ USC embedded program. Upon graduation, there weren’t any available positions as a classroom therapist throughout Seneca. However, serendipity was on my side when I initially interviewed with All-In! for another position. That was when I also got to meet Amy who was then part of SOAPS and she offered me a position once the program got new contracts. I’ve been a Classroom Therapist at TCN since August.
Fun Fact/Quote: The most I inline skated (aka rollerbladed) in one day was about 6 hours.
What does your average day look like? I spend my first hour of the morning at the therapy office completing logistical work and documentation. Once school starts, I (co)facilitate morning meetings. Then I’m either having individual therapy, group therapy, am in the classroom, or am in my office planning for therapy. When I can, I like to come back in the classroom for check-out at the end of the day and then check-out as a team once the student’s have left. Then if needed, I reach out to necessary people and/or complete work at the therapy office.
Why do you do this work? I continue to do this work because it fills my cup. I’m part of an amazing team and program committed to each student’s success. I appreciate the collaboration, the norms of communication, and the routine you get in a school setting. I learn so much from the student’s insight and play. It’s a privilege and purposeful challenge to work with the clients and their family about meeting the student’s needs.

Name: Dina Ochoa
Position: Mental Health Associate
What led you to your current position? Before working with Seneca I worked with children who presented with behavioral challenges and supported them by using applied behavior analysis to help them improve social behaviors and helped them to increase or decrease targeted behaviors. While working with kids I wanted to have the opportunity to work with the clients entire team, which I found in Seneca. I started as a student support assistant at Seneca in which I've been given the opportunity to work with them in the classroom to reduce negative behavior and help them increase positive behaviors. While working with these students I knew I could do more than just being in the classroom and I was given the opportunity to grow as a professional and continue graduate school to become a clinician. Working with children one on one and in group outside of the classroom to target social skills groups and help them overcome their difficulties is what is rewarding for me as I continue to build bods and relationships with the students and families. As a Clinician I am able to see my students through a different lens and be able to support them emotionally and socially is what I enjoy doing.
Fun Fact/Quote: I love to eat, I enjoy going to new restaurants and trying new food! I also enjoy cooking and hiking!
What does your average day look like? In the mornings I do CICO with students, which I enjoy because it is a way for me to have a brief conversation with my students to hear how they are feeling that morning and what are their goals for the day. I then, support some of my clients in the classroom to help them apply strategies and skills that we learn in therapy. I see students one on one in therapy, which I enjoy because this is a time that's designed for them to help them work through their healing and process of their difficulties at school. My students are very hands on, love art, music, board games, and are very creative. I also run social skills group, which is also a great way for my students to practice the skills they are learning in the moment. In addition to working with the students I find time to collaborate with my student's teachers and families. 
Why do you do this work? I do this work because I want to be able to impact my students, families, and school community by doing what I do. I enjoy working with children and support them to help them be successful at school both academically and socially. Collaborating with a team is something that I value and believe it is important to help my students be successful and I get to do that at New School of San Francisco. I want my students to feel empowered, successful, and help them increase their self-esteem and in my role I am able to support them with that. ​

Name: William Chiang
Position: Strategic Initiatives Project Manager
What led you to your current position? After a prolonged absence from the Bay Area, I was eager to find an opportunity to serve the community that instilled my passion to help underprivileged families close the opportunity gap. After learning more about the core values of Seneca as a family agency, the All-In Partnership Project sparked my interest by exemplifying how the Unconditional Education framework is a living, breathing operation that is being carried out by people that get “it”. Whether it’s providing students with therapy, supporting teachers inside the classroom, or crafting intervention strategies with impacted stakeholders, being part of this dynamic team was where I knew I wanted to play my part and support initiatives to redefine educational attainment for all students. Though my journey with Seneca just started, I am confident that our collective contributions will help make lasting positive impacts in the lives of the families we serve - one child at a time. 
Fun Fact/Quote: “Some you win, and dim sum you lose” – Maurice
What does your average day look like? I have the privilege of coming into the office every day where I get to collaborate with amazing staff that help empower entire school communities in numerous ways. That said, I’m usually working on a variety of different tasks that are all equally important so finding the right balance of prioritization is a daily objective of mine to start and end the day. 
Why do you do this work? I believe that innovation based on equitable progressive values will help dismantle systems in place that have been designed to prevent disenfranchised communities from achieving their full potential in every aspect. By continuing to think outside the box, I strive to utilize my background and knowledge I’ve gained to become an agent of change. 

All-in’s Department of Strategic Initiatives has been working hard to think about the dissemination of our model and approach with a broader community. In that vein, I have been afforded the opportunity to work closely with our internal lead training team (Jason Keppe, Jordan Ullman, William Chiang) to codify our existing systems and structures to better support the coordination of trainings for our partners and think about how to extend the great work that is already happening in the area of training and development.

“Without question, when the majority of students in public schools are students of color and only 18 percent of our teachers are teachers of color, we have an urgent need to act. We’ve got to understand that all students benefit from teacher diversity. We have strong evidence that students of color benefit from having teachers and leaders who look like them as role models and also benefit from the classroom dynamics that diversity creates. But it is also important for our white students to see teachers of color in leadership roles in their classrooms and communities. The question for the nation is how do we address this quickly and thoughtfully?”

- Education Secretary John B. King, Jr., speaking at Howard University, March 8, 2016.

Here are two facts about the student body population in the state of California:

• The student population in California is becoming increasingly diverse.
• There’s are not enough teachers of color teaching in our classrooms.

When I was a kid, I attended an elementary school in Oakland. Its name “La Escuelita”, means “Little School” in Spanish. At La Escuelita, 90% of the teacher and admin body was composed of teachers of color. From pre-school to fifth grade, I was lucky enough to be taught by staff who looked and sounded like me. My parents were heavily involved in my education, and the administration welcomed their presence and opinions. Everything was taught in Spanish and English, which allowed me to develop complex thinking skills and a solid understanding of both languages. As a result, I legitimately grew up thinking that I could become anything I wanted to be. The thought of higher education was not daunting, rather an expectation for me.
 
It wasn’t until 6th grade that I learned that I’d been living a fallacy of sorts. La Escuelita wasn’t the norm, it was the exception. Teachers were constantly taken aback by how “smart” I was. I remember talking about my life plans with my 8th grade teacher years later. I told her about my plans to go to college and later become a successful, doctor? I can’t remember what I wanted to be anymore. What I do remember is the look on her face. She told me I was the first student she had ever met who thought about college as something that was definitely going to happen. She’d spent years teaching children involved in gangs in the streets of Chicago and now she was in Oakland hoping to save the next crew of students. I was confused. I wasn’t in a gang, and I didn’t need saving.

In an effort to connect with us, my summer book list was composed of books like, Always Running by Luis Rodriguez (a book about a student who overcomes gang life) and another book about teenage pregnancy. My parents were around, but not comfortable enough to bring up the evident stereotyping issues in our assignments. Unsurprisingly, none of the books on my summer reading lists made any of the topics on the SAT’s or my college English placement tests.
 
In 2016, the US Department of Education released The State of Racial Diversity in the Educator Workforce Report, which states the following: “...compared with their peers, teachers of color are more likely to:

1. Have higher expectations of students of color (as measured by higher numbers of referrals to gifted programs);
2. Confront issues of racism;
3. Serve as advocates and cultural brokers;
4. Develop more trusting relationships with students, particularly those with whom they share a cultural background”

 
I am incredibly proud of the work that Seneca is doing to promote POC’s in leadership and teaching positions, but we can still do more!
 
So tell me. What do you all think? What can we do to bridge this gap in educators?
 
Leave your thoughts below!