As summer winds down, many of us are headed back to school. At AAOP, that got us thinking about mental health among our Asian youth community. School can help our mental health, be a place to connect with friends and build community systems of support. School can also impact our mental health negatively via academic stress and sometimes challenging social dynamics.
Another aspect of mental health is the difficulty of accessing mental health care, especially culturally-specific mental health care. We recently had the chance to speak about this topic with Mary Vang Her of the Amherst Wilder Foundation. Through the Wilder Foundation’s Hlub Zoo (pronounced LOO-ZHONG) program, which Mary helped found, Mary is part of a team providing culturally-informed mental health support to Hmong and Karen students. Hlub Zoo does this by connecting with students and their families directly through the school system, creating partnerships with individual schools that allow providers to work directly from school buildings.
In our conversation, Mary shares about the importance of cultural-awareness in health care, why connecting mental health providers with students in school is so helpful, and what she hopes to see in the future of youth mental health services.
& scroll to the bottom of this blog for a list of mental health resources geared towards Asian youth!
Content warning: The following interview contains mentions of mental health crises, domestic violence, and suicide.
My name is Mary Vang Her and I am a clinical social worker. I’ve been practicing social work for almost 19 years and been with the Amherst Wilder Foundation for about 16 years. Currently, I’m a Senior Clinical Supervisor and I oversee some of the Wilder Foundation’s school based mental health (SBMH) therapists. I also helped start and oversee our Hlub Zoo program, which is a culturally specific program for Hmong youth in St. Paul. Currently our Wilder SBMH programs provide therapeutic services at 28 schools across St. Paul.
I helped start this program about eleven and a half years ago after we started seeing an increase in Hmong youth and children having difficulties in school. The program started at Jackson Elementary school, and initially it was more of a mentoring program than a mental health program. The reason for that was because we were still figuring out the best way to reach out to the Hmong community. At that time, it was difficult to talk about mental health without bringing shame upon a child who is experiencing mental health symptoms. There is a lot of stigma that comes with a mental health diagnosis, this is true in the general community, but even more so in the Hmong community. We wanted to be respectful and wanted to make sure we were going to be able to create a narrative and approach that would be sensitive enough to meet the needs of the community.
About two years into the program, we realized we couldn’t sustain the program as a non-clinical program because there just aren’t a lot of grants to pay for that type of work. So, we had to shift the model in order to provide more clinical therapeutic services. With that shift, we had to design an intake process that would be culturally sensitive and non-stigmatizing. We started with some pre-sessions with families to help them understand the needs of their child, provided them with psychoeducation and informed them of what clinical work actually is. The two previous years of the non-clinical programing helped too, because families had known the program existed, so there was already a type of buy-in, and interest in making sure kids had these services.
When we started Hlub Zoo, there were many barriers, not just from clients and families, but also from educators and school counselors. For example, when I first started at the school, I was told by educators that Hmong students didn’t have any issues: they were quiet, they listened, they did what they were supposed to in class. And so I thought “wow, if this is the case, maybe I won’t have a job in a month because they can’t seem to identify any students with any struggles or mental health issues.” That was a little discouraging. However, as a Hmong young child myself growing up in America, I remembered how anxiety impacts an individual, especially children. I realized that many of these students were probably internalizing their emotions, so I created an internalizing behavior checklist and gave it to teachers. I asked them to look at the list and identify and refer students who met some of the symptoms. Within the next two weeks, I got 35 referrals.
Hlub Zoo is currently at seven schools, which is incredible to me, I never thought we’d grow that fast! Our therapists are from the same cultural and ethnic group as our clients because we want to make sure there’s a cultural match with that family and community. We provide individual and family therapy at the school, and sometimes we provide family therapy at home. Our therapists will usually see clients once or twice a week, depending on their need. We work closely with teachers on scheduling appointments to make sure the students can be seen by the therapists on a regular basis. Hlub Zoo serves Hmong, Karen, and other Southeast Asian students as well if needed at the specific school. The Wilder Foundation also runs other culturally-specific SBMH programs serving different cultural communities.
Another significant part of Hlub Zoo programming is that we have a “”Rites of Passage” curriculum, where we hold events that focus on culture, identity, and history. We meet about four or five times a year and bring all our fifth graders together. For example, we’ll teach the kids about the significance of New Year’s celebrations, talk about the role of religion and spirituality, the role of food, the role of clothing in Hmong culture. We really try to help the kids stay grounded in their cultural histories and identities. We want them to value who they are, and never lose sight of that.
When we started Hlub Zoo, we realized that many Hmong families who needed mental health support were not calling mental health clinics for help when they needed it. This is partially due to a perspective that states “whatever issues an individual has should stay in the family.” But parents care about the education of their kids, they want their kids to do well. So I felt the best way to reach Hmong families was going to be in school. Also, kids spend so many hours in school, and there are eyes that are on them that can assess their needs. And it is just so much easier for families to obtain services when we are located in the school.
Specifically for Hmong youth, there are a lot of changes happening in our Hmong community, a cultural shift from being more focused on the family versus the individual. We’re such a collectivistic community, which is why the Hmong community is so strong even here in Minnesota, because we tend to congregate and really support one another. This is a strength within our community, but we’re also seeing that families are becoming more isolated, less connected than we want to be. We see more stress in the home, a higher level of divorce or single-parent homes, and unfortunately domestic violence continues to occur. There are high levels of depression, and with COVID-19 there has been an increase of mental health issues due to isolation and lack of peer interaction.
In our Hmong community, we’ve also seen an increase in suicides. That’s why I am also part of an initiative called Project Tshav Ntuj, which promotes suicide prevention and mental health and wellness. But there continue to be many issues that impact our community, drugs and alcohol, and just so many of the typical social issues that a lot of American kids deal with.
Many times when our students see a provider who isn’t Hmong, they can feel like that provider doesn’t understand their narrative, their history, or their family systems. And if you’re trying to educate the therapist who is trying to help you, that’s hard. Whereas, when I as a Hmong therapist work with a Hmong client, they can see me as a person who understands them, who speaks their language, and recognizes their family’s values. That’s not to say that somebody of a different culture can’t provide support: sometimes that’s all we have. Which is why it is so important for providers to educate themselves, and to be mindful of the cultural differences between them and their clients
I’ve experienced this myself working with Karen clients, for example. We might both be Asian, but there’s a whole history and narrative there that I don’t necessarily understand. There are parallels between my parents’ experiences and some of my clients’ experiences I can draw on, but it is still very different. I think the crucial thing is to realize and understand there is a barrier, and to work mindfully to still validate clients’ experiences.
My hope is to continue to grow these mental health services within our schools. Specifically, I want Hlub Zoo to be in every school with a significant Hmong youth population. I also hope we can have multiple therapists in each school, and multiple therapists of different cultural backgrounds. I just want to see lots of therapists in schools who are culturally sensitive to the needs of the community they are working with, because sometimes when that doesn’t happen, kids can have bad experiences with therapy which stops them from wanting to pursue it again. So, more resources for families and kids, more BIPOC therapists particularly Asian therapists, and more funding and support so we can continue to provide and expand these services.
Learn more about Hlub Zoo!:
Helplines:
-Asian LifeNet Hotline: 1-877-990-8585 (24/7; Cantonese, Mandarin, Japanese, Korean, and Fujianese language services offered)
-DEQH (Desi and South Asian LGBTQ+ support): 908-367-3374 (Thur 8-10pm ET, Sun 8-10pm ET or contact online)
-NAMI: 1-800-950-6264 (10am-10pm ET)
-National Runaway Safeline: 1-800-786-2929
-Suicide and Crisis Lifeline: dial 988 (24/7)
Local
–Bridge for Youth (Basic needs for youth)
–Family Partnership (Therapy)
–Hmong American Partnership (Youth mental health programming)
–Karen Organization of Minnesota (Mental health programming)
–LGBTQ+ Therapists Network (Therapy)
–Mental Health Minnesota (Helpline, resources, peer support chats)
–Minnesota Mental Health Clinics (Therapy)
–NAMI Minnesota (Support groups, resources)
–Project Tshav Ntuj (Suicide prevention outreach for Hmong folks)
–Reclaim (Therapy for queer and trans youth)
–SEWA-AIFW (Mental, physical, and community health services for South Asian Minnesotans)
–University of Minnesota CUHCC (Therapy)
–Vietnamese Social Service of Minnesota (Assistance accessing mental health care)
–Walk-In Counseling Center (Free, confidential counseling)
–Wilder Foundation (School-based youth mental health services, including services specifically for BIPOC youth)
National
–NAMI (Resources)
–National Asian American Pacific Islander Mental Health Association (NAAPIMHA) (Resources, training/webinars)
Online
–Asians Do Therapy (Resources, how-to’s, affirmations)
–Asian Mental Health Collective (Online space, resources); Lotus Therapy Fund (Financial support and funding to make therapy accessible for Asian folks; support also available for Asian clinicians interested in reduced-cost trainings via Asian Mental Health Collective and its partners)
–Brown Girl Therapy (Resources, affirmations)
–Join the Cosmos (NYC-based org supporting wellness for Asian women and femmes; on hiatus until September)
–Map for Health (Connect with API LGBTQ+ youth and allies)
–Minnesota Teen Mental Health Directory (Resources, some specifically for BIPOC youth, LGBTQ+ youth)
–Project Lotus (Youth-run organization; online space, webinars, resources)