To get services, English learners face extra obstacles

The behavioral health system is complex. Any language barrier makes it even tougher to navigate.

This article was originally published in The Notebook. In August 2020, The Notebook became Chalkbeat Philadelphia.

When Mi Phong arrived in Philadelphia in 2015 from Vietnam, she was a middle school student excited to start school, make new friends, and experience new things. But Phuong found herself being bullied by her classmates because of her accent.

When she went home, the criticism continued because Phong was hard on herself.

“I used to blame myself all the time because of my accent and how I’m not speaking English enough, not trying hard enough,” said Phong, now a senior at Girard Academic Music Program.

Some teachers tried to help, but she stayed mostly quiet during the school day.

“I couldn’t have access to teachers because I didn’t know how to express myself to them,” Phong said.

These experiences led to behavioral health issues.

“I was depressed,” Phong said. “I locked my door and hid in a closet every morning so my mom had to pull me out.”

But for Phong and many other English learner (EL) students attending Philadelphia public schools, obtaining access to behavioral health services can be a challenge. The reasons include a lack of appropriate services readily available in schools, community stigma, and isolation as a result of language and cultural barriers.

For students and families who need counseling and case management for their therapeutic needs, the process to obtain them is difficult. Not every school has psychologists, clinicians, and social workers.

Getting help

Joelle Bradley directs four case managers at Penn Medicine’s Hall-Mercer Behavioral Health Services, which serves as one of about 10 case management teams for Children’s Blended Case Management in the city. The service is underwritten by Medicaid through the Philadelphia Department of Behavioral Health. Teams throughout the city provide language-specific case managers or in-person interpreters to visit homes, set goals for parent and child together, and register them for appropriate treatment and recreational programs if necessary.

However, accessing these services requires an existing psychiatric evaluation, which can be hard for families like Phong’s to obtain.

The student might begin the process by seeing a social worker. If the school has no social worker, the student may go to a school counselor and be referred to a school psychologist. But school psychologists are overburdened; most serve several schools and are also responsible for testing for special education, speech therapy, EL programs, and therapeutic programs.

“A child who has a behavioral health diagnosis, through school programs or outpatient services, needs community linkages or support within the school to get appropriate services for that child,” Bradley said.

However, “those supports for students and teachers were eliminated because there was no money,” she said. Due to tight funding, many schools in the District don’t have on-site social workers, clinicians, and behavioral health counselors.

As a result, many students lack the necessary intermediary step between school referrals and services provided by the city’s Department of Behavioral Health.

Limited English proficiency makes it more difficult for EL students to access services in a complicated behavioral health system.

An Nguyen, a senior at South Philadelphia High School who was enrolled in the EL program during her junior year, said that behavioral health issues are not often discussed among her peers.

But she doesn’t doubt the prevalence of these issues.

“I’m sure there’s a lot [of EL students with behavioral health concerns] because I have some friends who speak little English and it’s really difficult to assimilate,” she said. “One of them is having mental health issues. She has to check with the doctor periodically.”

And her friend does it alone.

“Her teacher [who’s close to her] might know, but her parents don’t know a thing.

“She keeps it a secret.”

Identifying the barriers

For the many Limited English Proficiency (LEP) families who are working to help their children access behavioral health services, the lack of professionals such as bilingual counselors to help them proves to be a significant obstacle.

Alexandra Wolkoff hears about the effects of bilingual staff shortages from families with limited English proficiency at Southwark Elementary School. She said that there is a “long waiting list to work with the Spanish-speaking clinician.”

Wolkoff is education director of Puentes Hacia El Futuro, an afterschool program of the community health organization Puentes de Salud stationed at Southwark. As one of the nine community schools designated by the city, Southwark is aided by organizations like Puentes, which helps refer students to the school clinician and to therapeutic services out of school.

She says that “linguistic and cultural competency of the practitioner” are needed to effectively serve English learner clients.

“It’s important to have someone who’s bilingual working with a bilingual child and family,” said Wolkoff.

Distance and travel are also challenges.

“If there were more people and outlets to access locally, that would help immensely with [issues like] bad weather, juggling other kids, no bus,” Wolkoff said.

The cultural stigma of mental health issues can also be a barrier. Although Wolkoff said that she has seen changing and positive attitudes to mental health services, she also acknowledged the challenge of dealing with mental health stigma in Latinx communities.

“Mental health is less tangible [than physical health]. There is a perception of, ‘Why would you share your problems with a stranger? Why would I want my child to talk about our family dynamics with someone?’”

Such a stigma, which affects students of many racial and cultural backgrounds, makes it harder to navigate a system alone.

“I can never express all my feelings to my mother or family,” Phong said.

“You can’t go back to them and ask for help, because they can’t help you with anything.”

The role of schools

Schools have tremendous influence in addressing behavioral health concerns of EL students.

For one, the cohesiveness of an EL student community may be related to factors within a school’s EL program, such as whether there are enough students to form an EL classroom.

According to a June 2016 research brief published by the Philadelphia Education Research Consortium (PERC), both small and large numbers of EL students present academic challenges for the wide variety of EL programs in the District. Researchers stated that “a school’s capacity to establish a strong infrastructure for EL programs may be affected by the size of the population it serves, as the number of ELs enrolled is one factor considered in staffing decisions.”

In addition to the academic challenges in programming, Phong believes that the sense of isolation felt by some EL students can be due to lack of connection and meaningful interaction with students of similar backgrounds.

“Usually EL teachers sat next to me to help me or pull me out of class,” Phong said. “I didn’t find that helpful, especially in a small school.”

When she transferred to a school with a larger EL population, the change in learning structure led to emotional improvements for Phong.

“They gathered all the EL students and put them in one classroom,” she said. “Surrounding me were all EL students.I felt so safe there, and I felt connected with other people. That should happen to different EL programs.”

Teachers also help create that safe space, according to Phong.

“They say, ‘You are not lower than them. Don’t let them say that to you.’ It feels like a family in that classroom; everybody’s so nice to each other.”

Nguyen, the South Philadelphia High senior, suggested paying attention to EL students with lower English proficiency, “especially if they’re studying in an environment where most people don’t speak their native language.” She said that this contributes to “less encouragement to step outside of their comfort zone and join activities.”

Nguyen agreed with Phong that a critical mass of EL students, enough for a full class, positively affects behavioral health.

“Definitely, the lack of EL class would make students feel lonelier. They would feel inferior to native speakers,” Nguyen said.

Outside the classroom, others have brainstormed co-curricular ways to cultivate good behavioral health and well-being.

Wolkoff sees potential in art or movement-based therapy for EL students. Many students don’t need to see a clinician very week, but would benefit from occasional check-ins supplemented by such programs.

“Certainly there’s a lot of stress happening with [President] Trump and our political situation, stressors of being undocumented, in poverty, learning English as a child with [limited English proficient] parents – there’s a lot of general stress,” she said.

Some have dealt with stress, trauma, and isolation by participating in other initiatives focused on EL populations, including leadership development and social connections with peers.

For instance, Phong said that “with a lot of Vietnamese students, they keep stuff to themselves, but a lot of them step up to leadership roles.”

She speaks from experience. Phong joined the community organization VietLead less than two years ago and has since continued participating in the organization that helped her in the first steps in the long journey to good behavioral health.

“They made me realize that it’s not my fault. They changed my life.”

Amy Xu is an intern at the Notebook.