The start of the new school year brings the usual set of challenges for students as they navigate new schedules, lesson plans and social dynamics. Those changes can also take a toll on a student’s mental health.
A survey conducted in 2023 by the Centers for Disease Control and Prevention found, for example, that 40% of high school students nationwide reported depressive symptoms — an increase of more than 10% since 2013. Former U.S. Surgeon General Dr. Vivek Murthy issued an advisory in 2021 warning about worsening youth mental health, exacerbated by the pandemic and excessive use of social media.
The Ballmer Institute for Children’s Behavioral Health at the University of Oregon is working to help address this crisis of youth mental health. Launched in 2022, the institute is pioneering the first program of its kind in the nation to educate and train a new class of healthcare workers: child behavioral health specialists.
The 4-year program provides an alternative to the additional years and cost a student would typically have to spend in graduate school to become, for example, a school psychologist or social worker. Instead, the undergraduates in the program obtain 700 hours of applied training that starts their junior year with internships at Portland area schools, clinics and community organizations.
While they can’t provide diagnoses or conduct psychological evaluations, the interns can help prevent and mitigate behavioral health challenges by teaching, for example, problem-solving strategies or coping skills kids can use during stressful situations.
Joining us for more details are Cody Gion, an assistant clinical professor at UO’s Ballmer Institute for Children’s Behavioral Health; Sophia Morgan, a UO senior and child behavioral health intern who is currently working at a high school in Portland for students in recovery from substance use; and Anne Libby, who is also a UO senior and child behavioral health intern currently working at a pediatric clinic in Hillsboro.
Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Three years ago, Connie and Steve Ballmer of Microsoft fame and fortune gave close to half a billion dollars to the University of Oregon. The school used that money to create the Ballmer Institute for Children’s Behavioral Health. Undergraduates in the first cohort are now seniors at the Institute. They’re part of a first-in-the-nation program intended to address the nationwide youth mental health crisis. They’ve been interning in Portland schools to get direct experience working with young people in need.
Sophia Morgan and Anne Libby are seniors at the U of O and interns at the Institute. Cody Gion is an assistant clinical professor there. I talked to them recently. I started by asking Cody what the big idea is behind the Ballmer Institute.
Cody Gion: The big idea of the Ballmer Institute is trying to meet the need of this growing mental health crisis that we see in the state of Oregon, across the United States. We don’t have enough providers right now to meet that need. So our institute is really focused on growing a bachelor’s-level credential that our students can go out into the field right away and provide direct service to youth and to families, to help support behavioral and mental health. And so we want to grow that workforce in a pretty rapid way. And also, by doing it at the bachelor’s level, we’re also hoping that we also can diversify that workforce to be more reflective of the communities that might need some support.
Miller: It’s been a little while since we’ve talked about this issue broadly. How big is the gap in Oregon between child behavioral health needs and available services or providers?
Gion: Last time I remember, it being checked, Oregon was 49th out of 50 states that have a need for mental health but not providers to fill it. So definitely we are on the low end of that. And then that shortage is also throughout the nation. There’s not a ton of states that are meeting that need anyway, but Oregon is among the worst right now.
Miller: No one’s doing great, we’re doing basically the worst.
So you talked about the bachelor’s degree piece of this. What’s the typical pathway for people to provide some kind of mental health support, let’s say for kids in schools?
Gion: So the typical pathway to be a licensed mental health provider is that you have to go to graduate school and you have to at least get your master’s. Sometimes to provide service outside of even school settings, you have to have your doctorate to provide private practice that way as well. So you have to have an advanced degree, and you also have to go through a tremendous amount of more training. And I think that those can be some barriers to growing that workforce.
Miller: Sophia, when you started at the University of Oregon this program had not even opened its doors yet. I think that was the year that this big gift from the Ballmers was announced, but a lot of stuff had to happen before it could be up and running. Why did you want to take part?
Sophia Morgan: So I was studying general psychology at University of Oregon. I had known for a long time that I wanted to study psychology and be involved and work in mental health, but I also wanted to work with kids. So my second year at University of Oregon I actually switched to studying family and human services to try and get closer to that goal. And then I heard that the child behavioral program was created, and I applied immediately because I thought that’s exactly what I want to do.
Miller: Why? What was it about this work that attracted you?
Morgan: I think early intervention is so incredibly important. We think about mental health and we think about teenagers and adults struggling with anxiety and depression. But I feel like society overlooks child anxiety and child depression so much. And if you can get mental health services involved during that earlier time when it’s starting to develop, then it just can make the world of difference.
Miller: Anne, what about you? What attracted you to this program?
Anne Libby: When I initially heard of the Ballmer Institute, I was actually studying at Portland Community College. And when I heard about it, I had been planning on going to get my bachelor’s in social work and then eventually transition to get a master’s in social work. So that was my plan ...
Miller: Just to interrupt you for one second, that’s exactly the kind of career pathway that Cody was talking about – a bachelor’s and then a graduate degree so you can provide these kinds of services. That was your plan?
Libby: Exactly, that was my plan. But like he was talking about, the financial and the time constraints of a master’s degree were a barrier to me. So when I heard about this program, it was like Sophia said, exactly what I wanted to do – a perfect mix of working with kids and getting that direct support practice, but also it’s not quite as huge of a time or money commitment as maybe a master’s program would be.
Miller: You’re both seniors now, and last year was the first one where you spent significant chunks of time, dozens and dozens of hours in two different middle schools. Anne, you were at Harriet Tubman Middle School, if I’m not mistaken, in North Portland.
Libby: Yes, that’s correct.
Miller: What do you remember from your first days or weeks there?
Libby: My first days and weeks at Harriet Tubman were really full of learning, just soaking up the environment, learning about the culture of the school, of the students and the staff, and figuring where I fit into that system. We slowly started to branch out our services, and meet with more and more students as we got comfortable, and learned what the needs were and how we could support those needs.
Miller: What kinds of needs did you see? What were the problems that kids opened up about most often?
Libby: We saw a lot of anxiety, specifically around school anxiety, trouble wanting to get into the building or get into class. Just a lot of school avoidance was one of the main things that we saw. We’d have a lot of students coming in complaining about some somatic symptoms maybe that were related to that anxiety: stomachache, headache, stuff like that. That stuff was really a hindrance, so they would stay home from school or not want to go to class because of these pretty severe anxiety symptoms.
Miller: What kind of help could you provide?
Libby: We provided a lot of relaxation and calming, so we would teach them different breathing techniques or grounding techniques. We did a lot of group supports too, so we had a group focused on executive functioning skills, stuff around like time management and planning, and that was super helpful for them.
Miller: Sophia, you were at a different middle school, George Middle School. What do you remember about your beginning there?
Morgan: My beginning was great. I actually had Cody as my supervisor, and I really enjoyed the way that he just, for lack of a better term, threw us in. We got right in on the action. And I was a little nervous at first, but I didn’t realize how naturally I would end up taking to it, especially because I’d never worked with middle schoolers at that point, only elementary students.
Miller: So are you like 19 or 20 when you were doing this last year?
Morgan: Yes, I was 20.
Miller: And you work with middle schoolers. So obviously you’re a college student, you’re at that point a little over halfway through college. There’s a huge experience gap. But there’s not – I say this as someone who’s about to turn 50 – a huge age gap. What was that like?
Morgan: I think not having that huge age gap actually proved to be really valuable, especially in building rapport and connections with the students. I think it was really nice for them to have someone who was younger there that knew about their favorite music or their favorite video games, and could relate, talk to them and listen to what they had to say, because I think a lot of adults in their lives, they couldn’t form that genuine bond and connect about those things with.
Miller: Cody, why middle schools?
Gion: Middle school is such a critical time. You’re in that early adolescence, you’re trying to figure out what is your own identity, what is your own self-concept, and that’s where a lot of mental health symptoms arise, and where a lot of earlier intervention can happen. And certainly happen earlier on in elementary schools, but middle school is really where you’re starting to get some more independence. We’ve all been through middle school and you know the body changes, the social changes that happen. It’s a really critical time for a lot of youth.
Miller: As Sophia said, you were at George helping her and other interns there. She said that she appreciated that you just threw these interns in, with some support, but it was up to them to figure out what was happening. What do you want your interns to learn at these schools where they’re serving students?
Gion: I think that that’s the biggest thing that you just mentioned, that word “service.” When we go into these communities, it is not that we know all these things to help and save you, right? That’s not the mindset that we go in. It’s about how can we serve, how can we support, and really taking that in. The reason why we started right away with doing is, we can talk about it, but doing it is different, right? You experience different things when you’re doing it. You experience some struggles, you experience some different things.
One of our interventions for youth around anxiety is facing your fears. So one of these things where we’re training new practitioners is about how do you face your own fears? How do you face your unknowns, doing these new practices with students that you might not have worked with before? That can be anxiety provoking, but how do we lean into that and how do we support that?
Miller: Anne, what were some of the challenges last year as you were working with kids, in some ways for the first time?
Libby: There were a lot of challenges that came up that I wasn’t expecting, a lot around their willingness to participate in services. We had a lot of kids who would sign up for meetings, and then we would come and they wouldn’t say anything, or they wouldn’t want to engage in the skills that we wanted to provide them with. So a lot of working with them to find a style that they liked and they felt comfortable with, and working with them to find a unique approach that supported what they were looking for a little bit more than just a one-size-fits-all intervention.
Miller: Sophia, we were talking about the two middle schools where you both worked last year. There was another piece of the practical work experience part of your education last year, which was interning at YouthLine, the crisis line for young people, which seems very different in a lot of ways than working at a middle school. What did you learn there?
Morgan: I remember being so incredibly nervous for YouthLine because it’s such heavy work. Crisis work can be a really big load to take on. But I remember realizing how grateful I became to get experience in crisis management and crisis work. Because if you’re working in the mental health field, crises are things that are going to come up. Being able to be exposed to this high acuity of different cases, and learning how to safety plan and de-escalation techniques was just really, really valuable.
Miller: Sophia, did you have anybody in your life when you were in middle school who played the role that you and Anne are training to be right now?
Morgan: I did not. That’s part of why I joined this program. I really wanted to become the kind of person that I wish I had in middle school, when I really needed someone to talk to when I started struggling with mental health.
Miller: Anne, what about you?
Libby: My answer is going to be very similar to Sophia’s. I always felt like I struggled a lot in my middle school and high school years, even before that. And the only people I really had in my life to talk to about it were adults, who would either brush me off or kind of diminish the struggles that I was going through. So I definitely longed for that support of someone who was a little bit more experienced, or even just a little bit closer in age, who would understand and have some skills to work with me.
Miller: Cody, you were talking before about one of the big ideas here is to lower the bar, to bring many more numbers and also more diversity to the child behavioral health workforce. What won’t child behavioral health specialists be able to do?
Gion: That’s a great question and a question we get a lot. What we try to say around that is it doesn’t replace having a graduate degree, it doesn’t replace some of those things that when you are a licensed mental health professional right now that you have. And specifically, that is a breadth and depth of understanding of a lot of different modalities or therapies that can be applied. We’re training our students to really provide support in a very narrow way, that looks at what do we know about the biggest impacts, based off of research with very diverse communities, a lot of different studies across the board, and how do we bring those in that we know are really evidence-based for prevention and early intervention?
So what what looks like is they provide a lot of those things, as Anne and Sophia were mentioning, around skills instruction, how do I help you understand what is going on with your body, your thoughts and things like that, and what are some ways that you can cope with that? So we can intervene on depression, anxiety, misconduct. But where we refer is some of those more acute cases, where we have students or we have youth that are going through active suicidality, that need much more safety planning around that psychosis, really extreme forms of anxiety. And what we’re hoping [it] allows existing professionals to do is really to work at the top of their license, to work out what is their high level of training that they have, instead of trying to meet all the needs of everybody,
Miller: Sort of thinking about workforce and triaging based on workforce specialization?
Gion: Exactly.
Miller: Am I right that this is the only program like this in the country, still?
Gion: It is.
Miller: So how are you going to get schools or other placements to say, “yes, I will take these people on,” these newly minted people, if this model is brand new?
Gion: One of the things that we found is that people know there’s a need out there. They are clamoring for people to be able to fill that need. And I think what people do right now is they hire people that are good with kids, might have some behavioral background, but don’t have specialized training. And I think that’s where we can fill a lot of that need – not in the licensed positions that are already out there. Counselors, school psychologists, social workers, all those people are still needed. But there’s a lot of people that are providing behavioral and mental health services that don’t really have some training, and we can bring some “here’s a workforce that’s actually trained to provide that type of service.”
Miller: Anne, do you have a sense for what you want to be doing next year?
Libby: There are a lot of different options that we can do with this degree. Right now, I’m at an integrative practice site, Hillsboro Pediatric Clinic, and there’s a possibility that they’ll take me on after graduation as a behavioral health provider there, as an employee and not just an intern. So that’s one option for me. And then social work still really is of interest for me, so that could be something that I work towards while getting to experience field work with my bachelor’s degree.
Miller: Sophia, what about you?
Morgan: Yeah, very similar, there are multiple options. I’m currently at a recovery high school for teens who are struggling with substance use disorder. So there is the possibility that I could stay there after this year and they could take me on as part of their recovery team as a child behavioral health specialist. But I’m also really interested in still going to graduate school and pursuing a career in school psychology as well.
Miller: Cody, is it your assumption that some people will do this job and, like Sophia and Anne are saying, maybe age out is the way to put it? Or just say they want to move on and actually get an advanced degree? Is that the way you’re thinking about this, that for some people, this will be a stepping stone to other work?
Gion: Yeah, definitely. The major goal we have is to grow the workforce, to get people out in the field. But that’s a natural progression, that’s a natural thing of, “I want to go and get a more specialized degree to work with a different population, maybe the more acute population.” And what I think is great about that is that they’re going to have training in their bachelor’s around what this looks like.
They’ll also have service experience of what this looks like: “Do I really want to do this? Do I really want to become a school psychologist, become a social worker? And I know what that looks like because I’ve been in the related field. I might not have been doing that work yet, but I know what it is to work with kids.” I think that can help with retention in those allied fields. And I also think we can help grow the direct service right away.
Miller: Cody, Sophia and Anne, thanks very much.
All: Thank you.
Miller: Sophia Morgan and Anne Libby are students and interns at the Ballmer Institute of Behavioral Children’s Health at the University of Oregon. Cody Gion is an assistant clinical professor there.
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