The Fuerte program provides mental health education to incoming young immigrants

[Pictured: Dr. William Martinez, UCSF Director of Pediatric Mental Health for the UCSF Health and Human Rights Initiative, is the principal investigator of the Fuerte program, a school-based group prevention program targeting newcomer immigrant youth at risk of behavioral health concerns. Photo: Anna Hoch-Kenney]

According to the district, about 500 newly arrived immigrants enroll in San Francisco public high schools each year. Of those 500, well over half are from Honduras, El Salvador and Guatemala. Another eight percent come from Mexico.

Linguistic, academic, social, financial and now pandemic stress is common among recent immigrants. According to a study by the William T. Grant Foundation, Latinx newcomers are at increased risk for traumatic stress and behavioral problems. They are also less likely than their white counterparts to have access to and use mental health services.

Fuerte, a semester-long mental health education program for Spanish-speaking Latinx newcomers to the San Francisco Unified School District (SFUSD), is trying to change that. Since its inception in 2015, it has served over 350 youth, weathered the pandemic, and its current iteration is being evaluated by UCSF researchers for impact on mental health literacy, linkage and access to mental health services, and social connectedness.

according to dr William Martinez, the lead researcher, the study is an opportunity to show the tangible impact of mental health programs like Fuerte on immigrant youth. “If we can demonstrate that this program is benefiting this population, then we can get funding to sustain it [and] spread it to other places in California,” he explained. Funding for the San Francisco program is guaranteed for at least two more years thanks to the Mental Health Services Act Innovation Fund, which has been funded by a 1% income tax on annual personal incomes over $1 million since 2004.

In addition to recognizing the unique mental health needs of newly arriving migrant students, Fuerte is pioneering in emphasizing the importance of preparedness. Martinez and his clinic colleagues first recognized the need for a preventative mental health program in 2013, when they “started seeing a lot of it [Central American] children come in [to the UCSF clinic] with a lot of trauma,” he said. “Newcomers came in…when they were already much more acute, [with] much more behavioral health problems.” The psychological impact on immigrants of the inhumane policies of family separation and detention centers of the United States, its criminalization of immigration, and its racist rhetoric at the national and interpersonal levels cannot be underestimated here.

Part of Fuerte’s program is therefore screening, designed to identify mental health care needs and to connect students to services earlier. However, structural access barriers remain. Interviews with Latinx newcomers to the program revealed that most of the youth were unavailable outside of school hours. “Most of our kids work after school, and many of them work more than 20 hours a week,” Martinez said El Tecolote. “We have staff turnover … for the same reason — it’s so expensive,” he said. A shortage of Spanish-speaking psychiatrists in San Francisco means care for patients requiring bilingual services is often delayed.


Erik Martinez, Supervisor of SFUSD Focal Services, said that for freshmen, “there is a critical mental health need [support]. There are waiting lists for people who have access. Some of these waiting lists are closed…[some are] at least a month, meaning someone isn’t seen for a month. I think Fuerte helps – I think school support helps, but I think we also have to remember that schools close in the summer.”

What makes Fuerte so great – that it’s easily accessible during school holidays – is also a reminder of the program’s limitations. Ensuring access to mental health resources for freshmen is a task that extends well beyond Fuerte’s borders and into health policies and priorities at local and state levels. No child should wait months for a therapy appointment. Not addressing the proven need for Spanish-speaking clinicians in the city with urgency means neglecting Latinx communities.

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Furthermore, even when it comes to literacy and linkage needs, Fuerte’s program has uncovered new ones as well. For Latinx newcomers who speak Portuguese or indigenous languages, for example, there is a double language barrier: no English and no Spanish. “We were referred to a lot of people who spoke Portuguese [or] Mom,” Martinez said. In one year, five Brazilian newcomers were referred to Fuerte and the program turned them away instead of trying to accommodate them.

A few years ago, San Francisco International High School, one of three high schools offering Fuerte programs, approached the research team and asked for an accommodation for Syrian and Yemeni newcomers. Rollout of the modified curriculum began in early 2020 but collapsed shortly thereafter when the pandemic hit. However, the transition to Zoom and Telehealth hasn’t hampered the more established Spanish-language programming. In fact, the program was even able to virtually develop the students’ sense of social connectedness. One teenage participant said in a focus group: “ford is a great group because we share our ideas and dreams for our future and other things about ourselves and we share those with the group… I learned a lot about that [the other youth participants]and they also found out about me.”

Effectiveness of the program versus telemedicine is particularly important in terms of scale-up and expansion to reach more newcomers. In more rural areas without enough Spanish-speaking providers but with significant needs, like the Central Valley, we now know that mental health education and prevention programs can take place virtually and have a significant impact.

In relation to other future directions, the Fuerte team is discussing whether and how parents can be involved in their programs. Many newcomers are “now reunited with family members they have never met before, [or that] They haven’t seen each other for a long time and now they have to learn to get along,” Martinez said. But again, there are similar barriers to implementation and access. Like their children, parents often work multiple jobs and/or care for children. Waiting lists are long. “We have to get creative,” Martinez said.

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