Adolescent Behavioral Health Project

Although the need for culturally competent behavioral health care in Hana was extensive, such services generally were not available. Children at greatest risk for serious emotional disturbances were those from families with a history of mental or addictive disorders; multigenerational poverty; and caregiver separation, abuse, or neglect—problems that were highly prevalent in the community. Hana is a designated medically underserved area, a primary care health professional shortage area, a dental health professional shortage area, and a mental health professional shortage area.

The most innovative feature of the Adolescent Behavioral Health Project was the activities in which employed youth became involved. These culturally relevant health and wellness activities included growing and gathering food, cooking, eating a traditional Hawaiian diet, exercising, and participating in the kupuna (elders) nutrition program.

The program had hoped to serve a larger number of children and adolescents, but several problems prevented the project from reaching its goals. The project faced some resistance and distrust on the part of teachers, counselors, and care coordinators when the school-based behavioral health component was initiated. This lack of support on the part of Hana school staff made it more difficult to implement the program as originally planned. Other problems included recruiting a qualified project coordinator willing to live in or commute to Hana. It took more than 5 months to fill this position, and then the project coordinator resigned after only 9 months on the job. However, the second project coordinator served in this role until the grant period ended.

Although only three organizations participated in the project, coordinating activities, scheduling meetings, and working around staff travel schedules was a difficult challenge. Logistics were a major problem for consortium members because medical center staff and other behavioral health specialists lived outside the Hana district. In addition, the original school principal was a strong supporter of the partnership; however, she was removed from her position in the middle of the project’s second year and replaced by an interim principal during the final months of the project. This affected the project’s ability to carry out some of the planned evaluation activities.

In 2004, the Hawaii State Legislature earmarked $500,000 so the Hana Community Health Center could continue to provide school-based behavioral health services at Hana High and Elementary School. The legislature found the program to be an excellent model for providing such services for children in geographically isolated communities. State funding was conditional on the state department of education matching the $250,000 appropriated to the health department. This funding was supposed to be outsourced via a contract with the Hana Community Health Center.

Instead, the education department decided to attempt to provide these services on its own. As a result, the health center continues to collaborate with the medical center to meet the mental health needs of children unable to access school-based mental health services.

The youth employment program has been expanded to a fullscale, small farming operation that provides employment opportunities for youth and a pro-recovery setting for adults with substance abuse problems. The farm produces more than half of the produce used in the nutrition center, and outside produce sales are generating income for the farm. The health center has retained seven part-time youth employees on the farm, one youth employee in the nutrition center, and one youth employee in the fitness program. In addition, two youth who participated in the employment program are full-time health center employees. Clearly, this component of the program has had a tremendous impact on the lives of the young people it served.