Allcove centers provide a range of services to young people, including mental health screening, short-term therapy, primary care, and addiction treatment.
In California, Stanford Children's Health is helping to open allcove centers, which is a new model for prevention, early detection, and treatment of mental illness in young people.
Millions of American children and young adults experience mental health conditions, and access to care is a challenge. In 2020, 13.01% of Americans aged 12 to 17 reported experiencing a major depressive episode in the previous year, according to Mental Health America. The mental health of high school students has deteriorated during the coronavirus pandemic, with 37% of students reporting they experienced poor mental health in 2021, according to the Centers for Disease Control and Prevention.
The status of mental health for children and young adults is raising alarm, says Steven Adelsheim, MD, director of the Stanford Center for Youth Mental Health and Wellbeing.
"Prior to the pandemic, we were already facing a crisis in terms of access and support for children's mental health issues. There were increasing rates of youth suicide and struggles to have access to care in terms of enough qualified providers to meet the needs of young people. With the pandemic, the challenges have increased, including the growing number of young people needing mental health support. We have higher rates of anxiety, higher rates of depression, and more young people coming into emergency rooms for suicidal ideation and suicide attempts," he says.
Adelsheim and his colleagues at the Stanford Center are playing a leading role in the creation of allcove centers across California. With support from Santa Clara County Behavioral Health Services, two allcove centers opened in Santa Clara County in June 2020. There are plans to open five more allcove centers, with as many as three opening by the end of this year.
The allcove model
Allcove centers are designed to play an important role in the behavioral health continuum of care for young people, Adelsheim says. "We have seen a lot of national attention on school mental health services. The allcove centers become the community place for young people 12 to 25 to come in and get early care. So, we are trying to create a public mental health continuum of early support from school mental health to allcove centers to even early psychosis programs that have grown exponentially across the country since the federal government made the investment through the federal 10% set-aside for early psychosis programs."
Mental health services available at allcove centers include screening and short-term therapy, he says.
"Generally, it is a short-term therapy model, so staff help young people feel comfortable if they are having a breakup in a relationship, or sexual orientation questions, or bullying, or some other type of challenge. They do not have to wait until things become severe. Most of the time, we see young people and families accessing mental health services through emergency rooms at times of crisis. The idea with the allcove centers is they are places that are comfortable enough for young people to come in for an early mental health visit with a licensed therapist and be able to access short-term support. Family therapy is available. Group services are available."
If young people need a higher level of mental health care, allcove center staff can connect them with other behavioral health providers.
Other services provided at allcove centers include primary care, education and employment support, addiction treatment, and peer support, Adelsheim says. "We are looking at a range of supports for young people. Some services support building resiliency and wellness. Other services provide mental health support. We also have integrated support with primary care clinicians who can provide sexual health services for young people as well as general medical services. In addition, we have peer support services. Every young person who comes in to an allcove center is met by a peer support specialist—someone who is close to their age who may have a lived experience with a mental health issue. The peer support specialist can help a young person learn about the services that are available at the allcove center."
Allcove centers have been designed and developed by young people for young people, he says. "Each allcove center has an active youth advisory group that is involved in decisions about the services that are provided. The youth advisory group is involved in the hiring of the staff."
The physical characteristics of allcove centers are designed to create a welcoming environment for young people, Adelsheim says.
"They all have a space called The Cove, which is a warm and welcoming place for young people where they can be together and be able to interact with each other in a comfortable way. One of the ideas is to be able to come in for a moment of pause. Young people can be alone, without really being alone. … The colors and the design are set up to create a level of comfort for young people in terms of the space itself. We try to create a space that is not as clinical as one might see in a typical mental health clinic. There are areas for young people to do creative things and snacks are available. There are art supplies available."
Launching allcove centers
At this stage of the allcove center initiative, the facilities have relied on a range of financial support, he says.
"We are working with the state of California on funding models to be able to provide Medicaid as well as commercial insurance support for the centers. We are doing that work through a partnership with the state Mental Health Services Oversight & Accountability Commission. The centers that opened in Santa Clara County started with some funding from California's millionaire tax for mental health. Santa Clara County also used some of their innovation funds for their two centers. In addition to the state pilot funds, communities are also pulling together other funds from their own mental health services. We are also working with managed care networks to talk about how we can build in the capacity for early and upfront support. There is also some foundation support. The goal is to create a financial model that will allow for broader sustainability over time."
There have been discussions to open allcove centers in other states, Adelsheim says. "They can connect with us through our website, allcove.org. We have information available to share with communities that are interested in rolling out this model. We have a technical support team whose role is helping interested communities think about what it would take to start a model like this. Opening a center often begins with developing a youth advisory group because the youth voice is important to developing services and to helping communities pull together the service delivery partners."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Mental health for children and young people was in a state of crisis before the coronavirus pandemic, and the situation has worsened during the public health emergency.
Allcove centers are designed to provide early intervention for young people experiencing mental health issues before conditions become severe.
Youth advisory groups play a crucial role in allcove centers, including decision-making about services and hiring of staff.