Taking Action to Support Youth Mental Health

NYHealth grantees like the New York School-Based Health Foundation and Organización Latino Americana of Eastern Long Island are working to support the mental health needs of students in communities across New York State. 

The COVID-19 pandemic exacerbated existing mental health challenges and highlighted the urgency to increase access to comprehensive mental health services. Findings from an NYHealth data brief showed that while rates of poor mental health among New Yorkers fluctuated throughout the pandemic, more than three in ten (31.5%) adult New Yorkers reported experiencing depression and/or anxiety in March 2023.  

Young people’s mental health may be even more precarious. According to a CDC report, the rates of youth who persistently felt sad or hopeless increased substantially between 2011 and 2021, from 28% to 42%.  

For newly arrived New Yorkers and those who don’t speak English, language barriers and difficulties navigating complex health systems can compound young people’s symptoms of anxiety, depression, or post-traumatic stress.  

School-Based Mental Health Services 

The New York School-Based Health Foundation used NYHealth funding to offer technical assistance and develop resources to support in-school mental health services in schools throughout the State. It assisted schools with implementing events like health fairs and screening programs, as well as meetings on topics such as stress management, weight loss, and self-esteem. It also provided staff training on evidence-based mental health support services. Across the two-year project, 1,600 students were screened for behavioral health symptoms, and more than 350 students enrolled in treatment, with the majority receiving care at school-based health centers.  

As part of the project, school-based health centers created support groups across various themes.  One school-based health center aimed to meet the needs of students who’ve newly arrived in New York.

“Every month, we still get kids who are new to the country; 40% of the kids in the school are newcomers. They’re not alone [in being] the only kid in school that’s new and speaks a different language,” noted a school-based health center social worker. The support group provided age-appropriate social activities, including painting, board games, and vision-board making, to ease anxiety about school. It became a safe space for students to bond over their experiences. “We used this game called My Journey into the U.S., and it allowed for the kids to share their experience when they got here.” She added that addressing the mental health challenges of the school community also means meeting basic needs, including stocking up on toiletries and extra clothing for students who need them. School-based health centers have been playing that crucial role. “Everyone’s trying to survive. You can’t just leave a student who’s struggling without resources and support, but I find that the kids are so resilient.” 

Based on the learnings from this project, the New York School-Based Health Foundation has launched a two-year grant program to support school-based health centers in serving students in the downstate region who have newly arrived in New York and are experiencing migration and settlement transitions. 

Bilingual Mental Health Support on Long Island 

Thousands of Latinos live in the area year-round working in essential industries like landscaping, farming, and hospitality. Many are immigrants, face food and housing insecurity, and have limited access to health and social services. In some school districts in the region, up to 40% of students are Latino, and up to 60% live below the federal poverty level.  

Organización Latino Americana (OLA) of Eastern Long Island used its NYHealth grant to expand student access to crisis counseling and mental health services in English and Spanish. OLA’s Youth Connect hosted workshops for Eastern Long Island school districts and provided an estimated 2,000 middle and high school students with access to a confidential bilingual crisis helpline.  

Common themes shared with Youth Connect’s anonymous hotline included family tensions, being overwhelmed at school, depression, and anxiety. But there were also concerns about immigration stressors, which underscored the need for trauma-informed approaches.

“They miss the family that they left behind,” explained Adriana Cardona, a Youth Connect crisis counselor. OLA also emphasized the importance of incorporating language justice and ensuring culturally accessible programming. “When they’re in emergent situations, especially for youth and teens, [things] can be misconstrued in some way, or they can’t fully express themselves,” another OLA staff member added. Counselors who speak the same language and understand their culture help young people address their mental health needs while honoring the complex emotions related to assimilation. OLA continues to provide workshops and access to a confidential bilingual crisis helpline. Learn more about OLA’s services here. 

Rebuilding a Good Life

Pazir* was ripped from the life he knew when the Taliban bombed the Kabul International Airport in Afghanistan on August 26, 2021.

Pazir had spent two years working at the U.S. Embassy in Kabul. The day of the bombing, everything changed. Pazir lost a close friend and was himself hospitalized for 25 days.

Pazir grew up in Kabul surrounded by a strong support system of family and friends. At 24 years old, he had already started a small business—a bakery—that had turned into a restaurant. “We used to make homemade, delicious food,” he reminisced. Pazir studied public law and had plans in place to grow and expand his business.

When the Taliban attacked the airport, Pazir fought back. “We fought for the country, we fought for the people. We fought for the commitment that we had to the United States government.” While the rest of this team left the country, Pazir was chosen to as part of a trusted team to stay and help the U.S. Marine Corps as an interpreter. After the Taliban took over, an injured Pazir fled to the States, leaving behind the life he knew and loved. He arrived in Fort Dix in New Jersey and spent time in refugee camps before ending up in Buffalo, NY. He found housing and employment within a few days of arriving in Buffalo, working as a cashier in a grocery store.

But the physical and mental trauma of the attack and his sudden relocation weighed on Pazir. “It’s really hard to leave your home where you grew up; where you made yourself; where you made your career; where you established a good life—like, a really good life.” Torn from his life and career, Pazir struggled with mental health issues as well as physical ones. Despite growing up in a culture where speaking to a psychologist is laden with stigma, Pazir recognized that he needed to seek help. He sought out a counselor at Jewish Family Services of Western New York (JFS), who helped him unpack the trauma that had been plaguing him since the explosion. Together, they worked through his disturbing memories and Pazir rediscovered his goals, vision, and direction in life.

“I was totally lost before engaging in this program. Having a good person—a good counselor—like [in] the program is life-saving, honestly.”

More than a year later, Pazir started working at JFS as an intensive case manager and refugee specialist. He hopes to help other refugees like himself work through trauma and settle into a healthy life in New York.

*Name changed to protect privacy

JFS provides complex medical, psychological, immigration, and legal services to immigrants, refugees, and asylum-seekers. Under an NYHealth grant, it provided access to mental health services that often fall outside the boundaries of resettlement services. It worked to deliver and connect refugees to emergency mental health services and nonclinical support groups, as well as help them recognize the signs of mental health issues.

Connecting More New Yorkers to Fresh, Locally Grown Produce

Nutrition incentive programs can help people living on low incomes purchase fresh fruits and vegetables. The Double Up Food Bucks program lets Supplemental Nutrition Assistance Program (SNAP) recipients use their benefits and receive a matching value on dollars spent on fresh produce at participating farmers markets, mobile markets, and corner stores.

For instance, a family that spends $10 in SNAP benefits with a participating vendor receives an additional $10 in Double Up Food Bucks to purchase locally grown fruits and vegetables. In addition to helping families living on low incomes purchase more fruits and vegetables, the program supports local farmers and local economies.

In 2014, Field & Fork Network began administering the Double Up Food Bucks programs at seven markets in Western New York. The following year, NYHealth made its first grant to Field & Fork to support the spread of the program across the State. Field & Fork Network offers Double Up Food Bucks at various outlets—including farmers markets, mobile markets, and small retail and grocery sites—across urban, suburban, and rural communities. Using SNAP enrollment and health outcomes as key indicators, Field & Fork Network works in communities that reflect the greatest need and where Double Up Food Bucks will have the greatest impact. NYHealth continued to support its ongoing expansion to other regions of the State, with grants in 2017, 2018, and 2021.

Despite the crucial role they play in connecting people to healthier foods, nutrition programs are under-enrolled. Field & Fork collaborated with community organizations to help enroll residents in Double Up Food Bucks, many of whom weren’t aware they were eligible for SNAP. On the vendor side, Field & Fork connected with both existing Double Up Food Bucks farmers markets and new sites to ensure they had the tools and technology to successfully operate the program as well as address customer questions and needs.

When the COVID-19 pandemic hit in early 2020, it had a particularly devastating effect on New York State, including exacerbating food insecurity and inequities among many New Yorkers. In fall 2020, the United States Department of Agriculture (USDA) notified Field & Fork that it could qualify for an additional $750,000 in funding—but it would need to find matching funds for any federal amount and with only a 48-hour window to do so. NYHealth became the first funder to support this effort, and then worked quickly to connect Field & Fork with other funders across the State. Within the 48-hour deadline, a coalition of funders committed to nearly the full amount—collectively channeling $1.5 million of support to hungry New Yorkers.

Over the course of 2020, despite the lockdown, Field & Fork worked to add Double Up Food Bucks at 12 new sites at grocery stores, farmers markets, and small retail and mobile markets, representing 16,000 new users.

As a result of Field & Fork’s efforts, a total of 32 New York counties are now participating in Double Up Food Bucks, giving more families living on low incomes better access to healthy, local food. To date, 42,000 New Yorkers and more than 200 farmers markets, mobile markets, and farm stands have participated. The dollars involved are equally impressive: $4.9 million in SNAP & Double Up Food Bucks dollars have been spent in New York State since 2015.

Field & Fork has also been successful in securing additional USDA matching support through 2024 and, for the first time, a $2 million annual appropriation from the State in 2022 to expand the program. Through this leveraged funding, Field & Fork anticipates reaching approximately 140,000 new SNAP recipients in 45 counties in New York State and distributing $4.3 million in produce.

Spreading Open Notes Throughout New York State

Clinical visit notes are an important resource for helping patients and families remember and act on information discussed during a visit, including treatment plans, medication, and care coordination.

Shared visit notes, often referred to as open notes, also help patients become active participants in their own care. Established in 2010, OpenNotes is a national effort to give patients access to shared visit notes.

NYHealth has long supported the spread of open notes throughout New York State as a leading strategy in our consumer empowerment portfolio to promote transparency and patients’ access to their own information. The 21st Century Cures Act, which went into effect in 2021, has helped to accelerate this work by requiring health care providers to make visit notes available to patients electronically and at no charge—galvanizing efforts by NYHealth and our grantee partners to connect more New Yorkers with their open notes.

NYHealth began this signature initiative in 2016 with an initial grant to NYC Health + Hospitals to launch open notes at the largest public hospital system in the country. This pilot was followed by a grant to NewYork-Presbyterian to test open notes among its elderly Medicare patients through its accountable care organization.

To help the spread of open notes to more patients throughout New York State, NYHealth supported 10 geographically dispersed hospital systems across the State in implementing open notes at their facilities in 2017. We then turned to federally qualified health centers (FQHCs) and other nonhospital settings in 2019 to ensure that all New Yorkers, especially those in underserved communities, have access to their own health information.

Among the projects:

  • University of Rochester Medical Center and Rochester Regional Health—two competing hospitals—came together for region-wide implementation of open notes. As a result, patients reported having a better understanding of their health, more trust in their doctors, and an improved ability to follow their treatment plans.
  • NYC Health + Hospitals (H+H) piloted open notes in all outpatient settings, except behavioral health, at three of its hospital sites. By the close of its grant project, nearly 1,500 providers across 174 departments had shared more than 374,000 notes.
  • NewYork-Presbyterian and its partner health system entities piloted open notes at their accountable care organization, which served 31,000 Medicare patients, of whom 29% are over the age of 80. By the end of the grant period, more than 34,000 notes had been shared with patients.
  • Care for the Homeless provides integrated health services, shelter, and supportive services to people experiencing homelessness across New York City and operates 19 FQHCs. Care for the Homeless introduced outreach specialists to contact patients and help them enroll in a patient portal to see their notes. Over the course of this grant, more than 1,100 patients were engaged and portal usage among patients doubled.
  • The Institute for Family Health, one of the largest FQHC networks in New York State, contracted with a vendor to translate notes into Spanish so all patients, regardless of their level of English proficiency, can understand and use their health information. By the end of the grant period, more than 50,000 patients had enrolled in the MyChart online tool, with nearly 76,500 notes shared.

Many patients surveyed and interviewed as part of these NYHealth-supported initiatives have reported positive effects and interactions with reading their notes. For non-English speakers, open notes have been particularly useful; as one patient at H+H shared: “The consistency in what my doctor told me during the visit and what they would write down in their notes is what generated my trust in my doctors and in the care that I was receiving. At times, we don’t understand the purpose of an exam or a treatment but if you review your notes, the explanation is there. If you don’t speak English, you can easily copy the information and translate it using online tools.”

After the 21st Century Cures Act went into effect, a growing number of health systems began adopting open notes. However, the level of compliance and, most importantly, the proactive use of open notes to improve care varies among hospitals and health systems.

NYHealth saw the federal mandate as an excellent opportunity for hospital systems not only to comply with information-sharing requirements, but also to use open notes to spark a culture change and more meaningfully engage patients. Currently, NYHealth—in partnership with the OpenNotes national program office—is providing 16 hospitals with funding, technical assistance, and peer-learning opportunities to implement and share open notes effectively. Building on this effort, NYHealth will release a Request for Proposals (RFP) in fall 2022 for FQHCs, private physician practices, and other ambulatory care settings to support open notes adoption and consumer engagement.

Through these combined efforts, health care providers across the State have made great strides, sharing notes with more than 1 million patients and using innovative strategies to engage them. New York State has gone from worst in the nation to among the best in terms of adoption. As a result, ever-greater numbers of New Yorkers have access to their clinical notes to make choices about their health care, advocate for themselves or a loved one, and engage in shared decision-making.


Pursuing Racial Health Equity

Summer 2020

NYHealth aims for all New Yorkers to be as healthy as possible and to get the best care when they need it. But not all New Yorkers have equal opportunities to be healthy; wide disparities persist across race, ethnicity, geography, gender, education, employment status, immigration status, income, and other factors.

For NYHealth, health equity means that everyone has the opportunities and resources they need to be as healthy as possible and that no one is disadvantaged.

Racial and ethnic disparities in health are especially pervasive and persistent, so achieving health equity requires particular attention to the health needs of New Yorkers of color. Systemic racism in the United States is a public health issue that dates back hundreds of years, as exemplified by the enslavement of African people, and has persisted through discrimination in housing, education, economic opportunity, the justice system, and myriad other ways. The COVID-19 pandemic is just the most recent example of racial disparities in health, with death rates and hospitalization rates more than twice as high for Black residents as for their white counterparts. Black and Hispanic New Yorkers are also less likely to have health insurance and adequate access to care and more likely to experience food insecurity, complications with childbirth, chronic health conditions like diabetes and asthma, and premature death.

Mural installation through a project with the Niagara Falls National Heritage Area.

Over the years, health equity has been an underlying theme of much of NYHealth’s work, but it has not been an explicit focus. In 2020, as our nation reckons with the murders of George Floyd, Breonna Taylor, and so many others—and as communities of color rightly live in fear that they will not receive equal justice—we are re-examining our approach to health equity, particularly through the lens of racial inequities.

As a first step, we are reflecting on the work we’ve done to address health equity issues in communities of color in New York State, as well as some of our analytic work that can offer insights into opportunities for improvement. This is an ongoing process—there is always room for us to do more and to do better. As we take a look at what has worked and where we’ve fallen short, we can identify gaps that could inform future work to improve racial health equity in areas like food security, maternal health, and veterans’ health. Below are some examples:


Ensuring equitable access to healthy food
Disparities in food security in New York State are serious and persistent; Black and Hispanic New Yorkers are much more likely than their white counterparts to experience food insecurity. NYHealth’s efforts to ensure equitable access to healthy food include securing universal free school lunch in New York City; providing seamless access to nutrition benefits during the COVID-19 pandemic; and supporting Isabahlia Ladies of Elegance Foundation, which is training young people to advocate for quality produce and healthier foods in supermarkets in Brownsville, Brooklyn.

Empowering expectant parents
Black and Hispanic New Yorkers are much more likely than their white counterparts to experience serious complications with childbirth. NYHealth has supported the development of the ExpectNY tool to help expectant parents in New York City and Long Island make informed decisions about where to get high-quality maternity care. Another project is supporting the Building Service 32BJ Health Fund to develop a high-value maternity care network for its members, who are predominantly lower-wage union workers and women of color.

Meeting the needs of minority veterans
Racial and ethnic minorities made up 21% of New York’s veteran population in 2015, a proportion that is expected to rise to 37% by 2040. An assessment from the Center for a New American Security makes recommendations for better meeting the unique needs of minority veterans. Black and Hispanic veterans are also more likely than their white counterparts to be incarcerated. A project with the Urban Justice Center is working to meet the health and legal needs of justice-involved veterans at Rikers Island.

Engaging patients of color as partners in their health care
Although all patients should be valued as partners, patients of color can face unique obstacles, including racism, bias, mistrust, and gaps in communication between patients and physicians. In 202o, NYHealth issued a request for proposals, “Patients as Partners: Advancing Equity,” our first program focused explicitly on racial health equity. Five grantees were selected to engage patients of color as partners in their health care at both the systems and individual levels to ensure their priorities, preferences, and experiences guide efforts to develop a more equitable health system.

Training health care providers on equity issues
One promising way to improve health equity is to ensure that health care providers are culturally competent and are well-trained on issues like implicit bias. The Greater New York Hospital Association teamed with community-based organizations to train primary care residents on the social determinants of health—those factors outside of the health care system, including racism, that affect how healthy we are.

Addressing the needs of formerly incarcerated New Yorkers
Racial inequities are inherent in our criminal justice system; these have a ripple effect on the health of people who have been incarcerated and their families. Amid the COVID-19 pandemic, NYHealth made a grant to expand emergency telehealth services to New Yorkers recently released from incarceration, with a particular focus on justice-involved Black and Latinx males. Another project is supporting formerly incarcerated New Yorkers with virtual discharge planning and re-entry services, including wellness check-ins, connections to health and food access benefits, and housing. NYHealth is also helping child welfare agencies to provide educational services and programming to children of incarcerated people during the pandemic.

GrowNYC Farmstand in Brownsville, Brooklyn.

Analytic Work

More Diverse and Older: Demographic Implications for New York’s Health Care System: This publication examines how New York State’s demographics are expected to change over the coming decades and how the health care system will need to prepare to care for an older and more racially and ethnically diverse population.

Complications of Childbirth: Racial & Ethnic Disparities in Severe Maternal Morbidity in New York State: This analysis finds persistent racial and ethnic disparities in potentially life-threatening complications during or after childbirth. Black women in New York State are 2.3 times more likely than their white counterparts to experience such complications. Rates among Hispanic women were 1.7 times higher and among Asian women 1.5 times higher than for white women.

Nutrition Incentives for New Yorkers in Need: A number of nutrition incentive programs in New York State are designed to make it easier for food-insecure families to purchase and consume fresh produce. This issue brief highlights many of these existing programs, next steps for their continued development, and recommendations for how to make it easier for New Yorkers to participate in these programs.



Engaging the Residents of Niagara Falls

In this Grantee Spotlight Q&A, NYHealth Program Officer Nupur Chaudhury interviews Brian Archie and Evelyn Harris, Co-Chairs of the Create a Healthier Niagara Falls Collaborative and long-time residents of the community, to discuss their work in North End, Niagara Falls, a Healthy Neighborhoods Fund community.

As the community convener grantee for North End, Niagara Falls, the Collaborative is working to support the health and wellness of residents by improving the local food and built environments. These efforts have included the formation of a Resident Engagement Council, a group of locals who act as peer educators and advocate for the needs of the community in the implementation of food access and built environment projects. Watch the following Q&A segments to learn more.

What is resident engagement? How have you been integrating it into your work in Niagara Falls?

Tell us about the community in Niagara Falls.

What are some projects that are going on in the community?

What would you like to see for the Council and Niagara Falls in the next 5 years?