Tomas Alvarez is making mental health and wellness services more accessible, useful, and meaningful for youth of color by integrating pop culture and community-defined strategies with proven therapy models.
La idea nueva
Tomas Alvarez has developed a new model of mental health therapy that has systemic implications for how we reach, engage, and heal youth with mental health needs. He is the founder of Beats, Rhymes and Life (BRL), which is dedicated to improving mental health and social outcomes among young people of color by using hip hop and other forms of youth culture as catalysts for healing. Our current therapeutic model of talk therapy and case management has not been successful at engaging diverse youth – and young men of color in particular.This is in part because current efforts are rarely developed with cultural appropriateness in mind, and mental health workers themselves lack gender and ethnic diversity. As a result, there is significant reluctance and stigma to seek out help – and dropout rates are high among those who do – despite high levels of violence and trauma within urban American communities. The cornerstone of Beats, Rhymes and Life is a Therapeutic Activity Group which reinvents how mental health services are designed and delivered for communities of color and other marginalized groups. These so-called TAGs combine teaching artists, trained clinicians, and peer mentors to guide a process of creative expression and music/art development, all within a therapeutic setting. This unique combination is more effective at attracting youth in the first place because it incorporates therapeutic components to avenues already reaching young people. In addition, it sheds the pathology framework for a more empathetic youth-led framework that is ultimately about providing young people with the tools for self-care and resilience in the face of episodic trauma. In this sense, more than a new treatment model, BRL has crafted a system for early intervention and prevention that youth groups, families, schools and whole neighborhoods can use to build communities of care. While the use of music for therapeutic purposes itself is not new, several components of BRL are distinct: the TAG model that integrates music and art with evidence-based therapy practices, the premium on youth agency and peer learning, and a youth academy that trains former participants to become the next (and more diverse) pipeline of clinical social workers. Perhaps most important, Tomas has a unique focus on facilitating broader shifts within the existing mental health paradigm. He and his team are collaborating with mental health agencies across California that want to improve how they approach and serve diverse communities – a widely acknowledged failure. By working with institutions and public health systems as well as individuals, Tomas hopes to disseminate a new blueprint for our mental health apparatus that is more culturally relevant and that focuses more on prevention and on helping communities help themselves. BRL was founded in Oakland, CA in 2011 and has served more than 800 youth across the Bay Area and in New York City. In 2012 BRL developed a partnership with Seneca Family of Agencies, one of California’s premier mental health agencies.
For youth living in many of America’s urban centers like Oakland, California, witnessing or being a victim of violence has almost become commonplace – so much so that in recent years young adults who’ve experienced repeated trauma are increasingly diagnosed with post-traumatic stress disorder (PTSD) akin to soldiers returning from combat. And yet for the most part our mental health systems of care remain ill equipped to meet their needs. It has been repeatedly documented that racial and ethnic minorities in the United States are more likely to underutilize mental health services and prematurely terminate treatment despite their continued need for it. According to the CDC, African Americans tend to delay seeking help for mental health issues, although they are 20 percent more likely to report having serious psychological distress than whites, and Latinos receive mental health treatment half as often as whites. Some of this is a problem of access. For many youth, their first entry point for getting help is the juvenile justice system once a significant amount of damage has already been done. An additional problem is that mental health is still a taboo topic in many minority communities and has become quite stigmatized – perhaps no more so than among African American men. This is fueled by mistrust of a system that has historically pathologized ethnic and racial minorities – dating back to the days of slavery in the mid 19th Century. Indeed, some branches of psychology have used genetics to explain racial differences in psychological assessments while minimizing the impact of structural factors such as socioeconomics, unequal access to good education and health care, and racism and discrimination. But much of the disparity can be explained by the type and quality of care itself. That’s because those who do get help may receive care that is not always respectful, or culturally and linguistically appropriate. Very few clinicians come from similar backgrounds and cultures as their patients. Indeed, studies have shown that the likelihood of misdiagnosis is greater for African American clients than for their Caucasian counterparts as a result of cultural insensitivity among the treating clinicians, and that diagnostic and treatment methods themselves may be less effective because they were developed almost exclusively with Caucasian participants.
Thus both the who and the how of treatment have become barriers to effective results. This, coupled with a failure to incorporate families and communities into the therapeutic process, has resulted in poor outcomes or temporary ones at best.
Tomas’s goal is to facilitate a fundamental shift in how mental health services are developed, funded, and administered to youth of color, and he hopes to do so by showcasing an effective alternative and then finding avenues for that alternative to gain traction – both within and outside the mental health establishment.Tomas’s alternative involves the purposeful integration of hip hop with therapeutic practices in a format called the Therapeutic Activity Group (TAG). First and foremost, this format changes the setting from a more sterile, one-on-one medical relationship to a group of peers together with a trained clinician and an experienced teaching artist. This unique facilitation model reverses the power dynamic. There is no “sole expert” in the room; youth are not patients but rather co-designers in a process of healing that is as much about developing agency and resilience for the long-term as it is treating an acute need. Each 20-week program is meant both help individuals cope more effectively with mental stress and trauma while simultaneously educating them to be peer coaches and mentors for others in their circles – a train the trainers approach. Similarly, the participating health professionals carry back new learning themselves about how to incorporate culturally relevant practices into their work, especially as they seek to reduce health disparities. Shifting from a focus on treatment to one on prevention begins on day one. A series of exercises helps participants identify what their current needs are, and what might fill those needs. For example, youth are asked to complete a “What Are you Packing?” worksheet to fill a metaphorical backpack with both tools they believe they have for coping with mental stress and trauma but also with anything that weighs them down or prevents them from moving forward in life. Another exercise asks participants “Who’s In Your Corner?” to identify who their biggest advocates and mentors are, and also to choose who they might want in a corner and how they might make that happen. By completing these exercises as a group, participants naturally develop a peer support network that then accompanies them through school and life each day.Each group spends considerable time developing and creating expressive art, using popular culture like hip-hop as a way to package time-tested narrative therapy methods to youth. Narrative therapy is the central avenue through which youth heal and learn how to cope with future trauma: by re-authoring their stories from a place of power and dignity as opposed to victimhood and survival. In fact, each semester ends in a final product and group showcase of various expressive arts in front of friends, family, teachers, and others. One year, a group of Oakland students produced a documentary film “A Lovely Day” about their lives and communities that went on to win several film festival awards across the country. Tomas first began experimenting with hip hop therapy as early as 2004 because of its natural storytelling quality, its long history as an expressive avenue within communities of color in particular, and because of its immediate appeal to young people. Indeed, BRL has helped turn the referral system upside down: rather than being diagnosed and directed to a treatment program, youth themselves are signing up for the program and advocating for it among others under the banner of rap therapy. Whether the avenue is hip hop or the development of a youth fashion magazine is less important than the underlying framework of reaching and engaging youth in a way meaningful to them, and in a way that builds upon people’s strengths and passions with the ultimate goal of helping them help themselves long after formal participation is complete.This, for Tomas, is a key part of reaching broad impact. Not only are youth of color more likely to engage in this non-conventional therapy, but their parents, schools and communities will be provided with a blueprint which they can adapt to their own needs, regardless of the role mental health systems play, and with limited resources. Tomas understands that BRL as a program can only reach so many youth, but as a new framework and methodology can have much deeper impact. For example, Tomas sees the thousands of youth-serving organizations as promising avenues for dissemination since they confront mental health needs on a daily and weekly basis but lack the tools to meet those needs. In this sense, Tomas believes BRL can act as a bridge between mental health organizations and youth-serving organizations, helping both to improve how they promote mental wellbeing.But Tomas also knows that a central ingredient for transformative impact is shifting how the existing mental health paradigm engages with communities of color. To this end, he has actively sought out partnerships with individual providers and whole systems of care. The timing couldn't be better: many are hungry for improved ways to serve diverse communities. And in California, the recent Mental Health Services Act has freed up millions in funding for workforce development to this end, as well as for the development of innovative preventive approaches. For nearly two years Beats, Rhymes and Life has worked closely with a large California provider, SENECA, to facilitate trainings for its staff, with demand increasing after each set of modules. In early 2014 BRL will pilot eight training modules with Contra Costa County – the publicly funded entity that oversees and funds mental health care agencies in the entire county. Through a fee-for-service model these partnerships enable BRL to raise operating revenue as well as pay to distill and package methodologies for communities that may not be able to pay. To date BRL has offered 225 distinct trainings for more than 30 organizations.
In an effort to change the who in addition to the what and how of mental health delivery, Tomas has founded an academy for BRL alumni and others interested in clinical social work and mental health peer mentorship. A newly proposed CA certification that would not require graduate education or even a college degree could open up the field to whole new populations in a role analogous to a community health coach. Beats, Rhymes and Life has seen high levels of retention and success among its participating youth who fit the “resistant to therapy” profile, which has contributed to the strong interest and demand for training by providers and health agencies. However, Tomas recognizes the importance of strong metrics and has implemented a rigorous qualitative analysis pre- and post-program for his current participating class. He expects that working alongside providers will enable BRL to tap into additional resources and expertise to measure effectiveness, while simultaneously influencing the kinds of factors that are included when that analysis relates to minority communities. BRL’s 2013 operating budget was $650k, up from $514k in 2012 and $121k in 2011, the first year it incorporated as a 501(c)(3). To date the vast majority (over 90%) of BRL’s budget has come from fee-from-service contracts with schools and mental health organizations. Moving forward BRL is beginning to diversify its funding streams by applying for grants, building a private donor program, pursuing corporate sponsorships and contracting with local health care systems. They are also exploring how to become a certified medical provider to fund their treatment programs.
For as long as he can remember, Tomas has felt most alive when working with so-called ‘at-risk’ youth. During a hiatus from his college studies Tomas mentored a group of young people with severe emotional and behavioral challenges, and recognized just how prevalent trauma was within urban communities, and how quickly it could derail lives. His own personal experience with loss and trauma also served as a guide: Tomas’s mother passed away when he was just two years old. Growing up as a minority attending an affluent middle school, and as a young person of color in San Jose, brought him face-to-face with racism and highlighted how youth who get hurt then act out and hurt others as a way to cope. He recognized the importance of having avenues for expression – which he didn’t have a home, but ultimately found through a peer community – to instead translate hurt into healing. While studying for a Master of Social Work at Smith College, Tomas served as a social worker at Berkeley High School for his first-year graduate internship. Tomas arrived in his position with confidence: he was both male and a minority, and so expected to connect with diverse youth who had been resistant to therapy of any kind. But most quickly turned away his overtures. This is when a light bulb went off: it wasn’t just who was conducting therapy, but it was the very nature of the therapy itself. The more he looked, the more he saw the gap between academic programs and models and the realities within urban communities. It was then that he began to experiment with alternative therapy models – pulling from field-tested principles of clinical psychology but incorporating community-defined strategies and putting a premium on self-healing and community. His therapeutic model was designed to focus on developing agency rather than treating illness. All ten of his first students remained with him throughout the whole semester despite many previous failed attempts to engage them. Since he was a child, Tomas used to love building machines and devices with whatever he could find around the house, taking apart stereos and telephones and converting them into airplanes. MacGyver was his favorite television show and he tried to emulate that resourcefulness, often to the chagrin of his grandmother. Today Tomas sees himself doing essentially he same thing: leveraging the strengths of young people and communities and building a new model of care that they can own and carry forth.