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Two days a week, my team and I from Stanford Children’s Hospital deliver health care to underserved kids from a mobile clinic. This was how we met Mary (not her real name), a homeless teen girl who came in for help with depression. Like so many young people who call cars, streets or shelters their home, Mary’s health was a complicated knot of mental health conditions, substance abuse, risky sexual behavior and the effects of life on the streets.
Cases like Mary’s illustrate the complexity of treating young people with addiction. They also illustrate what is at stake as California, soon to be flush with new cash from the state’s marijuana tax, ramps up substance abuse programs for adolescents. Sen. Anthony Portantino, D-La Cañada Flintridge, is the author of SB 275, which puts in place sorely needed standards and oversight to ensure that hundreds of millions of dollars targeted for youth treatment over the next few years are well-spent.
Kids who sleep in tents, cars or shelters have already survived the worst – sexual abuse, hunger, trauma and insecurity. Scarce funding and confusing mandates between multiple state and local agencies allow many to fall through the cracks. But without clear standards or oversight for the money headed toward youth substance-use disorders, we risk not only squandering these resources, but failing our kids again.
SB 275 requires the state to convene a panel of experts to develop standards for publicly funded youth treatment programs that take into account the unique factors affecting adolescents. The bill prevents public funds from being misspent on substandard care or placed in the hands of unqualified practitioners.
Today, state law allows virtually anyone to set up a “rehab center” and offer treatment to children, even that paid for by taxpayers. No expertise in youth substance abuse treatment is required. As an expert in youth treatment, this situation alarms me.
Adolescent brains are fundamentally different than grown-ups’ brains. Young people’s brains have not fully developed impulse control. Youth treatment can be complicated by abusive or unstable families. Addressing school performance and sexual behavior needs to be considered as part of a treatment plan. Treatment must consider cultural factors, including ethnic background and sexual orientation and identity: 20 to 40 percent of homeless youth identify as LGBTQIA.
Mary ran away from an abusive home. Substance use was a coping mechanism for her depression and anxiety; getting her on the right medications, into therapy and into housing were all necessary to address the addiction. Today she’s not only stopped abusing multiple drugs, but has improved her nutrition and cleared up her acne, which has improved her confidence.
Quality, on-going interventions for the age group 10-25 can prevent a lifelong cycle of addiction for young people like Mary. Which is why California can’t miss this opportunity to get things right for kids.
In 2015, The Mercury News exposed a crisis inCalifornia’s foster youth program: Adolescents were pumped full of psychotropic drugs instead of receiving the comprehensive and often complicated care they needed to recover from trauma, sexual abuse, and mental health conditions. The episode was a prime example of well-intentioned programs gone awry when the care of vulnerable youth is placed in the wrong hands without appropriate standards and oversight.
As California plans to plow hundreds of millions of dollars in new funding into treating addiction, with a focus on youth, we can’t risk losing the opportunity to do it right. SB 275 faces a June 26 hearing in the Assembly Health Committee, which should take the opportunity to put California on a sure-footed path to achieving the quality services our youth deserve and preventing more homelessness.
By Dr. Seth Ammerman
21 June 2018
Dr. Seth Ammerman is a clinical professor in pediatrics and adolescent medicine at Stanford University. He is the founder and medical director of the Teen Health Van, a mobile clinic program providing health care services to homeless, uninsured and underinsured youth from San Francisco to San Jose.
