Fred Cardenas: Improving Mental Healthcare for Kids in San Antonio

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“I hear demons telling me to be bad.”

“I need my medicine to calm down.”

“Mom has a new boyfriend, but that’s okay cause dad has a new girlfriend.”

Fred Cardenas has heard these statements from kids ages 6 and younger who suffer mental health issues.

Cardenas, who has spent 30 years in early childhood services in San Antonio (68% Latino), said overwhelmed parents and stressed teachers struggle to deal with these kids. Health workers too often look for a psychiatric diagnosis to medicate.

He wanted to help parents, teachers, and health workers look more at the context and relationships experienced by the kids.

So Cardenas helped build a program—Early Childhood Well Being (ECWB) at Family Service Association of San Antonio. ECWB intervenes early for kids ages 0-8 who have mental health issues, and provides parent-child, teacher-child, and child-healthcare-provider interaction strategies and social skills training.

“True prevention is the key. Why just treat the 10-year-old diagnosed with ADHD when we can effectively prevent that trajectory of the 4-year-old in partnership with home, school and community?” Cardenas said.

Lack of Proper Childhood Mental Healthcare

Years ago, Fred Cardenas wondered why few mental healthcare services targeted kids.

“One of the things we were seeing was that traditionally [mental health programs] serve the elderly, they serve youth, they serve adults, they do the traditional counseling. But we kept seeing that there was a gap in [not appropriately] treating young kids,” Cardenas said.

Childhood mental health issues can contribute to developmental challenges, high-school dropout rates, suicide rates, and adult mental health problems—all of which impact Latinos more than their peers, according to a Salud America! research review.

Cardenas said it’s imperative to determine the causes of a child’s behavior and address mental health issues early.

But that can be hard to do.

For example, take a 4-year-old boy in Pre-K who is showing behavioral problems.

“There is a challenge in differentiating between a behavior that is occurring,” Cardenas said. “Does it have to do with his developmental challenges? Does it have to do with a mental health problem? Does it have to do with a family issue? Or is it just the typical challenges in development?”

Parents can be confused and overwhelmed. Teachers may not know how to react, or they might be too busy.

And healthcare workers rely on traditional counseling or traditional mental care that mainly focuses on finding a diagnosis and treating with medication.

“The field needs to get away from child mental health practice as usual: labeling, diagnosing, using a medical model, sometimes influenced by business-oriented forces,” Cardenas said. “Mental health professionals must examine children’s experiences and environments much more closely and the most effective intervention is likely to more intentionally engage teachers and parents more effectively vs. ‘blaming the victim.'”

How could Cardenas improve mental healthcare for young kids?

The Birth of a Program

Family Service Association has worked since 1903 to empower San Antonio individuals and families to transform their lives and strengthen their community. They have programs to promote education, senior assistance, job training, and more.

In 2011, the organization wanted to add a focus on childhood mental health.

So they launched the Early Childhood Well Being (ECWB) program, thanks to a grant from Methodist Healthcare Ministries. Cardenas joined Family Service Association to run the ECWB program that year.

The ECWB program is a referral program that provides direct consultation and training to parents, teachers, caregivers, administrators, and healthcare professionals, in evidence-based approaches that improve mental health among young children.

Here’s a typical example of how ECWB works:

• A teacher refers a child to the program after aggressive, anxious, withdrawn or otherwise disruptive behavior.
• A highly trained early childhood clinician from the program observes the referred child at school.
• The early childhood clinician will consult with the child’s teacher and provide written behavioral-management recommendations.
• After several classroom visits for a referred child, the clinician may develop a behavioral plan in collaboration with the teacher, and offer follow-up coaching and support.
• The clinician then starts home visits. They do a family assessment. They start customized parenting sessions along with optional counseling for kids, parents, and other family members.

All the visits and consultations lean on evidence-based practices. These include: Parent-Child Interaction Therapy, The 2nd Step Social Skills Curriculum, Incredible Years Parenting Curriculum, and Early Childhood Mental Health Consultation Concept.

“Solutions include maximizing those psychosocial interventions that include the context directly (classrooms, parents, community) and ‘slow down’ the process to ensure adequate assessment where the environment or context of the child is examined as closely as the child and his/her behavior,” Cardenas wrote in a blog post.

And all visits are customized to each kid, family, and teacher.

That includes translating the consultations and curricula into Spanish.

“We tailor [our work] to the language and culture of the family that we are serving,” Cardenas said.

Is the Program Improving Childhood Mental Health?

The program impacts about 200-250 referred kids a children a year through early childhood mental health consultation services in classrooms and homes, Cardenas said. They also train more than 900 teachers and healthcare workers a year.

More than 3 in 4 of referred kids are Latino.

About 90% of children show behavioral improvements, according to surveys and before/after comparisons, Cardenas said.

Also, 85% of teachers and parents reported they gained confidence in addressing their children’s/student’s behaviors, and more than 90% of training participants have learned something they can utilize in their work with children.

“All of this work includes advocating for teachers and families and educating them—and learning from them to maximize the effectiveness of early childhood mental health services,” Cardenas said.

Cardenas used his personal network built through three decades of work in early childhood services—San Antonio School districts, Head Start programs, counseling programs—to build ECWB’s community connections.

“We have had over 30 community partners through the seven years the program has been around,” Cardenas said. “It is really easy to reach out to these partners and use their strengths. And then we do the same, we offer our own services to them.”

Mentoring the next generation of mental health professionals also is important.

The program recently trained 20 graduate students from Our Lady of the Lake University and UT San Antonio.

“[The students] are working in different capacities and different areas, but they are taking that insight, those skills and applying it to whatever their work setting might be,” Cardenas said.

New Territory and Partnerships

The program has expanded beyond San Antonio into Uvalde, Carrizo Springs, Crystal City, Batesville, and Brackettville.

“We have extended to the rural community and the need there is much greater because of low resources,” Cardenas said.

ECWB is also expanding its advocacy efforts.

They are trying to work with the state of Texas to impact state policy for more developmental appropriate mental services for young children.

They also started working on “Baby Court.”

That is where program early childhood clinicians provide expedited services to reunite and support families or caregivers with children ages 0-3 in the foster care system, in collaboration with Bexar County Courts and Child Protective Services.

“Program staff are quite excited about [Baby Court],” Cardenas said.

Let’s do Our Part for Our Children

Cardenas is continuing his laser focus on early intervention with young children with mental health issues and trauma.

Sadly, 78% of Latino kids suffer at least one adverse childhood experience (ACE), such as poverty, neglect, abuse, household dysfunction (divorce, violence, etc.), according to The State of Latino Early Childhood Development: Research Review.

1 in 5 children are affected by a mental health issue by age 4.

“Let’s catch these problems early on and let’s put more resources for young children and their families to catch these things,” Cardenas said. “And once we catch them, let’s not jump to conclusions and diagnosis so quickly before we work with them.”

How can you help improve childhood mental health in your school or community?

Contact us to get in touch with Fred Cardenas and follow in his footsteps!

Why just treat the 10-year-old diagnosed with ADHD when we can effectively prevent that trajectory of the 4-year-old in partnership with home, school and community?

Fred Cardenas
Early Childhood Well Being, Family Service Association, San Antonio