In 2018, San Mateo County launched a specialized clinic in East Palo Alto aimed at providing treatment to underserved teens suffering from substance use disorders. It was meant to be a hub for troubled teens to tap into low-cost therapy and mental health support, with an eye toward relapse prevention and mindfulness.
But three years later, the clinic has been permanently shut down, and both the county and the nonprofit running the program -- Healthright 360 -- agreed to cut the program loose after its short-lived run. The reason? Too few kids were willing to show up, making it an ill fit for tackling the problem of teen drug abuse.
The clinic was meant to be there for the long haul. Healthright had spent a year finding a suitable place for outpatient services, and sought to weave itself into the safety net services available in southern San Mateo County. Though the doors were open to all, the clinic sought to serve the most vulnerable youth, including those with a criminal record and those with incarcerated parents.
Since opening, however, the clinic barely served more than a half-dozen people at any given time, well below what Healthright had hoped, said Vitka Eisen, president and CEO of the nonprofit.
"We never really saw more than five clients at any given time, maybe six, which is not a lot," Eisen said. "Despite our team working very closely in the community, we did not see lots of clients who were coming in for care."
Unpacking what went wrong, Eisen said it likely comes down to a fundamental mismatch between the services provided and what teens are willing to voluntarily attend. The program was funded by Medi-Cal, Eisen said, which has a narrow scope for what services are eligible for reimbursement. And it turns out those limited services -- specifically individual and group therapy -- don't hold enough allure to attract teens suffering from drug abuse. Most clients in traditional outpatient treatment are in their late 30s and 40s, she said.
"Young people are more engaged in care when you have social activities, athletic activities, field trips and things that are more engaging, and you build therapy around that," Eisen said. "Medi-Cal doesn't really fit that."
Also suppressing the number of kids showing up at the clinic were changes to mandatory substance use treatment by the courts. San Mateo County health officials say a decline in court-ordered treatment means fewer teens are being compelled to enter outpatient treatment programs, which had been a common source for new referrals. When Healthright began its effort to open the clinic, there were 140 kids in juvenile hall with some history of either drug use or possession of drugs, Eisen said. By the time the program opened up, that number had plummeted.
Eisen said the changes to the criminal justice system are positive, and that there is an overreliance on coerced treatment that criminalizes health conditions. Telling people they can either go into substance use treatment or go to juvenile hall for drug arrests causes long-term damage, particularly in Black and brown communities, she said. But it also means more people who could benefit from outpatient treatment are now falling through the cracks.
"The circumstances changed so we weren't coercing people into treatment, which is great, but it means young people aren't necessarily going into treatment," she said.
Healthright was among the nonprofit mental health providers that switched to telehealth during the pandemic, meaning the clinic's shutdown at the end of December last year was a quiet loss. Instead, Eisen said the nonprofit will continue to provide drug treatment services within East Palo Alto without a brick-and-mortar clinic, meeting clients in places like schools and community centers. The goal is to stay integrated in the community, she said, and it doesn't take a physical location to do it.
"The important part is to remain visible and engage with the community, and having an office in a place, staffed at all times, where people don't come is not necessarily welcoming," she said. "Having a connection to the community, I think, is just as effective."