Addressing Critical Workforce Shortages in Youth Mental Health: Implementation of a Multicomponent Career Development Program

Abstract

Objective

With rising prevalence of mental disorders, especially among underserved and under-resourced youth, mental health workforce shortages are evident across the United States. This study aimed to assess the feasibility, acceptability, and pilot implementation of a multicomponent career development program, the Youth Mental Health Academy (YMHA), for structurally marginalized youth—including underrepresentation based on race/ethnicity, disability, sexual orientation/gender identities, socioeconomic challenges, parents/caregivers without college degree, geographic isolation, foster care/juvenile legal system involvement, or having a parent/caregiver in the military.

Method

Structurally marginalized high school students interested in mental health careers were encouraged to apply. Students completed baseline and post-program assessments and weekly acceptability ratings. Program feasibility was assessed via attendance, recruitment, and retention rates.

Results

A total of 135 students enrolled in the YMHA pilot. Participants were ethnoracially diverse—51.9% Hispanic/Latinx, 30.4% Asian/Asian American, 14.1% Black/African American, 3.7% Middle Eastern, and 3.7% White; 68.9% identified as female. Approximately 40% met criteria for socioeconomic challenges (eg, Federal Free and Reduced Lunch eligibility), 15% had histories of foster care or juvenile legal involvement, and about 7% reported a chronic condition/disability. Of participants, 92% (n = 125) completed the first summer program with high attendance (>75% days attended), and 87.4% (n = 118) completed a second summer internship. High acceptability was maintained throughout. After the 14-month program, 82.9% of students indicated interest in pursuing mental health careers.

Conclusion

High acceptability, retention, and engagement indicate that the YMHA program is a promising approach to diversifying the mental health workforce. A large-scale study is needed to examine the scalability and sustainability of this model.

Diversity & Inclusion Statement

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. Diverse cell lines and/or genomic datasets were not available. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Plain language summary

The Youth Mental Health Academy (YMHA) is a 14-month career development program for high school students from underrepresented backgrounds to explore careers in mental health. This study enrolled 135 students from diverse backgrounds (51.9% Hispanic/Latinx, 30.4% Asian/Asian American, 14.1% Black/African American, 3.7% Middle Eastern, and 3.7% White; 15% with history of foster care or juvenile legal involvement) who were interested in mental health careers to participate in the program. Most students who participated stayed engaged (92%) and found the program helpful, and 82.9% indicated interest in pursuing mental health careers. This type of program may be a promising approach to diversifying the mental health workforce.

The severe and persistent shortage of mental health professionals in the United States continues to impede timely and effective mental health care for youth, especially within structurally marginalized communities. Structural marginalization refers to the historical and systematic disadvantage experienced by certain groups through institutional policies, social norms, economic systems, or political structures that limit access to resources, decision making, and opportunities.^1,2 Nearly 50% of US citizens, approximately 169 million people, live in areas with mental health professional shortages³; this burden falls disproportionately on rural, high-poverty, and other structurally marginalized populations. For youth experiencing symptoms of mental disorders, this shortage often translates into delayed treatment, misdiagnosis, or lack of care altogether, further exacerbating preexisting mental health symptoms and disorders.⁴ The mental health workforce shortage is persistent; data from various sources show a projected record low number of mental health providers in 2024.⁵ Mental health disorders and their symptoms are further compounded by the lack of diversity in the mental health workforce.⁶ Despite recognition of the increasing need for culturally competent and congruent care, 80.9% of mental health practitioners are non-Hispanic White, with minimal representation from Hispanic/Latinx (8.0%), Black/African American (5.1%), Asian (3.3%), and other racial/ethnic groups (2.8%).^7,8 This representation gap has direct consequences on the quality and relevance of care provided to youth from these communities, as practitioners often lack the cultural responsiveness, knowledge, and lived experiences necessary to offer effective and contextualized support.⁷ Previous research suggests that matching therapists and adolescents by gender and race/ethnicity can increase treatment completion, retention, and therapeutic alliances.⁹ However, other studies indicate that racial matching alone does not always predict adolescent treatment engagement; instead, a youth’s perceived cultural understanding from their mental health provider is a stronger predictor of higher engagement.¹⁰

These workforce shortages have intensified with the surge in prevalence of mental health disorders, as well as increasingly frequent symptoms experienced by youth. In 2021, the Centers for Disease Control and Prevention (CDC) reported that 42% of high school students felt persistently sad or hopeless, and 29% experienced poor mental health.¹¹ Structurally marginalized youth experience significant disparities for these rates of mental health difficulties, such that ethnoracially minoritized youth,¹² sexual gender minority youth,¹² and systems-involved youth (ie, juvenile legal system/child welfare system)¹³ experience disproportionately higher rates. Global rates of adolescent depression and anxiety doubled during the COVID-19 pandemic,^14,15 driven largely by social isolation and uncertainty.¹⁶ The 2023 US Surgeon General’s advisory on loneliness highlights the escalating public health crisis caused by rising social isolation and its connection to mental health disorders and suicidality in youth.¹⁷ Yet, despite the growing need, the pipeline for developing culturally responsive, well-trained mental health professionals remains alarmingly inadequate.¹⁸ Without targeted initiatives, youth in structurally marginalized communities will continue to fall through the cracks.¹⁹

Existing Programs for Structurally Marginalized Youth

Several programs have been developed to foster career development outcomes, defined as improvements in knowledge, skills, confidence, and preparedness of youth related to academic and career pathways. These outcomes are particularly critical for youth from underserved or structurally marginalized backgrounds, who often face systemic barriers to career exploration and advancement. However, only a limited number of these programs have been systematically evaluated to assess their implementation or effectiveness. One such program, Project R.E.S.C.U.E. (Reaching Each Student’s Capacity Utilizing Education), a year-long mentorship initiative, was qualitatively assessed; the evaluation found that mentorship from positive role models significantly boosted academic motivation, self-esteem, and social skills among at-risk youth.²⁰ However, this evaluation was limited by a small sample (n = 18 mentee–mentor dyads) and did not include pre- and post-quantitative data to support program evaluation outcomes.

Another large-scale, mixed-method evaluation of Bring Change 2 Mind (BC2M) youth engagement school clubs revealed that the program effectively reduced mental health stigma in high schools, while fostering empathy, help-seeking attitudes, and positive campus climates.²¹ Although BC2M did not directly assess career intentions of its participants, the emphasis on reducing stigma and encouraging help-seeking behaviors may indirectly support future mental health service career development. Only 2 career development programs targeting high school students from structurally marginalized backgrounds have been formally evaluated. The first, PRO-100, a 7-week career development program offering paid and supervised internships, enhanced participants’ job search skills, career planning, and overall job satisfaction,²² underscoring the value of hands-on internships in facilitating career readiness. Similarly, a retrospective evaluation of the Youth Employment Program found that paid summer internships positively influenced career self-efficacy and career decision making among ethnoracially minoritized adolescents, though it recommended longer, sustained interventions for more enduring effects.²³

In summary, existing efforts suggest that mentorship, stigma reduction, and paid internships support career development for structurally marginalized youth. However, many programs are limited by short durations, single-component approaches, small numbers of participants, and a lack of long-term evaluation. To address these gaps, the Youth Mental Health Academy (YMHA) was designed as a comprehensive, multicomponent, long-term (14-month) career development program that integrates culturally relevant curricula, sustained mentorship, and applied learning experiences, supported by ongoing assessment, with long-term follow-up.

Current Study

The current study aimed to evaluate the feasibility, acceptability, and early impact/success of the YMHA, a community-partnered, multicomponent pilot program designed to increase mental health career readiness among high school students from structurally marginalized backgrounds. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework,^24,25 this evaluation sought to understand how well the program was received by students and staff, identify lessons learned for improvement, and explore the program’s potential as a scalable model for workforce development and diversification in mental health. To achieve these goals, we conducted needs assessments and focus groups with community partners (eg, high school teachers, career counselors, and school superintendents) during the development phase and collected pre- and post-assessments from participating students and program staff (ie, classroom curriculum facilitators). Key domains assessed included program recruitment, retention, engagement, satisfaction, and implementation challenges and successes as follows:

• 1.Acceptability: Ratings of liking and learning from the 5-week YMHA summer academy curriculum and second summer internship from students.
• 2.Feasibility: Ability of teachers/facilitators to deliver the curriculum, as well as recruitment and retention of students.
• 3.Engagement: Student attendance at the 5-week summer academy and second summer internship.
• 4.Program satisfaction and success: Student ratings of satisfaction with program components and likelihood of recommending the program to peers were collected as indicators of program acceptability. To assess program success, the primary outcome of interest was students’ intentions to pursue mental health careers, with secondary indicators including college application and acceptance rates.

Method

Development of YMHA

The YMHA program, funded by the State of California, is a 14-month community-based career development program for high school students from structurally marginalized communities who are interested in pursuing a career in mental health or a related field. Guided by the RE-AIM framework,^24,25 the YMHA was codeveloped through extensive stakeholder engagement, including needs assessments (administered via brief online surveys) and focus groups with 37 community members, including high school educators, career counselors, and mental health professionals, from December 2022 to March 2023 (Figure 1). Needs assessments and focus groups focused on gathering data from community partners on key barriers faced by structurally marginalized youth in accessing mental health careers. Data from these needs assessments and focus groups revealed the following barriers that structurally marginalized students face: limited access to educational resources, financial barriers, a shortage of career counselors, and lack of representative role models and mentors among mental health professionals. In response, the YMHA program was designed as a multicomponent program aimed at addressing these barriers and providing structurally marginalized students with an academic curriculum, peer mentorship, and practical experience aligned with their career interests in research, clinical practice, or media communication.

Figure 1.

Youth Mental Health Academy (YMHA) Program Development Process

Key components of the YMHA program include the following:

• 1.Five-week summer curriculum and capstone projects: The YMHA summer academy offered a comprehensive, culturally responsive 5-week curriculum covering topics such as brain anatomy, mental health bias, health care disparities, and public health (Figures S1 and S2, available online). The curriculum was grounded in Vygotsky’s social constructivism and Bandura’s mastery-based self-efficacy theory, emphasizing that learning occurs through social interaction and is reinforced through successful, confidence-building experiences.26, 27, 28, 29 A core instructional approach was inquiry-based learning, which engages students in actively exploring complex questions, problems, or scenarios rather than passively receiving information. For example, students were encouraged to investigate real-world mental health challenges in their communities, develop research questions, and explore evidence-based solutions, culminating in a final capstone project. These projects allowed students to synthesize and apply their learning while presenting their findings to peers, mentors, facilitators, and family members—promoting both collaboration and real-world skill development. Interactive discussions, culturally relevant content, and student-led exploration were integrated throughout to deepen engagement and promote critical thinking. Teaching facilitators were equipped with a detailed teaching guide that included daily check-in questions, learning objectives, optional enrichment activities, and links to resources. Facilitators also received professional development and ongoing technical support from master’s-level high school educators who helped codevelop the curriculum. All classroom facilitators were required to have a background in mental health or experience working with high school students; experience providing classroom support; and strong facilitation skills, particularly for collaborative group projects. On successful completion of the program and presentation of their capstone projects, all students received a $2,000 stipend.
• 2.Peer mentoring: Participants were matched with near-peer mentors who are currently pursuing careers in mental health, including graduate students, psychiatry residents, and undergraduates from fields across neuroscience, psychology, social welfare, and public health. Throughout the academic year, YMHA mentors were available to meet with participants to provide guidance and feedback on college applications and shared personal experiences, ensuring culturally competent support tailored to mentees’ goals. Peer mentors were encouraged to have at least 1 mentee check-in per month during the academic year and were compensated $1,000 for their time. All mentors received an onboarding and training session (8 hours total), during which they learned about mentoring approaches and clinical tools for use in supporting their students; YMHA mentors were also provided with a relevant resource guide for use with their students.
• 3.Remote webinars: Throughout the academic year, students were invited to participate in optional YMHA webinars delivered remotely on topics such as the youth mental health crisis, personal statement writing, and strategies for applying to college and financial aid. Because participation was not required and recordings were made available for asynchronous viewing, attendance was not systematically tracked. This flexible format was intentionally designed to reduce barriers to participation, accommodate students’ varied schedules, and promote equitable access to supplemental learning opportunities.
• 4.Five-week paid internships and career exploration: During the second summer of the YMHA program, students participated in a 5-week paid internship, tailored to their interests in mental health. Internship sites were identified through the project teams’ existing relationships and outreach efforts to local mental health–focused clinical and community-based organizations. Internship hosts received a set of guidelines before the internship began and were encouraged to stay in communication with the YMHA team through e-mail and open office hours throughout the internship period. These internships provided hands-on experience in research, clinical settings, community settings, or media communication, allowing students to apply their academic knowledge in real-world environments. By engaging directly with professionals in their chosen areas, participants gained valuable practical skills and insights, enhancing their readiness for future careers in mental health. Students who completed the second summer internship were provided another $2,000 stipend to support their participation in the program.

Study Design and Program Evaluation

To appropriately assess and evaluate the feasibility and acceptability of the YMHA program, data were collected at multiple time points throughout the program. Data collection began immediately after youth were accepted into the program. At the time of onboarding, students were given the option to participate in research; all students interested in research were given research assent forms to complete, and their parents/caregivers were given research consent forms. This evaluation included 135 of the 162 accepted students (83.33%). The remaining 27 students did not have research assent and/or consent. We do not have specific data pertaining to youth and/or parent/caregiver reasons for opting out of research; however, we are aware of the potential influence of historically relevant mistrust and abuses of research among underrepresented groups.

The pilot program was held on 4 college campuses in Los Angeles: California State University Los Angeles (2 classrooms, CLA1 and CLA2), California State University Long Beach (2 classrooms, CLB1 and CLB2), West Los Angeles College (WLA), and El Camino College (ELC) (Figure S3, available online). Students were assigned a site based on proximity to their stated residence. All participating students were given a Chromebook to facilitate their learning and their ability to complete online surveys throughout the program. For the baseline assessment, students were given a link to a REDCap (https://project-redcap.org/) survey during the first day of the YMHA summer academy; they were incentivized with a $25 e-gift card for completing the survey. The post–summer academy survey was also completed by sending all students a REDCap survey link (via email); they were incentivized with another $25 e-gift card for completion. The end-of-program survey, which was conducted after all students completed the second summer internship, was similarly administered by emailing all students a REDCap survey link. Students who completed the end-of-program survey were also given another $25 e-gift card as incentive. In addition to gathering data related to the program’s key outcomes before and after the 5-week YMHA summer academy, weekly assessments of feasibility and acceptability were obtained during weeks 1, 3, and 5 of the summer academy and weekly throughout the internship in the second summer. All study procedures were approved by the Advarra Institutional Review Board.

Outreach and Recruitment

Recruitment for the pilot cohort occurred from March to June 2023 and focused on the Los Angeles County area. Four key outreach methods were employed to recruit eligible participants, including digital marketing campaigns (eg, social media and content marketing); partnerships with school districts and high schools in the Los Angeles area; in-person presentations and visits at colleges, universities, and high schools in the Los Angeles area; and virtual informational sessions. Applications for the pilot cohort opened in March 2023 and were managed using a secure platform (REDCap).

Participant Eligibility

Core program eligibility criteria included being 16 years old or older by June 1 of the second summer and having a cumulative high school grade point average of at least 2.5 on a 4.0 scale. Participants were also required to attend the 5-week YMHA summer academy in person. Additional eligibility criteria included belonging to a structurally marginalized group, including 1 or more of the following:

• 1.Identifying as an underrepresented ethnoracially minoritized youth (ie, American Indian or Alaska Native, Asian, Black or African American, Hispanic/Latino, Middle Eastern or North African, Native Hawaiian or Other Pacific Islander)
• 2.Identifying within the LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and others) community
• 3.Reporting a chronic condition and/or disability as defined by the Americans with Disabilities Act of 1990,³⁰ including sensory impairments, mobility impairments, learning disabilities, and mental health disorders
• 4.Identifying as a member with a disadvantaged background, such as past or current homelessness, foster care involvement, eligibility for the Federal Free and Reduced-Price Lunch program or Pell grants, first-generation college student, support from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), residency in a US rural area or Health Professional Shortage Area, history of juvenile legal involvement, or having a parent enlisted in the US military.

Students meeting 1 or more of these 4 eligibility criteria were given priority for participation; however, students who did not endorse belonging to any of the above-listed structurally marginalized groups were not automatically disqualified.

Participants

Of the 162 students enrolled in the program, 135 provided assent and consent for research participation (83.33%). Research participants were ethnoracially diverse (30.4% Asian/Asian American, 14.1% Black/African American, 51.9% Hispanic/Latinx, 3.7% Middle Eastern, 3.7% White). More than half identified as female (n = 93, 68.9%), and about a third of students (n = 42, 31.1%) had no previous mental health educational experiences; participant characteristics are summarized in Table 1. Of 135 students who consented to research at baseline, 101 (74.8%) completed the post–summer academy survey, and 82 (60.7%) completed the post-internship end-of-program survey.

Table 1.

Youth Mental Health Academy (YMHA) Participant Characteristics

	YMHA pilot cohort (n = 162)		Consented to research (n = 135)
	Mean	(SD)	Mean	(SD)
Age, y	16.4	(0.8)	16.4	(0.8)
	n	(%)	n	(%)
Sex assigned at birth
Male	31	(19.1)	26	(19.3)
Female	131	(80.9)	109	(80.7)
Prefer not to answer	0	(0.0)	0	(0.0)
Gender identity
Male	32	(19.8)	27	(20.0)
Female	114	(70.4)	93	(68.9)
Nonbinary	3	(1.9)	3	(2.2)
Transgender male	3	(1.9)	3	(2.2)
Transgender female	0	(0.0)	0	(0.0)
Genderqueer	7	(4.3)	7	(5.2)
Prefer not to answer	3	(1.9)	2	(1.5)
Sexual identity
Heterosexual or straight	93	(57.4)	75	(55.5)
Gay or lesbian	10	(6.2)	10	(7.4)
Bisexual	16	(9.9)	14	(10.4)
Queer or another identity not specified	26	(9.9)	22	(16.3)
Prefer not to specify	17	(10.5)	14	(10.4)
Race/ethnicity
American Indian or Alaska Native	3	(1.9)	2	(1.5)
Asian	50	(30.9)	41	(30.4)
Black or African American	25	(15.4)	19	(14.1)
Hispanic, Latinx, or Spanish Origin	83	(51.2)	70	(51.9)
Middle Eastern or North African	5	(3.1)	5	(3.7)
Native Hawaiian or Other Pacific Islander	1	(0.6)	1	(0.7)
White	14	(8.6)	12	(3.7)
Some Other Race, Ethnicity, or Origin	1	(0.6)	1	(0.7)
Prefer Not to Answer	1	(0.6)	1	(0.7)
Disadvantaged background
Parent/caregiver enlisted in US military	6	(3.7)	5	(3.7)
History of foster care	4	(2.5)	4	(3.0)
Eligible for ≥2 years for FRPL	63	(38.9)	58	(43.0)
Eligible for Federal Pell Grants	16	(9.9)	15	(11.1)
Receipt of WIC support in household	40	(24.7)	36	(26.7)
Grew up in a US rural area	7	(4.3)	5	(3.7)
Grew up in a CMS-designated Low-Income and HPSA	26	(16.0)	23	(17.0)
Grew up on a Native American reservation	1	(0.6)	1	(0.7)
History of involvement in juvenile legal system	1	(0.6)	1	(0.7)
History of sharing housing due to finances	20	(12.3)	20	(14.8)
History of living in hotels, trailers, or campgrounds	3	(1.9)	2	(1.5)
History of living in shelters	1	(0.6)	1	(0.7)
History of living in public spaces	2	(1.2)	2	(1.5)
None of the above apply	64	(39.5)	50	(37.0)
Do not know/unsure	23	(14.2)	18	(13.3)
History of chronic condition or disability diagnosis
Yes	10	(6.2)	10	(7.4)
No	149	(92.0)	122	(90.4)
Prefer not to answer	3	(1.9)	3	(2.2)
Highest level of parent/caregiver education
Did not graduate high school	22	(13.6)	19	(11.7)
High school graduate or GED	26	(16.0)	24	(14.8)
Professional certificate or license	3	(1.9)	3	(1.9)
Some college but no baccalaureate degree	22	(13.6)	17	(10.9)
Graduate of 4-year college	28	(17.2)	23	(14.2)
Master’s degree	19	(11.7)	15	(9.3)
Doctoral degree	8	(4.9)	5	(3.1)
do not know or unsure	8	(4.9)	7	(4.3)
Prefer not to answer	4	(2.4)	3	(1.9)
	Mean	(SD)	Mean	(SD)
High school cumulative GPA	3.7	(0.5)	3.8	(0.5)
	n (%)		n	(%)
Prior mental health opportunities
Introduction to psychology course	49	(30.2)	42	(31.1)
Advanced level psychology course	43	(26.5)	38	(28.1)
Completed AP psychology examination	32	(19.8)	29	(21.5)
Mental health–related club at school	56	(34.6)	47	(34.8)
Mental health–related club outside of school	23	(14.2)	17	(12.6)
Volunteered in mental health field	23	(14.2)	19	(14.1)
Internship in mental health field	5	(3.1)	3	(2.2)
Shadowed a mental health professional	6	(3.7)	5	(3.7)
Another mental health opportunity	29	(17.9)	24	(17.8)
No previous experience	51	(31.5)	42	(31.1)

Note: AP = advanced placement; CMS = Centers for Medicare & Medicaid Services; FRPL = Free and Reduced-Price Lunch; GED = General Educational Development (certification); GPA = grade point average; HPSA = Health Professional Shortage Area; WIC = Special Supplemental Nutrition Program for Women, Infants, and Children.

Quantitative Measures

Engagement, Retention, Acceptability, and Feasibility Outcomes

Student engagement was primarily evaluated through measures of student attendance and retention throughout the 14-month program. Attendance during the YMHA summer academy was recorded every morning by the teacher/facilitator of each class and self-reported weekly by students during the second summer internship. At weeks 1, 3, and 5, students were asked 2 questions from the Acceptability of Intervention Measure³¹: “How much did you like the content this week?” and “How much did you learn from the content this week?” Both questions were assessed using a 4-point Likert scale, ranging from 0 (“not at all”) to 3 (“a lot”). Student retention was assessed using the number of students who completed the summer academy and the number of students who went on to complete the summer internship.

YMHA Satisfaction and Impact Outcomes

To evaluate various specific aspects related to the YMHA program, 20 questions developed by the YMHA were used (Table 2). For the YMHA summer academy, satisfaction outcomes were assessed using 2 questions to assess students’ likelihood of pursuing a mental health career (eg, “How likely are you to pursue a career in mental health?”), rated on a 4-point Likert scale, ranging from 1 (“not at all likely”) to 4 (“definitely”). Four questions assessed the curriculum content taught during the 5-week YMHA summer academy (eg, “How would you rate the effectiveness of the following program components: content and delivery and teaching?”), rated on a 5-point Likert scale, ranging from 1 (“very ineffective”) to 5 (“very effective”). Three questions assessed the capstone project (eg, “To what extent did this capstone project align with your previous interests in the mental health field?”), rated primarily on a 4-point Likert scale ranging from 1 (“not at all”) to 4 (“a lot”). Three questions assessed different relationships (eg, “How would you rate the following relationships: teachers/facilitators, mentors, students/peers?”), rated on a 5-point Likert scale ranging from 1 (“poor”) to 5 (“excellent”). Lastly, 8 questions assessed students’ overall evaluation of the summer academy (eg, “How much do you agree with the following statement: I have gained a better understanding of mental health conditions through participating in the YMHA summer academy?”), rated primarily using a 5-point Likert scale ranging from 1 (“totally disagree”) to 5 (“totally agree”).

Table 2.

Five-Week Youth Mental Health Academy (YMHA) Summer Academy Satisfaction Ratings

	YMHA students (n = 101)
	n	(%)
Likelihood of pursuing a mental health career
Before YMHA summer academy
Not at all likely	9	(8.9)
Somewhat likely	41	(40.6)
Very likely	36	(35.6)
Definitely	16	(15.7)
After YMHA summer academy
Not at all likely	1	(1.0)
Somewhat likely	22	(21.8)
Very likely	42	(41.6)
Definitely	37	(36.6)
Curriculum content
Content
Very ineffective	4	(4.0)
Ineffective	3	(3.0)
Slightly effective	21	(20.8)
Effective	50	(49.5)
Very effective	23	(22.8)
Delivery and teaching
Very ineffective	3	(3.0)
Ineffective	1	(1.0)
Slightly effective	13	(12.9)
Effective	44	(43.6)
Very effective	40	(39.6)
Frequency of engaging with material outside of summer academy
Not at all	3	(3.0)
Rarely	10	(9.9)
Occasionally	48	(47.5)
Often	31	(30.7)
A lot of the time	9	(8.9)
Have you shared what you learned with others?
Yes, parents, caregivers, or guardians	48	(47.5)
Yes, siblings	6	(5.9)
Yes, friends	32	(31.7)
Yes, non-YMHA mentors (eg, coaches, teachers)	2	(2.0)
Yes, other	5	(5.0)
No	8	(8.0)
Capstone project
Group capstone project
Very ineffective	1	(1.0)
Ineffective	1	(1.0)
Slightly effective	14	(13.9)
Effective	48	(47.5)
Very effective	38	(36.6)
Extent that capstone project aligned with previous mental health interests
Not at all	4	(4.0)
A little	26	(25.7)
Pretty much	49	(48.5)
A lot	22	(21.8)
Extent that capstone project aligned with current mental health interests
Not at all	3	(3.0)
A little	28	(27.7)
Pretty much	45	(44.5)
A lot	25	(24.8)
Relationships
With YMHA teachers/facilitators
Poor	1	(1.0)
Fair	1	(2.1)
Good	11	(10.9)
Very good	30	(29.7)
Excellent	58	(57.4)
With YMHA mentors
Poor	5	(5.0)
Fair	11	(10.9)
Good	23	(22.7)
Very good	23	(22.7)
Excellent	39	(38.6)
With YMHA students/peers
Poor	0	(0.0)
Fair	3	(3.0)
Good	11	(10.9)
Very good	31	(30.7)
Excellent	56	(55.4)
Overall YMHA summer academy satisfaction
Effectiveness of summer academy in providing students who are interested in pursuing a mental health career the opportunity to broaden their skill set and knowledge in the field of mental health
Very ineffective	4	(4.0)
Ineffective	1	(1.0)
Slightly effective	12	(11.9)
Effective	47	(46.5)
Very effective	37	(36.6)
I have gained a better understanding of mental health conditions through participating in summer academy
Totally agree	46	(45.5)
Agree	39	(38.6)
Almost agree	8	(8.0)
Disagree	3	(3.0)
Totally disagree	5	(5.0)
Compared with before the summer academy, I know more about mental health issues after participating in the summer academy
Totally agree	49	(48.5)
Agree	35	(34.7)
Almost agree	8	(8.0)
Disagree	5	(5.0)
Totally disagree	4	(4.0)
By participating in the summer academy, I feel like my understanding of mental health career paths that are available to me has increased
Totally agree	43	(42.6)
Agree	40	(39.6)
Almost agree	10	(9.9)
Disagree	3	(3.0)
Totally disagree	5	(5.0)
I feel confident in my ability to take the steps necessary to reach my career goals, including seeking help and support from others
Totally agree	38	(37.6)
Agree	44	(43.6)
Almost agree	11	(10.9)
Disagree	5	(5.0)
Totally disagree	3	(3.0)
I feel capable of applying what I learned from the summer academy to my life, academics, and future career
Totally agree	43	(42.6)
Agree	41	(40.6)
Almost agree	9	(8.9)
Disagree	3	(3.0)
Totally disagree	5	(5.0)
I have felt well supported by the YMHA community
Totally agree	55	(54.5)
Agree	31	(30.7)
Almost agree	7	(6.9)
Disagree	3	(3.0)
Totally disagree	5	(5.0)
I feel like I belong in the YMHA community
Totally agree	55	(49.5)
Agree	34	(33.6)
Almost agree	9	(8.9)
Disagree	3	(3.0)
Totally disagree	5	(5.0)

For the YMHA summer internship, students were again asked 2 questions on intention and likelihood of pursuing a mental health career, 2 questions about confidence in doing well in a mental health career, and 2 questions on sense of belonging to the field of mental health (eg, “I feel like I belong in the mental health workforce” and “Being a professional in the mental health workforce is an important reflection of who I am”). After completing the summer internship, students were also asked to rate their awareness of mental health careers, their confidence in further pursuing a career in mental health, their perceived support in pursuing mental health careers, and the impact that the summer internship had on their mental health (Table 3). To assess the impact that the YMHA had on student career trajectories, all students were asked to answer questions regarding their plans after high school graduation, including whether they applied to and were admitted to college and, if so, what were their intended majors.

Table 3.

Five-Week Youth Mental Health Academy (YMHA) Summer Internship Satisfaction Ratings

	YMHA students (n =7)
	n	(%)
Interest in pursuing a mental health career
Not interested	1	(1.5)
Slightly interested	8	(11.9)
Moderately interested	18	(26.9)
Very interested	17	(25.4)
Extremely interested	23	(34.3)
Understanding of different mental health careers
Not at all	0	(0.0)
A little	4	(6.0)
Moderately	16	(23.9)
Well	33	(49.3)
Very well	14	(20.9)
Confidence in pursuing a mental health career
Not at all	0	(0.0)
Somewhat confident	2	(3.0)
Moderately confident	26	(38.8)
Very confident	20	(29.9)
Extremely confident	19	(28.4)
Areas of mental health in which students are interested
Research	24	(32.9)
Clinical	31	(42.5)
Community and advocacy	20	(27.4)
Media and communications	12	(16.4)
Other	1	(1.4)
Awareness of issues in mental health field
Not aware	0	(0.0)
Slightly aware	1	(1.5)
Moderately aware	17	(25.4)
Very aware	35	(52.3)
Extremely aware	14	(20.9)
Considering additional mental health training
No	14	(20.9)
Yes	53	(79.1)
How supportive is your family of a mental health career?
Not supportive	0	(0.0)
Slightly supportive	4	(6.0)
Moderately supportive	17	(25.4)
Very supportive	21	(31.34)
Extremely supportive	25	(37.3)
How supportive is your community or school of a mental health career?
Not supportive	0	(0.0)
Slightly supportive	1	(1.5)
Moderately supportive	16	(23.9)
Very supportive	28	(41.8)
Extremely supportive	22	(32.8)
Missing	6	(8.2)
I saw people from my background/culture in leadership positions during my internship
Very negative impact	1	(1.5)
Somewhat negative impact	3	(4.5)
Neutral	12	(17.9)
Somewhat positive impact	23	(34.3)
Very positive impact	28	(41.8)
I am proud to put my YMHA internship experience on my resume
Very negative impact	0	(0.0)
Somewhat negative impact	1	(1.5)
Neutral	2	(3.0)
Somewhat positive impact	8	(11.9)
Very positive impact	56	(83.6)
I would recommend others like me to participate in YMHA internships in the future
Very negative impact	1	(1.5)
Somewhat negative impact	1	(1.5)
Neutral	3	(4.5)
Somewhat positive impact	10	(14.9)
Very positive impact	53	(77.6)
People from my background/culture pursue careers in mental health
Very negative impact	0	(0.0)
Somewhat negative impact	1	(1.5)
Neutral	13	(19.4)
Somewhat positive impact	17	(25.4)
Very positive impact	36	(53.7)
The YMHA internship impacted my mental health
Very negative impact	1	(1.5)
Somewhat negative impact	2	(3.0)
Neutral	16	(23.9)
Somewhat positive impact	20	(29.6)
Very positive impact	28	(41.8)

Results

Engagement, Feasibility, and Acceptability Outcomes

Attendance and Student Engagement

Daily attendance across all 6 classes ranged from 72.0% to 100.0% (mean [SD] = 91.3% [0.06%]) throughout the 5-week YMHA summer academy. The class with the highest attendance was CLB2 (mean [SD] = 94.8% [0.04%]), followed by CLA1 (mean [SD] = 93.7% [0.06%]) (Figure S4, available online). Similar attendance rates were reported among the students who went on to complete a summer internship: 118 of the original 135 students; 115 interns completed at least 60 hours of internship (97.4%).

Acceptability and Feasibility Outcomes

Students and teachers/facilitators were asked to rate the acceptability and feasibility of the summer academy curriculum (Table S1, available online). At all time points, on a scale from 0 (“not at all”) to 3 (“a lot”), the majority of students reported high acceptability (week 1: n = 100, mean [SD] = 2.13 [0.73]; week 3: n = 84, mean [SD] = 2.03 [0.67]; week 5: n = 73, mean [SD] = 2.08 [0.69]) and high feasibility (week 1: n = 89, mean [SD] = 2.27 [0.86]; week 3: n = 77, mean [SD] = 2.03 [0.79]; week 5: n = 67, mean [SD] = 2.01 [0.83]) of the summer academy curriculum (Table S1, available online). On a scale from 0 (“not at all”) to 3 (“a lot”), across all weeks of the summer academy the mean (SD) student acceptability rating was 2.15 (0.71), and the mean (SD) feasibility rating was 2.16 (0.85).

Similarly, at all time points, the majority of teachers/facilitators reported high acceptability (week 1: n = 8, mean [SD] = 2.20 [0.79]; week 3: n = 8, mean [SD] = 2.20; week 5: n = 6, mean [SD] = 2.00 [0.76]) and high feasibility (week 1: n = 9, mean [SD] = 2.4 [0.70]; week 3: n = 6, mean [SD] = 1.9 [0.88]; week 5: n = 5, mean [SD] = 1.5 [1.1]) of the summer academy curriculum (Table S1, available online). Across all weeks of the summer academy, the mean (SD) teacher/facilitator acceptability rating was 2.14 (0.76), and the mean (SD) teacher/facilitator feasibility rating was 1.96 (0.92).

Five-Week Summer Academy Satisfaction

Of the 135 students who consented to participate in research and completed a baseline survey, 101 (74.8%) completed the post–summer academy survey. More than three-fourths of students (n = 79, 78.2%) reported being “very likely” or “definitely” inclined to pursue a mental health career after participating in the 5-week YMHA summer academy. Only 50.9% of students (n = 52) selected “very likely” or “definitely” when asked about their likelihood before participating in the 5-week YMHA summer academy (Table 2). The majority of students said that both the content (n = 73, 71.5%) and the delivery (n = 84, 82.3%) of the curriculum were “effective” or “very effective.” Nearly all students (n = 98, 96%) reported engaging with the curriculum content outside of YMHA settings at least once, primarily with parents, caregivers, or guardians (Table 2).

The majority of the cohort (n = 86, 84.3%) reported that the group capstone project was “effective” or “very effective,” and 70% indicated that the capstone project aligned with their previous mental health interests (n = 71) or current mental health interests (n = 70, 69.3%) (Table 2). More than three-fourths of students reported having “very good” or “excellent” relationships with their YMHA peers (n = 87, 87.5%) and YMHA teachers/facilitators (n = 88, 85.5%) (Table 2). More than 80% of students (n = 84, 83.1%) rated the YMHA summer academy as “effective” or “very effective” in providing them with an opportunity to broaden their skill set and knowledge in the field of mental health. Similarly, more than 80% of students reported having a better understanding of mental health conditions (n = 85, 82.3%), an increased breadth of knowledge about mental health issues (n = 84, 81.2%), and greater clarity about mental health career paths (n = 83, 80.2%) after participating in the 5-week summer academy. Most students felt more confident (n = 82, 80.2%) and capable (n = 84, 82.3%) in reaching their career goals. Greater than 80% of students reported feeling a sense of support from (n = 86, 83.5%) and of belonging to (n = 89, 81.3%) the YMHA community (Table 2).

Retention, Engagement, Acceptability, and Satisfaction of Summer Internships

Of 135 students who consented to research and completed a baseline survey, 118 completed an internship in the second summer. Of these 118 students, 82 (69.75%) completed the end-of-program survey. Of the 82 students who completed the end-of-program survey, 67 reported completing an internship and answered a set of post-internship questions. These students expressed interest in the following potential mental health career tracks: clinical (n = 31, 42.5%), research (n = 24, 32.9%), community and advocacy (n = 20, 27.4%), and media and communications (n = 12, 16.4%), reflecting the diversity of internship placement choices that were available to students. After completing the summer internship, more than two-thirds of participating students (n = 47, 70.2%) reported that they understood the differences in various mental health careers “well” or “very well.” More than half of the students (n = 39, 58.3%) reported feeling “very confident” or “extremely confident” in their ability to pursue a mental health career (Table 3).

Overall satisfaction with the summer internships was high with the majority of students (n = 64, 95.5%) stating they are proud to put their internship experience on their resume and that they would recommend others like them to participate in YMHA internships in the future (n = 63, 92.5%) (Table 2). Further, more than three-fourths of students reported that seeing people from their background/culture in leadership positions during their internships had a “somewhat positive impact” or “very positive impact” (n = 51, 76.1%) (Table 3). Based on monthly mentorship logs completed by program mentors (n = 30), 93% (28/30) of mentors held at least 1 successful mentorship meeting, 70% (21/30) held 2 successful mentorship meetings, and 53% (18/30) held 3 or more successful mentorship meetings. A successful mentorship meeting was defined as a mentorship meeting that was led by the mentor and at least 1 student in their mentorship pod or group.

Preliminary YMHA Impact

After the 14-month YMHA program, students were asked to complete an end-of-program survey. Of the 135 students originally consented to research at baseline, 82 (60.7%) completed the end-of-program survey. Of 82 students who completed the end of program survey, 42 reported that they were seniors and graduated from high school; the other 40 reported that they were still enrolled in high school. All 42 graduating seniors reported applying to college, and all 42 were admitted to a college; the majority (n = 34, 80.9%) were admitted to a 4-year university, and a smaller proportion enrolled in a community college/professional school focusing on health care certification programs (n = 8, 19.0%) (Figure 2). Students were admitted to the following 4-year institutions: University of California schools (n = 23), California State University schools (n = 3), Ivy League institutions (n = 2), and other public and private institutions (n = 6). Of the 42 students attending a college or university, 37 reported that they declared a major, with the most common majors related to mental health fields (ie, psychology, psychobiology, pre-med, neuroscience, neurobiology, public health; n = 32, 86.5%).

Figure 2.

College-Bound Students

Note:Of 135 students who consented to research at baseline, 82 completed the end-of-year survey.

Discussion

This pilot evaluation of the YMHA underscores the value of a sustained, multicomponent approach to fostering early interest and engagement in mental health careers among structurally marginalized high school students. We conducted an evaluation of the YMHA program to assess the feasibility, acceptability, and preliminary impact of the program. Typically, research participation rates among marginalized communities are well below 30%,^32,33 with higher rates indicating strong trust and relevance. The 83.3% consent rate seen here is notably higher than expected, likely reflecting effective community engagement and alignment with participant needs. Similarly, of 135 students who consented to research at baseline, 101 (74.8%) completed the post–summer academy survey, and 82 (60.7%) completed the post-internship end-of-program survey. The difference is primarily due to some high school students not completing the post-program evaluations; this is considered a good yield, given the typical challenges of obtaining post-program follow-up data in similar studies.³⁴ Preliminary evaluation results not only provide important insights about the YMHA, but also suggest strategies and lessons learned for the implementation of career development programs for structurally marginalized youth.

First, we found that a recruitment strategy centering community partners, with years of experience in working with diverse high school student populations, allowed for wide outreach to students across a wide spectrum of individuals from structurally marginalized backgrounds. For example, about one-third of students participating in the YMHA reported having no prior experiences with mental health curricula or programs, and greater than 50% of students participating in the YMHA reported being the first in their family to pursue higher education degrees. Notably, 95% of YMHA students came from structurally marginalized backgrounds that are under-represented in the mental health workforce, supporting a YMHA goal of increasing educational access to youth who are most in need. This community-based recruitment strategy has been proven to increase the participation of marginalized youth in research.³⁵ The high attendance rates and strong year-to-year retention observed—87.4% of students completed both summers—suggest that embedding culturally responsive curriculum, near-peer mentorship, and tangible supports (eg, Chromebooks, stipends) can effectively lower participation barriers. These findings contribute to a growing body of evidence that long-term, hands-on experiences are necessary to nurture students’ career aspirations in fields that have traditionally seen low representation from under-resourced communities.²³

Attendance averaged greater than 90% during the first summer academy, and 97.4% of those students met minimum hour requirements for their second summer internships (ie, at least 60 hours), surpassing typical rates in other high school enrichment programs.³⁶ This level of engagement speaks to the practicality and cultural relevance of the curriculum, as well as the importance of consistent mentorship throughout the academic year to reinforce student motivation. Remote webinars and tailored check-ins likely played a key role in ensuring that participants sustained their initial momentum. A key lesson learned from the implementation of the remote webinar component was the importance of balancing flexibility with evaluation; whereas asynchronous access helped reduce participation barriers, future iterations of the program would benefit from tracking engagement metrics beyond live attendance—such as video views or post-webinar reflections—to better assess reach and inform content delivery. The integration of social constructivism and self-efficacy principles appears to have resonated with participants, offering not only knowledge acquisition, but also an environment that promoted self-reflection, peer collaboration, and gradual mastery of mental health concepts.^26,27,29

The 2-summer model added further depth by combining structured classroom-based learning in the first summer with capstone projects that encouraged creativity, team building, and direct family involvement. The paid internships of the second summer provided direct exposure to clinical, research, media communication, and advocacy roles, enabling students to translate newly acquired knowledge and skills into tangible outcomes. This scaffolded design is particularly noteworthy given the significant proportion of participants—more than 30%—who reported no prior mental health educational experiences before starting the program. Such real-world placements not only broadened students’ professional perspectives, but also facilitated meaningful interactions with mental health leaders from similar backgrounds; this fostered a sense of belonging in a workforce that remains predominantly non-Hispanic White.^7,8 Indeed, consistent with prior research highlighting representation as a key factor in sustaining career interest,³⁷ participants frequently cited seeing someone “like them” in professional roles as a major motivator. Overall, the internship significantly contributed to students’ professional and personal growth, equipping them with essential career skills, enhancing their understanding of mental health, and helping them clarify their career goals.

Preliminary evidence indicates that the multilevel support of the YMHA was instrumental in sparking and solidifying students’ intentions to pursue mental health careers. Satisfaction and feedback questionnaires revealed consistent satisfaction with the program’s delivery and content, with more than 80% expressing increased interest in mental health careers. The sharp increase in reported interest—from about half of participants at baseline to more than three-fourths after the summer academy—suggests that comprehensive curricula, culturally mindful teaching, and dedicated mentorship can rapidly change students’ outlook on what is possible. Over the course of the 14-month program, many transitioning seniors successfully applied to and were accepted into college, often with declared majors directly aligned with mental health fields. Such early-stage outcomes, though not definitive proof of long-term career paths, provide a compelling signal that a carefully orchestrated blend of experiential learning, project-based collaboration, and near-peer mentorship can influence critical junctures in students’ academic decisions.^38,39 Although many students reported feeling strong connections with their mentors, implementation of the near-peer mentoring component highlighted several challenges, including logistical barriers to virtual meeting access and uneven mentor-to-student ratios across sites. These experiences underscored the importance of budgetary planning for technology access, proactive mentor recruitment strategies, and structured, site-level monitoring to ensure consistent and high-quality mentoring support. Additional implementation barriers to consistent mentorship engagement included logistical challenges for mentors, reduced student motivation without year-round incentives, and limited early relationship building during the summer academy, all of which highlight the need for clearer communication, deeper mentor integration from program onset, and sustained engagement strategies to support long-term mentorship continuity.

These encouraging indicators should be interpreted with caution. First, a key limitation of the current program was the exclusion of students without English proficiency, which highlights the need for future adaptations to support language accessibility and inclusivity in program delivery. Second, as with many pilot programs, the reliance on self-reported measures may introduce bias, and survey attrition limits the ability to capture nuanced participant trajectories. Our 30-minute survey duration might have contributed to lower completion rates at later time points. Future iterations will benefit from shorter, more focused surveys to improve data completeness. Similarly, future research would benefit from incorporating in-depth qualitative methods—such as interviews or focus groups—to more fully capture student perspectives and lived experiences. These mixed-method approaches are essential for understanding the nuanced impact of programming and can provide rich, contextual insights to guide iterative improvements and ensure that the program remains responsive to participant needs. Third, the Los Angeles County context—with its concentrated resources and diversity—may not fully mirror conditions in other contexts, especially rural regions or regions with low population density. Future research may explore hybrid or fully remote iterations of the YMHA that expand participation and reduce logistical barriers.

Long-term follow-up ins essential to ascertain whether the surge in interest persists into college and beyond, ultimately translating into a more diverse mental health workforce. The present study is nonexperimental, which limits our ability to infer causality or effectiveness of the program. Future work is needed to design a study that can help address potential confounders and biases and examine effectiveness of this program. Similarly, future work is needed to identify associations among program indicators or project components and the main outcome of program success. For example, future studies should explore how mentor characteristics—such as career stage, lived experience, and professional training—may influence the quality of mentor–mentee relationships and contribute to student outcomes. Still, this study offers an important template for educators, policymakers, and community organizations looking to address both workforce shortages and diversity gaps. It is important to acknowledge the evolving federal landscape and funding limitations that may impact the sustainability of workforce development initiatives focused on diversity, equity, and inclusion, such as the YMHA, which aim to expand opportunity and address critical mental health workforce shortages. Still, our work found that by integrating culturally relevant curricula, mentorship, and ongoing family engagement, the YMHA points to a promising, scalable model for elevating youth from historically under-resourced backgrounds into meaningful roles within the mental health profession.

CRediT authorship contribution statement

Jocelyn I. Meza: Writing – review & editing, Writing – original draft, Validation, Methodology, Funding acquisition, Formal analysis, Data curation, Conceptualization. Lindsay M. Alexander: Writing – review & editing, Project administration, Methodology, Formal analysis, Data curation, Conceptualization. Lisa Barkley: Writing – review & editing, Methodology, Conceptualization. Eraka Bath: Writing – review & editing, Methodology, Conceptualization. Denese Shervington: Writing – review & editing, Methodology, Conceptualization. Mirelle Kass: Writing – review & editing, Writing – original draft, Project administration, Methodology, Formal analysis, Data curation, Conceptualization. Virginia Henson: Writing – review & editing, Data curation. Daniel Sebbag: Writing – review & editing. Ivette Irene Sanchez: Writing – review & editing. Jamelia C. Silver: Writing – review & editing. Dyala Alameddine: Writing – review & editing, Project administration. Ally Herrnson: Writing – review & editing. Spencer Webb: Writing – review & editing. Tatum Connell: Writing – review & editing, Writing – review & editing, Project administration. Erin Brown: Writing – review & editing. Spencer Morenko: Writing – review & editing, Formal analysis. Robin Samuels: Writing – review & editing. Bennett L. Leventhal: Writing – review & editing.