Shekinah Jackson walked into her first day at Chicago Vocational Career Academy High School on the city’s Far South Side convinced she’d spend the next four years alone.

She’d been bullied for years about her weight, her skin complexion and the way she talked. In seventh grade, a classmate called her stupid in science after she asked a question. After that, she stopped speaking up in class.

By her freshman year in 2019, Jackson had come to believe the taunts. She tried to disappear at school — kept her head down, sat in the back, wore hoodies.

“I truly felt like I would never be good enough for anyone,” Jackson, now 18, recalled.

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Teen girls are in crisis. A Chicago-based group therapy program could be the fix

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Jackson is part of what experts are calling a crisis in the mental health of teenage girls.

A recent report from the Centers for Disease Control and Prevention found that in 2021, almost 60% of high school girls in the U.S. felt persistent feelings of sadness or hopelessness, nearly 20% had experienced sexual violence, and 25% had made a suicide plan. Clinicians, educators and policymakers around the country are looking for solutions. A recent study suggests that a Chicago-based program could be a model to help girls throughout the U.S. — especially girls of color — cope with the trauma and distress many face.

Working on Womanhood

The education nonprofit Youth Guidance launched the program Working on Womanhood — or WOW — in 11 Chicago public high schools in 2011. The school-based counseling and mentoring program was developed by Black and Latina women to help Black and Latina girls who experienced high levels of trauma but received little mental health support.

Over the last decade Ngozi Harris, WOW’s director of program and staff development, has worked with hundreds of girls who have seen loved ones die in front of their eyes, been raped or had to deal with hunger and homelessness. A large body of research shows those kinds of childhood trauma often lead to depression, addiction and suicide. But Harris said mental health resources are often funneled to boys, whose symptoms tend to stand out more.

“The narrative for girls is they don’t need help because they’re getting straight A’s,” Harris said. “They’re the strong ones. Our boys are acting out a lot, and they need more support. For us, it is about making sure that everybody understands that just because she’s able to sit quietly doesn’t mean that she’s not going through something and needs support.”

WOW counselors meet with small groups of girls weekly during the school year, relying on techniques like cognitive behavioral therapy to help the girls develop healthy coping skills and take more control of their lives.

The program clicked for Jackson in her freshman year. Her counselor, Nora-Lisa Malloy, passed out mirrors to Jackson and the other six girls in the group and asked them to describe what they saw.

“‘I am ugly. I’m not good enough. People call me loud. People call me fat. I’m too skinny,’” Malloy remembers the girls sharing. “They saw all these imperfections that are in their head.”

For the first time, she realized other girls felt just like her.

“It felt like weights being lifted off my shoulders,” Jackson said. “It just felt good that I wasn’t holding it in anymore. And that I can come and talk to someone about this, and that I’m just not dealing with it all on my own. It made me want to ask for help more.”

The very next week, Jackson needed help on a biology lesson. She had avoided asking teachers anything since that boy called her out in seventh grade. With the gaze of her classmates on her back, Jackson walked from the back of the class to the teacher’s desk.

“It was just me in the back of my head saying, ‘OK, you got this. Nobody’s going to say anything. It’s OK. You can go up there and ask for help,’” she said.

“That was where [Shekinah] broke out of that shell,” Malloy said. “Her head was held high. She’s walking down the hallway with so much confidence — she’s not worrying about what people are saying, what they’re doing.”

Girls like Jackson have thrived since WOW’s inception, Harris said. But she understood for the program to try to become a national model to help girls of color cope with their trauma, the organization needed more than anecdotes.

“We wanted to not only be able to say we are successful in this and we’re seeing impact in this,” Harris said. “We wanted the data to show it as well.”

Evaluating WOW’s impact

There has been relatively little research on the mental health of Black and Latina girls in the U.S.

In 2017, researchers Monica Bhatt, Jonathan Guryan and Harold Pollack at the University of Chicago’s Education Lab led a survey of girls across 10 city high schools as part of a larger research effort and found many regularly witnessed physical assaults and the sudden (sometimes violent) death of a loved one. More than one-third reported symptoms of PTSD, such as having persistent negative thoughts or constantly being on guard — twice the rate of PTSD symptoms seen among returning Iraq and Afghanistan war veterans.

“Candidly, when I started seeing those numbers come in, I thought there was something wrong in our measurement,” said Bhatt, the lead researcher. “I thought we were doing the analysis wrong.”

Next, Bhatt and her team ran a study that randomly selected 1,232 girls in 10 high schools to receive WOW counseling and mentoring to test the program’s impact. The study’s main goal was to see if the program improved girls’ mental health — specifically anxiety, depression and post-traumatic stress disorder — as well as grades and school attendance.

The researchers saw no significant drop in clinical mental health diagnoses compared to girls not enrolled in WOW, but they did find fewer symptoms of anxiety (10%), depression (14%) and PTSD (22%).

Sheretta Butler-Barnes, a developmental psychologist at Washington University who studies the mental health and academic achievement of Black girls and was not unaffiliated with the study, said WOW is one of the first one of the first school-based mental health programs designed for girls of color to show such positive results in a rigorous evaluation.

“This program is needed,” Butler-Barnes said of WOW. “And it’s needed in a lot of spaces because of what girls are going through, particularly girls of color.”

But the study found WOW had no impact on the girls’ grades or attendance. Bhatt said that makes sense, since most of the girls went into the program with strong attendance and at least a B average, and WOW’s focus is on improving mental health, not grades.

She said the findings challenge the notion that academic improvement should be a key element of any school-based mental health program.

“We’re forced to reckon with whether this is important,” she said, “to mitigate these harms for girls who are showing up and doing what society expects them to but are carrying a really big load.”

Attention and funding are growing

The study’s findings, published in the journal Science Advances in June, come at a moment when experts say policymakers have zeroed in on girls’ mental health.

Republican and Democratically-controlled states have poured at least $8.5 billion of federal funding, primarily pandemic relief dollars, into school mental health since 2021, with many states chipping in additional funding from their own coffers. Federal officials also have made it easier for Medicaid to pay for school-based mental health services.

There is evidence-based programming that has been shown to work, said Kathleen Ethier, the director of the CDC’s Division of Adolescent and School Health, including connecting kids to counselors and educating young people about mental health.

Research shows that kids who feel connected to the adults in their school are less likely to report poor mental health, illegal drug use, suicidal ideation and sexual violence.

“All of this is around increasing the sense of connectedness,” Ethier said, “so that young people are less likely to engage in violence, perpetuate violence and experience trauma. Or, if something happens to them, they have an adult right there.”

WOW’s ability to reduce PTSD symptoms is particularly promising, Ethier said, adding that she hopes more schools implement this sort of evidence-based intervention.

Still, significant barriers remain.

One in five schools had unfilled jobs for mental health workers as of last September, according to an analysis of federal data by KFF, a nonpartisan health policy think tank. And few districts meet the recommended ratios of student to school psychologist or school counselor. While some state and federal lawmakers have invested in hiring and training more mental health providers and some schools have turned to telehealth, experts predict it will take years for the workforce to grow enough to meet the demand. And this comes as federal COVID-19 relief money is beginning to dry up.

WOW looks ahead

From just 11 schools in Chicago in 2011, WOW is now running in more than 89 schools across Illinois, Boston, Dallas and Kansas City, including 65 in Chicago. Harris said since the study was published this summer, more school districts have reached out.

Shekinah Jackson said the skills she learned in WOW helped her navigate problems throughout her time in high school — from getting her grades up by the end of senior year to walking away from a toxic relationship.

“I learned that it’s OK to reach out and ask for help,” she said. ”And it’s OK to not be OK sometimes. It’s OK to cry. But I don’t have to sit there and suffer.”

She said WOW also gave her the confidence to expand her horizons and travel 180 miles from home to start her freshman year at Eastern Illinois University, where she hopes to study psychology.

“Honestly, right now I’m not scared of anything,” Jackson said. “I feel like I can overcome anything that’s being thrown at me.”

At 14, Jackson was confident she would never be good enough. At 18, Jackson is just confident.

If you or someone you know is in crisis, please call, text or chat with the Suicide and Crisis Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741.

This story comes from the health policy podcast Tradeoffs. Dan Gorenstein is Tradeoffs’ executive editor, and Ryan Levi is a producer for the show. The study on Working on Womanhood was funded in part by Arnold Ventures, which also supports Tradeoffs.