How a ‘mindful’ approach helped a youth mental health program gain acceptance in St. Paul’s Hmong community

A decade ago, when Pahoua Moua was a 10-year-old fifth-grader at Jackson Elementary in St. Paul, it seemed like most of the adults in her world expected her to fade into the background. As a girl growing up in a busy household of first-generation Hmong immigrants, it felt like nobody was all that interested in hearing about her troubles. 

“My family had a lot of other things to worry about,” she said. “What was bothering me didn’t seem that important.” 

Moua had accepted that her life was just going to continue that way, but then she heard about Hlub Zoo (pronounced “loo zhong”), a support group for Hmong girls that was holding weekly group meetings at her school. 

The group, whose name translates roughly to “Love well grow well,” was led by Mary Vang Her, a clinical supervisor at the Amherst H. Wilder Foundation. Hlub Zoo had been formed after teachers and administrators at Jackson, a dual-language Hmong/English school where 65 percent of the student body was Hmong, began noticing that many Hmong students, especially the girls, were struggling with their mental health and flagging self-esteem. Those issues were impacting the students’ grades, their interactions with their friends and teachers and their overall health.  

“At the time,” Her said, “the Hmong community did have some mental health services but culturally specific services were not offered in the school system.” Teachers and school administrators reported seeing some increase in mental health symptoms in Hmong kids, she explained: “In girls, we saw a lot of internalized behaviors and isolation.” 

While school officials knew that they needed to address these issues and share their concerns with parents, they also understood that they needed to introduce the idea carefully. Her, who grew up in a Hmong immigrant family herself, said, “there was a huge stigma in the Hmong community around seeking mental health services.” 

While it was clear that the mental health needs of Hmong students were high, Her said she also knew from personal experience that their parents would likely be reluctant to sign their kids up for a program that appeared to take a Western approach to the diagnosis and treatment of mental illness. She didn’t want to make parents feel like the school thought there was something wrong with their children. 

With support from her coworkers at Wilder and staff at Jackson Elementary, Her decided to take a more subtle and gradual approach to introducing mental health services for Hmong students.   

At the beginning, she explained, Hlub Zoo didn’t overtly include mental health services. The goal was to help families feel comfortable with the program, and, Her added, “We were trying to learn and understand more about the students and build a language that met their needs. We wanted to be more mindful and approach families in a way that would not scare them away.” 

This meant that in the early years, Hlub Zoo felt more like a support group, a safe place for Hmong girls to come together and lift each other up. It was important to start with girls, Her said, because their needs felt more acute. Traditional Hmong culture is generally more focused on the needs of men and boys, she explained, and girls’ mental health issues can get shuttled to the side, causing problems later in life. 

Moua was excited when her teacher said she could join the group. “Most of the girls in my class were in Hlub Zoo,” she said. “My sister was in it, too. They were always talking about how great it was, how kind and understanding Miss Her was, how they could talk about anything with her. I knew I really wanted to be involved.” 

First-hand experience 

In early Hlub Zoo meetings, participants met with Her in a little office at the top of a stairway in the building. They’d take turns talking about what was going on in their lives, and complete art, movement and role-play activities. 

“The structure of the group was to build up participants’ self-esteem,” Her said. “We built a group where the girls felt like their voices were heard. They could relate to one another and strengthen each other.” 

Her noticed that when the girls were together in the group, they were more willing to talk about their individual struggles. “In other settings, they were holding back and feeling alone,” she said. “This was a safe place for them to share their struggles and have confidence and build their self-esteem.”  

In early Hlub Zoo meetings, discussions centered on, “Relational issues, peer issues, self-confidence, including the way they looked and viewed themselves,” Her said. She led the group in discussions and ice-breakers. “We played games. We did a lot of roleplays to keep things active. The girls set goals for themselves and their futures. We even did some field trips and retreats. We did yoga and walked a labyrinth.” 

Moua remembers Hlub Zoo meetings as a place where she felt free to be herself and ask questions that she was afraid to bring up in class or at home with her family. “We would go to the room and then Miss Her would ask us how we’re doing and we’d share what’s going on in our lives,” she said. “Hearing my classmates and friends talk about the problems that they are experiencing at home really helped me open up. We could talk about anything that was going on in our lives that we were struggling with. It was a safe place.” 

Her said she understood the challenges many of the girls in the group were facing because she’d faced them herself. “Being Hmong and being raised in a first-generation home helped me understand where they were coming from,” she said. 

In Hlub Zoo meetings, Her would encourage participants to talk about their shared experiences and then help put them in context: “I could talk about the history of where our community has come from and what we’ve experienced as a collective. My personal experience helped give me credibility with students and, eventually, their parents.”

Ten years strong, with expanded services

After a few years as a girls-only support group, Hlub Zoo slowly began to shift to a more clinically based format. While participants loved the program’s original structure, there were practical matters that needed to be addressed, Her said. 

For one thing, the group had been grant-funded through the Wilder Endowment, and the money would eventually run out. “We couldn’t sustain a program that would not be able to fund itself,” she said. “We were able to keep some of our group programming for about five years, but then we had to ramp up our clinical services.” 

And there were kids in the community who needed mental health services that the original group could not provide. Clinical mental health services like one-on-one therapy sessions for students and family therapy with children and their parents are often covered by health insurance and can provide mental-health support beyond what a kid can get from even the best peer therapy group.

By this time, Her said, most families in the community were comfortable with sending their children to Hlub Zoo meetings. Expanding the program’s offerings felt like a reasonable next step. “We had a foundation to build on and a reputation with families and the community.” The program’s slow buildup helped cement it as a trusted community resource, she added: “That helped to build the program to where it is today. Now we are in five schools in St. Paul and looking to expand into the future.” 

Growing social acceptance of talking about mental illness and reaching out for support has also helped Hlub Zoo expand, Her said. “Families just are more receptive to seeking mental health services for their children now. It was more difficult 10 years ago, but now we’re working closely with schools; teachers are more aware of students and their symptoms and administrators are now doing better at identifying student needs.” 

While Hlub Zoo retains its focus on the Hmong community, it is expanding its services to children and families in other communities. And Wilder continues to create new school-based mental health support programs that focus on children in other ethnic groups. 

“Our Wilder school-based team has several different programs,” Her said, “Kofi, a school-based program for African American students, has been around for 30 years. There is another program for Latinx students, one for Somali students. We are currently in 24 schools in the district.”

2020 marked Hlub Zoo’s 10th anniversary. In the lead-up to this year, organizers had been planning a big community celebration timed to coincide with the yearly graduation ceremony for program participants. The program is now in five schools in the district, and serves Hmong and other Southeast Asian students. 

“We wanted to celebrate that milestone with the community,” Her said. But, like it has for so many important rites of passage, the pandemic forced organizers to shift gears and downsize the revelry. 

“We had to cancel our in-person graduation celebration,” Her said. But organizers made new plans. “Instead, we celebrated the graduation by doing a parade past participants’ houses to celebrate their accomplishments. We also created a virtual presentation [about the program] to share with the Wilder community.” 

It felt particularly important to Her and her colleagues that they still mark the twin accomplishments of graduation and 10 years with a splash. They wanted to send the message that, especially in tough times, taking care of children’s mental health is important. “We wanted to stress to the Hmong community the importance of reaching out and looking for support.” 

‘It is okay to ask for help’

For Moua, the impact of Hlub Zoo has carried through into her adult life. She started parenthood early, giving birth to her first child when she was just 15, and in September she and her husband welcomed their third child into the world. 

Though early parenthood can be a setback for many young women, Moua said that the self-confidence she gained through her participation in Hlub Zoo helped her push ahead and continue her education. Despite being a busy mother, she finished high school on time and enrolled in the nursing program at St. Catherine University. 

Those childhood Hlub Zoo meetings, Moua said, were formative: “In the group, I learned that it is okay to ask for help. This really stuck with me throughout the years. I was never afraid to ask people for help when I needed it. I feel like this really helped me to get through tough times.” 

Speaking up, especially among girls, isn’t always encouraged in Hmong families. Her said that she made a point of telling Hlub Zoo participants that their needs were just as important as others’. In the early years, that felt almost like a radical idea. 

“In the Hmong community, girls tend to have a harder time finding their voice,” Her said. As the program expands to include boys, she and other program leaders continue to emphasize that message. “One thing we want to come out of this program is for kids to be able to acknowledge that they need support and ask for help. We want them to know that their voices can be heard. It is a first step in improving their mental health.” 

Moua faced the dual challenges of early parenthood and marriage with a level of maturity and self-assurance that’s still lacking in many Hmong girls, Her said. “Pahoua has carried that self-confidence on throughout her life so far,” Her said. “Even though she got pregnant at a young age. she never gave up. She is now raising three beautiful children and she’s close to finishing her college degree.”

Moua said that she still hears the Hlub Zoo message that her voice is as important as anyone else’s, that what she can contribute to the world is essential. It’s propelled her through challenges she’s faced in her relatively short life, and she believes it will continue to shore her up as she faces the next stage of adulthood.

“Because of my time in Hlub Zoo, I know that no matter what there is going to be somebody out there that will be there for me when I need them,” she said. “It’s something I won’t ever forget and I’m trying to teach that to my children.”