An intensive El Camino Hospital program designed to teach high school students how to cope with serious mental health conditions is set to expand later this year, opening the door to middle schoolers and young adults.

The hospital's After School Program Interventions and Resiliency Education (ASPIRE) program is an eight-week course where high school students meet four times a week to learn techniques for stress management, mindfulness and coping skills through dialectical behavioral therapy and expressive arts. The program is an outpatient service hosted on the hospital site, and is intended to help teens who are struggling with depression and anxiety, and are showing significant behavioral and emotional symptoms.

Since its inception in 2010, the ASPIRE program has been tailored specifically for high school students, but that's about to change. Recent research on brain development has shown that early signs of behavioral health disorders can show up much earlier than originally thought, according to Michael Fitzgerald, executive director of behavioral health services at El Camino Hospital. That means mental health experts are re-assessing the importance of intervention starting as early as middle school.

The same adolescent brain development that takes hold in middle school extends well beyond high school, creating two fronts where behavioral health issues can become a serious problem.

"We realized that adolescence is a much longer period than we previously knew. It pretty much starts in junior high and continues until age 25," Fitzgerald said.

Local schools are becoming increasingly familiar with the ASPIRE program, Fitzgerald said, and the hospital get calls regularly referring students to the program. He said there have been a growing number of requests by superintendents and school counselors to expand the program into middle school, when mental health problems begin to crop up and early intervention could play a significant role. The middle school ASPIRE program, which is expected to start on April 18, would be the first of its kind in the area.

"I don't know of any other intensive outpatient programs in the region for middle-school students," Fitzgerald said.

The middle school ASPIRE program will have a lot of similarities to the high school program, with a strong focus on emotional regulation and learning how to tolerate stress. Parents are expected to play a stronger role, including getting advice on effective parenting, the importance of downtime for their children, and preparing for the high school environment.

At the same time, Fitzgerald said the hospital is working on creating an ASPIRE program designed for young adults ages 18 to 25 at El Camino Hospital's Los Gatos facility, set to begin in June. Young adults have higher rates of suicide than high school-aged teens, he said, and serious behavioral issues can become bigger problems once they start driving and have access to firearms.

Young adults are different from the other groups of students in that they have to deal with stress associated with having a job, being in a relationship and managing societal and personal expectations -- all of which can really weigh down on a person struggling with a mental health disorder.

"It is really tough. This population often feels that they don't measure up, they may have siblings (who) are doing well," Fitzgerald said. "The anxiety issue can be crippling at times."

This is also around the time that substance abuse can really take off, Fitzgerald said, and young adults can become increasingly isolated from their friends and family.

"This really feels like a group where, if we can get in there and do effective intervention, we can really make a difference," he said.

The ASPIRE program for all three age groups will more or less share the same format, with small groups of about eight students working together, sharing their thoughts and practicing techniques to manage stress and anxiety. Students rotate in and out, and oftentimes a teen enrolled in the program will encourage new-comers and reassure them that the program really does work, Fitzgerald said.

Despite the intimate environment, wait lists are rarely an issue. Fitzgerald said any waiting period to get into the program has less to do with overwhelming demand, and more to do with students who aren't quite ready to jump into the program. The intensive four-day-a-week program focuses on managing mental health crises. There are plans underway to develop an ASPIRE-readiness program with individual sessions, teaching students about crisis skills and medication management prior to jumping into the full program.

It's a little challenging to get feedback from students after they complete the program, but follow-ups three and six months after the program have shown students are still using coping strategies and stress management techniques regularly, and even automatically. Fitzgerald said that's a good sign, as the skills are now an integrated part of how they manage their behavioral health.

"The responses that we have heard are good," Fitzgerald said. "They are continuing to use those skills to manage crises."