# data[].attributes.body
Often it takes a tragedy for people to take children’s mental health seriously. To prevent this, schools need to begin promoting more informed, effective advice by improving collaboratively among schools, as a community, and in our families to help students seek more approachable advice and get the help that they need.

# data[].attributes.attachment_link.readable_text
Life has been incredibly tough for many of the teenagers at Elsie Allen High School in Santa Rosa.

Screening surveys found that about half of students who have sought help at the health center on campus have significant histories of trauma.

They've faced serious issues including physical or sexual abuse, domestic violence, parents who are addicted or incarcerated, traumatic experiences with immigration, unstable living situations, or homelessness.

Kaiser Permanente Northern California recently awarded Santa Rosa Community Health, the nonprofit that runs the health center, $98,000 to support counseling services that address the impact of trauma on at-risk youth at the school and in the surrounding community. The health center is open to all teens in Santa Rosa.

"If we can help these kids now, we can change the trajectory of their lives and help them live to their fullest potential," said Erin Moilanen, a family nurse practitioner and clinic lead at the health center. "We can help prevent teen pregnancy, chronic disease later in life, and even help keep them out of prison. Research shows that all these negative things are connected to trauma in childhood."

Improving Access to Mental Health Programs

The grant to Santa Rosa Community Health is part of a package of $1,755,000 in funding from Kaiser Permanente Northern California to 18 community-based organizations. The organizations expect to reach nearly 3,700 students and school employees at 21 public middle and high schools across Northern California. All of the schools being served are in high-need communities where 50 percent or more of students qualify for free or reduced-priced lunch programs.

The investments are part of Kaiser Permanente's ongoing commitment to improve access to mental health programs in the community, advance school-based wellness, and promote resilience. They are aimed at expanding mental health services and trainings that recognize and address the impact of trauma on students, teachers, and other school staff. The goal is to help young people and members of the community live healthier lives.

"Research confirms that trauma not only impacts the long-term and short-term health of individuals, but the ripple effect is evident in communities that are at greater risk for violence, poverty, and chronic illness." said Yener Balan, MD, FAPA, executive director of Behavioral Health for Kaiser Permanente Northern California. "So, these grants could potentially have a positive impact on more than 20,000 people."

Helping Both Students and Staff

The grants will also fund training to help schools develop a culture that recognizes the impact of trauma and wellness programs to help teachers, counselors, and other school staff who may be stressed by their work with students who have experienced trauma.

At the health center on the Elsie Allen High School campus, Erin Moilanen emphasized that staff support is essential.

"The teachers and staff see our students every day, and they're often dealing with difficult behaviors that are a result of trauma," she said. "They need guidance and an understanding to help the kids, and support to take care of themselves."

Over the past 4 years, Kaiser Permanente Northern California has provided more than $3.2 million in grants to help increase trauma screening, augment mental health and support services for youth, expand and strengthen medical and social service referral systems, and increase understanding among the public health community about the signs and symptoms of trauma.
Denice Alexander, communications manager for External and Community Affairs, contributed to this article.

# data[].attributes.attachment_link.description
Life has been incredibly tough for many of the teenagers at Elsie Allen High School in Santa Rosa. Screening surveys found that about half of students who have sought help at the health center on campus have significant histories of trauma.

# data[].attributes.attachment_link.readable_text
About one in five children in the United States shows signs of a mental health disorder - anything from ADHD to eating disorders to suicide.

And yet, as we've been reporting this month, many schools aren't prepared to work with these students. Often, there's been too little training in recognizing the problems, the staff who are trained are overworked, and there just isn't enough money.

When there are enough people to handle the job, how should all the different roles fit together?

Many experts point to one model. It's got a bureaucratic name - the "multi-tiered system of supports" - but when you picture it, just imagine an upside-down pyramid, or maybe a funnel. It starts with support for everyone and moves on to more and more specialized help.
The Village
Here, everyone in the school has a part to play. The collective mission is broad: Create a school environment of general well-being, and a climate where mental health isn't stigmatized.

It takes a lot of planning - with big decisions often coming from the top. Just askAmanda Aiken.

She is now the Senior Director of Schools at New Orleans College Prep, a charter school network. But before that she was a principal at one of their schools, Lawrence D. Crocker College Prep.

In that role, she made a point to stand outside her New Orleans school every morning. When the buses drove in, she was at each door. Other staff were stationed at the front and back entrances.

Every student, from preschool to eighth grade, shook at least two hands before they even get inside the building.

Every student, every day?

Sometimes, Aiken conceded, it was a hug rather than a handshake.

"They hear a lot of good-mornings and a lot of how-are-you-doings," says Aiken. "I require that human touch."

Now her successor carries on that tradition.

But Aiken wasn't just being nice. It was strategic.

Many students at Crocker, part of a charter school network, have a higher risk for mental health problems. Most students receive free or reduced-price lunches, and Aiken estimates as many as 70 percent have experienced some form of trauma in the last two years: violence in their neighborhoods, family troubles, the daily stress of living in poverty.

"We need to make sure what we're doing is not retraumatizing," she says. "I see the principal as the leader in setting the tone and the culture of how school will support students and families."

That starts in the morning, but extends far beyond. Crocker is a "trauma-informed" school, which means all staff are trained on how to work with, and identify, students who have gone through trauma.

It also means they have a focus on structure, so students know what to expect. They also have a social-emotional curriculum, yoga after school and a focus on keeping suspension rates low through restorative justice.

"They aren't going to be prepared for college if they're suffering," Aiken says.

As principal, she tried to prevent crises, rather than addressing them as they come up.

"If you have everyone trained and take an 'it takes a village' approach, you can do a lot of preventative measures to reduce the risk significantly," says Aiken.

But, she adds, a healthy school environment isn't enough.

"Teachers are trained to teach. We have all taken a child psychology class, but we're not trained to work with kids with mental health needs," she says.

That's where other professionals come in.
The First Responders
When a student does show signs of trouble, one of the first steps is to talk with them. That conversation will dictate what happens next, but getting students to open up? It's easier said than done.

School social worker Ana Bonilla-Galdamez is a pro at that. Her office at Charles Barrett Elementary School in Alexandria, Va., is a testament to the different strategies she uses to unleash the gift of gab in even the most guarded of students.

There's a lot going on in there. First, there's her bookshelf, with titles like: Growing Good Kids, The Special Education Treatment Planner, Small Group Counseling.

And then there's everything else. She has a lot of board games: Candyland, Operation and her favorite, Uno. She also has art supplies, balls, a dollhouse and a sand box. A Superman doll sits in her chair, because even Superman has a weakness.

These are her tools. They help students open up, and they also help build the skills those kids will need throughout life, like managing emotions.

Although now at an elementary school, Bonilla-Galdamez spent most of her 20-year career at the high school level, working largely in what she describes as "crisis mode."

"We would think, 'Man, if we just had met this kid before,' " she says. A few years ago, a job opened up in the elementary school and she decided to apply.

"I thought, this is my chance to see where this starts," she says.

Early intervention for the child - and education for the parent - is key, she says. That's where the games in her office and the phone calls home come in.

"My job is to dig," she says, "For me to do that, I need to build the trust of the parent and the child."

She tells the story of the time a young mom came in, worried about her kindergarten son. He had been telling her he wanted to die. In her office, Bonilla-Galdamez let the boy choose whatever game he wanted. As he grew comfortable, she asked him about life at home.

"He had witnessed people being killed," she says. "He had witnessed a lot of violence."

What to do next all depends on what that child needs. That kindergartner might have ended up in a small group, working on coping skills or managing his emotions. But, in this case that wasn't the answer: She had also learned that the young boy had run out into traffic when he was upset.

"The threat was imminent, so I referred him to emergency services," says Bonilla-Galdamez. "Our environment isn't suited to clinical interventions."

At that point, Bonilla-Galdamez continued working with the family, but she also helped them connect to more specialized help, and the kindergartner moved on to the third level for more support.
Clinical Care
At this level, a doctor or therapist may get involved for the first time. Often, school plays a vital role in connecting the student to a clinic.

Vital, but not necessarily easy. When school psychologists Monique Leopold and Danielle Palmer refer students to a mental health clinic, they know that a lot of the time, the appointment never happens.

The two women have a handful of high-quality programs that they rely on for referrals near their schools - a network of public charter schools in the nation's capital called DC Prep. Sometimes though, families can't get an appointment for months. And when they do, with so many living in poverty, getting there is one more complication in already chaotic lives.

"It's not that [those families] don't love their kids, it's that they don't have the capacity," says Palmer.

And even when the students do get professional treatment or medication, sometimes prescriptions lapse before the child could be seen again.

"Triggers are brought from the community into school," says Leopold, "They go to school without what they need."

To try and meet those needs, DC Prep started a partnership with Children's National Health System. Now, a psychiatrist visits the schools once or twice each month.

"I told a family this morning, 'Listen, we have a doctor here,' " Leopold says, "and the mom's eyes lit up."

Lisa Cullins, one of those psychiatrists who visits, says school is a logical place for students to get clinical mental health care.

"At school, they're going to be there anyway. It's something they do everyday," she says. The partnership isn't just easy on families. It's also easier on her.

"To know our patients, we have to know their school setting," she says. "When I walk in, I have a comprehensive packet of information on how the child has been doing since the beginning of the year."

# data[].attributes.attachment_link.title
Here's How Schools Can Support Students' Mental Health

# data[].attributes.attachment_link.description
About one in five children in the United States shows signs of a mental health disorder - anything from ADHD to eating disorders to suicide. And yet, as we've been reporting this month, many schools aren't prepared to work with these students.

# data[].attributes.attachment_link.readable_text
Commentary

As school psychologists, we found the report by Connecticut's office of the child advocate on the 2012 shootings at Sandy Hook Elementary School both heartbreaking and frustrating.

Heartbreaking because of the horrible losses to so many families. Frustrating because, although we are not in a position to judge the report's specifics, the identified systemic barriers to effectively meeting children's mental health needs are all too familiar. We are also concerned that attention to this issue is due to extremely rare violence rather than the well-established needs of millions of students.

The analysis, released in November, provides an in-depth history of the Sandy Hook perpetrator's physical, social, and mental health from early childhood until he committed mass murder and suicide.

It also includes a review of the services and supports the 20-year-old gunman received through schools and the community and decisions made by his parents. While the findings are of special significance to Newtown, Conn., families and others directly involved, their broader value is in the attention they bring to the continued challenges in our mental-health system, a system in which schools and communities both play critical roles. These challenges include inadequate and inconsistent access to mental-health professionals, fractured service delivery, poor information-sharing, and barriers to seeking help. They are not unique to this situation, nor are they new.

A 2013 study by the federal Centers for Disease Control and Prevention found that 13 percent to 20 percent of American children "experience a mental disorder in a given year." In 1999, the U.S. surgeon general pointed to findings that one in five youths ages 9 through 17 suffer from a mental disorder. Very, very few of these young people become violent.

It shouldn't take a horrific tragedy for us to take seriously the imperative to support children's mental health. Nevertheless, the Connecticut report serves as a painful reminder that we have much to do, and it provides an opportunity to recommit to actually doing it.

Boiled down to its essential conclusions, the report calls for improving collaboration among schools, community providers, and families; and promoting more informed, effective, and sustained decisionmaking. As school psychologists, we have experience with practical realities and what it takes to shape systems that facilitate, rather than impede, effective service delivery. While not all-inclusive, the following recommendations provide a foundation for meaningful improvements to school and community mental-health services.

1. Offer a continuum of school and community mental-health supports. An increasing number of schools are providing mental-health services through a multi-tiered system of supports, or MTSS. At one end of this continuum is the universal promotion of mental health and wellness (such as programs that promote social-emotional learning and universal screening for mental-health problems). Providing universal wellness promotion serves to mitigate more intensive problems while at the same time improving overall achievement. At the other end is coordinated, individualized, and intensive school- and community-based mental-health treatment designed for those students who develop mental disorders.

School-employed mental-health professionals have the expertise to provide a range of mental-health services (assessment, counseling, and consultation, for example) to meet the needs of most students. However, for students with severe mental illness, it is critical to have seamless access to community-based treatment resources.

2. Broaden access to school mental-health supports beyond special education. Special education services are essential for students who have learning and emotional disabilities that prevent them from accessing the general education curriculum. But many students who need mental-health supports do not meet the criteria for having a "disability."

Relying solely on special education as a mechanism to provide mental-health services limits our reach and effectiveness. Moreover, it puts parents in the position of believing that the only way to get their child help is to argue for a special education placement, even if it isn't genuinely appropriate. This isn't good for anyone.

In contrast, when schools provide mental-health supports within an MTSS, all students have access to services, while special education is focused on those students with disabilities requiring intensive and specially designed instruction.

3. Improve school-community collaboration to provide integrated and coordinated mental-health care. Disconnects between school- and community-based mental-health providers create some of the biggest problems in mental-health care.

Lack of effective communication leads to confusion, contention, fractured decisionmaking and implementation, and, as the Connecticut report notes, missed opportunities. These disconnects are caused in equal parts by structural differences (e.g., separate privacy laws regarding students and health), use of different terminology (e.g., "emotional disturbance" has a very different meaning in special education versus clinical settings), and ignorance about (and perhaps a dismissal of) the other's systems and processes.

The reality is that, to improve our system of mental-health services, neither sector can afford to go it alone. Both are necessary elements of the continuum of mental-health care and must work in concert.

Steps toward building effective partnerships include establishing a leadership team composed of school and community mental-health professionals, conducting an assessment of needs and existing resources, clarifying roles and responsibilities, providing professional development, and making time for regular problem-solving and evaluation. Effective partnerships empower school and community providers to make more informed, efficacious decisions and best use of resources, and to make support over time more consistent and cohesive.

4. Empower families to manage the myriad decisions and resources they need to meet their child's mental-health needs. Parents should be the ultimate arbiters of their child's care and well-being. And they are often the primary, if not the only, bridge between school and community services.

Amid what can be a painful, surprising, or even frightening emerging reality for their child, they also face the daunting task of making difficult and sometimes confusing decisions. In some instances, this results in intensive advocacy on their part. In other cases, it results in inaction out of indecision, lack of understanding, or lack of resources. In still other cases, parents find themselves caught between conflicting recommendations or perspectives of different professionals, leaving them feeling overwhelmed and isolated.

Respecting the parent's role while also conveying critical information about needed services is a delicate but critical responsibility for school and community professionals. This responsibility includes reducing stigma and facilitating help-seeking. It requires providing information in clear and culturally appropriate terms. It also requires tenacity, compassion, and, perhaps most importantly, establishing a trusting relationship anchored by recognition that all parties want to do what is best for the child. In this regard, improved school-community collaboration that views parents as partners facilitates their ability to make good decisions and get the help their children need.

Improving our mental-health system requires a concerted effort among all of us. In addition to reframing our approach, increasing human and financial resources is essential. Current levels of both school-employed and community-based mental-health providers are grossly inadequate. Many of us are only able to serve children with the most intense needs, with little time to engage in critical prevention and early-intervention services.

When it comes to ensuring student success, mental health matters, and educators should be leaders, not bystanders, in this effort. Schools have the tremendous advantage of being a major hub in children's lives. Schools are already communities with interdisciplinary collaborative systems and supports. We can initiate conversations with local community providers and begin to take meaningful steps toward improving our mental-health systems so that all children are afforded the continuum of care they so desperately need.

Published in Print: January 21, 2015, as Four Ways We Must Improve Student Mental-Health Services

Please enable JavaScript to view the comments powered by Disqus.
Back to Top

# data[].attributes.attachment_link.title
Four Ways to Improve Student Mental-Health Support

# data[].attributes.attachment_link.description
Commentary As school psychologists, we found the report by Connecticut's office of the child advocate on the 2012 shootings at Sandy Hook Elementary School both heartbreaking and frustrating. Heartbreaking because of the horrible losses to so many families.