Kids in Crisis: Therapists bring mental health services into schools
A new approach takes therapists out of clinics and puts them inside schools. That makes the services more convenient and affordable.
Kids in Crisis: Therapists bring mental health services into schools A new approach takes therapists out of clinics and puts them inside schools. That makes the services more convenient and affordable. Check out this story on fdlreporter.com: https://jsonl.in/2BZZU6E
Rory Linnane and Annysa Johnson, Milwaukee Published 6:27 a.m. CT Dec. 22, 2017 | Updated 12:20 p.m. CT Dec. 25, 2017
School psychologist Kate Schmidt (left) and social worker Jyl Ellmaker instruct 4-year-old students in gun safety at Pierce Elementary School. Schmidt and Ellmaker work closely with psychotherapist Jennifer Scott, who spends two days a week working with children at the school.(Photo: Rick Wood / Milwaukee Journal Sentinel)
At this time last year, Monica Pendleton felt like her 5-year-old son was in a constant temper tantrum.
She'd get calls from his school: He was screaming or kicking tables and chairs, or both. Teachers were at a loss. Pendleton would have to leave work to pick him up.
"The front office knows me and him personally," Pendleton said.
Last month, in a room in the basement of Pierce Elementary School, she told a therapist that her son, now 6, has completely turned around his behavior.
"Now, he loves school," Pendleton told the therapist. "He's doing so good in school, and now he's not as negative anymore."
Pendleton and her son are part of a new model of behavioral health care taking hold at several Milwaukee Public Schools and in some other schools throughout the state. The approach takes therapists out of their clinics and puts them inside schools. That makes the services more convenient and affordable.
The "Kids in Crisis" series examines barriers to mental health care and seeks solutions. As teen suicide rates rise and schools are overwhelmed by mental health needs, you can join us in bringing these topics out of the shadows. Read more from the series
The model grew in response to a problem: Students are increasingly coming to school with untreated mental health challenges that interfere with learning. School staff are not equipped or given enough time to handle severe needs. When staff members refer families to mental health professionals, too often nothing happens.
"Even though there's a lot of services in the city, they're not necessarily accessible," said Dena Radtke, who oversees social work services for Milwaukee Public Schools.
Some guardians can't find time for the appointments, or child care for siblings. Some lack transportation. Families might not have the money, or speak English, or feel comfortable walking into a clinic. When they get past those barriers, families might get stuck on a waitlist.
When therapists are located in schools, professionals say, families are far more likely to actually get care.
Only in select schools
The concept of school-based care has roots in a decade-old Minnesota pilot program, which expanded to provide therapists in more than 600 schools across the state in 2014. Students in those schools improved their test scores and had fewer suspensions after getting the program.
The model helped inspire Milwaukee's School Community Partnership for Mental Health, which has been expanding over the last seven years. There are now 22 MPS schools that host therapists from Children's Hospital, Aurora Family Services, Shorehaven and Sebastian Family Psychological Services.
"We need to bring the services to our families so they can access them," Radtke said.
Therapists in schools under the partnership can bill insurance for some costs. But for families without insurance — or with copays and premiums they can't afford — the district uses grant money to cover the costs.
Most of the students who see the therapists have never had mental health services before, said Ann Rolling, community services counseling manager for Children's Hospital. In other cases, the students may have seen a professional for a couple of sessions but stopped.
"I think we really are reaching families who would otherwise not have access to mental health care," Rolling said.
Rolling said she'd like to see every school have therapists on site, but funding falls short. Insurance payments alone are not enough — particularly those from Medicaid, which is used by the majority of Milwaukee students. There is a heavy reliance on limited grant funding.
After a request by state Superintendent Tony Evers, state lawmakers this year set aside $3.25 million for expanding school-based mental health services. Schools will be able to apply for grants from this new pot of money next summer.
Embedded at school
Therapists embedded in MPS schools don't only work with the kids. They work with school counselors, social workers, psychologists and teachers to develop plans to support students in the classroom and beyond.
At Pierce Elementary in the city's Riverwest neighborhood, Pendleton's psychotherapist, Jennifer Scott of Children's Hospital, works closely with school psychologist Kate Schmidt and social worker Jyl Ellmaker.
Typically, it's Ellmaker and Schmidt, who together have nearly 30 years of experience at the school, who refer a family to Scott. This often happens when their own efforts to help the student haven't been successful or the family is struggling to get outside therapy services.
Brodi Ott, a teacher at Pierce Elementary School, reviews a book with students during class. Pierce is among a number of schools offering school-based mental health services for students. (Photo: Rick Wood/Milwaukee Journal Sentinel)
"For a lot of our parents, it can take a while to build that rapport, and once we do, they know that we have their children's best interests at heart," Schmidt said. "So, when we bring up Jenni, and the prospect of having therapy here at school, almost all of them are open to it."
All three believe the in-school model is more effective than referring students and families to providers off-site.
"I would make a lot of referrals in past years, (but) the follow-through in actually getting parents to those locations was very poor," Ellmaker said. "And if they did get there, the communications with the agency was very challenging."
Often, she said, it could take weeks of phone tag with multiple providers just to make sure consent forms were signed and to confer about progress and strategies. Once contact was made, it might only lead to one or two conversations.
"It would feel like we weren't always on the same page," she said.
That's different with Scott, who spends two days a week at the school.
Children's Hospital of Wisconsin psychotherapist Jennifer Scott (right) confers with Pierce Elementary School psychologist Kate Schmidt about the progress of students who are receiving services there. Scott spends two days a week at the school as part of a program to better deliver mental health care services to children. (Photo: Annysa Johnson / Milwaukee Journal Sentinel)
Ellmaker and Schmidt have referred 13 cases to Scott so far this school year, a more manageable caseload after the 35 or so by the end of last year. Many of the children show signs of traumatic childhood experiences; about half score high for exposure to violence, whether directed at themselves or those around them.
"There's a lot of separation of parent due to incarceration, exposure to violence, whether that's witnessing domestic violence or violence in their neighborhoods," Scott said.
"While not every kid on my caseload would have a formal PTSD diagnosis, they're having ongoing trauma symptoms we're addressing, on top of whatever else we're working on."
That trauma can present itself in many ways: an inability to regulate emotions, unpredictable behavior, misinterpreting social cues, emotional responses that don't match the circumstances.
"That can look like physical aggression, verbal aggression, tantrums, withdrawal, crying easily, and being off task — walking around or out of the classroom a lot," Schmidt said.
The majority of referrals are boys, typically for disruptive behaviors. But the team is making a concerted effort to be on the watch for so-called internalizers.
"Those are the students who are more withdrawn," Ellmaker said. "They are not going to be loud or show major behavior problems. But they may be experiencing suicidal or self-harm thoughts, depression or anxiety."
Teamwork is key
The Pierce Elementary team meets weekly to discuss students' progress. On this December day, it was a mixed bag.
One student was doing surprisingly well. Another had been making improvements but had regressed in the last week. A third was in the throes of a near meltdown, brought on — they suspect — by the lingering effects of a violent incident the family experienced more than a year ago.
In the last week, the child had been especially emotional and disruptive at school, screaming and crying, knocking things over.
"That would definitely explain the decline," Schmidt said after Scott relayed a recent conversation she'd had with the child's mother.
RELATED: Wisconsin teens are changing the mental health conversation from illness to wellness to lessen stigma
RELATED: By understanding trauma, Wisconsin youth find path to healing
Student privacy is paramount. Teachers and administrators are looped in on a need-to-know basis only. (Children were not identified to the Journal Sentinel during observation. Children and families are only named in this story with consent.)
One strategy for this student who was experiencing outbursts, team members said, is to try to flip a switch in the child's brain, from the emotional to the intellectual, with a simple math equation. Scott also suggests getting the student to count to 10. As in, "Let's see if you can calm yourself by the time we count to 10."
The group decides that Schmidt will reach out to the teacher to make sure they're on the same page.
Teachers have been supportive of the program, for the most part. But it can be burdensome in some classrooms where they are trying to cover the required academic material, and are already struggling to manage behaviors.
"They're overworked and overloaded," Scott said. "And, now, there's this additional thing."
Scott met with one of the more enthusiastic teachers later that morning to discuss two students they've been working with.
One had been doing well but had been getting into fights in the last week and becoming more defiant. For the other, the teacher said, "it's a complete change."
'He's just more receptive to me'
Scott is quick to give the teacher credit, noting that she's adopted some new strategies for dealing with his behaviors. Among them, using "if-then" statements – as in, "if you do this, then this will happen" — following through on consequences of those choices and keeping her cool when things get out of hand.
"I've been trying to be a lot more calm because he does not do well if you get really upset," the teacher said.
Case in point, she said, was an incident that morning. The boy was out of his desk and misbehaving. She spelled out the consequences and he responded favorably.
"He got mad for a minute, and then he got back into his seat and turned it around without arguing with me," she said. "Usually, that … situation would have turned his whole day into a terrible day. And he was fine."
The other child, she said, has relapsed, getting into fights, being disruptive in class. They've been working on helping him follow directions, take responsibility for his actions and introducing positive statements he can say to himself, like, "(She's) just trying to help me learn, so don't get mad at her."
Another idea they kick around is having the two students, who are friends already, work on motivating each other, and base their rewards on their mutual success.
"That could even be a cool conversation you could have with your whole class," Scott said. "Just talking about, 'What are three things we can do to help others make good choices?'"
Seeing success
The program also has shown some success, according to Schmidt, based on the surveys parents take before and after services.
"It's wonderful to see these parents, who are mostly younger parents, that are open to services and putting in the work to practice what Jenni teaches them at home," Schmidt said.
In the session with Scott, Pendleton played with her son as she practiced ways to build his self-confidence and encourage calm learning. Scott has been coaching Pendleton on providing "labeled praise" — specific compliments that make children feel understood, proud and cared for.
"You're doing a nice job being gentle with the toys," Pendleton said, watching her son build with Legos. "I like your car."
"Thank you," Pendleton's son replied.
"Nice labeled praise," Scott whispered.
As Pendleton and her son zipped their coats to leave, she and Scott agreed it might soon be time to discuss ending the therapy sessions because of how well her son was doing.
"With this program, I think it helped me more as a parent, and that helped him be more positive," Pendleton said. "I learn to focus more on the good than the bad."
Top Headlines:
We followed four Wisconsin dairy farms for a year as they struggled with an industry-wide crisis, one didn't make it
Wisconsin lawmaker proposes resolution honoring white people, among others, during Black History Month
Wisconsin once had a 'model' voting rights program for people with disabilities. Officials have let it decline.
FOLLOW THE JOURNAL SENTINEL: Facebook | Twitter | Instagram
Read or Share this story: https://jsonl.in/2BZZU6E