The Pulse: Bringing Mental Health Care To Kids In School

Oct 20, 2016

Accessing mental health care can be tough for kids in Rhode Island. There’s a shortage of practitioners and programs and a growing need for care. This week on The Pulse, we explore how schools and communities are bridging some of the gaps, bringing mental health services right into the school building.

All of a sudden, one of Ingrid’s five children started acting out in school. We’re not using her last name or her son’s to protect their privacy. She’s come to the principal’s office at West Elementary School in Providence to share the experience. She describes what life was like in Spanish .

“Se portaba bien fuerte. Me llamaban todos los dias. Siempre estaba peleando con los demas ninos. Estaba rumpiendo cosas, corriendo, se escondio  en las escuela. (“He behaved really badly. They called me every day. He was always fighting with the other kids. He was breaking things, running, he hid in the school.”)

Sandra Stewart has been the principal of George West Elementary School in Providence for six years. She says out of 860 children, a significant percentage deal with mental illness or trauma.
Credit Kristin Gourlay / RIPR

West Elementary had just joined forces with The Providence Center, a community mental health care provider, to bring  trained counselors on site. They could identify kids who needed help, diagnose the problem, and provide counseling during lunch or recess. School administrators suggested it for Ingrid’s son. She agreed. And now, he’s being treated for Attention Deficit and Hyperactivity Disorder and anxiety – just a couple of the mental illnesses that can emerge in young children. For Ingrid, who doesn’t have a car and doesn’t speak English, finding help at school was a godsend. And since her son started the counseling program at school, life has changed.

“Por que ahora yo puedo estar mas tranquila en la casa, teniendo la nina, mi miento también, por que me preocupaba mucho. Era demasiado fuerte." (“Because now I can be more at ease at home, taking care of the kids. My mind, also, because I was worrying a lot. It was too much.”)

Most schools have guidance counselors, and many have psychologists and social workers. But West Elementary principal Sandra Stuart says they already have a lot on their plates.

“My psychologist is not here on a full time basis so a lot of times it would fall on my assistant or myself on assisting the families when they were not here," says Stuart .

Many West Elementary students cannot afford outside counseling services. Most child psychiatrists and psychologists in Rhode Island do not take insurance.
Credit Kristin Gourlay / RIPR

Stuart says she and her administrative staff tried working with outside agencies to get students the help they needed – whether  it was for depression or post-traumatic stress disorder. But families didn’t always make the connection.

“One, some of them work two or three jobs, so it’s very difficult for them to take time out of work," Stuart says. "Two, a lot of our families don’t speak English, or were not born here and are really nervous about going anywhere outside the school. Obviously they feel very vulnerable. Another thing also is they yes you to death when they’re here and then when they leave they don’t always follow through.”

Follow through on outside counseling appointments for their children, that is. Then she had an idea:

“If we could bring the services here to them, then we could bypass a lot of the obstacles and challenges.”

Parents appreciate the convenience, including the fact that they just have to be present for the assessment, not every appointment. Another bonus? The school doesn’t pay a dime, says school district psychologist Gail Mastropietro. The Providence Center bills children’s insurance.

“So it does not come out of the school’s budget. There’s no cost there. It’s a true partnership.”

Mastropietro says schools have always played a role in children’s health, but it’s a new moment for mental health.

“We’ve done that for years on vision, on hearing, a host of other things," says Mastropietro. "Mental health was something we didn’t deal with well. Now I think it’s more out in the open and it’s making for improved outcomes for our kids.”

Principal Sandra Stuart says students who are getting treated through the program are already showing signs of improvement.

“A lot of our children who were either depressed or had anxiety, we’re starting to see increased attendance here at school," says Stuart. As she walks through the school hallways, she greets students changing classrooms. She gets hugs and smiles. It feels like a safe place. That’s important, says Stuart, because she’s concerned many more of her students may be suffering from post-traumatic stress disorder than previously thought.

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Sarah Dinklage heads Rhode Island Student Assistance Services. It’s an organization that’s been staffing Rhode Island high schools with counselors for nearly 30 years.

“What we’ve found in providence and other urban schools is that most of these kids have chronic repeated trauma," says Dinklage. "So obviously serious neglect, witnessing violence in the home.”

Until recently Dinklage’s organization focused more on preventing drug abuse. Now, says Dinklage, there’s more awareness about the role schools can play in helping kids with mental illness. That includes a growing recognition that more children suffer from post-traumatic stress disorder than previously thought.

“And we know trauma impacts the brain at an early age, so obviously it affects school performance.”

Dinklage will be helping pilot a new program with the Providence Children and Youth Cabinet to bring trauma-centered counseling into a couple of Providence high schools. Bradley Hospital’s Dr. Greg Fritz says it’s a great idea. As long as we support schools.

“I think we have to be careful that we don’t just assign schools the proverbial unfunded mandate," says Fritz, "take care of the kids’ mental health, with extra time, no support and no money.”

But Fritz says it makes perfect sense to acknowledge that teachers are the first eyes and ears, the frontline for expanding access to mental health services.

“In my experience, teachers generally have an eye for the sort of stuff they see. They see tons of normal kids in the age group they’re teaching," Fritz says. "So I think their judgment and recognition skills are excellent.”

West Elementary has figured out a way to help students when their teachers notice a problem without adding a budget line or hiring more staff, through their partnership with The Providence Center. And more schools will be adding the program soon, according to Providence school district officials.

Bradley’s Fritz is quick to point out that these programs don’t replace services for serious mental illness. But they may be the key to catching problems before they escalate into a crisis – and require hospitalization