Mental health services in schools seen as bearing fruit
Posted on Sunday, March 26, 2006
A growing state Department of Education initiative credited for raising student grades and decreasing behavior problems is incorporating mental health services into public schools across Arkansas.
The School-Based Mental Health Network — started as part of a plan to address a federal citation — has expanded to include 70 school districts, more than a quarter of all 251 districts, serving some 3, 500 students so far this year.
The network began in 2002 after a report in 2000 from the U. S. Department of Education’s Office of Special Education Programs that cited the Arkansas Department of Education for its lack of counseling and psychological support services. The federal agency, which released the state from its corrective action plan in 2004, requires schools to provide specific services to children who need them to benefit from their education.
Mental health workers and school district officials hail the program, available free to any student identified as needing it, as a pioneering tool to reach children who have not previously received mental health help.
But others, including a state administrator, say the program needs accountability standards to prevent the misuse of Medicaid reimbursement and more parental participation in student treatment. Still others caution that it could lead to the misuse of medications and assert that pharmaceutical companies are pushing the program to boost drug sales.
Over the past decade, schoolbased mental health programs have grown as the federal government conducted studies and funded two research and policy centers to examine the subject.
A 1999 U. S. Surgeon General’s report on children’s mental health found that one in five youths, or about 14 million, will experience a significant mental health problem during their school years and approximately 70 percent of those who need mental health services will not receive them.
In 2003, the President’s New Freedom Commission on Mental Health recommended in its final report improving and expanding school mental health programs.
Arkansas school-based health program directors say students’ problems cover a wide spectrum, including depression, anxiety, bipolar disorder, drug and alcohol abuse, and occasionally suicidal tendencies. Other short-term needs may arise upon the death of a student or other traumatic event, they said.
In the past, school counselors would refer children to mental health services, but often parents could not afford to take off from work to take the children to counseling appointments. The result left school counselors burdened with an unmanageable number of children needing more time and attention than one person could give, said Blair Olson, executive secretary of the Arkansas Counseling Association. “Before, we were simply scratching the surface,” said Olson, who is also a professor and chairman of the Department of Counseling at Henderson State University in Arkadelphia. “Now, we are making inroads.”
FINDING FUNDING Arkansas school-based mental health programs are funded through a variety of sources, including federal, state and local. The Arkansas Department of Education is to distribute $ 2 million in federal grants this year to 10 school districts participating in the network. The state Department of Health and Human Services’ Division of Behavioral Health Services is also jointly funding five programs, said Marcia Harding, associate director of the Special Education Unit of the Education Department. Over time, federal funding decreases, and school districts must use more of their own funds in addition to reimbursements from Medicaid or private insurers, she said. Harding’s office does not keep statewide figures on total school district spending for mental health services. The Division of Behavioral Health does not track Medicaid spending on school-based mental health, although it does track overall Medicaid spending on children’s mental health.
Anne Wells, Division of Behavioral Health Services’ assistant director for Children Services, said the school-based programs are “integral” to providing mental health services to children. But the program needs more accountability measures and standards to ensure that the programs are carried out properly. For example, students should not be removed from academic classes for counseling, Wells said.
The state does not have the capability to ensure that taxpayers’ dollars are being used for legitimate diagnoses and treatment, Wells said.
Families should also be involved in family therapy in addition to their children’s individual sessions, she said.
“You can’t sit down with a 7- or 8- or 9-year-old child and treat them in individual therapy and expect there to be positive outcomes,” she said.
Wells is working with the Special Education Unit and the administrators of the state’s Medicaid program to develop certification standards that would address the concerns she cited and ensure that children receive appropriate treatment that is based on proven and effective approaches, known as “best practices.”
In Van Buren County, the mental health program is based in Clinton and serves three school districts. The state provides about $ 76, 000 in federal grants, while the three districts pick up the rest of the $ 180, 000 annual cost. Last year, the program received about $ 4, 000 in Medicaid reimbursement, said Deb Swink, Special Education Supervisor for Van Buren County, which includes the Clinton, South Side-Bee Branch and Shirley districts.
Swink said the benefits of the program are so great that she expects the program to continue even when current grants run out.
Many districts sign contracts with private mental health providers or publicly funded community mental health centers, but in some rural areas such as Van Buren County, the school districts are hiring their own mental health workers. School counselors usually refer students who display a sudden change in behavior or a drop in grades for counseling services. In the Clinton program, juvenile courts also refer youths to the school-based services.
Parents must give permission before students receive the services, which can include individual counseling or group therapy on topics such as eating disorders, anger management or divorce. The Clinton program has also offered family programs, including a light supper, parenting classes and activities for children.
At Shirley High School, students in the Alternative Learning Center work once a week with Mel Long, a school psychology specialist. Students qualify for the alternative program if they meet a variety of criteria, ranging from failing in school to home problems to being a victim of abuse. Vicki Sandage, director of the Alternative Learning Center, said Long’s weekly visits give her students, who frequently deal with instability in their lives, something to look forward to every week. “They have bonded with her and trust her,” Sandage said. “I can’t teach them self-esteem or self-worth, but I can give them an opportunity to experience something that makes them feel better about themselves, and then they build on that. And that’s what this does.”
TACKLING STRESS During a Tuesday morning session, Long gave students a worksheet for them to use to measure — from a low score of 1 to a high score of 5 — their stress levels in certain situations.
Rebecca Davidson, 16, said she rated being bullied as a 5, which prompted Long to lead a discussion about what choices Davidson could make in how she responds to the bullying.
Suggested responses from the students included physically fighting back, telling a teacher or principal, or walking away.
Davidson, a junior who has been in school-based counseling for two years in addition to counseling from another provider, said the school group sessions help her share her feelings.
“It makes me feel better,” she said. “I don’t have to hide anything. We all talk about our problems and get to know each other.”
Davidson said she now listens to her parents more and has set a goal of attending a four-year college.
School-based mental health has also been credited with keeping students from returning to in-patient psychiatric facilities, said Harding and Olson.
Patti Allison, coordinator of the mental health program at the Greenwood School District in Sebastian County, said one junior high student there has particularly benefited from the school services.
The boy, who has been diagnosed with bipolar disorder and oppositional defiant disorder in addition to other problems, has spent several stints in residential psychiatric treatment facilities.
After his last stay over the summer, those treating him said there was nothing left to do to help him, Allison said. With the help of school therapists who helped him learn how to interact with other students and teachers, he remained in school and out of residential treatment centers. Although academics are still a struggle for him, goal-setting and meetings with counselors help him function, Allison said.
DRUG CONCERNS Opponents say school-based mental health programs can lead to the misuse of medication. Vera Sharav, president of the Alliance for Human Research Protection in New York, asserts that members of the New Freedom Commission had ties to the pharmaceutical industry, which influenced commission members to recommend expanded mental health services in schools. The alliance is a watchdog organization of laymen and professionals that advocates responsible and ethical medical research practices.
“That’s what’s turning all of this,” she said.
Michael F. Cannon of the Cato Institute, a Washington Libertarian think tank, said some schools may be eager to medicate children as a low-cost option to curb behavioral problems.
Parents should have the option to choose another school that may offer another curriculum as an alternative to medication, he said.
But Sonyarae Lemings, whose 9-year-old son, Tyler, receives individual counseling at South Side Elementary School in Van Buren County, said the therapy has helped her son learn to control the symptoms of his attention deficit hyperactivity disorder when he’s not on medication. Tyler takes medication on school days, but Lemings is hopeful that with counseling eventually Tyler will no longer need the pills.
While school program directors say they are seeing the benefits of school-based mental health, there are no statewide data available yet on the outcome of the programs.
Harding’s office is collecting the data and hopes to release an analysis by the end of the 2006-07 school year.
Harding hopes the number of schools providing mental health services continues expanding.
Some school districts have contracted with counseling agencies to provide services to students but have not met all of the requirements — such as having services available 24 hours a day — for joining the network. Others have cited a lack of money to support such programs, she said.
Since the inception of the network, Harding has seen an increased emphasis on meeting children’s mental health needs.
“Now everybody realizes that those kids... if their problems are left unaddressed, turn into the adult problems of tomorrow.”
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