JN: MH Clinics, Programs Going into School Programs

Mental Health Joins the Class as Nonprofits Open In-School Clinics

By Elizabeth Ganga and Randi Weiner Journal News March 31, 2013

Yonkers elementary teacher Kathleen Richmond reads the crime reports in the newspaper before heading to school.

It’s one way she prepares for the day at a school where children come to class after having seen neighbors shot, gang wars on the street and violence in their own families. Ninety percent of the time what happens on the streets comes into the schools, she said.

“Right away, within seconds, you can read on the faces of these kids that there’s something going on,” said Richmond, a fourth-grade teacher at the city’s Martin Luther King Jr. School. Children turn up with a range of problems from post-traumatic stress and anxiety disorders to depression and learning disabilities.

But Martin Luther King has an advantage in the war for children’s well-being. The prekindergarten through eighth-grade school has a satellite mental health clinic on school grounds run by Westchester Jewish Community Services that provides counseling and support for the children and their families.

A Journal News survey shows mental health clinics and programs run by nonprofits are increasingly setting up shop in schools as awareness grows of the need to address problems early and break down barriers for families accessing services. The expansion means they are well placed to work with schools as districts emphasize violence prevention following the December school massacre in Newtown, Conn.

The increase in school-based mental health services comes as schools have drastically cut their own guidance and support staffs, putting more of a burden on the nonprofits to pick up the slack addressing the daily traumas of childhood and identifying what could be the beginnings of deeper mental health issues before they take hold. Problems can range from anxiety and acting out to the early stages of bipolar disorder and psychosis. About 20 percent of teens in the United States suffer from a mental disorder at some point, and half of all cases of mental illness start by age 14, the National Institute of Mental Health says. But many don’t get help. Only about 36 percent of young people with mental disorders ever received services, according to a NIMH-funded survey published in 2011.

In the past two years, nine satellite clinics have opened or expanded in schools in Yonkers, Peekskill, White Plains, Port Chester and Mount Vernon, bringing the number of school-based clinics in Westchester to 22. Last year, the first school-based clinic in Putnam opened at a Brewster Head Start, while Rockland BOCES is adding mental health services, part of a full-service community school model, to a new school in Haverstraw. At other schools in the region, nonprofits provide consultation, screening and specialized curriculum aimed at building more resilient kids, and they refer out those who need services.

“They’re recognizing they can’t do it alone,” said Grant Mitchell, commissioner of the Westchester Department of Community Mental Health.

Data from the state Education Department show that the number of school psychologists, social workers and guidance counselors in Westchester dropped from 894 in the 2007-08 school year to 789 in 2011-12, a decline of almost 12 percent. Rockland lost only five of 275 counseling staff over the same period, and Putnam lost four of 111. In some communities, however, the cuts have gone much deeper. In Yonkers, the counseling staff shrank from 51 guidance counselors, 34 psychologists and 17 social workers in 2009-10 to 15 guidance counselors, 17 psychologists and eight social workers this year for a district with 40 schools and 26,000 students.

'A friendly face'

In 2010, Melissa Pagett’s husband died. A neurological disease robbed him of his mobility and eventually his life within about 18 months. Her son, Jaden, was 3 1/2 years old and watched as his beloved father dwindled away.

“My son went from watching him going from walking and talking to a wheelchair and then not being able to eat,” the 29-year-old Peekskill mom said.

While Pagett was going through crying jags and staying in bed, Jaden was in Head Start and beginning to act out. Taking him to the grocery store became a battle of wills, his mom said; he was the child who would run through the aisles tossing down cans, screaming and kicking. He yelled that he hated his mother, and he refused to go outside or on the bus without a fight.

It really started with me,” she said. “I just couldn’t function, couldn’t do what I ought to do, would go out to the car and break down.”

Jaden, now a kindergartner, started seeing a therapist recommended by Head Start, WJCS licensed clinical social worker Cathy Kunin, who is assigned to Woodside School.

“They hooked us up, and we’ve been in treatment ever since,” Pagett said. “It’s great just having somebody else in the school. It’s nice to have that extra person to talk to during the day. Sometimes Jaden needs a friendly face, and I can’t be here.”

The expansion into schools is happening more and more as schools and providers realize the benefits of putting the teachers, clinicians, students and parents in the same place, said Megan Flynn, assistant executive director for children and youth programs at WJCS.

“If you are where families come, it opens those doors much more widely,” Flynn said.

Models vary

Schools have several models to choose from. Community schools come with an array of services that include mental health; mental health satellite clinics staffed with social workers and psychologists can do group and individual counseling; or consulting mental health professionals can add to curriculums that teach coping and problem-solving skills to an entire school community. The programs are paid for through a combination of Medicaid billing, grants, foundation fundraising and support from various levels of government.

The state recently announced that School 13 and Enrico Fermi School for the Performing Arts in Yonkers will receive grants of $4.5 million each from the state Education Department for program improvements that will include links to community services. Amanda Curley, executive director of instructional support for Yonkers schools, said she already has contacted one private social service provider to bring in mental health services to the schools and is planning to ask for proposals from others.

This year, Rockland BOCES has crafted a community school in what used to be Neary Elementary in Haverstraw. The building, which houses the Hilltop School for elementary and middle school children with social and emotional needs, also has a child-care center. It’s in negotiations for a dental clinic and also will, courtesy of the Westchester Department of Community Mental Health, include mental health services.

Mary Jean Marsico, Rockland BOCES superintendent, said the community school was created to fill a gap that had been opening in the past few years.

“We’ve been seeing a reduction in mental health and social worker support in the schools because of finances,” she said.

“They (now) have to come from the private, community-based services. These clinic supports have adapted well to alternative high school programs among people that need a smaller learning environment and wraparound services for the family.”

Westchester County started giving grants for mental health in early childhood programs after providers started seeing problems in the youngest children.

“There were stories of 3-year-olds being kicked out of day-care centers because of their behavior,” said Vicki Forbes, who works on early childhood mental health at WJCS.

At Yonkers Children’s Place the other day, 3- and 4-year-olds were getting a lesson on recognizing other people’s feelings. The teacher, Latasha McCallum, showed the children pictures with happy, sad and mad faces and talked about what to do when a sibling takes their toys and how to help another child upset at missing out on the big dinosaurs.

“What do you think we can do?” McCallum asked.

“Shaaaaare,” several of the kids said in unison.

The program, called Early Step Forward, has been at Yonkers Children’s Place, a Head Start program run by Westchester Community Opportunity Program, for about six years and makes a clear difference, said center director Barbara Maetke.

The children are calm. They sit and talk to one another. There isn’t the chaos you might see in other preschool classrooms, she said.

Another WestCOP Head Start in Brewster has a part-time clinic on-site run by Putnam Family and Community Services. The clinic, which started in November, grew out of a state grant-funded program that let Putnam Family staff assess kids from local schools and refer them to a community clinic.

Having the clinic in the school itself helps the kids and their parents, most of whom are from the area’s large Hispanic immigrant community, feel more comfortable and avoid the stigma of going to the community clinic, said Kathleen Moccio, director of Head Start.

“The therapist that comes in is just one of everyone else (who’s) here,” she said. About one-third of the 74 kids are getting some help from counselors who help the children deal with divorce, fighting in the home or other trauma. The therapists, who come in eight hours a week, also work with the families to give them skills for dealing with stress.

“I have a lot of parents that are surprised the children they once knew are (now) throwing a lot of tantrums. They’re shutting down,” said Jessica Inglis, one of the social workers who counsels the children.

Building trust

The goal is to get the children help as early as possible to take care of problems before they grow more serious, the professionals said.

“That’s huge because you’re treating the kids at a young age, which to us is prevention,” said Diane Russo, executive director of Putnam Family and Community Services.

At Eugenio Maria de Hostos MicroSociety magnet school in Yonkers, the on-site clinic has helped build trust between the families and the providers. The school sees many families struggling with transitional issues, said Principal Elda Perez-Mejia, with the parents looking for homes or jobs, becoming homeless or dealing with other family situations.

“It’s nice to have WJCS here because they can pull (students) out to talk,” Perez-Mejia said. “Unfortunately, because of cuts, there’s nobody else to do it. In buildings without WJCS, the principal becomes that person.”

Port Chester High School, which has a large population of new immigrants, has had a clinic run by Family Services of Westchester for almost 12 years that provides individual and family counseling. The children often come to the U.S. years after their parents and suddenly have to deal with new rules and expectations.

“Most of the kids I have seen, they have been living without their parents and they feel abandoned by them,” said Hortensia Alvarado, a Family Services social worker at the school, which has 42 new immigrant students this year. The clinic helps make a difference in the dropout rate, the teen pregnancy rate and other outcomes, said Karen Fink, the clinic director.

With the drastic cuts to support services in Yonkers, Martin Luther King Jr. School wouldn’t work without the WJCS clinic, teachers there said.

“The teachers would be running out of the building,” said Terri McCarthy, a first-grade teacher.

Sometimes the solutions are simple. One girl, Richmond said, was chronically late to school. She and her several siblings all shared one room. She said she didn’t have an alarm clock - so Richmond bought her one.

“The child was never late again for the rest of the year,” she said. “That child is in college now.”

By the numbers

20 percent of youths are affected by a mental disorder at some point

8 percent of teens have a serious emotional disturbance

50 percent of lifetime cases of mental illness begin by age 14

20 percent of children with mental disorders are identified and receive services in any one year.

Sources: National Institute of Mental Health, National Alliance on Mental Illness