School-age children are seeking out mental health care more than ever
As the pandemic has progressed, more school-age children sought out mental health support when they returned to in-person learning this school year, officials believe.
The co-chairs of the state legislature’s Children’s Committee, Rep. Liz Linehan and Sen. Saud Anwar, hosted a children’s mental health panel at the end of October. Doctors, social workers and mental health experts said emergency departments are seeing an overwhelming number of children in crisis because parents often are unaware of alternatives to the emergency departments, whether they be in their communities or schools.
“Parents, schools, physicians often rely on emergency rooms, frankly, as an expedited way of getting the kid seen,” Howard Sovronsky, chief behavioral health officer at Connecticut Children’s, said during the discussion. “But the nature of the pandemic that we are experiencing now, and it is a mental health pandemic, has resulted in an inordinate number of children being brought to emergency rooms — not just ours, but every hospital around the state and around the country is experiencing this increase in demand.”
Efforts to address children’s mental health in Connecticut were in motion before schools shut down in March 2020, but state and district officials want more resources for this issue, which some say will continue to grow.
“The traumas that [students] have been through, some of it I think has been exhibited in school,” said Charlene Russell-Tucker, Connecticut’s education commissioner, adding that the department is hearing from districts that the adjustment of being back in person has also been challenging for some children.
“So it surely is an area of concern for us to try to really accelerate the work and supports that we are providing our districts.”
One of the state Department of Education’s priorities is using the additional $1.1 billion in federal aid for K-12 schools granted to Connecticut through the American Rescue Plan to support additional social-emotional supports — the state budget also boosts overall school aid by $46.4 million, a 2.2% increase, most of which is directed at lower-income districts.
Districts plan to expand social-emotional programs in schools with federal funds through stress reduction and classroom yoga, one-on-one counseling for students, connecting with local non-profits to address parental needs, repurposing spaces in schools for mental health areas for services, and hiring more school psychologists, social workers and nursing staff, Russell-Tucker explained.
“[We’re] really, really proud of the fact that we placed it as a priority and districts are actually thinking creatively about how those funds can be utilized,” she said, adding that the department getting these applications from districts and seeing their plans are helpful for them when it comes to figuring out where they can apply state-level funds to support districts.
“It’s really all hands on deck to be able to provide the support,” Russell-Tucker said. “So we’re actively taking the information that we’ve gathered from districts, knowing where they’re already invested, hearing from them in terms of what the needs are, so we can have an approach that can stand up as quickly as possible to help to support what they’re doing, but more than anything else to support our students and families.”
What’s Connecticut’s plan to measure the need?
After seeing how great of a concern children’s mental and social-emotional health became in the last year, state agencies are launching additional resources in schools.
In March, the state Department of Education announced a partnership with Aperture Education to launch a social and emotional learning assessment for K-12 schools throughout the state beginning in the fall called the Devereux Student Strengths Assessment system, or DESSA.
DESSA is a teacher-driven assessment of student behaviors and social-emotional well-being. John Frassinelli, director of school health, nutrition, family services and adult education at the state Department of Education, said this will help schools identify interventions and supports for students who are known to need help.
The assessment is done in two parts. The first is a screening that can be administered in 60 seconds that takes an overall look at a student’s social and emotional competence. The second part is a five-minute follow-up for students who were identified with more needs. It provides more detail about which social-emotional supports will benefit them.
Frassinelli explained that the assessment includes questions such as “how often in the last week has the child worked through a problem?” or “how often has a child resolved a social issue they had with another child?”
“So in other words, it’s not looking at a child saying ‘they can’t do this or can’t do that.’ It’s not deficit-based, it’s strength-based,” he added. “The teacher then can help the student work on areas that they need some additional support — so maybe it’s socialization, maybe it’s self-reliance.”
The state is making the free DESSA system available to nearly 100 districts during the 2021-22 school year and nearly 200 districts the following school year. The state announced the first cohort of the 33 districts that will participate and receive the assessment in July and expanded to an additional 75 districts this fall.
“[Mental health] is one of the focus areas around the work that’s happening with students with regard to student social-emotional situations, and providing ongoing training to school districts so that they have the tools to support families and students throughout the pandemic,” Frassinelli said.
Before the roll-out to the first cohort, Naugatuck Public Schools was one of few districts that already used DESSA.
Denise Tafuto, Naugatuck Public Schools social-emotional learning coach and Project AWARE coordinator, said using the information coming through the DESSA assessments has helped the district with making data-informed decisions to get the right support services to students.
“Some things that come along with the DESSA program is that they have built-in evidence-based interventions right in the system,” Tafuto said. “So if we identify student A is struggling in a self-awareness category, we can go into the system, into the self-awareness category, and … there’s all these different research-based programs that feed into this DESSA system that we can use.”
Possible staffing concerns
Although getting more mental health resources out to local school districts and surrounding communities is a priority, mental health professionals also wonder if schools have enough staff to address the needs of students.
“Some schools have just one worker in schools or a social worker with 800 kids in a school," said Steve Wanczyk-Karp, executive director of Connecticut’s National Association of Social Workers chapter. "So it's really stressful for our school social workers, but they all find creative ways to deal with this."
With an uptick in students being referred to her during the pandemic, North Haven High School Social Worker Lauren Gray said trying to connect with students online was one of her biggest challenges in the spring.
Some refused to turn their cameras on during a meeting, some didn’t show up to meetings at all, and others wouldn’t leave their rooms to check in with her during a home visit.
"It's a whole team effort here. We've got multiple social workers and single cases so that we can all get as creative as we can with different viewpoints," Gray said. "The students may connect better with one than the other, and I think that's OK as long as someone is connected. But really trying our best to connect in any way we can."
By the end of the last school year, she said, it was challenging — especially when it came to getting students back on track in the spring. But she said teachers, school counselors, social workers and psychiatrists worked together to develop plans over the summer to help the students who were hard to reach last school year to transition back this fall.
Gray explained the plans are individualized and focused on meeting students' needs.
This could include doing things for students who are anxious about returning like coming in after school for an hour or two while no one is there to have a quiet place for them to work, and having professional development for teachers before the start of this school year.
"Obviously we would love for all of them to just jump back in and everybody be back to normal, but that's unrealistic," Gray said, adding that they are trying to help teachers build students' confidence when they're in the classroom because they're the ones "on the front lines."
"So a lot of that social-emotional learning, and teaching the teachers about that, is what we're focusing on right now so that they can feel prepared, or as prepared as they can be, to work with these guys who may not be their typical student."
Russell-Tucker said the department will examine where to add staff as more social emotional services are put into schools.
"We are looking also to see other benchmarks, see what other states are doing. But that's really where we are, and there are different approaches. In some districts, I know folks are preparing institutions for social workers, for example," she said, "But those are ongoing conversations ... it's going to get more focused as we determine where we're going to go in terms of the supports that we're providing in this very active conversation."
Expanding existing services
Addressing children's mental health was one of many issues legislators prioritized during the 2021 legislative session and continues to be top of mind as they prepare for the 2022 session.
One bill, which was signed by Gov. Ned Lamont, establishes suicide prevention training in local health departments. The training will be administered by the Office of the Child Advocate and the Youth Suicide Advisory Board once every three years starting next July. The legislation would also implement mental health training and education for health care professionals starting next year and would allow K-12 students to take up to two mental health days during the school year.
"My big, audacious goal is to ensure that all school buildings have the resources they need to provide comprehensive behavioral health, trauma-informed support to students and staff," Russell-Tucker said. "Recognizing we've got the data over decades, that there is a direct link between health and achievement. So we recognize we have to address those barriers to learning in order to make sure that kids can access the resources that's provided for them academically."
One piece of legislation that could address that school-based investment is Public Act 21-35 , which passed during the 2021 legislative session and establishes a task force to look at strategies to expand access to school-based health centers or expand school-based health center sites, including placing mental health clinics on school grounds as well.
"Prevention is a big word ... and yes, it's about school based mental health — a majority of schools in districts in Connecticut don't have school-based mental health," Sarah Eagan, the state's Child Advocate, told legislators during a children's mental health forum earlier this month. She added that the "actionable recommendations" for school-based health clinics that are supposed to come to the legislature through PA 21-35 at the start of the 2022 session is something important for the state to pay attention to.
The most recent results of an annual Department of Education survey show that students' needs for mental health services in schools had already increased when classes went remote in spring 2020.
Frassinelli explained the data show a lower response rate because the pandemic made it difficult to collect responses at the end of the 2019-2020 school year. Districts were surveyed during the 2020-21 school year as well, but the results will not be available until the new year, according to Eric Scoville, a spokesperson for the department.
The state education department is also continuing to work in partnership with the Department of Children and Families, the Department of Social Services and organizations like the Child Health and Development Institute (CHDI) to "increase the capacity to support students and staff in schools."
"There are a number of behavioral health providers that are working with districts," Frassinelli said. "What we want to be able to do is scale their work up so that there's an opportunity to provide additional supports through those behavioral health partnerships to support students and staff in the school districts."
Jeff Vanderploeg, CHDI president and CEO, and Jeana Bracey, associate vice president of School and Community Initiatives at CHDI, said they would like to see the state departments of Children and Families and Education work with districts across the state to fully expand Project AWARE. Both departments work to provide grant funding to the program.
Project AWARE screens students for social-emotional learning needs, links students with multi-tiered support and creates school-community partnerships for kids.
"What's important about the approach is that it goes beyond just guidance of what should be done," Bracey said, adding that things like addressing social-emotional learning and providing supports for behavioral and mental health should be happening already in schools, but this initiative dives further into how to implement and improve those resources.
"That's where the AWARE initiative is really beneficial and going above and beyond just sort of awareness of what's existing already, but how you actually implement and monitor that it's making a difference."
In addition to rolling out the DESSA system, Naugatuck is one of three districts using Project AWARE.
Tafuto, who is also the Project AWARE coordinator at Naugatuck Public Schools, said having resources through this initiative, which they've been using for nearly two years, was helpful for them when schools shut down in March 2020 because it allowed them to immediately prioritize their students' mental health needs.
"Last year when pandemic started, we were just kind of getting all of our universal supports up and running, so we didn't have any pre-data to kind of compare it to," Tafuto. "But what it did was allow us to then plan for how to support the kids. So had we not had Project AWARE in place and we didn't have the DESSA coming out and we didn't have the trauma groups available, we would have had to look for these things."
CHDI's Project AWARE team also developed a school mental health resource sheet that aligns with the state Department of Education's priorities for the second round of Elementary and Secondary School Emergency Relief (ESSER) funding and American Rescue Plan ESSER funds.
Most of the resources include various mental health training tools for school staff and how they can access and use services like mobile crisis as a collaboration as well as knowing how to identify youth who are having thoughts of suicide, showing warning signs and risks. Mobile crisis is an intervention service in Connecticut where teams of mental health workers will come to respond to behavioral health emergencies for children through the Department of Children and Families.
Between fiscal years 2017-2019, schools were the most common referral source to mobile crisis, according to CHDI's annual mobile crisis report. But that shifted when schools closed due to the pandemic the last 3-4 months of the 2019-20 school year and many schools implemented remote learning for a large part of the 2020-21 school year.
"Many schools in Connecticut are successfully using mobile crisis as an alternative to sending a student experiencing a behavioral health crisis to the emergency room," Vanderploeg said, adding that when a school or caregiver calls 2-1-1 for mobile crisis, a licensed clinical social worker will come directly to their location within an hour or less to "help stabilize a difficult situation" and address immediate care.
"They are also trained to assess whether a child needs to be admitted to an inpatient hospital bed or whether they can be safely cared for through community-based services.”
Ben Chaback, a school social worker at Dodd Middle School in Cheshire, stressed how important it is for families to know who they can turn to for help at their child's school because the first line of support can often be found there.
"What parents often don't realize is the team that they have at their school," said Chaback. "So a lot of times what I find is that when a child does some type of self-harm or expressing that they're depressed, they beeline for the emergency room or they get on the phone or call with their private therapist, which is OK, but it's really important for parents to learn who their team is at school because they have a lot of professionals at their disposal who could help within the educational setting."
In the Cheshire school system, he said, there's a team effort between social workers, counselors, therapists and teachers to ensure that a child's needs are being met both in and outside the classroom.
"As a school, the [pupil personnel services] department meets with the educational team at least once a week and goes over cases," Chaback explained. "And we will expect to maintain confidentiality, but if parent and student allow us to share with the team, which often they do, we'll share with [teachers] what's going on and they'll know, 'OK, I need to keep an extra eye on this kid. I need to provide them with less homework,' and stuff like that. So it really comes full circle."