By Leah Askarinam
January 13, 2016


Nearly forty per­cent of youth who needed men­tal health care between 2011-12 didn’t re­ceive the ne­ces­sary treat­ment, ac­cord­ing to the Chil­dren’s De­fense Fund’s 2014 State of Amer­ica’s Chil­dren re­port. For fam­il­ies liv­ing in poverty, that num­ber reached 45 per­cent, and for black and Latino chil­dren, it was 55 and 46 per­cent, re­spect­ively.

But schools may soon have more re­sources to change that.

In ad­di­tion to shak­ing up stand­ard­ized test­ing rules, the Every Stu­dent Suc­ceeds Act, the na­tion’s new fed­er­al edu­ca­tion law—the suc­cessor to No Child Left Be­hind—in­cludes fund­ing for schools to in­vest in the men­tal and be­ha­vi­or­al health of their stu­dents.

The new law au­thor­izes grants to the tune of $1.6 bil­lion. School dis­tricts that serve the highest con­cen­tra­tion of stu­dents liv­ing in poverty will be eli­gible for the most fund­ing, at least 20 per­cent of which must be spent on men­tal and be­ha­vi­or­al health ser­vices per dis­trict. No Child Left Be­hind had a nar­row­er fo­cus on men­tal health needs—namely through the Ele­ment­ary and Sec­ond­ary School Coun­sel­ing Pro­gram—which was a com­pet­it­ive grant awar­ded to se­lect school dis­tricts.

“We do a lot of work with su­per­in­tend­ents and prin­cipals, and they want it. They all say they want more [men­tal health] ser­vices,” said Kelly Vail­lan­court Strobach, dir­ect­or of gov­ern­ment and pro­fes­sion­al re­la­tions at the Na­tion­al As­so­ci­ation of School Psy­cho­lo­gists. “I’m hope­ful that some of this de­creased fo­cus on the im­port­ance of stand­ard­ized tests may al­le­vi­ate some of these chal­lenges be­cause prin­cipals might feel that they’re ac­tu­ally able to ded­ic­ate some more time dur­ing their school day to stu­dent well­ness.”

While Medi­caid and the Chil­dren’s Health In­sur­ance Pro­gram pay for coun­selors and ther­ap­ists for chil­dren that need more rig­or­ous treat­ment off-cam­pus, the new funds can help en­sure that schools teach stu­dents self-aware­ness and emo­tion­al self-reg­u­la­tion, and identi­fy when a stu­dent needs a re­fer­ral to re­ceive one-on-one treat­ment.

Stu­dents who live in poverty ex­per­i­ence a great­er de­gree of ad­verse ex­per­i­ences, which con­trib­utes to men­tal ill­ness, says Darcy Grut­tadaro, dir­ect­or of NAMI’s child and ad­oles­cent ac­tion cen­ter. They may deal with hous­ing in­stabil­ity, vi­ol­ence and food in­sec­ur­ity, for ex­ample, which could res­ult in long-term (men­tal) health con­sequences.
The Ad­verse Child­hood Ex­per­i­ences (ACE) study, a col­lab­or­a­tion between the CDC and Kais­er Per­man­ente, found that chil­dren who ex­per­i­ence or wit­ness ab­use, neg­lect or dys­func­tion at home are more likely to ex­per­i­ence not only men­tal health is­sues but also phys­ic­al dis­orders later in life. Par­ti­cipants who had ex­per­i­enced four or more ad­verse ex­per­i­ences were at great­er risk for de­pres­sion and sui­cide at­tempts, and for med­ic­al con­di­tions such as obesity and can­cer. The ACE ques­tion­naire asked par­ti­cipants about ad­verse ex­per­i­ences such as phys­ic­al ab­use, the loss of a fam­ily mem­ber, poverty, and emo­tion­al neg­lect.
“Kids in low in­come com­munit­ies have those ad­verse child­hood ex­per­i­ences stacked up against them, lit­er­ally,” says Grut­tadaro,
In­ter­ven­ing early can help chil­dren deal with those stresses, be­fore the symp­toms pro­gress to a point that re­quires in­tens­i­fied care. MaryLee Al­len, dir­ect­or of policy at the Chil­dren’s De­fense Fund, de­scribes men­tal health treat­ment as a con­tinuum: One end in­volves help­ing chil­dren deal with trauma, and the oth­er end in­volves in­tens­i­fied care, such as res­id­en­tial treat­ment. The stress and vi­ol­ence that chil­dren in poverty ex­per­i­ence, not a gen­er­al pre­dis­pos­i­tion to men­tal ill­ness, makes the be­gin­ning of that con­tinuum crit­ic­al.
“There’s just more stress in their lives,” Al­len says. “So, it’s im­port­ant that we un­der­stand the im­port­ance of emo­tion­al health, that we help them deal with that stress, and get them at a point where it’s not im­ped­ing their abil­ity to per­form in school and oth­er sorts of things.”
Early in­ter­ven­tion is something Deniece Chi’s daugh­ter might have be­nefited from. The single mom missed work at a nurs­ing home and then at a ca­ter­ing busi­ness to re­peatedly pick Lucy up from school for be­ha­vi­or is­sues be­fore the now 24-year-old’s bi­polar dis­order dia­gnos­is a dec­ade ago.
A New York pub­lic school nurse and loc­al clin­ic ini­tially linked Lucy with AD­HD, but it wasn’t un­til after she at­temp­ted sui­cide at age 14 that she re­ceived the of­fi­cial bi­polar dis­order dia­gnos­is.
Chi, who now works at the Na­tion­al Al­li­ance on Men­tal Ill­ness (NAMI) in New York City as pro­gram dir­ect­or, knew little about about bi­polar dis­order or the types of treat­ment that might help Lucy. She reached out to fam­ily mem­bers, who labeled her daugh­ter “crazy” and pegged le­ni­ent par­ent­ing as the source of her prob­lems. They sug­ges­ted that strict dis­cip­line was the solu­tion.
Look­ing for in­form­a­tion about men­tal health dis­orders, Chi called the NAMI-NYC helpline, where she learned about bi­polar dis­order in de­tail for the first time. The NAMI rep­res­ent­at­ive ex­plained that Chi was not to blame for her daugh­ter’s symp­toms—and that her daugh­ter wasn’t to blame for her own symp­toms, either.
“If it’s not my fault, if it’s not her fault, what is it?” Chi asked. “And he star­ted ex­plain­ing to me what men­tal ill­ness really is.”
Schools as Men­tal Health Re­sources
NAMI walked Chi through op­tions for treat­ment and sup­port.  She was able to send her daugh­ter to one-on-one ses­sions through a New York State sponsored health care plan, too. Even­tu­ally, she star­ted teach­ing classes to fam­il­ies and pro­fes­sion­als about the iden­ti­fi­ers of men­tal health dis­orders, hop­ing they could bring those les­sons to their com­munit­ies. Chi nev­er re­ceived that type of in­form­a­tion from a hos­pit­al or from her daugh­ter’s school, so she wants schools to re­ceive train­ing.
“Chil­dren spend most of the day at the school,” Chi said. “So, if you have a guid­ance coun­selor or so­cial work­er who doesn’t know how to ex­actly identi­fy the symp­toms of men­tal ill­ness or what it looks like, when the child starts act­ing out, or starts act­ing out the way my child was act­ing out, they as­sume it’s something the par­ents did, or something in the home, or something is not right.”
Kam­i­l­ah Jack­son, a child and ad­oles­cent psy­chi­at­rist in Phil­adelphia, hopes more schools will con­sider a tiered men­tal health sys­tem, with train­ing to help teach­ers un­der­stand be­ha­vi­or­al health at the ba­sic levels and more in­tens­ive ap­proaches for stu­dents who re­quire it. While that top tier, which could en­tail one-on-one ther­apy, may re­quire a re­fer­ral to a pro­fes­sion­al out­side of the school set­ting, school per­son­nel can help with the lower tiers and with is­su­ing re­fer­rals for that top tier.
When school dis­tricts are de­cid­ing how to use these funds, Jack­son sug­gests that they con­sider how to en­sure that every edu­cat­or un­der­stands the ba­sics of be­ha­vi­or­al health, which many teach­ers do not learn from their train­ing.
“I hear this all the time from teach­ers: ‘Nobody pre­pares me for what I walk in­to, when I walk in­to a classroom with 30 kids who are in and out of their seats, and I have no idea where to start.’ So, I think it’s really clear that the so­cial and emo­tion­al part of train­ing for edu­cat­ors has not been on the radar at all,” Jack­son says.
Low-in­come Chil­dren to Be­ne­fit Greatly
Un­der Title I, school dis­tricts already re­ceive some fund­ing for stu­dents from low-in­come fam­il­ies which can go to­ward men­tal health re­sources. But a re­cent re­port from Brook­ings In­sti­tu­tion noted that 81 per­cent of prin­cipals spend those funds on pro­fes­sion­al de­vel­op­ment. At schools with high­er rates of poverty—those which served more than 75 per­cent of stu­dents free and re­duced-price meals—more than 90 per­cent of prin­cipals re­por­ted spend­ing their funds on pro­fes­sion­al de­vel­op­ment.
Michelle Malvey, a prin­cip­al at an ele­ment­ary school that re­ceives this fund­ing in Love­land, Col­or­ado, de­cided to take a dif­fer­ent ap­proach. Her school be­came eli­gible for a school-wide Title I pro­gram this year, mean­ing more than 40 per­cent of stu­dents qual­i­fy for free or re­duced-price meals. She used those funds to ex­tend the hours of her half-time coun­selor to full-time. She said that the ad­di­tion­al hours cost more than pro­fes­sion­al de­vel­op­ment, but that in­vest­ing in staff ded­ic­ated to men­tal health was para­mount.
“We can have all the pro­fes­sion­al de­vel­op­ment in the world, but we can’t ap­ply it in the classroom if we don’t have kids who are there with us, if we don’t have this safe, in­clus­ive learn­ing en­vir­on­ment,” Malvey said.
Through a grant and an agree­ment to pi­lot a new pro­gram, Malvey im­ple­men­ted a cur­riculum based on her stu­dents’ so­cial and emo­tion­al needs. In­stead of send­ing stu­dents who demon­strate dis­rupt­ive be­ha­vi­or to the of­fice, for ex­ample, staff mem­bers go to their classrooms and sit with them so that stu­dents can re­main in an edu­ca­tion­al set­ting. The school also al­loc­ates 20 minutes daily to a so­cial and emo­tion­al health cur­riculum, and the men­tal health staff meet with Malvey weekly to dis­cuss ex­ist­ing stu­dent men­tal health is­sues.
Though Malvey said the school-wide at­ten­tion to men­tal health has re­duced the need for one-on-one ses­sions between stu­dents and coun­selors, there are still bar­ri­ers for stu­dents with men­tal health dis­orders that re­quire in­di­vidu­al­ized at­ten­tion. While the cur­riculum sup­ports so­cial and emo­tion­al health, it does not provide clin­ic­al ther­apy for stu­dents who may need it. School-wide cur­ricula and set­tings that sup­port self-aware­ness and self-reg­u­la­tion may pre­vent a num­ber of stu­dents from reach­ing the point where one-on-one in­ter­ven­tion be­comes ne­ces­sary, and edu­cat­ors who re­cog­nize the symp­toms of men­tal ill­ness can is­sue re­fer­rals for re­sources out­side of school be­fore symp­toms be­come dif­fi­cult to man­age.
“When I came in, I was the third prin­cip­al in three years, so there was a lot of work to be done cul­tur­ally with the staff and kids,” Malvey said. “And so, we’re over a 50 per­cent re­duc­tion in dis­cip­line. If you look at things like in-school sus­pen­sions and out-of-school sus­pen­sions, that’s prob­ably a 75 to 80 per­cent re­duc­tion. We’re just not hav­ing it at the level where a stu­dent would need to be re­moved from the learn­ing en­vir­on­ment, which is what we want.”