This story appeared first in the Sunday edition of the Wisconsin State Journal newspaper.

With nearly one in six students exhibiting mental health problems and fewer specialists to monitor their behavior, Madison school and community leaders are launching new efforts to better treat student mental health.

The Madison school district is expanding services this fall, and Superintendent Dan Nerad is calling for a task force from the broader community, including health care providers, to review the issue and devise solutions.

“The need far outweighs the resources that are currently available,” Nerad said.

Local experts say untreated children’s mental health problems such as depression, anxiety and post-traumatic stress can result in lower academic performance, higher dropout rates, and more classroom disruptions, truancy and crime.

The problems are often exacerbated by childhood trauma related to poverty, domestic violence and substance abuse. Madison’s growing number of low-income students, who account for two-thirds of those exhibiting mental health problems, also face barriers to accessing mental health services, local experts and advocates say.

Last week, the Madison School Board approved spending more than $500,000 next year to expand services and try two new programs at Whitehorse Middle School. Approval came only after several board members questioned whether the new approach would eventually cluster troubled students into a handful of middle schools and retreat from the district’s commitment to inclusive education.

Nerad said the new approach in schools stems partly from staff reductions, including cuts of 165 special education positions in the past 10 years. Meanwhile, the district has added about 9 social workers and psychologists in the past five years.

‘Constellation’ of problems

The district’s new programs are designed to help students like Michelle Hicks’ daughter, a sixth-grader diagnosed last year with psychosis who is already in an alternative school program.

In the past, Hicks said, her daughter has hit teachers, climbed out of windows and tried to drown herself. This past semester, she was suspended twice: once for threatening a student with a putty knife and again for slamming a staff member’s hand in a door and locking herself in the school office.

Hicks said her daughter’s father has been in prison for nearly her entire life and her older brothers and classmates bullied her. The girl was diagnosed with epilepsy at age 2 and medicated for anxiety, attention deficit and mood disorders beginning at age 7, Hicks said.

Should Hicks’ daughter receive services under the new Whitehorse programs, she would receive them at one school, where officials said she would have closer connections with counselors and peers. Last year, she split time between Whitehorse and a special program at Shabazz City High School.

Though Hicks’ daughter may have more problems than most, many students have a similar “constellation” of problems that can affect their mental health and behavior, said John Harper, who oversees special education services for the School District.

“That’s the vexing issue,” Harper said. “How do you effectively intervene when a student has a multitude of serious factors that by most people’s standards would impact learning.”

Mental health has long been considered something to treat when it manifests itself as a disorder such as schizophrenia or severe depression. But now, experts recommend screening people before a mental health disorder develops, similar to how the focus on physical health has shifted from treatment to wellness and prevention, said Lisa Jaycox, senior behavioral scientist at RAND Corp., a global research organization.

Outside of the doctor’s office, schools are seen as being in a key position to identify students who may show signs of a mental health problem. Nerad and others say they need to improve services to students with mental health disorders to help their learning, minimize disruptions in the classroom and keep schools safe.

Students, counselors surveyed

Madison has been at the forefront of screening student mental health, Jaycox said. In the 2004-05 school year, the district started surveying sixth-graders annually for trauma-related distress, becoming one of the first in the country to do so.

The survey, which is more commonly used in populations affected by natural disasters or community violence, screens students for symptoms of depression and post-traumatic stress disorder based on a short questionnaire. In the 2010-11 survey, 31 percent of Madison sixth-graders tested positive for such symptoms.

In addition, the district has surveyed school psychologists, social workers and counselors twice in the last five years about student mental health. In the most recent survey, from 2009-10, respondents identified about 16 percent of students as having one or more mental health problems, ranging from depression, attention deficit disorder and autism to “conduct concerns” like bullying and exhibiting multiple “oppositional” traits such as being spiteful, temperamental or argumentative with adults.

Comparable data aren’t available at the state or national level. But a 2009 national study found 12 percent of students received treatment or counseling for a mental health problem, while 20 percent of state students that year reported feeling sad or depressed each day for two weeks or more in the previous year. The 2009 Dane County Youth Risk Assessment found 14 percent of respondents said they had a long-term mental or emotional health disorder.

Nic Dibble, a school social work consultant for the Department of Public Instruction, said studies have found children who grow up with traumatic experiences have different brain development than other children.

“It undermines their ability to learn, form relationships and to have functional performance in the classroom,” Dibble said.

Ideas to help students

Adolescent mental health has been a topic of discussion in Dane County for years, but efforts to improve access to treatment, especially for the area’s growing low-income population, have emerged only recently.

Last month, the United Way of Dane County issued recommendations to improve access to mental health services for children, adults and seniors, and tabbed Dr. Ken Loving, CEO of Access Community Health Centers, to lead a group that will implement changes.

One goal is for primary care doctors to have behavioral health psychologists on staff to assess a patient’s mental health during routine checkups or sick visits, a model that Access Community Health uses.

Another goal is to connect patients with psychiatrists, which can be difficult because of the stigma many still attach to psychiatric treatment and because some psychiatrists won’t accept patients on Medicaid.

Dr. Randall Cullen, a Madison psychiatrist with 26 years of experience, holds Saturday sessions to meet demand, including students brought in directly by teachers and guidance counselors.

“Much to my surprise, I started getting calls from people saying they called six, seven or eight places and none of them would take (Medicaid) patients,” Cullen said. “There’s an undertow of desperateness out there and without the personnel to see the kids, there’s no easy, quick answer.”

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A 2009-10 survey of school staff found 20 percent of middle school students exhibited mental health problems. Next year, the district will try a new program at Whitehorse Middle School, which had the highest incidence of mental health concerns. The Whitehorse program and other changes are expected to cost $524,344 next year.

CURRENT PROGRAMS

Cluster: Half-day program at Sherman Middle/Shabazz City High School for special education and general education students with more severe behavioral or mental health problems. Students spend other half of day in community program or at home attendance area school. Sixteen students in two classrooms. Cost: $206,875.

NEON: Half-day program at Hoyt school for students with an emotional behavioral disability. Students spend other half of day in their home attendance area school. Maximum enrollment of 16 students. Cost: $522,840 plus transportation.

REPLAY: One semester program for seventh- and eighth-graders who have been in the juvenile court system. Cost: $79,915.

2011-12 CHANGES

Cluster: Eight students; two fewer staff positions. Cost: $126,960.

NEON: Expansion to full-day program with the addition of a second, yet-to-be-determined site. Students would transition back to their home attendance area school gradually. Cost: $614,551 plus possible lease of non-school district space.

REPLAY: No changes.

New school-based alternative: Students with emotional behavioral disabilities in La Follette area would attend full-day program at Whitehorse. Maximum enrollment of eight students. As behavior improves, students would transition back to home attendance area school or into Whitehorse. Cost: $219,860.

New transition room: Students with behavioral or academic problems would be educated in a separate classroom with performance reviewed weekly for transition back to general education classroom. Maximum enrollment of up to 16 students per year with smaller, fluctuating daily enrollment. Cost: $212,773.