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How do Southeastern NC schools deal with mental health?

Star-News - 3/17/2018

March 17--SOUTHEASTERN N.C. -- By age 16, children are weighing decisions that affect the rest of their lives.

How they perform in school, where they'll go to college, if they'll get a job, what kind of person they want to be -- these questions put major stress on the mind. What if that stressed child is also bullied? What if she feels alone? What if he struggles with an undiagnosed mental health condition?

How do those factors affect a child's capacity to hurt himself, or others?

"Being a young person is difficult," said Tanya Jordan, counseling supervisor for New Hanover County Schools. "If you couple that with a child that may be anxious, that may be depressed, that may be suffering from grief or loss of a loved one, that may be in a family situation that may be volatile, there's a lot of things that a child can experience."

In the month after the school shooting in Parkland, Florida, the nation is once again in heated debate over school violence. Schools, including those in Southeastern North Carolina, are zeroing in on the factors they can address -- on-campus security measures and student mental health.

At a recent round table on school safety, New Hanover County Chief District Court Judge Jay Corpening said mental health care is a critical part of protecting students from violence.

"You can harden schools as much as you want, you can put as many cameras in the schools as you want, you can put as many (school resource officers) in the schools as you want," Corpening said. "But until you take care of what's inside the walls, schools aren't going to be safe."

By the numbers

No matter what public school your child attends in New Hanover, Brunswick or Pender counties, there are mental health professionals there for her. But the number and types of resources available are not always the same.

Every school in the region has at least one guidance counselor, while middle and high schools often have two, three or four. Schools also share school psychologists: seven each in Pender County Schools and Brunswick County Schools. School psychologists often provide more intensive intervention services than counselors, including referrals to outside health care. School staff, even those not directly involved with mental health care, in all districts get training on student safety protocol and recognizing the warning signs of harmful behavior.

New Hanover County Schools -- at 26,000 students the region's largest district -- has several layers of mental health services.

In addition to 69 counselors and 48 social workers, the district's school psychologist page lists 16 staffers for 47 schools. At the elementary and middle school level, 13 additional clinical therapists provided by the New Hanover County Health Department split their time between 19 schools. Wilmington Health Access for Teens (WHAT) also has an on-campus clinic with mental health services in all four traditional high schools.

"We have therapists in the school for school-based mental health, which is awesome for students because it gets them a chance to assess their needs without having to take time off," Jordan said.

WHAT's parent organization Coastal Horizons also contracts with all three school districts for additional care, as to other mental health organizations.

Robbie Cauley, director of student services at Pender County Schools, said the amount of students a counselor works with varies widely by school.

"There's no such thing as an average caseload," Cauley said. "There may be a school with 500 students in it and one counselor, so their caseload is that entire student body, and that's pretty typical across North Carolina."

But school officials cannot make mental health diagnoses, often needed to secure treatment, medication, or money for both through Medicaid or private insurance.

New Hanover County Health Director Phillip Tarte said when school staff meet with a troubled student, a key step is creating a safety plan that often includes referrals to off-campus mental health care.

"If they can, they plug them into other services such as psychologists or psychiatrists," he said. "We have school nurses in each one of our schools as well, and it gives us another set of professionals to interact with these kids before they become teenagers, when they're most vulnerable."

Assessing the risks

What makes a child more likely to hurt herself or others? Schools actually have roadmaps for finding those answers.

New Hanover County Schools, for instance, uses different protocols for potentially suicidal or homicidal students. There are two versions of each, one for students with average cognitive skills and one for low cognitive skills, which can include kids with special needs or young students.

Students at risk of suicidal behavior are evaluated using the Columbia-Suicide Severity Rating Scale, developed at Columbia University. The scale is a detailed, three-page worksheet that a school social worker or counselor fills out with the child. There are questions like, "Have you done anything to harm yourself?" and, "Have you wished you were dead or wished you could go to sleep and not wake up?"

The form has spaces to note if a child has been abused, has a chronic medical condition or family history of suicide. It also accounts for positive factors, like whether she can name reasons for living, or has supportive friends and family.

If school staff determine a child has moderate or high risk of suicidal behavior, they call in her parents to talk about next steps. In some cases, the child will not be able to return to school until she has clearance from a licensed mental health professional.

For possibly homicidal students, NHCS uses a protocol developed at the University of California, Berkeley. The Berkeley form guides school officials through questions about how a student might hurt others, whether she's hurt people in the past and what stops her from hurting people. Students are ranked on a 0-to-10 risk severity scale, connected with a support plan and crisis intervention resources.

In the most serious cases where a threat has been made, law enforcement is called.

"They also are required to see a licensed mental health professional as well, but of course with that type of threat it's kind of a case-by-case basis as to next steps," Jordan said. "We have to work with law enforcement."

Is it enough?

The National Association of School Psychologists recommends one school psychologist per 700 students. The average for North Carolina schools is one per 2,100 students, according to the N.C. School Psychology Association (NCSPA).

NCSPA President Heather Lynch Boling said the organization is currently compiling district-by-district ratio data. Based on staffing numbers from the districts, the ratios in New Hanover, Brunswick and Pender schools would be as high as 1,625-to-1, 1,785-to-1 and 1,270-to-one, respectively.

Boling said that statewide, there are just 740 school psychologists; 12 of the state's 115 school districts have zero.

School psychologists' responsibilities fall under what's called the Multi-Tiered System of Supports (MTSS), which includes helping kids succeed academically as well as behaviorally. In districts with just a few school psychologists, staff only have time to focus on the academic component of MTSS or "putting out fires" on the behavioral side.

"That requires a lot more staff because that means that you need to be a part of that community -- you're housed at the school or you're housed at a few schools and you're not just going in to do this very finate task," she said. "We really would rather spend that time on the preventative end, and that also helps more kids. When we're just working in reactionary mode, we have to work with one kid at a time."

On Wednesday, the NCSPA will be presenting at a meeting of the North Carolina School Safety Committee at the N.C. legislature, formed in response to Parkland.

"Sometimes it takes a very big societal crisis to realize there's a gap between our kids and our services," Boling said.

Students in more rural areas also have a harder time accessing mental health care outside of school.

"You can always use more," said Meredith Lloyd, who oversees counselors for Brunswick County Schools. "As needs increase in our community, the needs increase within our schools."

Melissa Quinlan, director of BCS's Exceptional Children Program, said students in places like Ash or Supply -- even Southport -- have a longer trek to psychiatrists offices than students in Leland.

"Our families don't have access to transportation, or they don't have money to pay for gas for transportation," she said.

Jordan, of NHCS, said the need for school mental health care is significant. But she said Southeastern North Carolina schools have stepped up their resources significantly in recent years, even as students in need struggle against the stigma of asking for help.

"I think the world is changing in a way that mental health needs are great, and fortunately the awareness of those needs is great," Jordan said. "Mental health is important, that's health. And just like if we saw a child with a broken arm, we wouldn't turn our heads and do nothing."

Mental health staff

New Hanover County Schools

* Counselors: 69

* School psychologists: 16

* Social workers: 48

* Clinical therapists (provided by county): 13

Brunswick County Schools

* Counselors: 30

* School psychologists: 7

* Behavioral specialists: 7

* Social workers: 5

Pender County Schools

* Counselors: 21

* School psychologists: 7

*Does not included all contracted staff from outside mental health care organizations

Sources: New Hanover County Schools, Brunswick County Schools, Pender County Schools

Reporter Cammie Bellamy can be reached at 910-343-2339 or Cammie.Bellamy@StarNewsOnline.com.

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