Taking care of mental health at school

Back to school can be stressful: Teachers have to prep for a new batch of students, parents have to gather school supplies and figure out schedules, and kids have to say goodbye to the freedom of summer and get back into a regular routine.

School-Based Health Center open to all

One Community Health opened its first School-Based Health Center (SBHC) at Hood River Valley High School in 2015 and it is available for all students living within the Hood River County School District. The center is open 8 a.m. to 5 p.m. while school is in session, following the school district’s annual calendar.

SBHCs are public-private partnerships between the Oregon Public Health Division and a county or school district, OHA states. These health centers are all located either within a school or on school property.

While One-Community Health primarily offers physical health care, the SBHC also offers behavioral and mental health counseling – all regardless of insurance.

“SBHCs serve children and youth even if they don’t have insurance or can’t pay,” Oregon Health Authority states, “SBHCs can bill Oregon Health Plan and often bill other insurance.”

For non-emergency help outside of school, contact MCCFL at 541-386-2620 (Hood River) or 541-296-5452 (The Dalles) or visit http://www.therap... to find a private practitioner. HAVEN, which primarily serves survivors of sexual violence, has a non-emergency line at 541-296-1662.

The Hood River Mental Health Department, 541-386-2620, offers information on behavioral health and available resources in the area.

In an emergency, 24-hour crisis lines are available at MCCFL (1-888-877-9147), HAVEN (541-298-4789), and Youthline (887-968-8491), which also offers texting service between 4-10 p.m. (send “teen2teen” to 83986) and online chat at OregonYouthLine.org.

While teachers ready their academic curriculum, school counselors work to help kids with another important subject: Mental health and emotional learning.

Calum Robertson and Kate Hagner, counselors at Colonel Wright Elementary and Dry Hollow Elementary, respectively, go between classrooms teaching units on bullying and other emotional health issues; but a large part of their jobs is to help individual kids with social or behavioral issues.

“We’d rather help a kindergartener or a first grader learn to self-regulate than a high school student,” Hagner said, commenting on the social costs bad behaviors can have for kids as they grow up. These behaviors can also have academic costs, Robertson said, “if they get behind early on, then they’re always behind academically, so that’s a difficult road to go on,” he said.

“If we’re not addressing (the issues) now, then they’ll just get bigger and bigger and bigger…and then I think you start seeing more serious signs in middle school and high school …” Robertson added.

Part of Melissa Bentley’s job as a counselor at Hood River Valley High School (HRVHS) is to keep an eye out for those signs as they manifest.

When asked what changes she’s noticed in her years at HRVHS, Bentley said that she has noticed an increase of anxiety, depression and suicidal thoughts among her students, as well as an increase in students and families wanting help for those issues.

According to studies published by the National Institute of Mental Health in November 2017 (the most recent data available), 20 percent of youth ages 13-18 live with a mental health condition and 50 percent of all lifetime cases of mental illness begin by age 14, 75 percent by age 24. Suicide is the third leading cause of death in adolescents ages 10-24 and 90 percent of those who died by suicide had an underlying mental illness.

On average, the delay between the onset of symptoms and intervention is 8-10 years.

“School is a resource and a partner in this,” Bentley said, “we are there for the whole child.”

Like all school staff, a school counselor’s job is to help kids be as successful as possible, which for Bentley, means helping students in many different aspects of their school lives.

Bentley is entering her seventh year as a counselor at HRVHS and though she’s worked with all grades in the past, she’ll be primarily working with the freshman class this upcoming school year.

During the fall semester, she focuses on getting the students scheduled for classes and orienting them to their classrooms and the high school setting, as well as helping them with study strategies.

Year-round, most of Bentley’s job is to help students with forecasting, post high school planning and goal-setting, as well as keeping an eye out for students who are struggling with their grades or attendance.

For these kids, Bentley said, she’ll work with the student to put together an intervention plan and arrange regular check-ins.

“I think it just really helps students to know that someone is watching them and caring and holding them accountable,” she said.

While academic and attendance issues can be judged by looking at data, mental health issues often require someone to disclose that there is an issue.

In her experience, Bentley said, middle school teachers often let her know when an incoming kid has something going on. Parents, the student’s high school teachers — and even the students themselves — have also disclosed problems to Bentley in the past.

Bentley said she is very involved in the inner-workings of her school, attending events and acting as the adviser for several clubs, to build trusting relationships with the kids.

“I try to go into as many classes as I can,” she said.

Both Robertson and Hagner try to be as present in school activities as possible, so they can get to know the kids well enough that they can notice when something is wrong.

“I’ll be walking down the hallway and I’ll see a kiddo who’s normally happy and smiley and they look really down, so I make a note ‘I need to check in to see what’s going on there,’” Hagner said.

When interacting with kids, she emphasizes teaching them how to deal with big or negative emotions rather than discouraging those emotions.

“I think a lot of kids think that when they do something bad, that means they’re a bad kid,” she said, “I think that children need to know that they’re accepted for who they are, and they’re loved, and it’s okay to have these big feelings.”

Both Hagner and Robertson keep lists of kids that they regularly check in on and provide one-on-one counseling, help with skill-building and “friendship groups” specifically for students having trouble making friends.

“It’s all about slowing things down for them,” Robertson said.

School counselors are often unequipped to handle major mental health issues, so when they come across students who need more support than the school can offer, Robertson, Hagner and Bentley help connect families with outside resources.

Mid-Columbia Center for Living (MCCFL) in particular works closely with schools in Wasco, Hood River and Sherman counties and is the designated behavioral health agency for those counties, receiving some funding through state and local government programs.

The center offers family services such as substance abuse counseling, diagnosis and assessment, outpatient therapy and crisis services at its offices in Hood River and The Dalles. It also offers wraparound services for youth and families involved in multiple systems.

“It’s designed to help families who are involved in multiple systems navigate those systems better,” said Tyson Rittenmyer, the clinical supervisor of MCCFL’s Family Services department.

Though referrals rarely follow the same formula, schools often send MCCFL a call or written referral explaining the nature and urgency of their concerns for the child in question. Those referrals then go to MCCFL’s referral specialists, who reach out to families to schedule an assessment. Other times, the responsibility of reaching out to services falls on the parents.

But referrals don’t necessarily mean treatment, as Robertson and Hagner know all too well.

“We can make the referral, but whether or not the parents follow through and make it, whether the people we make the referral to are able to reach out and help coordinate that process… we see there’s a big gap there, from us seeing the need to the students getting the support,” Robertson said.

MCCFL has two outpatient therapists and a family coach in Hood River and four outpatient therapists in The Dalles. On a typical day, each spends roughly four to five hours in individual appointments, which typically last 50 minutes a session — though they can last up to three hours in more intensive cases. They also have a child psychiatrist managing prescription medication, who goes between the center’s Hood River and The Dalles offices.

“I’ve had a lot of parents come to me and say they tried calling these places and no one is accepting any more clients, and so I’ll give them a couple more names to try and hopefully that works out,” Hagner said, “but like Cal (Robertson) said, we can recommend and refer, but we can’t drive the child to the appointments. It would be lovely if we could, but we can’t really ensure that they are going to get to be seen.”

Bentley is grateful to be in a position where she can physically walk her kids to a health center, introduce them to the staff and help them make those first appointments.

“That (the health center) has been huge,” Bentley said.

In her years at HRVHS before the health center opened, Bentley said that families were largely left to figure out treatment options on their own, and those options largely relied on the parents’ insurance.

One of the resources she offered — and still recommends — was the website Therapy in the Gorge (therapyinthegorge.com), which serves as a consolidated list of private mental health providers on both sides of the river, including their specialties and what insurance they accept.

MCCFL primarily serves Oregon Health Plan recipients, Rittenmeyer said, and will often work with Moda Health, but does not accept most private insurance. The center can also offer reduced fees based on a sliding fee scale and some grant supported services can be offered at zero cost.

“No individuals will be denied behavioral health care services because of an individual’s inability to pay,” MCCFL states on its website.

Starting this school year, MCCFL will have dedicated clinicians for schools in Wasco and Hood River counties as part of the center’s outpatient program.

MCCFL had one clinician last year who served a couple of schools in both counties “and it just proved to be too much for one person, but very well received,” Rittenmeyer said, “so, the need is there.”

Hiring began last February and coordination continues throughout the summer.

As of early August, Rittenmeyer said, MCCFL has hired two clinicians to serve schools in the Wasco County School District: One clinician to work between The Dalles Middle School, Maupin School, and the three Wasco County elementary schools: Chenowith, Colonel Wright and Dry Hollow; and a second specifically assigned to The Dalles High School.

“We don’t have that amount of coverage for Hood River, but we’re currently hiring,” Rittenmeyer said.

The clinicians at the Wasco County schools should be ready once kids start school again in a few weeks. Meanwhile, Robertson, Hager and Bentley are getting ready to meet the latest batch of kids and the School Based Health Center at HRVHS is getting ready to reopen its doors for the first day of school Sept. 4.

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