School-Based Mental Health and the Achievement Gap

According to a recent report issued by the General Assembly’s Legislative Program Review and Investigations Committee, “Students enrolled in a school-based health center gained three times as much classroom seat time as students not enrolled, and SBHCs significantly reduced the number of early dismissals from school in comparison with students who received school nursing services alone.”

The Feb. 22 report is titled “Adolescent Health in Connecticut: RBA Project 2011.” About half of this very thorough and timely study focused on the impact of school-based health centers in Connecticut. According to the report, there are currently 71 state-funded school-based centers in our state, most of which serve as natural medical homes for students of all ages, providing free primary care and mental health services.

Not surprisingly to those of us who work with children every day, the top reason for visiting a school-based health center in all four years of the study’s span was for mental health concerns, which represented about a third of all visits. Based on a 2009 survey that was cited in the report, 78% of students felt using the center improved their overall health, 34% said their condition would have worsened without such a center in the building, and 18% stated that they would have likely stayed home if care was not available in school. An impressive 92% of adolescents receiving services from a school-based health center returned to class the same day.

In other words, the report indicates that emotional-behavioral problems represent the most common reason for referral; the centers help children overcome barriers to receiving mental health services; and the mere presence of such a facility can boost school attendance. There is also compelling and robust evidence from other states indicating that the presence of a school-based health center can improve school climate and reduce stigma surrounding mental health problems. Moreover, the use of these centers has been shown to be associated with improved academic performance among students who use them.

These health centers represent a “sweet spot” in our quest to help children: They are housed in their natural environment, the school building; they represent obvious and accessible “medical homes”; they improve health and developmental outcomes; and they boost academic achievement. There are few places in the budget where $1 goes such a long way.

Recognizing the powerful role of these centers among children, families and the educational system in general, the Appropriations Committee recently recommended to increase the number of school-based health centers to 92 in Connecticut.

To further enhance the impact of the newest centers, the Appropriations Committee astutely called for 20 new facilities to be placed in the 10 educational reform school districts as identified by the State Department of Education. So, while the broader education reform measures are being debated, we can be assured that there is already something in place to help support learning and development among our neediest students.

There are an estimated 120,000 students in our state with diagnosable and treatable mental health problems, ranging from mild anxiety and depression, to disorders that severely impair functioning.

Unfortunately, only about 20,000 of these students can access the appropriate clinical services, leaving about 100,000 Connecticut students and their families with little or no help. Remarkably, about 75% of all child mental health services are delivered in school buildings. That’s right: for most kids, the school system is the de facto mental health system.

Schools and their staff are already facing an uphill battle. We are piling more and more expectations on schools: teach our students critical thinking skills, prepare them for standardized tests, act as surrogate parents, keep them physically safe. Now we expect overextended teachers and staff to deliver comprehensive mental health services?

Connecticut is not the only state struggling with this issue. On April 8, the New York Times ran a story titled “Keeping Students’ Mental Health Care out of the E.R.”

The delivery of mental health services to children in schools makes sense, but it has to be a collaborative effort that includes all stakeholders in child mental health. On Jan. 25, Commissioner Stefan Pryor of the education department and Commissioner Joette Katz of the state Department of Children and Families appeared side-by-side to exchange ideas with family, community and school representatives at Connecticut’s first-ever School Mental Health Forum held at the Church Street Elementary School in Hamden.

Organizers expected about 50 people to attend this event, which was aired by CT-N. Instead, about 170 filled the school gymnasium, and other notable attendees included House Majority Leader Brendan Sharkey, D-Hamden, Rep. Jonathan Steinberg, D-Westport, Fred Volkmar, M.D., chairman of the Yale Child Study Center, James Comer, M.D., a nationally recognized pioneer in school mental health and director of the Yale School Development Program, and Sharon Stephan, Ph.D., director of the Center for School Mental Health at the University of Maryland.

The forum, organized by the Children’s Committee of the Keep the Promise Coalition (aka KTP Kids), included presentations from several organizations working collaboratively with schools to enhance the mental health care of students. KTP Kids is Connecticut’s largest advocacy coalition of stakeholders in child mental health; school mental health is currently among our top priorities.

On April 16, the Connecticut Juvenile Justice Alliance and KTP Kids sponsored a screening of the documentary “Education vs. Incarceration” at the Legislative Office Building in Hartford. The event, which was attended by many key lawmakers, helped to underscore the risks of waiting too long to address the mental health concerns of students. About 70% of children in the juvenile justice system have a diagnosable emotional-behavioral disorder. There is plenty of evidence to show that their lives would have been much different if they had been able to access appropriate services and supports earlier in life.

On the following day, the Achievement Gap Task Force organized a Community Schools Roundtable, which brought together experts and advocates from different fields, including mental health, in the name of collaborating to boost developmental and academic outcomes for Connecticut’s students.

The leadership of the State Department of Education leadership deserves praise for recognizing the importance of reaching out to all stakeholders who are passionate about the wellbeing of our children, and recruiting us to work together to help shrink the academic achievement gap of our state’s students.

We all still have a lot of work to do: in Connecticut, about 2,000 students miss school daily because of the effects of bullying, and 1 in 14 high school students attempted suicide in the last year.

On the other hand, this is shaping up to be an exciting and promising time for those of us hoping to enhance mental health services for children in schools. To those of you who are making this possible: thank you. Please continue to do all that you can to stay focused on this critical issue.

 

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