When Jeffrey J. Vanderploeg goes to national conferences and talks about the mental health services available to children and adolescents in Connecticut, his counterparts from across the country let him know how the state compares.
“We’re sort of the envy of most other states because we have so many intensive, in-home, evidence-based practices,” said Vanderploeg, associate director of the Connecticut Center for Effective Practice at the Child Health and Development Institute of Connecticut.
Even so, the vast majority of Connecticut youth with mental health problems don’t get the help they need, according to Vanderploeg and his colleagues in a report released Monday by the Child Health and Development Institute.
Based on national figures, the authors projected that 160,000 children and adolescents in Connecticut — one in five — have mental health issues, and that only about 20 percent can access the care they need. That leaves about 125,000 with unmet needs.
The report focuses on the role schools play in addressing children and adolescents’ mental health needs, and recommends an expanded approach. It notes that failing to meet students’ mental health problems can lead to poor academic performance, classroom disruptions and young people ending up in the juvenile justice system rather than receiving treatment.
“Children receive mental health services in schools more frequently than any other setting,” the authors wrote.
But they also wrote that there’s uneven access to mental health providers within schools, and inconsistent links to community-based mental health services that could help students. About 15 percent of the state’s school districts don’t have a social worker on staff, according to the report.
In addition, they wrote, teachers and other school staff often don’t have the knowledge or support to manage the mental health needs of students without resorting to suspension, expulsion or arrest, which can leave already vulnerable students at greater risk of dropping out.
Post-Newtown focus on mental health
Some of the report’s findings echo those voiced during public hearings about mental health that followed the massacre at Newtown’s Sandy Hook Elementary School. And some of the recommendations are reflected in legislation passed this year, including a requirement that schools, mobile crisis service and community mental health providers develop formal agreements.
The authors also recommended developing a comprehensive, state-wide system for expanded school mental health, following a framework that emphasizes the ability of all families to get care and coordination between school and community programs.
“Schools need to have enhanced internal capacity to take on the kinds of mental health issues that they see,” Vanderploeg said. “And secondly, I think they need to better connect to their really robust community-based mental health system that’s available in their community.”
School mental health services limited
Many experts point to school-based health centers as a way to improve students’ access to mental health services. But the vast majority of Connecticut schools don’t have them.
Bert Plant, chief clinical officer at Wellmore Behavioral Health and a former official at the state Department of Children and Families, said the school-based health center model has worked well. Since the clinics often provide both medical and mental health services, going into one doesn’t carry the stigma that walking into a mental health office might.
“Oftentimes you find, particularly in younger kids, they go to the nurse for a stomach ache and what’s behind the stomach ache is anxiety or depression or trauma or something else,” he said.
But Plant said one limitation of school-based clinics is that they often operate during school hours, which can make it hard for parents who work to participate in treatment. Research suggests that the most effective interventions for kids involve the whole family, he said.
Not enough social workers
More schools have social workers than school-based health centers, but there still aren’t enough, according to the report. The National Association of Social Workers recommends that for every social worker, there be no more than 250 regular education students. But according to the report, there are about 1,000 school social workers in the state and 530,000 K-12 students. On average, that’s more than double the recommended ratio.
And tight budgets can make things worse.
“When there are cuts, cuts tend to get made in the social work and the guidance and the other areas, because there’s such a focus on academics,” Plant said.
Legislation passed this year in response to the Sandy Hook shooting calls for school staff to get training in mental health first aid, which teaches people to recognize signs of mental health needs and how to respond. Vanderploeg said it’s a good place to start. But he said teachers and administrators also need help understanding what to do once they’ve identified a student’s mental health needs.
“The question then becomes, ‘Once I recognize a kid who may have mental health problems, what do I do next?’” he said. “And that’s where I think the piece around understanding your community-based mental health system is really, really important.”
Recognizing when to use crisis services
As a key link between schools and community-based mental health services, the report cites the state’s Emergency Mobile Psychiatric Services, or EMPS. People can access it by calling 2-1-1, and the program will make a clinician or team available to address the crisis. EMPS providers also provide screening, short-term treatment, and link clients to more long-term sources of care.
The services are free and available to all children in the state.
The program gets 14,000 calls a year, nearly three times as many as four years ago. Schools are the second-highest referrer to the program, behind families and caregivers. But according to the report, it could be used more.
Vanderploeg and Plant said school personnel don’t always recognize the full range of situations when it could be used.
“Most schools will know, for example, that if I have a kid who comes in presenting and talking about suicidal thoughts, I can call EMPS for that,” Vanderploeg said. “But what they don’t understand is that you can call for a kid who you even have more mild or moderate concerns about.” Those could include a student who appears more withdrawn or depressed, who has been acting out or had a drop in grades.
Within school districts, there are sometimes major variations in how often individual schools call EMPS, said Tim Marshall, DCF’s director of behavioral health. Often, he said, whether a school uses the program or not depends on administrators’ view of whether the service is helpful.
Plant, who worked on EMPS at DCF, said another factor is if school officials view a behavior problem that’s rooted in mental health issues as a discipline problem instead.
Avoiding arrests
As an example of a model that works, the report cites the state’s School-Based Diversion Initiative, a five-year-old program intended to reduce the frequency of in-school arrests, expulsions and out-of-school suspensions, to link young people at risk of arrest to more appropriate services, and to help school staff recognize and manage behavioral health crises. It’s funded by the state Judicial Branch’s Court Support Services Division, DCF and the State Department of Education, and staffed by CHDI.
The program, they wrote, uses the expanded approach they’re advocating, by employing strategies that include classrooms, crisis response, links with outside mental health providers, and helping families access services. 
Teachers get training in managing behavior and recognizing mental health systems, while administrators, school mental health workers and school resource offers get training in linking students to services that can help.
Part of the goal is for schools to make sure their disciplinary procedures use less restrictive approaches when possible, and involve law enforcement only as a last resort. There’s a push for schools to be aware of EMPS.
Vanderploeg said it makes sense for the school, mental health and juvenile justice systems to work together, because they’re often dealing with the same kids.
“Between 60 and 80 percent of youth involved with the juvenile justice system have a diagnosable mental health condition,” the report says.
Marshall noted, though, that schools are often in a tough position, with many groups trying to get schools to take on additional roles.
“The challenge is just so many social issues out there that people think, ‘Ah, let’s go to the schools,’” Marshall said. “It presents a challenge to all the administrators in schools about how to best handle that and which ones are you letting in this year. There’s always a line of folks trying to get in.”