Minneapolis schools lead the way on youth mental wellness
Author: Casey Chaffin
Chaffin, Casey. “Minneapolis Schools Lead the Way on Youth Mental Wellness.” Oregonlive, 12 Sept. 2019, www.oregonlive.com/education/2019/09/minneapolis-schools-lead-the-way-on-youth-mental-wellness.html.
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Medical assistant Mary Tkadlec talks with a student in the reception area of the clinic at Minneapolis' South High School. Tkadlec has worked at this clinic, which provides both physical and mental health services, for seven years and says, “Students are not afraid to talk here.”
MINNEAPOLIS -- On a sweltering July day, mental health practitioners who work with young people in Twin Cities schools and clinics gather at the Washburn Children’s Center Training Institute to share techniques and learn from seasoned experts.
They talk about the importance of connecting with patients’ family members and practical ways to engage families who might be struggling as much as their child.
The clinicians, including full-time therapists in local schools, came together during the summer because they work with youth served by one of the nation’s strongest school-based mental health systems — and they want it to grow even stronger.
For years, Minnesota has ranked in the nation’s top five states for addressing youth mental health. And, officials there say, Minneapolis schools have led the way when it comes to school-based mental health care.
Most mental health conditions first manifest during adolescence, and they are most effectively treated when addressed immediately. Studies that tracked teen patients in the 1990s found that school-based care is the most effective way to treat youth mental health at scale.
Minneapolis’ program, which started small 15 years ago, has matured and expanded to reach 70 percent of the city’s public schools. Each of these schools has a full-time mental health therapist who provides direct services to students in greatest need of one-on-one therapy. Those therapists also train teachers and other school employees to address low-level mental health challenges faced by broad swaths of students.
That’s helping to create a culture where students who struggle can get help, not suspensions, said Rochelle Cox, executive director of special education and health services for Minneapolis Public Schools. “Teachers are understanding that traditional discipline is not changing kids' behavior and that when we exclude kids from instruction, they just fall further and further behind,” Cox said. “We need to have people who have a therapeutic approach.”
When teachers learn the pattern of behavior of kids there would be a better place for the kids and their education doesn’t have to be interrupted , if teachers learn to patient and deconstruct certain action with better understanding and better teaching .
Courtney Perry / Special to The Oregonian
A collection of stress-relieving items sits in the center of mental health therapist Farah Hussein's office at South High School in Minneapolis.
The city of Minneapolis runs the school-based clinic.
Teens who need professional help for depression, anxiety or other mental health challenges can face barriers, including costs, stigma and finding it hard to get to a clinic, mental health advocates and practitioners say.
“We want to eliminate barriers to accessing treatment for children,” said Sue Abderholden, director of the Minnesota chapter of the National Alliance for Mental Illness. With school-based services, parents don’t have to take off work to transport kids to appointments, and kids don’t have to miss more school than necessary to keep them.
regarding family circumstances and economic situation, kids aren’t able to resolve their trauma to control their behavior , it becomes worst when parents don’t understand it either and if schools are able to provide this , kids will be able to acknowledge their behavior , accept it , and better themselves for their own good and focus better in school.
Offering free or low-cost appointments in the familiar and convenient school setting means more youth can access these services, Abderholden said.
Minneapolis’ program ensures that all students — whether on private insurance, Medicaid or with no insurance at all — can access mental health care.
The Center for School Mental Health at the University of Maryland has described the school-based mental health program in Hennepin County, home to Minneapolis, as one of the best in the nation.
Sarah Washington’s daughter Angelica struggles with depression as well as learning and developmental disabilities. Angelica, who just turned 21, didn’t start receiving school-based mental health treatment in Minneapolis Public Schools until she was in high school.
“It’s life-changing,” Washington said.
She wishes her daughter had known about the resources sooner. “She probably would’ve been better off,” Washington said.
Washington describes herself as “a professional mom,” because she has to constantly work to get her child the care she needs, whether that be advocating for her daughter to receive a proper diagnosis or taking her to appointments. When her daughter was in school, school-based care made that easier for her and her daughter, she said. Washington said the school clinician her daughter worked with went out of her way to support Angelica — from helping coordinate resources to visiting Angelica when she was hospitalized to informing about Washington the types of care available after Angelica graduated.
Washington belongs to a Hennepin County parent leadership group, which engages parents in advocating for better student mental health support.
“It changes people’s lives if you can find someone who can help,” she said.
Courtney Perry / Special to The Oregonian
Signs of encouragement adorn the walls and cabinets of the school-based clinic at South High.
Part of their work is creating outreach materials so other parents know what resources are available to their kids as early as possible.
“Things are going in the right direction,” she said. “Fifteen years ago, I wouldn’t say that.”
Mark Sander, director of school mental health services for both Hennepin County and Minneapolis Public Schools, has been involved in the creation of the county’s school-based mental health infrastructure since the program began in 2005.
Over time, he said, studies of Minnesota’s system found that school-based mental health resources increase access to care, especially for students with acute needs. In the state, around 50 percent of students who received school-based care were receiving mental health care for the first time. Students who receive school mental health care receive fewer suspensions, increase their attendance and feel more connected to their schools, researchers also found.
According to a survey by the Wilder Research Foundation, based in St. Paul, 63 percent of Hennepin County parents whose students received school-based care reported improvement in their child’s attendance. That survey also found that 91 percent of school staff reported that the students were more connected to the school community after receiving those services.
And while its difficult to statistically correlate mental health care with academic outcomes such as standardized test scores, surveys show that parents and teachers report students who have their mental health needs met perform better in the classroom.
“We’re trying to improve students’ mental health so when they’re in class, they're able to take in the instruction,” Sander said.
Minneapolis’s system is not without flaws. For youth with mental health conditions, unmet need remains an issue. The shortage of mental health care for youth is a nationwide problem, and Minnesota experts who look at their state’s best-in-nation ranking say Minnesota is more accurately described as the least-bad of the bunch.
“It's hard to be ranked at the top because it's a false sense of security at times,” said Shannah Mulvihill, director of Mental Health Minnesota, the state’s oldest mental health advocacy organization. She noted that the state still has a long way to go before being able to meet the majority of student needs.
Even in an area where Minneapolis shines, school-based mental health care, waitlists are common.
A therapist’s caseload usually maxes out at around 20 students, clinicians say. School counselors, school psychologists and school social workers can help try to fill the gaps, particularly for kids who may need some support aside from outpatient therapy, Minneapolis officials say.
“A lot of times what happens is the school social workers are trying to fill in while the kiddo is on the waitlist and provide support,” said Kim Olson, a Minneapolis-area school therapist.
Courtney Perry / Special to The Oregonian
Mental health therapist Farah Hussein puts away the yoga mat she sometimes encourages students to use during sessions in her office at South High.
School counselors, psychologists and other support staff play a crucial role in the system of school-based mental health support. But they can feel too stretched to do it well, given other responsibilities, Minneapolis school staff say. According to state statistics, the average number of students under such employees’ purview, depending on the position, can range from a few hundred students to a few thousand.
“You need all of the pieces of the puzzle for the puzzle to work,” said Marcia Sytsma, a Minneapolis school psychologist. Minneapolis still isn’t where it needs to be in funding all the pieces of the puzzle, Sytsma said, but the school district says it’s working on prioritizing funding for school support staff.
Oregon schools struggle to meet demand
Oregon, by contrast, ranks near the worst in the nation. In 2017, state health surveys found one in five Oregon eighth- and 11th-graders have mental and emotional health care needs that have gone unmet. Staffing shortages in Oregon, as in Minnesota, are an issue; for example, the average student to school social worker ratio in Oregon is 8,831 to one.
Portland Public Schools, Oregon’s largest district, has one of the most robust school-based health programs, thanks in part to Multnomah County providing funding and clinicians.
In the past four years, Portland Public Schools has increased the percentage of schools with an onsite mental health provider from 20 percent to 60 percent, according to Amy Ruona, manager of mental health services for Portland Public Schools. But that statistic doesn’t mean the same thing as in Minneapolis. Not all of those providers work full-time at a single school. Many move between multiple schools in a week. Some visit multiple schools in a day.
Galen Cohen, a Portland school therapist, used to serve multiple schools in a week prior to his full-time placement at Madison High School.
“You feel more disconnected,” Cohen said. “You feel like you’re someone who comes in just for the sessions.”
When therapists move around a lot, Cohen said, “It’s not the full school-based mental health experience.” The point of being based in a school, he said, is to work with the whole system.
Being onsite full time allows a therapist to integrate into the school community and build relationships with students and school staff, he said. “Without a trusting relationship, you’re not going to get cases, you’re not going to get referrals, you’re not going to get support when you need it with a case,” Cohen said. “It really should be a team effort.”
Portland’s school-based therapists have varied employers. Some, like Cohen, work for Multnomah County. Others are employed by community mental health providers. Because of this, the types of insurance each therapist can accept vary.
Beth Nakamura / The Oregonian|OregonLive
Parkrose Health Center, located at Parkrose High School, is staffed by Multnomah County health care workers.
Portland Public Schools relies on the county and numerous non-profit partners to provide students with health care on their school's campus.
Multnomah County employs 23 school therapists in 37 schools across six districts in Multnomah County. Most serve one to three schools. County clinicians primarily serve students who are uninsured or on the Oregon Health Plan.
“The students we’re serving would likely not get services without the county,” said Stephen Dunlevy, the school-based mental health supervisor for Multnomah County.
The county will sometimes serve students with private insurance in crisis or with significant barriers, but doesn’t have the internal infrastructure to bill private insurance or the capacity to take on many privately-insured students, he said.
When it comes to overall mental health care for Oregon youth, clinicians and parents say there are more resources available to students on the Oregon Health Plan than on private insurance.
“Sometimes there are people with private insurance who are essentially uninsured for mental health,” Cohen said.
Minneapolis’s system avoids some of these issues. All its school therapists are employed by community mental health providers that contract with the county and are able to bill private insurance as well as Medicaid. A yearly state grant helps fund school-based care for uninsured students.
Minnesota’s grant, initially approved in 2008 and increased over time, now allocates $13.2 million every year to school-based mental health services.
“When you look at something like a huge state budget, the amount of money that's been invested in school based mental health is a tiny, tiny amount,” said Tom Steinmetz, chief executive officer of the Washburn center which receives state funding to provide community-based mental health services in schools. “It's also an incredibly significant, important, critical and transformative amount, because that investment fills in the missing funding pieces to help jump-start and sustain school-based mental health services.”
Oregon also has a state school-based mental health grant. But it’s a newer and smaller than Minnesota’s. The grant, authorized by the legislature in 2014, currently allocates $3.6 million per year to high-poverty counties for school mental health care. On a per-student basis, Minnesota’s grant is 2 ½ times the size of Oregon’s.
Still, Minnesota mental health stakeholders say, there’s a long way to go.
Taking care of more young children’s mental health needs earlier in life needs to be a priority, said Shannah Mulvihill, director of Mental Health Minnesota.
“For those concerned about long-term costs to the system, investing early in services for our young people not only saves money over time, but really, it saves lives,” Mulvihill said. “It changes the path of people’s lives in a very positive way. And so it’s not only the less expensive thing to do, it’s the right thing to do.”
--Casey Chaffin; [email protected]; @todaycaseysays
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