Editor's note: The Notebook has a two-year grant from the van Ameringen Foundation of New York to cover behavioral health in schools.
Although most of our coverage will focus on Philadelphia, we will occasionally highlight programs in other areas where the work might be of interest to our readership.
In the first of these stories, we take a look at behavioral health services in some Baltimore City schools and the differences those services are making for students.
Almost immediately after starting her job in 2015 as Baltimore’s health commissioner, Leana Wen took a series of walking tours around the city, listening to residents’ concerns.
Much of what she heard was expected, but what she was told by public school students surprised her.
“I thought they’d ask about smoking or STDs,” Wen recalled. “But what every single one of them talked about was mental health.
“They talked about what it was like to grow up in a house where they were the only one to get up in the morning. Everyone else was on drugs.
“They saw moms, fathers, and uncles overdose. They saw their fathers being shot. They were talking about what I would call pervasive trauma.”
Three months later, as Wen worked with health officials, the schools, and other agencies to develop a strategy to deal with the problem, the death of Freddie Gray in April 2015 put a national spotlight on Baltimore.
Gray, 25, died from spinal injuries a week after he went into police custody, and his case led to more than a week of protests and rioting. Businesses were burned and looted, almost three dozen arrests were made, and 15 police officers were injured.
But the case also gave the schools and the Health Department a chance to concentrate behavioral health services in, essentially, three traumatized neighborhoods in West Baltimore.
Last September, the city school system received a two-year, $2.3 million Promoting Student Resilience grant from the U.S. Department of Education. Only two other cities – Chicago and St. Louis – got one of the grants, which are targeted for areas traumatized by civil unrest.
About the same time, the Health Department received a three-year, $5 million companion grant from the Substance Abuse and Mental Health Services Administration to provide trauma-informed community services in the neighborhoods.
“Our schools were experiencing trauma,” said James Padden, director of related services for the school district. “The whole city was experiencing trauma.”
Padden recalled the furious scramble to meet the application deadline. “We did it in 19 days … 11-hour days, nights, weekends.”
What emerged was a plan concentrating on 13 “focus schools” with more than 4,600 students in what would come to be called “the Freddie Gray neighborhoods” – Upton-Druid Heights, Sandtown-Winchester, and Penn North.
The plan included:
Putting a full-time mental health clinician in each of the 13 schools.
Hiring a full-time trauma manager and two full-time trauma trainers.
Increased training for all school personnel on the effects of trauma. Every person in every school now gets a 30-minute module on trauma-informed practices, sexual abuse, child abuse, and neglect. (To learn about training for school police and its effects, see “Baltimore school police help shift school climate”).
An evaluation by the University of Maryland Center for School Mental Health and Johns Hopkins University.
School officials and teachers see the effort not so much in terms of reinventing the wheel as in making sure seeing that all the wheels finally turn together.
“We’ve always had so many piecemeal responses,” said Megan Miskowski, a speech-language pathologist.
Sonja Santelises, CEO of the public school system, said, “Even with real, substantive efforts, the reality is that systems this large aren’t equipped to take a cohesive approach.”
Now, there is hope that this will happen.
“As bad as it was, [Freddie Gray's case] brought us all together,” said Philip J. Leaf, a public health professor at Johns Hopkins and co-chair, with Padden, of the grant’s steering committee.
A battered city
In its application for the student resilience grant, the school system noted that for years, Baltimore has had one of the highest murder rates in the nation.
“In 2015,” the application stated, “29 percent of all homicides were of individuals aged 10 to 25 years.”
In the zip codes where the focus schools are located, the picture is equally grim. Twenty-five percent of the children live in extreme poverty.
In one of the neighborhoods – Upton-Druid Heights – the median household income is less than $16,000 a year.
Sixteen percent of the city’s high school students have seriously considered suicide, according to Baltimore Behavioral Health Systems (BBHS), which coordinates behavioral health programs for the school district and other city agencies.
Denise Wheatley-Rowe of BBHS estimates that at any one time, 2,300 of the system’s 84,000 students are homeless, living in shelters, or “couch surfing” with different friends or relatives.
A drive through the neighborhoods puts faces on the numbers. At the transit hub where the Freddie Gray rioting started, addicts wander aimlessly.
The commercial streets are lined with pawn shops, takeout joints, and cheap clothing stores.
“What you don’t see are banks,” said Andrew Masters, youth health and wellness coordinator for the Health Department.
There are no dentists, he noted, no eye doctors and, equally important, no police officers.
Social worker Henriette Taylor, who is the community school coordinator for the Promise Heights neighborhood, recalled two mothers who had each lost two children to violence forming a neighborhood trauma support group.
When the neighborhood received a donation of playground equipment, about 500 volunteers jumped in to assemble it.
On an unseasonably warm winter day, the playground was filled with kids. But the benches they had also assembled were missing, stolen by residents who needed furniture.
“We’re building the capacity to climb out of holes,” Masters said.
Serving those in need
Although the grants to the school system and the Health Department were from new federal programs, the school system had a considerable background in behavioral health.
Leaf noted that in the mid-1930s, Baltimore became one of the first U.S. cities to have social workers in the school system. Today it has more school psychologists than the Philadelphia system, which has more than 50 percent more students,
Since 1987, Baltimore has provided Expanded School Mental Services (ESMH) to supplement school social workers, psychologists, and guidance counselors.
The system now serves 120 public and charter schools. A 2008-09 program evaluation showed that students receiving ESMH made up about one-fifth of all students, and in most grades, they showed improved academic performance and attendance.
In addition to ESMH, the resilience grant will provide:
Training for all school staff in Restorative Practices, a framework for dealing with problem behaviors through parties taking responsibility for their actions and working to rebuild any damaged relationships.
*Kognito, an online avatar-based program that teaches adults to recognize and address psychological distress in youth, and Friend2Friend, a similar program for youth 14 to 18 on dealing with peers experiencing distress.
Mindfulness and yoga groups to which students may be referred.
And training for school-based behavioral health professionals on providing evidence-based trauma treatment for youth up to age 18 and their caregivers.
The schools are also experimenting with using tele-health options for short-term psychiatric treatment, sharply increasing the number of students who can be seen.
In addition, social worker Jennifer Cox said, “You’re in your school, where you’re comfortable.”
Psychiatrist Aronica Cotton said she finds the system to be working. The students are used to being in front of computers and it makes it easier for the schools to create a treatment team.
Speech pathologist Miskowski said that the team approach is one of the reasons she finds the new grants promising.
Even though she isn’t a behavioral health specialist, she said, someone in her position might be the first to notice mental health issues.
And in neighborhoods plagued by poverty, drugs, and violence, the school might be the best place to spot it.
“Often, it’s the safest place they can be.”
Paul Jablow is a freelance writer who contributes frequently to The Notebook and is anchoring our mental and behavioral health coverage.