Behavioral health supports are expanding in the District

This article was originally published in The Notebook. In August 2020, The Notebook became Chalkbeat Philadelphia.

A child’s emotional state can have a profound impact on his or her ability to learn, as any classroom teacher knows. Emotional issues often lead to problem behaviors.

With many of the District’s 167,000 students coming from stress-filled environments, the District and the city Department of Behavioral Health have been collaborating to increase access to school-based behavioral health programs for District students.

Today, almost 100 schools have teams of behavioral health staff, and more than 11,000 students received school-based services last year.

But the need is even greater. And there are still challenges with getting some school leaders to accept having such services on-site and successfully integrate them.

School-based behavioral support is “a much more positive way of addressing behavior issues than sending [the students] home or following [disruptive behavior] with a suspension,” said Anita Duke, principal at Wright Elementary.

“These children have issues that little children shouldn’t be dealing with,” she added. With school-based behavioral support, “they have someone they can go to if they are upset.”

Although such services have existed for about 15 years in Philadelphia, they’ve greatly expanded within the past seven. Despite funding issues, Superintendent Arlene Ackerman has plans to put services in every school in 2010 through its staff of Consultation and Education specialists, or C&Es (see Eye on special education).

Community Behavioral Health (CBH), the public behavioral health managed-care company, has several major programs with the District.

One, the School Therapeutic Service (STS), was developed as an alternative to the full-time aides, called wraparounds, that can be assigned to individual students as a result of consistently challenging behavior in schools. STS has been implemented in some schools with a history of having high numbers of wraparound aides – sometimes several in one classroom, said Gail Edelsohn, associate medical director for children’s services with the city’s Department of Behavioral Health and Mental Retardation.

STS is currently in 65 schools, mostly elementary schools. A behavioral health team in each building, generally provided under contract with an agency, includes a lead clinician and about five behavioral health workers. The clinician conducts individual and small group therapy sessions about once a week, while the behavioral health workers are each assigned three students and tailor their time based upon suggestions made by the students’ teachers.

In contrast to traditional wraparounds, these workers do not stay with the individual child throughout the school day, but are available on an as-needed basis, such as during transition times or at times of emotional crisis.

Nina Miller, a counselor at Blankenburg Elementary, said that the STS program at her school is more effective than wraparounds because it allows students to be more self-reliant.

“This way, the kids have to be more independent,” she said. She also sees the on-site therapy as a plus.

“Previously the parents would take [students] out at 9 a.m. for counseling and never bring them back. Here they’re seen on the spot. It’s a win-win situation.”

An older and similar CBH-funded program, School-Based Behavioral Health (SBBH), is in 28 schools. Like STS, SBBH agencies participate in the Comprehensive Student Assistance Process (CSAP) and provide individual and group therapy, as well as staff who sit in classrooms and help with transitioning and other activities that may trigger negative behaviors. They also offer psychiatric and case management support.

The most intensive behavioral health service available is the CARE (Children Achieving Through Re-Education) program, which is an alternative to hospitalization for students with severe problems. Students who qualify are assigned to one of eight year-round regional programs. With a ratio of 10 students to three staff – a mental health clinician, a certified teacher, and a behavioral health worker – CARE serves children in grades K-8.

Brenda Taylor, the deputy chief in the District’s Office of Specialized Services, said that the transition back to the student’s home school is easier from a CARE program than from a hospital stay.

Additionally, CARE takes place within an educational framework: the program adheres to the District’s core curriculum, and computers, assemblies, and field trips play an integral part. There are three classrooms per program – two are elementary classrooms and one serves middle grades; 240 District students are currently enrolled.

Dennis Barnebey, education specialist with Public Citizens for Children and Youth, believes that the District is on the right track with these programs. “Having a clinic in a school is a good idea,” he says.

However, he cautioned, the integration of clinicians works better in some schools than in others, depending on the buy-in from leadership.

“Some administrators don’t see [the clinicians] as helpful,” he said, explaining that it can be difficult to wean principals from handing out suspensions rather than seeking behavioral health intervention for students who misbehave.

“Where SBBH is working well is where school leaders have made the SBBH team a part of the school,” he said. “These places are creating safe spaces where kids have the opportunity to talk with adults about what’s going on in their lives.”

He concedes, however, that adequate funding is a problem. Agencies have conferences with teachers to identify the neediest kids.

“I don’t know of places where the slots weren’t all full,” he says.