In a sunny office at Sixth Avenue Elementary School in Aurora, an upbeat school psychologist named Shannon Kishel tossed out questions to four third- and fourth-grade boys sitting around a table: when a student hurts or teases another student, how do you stand up for the victim?

At first, the answers were fairly predictable. One after the other, the boys either said they’d tell the bullies to stop or go to a teacher for help.

As the discussion deepened, the contradictory realities of childhood emerged. A soft-spoken boy in a white polo shirt asked, “But what if the adult doesn’t believe you?”

It was a good question, Kishel said, and she encouraged him to dig for an answer. He did just that.

“I would get proof from someone else or I would make the bully admit it,” he said.

All the boys in Kishel’s office were cooperative and easy-going. Based on the session alone, it would be hard to see them as anything but average boys: one talking about soccer, another about his trampoline, one wearing a Broncos t-shirt, one asking if Kishel had any more bite-sized Twix bars when she handed out treats at the end.

But the students were all selected for Kishel’s weekly group based on the outcomes of a universal mental health screening, a process that identifies students who are at risk for problems ranging from aggression to social isolation. All four were rated “extremely elevated” for various characteristics that could mean trouble down the road.

Mental health issues affect many Colorado students, causing problems such as disruptive behavior, anxiety and absenteeism that can hinder academic success. These problems also impact teachers, making their jobs harder. According to a 2011 survey of educators and school mental health professionals by the Colorado School Safety Resource Center, 59 percent of respondents said they needed assistance with students’ mental health needs.

But formal mental health screenings —  the kind being piloted at Sixth Avenue, and five other district schools — are rare in Colorado and nationally.

Among large districts, Boston Public Schools is one of the few that conducts them. Experts praise universal screening both for casting a wide net and enabling early intervention. But the screenings also raise questions for school districts, ranging from how to pay for them to whether they have the ability to obtain services for all students the screenings identify.

Despite the obstacles, interest appears to be growing. The Center Consolidated district plans to launch a universal screening program next fall and other school health leaders have taken notice as well.

Karina Delaney, coordinated school health manager for Adams 12, said, “It’s definitely a conversation I’m planning to have with our district.”

In the wake of the recent Arapahoe High School shooting, it’s hard not contemplate how things might have turned out differently if Karl Pierson had gotten mental health services long before he was capable of pulling the trigger. But while acts of school violence are all too familiar in Colorado, they are hardly the only reason to teach kids social-emotional skills like how to join a playground game, resist peer pressure or resolve an argument.

By incorporating social-emotional skills into the school day, Aurora administrators are hoping that they can head off problems before they start, creating healthier, more productive classrooms and ultimately higher student achievement.

“I am passionate about prevention,” said Jessica O’Muireadhaigh, the Aurora special education consultant who spearheaded the district’s screening program.

Helayne Jones, president and CEO of the Legacy Foundation, said Aurora is a perfect example of a district where leaders see the link between good mental health and academic success.

“We really applaud their work,” she said. “Some districts don’t see the connection yet.”

The Legacy Foundation has been a leading advocate for mental health services in schools. In November, the foundation distributed to all Colorado districts its new School Behavioral Health Services Framework, which offers strategies and tools for providing mental health services in schools. This month, the foundation announced $5,000 grants for mental health initiatives to five districts, including Aurora and Center, both of which will use the money for universal screening.

Reaching all kids, focusing on some

Aurora began its “Social Emotional Learning Pilot” in early 2013 after top administrators asked O’Muireadhaigh to develop a program to address students’ social emotional health. In addition to the universal screening, the pilot includes weekly lessons on social-emotional topics for all students from the Caring School Communities curriculum. All told, the program costs $27,000 per school.

Resources on mental health and universal screening

Illinois, which has detailed social-emotional learning standards and benchmarks for every grade, was one of O’Muireadhaigh’s models as she crafted the pilot program. But she wanted to go a step further and add the screening.

“They aren’t as systemic as we are,” she said.

Aurora’s six pilot schools use a “two-gate” screening system that uses two respected  tools. Teachers use the first, called the SSBD, about six to eight weeks into the school year to rank the top three “externalizers” and top three “internalizers” in their classrooms. Externalizers are students who show defiance, aggression or temper tantrums, while internalizers show anxiety, depression or withdrawal.

Teachers then use the BASC-BESS instrument to determine whether the six students identified by the first screening are in the “average,” “elevated” or “extremely elevated” range for various social-emotional issues. Typically, one or two of the original six students fall into the “extremely elevated” category and are flagged to participate in small intervention groups with Kishel or a school social worker. .

O’Muireadhaigh said about 30 students participate in small groups at five of the pilot schools, including Sixth Avenue, Sable, Vaughn and Altura elementary schools as well as Boston K-8. Jamaica Child Development Center, the only preschool in the pilot program, is the exception. There, only a few three- and four-year-olds participate in a small group because there is a major emphasis on social-emotional skills for all children throughout the school day.

In February, the students who have been meeting weekly in small groups since the fall will be assessed to see if they have made progress on their social-emotional skills. Those who still have significant struggles will be placed in new groups that use a different, more explicit curriculum.

Of the four boys Kishel worked with on that recent afternoon, there was one she suspected might need to remain in a small group after the February assessment. Though he had made an effort to participate in the session, he struggled with his words, and mostly parroted answers that other students had already given.

Other screening methods

While universal screenings that use evidence-based tools are lauded for identifying students, particularly internalizers, who need extra support, there are other ways to identify students who are having social, emotional or behavioral difficulties. In many districts, teams that include administrators, counselors, psychologists, social workers, special education staff and teachers, meet weekly to compare notes and create plans for struggling students.

For example, in Denver, a pilot mental health expansion pulls together staff to design individual programs for at-risk students. The district or staff at the 39 participating schools scans attendance and disciplinary data to identify struggling students. School staff then meet to discuss what risk factors might be at play for the student and what interventions can be effective.

“The mental health expansion is looking at this subgroup and trying to find the root cause,” said Steve Nederveld, who manages the the district’s mental health division. Those root causes can include “depression, family conflict, gang involvement, juvenile justice involvement, bullying.”

The expansion is, in part, the district’s response to last year’ school shooting at Sandy Hook Elementary.

“[Denver superintendent Tom Boasberg’s] response to Sandy Hook was making sure our kids get our social emotional supports rather than more police,” said Eldridge Greer, the director of the mental health and assessment program.

Greer thinks Denver’s approach could be ground-breaking.

“I think it has the potential to be a profound shift,” Greer said. “Before this, schools really operated on a 19th century model of I’ll wait for students to come into my office.” There wasn’t a “good connection between behavior and therapeutic interventions.”

He also hopes it will transform student and parent perceptions of the district.

“The district is responding in a way that is not punitive,” Greer said.

Plans in Center

The biggest mental health problem in the 617-student Center school district is depression, said Katrina Ruggles, a counselor for the district. Students also struggle with divisive family relationships, divorce, substance abuse and dating violence. Nearly 92 percent of students in Center qualify for free or reduced-price meals.

And although the district has a partnership with San Luis Valley Mental Health to provide services two days a week, Ruggles said it’s not enough.

“We have a high at-risk population so we have to provide a lot of services that other districts don’t have to provide.”

And so the district is going a step further to universal screenings, with plans to select a screening this spring, launch it K-12 next fall and pilot it for three years.

“We understand there’s a really fundamental connection between your behavioral health, your physical health and your academic health,” said

Ruggles said some students — elementary school boys with ADHD, for example — are easily flagged for evaluations or services, but she believes there’s a subset of students who don’t always attract much attention though they may need it.

“Sometimes there are kids that slide under the radar and we’re missing those kids,” she said.

Jumping the inevitable hurdles

Universal screenings may make perfect sense to mental health professionals, but many people have never heard of them. That can make securing parent permission a thorny problem for school districts. There also may be concerns about the validity of screening tools, that kids will be unfairly stigmatized, or that schools have no business evaluating mental health in the first place.

“Schools are very leery to do it,” said Barb Bieber, school psychology consultant at the Colorado Department of Education. “So we’re hoping that Aurora will have some good outcomes from their work.”

In Center, Ruggles expects it may be a challenge to get parents on board.

“We’re going to have to make sure that parents are really informed about what we’re doing so it doesn’t feel intrusive,” she said.

So far, Karmin Braun, a second-grade teacher at Sixth Avenue Elementary, said she hasn’t fielded any parent concerns about the program.

In fact, just the opposite. She described how one little boy who would “break down and cry very easily if you redirected him” has made immense progress since he joined a small group in the fall. At a recent parent-teacher conference, the boy’s parents remarked on his improvement and said they were impressed with the program. Aurora’s screening program requires signed parent permission slips only for students who are flagged for small groups.

O’Muireadhaigh said that while individual students will likely show significant social-emotional growth within one school year, it will take at least three to five years for the district to see a more global student achievement effect.

“We’re kind of in our infancy and we’re still collecting the data,” she said.

Research on the subject suggests that aggregate academic gains are likely. According to a 2011 meta-analysis of universal social-emotional programs in schools, researchers not only found that students’ social-emotional skills, attitudes and behavior improved, they cited an 11 percentile-point gain in student achievement.

Finding the money

Perhaps one of the biggest questions about universal screening is funding, and not just funding for the screening tools themselves and training so teachers know how to use them. Experts say that screenings must be accompanied by services for students who are identified or they’re not worth doing.

“Funding is always a big issue,” said Jones. “Where [schools] cut…is often in all those areas that support the affective and social-emotional needs of students.”

That may be part of the reason that 29 Colorado districts applied for just five mental health grant awards from the Legacy Foundation. While Aurora’s grant will help purchase more social emotional learning materials, O’Muireadhaigh said the pilot’s costs, including the addition of 1.6 employees, is currently covered by the general fund budget.

In Center, Ruggles also expects administrators will have to rely on their general fund to help implement and sustain the screening program. She echoed other educators in saying there’s not a lot of grant funding available for mental health.

“We try to find it where we can and piece it together.”

 Offering alternatives

During the recent small group session in Kishel’s office, it became clear that social-emotional skills don’t always come naturally.

After the four boys watched a short video in which a boy pushed a girl while waiting in line, a boy in a blue shirt next to Kishel condemned the pushing: “You can’t push a girl. You can’t even touch girls,” he said.

When Kishel asked if it’s okay to push boys, the student responded without missing a beat.

“Yeah, you can push boys.” Another student added, “If they’re messing with you.”

Kishel was unphased, but urged the boys to think about peaceful solutions using words instead of aggression. Although the boy in the blue shirt proposed fighting another time or two, the group came up with several creative (and sometimes unrealistic) solutions to bullying, from befriending the bully to making a bully who teased a student about his clothes wear the same thing as the victim.

After the boys returned to their classroom, Kishel and O’Muireadhaigh acknowledged that students often default to solutions that might make sense in the rest of their lives.

Still, O’Muireadhaigh said of the boy in the blue shirt, “At the most basic level, he heard an alternative.”