Why will we asking math teacher Molly to ignore the fact that 7 out of her 28 fifth-grade students are living in homes where various forms of emotional abuse and neglect exist?
Summer. School is out. What better time to ask the leaders of our education and behavioral health care systems to draw up a plan for addressing the epidemic of childhood trauma impacting a quarter of the student population. Yes, one out of four student has or will endure three or more adverse childhood experiences. One in eight get substantiated as maltreated by child welfare before age 18.
In Anna, Age Eight, we write about addressing the challenge of student trauma in Chapter Six: Trauma's fuel tank: The ongoing crisis in mental health care.
Let’s make this easy: We believe that America can take a big and fairly simple bite out of this problem by installing behavioral health services in schools, and streamlining the process by which kids and their family members get access to services.
Schools already have counselors, but they tend to focus on testing, academic planning, college applications, and the like. Some schools have a resident social workers who may be covering numerous schools. And just like the social workers we met in the previous chapter, their caseloads are often much too high to allow for effective psychological work. Coverage is spotty, and it’s not what we’re talking about anyway.
We would instead like to see regular psychologists, psychiatrists, and other counselors actually set up practices for kids and their families right in the schools. Once the final bell rings, there is usually plenty of space to be had, but every school we’ve ever been to could probably fit a few providers in during the day as well. (We know of one school that did counseling in a surprisingly ample former janitorial supply closet.) Under this scenario, the school would not need to hire the practitioners, but rather just give them space and let them bill insurance just like they always do. (For the uninsured or those with catastrophic policies, it would be helpful to establish a subsidized, sliding scale fee structure, but this is of course a separate and bigger logistical issue involving more money.)
This sort of school-based operation would go a long way toward removing the practical and psychological barriers to behavioral healthcare. Finding a provider can be a pain, but much less so if you already know where one or two of them practice. Transportation to a provider’s office can be hard as well, both because it could be far away and because it could require extra emotional energy learning a new place and how to get there. But that’s not the case if they work at the school.
This system would also reduce the logistical burden of parents, who often don’t have the resources to make the health care happen in the first place. Their role would be reduced from critical to optional. Today, if a teacher or school nurse recommends to a parent that a child get some help, it is usually up to the parent to make the phone calls and arrange for transportation. If the provider worked at a school, it could be as simple as sending the parent a courtesy heads up that the health care was happening. (This would work primarily for Medicaid in circumstances that did not involve copayments. We are definitely not proposing that schools conspire to rack up large bills behind parent’s backs.)
For extra credit, something we know education professionals love, there are a few other things they could do to ensure that all students found the care they needed in order to succeed in school.
- Collect health insurance information during school registration and get permission to forward it to the on-site providers. That will save a step later.
- Arrange for an insurance enroller (who can do both Medicaid and Affordable Care Act exchange coverage) to visit from time to time and make sure those families without insurance get it.
- Arrange for rides home for the kids who stay after school for appointments. (It might just be the same bus that the football team uses to get home.)
- Think about throwing the doors open to primary care health care providers as well.
- If you have kids who need help and are unable to get insured, see if the district or some other entity (like a local foundation, hospital community outreach department, or non-profit working in youth development) will supplement care.
There are lots of models for school-based health care out there, and if we had a magic wand, we would actually do something more comprehensive than this. But we still like the model because it has a very low barrier to entry. Schools can just let practitioners use space they weren’t using anyway, and maybe do a little logistical work on the side. No funding streams to manage unless someone really wants to go above and beyond the call of duty. But for the “ideal world” version of this, if you want to learn more, we recommend a quick search on “full-service community schools” and “school-based health centers.”
About a community conversation on ACEs, Trauma and Child Welfare 2.0: The authors of Anna, Age Eight: The data-driven prevention of childhood trauma and maltreatment, Katherine Ortega Courtney, PhD and Dominic Cappello, discuss their book focused on how we must and can fix child welfare—a monumental challenge that requires the engagement of all of us. Thursday, June 28, 2018 2:30 PM - 4:30 PM, Santa Fe Community Foundation Fees: FREE. Please register. Contact: amclaughlin@santafecf.org or 505-988-9715. Download a free chapter here: www.AnnaAgeEight.org
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