Press-Republican

March 3, 2013

Mental-health services offered locally for youth

By JEFF MEYERS
Press-Republican

---- — PLATTSBURGH — The focus on childhood mental health has increased dramatically since the tragic shooting in Newtown, Conn., that left 20 students and six adult staff members from Sandy Hook Elementary School dead in December.

Regional caregivers have been addressing childhood access to mental-health services for years and believe they are providing critical services that have been on the minds of many since Newtown.

In a joint effort between Behavioral Health Services North and Champlain Valley Education Services, the Safe Schools/Health Students project has allowed for on-campus access to mental-health counseling in three schools in Clinton County and another two in Essex County.

And those numbers are continuing to grow.

SCHOOL-BASED CLINICS

“The Newtown tragedy has brought this issue (of childhood mental health) to light, but this project has addressed student mental-health needs in a way I don’t think we’ve ever seen or done in our schools before,” said Henry Goldenberg, clinical director for the Behavioral Health Services North Childhood Services programs.

“This (program) has been great news for the community and has achieved a lot of success.”

Safe Schools/Health Students, a federally funded program that includes such related topics as education on bullying and adventure-based learning, was initiated regionally as a pilot study to gauge the effectiveness of school-based mental-health clinics.

“We’ve partnered with BHSN (Behavioral Health Services North) for five years now and are providing mental-health services along with violence prevention, drug-use prevention and emotional-development programs,” said Wanda McQueen, project administrator for the Safe Schools/Health Students program.

“We wanted to see if these could be sustainable programs once the (federal) funding came to an end (after the five-year pilot program),” she added.

“With the help of BHSN, we’ve put together a school-based, mental-health model that has been extremely successful and can be sustained (financially).”

EXPANDED SERVICES

The program initially began by serving elementary-age students in Northern Adirondack, Saranac and AuSable Valley Central schools in Clinton County and Moriah and Ticonderoga Central schools in Essex County.

Since then, the program has expanded to include students in middle schools and high schools in those districts.

Peru Central School and the Beekmantown Central School main building in Clinton County and Crown Point Central School in Essex County have begun the process to incorporate mental-health clinics on their campuses, as well.

“The number of children receiving services on those campuses (now being served) has been tremendous,” Goldenberg said. “There are about 80 students who may not have been getting mental-health services otherwise.

ACADEMIC IMPROVEMENTS

Transportation to mental-health services at the Behavioral Health Services North clinic in Plattsburgh “has always been an obstacle,” he added. “This project has brought mental-health services to outlying areas to a degree that we’ve never had before. Access has never been better.”

Having school-based clinics also support the student’s ability to focus on school-related activities.

“There is less loss of instruction time,” McQueen said of the opportunity for students to access appointments with mental-health therapists and then return to their regular schedule in school.

Traveling for an appointment at the clinic in Plattsburgh usually

involved the entire day, meaning the student would be absent from classes all that time.

“It’s not just about wanting these kids to be better,” she said. “There are lifetime advantages as well. Scores (of students receiving mental-health services) on math and verbal standardized testing have improved significantly.

“Attendance has improved,” she added. “The students are feeling safe and valued and show improved self-esteem. They’re better able to make decisions, and they want to be in school. When they’re not in school, they can’t learn.”

Confidentiality is upheld for all of the students, who are referred to counselors with the permission of parents. A student will typically meet with a counselor on a weekly basis, as needed.

“The services we provide (at school) mimic what we provide here at the clinic (in Plattsburgh),” said Meghan Lannon, a therapist for Behavioral Health Services North who provides school-based support at NAC.

“We offer outpatient mental-health therapy, either individually for the child or with family members.”

EARLY TREATMENT

Students who have accessed the services cover a broad spectrum of mental-health disorders, including clinical depression and anxiety, Lannon noted.

“The earlier you can start with young children, the more successful you can be in developing self-esteem and social-emotional skills,” she added. “I’ve seen a lot of improvement in the students I’ve worked with.”

Families using the services should see a “seamless transition” as the program moves from a federally funded to a self-sustained service, she said.

Officials are transitioning to a

fee-for-service format where families will use health insurance to cover the cost of services.

The Clinton County Office of Mental Health and Addiction Services has also expanded its programs to include area pediatrician offices. Therapists are now providing a regularly scheduled presence at Mountain View Pediatrics in Plattsburgh and Dr. Maurice Racine’s clinic in Champlain.

“The pediatrician is often the person who recognizes that a child may have a problem,” said Sherrie Gillette, director of the Office of Mental Health and Addiction Services.

“People are often reluctant to access services (in a mental-health clinic) but feel much more comfortable in a doctor’s office,” she added. “We see that as a real advantage and are eager to open more satellites in physicians’ offices.”

MOVING INTO COMMUNITY

With a significant shortage of psychiatrists in the North Country, keeping a mental-health presence in medical offices is one way to expand services that are available, Gillette noted.

“Pediatricians work closely with psychiatrists on medication management. This (satellite clinics in pediatrician offices) seems to be a logical step in strengthening the connection (between health care and mental-health care).”

There has been no funding available for the satellite clinics, so the county is moving forward with the concept slowly. Therapists spend one day per week in each practice, but Gillette believes that that presence will continue to grow and expand to other practices.

“Historically, clinics have provided an opportunity for people to come to us, but I think you’ll see that change,” she said. “We should be able to get out to the community and meet people where they’re at. Our clinics may become smaller as we move out into the community.”

TIMELY SERVICE

Using a strong connection with Behavioral Health Services North and the National Alliance on Mental Illness: Champlain Valley, the county has been able to take large strides in improving childhood access to mental-health services.

“Eight years ago, we had 150 kids on a waiting list, often waiting six months before getting in,” she said. “We knew that was not acceptable and had to rearrange how we do things to provide access.”

Today, the county serves more than 300 children at any given time, and they are seen on a timely basis.

“We have walk-in clinics Monday through Friday from 8:30 (a.m.) to 12 (noon) for assessment,” said Casey Caron, a licensed mental-health counselor who sees children at the Ampersand Avenue Clinic and at Mountain View Pediatrics.

IDENTIFYING CONCERNS

Often, the parent of a child may visit the open clinic to discuss issues of concern with a specialist.

“Parents know more about their child than anyone else,” she said of a parent’s role in identifying mental-health concerns in a child. “Are there sudden changes in behavior, idiosyncrasies? Families should be sitting down and talking about issues if they have concerns.

“But it is all right to reach out for help,” Caron said.

Caron or other therapists will have an initial discussion with the parent, child or both and begin to assess what the child’s needs may be.

“We need to begin the planning process, whether a child can benefit from therapy sessions or may need further mental-health referrals,” she said. “We need to assess our goals, what issues need to be addressed.”

Each person needs to be treated individually, as no basic plan for service covers everyone, she added.

“We need to determine if the child is best served here or at another place,” Gillette said. “We are pretty careful that we don’t want to over-diagnose a child and pretty conservative in our approach. We certainly don’t want to label a child.”

INPATIENT UNIT

Children accessing mental-health services through the county are typically between 5 and 17 years old, though children as young as 3 have also entered the program.

The largest age group is 13- to 17-year-olds, with kids age 10 to 12 representing the second-largest group.

About 47 percent of the

children being served are on medications, as well.

But the region has another option available for children whose problems may become more severe. The CVPH Medical Center’s Inpatient Mental Health Unit has a 12-bed facility for children who need to be admitted for immediate care.

“Our services provide acute stabilization for their mental-health needs,” said Dr. Alisson Richards, staff psychiatrist at CVPH. “These are kids we have concerns about their safety, whether they’re wanting to hurt themselves or someone else.”

Children are often admitted to the unit through the hospital’s Emergency Department or from referrals outside the hospital.

“Referrals are sometimes sent from school — children who are out of control, destructive or threatening themselves or other people,” said Sharon Schmidt-Twiss, director of Behavioral Health Services for the hospital. “There are reasons these children need hospitalization.

“The community thinks we do these mental-health assessments (on admitted patients),” she added. “We’re not here to do assessments; we’re here to provide care for these children prior to referral (for outpatient services) to Clinton County Mental Health or BHSN.”

Children entering the unit through the ER do receive a full psychological assessment and a medical-health history, Richards added.

Staff members will also talk with family members or social workers involved in the patient’s case as they prepare a treatment plan for the next several days.

“We have several skills-building objectives and continue to provide education (while children are admitted),” Schmidt-Twiss said. “We have contracted with school teachers to provide education as our treatment team provides support.”

“We provide occupational therapy, nutritional counseling,” Richards said. “We work very closely with parents, teachers and the children in setting probable goals.”

The hospital will discharge a patient with recommendations for additional therapy, but a child will sometimes have to be readmitted for continued acute care. At that point, the staff will work to determine what other services might be beneficial for the child.

“We sometimes request a child be placed in a residential-treatment setting, but those are very few, and there are always long waiting lists,” Schmidt-Twiss said.

“We get kids in crisis, families in crisis,” Richards said. “Our treatments can vary a lot from one crisis to another, but we’re able to offer a service this community is privileged to have.”

REDUCING STIGMA

Mental-health advocates have been emphatic in noting that most people who behave violently do not have a mental disorder. They point to studies that show that people with mental illnesses are more likely to be the victims of violent attacks.

Experts believe the stigma associated with mental illness stems from the link many people in the general public have between mental illness and violence.

But mental-health services across the North Country are doing their part in fighting to reduce that stigma while continuing to improve the care offered for residents of all ages.

Email Jeff Meyers: jmeyers@pressrepublican.com

+++++

TO LEARN MORE

For questions about services and clinics offered: Behavioral Health Services North's Child and Family Services, 561-1767. Champlain Valley Education Services, 561-0100. National Alliance on Mental Illness-Champlain Valley, 561-2685. 

WHERE TO GET HELP

If you're considering suicide, instead get help by calling the following numbers: 

For counseling: Clinton County Mental Health, 565-4060. Essex County Mental Health Clinic, 873-3670; after-hour emergencies, (888) 854-3773. In northern Franklin County, around the clock, 483-3261; southern Franklin County, 891-5535.

For emotional crises: The toll-free Clinton County suicide hot line number is (866) 577-3836. Out-of-county calls are accepted but other options are: The National Suicide Prevention Lifeline, (800) 273-TALK (8255). The Essex County Mental Health Association Hope Line, (800) 440-8074. That last number is staffed 24-7, but the phone system handles limited calls. If there's no answer, hang up and try again. Or call 911 or go to your closest emergency room. Mary Anne Cox holds a Suicide Survivors Support Group in Plattsburgh the second Wednesday of the month. Register with her ahead of time at 563-1141.