girl silhouetteA young student goes the whole school day without using the restroom because her anxiety makes her afraid to be alone in closed-in spaces. Another can’t focus in class because he’s worried about a sick parent. Others have lost sleep listening to family members argue or thinking about the eviction notice posted on their front door.


Nationwide, one in five children struggles with a diagnosable mental health problem. It’s a statistic that Jeannette Deloya, the district’s Coordinator of Mental Health Supports, says is reflected locally, impacting students’ ability to learn or be engaged in school.


For many kids, this is a result of adverse experiences, like exposure to community or family violence. Others are dealing with homelessness, frequent family moves or extended absences due to medical or psychiatric hospitalization.


For far too long, students who need specialized mental health supports have been unable to access them. Barriers to access, Deloya explains, “are as diverse as the kids in the schools” — lack of transportation, being on the wrong bus route, waiting lists, work schedules, services not being available in the language spoken at home, feelings within families that they aren’t culturally relevant and stigma, to name some.


“There is some cultural acceptance [of mental health services] among white middle class Americans, but that may not be true for all the people who live within our community,” Deloya points out. For some, there is a degree of shame, “that somehow seeking mental health services means there’s something wrong with you. Or that you’re weak. And that if you just tried harder you would get over it.”


When mental health issues go unresolved, kids are not available for learning. “The brain is basically trying to stay safe. Thoughts like I’ve got to protect my environment so that I can be safe. Or I’ve got to make sure I don’t connect with people who might be threatening to me so that I can stay safe take an enormous amount of cognitive energy,” Deloya says.


So when a teacher has just given the class a set of instructions for a math equation, “this child is sitting there worried about … who they’re going to sit with in the lunchroom,” she offers, or what’s going to happen when they get home. “And they’ve missed all the instructions. And then they’re embarrassed ... and thinking about how it’s going to look to everybody else. ”When this happens day after day, week after week, a child can quickly fall behind.


Not surprisingly, unmet mental health needs can take a heavy toll on teachers, who try hard to cope so they can be available to do their best teaching for children.


“That’s what they’re inclined to do. That’s what they’re wired to do. That’s why they came into this teaching field. And they will do it,” Deloya says. “They’ll do it and they’ll do it until the weekend comes. And then they’ll rest and then they’ll come back on Monday and they’ll do it again.”


"They see a kid who is worried and in pain and they take that on because they care about kids." – Jeannette Deloya


Any teacher can tell you that a student struggling with an unmet mental health need can bring an entire lesson plan to a screeching halt. On top of that, teachers worry. “They see a kid who is worried and in pain and they take that on because they care about kids,” and that’s stressful, Deloya says.


Enter Building Bridges, a 90-day stabilization program that serves students in 4K-8 in Madison, Sun Prairie, Verona and DeForest, now in its second year. The program grew out of two converging concerns.


Dane County Executive Joe Parisi was hearing consistently from school districts in the county that students lacked access to mental health services.


“The effects of mental illness are far reaching,” notes Parisi, “affecting classrooms, families and workplaces. We all have personal accounts of its impact and the barriers it presents to learning in school and professional development at work, not to mention the challenges it presents to maintaining safe and healthy homes.”


At that same time, the MMSD mental health task force identified “crisis coordination” — now called “short-term stabilization” — as a high need.


“Building Bridges came out of that combined need and the county’s willingness to support it,” Deloya explains. Through Building Bridges, school districts partner with Dane County Human Services and Catholic Charities to provide short-term support to students, their families and school teams when kids are struggling with acute mental health issues. The program is voluntary and there is no cost to families.


In the 2014-15 school year, MMSD piloted Building Bridges with 14 open spots per 90-day cycle in the East attendance area.


MMSD Social Worker Meg Nelson is the Crisis Stabilization Lead with Building Bridges. Last year, she and Clinical Coordinator Lynn Witte from Catholic Charities made up one of three pairs of Building Bridges caseworkers — one pair per district (DeForest is new this year).


"I was expecting a lot of the older elementary and middle school kids. The majority of the kids we see have been in the kindergarten, first, second and third grade levels." – Meg Nelson

Initially, Nelson was surprised at how many of the cases referred to the program involve younger children. “I was expecting a lot of the older elementary and middle school kids. What we found is that the majority of the kids we see have been in the kindergarten, first, second and third grade levels,” she says.


As a first step, she and Witte set up an intake meeting with the child’s school “to find out the full history on the student and collect any records we want to review including Special Education evaluations and IEPs (Individual Education Programs).” They then meet with parents.


“During those intakes we’re asking, ‘What is it specifically that we want to focus our attention on?’ The school team might need some strategies for working with a student with a trauma history. Or strategies for keeping them regulated and safe within the classroom...We ask parents, ‘What are you hoping for [or] wanting out of this time together?’”


They then perform a number of observations and try to meet with the student to find out how they feel about school, if they’re feeling connected, if they feel they have safe people to go to and if they have goals in mind to work toward.


The whole team — Nelson, Witte, student, family and school staff — review the treatment plan and connect weekly through the 90 days. The plan might call for working directly with the student, teaching staff or family members specific strategies or simply connecting students to outside service providers.


girl in autumn looking away“What’s nice is that a lot of times we’re able to meet with families in the evenings so parents don’t miss work. We can drive to appointments or to the food pantry if that’s what the need is. And we’re having conversations around their child in those moments,” Nelson says.


Many of our students are not connected with service providers, “so we are helping parents make that first phone call, getting them to the appointment, helping them ask appropriate questions in those first appointments so that they’re comfortable,” Nelson explains.


When a student does have existing services in place, Building Bridges will typically connect with them to make sure they have a very clear picture of what’s happening at school.


“We’re asking the question from the family and of the school and of the service providers, ‘What’s the most important thing for us to focus our attention on?’ We’re coming up with a treatment plan that everyone is informed of and can work toward the same goals.”


94 percent of teachers and school staff surveyed said they noticed improved behavior after the program.

A successful intervention ends with a discharge summary and termination plan, which makes recommendations for the sustainability of the plan. Follow-ups happen at one month and sixth months.


To measure program success, they look at the measurable outcomes of the treatment plans, feedback from schools and families and whether kids are continuing to see clinicians or community supports outside of the schools.


“Anecdotally, I can say that the feedback we’re getting is pretty positive and that kids are being connected with services that can provide long-term support if needed,” Nelson says.


A survey of teachers and school staff this summer found 94 percent noticed improved behavior after the program, 87 percent said there was a decrease in office discipline referrals or suspensions and 93 percent noted a decrease in high-risk behavior in the classroom.


County Executive Parisi finds the data uplifting. “I am thrilled this program has resulted in such success for our youth struggling with mental health issues. These initial successes are exactly why I created Building Bridges. We must continue to invest in what we know works and continue our commitment to our children.”


To that end, in September 2015, Parisi announced an expansion of Building Bridges to deploy three more teams of health professionals that will provide access to all MMSD elementary and middle schools to help kids in crisis.


“We hired two staff in MMSD that started at the beginning of this year,” Jeannette Deloya explains. Those staff will join with the Catholic Charities staff for a total of three teams, which will eventually become four, with a team dedicated to each attendance area.


A positive side effect of Building Bridges is that school staff are being exposed to strategies for helping kids cope with mental health challenges that that can benefit a larger population of students.


“As we’re starting to get to know schools,” explains Meg Nelson, “we’re having lots of individual discussions around collaborative problem-solving, around trauma-informed practices or around anxiety and how to work with students who look anxious.”


She’s hoping that by having these discussions, and possibly holding building-wide professional development in the future, teachers can walk away and generalize some of those tools for the other kids too.


“We’re amazed at what teachers are be able to do for the kids, given what kids are showing up with,” says Nelson, adding that the resiliency that staff, students and teachers show in the face of mental health challenges leaves her speechless.


December 2015