Elementary School Children Receive Mental Health Evaluation and Treatment at School

Morgan Stanley Children's Hospital In-School Programs Address Substantial Need<br /><br />Programs Cover 11 Schools in Washington Heights, Inwood, and Central Harlem; Soon To Cover 13 Schools

Jun 24, 2005


Addressing a substantial need for mental and behavioral health care evaluation and treatment, elementary school students are treated by specialists onsite at 11 elementary schools in Washington Heights, Inwood, and Central Harlem, as part of the School-Based Mental Health Programs provided by the Pediatric Psychiatry Service at Morgan Stanley Children's Hospital of NewYork-Presbyterian. The programs are conducted in concert with the New York City Department of Education and the New York City Department of Health and Mental Hygiene, and receive support from several local foundations. Beginning in July, the programs will be expanded to serve approximately 625 children at 13 school sites.

Well-established child psychiatric epidemiologic rates suggest that 16 to 21 percent of children and teens nationally would meet diagnostic criteria for treatable mental illness. Locally, contributing factors include insufficient housing, economic stressors, community violence, and some of the city's most overcrowded schools. Existing child and adolescent mental health clinics can only serve 20 to 25 percent of the children who need such services.

"Our school-based programs extend access to care to children and families who often have difficulty coming to clinics, and, because our clinicians are onsite with the children, they can offer additional classroom and school interventions that increase the effectiveness of the services we offer," says Dr. Charles Soulé, child psychologist, director of school-based mental health service development at the Morgan Stanley Children's Hospital pediatric psychiatry service, and assistant clinical professor of medical psychology in psychiatry at Columbia University College of Physicians and Surgeons.

The programs, which are all voluntary and confidential, operate in close collaboration with parents, teachers, and school student support staff to give them tools to improve the behavioral and mental-health status of their children. "Our programs give us easier access to key caretakers in the family and at school. For example, we can give teachers classroom-based training in conflict resolution and strategies for disruptive behavior. One of our goals is that, with appropriate treatment, many children can succeed in mainstream classrooms," says Dr. Soulé.

The school-based programs include, (1) the school-clinic program, comprising comprehensive clinics in five elementary schools; (2) the Mobile Outreach, Referral, and Education (MORE) program, comprising urgent evaluation, short-term treatment, and referral services in another six elementary schools; and (3) school-based specialty trauma services, prevention, and outreach program in all 11 of the schools served above.

Serving children aged four to ten, and grades pre-K through fifth grade, the programs are staffed by a multidisciplinary and bilingual team that includes psychiatrists, psychologists, social workers, and case mangers. Services include comprehensive mental health evaluation, crisis counseling, short-term individual, family, and group psychotherapies, psychopharmacology, and active advocacy and referral services for children and their families. All services involve the active and ongoing participation of parents, families, and school staff.

Most children are referred for services by school staff, but children and families can seek services directly. Clinicians do regular education and outreach to families and school staff, helping caretakers to identify children who may need services, and are active members of the school-child study teams that coordinate all special services for children. As in most child outpatient mental health settings, between 60 and 70 percent of the children seen by the programs have a primary disruptive behavior disorder, with attention deficit disorder (ADD) the most common, and 30–40 percent have depression, anxiety and/or post-traumatic stress disorder (PTSD). Many children present with both significant disruptive behaviors and depression, anxiety and/or PTSD. Additional behavioral problems include selective mutism, and school-refusal. "One of the main causes of child mental health problems is trauma or loss of a loved one; 25 to 40 percent of the children treated by the programs have a history of one or the other," says Dr. Soulé. "For these patients, our clinicians offer education and coping skills, including relaxation training and tips on how to recognize, understand, and control difficult feelings."

A large portion of the school-based programs – including the MORE program and the addition of second clinicians at each of the school clinic sites – are funded by foundation grants. "Much of this funding expires at the end of 2005, and we are always actively advocating with public and private funders," says Dr. Soulé. The programs began in 1986 and have grown tremendously since 2000.

Morgan Stanley Children's Hospital of NewYork-Presbyterian

Ranked by U.S.News & World Report as one of the top five children's hospitals in the country, Morgan Stanley Children's Hospital of NewYork-Presbyterian offers the best available care in every area of pediatrics – including the most complex neonatal and critical care, and all areas of pediatric subspecialties – in a family-friendly and technologically advanced setting. Building a reputation for more than a century as one of the nation's premier children's hospitals, Morgan Stanley Children's Hospital of NewYork-Presbyterian is affiliated with Columbia University College of Physicians and Surgeons, and is New York City's only hospital dedicated solely to the care of children and the largest provider of children's health services in the tri-state area with a long-standing commitment to its community. Morgan Stanley Children's Hospital of NewYork-Presbyterian is also a major international referral center, meeting the special needs of children from infancy through adolescence worldwide.