Tiers of mental and emotional support for students from kindergarten up

A survey of parents conducted by the University of Michigan found that 16.5% of youth between the ages of 6 and 17 experienced a mental health disorder in 2016, but about half of those estimated 7.7 million children went untreated.

In much of Houghton County, there is an overlapping and growing network of programs designed to address the mental health issues of youth as early as possible. They don’t meet every need, but several are newly implemented and seeing positive results even during a tumultuous time.

Many schools are also focusing on mental health supports for students without impairments, or any illness or acute needs at all, too. The idea behind these new programs is to support a student’s mental health needs, starting from basic social support and potentially scaled up to 1-on-1 therapies, as necessary.

Multi-tiered Systems of Support

This is based on Positive Behavioral Interventions and Supports and is being rolled out through the Michigan Department of Education and locally through the intermediate school district. MTSS was launched to take a more proactive approach to identify students with greater needs by first taking a schoolwide approach to basic mental health supports. The program is optional.

“School districts can choose whether or not they have tiered levels of support for students in the schools,” Natalie Morgan said.

Morgan is the mental health services coordinator with the Copper Country Intermediate School District.

Not every school district is involved with MTSS. If districts choose to participate, they create a local team that works with Morgan or another CCISD “coach” to develop and execute the details of their MTSS program.

All students in participating districts are screened and school data is assessed three times throughout the school year. Tiers of support can be escalated to meet an individual or group of student’s needs. Parental involvement is also emphasized.

“We try to have as much communication with parents as we can,” Morgan said.

Sometimes the school can call meetings between a student’s parents, teachers, mental health provider, and even an administrator if necessary, but there are other, positive steps taken first.

“Every student throughout the school gets the tier one supports,” Morgan said.

Tier one - School-wide, foundational work to create a generally structured and supportive atmosphere for students. 

This can look different in different schools and classrooms. The structure element comes from the expectations of behavior and conduct.

“So the things that are in, like the student handbook,” Morgan said.

Rather than simply having these posted or distributed, the teacher takes time to teach what the expectations of behavior are.

“Then tier two supports are for those students who just need a little extra boost of those tier one expectations,” Morgan said.

Tier two - Group-level interventions that might include a special reading group or study hall. 

These groups can offer some students some extra assistance toward catching up with peers on schoolwork or offer social-emotional learning lessons.

“So that could be friendships, it could be talking about empathy,” Morgan said.

After seeing a lot of missing homework in their data, Baraga High School recently had a homework catch-up day that allowed students to catch up on homework.

“They didn’t tell the students about it at first…” Morgan said. “The percentage of homework completion that was done was like, through the roof.”

Tier two might also include regular 1-on-1 check-ins with teachers throughout the day.

“And it’s not, you know, a 10-minute conversation,” Morgan said. “It’s ‘thanks for sitting down and getting your pencil out right away’ kind of thing.”

Tier three - Individual interventions for students who might need support like 1-on-1 counseling.

“We have a whole range of students who are referred for services,” Morgan said.

Sometimes a student can be referred because of truancy or problem behavior in class, other times it can be because of something that happened at home.

“So it kind of depends on what the school is seeing and how they assess that situation,” Morgan said. “And then a lot of times it’s a referral to services here. To the ISD.”

The CCISD has two full-time and two part-time clinicians to meet referred students with mild to moderate needs. Students with extremely high needs can be referred to Copper Country Mental Health or served by CCISD staff under Project AWARE.

Sessions are usually once a week for 30 to 45 minutes.

Project AWARE

A new program to the area, this program is launched with federal grant dollars from the Substance Abuse and Mental Health Services Administration.

“We technically started it in like January, maybe February of this year,” Morgan said.

Along with some money toward supporting youth mental health treatment, it also funds money toward public education and fighting the stigma surrounding mental health treatment.

One program under this umbrella is Youth Mental Health First Aid. The training is for people like youth pastors, team coaches, and other people who regularly interact with youth.

“It can be employers if they’re an employer that employs youth,” Morgan said.

The training helps someone recognize if a youth is struggling with something and get them any needed support.

DEFINING TRAUMA - A quick sidebar

Trauma is often thought of as something that occurs after a violent or sudden event, like a fire, car crash, or physical abuse.

“It can be that car accident or that one event that happened that’s traumatic,” Morgan said.

But it could also be a divorce or death of a close family member or mentor. There are also complex traumas like generational drug and alcohol abuse or poverty.

“When a traumatic experience happens it can shift how your brain absorbs information,” Morgan said.

The traumatic experience becomes a lens through which the entire world is filtered.

“We see that in soldiers who come back from war,” Morgan said. “If they hear a door slam it can trigger their brain into thinking that is, you know, a gunshot or an explosion of some sort.”

For children, different things can be experienced as traumatic.

“We’ll work with students who have adults in their life who have identified a traumatic experience that the student went through,” Morgan said. “We’ll start working with them and they don’t see it as traumatic.”

When that’s the case, Morgan said they don’t pressure the person to see it as a traumatic event. She said it all depends on how the individual is internalizing an experience. If a person feels it is traumatic, and that memory is impacting how they perceive and react to the world, then therapists work to help them.

Therapy under Project AWARE is with Morgan as a therapist and Andy Kalcich or Allie Richmond, CCISD mental health services specialists, for skill-building. Therapy is where a student might work through trauma or practice mindfulness techniques. In the skill-building portion of their work, they talk about things like what coping skills they use, and each’s respective effectiveness for that individual.

Capturing Kids’ Hearts

Capturing Kids’ Hearts is a program launched by the Flippen Group that also relies on some of the same PBIS science in MTSS, but involves more intensive, direct training for the adults in a school than the state has dedicated for MTSS. CKH particularly focuses on building strong relationships between the students and adults within a school.

Calumet, Laurium and Keweenaw Elementary School recently launched their program locally with grant assistance from the Portage Health Foundation, and this year they were recognized nationally as a model school. It’s only the second year they’ve participated in the program. The selection process includes a direct evaluation as well as surveys from students, parents and staff.

“But the biggest thing to hang our hat on,” Julie Giachino said, “is just the culture we’ve created for these children and staff.”

Giachino is the assistant principal at CLK Elementary School, and one of the school’s first participants in the Flippen Group’s 2-day training. She described the culture transformation as “magical.”

Students are individually greeted as they enter the school building and classrooms.

“You’re engaging that student and finding out--What are their needs, right now?” Darren Kinnunen said.

Kinnunen is the social worker at CLK Elementary. He said a student isn’t going to learn well if they have distractions like needing breakfast or having lost something important to them, or other personal issues. These initial, immediate check-ins are a way to discover those needs and address them before they lead to bigger issues during instruction.

One of the first things a class does together at the beginning of the year is create their shared social contract.

“It could be viewed as your set of rules,” Giachino said.

The group develops the classroom rules for the year together, with the teacher leading a discussion about how the students want to be treated, and how the teacher should be treated. Involvement in the process empowers kids to check in on each other, as the rules are shared, rather than just the teacher’s own.

“So anytime there’s conflict or anything in the room… we always go back to that social contract,” Giachino said. 

The school staff also develops one for themselves at the beginning of the year. In kindergarten classrooms, they call it the ‘classroom promise’ to keep the vocabulary understandable to the young students.

Kinnunen said that some instruction time is lost to these extra interactions, but by eliminating distractions and stress students can focus more on academics. He said that Horizons Alternative High School has found more classes are being completed since they’ve started spending time implementing Capturing Kids’ Hearts.

“Once you have their heart, their minds are open,” Giachino said.

The concepts of CKH are along the same guidelines at Tier one MTSS supports. The program also dovetails with other programs CLK Elementary has enacted in the last couple of years.

KINGS Time

Through each week, the CLK Elementary School’s social worker, Kinnunen, spends 40 minutes with each class talking about things like problem-solving, developing empathy, understanding your own emotions, and social interaction.

“Some kids are maybe getting it at home, right?” Kinnunen said. “Just because of the household that they have. Some kids aren’t getting it.”

It also helps Kinnunen build a rapport with the kids so that if they come in to see him about an individual problem, they already have the basis of a mentor-mentee relationship.

“For me, it’s just a great opportunity to connect with kids,” Kinnunen said.

These social classes are also very similar to some Tier two MTSS supports, but enacted across the entire elementary school rather than targeted.

Therapy Dogs

The CLK district currently has five hypoallergenic therapy dogs that spend their days at the schools. Two are in the elementary school. Sometimes they’re scheduled to be in classrooms, other times they’re in one-on-one meetings.

“He even comes in here once in a while for some of our parent meetings and he’ll jump over there on the chair,” Matt Hampton, CLK Elementary School principal, said. “It really not only puts students at ease but also puts parents at ease.”

Right now the new dogs are training with Hampton and waiting for programs to restart after the pandemic. The dogs that have been in the building longer went through Pet Partners training.

“It’s been a great success for us,” Kinnunen said.

Handle With Care

CLK Schools have coordinated with local police in this state program to increase their awareness of what students are experiencing outside of school. 

“We recognized that there are some students in our district that may have been affected by just, trauma, in their life,” Kinnunen said, “and that maybe we weren’t picking up on some of that.”

Kinnunen would sometimes find that students in his office had major events happen in their lives that the school staff was completely in the dark about.

In the Handle With Care program, if police encounter schoolkids when on a call, they inform the school; not of all the details, but simply that the student may be tired from lack of sleep, distracted in class by something that happened, or need extra support temporarily.

“Depending on the circumstance, it might just be a check-in and not really talk about what happened last night,” Kinnunen said. “But just to say ‘Hey, how are you doing?’”

It’s a simple program, conducted via email, and Kinnunen highly recommends it to other districts.

Copper Country Mental Health

In addition to assisting schools with many of the above programs and being directly involved with Project AWARE, Copper Country Mental Health also provides several independent programs. 

“We provide a whole array of services, as required by the Michigan Department of Health and Human Services,” said CCMH Executive Director Cari Raboin.

Much of their programs are paid for through Medicaid, which sets a severity condition on the treatment they can offer and requires them to follow other MDHHS rules, too. 

Independent referrals go through NorthCare Network. Most children need a parent or legal guardian involved, but there are some limited services available without parental consent to those over the age of 14.

Leslie Griffith is the outpatient program director at Copper Country Mental Health, but spent 17 years of her career focused on early childhood and youth treatment, a segment of the population she says are particularly underserved.

CCMH considers youth to be prenatal to age 21.

Griffith wrote in an email that the goal of youth intervention programs is to reduce problematic behaviors and symptoms to ultimately have “a decrease in functional impairment”. Functional impairment is simply the barriers or limitations an illness places on carrying out a person’s daily life.

Services can be paid for through some private insurance, Medicaid, or MiChild insurance, according to Griffith. Charges are also income-adjusted.

“I’m concerned that people aren’t calling us who are eligible for our services,” Raboin said.

She said anyone in doubt of their need or financial assistance eligibility should call 1-888-906-9060 for a screening.

Parent Support Partner

PSP is a program to help parents with training and support to be caretakers of children with serious emotional disturbances. The goal is to move families to independence from counselors and other interventions through training in how to directly participate in the treatment process.

Youth Peer Support Services

This program pairs youth with a young adult to offer advice and support.

Wraparound

This program helps coordinate the supportive adults in the orbit of a child who has serious emotional disturbance to have a team approach in managing the necessary support. The program is especially effective for those involved with multiple institutions.

The Institute

A variety of education and training programs.

Dial Help

A local organization originally established to address addiction, Dial Help now offers a variety of support services.

Crisis Line

To talk to someone about available help and resources in the community, Dial Help keeps someone available around the clock. They offer specialized youth services and can make referrals to other experts.

Call: 1-800-562-7622

Text: 906-356-3337

Communities That Care

Dial Help supports the local Communities That Care initiative, which uses an evidence-based prevention model to address youth substance abuse, delinquency, and mental health. The organization relies heavily on volunteers.

Pandemic’s impact on youth mental health

“There’s definitely been some ups and downs,” Morgan said.

One of the positives, according to her, is that insurance companies and other institutions have come to recognize the value and effectiveness of teletherapy, which is conducting therapy sessions via video conferencing.

“Some of those students who have been virtual, we’ve done virtual sessions with them,” Morgan said.

She said more people have been able to participate in meetings virtually, too.

On the other hand, the distance has created some problems, too.

“If a student doesn’t want to meet, they just don’t log on,” Morgan said.

Morgan said the pandemic exacerbated the anxiety and depression some students they see were already feeling.

“So it’s just being able to recognize that and really working with students on different coping skills and things that they can use to kind of help get through this,” Morgan said.

The CCISD staff has been approved to keep meeting with students into the summer.

At CLK Elementary, the challenge was how to continue connecting with students when schools went virtual. CLK Elementary was only closed twice in the last school year, both in the fall, but the staff said switching back and forth was difficult.

Social contracts and regular greetings continued, but the venue changed.

Kinnunen said that they tried to maintain what schedule consistency they could so that students could develop new habits.

“We’re all creatures of habit, right?” he said. “Anytime there’s a shift, it just throws your system.”

Kids that didn’t show up for classes got calls from paraprofessionals and other staff from the school to check in on why.

The change to virtual learning also presented some students with issues finding both devices and internet access to participate. Different solutions were found for each, with the Portage Health Foundation assisting with establishing wifi hotspots, too.

Struggling to meet community staffing needs

“It’s mostly just qualified therapists to provide the services,” Morgan said.

Morgan said the CCISD has been fortunate in their hiring, but other ISDs in the UP have struggled just to find qualified people to fill those positions, and keep them there.

Currently, the CCISD has a small staff serving several school districts, with more joining the MTSS program. Morgan said more support from within the individual school districts would be very helpful. Social workers in schools, like Kinnunen, are beginning to be more common.

“If we could have, you know, be able to provide a social worker in every school, that would be phenomenal,” Morgan said.

Griffith wrote that there are “certainly” unaddressed needs in the community, but that families with higher income have access to private practitioners.

Raboin also said staffing is an issue. CCMH covers a four-county area with a small staff that has to be able to do many different things. 

“Our staff really have to be jacks of all trades,” Griffith said.

Frequent turnover makes keeping well-trained people on the job difficult. The geographic differences across the state aren’t always accounted for in the requirements they’re placed under, and encouraging needed people to move to the area isn’t always easy, either.

Social workers and therapists have specific educational requirements that have to be met as well. Raboin said CCMH has found success using remote teletherapy for their patients, as then therapists can be non-local.