Q&A with Stephanie Taylor, Ed.S, NCSP, Vice President, Clinical Innovation and Outreach at Presence
Schools are facing a serious mental health crisis, exacerbated by the SARS-CoV-2 pandemic. Children’s mental health-related Emergency Department (ED) visits increased dramatically from April through October 2020 compared with 2019. A November 2020 report published by the U.S. Department of Health and Human Services offered this staggering statistic: “the proportion of mental health-related visits for children aged 5–11 and 12–17 years increased approximately 24% and 31%, respectively.”
The report continues: “The majority of EDs lack adequate capacity to treat pediatric mental health concerns…potentially increasing demand on systems already stressed by the COVID-19 pandemic. These findings demonstrate the continued need for mental health care for children during the pandemic and highlight the importance of expanding mental health services, such as telemental health and technology-based solutions (e.g., mobile mental health applications)….”
We spoke with Stephanie Taylor, Ed.S, NCSP, Vice President, Clinical Innovation and Outreach at Presence, about the role schools can play in meeting the need to expand mental health services for children. We asked Stephanie to clarify some of the challenges schools face in providing mental health support, and we asked her to share with us her ideal scenario for schools, given the pandemic relief funding that is currently available.
Q: How are the mental health needs of children different today from before the pandemic?
ST: It’s important to be clear that the mental health of children has been underserved for years—the pandemic did not change that. The broad picture of the necessary things that we should do for mental health is not different than it used to be.
What needs to be done to promote children’s mental health and help them to grow into socially and emotionally competent adults has not changed essentially since the pandemic started. The pandemic didn’t redefine what mental health is or how to address it. What it did is make it harder for everybody. It highlighted any gaps that adults and children had in their mental health, in their general coping abilities, in their ability to connect with other human beings. And it actively inflicted new trauma. The sooner that we address this deficit in critical mental health services, the less chance that there will be actual long-lasting or unalterable damage.
Q: What do you think schools should be striving towards right now?
ST: Schools want to support students’ mental health and well-being. The challenge is how to do it. We need to recognize all the hurdles our schools have in their way. Funding and staffing are always a huge hurdle for schools, but so is the perception about their function, which ultimately dictates how time is allocated in a student’s day. Many people view schools as primarily academic institutions. If state testing scores are low, the perceived solution is to spend more time on that academic subject. Unfortunately, all the factors that affect academic success, such as mental health, are often the items that don’t make the cut when funding, staffing, and scheduling decisions are made.
This unfortunate pandemic has provided an opportunity to reassess performance measures for schools. Until it is universally recognized at the federal level, state level, and superintendent level that mental health is going to be taught, tracked, and outcomes monitored, it will never be seen in the same way as academics and the systemic changes that need to happen in order to make improvements will never happen. That’s just the reality of it because all of us are that way—if we can’t track something and see how what we’re doing matters, we’re less likely to continue doing it.
Q: When people recognize that academic performance is going to go down if mental health isn’t being addressed, then tracking success starts to become a little more critical, doesn’t it?
ST: Yes. More and more, the definition of what constitutes school skills or academic skills is expanding. Are social skills part of academic skills? The pretty standard answer today is yes. But mental health is still seen as an ancillary skill in many places. However, it’s important that we take it one step further—to consider social-emotional skills to be educationally relevant, not only to be impactful on academics, but to actually constitute their own category.
So far, schools have been able to address some social skills and do some things that are school-wide but many haven’t had the opportunity to look at it in a systematic way. It is hard to focus on mental health skills—it’s hard to move things around to find the time and staff for them, and to “pay for them upfront,” but the schools that do, find that it ties into better academic performance later. It’s just that it’s very hard when there’s no budget set aside, no time in the day for it, and you’re getting judged on something else. So those three things combined are the proverbial “perfect storm”—no money, no time, no measurement—and make it really hard for schools to invest in that upfront payment. I’m very sympathetic to that—I’ve been there.
Q: Can you expand on the time element?
ST: If you’ve ever read the book Schools Cannot Do It Alone, author Jamie Vollmer talks about how it used to be that schools literally taught reading and writing and math and that was it. And they did that in the same school day that still exists now. Then he talks about how many things have been added over the last 70ish years in education. Now it’s computer skills, science, math, history, PE, Spanish, and everything else, but the amount of time that students are in school hasn’t changed much. So now we’re teaching a lot more content in the same amount of time, and we’re expecting all of them to have decent outcomes. That’s just not realistic. So, schools already do not have enough time to address everything they need to.
And so the question becomes, How do we fit it in? Do schools have a designated mental health class that students take, just like other subjects? If so, what do they take time away from? Or does the day get extended? How much time is the right amount of time for optimal outcomes?
That change has to start at the local level. I think it has to be about talking to your superintendent, your local leadership. We have to start by saying this is something we believe in, and we feel like it has to have some time during the day, but we can’t do it in the scenario that we’ve been given so how can we all do this?
There can be really great one-off programs—some schools out there are doing amazing work to make things happen for the students. But none of that is going to be widespread or replicable across the entire group of schools, until these changes are escalated and happen at a district and state level.
Q: It’s clear we need systemic change. So how do we redefine what an educational model for mental health looks like?
I do think there is an opportunity here as part of a post-pandemic shift in which mental health issues are more widespread than they’ve ever been. Now is the time to start conceptualizing what that shift would look like if we agreed mental health actually is an educational issue and not just a medical issue or a subset of academic skills. How do we redefine what is the educational model for mental health?
If we could imagine what was best for our students, and if we could make the day and their schedule how we want it for them, and we could add in the content that we want them to learn that we know would help them perform better in academics, help them have better social skills, help them feel good about themselves and be happier, more productive human beings, what would that look like for us? That’s what the reimagining of educational models would look like based on each population of students, because there’s not going to be one universal answer. Yes, time is going to be a constant, meaning we have to have time to address this. Money and personnel are going to be constants—we have to have those to address our students. But after that, it really comes back to what we are using to decide what the students need. Different populations of students have very different needs. Communities are different. Cultures are different. We need to look at each individual population and each event or school.
I think in this perfect world where I’m designing my own educational model of mental health, I would say there’s no tier one, there’s no tier two, there’s no general ed, special ed, there’s none of that. It’s simply this: what skills are the students missing, and is that skill more conducive to being taught in the whole group, small group, or individual? Then we might say for certain children, “We thought a small group would work and it worked for almost everybody else but it didn’t work for them.” We need to recognize their individuality and work on whatever that student needs. We would base the grouping on the skills and their best way of being taught rather than moving students through a tiered system, per se. That’s a student-centered solution and one that I would recommend in a perfect world.
Q: Do you have some suggestions on how a platform and clinical network fit into an education model of mental health?
ST: How each individual school addresses their needs is going to be different because, as I mentioned, we all know it takes budget and staff, time, and measurement. Those are the three universals but after that there are lots of ways that something could be implemented, and the more flexibility a school has to be able to implement those things, the more successful they will be.
For one, having access to a broader network of people is going to be essential because you’re going to need lots of hands on deck, probably more than a school typically has on staff, and schools are going to need to be able to access those people during the times of day that they need them for these concentrated mental health skills, but maybe they don’t need them the rest of the day so having flexibility in staffing would be a big help for schools.
Second, it will be important to have options for students who are not physically at the school: homeschooled students, hospital and homebound students, etc. There are also a lot of students in virtual schools, and we already know that many are not getting any mental health services because a lot of virtual schools don’t have that built in.
So it is important to have a platform that is engaging and can be used for a lot of different scenarios. It’s important to recognize that some students might need to connect with somebody who they don’t have the opportunity to see in their community. For example, in one scenario all the counselors that are employed at a school might be men and a female student would feel much more comfortable talking to another female. In other scenarios, a student might be very culturally different from the community that they live in and the idea that they could talk to somebody who is culturally similar is essential for establishing trust for some students.
It’s not just about supply and demand of staffing. It is also about how to help students make the best connection with the person they are interacting with and receiving the mental health instruction from.
Q: For schools that want to get started, where would be the place that you think they could get the most leverage in beginning?
ST: I think there are two ways to look at it. If I were talking to administrators who say they want to get something going and need to know where to start, I would say the one thing they should start with is adopting social-emotional learning standards and making them part of their accountability measurements each year.
If I were talking to a school district trying to do something at their local level, or people in a singular school building who are trying to do something, I would say that carving out the time of the day is the first thing they should do—everybody agreeing that there should be one designated time. And if that means in your building, you know that you’re going to add 10 minutes to the school day, that’s something you can do at the individual school level. You can at least designate and try to carve out some time. You may not be able to take away from other things but you might be able to add in.
If your school district is considering online therapy services, innovative staffing solutions, or new approaches to meeting the needs in your school communities, schedule a free consultation today.