Advocating for mental health

Northern Pines Mental Health Center Director of Operations Kate Sullivan, right, addresses the Morrison County Board, Tuesday. Listening are, from left, Melanie Erickson and Brad Vold of Morrison County Health and Human Services, Northern Pines Children and Familes Co-Director Stephanie Silgjord, Pierz Public Schools Superintendent George Weber and Northern Pines Executive Director Laura Vaughn.

A plan to invest $500,000 into mental health services in Morrison County schools over the next two years took a big step toward becoming a reality, Tuesday.

Following a lengthy discussion with local mental health providers, representatives from Morrison County Health and Human Services (HHS) and Pierz Superintendent George S. Weber, the County Board asked HHS Executive Director Brad Vold to bring a formal request for board action forward at its June 21 meeting. The project is a partnership between the county, Northern Pines Mental Health and local school districts.

Funding for the project would come out of the $6.5 million in federal American Recovery Plan Act (ARPA) money the county was allocated in 2021. The plan is to hire eight behavior interventionists that will work across the five public school districts in the county and Mid-State Educational Co-op.

“I think you could ask any teacher — anybody who works in the schools — to describe just how things have been the last couple of years as we’ve brought students back,” Weber said. “It’s just been more difficult, more stressful, and we have a lot of people leaving the industry.”

He said the biggest reason the project is needed is the number of students who do not, or cannot, follow the “standards or expectations” that come with going to school. Weber said it was almost as though they had forgotten how to behave at school after nearly two years of being at home and the uncertainly that came with distance learning and hybrid education models.

He said a “high percentage” of children require extra time to help them not only re-acclimate to a seven-hour day in school, but also to develop coping skills. The word he uses, he said, is “regulation.” That is, helping children with the capacity to regulate their emotions.

“You can relate to it when somebody has a 2-year-old that’s crying in a store,” Weber said. “You think, ‘Well, that child doesn’t yet know how to regulate.’ We’re running into that at all ages now, where they’re just not regulating. We have to teach that. We still have to have a functional day.”

He added that a high percentage of students do not qualify for therapeutic services, something that is required under the typical school mental health program, which follows a clinical model. That not only impacts what students can receive counseling services, but it also prevents schools from billing medical providers for certain services so insurance can help pay.

As a district, he said Pierz has put money into mental health services. Overall he is confident the district can operate under the same standards in 2024 as it did in 2018.

Piggy-backing off of Weber’s comments, Stephanie Silgjord, co-director for children and families at Northern Pines and an independent therapist at Pierz Public Schools, said she and her colleagues are seeing more and more students since COVID who do not meet the criteria to develop a diagnosis. Their job is to provide therapy and skills to children in the schools, but that is based off of a diagnosis from the Diagnostic Statistical Manual (DSM).

More often, they have seen children struggling with regulation, as Weber put it, along with being able to communicate and manage anxiety.

“I’ve been working in this profession since 2010, and I haven’t seen this level of anxiety in children, yet,” Silgjord said.

Many of the children, she said, are suffering from adjustment disorders. Typically, those come after the onset of a stressor or particular traumatic experience. They cannot be diagnosed until at least two months have passed since whatever triggered the issue.

“However, some of the kids that we have coming to us, there’s not a significant history of trauma, nuclear families, homes are intact,” Silgjord said. “But they just have this level of stress and learning how to cope with that level of stress is where they have the difficulty.”

The way she said she typically thinks about it is that kids have not been in a school building or living within a normal, secure routine for nearly two years. As such, a child who was 7 years old when the pandemic began would now be returning to school as a 9-year-old, though they may only have the coping and regulating skills of a 7-year-old.

She said having these interventionist positions in the school would allow providers to work with students — along with educators and school staff members — on those skills and supports which don’t require a diagnosis. They can also meet them where they’re at, such as in the lunchroom, on the playground, or even at home after school hours.

That flexibility is something Vold felt would be a big advantage to creating these positions.

Northern Pines Executive Director Laura Vaughn said she agreed with Weber that it might be possible to move on from this “time of transition” within two years.

Over the last six months, she said Northern Pines’ mobile crisis outreach has seen the number of calls it receives involving teen girls “skyrocket” by 86%. Part of that has to do with COVID, while it also has to do with changing communication styles — specifically a move to less interpersonal modes like text messaging.

The mobile crisis outreach, Vaughn said, has also received more cases of domestic violence and situations between parents and children during the last couple of years.

“The pandemic has given us a glimpse into our support, our routines, the things that help us to not feel anxious,” she said. “That predictability has changed.”

One of the main questions the Board has asked during previous discussions about the plan was why the schools were not paying for at least a portion of these services. Commissioner Mike Wilson broached that topic with Weber, who said nobody wrote more letters to state and federal officials regarding COVID-related funding for schools at the outset of the pandemic.

“I was outraged, frankly, about how $1.5 billion was going to flow through (the Minnesota Department of Education) MDE and the manner in which they’re giving it away,” Weber said. “It was obscene, frankly, for lack of a better word.”

He said the federal government came up with a “Title I” formula for getting money out to the states. He said it did not count the number of students in the schools, or even the number of students receiving free and reduced lunches. Instead, it factored in issues such as adults in the community who seek financial assistance.

The bottom line, he said, was that some schools got “a lot of money” while others received “hardly any money.” Pierz did receive some, but there were nearby districts Weber said received exponentially more. Much of what it did receive, he added, had to be spent on technology for distance-learning, or personal protective equipment (PPE), for example.

He added that schools do not receive any money from the state or federal government for mental health services. He said if he wants to hire a social worker, a counselor or even a school nurse, that money has to come out of the per-pupil funding the district receives to hire teachers.

“It’s always that, ‘OK, I need more medical help. Yeah, I know I could use another counselor. But, what grade am I not hiring another section of teaching for?’” Weber said.

“It’s always a balance of taking away from academics in order to provide more social, mental health support,” he continued. “That’s always a balance that we have to weigh out.”

Later, Commissioner Mike LeMieur said he was wholeheartedly supportive of the project. He believed a venture between the county, Northern Pines and the districts sounded like a great collaboration.

“I didn’t know, Mr. Weber, that you had to use your per-pupil funding for counselors and nurses,” LeMieur said. “That’s something that we should be screaming from the rooftops that that’s not allowable, or it should be allowed to be treated that way.”

To put the matter into further perspective, Northern Pines Director of Operations Kate Sullivan said it could be looked at as an investment. The program could not only benefit children at the school level, but it could also prevent them from having to enter into other mental health supports or deal with other issues down the line.

Ultimately, that could save the county money.

She added that children don’t have the life experience and learned tools to regulate the level of anxiety they’ve felt with all the changes and uncertainties over the past two years.

“As adults it was difficult for some of us after the pandemic,” Sullivan said. “How would we not think that kids would need extra support living through a global pandemic?”

Another issue previously discussed by the Board was that it might be difficult to fill eight behavior interventionist positions. Commissioner Randy Winscher, who sits on the Northern Pines Board of Directors, asked representatives from the organization their thoughts on that matter.

Silgjord said the providers would have their time split 50/50. As half of their time would be considered as an employee of Northern Pines, as long as the program is successful, they would likely be able to remain with the company even if this particular program ends after two years.

One of the biggest questions has involved who would fund the position if it goes beyond two years. Commissioners have balked at the thought of having to levy in order to keep the program alive once ARPA funding is gone, which it certainly will be in two years.

Vold reiterated that it might allow the county to re-allocate funds, if it is saving money elsewhere. There is also the possibility that Northern Pines could take it on entirely.

“I would assume a lot of it’s on the districts,” Weber said. “How bad do you want to retain this position? Is it a high priority or not?”

Board Chair Greg Blaine thanked everyone for their input, but pointed out some of the comments Weber made regarding children struggling with communication skills and adjusting to a routine. Those are things, he said, should be taught at home. He questioned how much of the responsibility should be placed on schools versus the parents or guardians.

“I’m not saying we shouldn’t do this or we shouldn’t react to helping these students or anything like that, but if we are really trying to succeed in addressing this problem, should we also look at this from a systemic lens and look at — do we need to be somehow helping in that parenting role?” he asked.

Further, he said there was no question in his mind as to whether or not the county should do its part in trying to help the students. Instead, he wondered if this program would only serve as a “two-year Band-Aid” rather than addressing the root of the issue.

“One program is not going to solve all of the problems,” Vold said. “It’s another tool in the toolbox. I think part of the conversation we’ve had is, we understand that parents are an important factor in kids’ lives and we need to help them just as much as we need to help the kids. That’s part of the flexibility that this also provides.”

HHS Children’s Mental Health Supervisor Melanie Erickson said, like Blaine, she liked to look at things through a systemic lens. She said, when one looks at the history of pandemics, there is often a major cultural shift shortly thereafter.

As such, she said isolation and a lack of connection are particularly detrimental to children. It impacts everything from suicide ideation to impulse control and vaping.

“I think that’s the parallel issue with the pandemic, is that it decreased that ability for kids to have interactions face-to-face at a time when they’re still socially, emotionally growing,” Erickson said. “They got stinted, is a way of thinking about that.

Silgjord said the program would also provide resources to parents when they don’t know what to do. Just to have someone they know they can connect with, she said, could do wonders in helping them as they navigate what both they and their children are going through.

LeMieur likened it to free-and-reduced meal programs. He said they know it’s important to ensure the children are fed because studies show they learn better “with a full belly.”

Further, he said there are some kids who “hate” to go on Christmas vacation because they know they’re not going to have someone to talk to, or a good meal to eat.

“Just think of that, what trauma that is,” LeMieur said. “Maybe we can’t help the family, but maybe we can help that little kid that is struggling to understand.”

“I think our country in general has gone through a lot in the last two years,” Wilson added. “We can continue to be putting out fires or we can start doing something to make it better. At some point in time, we’ve got to turn this thing around.”

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