Connecting with Children at School - Therapeutic Counseling
Coping in High School
Greater Cincinnati Behavioral Health (GCB) school-based therapist Dave Reis is a Newport native, through-and-through. He can recall colorful childhood memories when the neighborhood was defined by not only the legendary gambling scene, but also the thriving manufacturing backdrop. “The neighborhood suffered when all the industry moved out,” Dave says.
Today, Dave works at Newport High School as an in-house therapist, serving students aged 12-19. Dave provides counseling services to students with a variety of issues, including social anxieties, trauma, anger or acting out, as well as depressive or suicidal concerns. Teachers or parents usually provide the referrals, but often the students will self-refer. The services are funded in part through a grant from Campbell County Fiscal Court to provide Mental Health services in Campbell County schools.
The majority of the school’s population is eligible to receive free or reduced lunch. High levels of unemployment in the area contribute to challenges at home that the students have to deal with every day. “It’s not unusual for some of our families to be living without utilities due to unpaid bills,” he says.
With a caseload of over 25 students at the start of the year, Dave will see each child usually once a week. He works with the teachers to try and stagger the appointment times for flexibility. The students regularly see Dave at most of the school events as well as around town, so he is largely seen as a dependable and stable adult, which helps when he’s working to establish relationships based on trust.
“The main issues in the students I see are trauma, poverty, neglect and anger,” he says. “Many of them experienced negative imprints early on, which unfortunately is a real predictor of how they’ll do in school.” Trauma can include physical, emotional neglect, sex abuse, parental mental illness, incarceration, divorce, separation and domestic violence. At least half of all Dave’s caseload involve substance abuse issues.
“A lot of my kids have been diagnosed with ADHD,” says Dave, “But often, what is really going on is depression and trauma. Once they learn coping skills, we often include a goal to get them off medication.” It’s not unusual for Dave to see the same students for four to six years straight.
Family counseling is a critical component of each child’s diagnostic plan, so Dave works to bring in the parents at least once a month. Services for students need approval from the parents; then Dave can proceed with a crisis evaluation for each child, intake and then a full assessment and diagnostic plan.
Therapists in the School Based Services provide individual, family and group counseling. They are experienced in a variety of areas, including trauma, depression, anxiety, grief and loss, substance abuse, relationship difficulty, managing anger, domestic violence and conflicts at home, school or work.
Outcomes of his work with students can include improved behavior at school and at home, decreased stress and anxiety, and improved coping, social and emotional skills.
Goals outlined for each student are often “baby steps” – addressing behavior and ways of thinking. “They learn how to talk to adults, and not internalize so much,” says Dave. “I’m here to help the kids look at things differently, to give them ownership of their lives. If at least one person in their world is expecting them to be successful, that can make all the difference.”
“The Meds Won’t Fix You; You Have to Work on Your Skills” – Therapy in Elementary School
Elmwood Place Elementary is located in the St Bernard-Elmwood Place City School District in Cincinnati. More than 90 percent of the students come from low-income families. Susan Porter is the GCB school-based therapist, serving children aged 3-12. Susan’s caseload is about 26 kids; and although very few of the children ‘self-refer,’ there is “no perceivable stigma here, whatsoever,” she says.
“That’s what I love,” she continues. “The only thing they might say is, ‘Oh, you get to go see Miss Sue!’ But it’s important that I get in front of the classrooms regularly to explain what I do. I say that I am here to help them with the past, present and future, as well as the emotions that come with that. You don’t have to be a ‘bad kid’ to work with Ms. Sue.”
“What often looks like poor behavior – outbursts or crying, hyper-vigilance (constantly looking at the door) – can very well indicate anxiety, depression or post traumatic stress disorder,” she says. “The biggest issues at home for my kids are drugs, unemployment, incarceration and neglect. Their lifestyle is traumatic, and unfortunately, severe trauma can look like oppositional behavior.”
And while some of her students do ‘graduate’ from needing her services, middle school is a whole new ‘social ladder,’ and relapse is common. “In some cases, we have to start all over again,” she says. Her approach is teaching mindfulness, as well as behavioral management and traditional therapy, processing what’s happened. “I tell them the meds won’t fix you – you have to work on skills,” she says.
GCB currently partners with 15 schools in Cincinnati and Northern Kentucky combined. Outcomes indicate that of the 744 students with mental health needs and/or developmental disabilities who are receiving services, 87.6 percent have reached an important treatment goal or objective.
If this program could no longer be offered, for whatever reason, what kind of impact would that have?
“Many would most likely be sent to an alternative school,” says Susan, “which is a huge expense to the district. But more importantly, what we offer them are the tools to build a strong foundation for success at school and life as they move forward. We give them the confidence that at least one person in their lives believes in them. And that’s huge.”