The Other 60 Percent

A new tool in schools’ mental health tool box

Using Crayola markers set on each round table, small groups of adults from the Greeley area — school outreach workers, Boys and Girls Club staff and foster parents — created poster-sized pictures of what mental health problems look like. Glum stick figures sat under rain clouds, a face contorted from happy to sad and a placid face showed no outward signs of distress.

The pictures were just one of several hands-on activities sprinkled throughout a recent day-long training that aims to teach lay-people the signs of mental health or substance abuse problems in youth, and give them action steps to follow when they spot trouble.

Called Youth Mental Health First Aid, the training originated in Australia and was unveiled in Colorado last year. There is also an adult version of the training, introduced here in 2008, called Mental Health First Aid or MHFA.

Both are gaining momentum in what mental health advocates say is a welcome development in a state saddled with one of the highest suicide rates in the country and more than its fair share of school tragedies, including a deadly shooting at Centennial’s Arapahoe High School in December and a self-immolation at Westminster’s Standley Lake High School in January.

Olga Gonzalez, a community outreach worker who participated in the recent Greeley training, said she regularly fields questions from parents who are worried about their children but don’ t know where to turn. She recounted how one family she’d worked with discovered their son had started using drugs. Another learned that their son had stolen credit card information from a customer while manning the cash register at the family’s store.

“He has money in a savings account, you know. He just did it,” she said. “I wasn’t sure what kind of support he needs.”

Youth Mental Health First Aid aims to answer such questions for people who are not mental health professionals but who work closely with young people and their families. The target audience includes lay-people like teachers, coaches, guidance counselors, school nurses and even bus drivers.

Advocates for MHFA say Colorado now has one of the largest contingents of certified instructors—around 230 so far. In addition, it’s among only a handful of states to dedicate public funds to the trainings, with $750,000 appropriated for the program next year.

“We have been at the forefront of this since the beginning,” said Brian Turner, director of Mental Health First Aid Colorado at the Colorado Behavioral Healthcare Council.

Preparing first responders

The concept behind both versions of MHFA, much like medical first-aid, is to equip first responders with the know-how to address emerging mental health or addiction problems. The youth version is also meant to help distinguish between true mental health issues and the normal mood swings and behavior changes that characterize the life of a teenager.

But the training is hardly a technical lecture. It’s participant-friendly approach is evident in the hands-on activities, the video clips, the anecdote-peppered instruction and even the pile of bite-sized candy on each table. Originally, conceived as a two-day training, it has since changed to a one-day format.

“I think we try to make it accessible in a very non-threatening way,” said Pamela Collins Vaughn, one of the instructors at the Greeley training and quality assurance program director at North Range Behavioral Health.

The five action steps in Youth Mental Health First Aid.
The five action steps in Youth Mental Health First Aid.

Gonzalez, an outreach worker with Community Care Corps, said she learned about the training at a resource fair that she helped coordinate. Her work with families at two local middle schools, as well as in surrounding neighborhoods, made her want to refresh her knowledge on mental health issues.

While Gonzalez and other MHFA participants are certainly not charged with providing treatment, they do receive a customized local resource guide to help them connect youth with professional help when necessary.

In fact, encouraging youth to seek professional help is one of five action steps—condensed in the acronym ALGEE–outlined in the training. The other four include “Assess for suicide/self harm,” “Listen non-judgmentally,” “Give assurance/information,” and “Encourage self-help/other support.”

Turner said having concrete action steps is important because “there’s a big difference between learning about mental health and substance abuse problems and being able to do something about it.”

During the Greeley training, participants were asked to come up with gestures that would convey each of the five action steps. Soon, in an effort to commit the steps to memory, Vaughn and co-trainer Noelle Hause were leading the group in miming actions like non-judgmental head-nodding and reassuring arm-patting.

Reaching out to schools

While Turner said Youth Mental Health First Aid is not yet widely offered by school districts, there is growing interest. Among the districts that have offered it for at least some staff are Douglas County, Aurora, Thompson, and Weld County District 6.

Barb Becker, division director for community programs at the Arapahoe/Douglas Mental Health Network, said the one-day format make it a very doable training for educators.

One of the pictures made by participants at a recent Youth Mental Health First Aid training.
One of the pictures made by participants at a recent Youth Mental Health First Aid training.

“It just gives a really good overview,” she said, adding, “It takes away some of the stigma associated with mental health.”

While grants to offer Youth Mental Health First Aid are sometimes available and some mental health centers offer it for free, the price of the training can be a barrier for districts. Costs typically run at least $25 per person and can max out at $50 depending on facility and food costs.

While the new $750,000 in state funding will help with expansion, Turner said advocates are also investigating whether Medicaid reimbursements received by schools can help pay for the trainings. Currently, those reimbursements are used for all kinds of school health and wellness efforts, from paying school nurses to buying P.E. equipment.

If Youth Mental Health First Aid is widely adopted by schools, it will join a growing number of tools used to detect and combat mental health problems in students. Many schools already use suicide prevention curriculums, some are adding instruction on social emotional skills and a few conduct universal mental health screenings among students.

In addition, many schools regularly convene meetings to discuss and create plans for students who are showing signs of mental health or behavioral problem. Others publicize programs like Safe2Tell that allow students, parents or staff to anonymously report bullying or threats of school violence or suicide.

While Becker noted that middle-aged white men, not teens are actually at the highest risk for suicide in Colorado, she said it is still a problem among young people.

In 2010, Colorado had the seventh-highest  youth suicide rate among states and Washington, DC, with 16.7 deaths by suicide per 100,000 people in the 15-24 age group, according to data from the Centers for Disease Control and Prevention. In general, Colorado’s suicide rates are higher in rural and mountain communities than in urban areas. They are also higher among males than females.

Becker said there are a variety of reasons, including biological changes, peer conflicts and dating strife, that adolescents experience depression, which is a leading cause of suicide.

“It’s a hard time in life,” she said.

Ultimately, Turner hopes both versions of Mental Health First Aid will be widely available in all parts of Colorado. They won’t prevent all violent incidents, he said, but they might help. They can also aid in the healing process for communities that have suffered through fires, floods, droughts and other disasters.

raising the curtain

Aurora high school students started rehearsing a musical about an earlier time — and discovered ‘harsh truths’ about today

Ebony Nash, left, sings during a rehearsal of Ragtime at Hinkley High School. (Photo by Yesenia Robles, Chalkbeat)

Nine weeks ago, more than 50 theater and choir students at Aurora’s Hinkley High School came together to begin work on a musical set in turn-of-the-20th-century New York.

At first, the kids did what high school students often do — cluster into familiar cliques, or self-segregate by race. Then the students started immersing themselves in the material.

The musical, “Ragtime,” intertwines the stories of a white family, a Jewish immigrant family and an African-American couple to spotlight differences and commonalities in the American experience.

At the urging of their teachers and directors, the Hinkley students began to use the plot and characters to examine their own actions, prejudice and biases. About 92 percent of Hinkley’s more than 2,100 students are students of color, the vast majority of them Latino.

The cliques and segregation slipped away. The production began taking shape.

“Ragtime” gets its Hinkley High School debut on Thursday and will be performed again on Friday and Saturday.

Chalkbeat sat down with a group of students involved in the production as they were in final preparations to learn about what their experience had taught them. The following is a portion of that conversation, slightly condensed and rearranged for clarity:

Janelle Douglas, a 17-year-old senior who portrays a friend of one of the story’s main characters, said the first time she saw and read through Ragtime, “it was intense.” She often cries as she rehearses her solo, sung during a funeral.

DOUGLAS: “I thought, this is powerful. This is overwhelming. This is amazing.”

Pamela Arzate, 17, plays the role of Evelyn Nesbit, a real model and actress who is incorporated into the fictional story and accused of being shallow.

ARZATE: “It’s very eye-opening because you look at it and it’s just a simple musical, but if you take a step back and go to the real world, it’s the exact same thing that’s going on today.”

Hodaly Sotelo, 17, plays the role of Mother, a woman whose attitudes toward her identity as a wife and woman evolve throughout the story.

SOTELO: “It reminds me of when I was younger and I was like, ‘Oh yeah, we’re over all that racism.’ But now, I look back and I think, what the heck? This stuff is still going on and we thought it was way over.”

Brianna Mauricio-Perez, 17, is one of two student directors.

MAURICIO-PEREZ: “It talks about all of the harsh truths that no one wants to talk about.”

DOUGLAS: “I think it’s safe to say it shows the true colors of our history.”

MAURICIO-PEREZ: “Even within our cast we did have to have a talk about how we were so separated because we were at the very beginning. Everyone was in their little groups and with their friends. You just want to keep to yourself.”

DOUGLAS: “It was literally ‘Ragtime.’”

MAURICIO-PEREZ: “We had a big talk with everybody. Things have gotten so much better. By the end of Act Two, we were all mixed up.”

Brenda Castellanos, 17, plays the role of Emma Goldman, drawn from a real-life political activist and anarchist.

CASTELLANOS: “Now that we’re closer, now that we’re all comfortable, we put in more effort.”

After nearly every rehearsal, teachers and directors give students a talk, urging them to immerse themselves in the feelings of their characters, relating to them if necessary through their parents, grandparents or ancestors who were immigrants, or through current events.

“What if you saw someone beaten, and bloodied and killed in front of you?” one director asked.

They also remind students of why the play should be impactful. “You have to figure out how for two-and-a-half hours you can give hope to that audience,” Marie Hayden, Hinkley’s choir director told students last week.

CASTELLANOS: “I think it it helps us. Every day, we get more into it and more into it until we actually believe it. You actually feel it — like how Janelle feels when she’s singing and she starts crying and makes everybody cry. We all feel connected.”

Students say they have different scenes that impact them the most, but they don’t hesitate to find how the scenes relate to their life despite the story being set in the first decade of the 1900s. Hayden’s class and the practice for the musical are safe places where they can discuss those parallels, they said.

Shavaun Mar, 16, is a junior who plays the main character of Coalhouse Walker Jr., a ragtime piano player who is the target of racial attacks and struggles with revenge and forgiveness.

MAR: “I feel like that is crucial that we give people those opportunities to talk because a lot of people have very valid things to say but they just don’t have a way to get it out.”

CASTELLANOS: “The shootings.”

ARZATE: “The racism. They help us discuss it because there’s so many things that are going on. Pretty much everyday there’s a tragedy going on. And so, in a way, we can use that sentiment, that emotion that we feel with the real world and convey it when we’re doing this show. We use those feelings and we try to think about it in that way. To display that emotion. To display it to everyone else. And not directly represent what’s going on today but just to give them that ‘aha’ moment, like ‘wow.’”

Ebony Nash, 17, plays the character of Sarah, an innocent girl who wants to help her boyfriend settle his problems.

NASH: “It just makes us want justice in real life because these things are still going on even though it’s not out there. It just makes us want justice for our community. This musical showed me that I need to become better within myself because I’m not perfect.”

SOTELO: “It opened my eyes a lot more for sure. This kind of just makes me realize the problems I have. It makes me realize yea, I’m having immigration issues with my father right now, but that also my friends, you know, they’re going through the same thing too. This DACA stuff or this coming out stuff. I became more accepting of what other people might be going through and how I can help.”

MAR: “The past few years, I have been in a bit of a shell. So putting myself in this situation and pushing myself to be this other person has really shown me what I’m capable of and it’s helping me break out of that shell and realize who I am as a person.”

NASH: “Basically, this is our getaway from real life because we get to come on stage and be somebody else. It also makes us want to put the story out right so people can understand. So people can feel what we want them to feel.”

CASTELLANOS: “That there’s hope after all this corruption that’s going on.”

DOUGLAS: “That even in your bad times you can still laugh, cry, dance.”

NASH: “What I want people to get from this is change. To learn how to change and learn how to forgive and learn how to come together as a community and just, like their worth.”

SOTELO: “And to be strong. To stand up for what’s right.”

ARZATE: “And it might sound weird, but I feel like they should feel a certain level of uncomfort because that means that they’re going to look at themselves while seeing the musical. Maybe they’ll go ‘I’m uncomfortable because I do that’ or ‘I have that prejudice’ or ‘I feel that certain way,’ so if they come out and they feel uncomfortable and then at the end they’re like, ‘Wow. There’s that hope for change.’ Hopefully that like…”

DOUGLAS: “… It inspires them to do better.”

ARZATE: “Like, you can do it.”

SOTELO: “It’s kind of like a water droplet. One small move can domino-effect to something bigger.”

 



Taking attendance

Want to make middle school admissions more fair? Stop looking at this measure, parents say

PHOTO: Monica Disare
Middle school students write their names down at a high school fair in Brooklyn.

Parents across New York City have pushed for changes in the way selective middle schools pick their students, saying the process is unfair.

Now, a group of Manhattan parents has come up with a novel solution: Stop looking at students’ attendance records.

The parent council in District 2 — where about 70 percent of middle schools admit students based on their academic records — points to research showing that students from low-income families are far more likely to miss school. Those children are at a distinct disadvantage in the competition for the district’s top middle school seats, the council argues, even though factors beyond the control of any fourth-grader — especially family homelessness — often account for poor attendance and tardiness.

“This outsized focus on attendance disproportionately impacts students who don’t have secure housing and may not have secure healthcare, and that is troubling to me,” said Eric Goldberg, a member of the community education council in District 2, which includes stretches of Lower Manhattan and the Upper East Side. “There are many factors that should not impact a student’s educational opportunities — and the way the system is set up, it does.”

Eighteen of the district’s 24 middle schools are “screened,” meaning they rank applicants based on factors including test scores, grades, and interviews. Of those, all but one school also considers how often students were late or absent in fourth grade, according to the parent council.

Most of the schools assign points to each factor they consider. Some give absences 10 times more weight than science or social studies grades, the council found, while others penalize students for even a single absence or instance of tardiness.

Disadvantaged students are especially likely to miss school.

A recent report by the city’s Independent Budget Office found that homeless students are more likely than other students to be chronically absent — typically defined as missing about 10 percent of the school year.

Schools with the highest chronic absenteeism are in communities in “deep poverty,” which have the highest rates of unemployment and family involvement with the child-welfare system, according to a 2014 report by the New School at the Center for New York City Affairs.

“We can use chronic absenteeism as a good guess of all the other things kids are dealing with,” said Nicole Mader, a senior research fellow at the New School and a co-author of the report. “If these middle schools are using absenteeism to weed kids out, that means they’re going to automatically weed out those kids who have the most barriers to academic success already.”

The attendance requirement can put pressure on any family, regardless of their financial status or housing situation.

Banghee Chi, a parent of two children in District 2, said she sometimes sent her younger daughter to school with a fever when she was in fourth grade rather than have her marked absent.

Her daughter would show up to class only to be sent to the school’s health clinic — which would call Chi to pick her up. Chi was thinking ahead to middle school, when a missed day of class could hurt her chances of getting into the most sought-after schools.

“It was something I was really conscious and aware of during my child’s fourth-grade year,” she said. “I think it’s unfair.”

The education council’s resolution, which will be put to vote in December, is nonbinding because middle schools set their own admissions criteria. But a show of support from parents could lead to action from the education department, which has been prodded by integration advocates to make other changes in high school and middle school admissions.

This summer, the department announced it would end the practice of “revealed rankings,” which allowed middle schools to select only those students who listed them first or second on their applications. The city is also appointing a committee of parents, educators, and community leaders in Brooklyn’s District 15 to come up with a proposal for making that district’s middle school applications process more fair.

“We’re collaborating with communities across the city to make school admissions more equitable and inclusive, including in District 2,” said department spokesman Will Mantell in an email. The department looks forward “to further conversations about this resolution and other efforts to improve middle school admissions in District 2.”