Depending on how you see things, the Ashe County Board of Education received a mix bag of news from the district’s Assessment, Support and Counseling Center at its May 1 meeting.
The good news? The ASC Center will provide free mental health services to more Ashe County High students this year than ever before.
The not-so-great news? The need for those same adolescent mental health services continues to grow, according to the center’s personnel.
That’s the state of affairs according to Whitney Van Sant, the district’s School Mental Health Coordinator.
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“I’m proud of the work we’ve done this year,” Van Sant told board members. “We’ve served more kids than we’ve ever served at any of our sites, including Watauga or Alleghany.”
The idea for the program is simple: offer on-site mental health services to high school students where they need it most. By identifying at-risk youth, the program works to reduce serious depression and mental illness and gives treatment options where they’re most likely to be used.
The program began in 2006, after Appalachian State University’s Dr. Kurt Michael and then Watauga High School Principal Angela Quick met to find a way for licensed mental health providers to serve WHS students.
Teaming schools with mental-health staff
The pair felt they could advance the high school’s teaching mission by addressing behavioral and mental health issues that were hindering the school’s mission by teaming with professional school staff, including counselors and social workers, already in the building.
The basic model of service, starting late in the 2006/07 school year, included consultation/education with faculty and administration regarding mental health issues, crisis intervention, risk/substance abuse assessments, and referral.
Four years ago the program expanded to Ashe County High School.
In the 2016-2017 school year, Van Sant told the board, the program has served some 178 students, or roughly a fifth of the student body at ACHS and roughly a percent of the student body at Ashe County Middle School.
Roughly 90 percent of the year’s crisis events involved suicidal ideation, according to the ASC Center’s statistics but the majority of those were termed as “green” events — crisis events where students had low or no intent to harm themselves or others — but a small minority, 7 percent, involved homicidal ideation and just under 3 percent of incidents involved both suicidal and homicidal ideation.
Focusing on suicide prevention
Van Sant said any time a student expresses those thoughts, a risk assessment is performed and an individual treatment plan is charted for that student.
“Most students, even if they have great parents they can talk to, even if they have a trusted adult, they’re most likely to go to a peer,” Van Sant said, telling board members most cases are referred to the center by other students.
Over the past four years the center at the high school has documented some 217 total crisis intervention events, none followed by a death or suicide.
According to a Youth Outcome Questionnaire, 66.5 percent of students “recovered” or clinically significantly improved, while 26.6 percent remained unchanged and 5.3 percent deteriorated.
Most students received Cognitive-Behavioral Therapy, and students received an average of 10-1 sessions with an average session duration of 35 minutes.
Over the past four years, the most commonly elevated clinical scales at the beginning of treatment included depression, anxiety, social stress, somatization (examples include headaches, stomachaches), attention problems, family problems and sense of inadequacy.
But because the business of treating mental health concerns is sometimes an intensive process, the ASC Center also tracks which students actually have the means, roughly two-thirds, to carry out their plans.
“Access to means is important because getting into why someone is having suicidal ideation or intent is complicated - but how they want to do it is something we can immediately address,” Van Sant said.
That’s why the program has distributed 19 lock boxes during the course of the program to restrict a student’s access to means they could then use to harm themselves.
“Sometimes they may be for locking up drugs but in all of these cases they are for locking up prescriptions in the home for students with suicidal ideation,” Van Sant said. “It’s a very good measure to take, including locking up Ibuprofen.”
Van Sant and company said they hope to continue expanding services at Ashe County Middle School in the future, but said ASC staff must be wary of spreading themselves too thin to provide the kinds of intensive intervention for students when they need it.
“One of the things that make us effective is that we always have somebody on site,” Van Sant told board members. “Today we had three incidents in one block. That’s the first time that’s happened with crisis intervention so it speaks to the importance of having somebody on site.”