NELSONVILLE, Ohio — In a small town snug in the foothills of Appalachia, kindergartners gather in a circle to learn about hard emotions. Cindy Price, a therapist at their school, leads the discussion as 12 children name the toughest feelings they know. Frustration. Fear. Anger.
One school’s solution to the mental health crisis: Try everything
From home visits to grocery donations to therapy sessions to animal encounters, this Ohio campus is grasping for every possible remedy
“My cousin died,” another student says.
“My parents aren’t dead yet,” another kindergartner points out.
This is mental health three years into the pandemic: For many kids, the crisis is not over. There are still long waiting lists for therapists and surging mental health needs at schools. Adolescents already struggled before the pandemic, with rising rates of depression and anxiety. Then schools shut down in 2020, isolating and further disconnecting them.
Now, even as the national emergency has receded, the mental health emergency has not: The Centers for Disease Control and Prevention said recently that almost one in three American high school girls had considered suicide, and more than 40 percent of teens were persistently sad or hopeless. Last year, the U.S. Preventive Services Task Force recommended for the first time that doctors screen children age 8 and older for anxiety.
Helped by the influx of federal covid-19 relief funding, schools have tried to cope. But much of what students experience — online bullying, hallway fights, cutting, discord at home, depression and anxiety, slipping grades, body-image despair worsened by social media — defies easy solutions.
More than two-thirds of schools nationally say they have increased mental health services since the pandemic began, according to 2022 federal data. But the scope of efforts and the extent of staffing vary widely across the nation’s 100,000 public schools.
In this town in Ohio’s Athens County, school leaders grasped the depth of the crisis: More students were absent. More were involved in fights and other incidents. More quit on their class assignments. Some gave up on bricks-and-mortar school — switching to an online provider, only to return further behind. Reports of child neglect and abuse in the county jumped nearly 20 percent last year from a year earlier, according to Athens County Children Services data.
At Nelsonville-York City Schools, leaders believed that if kids weren’t emotionally and psychologically stable, they wouldn’t thrive academically. So the school district leaders put off other initiatives and zeroed in on mental health. The district’s efforts for the 2022-2023 school year were large and small, scripted and improvised — home visits, grocery donations, therapy sessions, animal encounters, curriculum change.
“Mental health has so many different facets to it,” Superintendent Rick Edwards said. Borrowing from his years as a volunteer firefighter, he added: “Sometimes when you have a building on fire, you can’t just attack it from one side. You have to surround it and drown it.”
It’s too soon to say how widely mental health efforts have made a difference, but experts say it’s best for schools to take multiple approaches at once. So far, many kids here are responding.
In the kindergarten classroom, Price thanks the children for bringing up the losses in their lives. “I think you are very brave,” she said. Their classroom teacher, Brooke Schultz, speaks gently, too, knowing the traumas are real and recent.
Soon, music therapist Kayla Stubblefield, who is with them, is strumming a guitar, singing about a grizzly bear who moves his body whenever he feels bad. He stomps his feet, the song goes. He squeezes his arms, then twists his shoulders, then reaches into the air, saying …
“ROAR!!” the children call out, their arms extended high.
So much need
The national emergency in youth mental health declared in 2021 by the American Academy of Pediatrics and other organizations continues two years later, said Sandy Chung, president of AAP and chief executive of a pediatric practice with 180 clinicians in the Washington region.
“It’s not gotten better,” she said. “We’re still seeing the long-term impact of the pandemic on top of an already existing mental health crisis.”
The CDC says that the nation’s schools are key to addressing this epidemic and that “connectedness” to school is linked to better mental health. It urges access to mental health care, social-emotional learning and high-quality health education. Other recommendations: more classroom management training for teachers and more inclusive school environments for LGBTQ students.
“The more of these things you do, the better the impact,” Kathleen Ethier, director of the division of adolescent and school health at the CDC, said as the report was issued.
Like elsewhere in the country, the pandemic was especially hard on the poorest families in Nelsonville, population 5,400, once a bustling coal and manufacturing town. After the coronavirus hit in 2020, workers lost jobs. Families holed up in cramped houses and trailer homes. In 2020 and 2021, the number of drug overdose deaths in the county climbed. Students being raised by grandparents worried about losing them to covid-19.
The city’s only public school felt the toll, too. Nelsonville-York City Schools educates 1,100 students from prekindergarten to grade 12 in a long, tan-brick building with a main hallway that stretches a quarter-mile and a large American flag hanging on a wall near the cafeteria. It is considered a high-poverty school and enrolls students from several surrounding areas.
“We have so many students who are in counseling and are in need of counseling,” said Chris Walton, assistant principal of the high school and middle school. “That’s been a huge uptick.”
Principal Elise Stephan said there had been several suicide attempts this school year and more middle school students cutting themselves. Nelsonville-York leaders have emphasized that students should come forward if they know a classmate in crisis or learn of a safety issue. Some weeks, school officials get two or three reports, she said. Most of the time, the reports amount to someone having had a bad day or saying something they did not mean, Stephan said, but “it gives us time to look into it before anything rises to a greater concern.” Before this year, it was not a consistent focus.
Stephan said at least five students were removed from their families — and placed in foster care — this school year and last. Until then, she said, it was not something she’d seen during her 16 years as principal.
Amid student troubles, therapists have been key. Five therapists worked at the school as the pandemic started, as well as a caseworker who went out to family homes — all employed by Hopewell Health Centers, a nonprofit that serves this part of central Appalachia.
Today, caseloads are larger than ever: Nearly 180 students receive care — almost a fifth of the student body. Some of them see therapists in a new school-based clinic, which includes medical care and opened in the fall with the help of $150,000 in federal covid relief funds. There, Price evaluates children who are referred for help and assigns them a therapist who decides what would work best — talk therapy, play therapy, art therapy or music therapy.
A sign of change this year: More parents and guardians support it. Nearly all who were asked for permission consented to treatment for their child, compared with 70 percent or so before the pandemic, Price said.
Nelsonville-York also has three school counselors, who help students in distress but also assist with class schedules, college plans or, for younger students, social skills. Its school psychologist is primarily focused on special education.
Among those in need this year is Baylee Bentley, a high school sophomore whose father died suddenly in September. Then 15, she was living with her grandparents and had already endured a house fire, an eviction and her grandfather’s hospitalization.
“I wasn’t getting any school work done,” she said.
What ultimately helped, she said, was the comfort of friends and family and the support of teachers — and, importantly, she said, the therapist she sees on Wednesdays. “She just talks to me about it,” Bentley said, “and she helps me find ways to cope.”
Help in many forms
Mental health efforts on campus go beyond therapy. Schools also should take more preventive steps, says Sharon Hoover, co-director of the National Center for School Mental Health. It’s more of a public health approach, akin to wearing a seat belt, she said.
One important way: mental health education, learning about well-being and how to get help when needed. Another: social-emotional learning, which involves teaching about qualities like empathy and trust, and skills like relationship-building and decision-making.
In Nelsonville, the district bought a new social-emotional learning curriculum during the pandemic years and expanded its approach. Now 30 minutes every Monday is set aside for social-emotional learning.
In elementary school, for instance, there might be a teacher-led lesson on honesty or perseverance. The message is then reinforced as the week goes on — during morning announcements, on hallway posters, at the end of lunch period.
“We hoped it would become embedded in the kids’ minds,” said Edwards, the superintendent.
Mental health care and social-emotional learning have not generated the controversy here that some school districts have experienced. No one has complained, he said, adding: “The vast majority of families trust the school to do what they need to do for their children.”
For the past two years, the school has held a suicide-prevention program for students in grades 6 to 12.
Other efforts may be more visible to children.
Three horses showed up at after-school care on several Mondays in a row, through the Natural Freedom Wellness Center, which provides trauma-sensitive experiential learning.
Small groups of children took turns getting close, quietly stroking the animals and asking their handlers questions. A 6-year-old girl in a bright pink jacket clasped tiny bows and barrettes to the mane of Nilla, a 16-year-old miniature horse.
Nearby, Babe, a brown-and-tan American paint horse who is 24 years old, drifted off to sleep as three other children gently brushed her.
The after-school program is free to families, covered by a federally funded grant. The school considers it important to mental health, too — giving young students a place to go, with academic help and activities that, like this one, help them regulate their emotions and build relationship skills.
Sometimes the basics are as important as anything else.
As a high-poverty school, all students here get free breakfast and lunch. (The student body is 93 percent White.) And in her office along the main hallway, Katherine King, a community outreach worker with Children Services, helps families find necessities.
Her office is filled with clothes separated by size and bins of dry goods. King finds shoes for one child in need, distributes food bags and boxes, helps with unpaid bills by getting families in touch with assistance programs or churches. One day, a girl sidled up. “Our water got turned off,” she said, “and my mommy doesn’t want to tell you.”
King is often out at children’s homes, especially when a family’s phone gets turned off and the school is trying to reach someone. Her role is not enforcement.
“We want to help people out before there’s a problem,” she said, “and be someone they can call if things start going wrong instead of being something scary.”
Help calming down
Asher Withrow, 8, was seated at his desk, wearing an orange-and-black hoodie and peering into his Chromebook. His class read a text together. He was working independently to answer a prompt.
Before this year, he had challenges completing work. “The improvement on his part is immeasurable,” Emily Cook, his teacher, said later.
The boy has been through years of upheaval and difficulty. Now staying with his grandparents, he has become steadier at school — though he needs daily support, which he gets four days a week from therapist Jesse Woodard.
“He helps me calm down,” the child said.
Asher says that math is his favorite subject and that he has recently learned about sharks and killer whales in science class. He talks with Lisa Mahorney, dean of students for the elementary school, about the school’s quiet area, with soft lighting and cushions, where he goes if he gets overwhelmed.
At lunch he brings his bright green cafeteria tray to an area outside Mahorney’s office to avoid the clatter of the lunch room. Still, the path to progress can be bumpy, and sometimes Asher struggles — as do many others, Mahorney said.
Some students are up against a lot, she said. Early in the pandemic, everyone in the school who was not teaching during remote learning brought bags of groceries to each student’s home; it was clear how little many families had.
Not everyone is ready or able to talk about their feelings. Kayla Stubblefield, with Central Ohio Music Therapy, says some children will sing or play an instrument. She sees students two days a week at the school.
Some teens struggling with trauma are more responsive tolistening to music, she said — discussing a song on YouTube, for instance, in what becomes a starting point to express more about their lives. Others write songs themselves.
“We talk about their lived experience, things that they’ve been through, maybe what they want their life to look like one day, how they deal with that, and it all comes out in the words,” she said.
For the kindergartners gathered to talk about hard emotions, she asked: “Who else has an idea of what we can do when we’re feeling mad? ”
“We can calm down,” one girl said.
“We can breathe out and breathe in,” another said.
Stubblefield strummed her guitar, singing, “I can breathe in and out,” as children joined in.
“I can take time to think …” she went on.
Then she returned to the chorus, as enthusiasm built. “And stretch up and ROAR!!” they exclaimed.
Story editing by Adam B. Kushner. Photo editing by Mark Miller. Copy editing by Kathy Orton. Design by J.C. Reed.