Breaking Down Barriers: Innovative, multi-tiered partnership delivers mental health services to students in need

Breaking Down Barriers: Innovative, multi-tiered partnership delivers mental health services to students in need

By Tyler Dahlgren

The conversation took place in 2015 between Paul Utemark and Mark Norvell.

Utemark, Fillmore County Hospital’s Administrator, and Norvell, Superintendent of Fillmore Central Public Schools, worked, literally, across the street from one another. In a small town like Geneva, everybody, from the school to the hospital, is invested in the well-being of area youth.

And there was a roadblock standing in the way. A barrier with a dark cloud hovering over it.

The hospital was treating more kids for self-harm, cutting and suicidal thoughts that, left alone, worsened to attempts. At the same time, staff was becoming alarmed at the amount of prescriptions being written.

Medications were flying off the shelves, prescriptions were spiking, but was anything truly being addressed?

Was there a chance, staff wondered, that they were missing the boat?

“Maybe these providers are comfortable prescribing than they are at peeling away at what’s underlying these problems,” said Stephanie Knight, Fillmore County Hospital’s Behavioral Health Administrative Director. “That’s what Mr. Utemark and Mark (Novell) had a conversation. We have the staff, you have the students, what can we do to make a difference in our community?”

Knight credits Utemark and Novell for seeing the writing on the wall. To really address mental health, they understood that conversations with children were necessary from a young age. Their visions aligned.

The hospital had the staff. The school had the students. And each shared the goal of better serving kids in the community. They set off to do just that.

Michele Rayburn, ESU 6 SPED Supervisor, and Aaron Veleba, Principal at Fillmore Central Elementary, joined the table, and a multi-tiered partnership was formed.

ESU 6 exists to serve, and for a long time has offered supportive student services to rural districts in Seward, Saline, York, Fillmore and Lancaster Counties. Naturally, when Rayburn heard Novell talk about an emerging need for mental health services, she and her staff began exploring ways to offer support.

“We sat down and started talking through how we could work together to get these services provided, just like we provide speech language support, special education support or occupational therapy,” said Rayburn. “We looked at it as one more need our population has. How can we work together, literally from right across the road?”

For Utemark, Knight and FCH, one of 68 Critical Access Hospitals in Nebraska, there was absolutely no hesitancy. Not even for a second.

“We knew that if we could help, and if we could make a difference for kids that we were already seeing-our neighbors and our friends-if we can do that in a way that is least-destructive to them in their school day, then that’s what we were going to do,” said Knight. “It wasn’t even a conversation. We all knew if we could make it work, then we were going to do our best to do that.”

Together, the hospital, the school district and the service unit went to work.

For the new partnership, the move to confront a topic that had, for a long time, triggered trepidation was a no-brainer.

“It’s really about removing that barrier,” said Veleba. “We see kids who come in all the time that have different barriers, and we try to knock down every one we can for them.”

The decision was an easy one, but the task at hand was anything but. Mental health is still followed by stigma. A dark cloud of uncertainty. How do you implement something into a school that, frankly, didn’t really exist 30, 20 or even 10 years ago?

“From the very beginning, we have thought outside the box,” said Knight. “There was no road map, but we weren’t afraid. We often say we built this airplane mid-flight, and that’s okay. That’s how many great things get started.”

And the partnership has been a great thing. It’s benefitted students from Fillmore Central, Exeter-Milligan, McCool Junction, Heartland Community Schools and Shickley. Phillips, who works out of ESU 6’s Milford office, praises Rayburn and the initiative she’s shown the last few years.

“She is a wonderful, professional special education administrator,” Phillips said. “She owns it, and she has grown that in the last couple of years to where they have a dedicated staff that comes in and supports these students. It’s a beautiful partnership model.”

The mental health professionals come into the schools to provide service. It’s been helpful for them to see the students being treated interact in a classroom setting. Perception, Rayburn said, is reality.

“We have kiddos here engaged for several hours a day, so for therapists to be able to see what part of their day looks like in comparison with home, it’s been beneficial,” Rayburn explained.

Communication is key. In fact, Rayburn calls it the “secret sauce” that fuels this innovative partnership. Before the collaboration existed, communication was disjointed, broken in all directions. Families were finding providers on their own. Providers would sometimes want to come in to the schools. Other times, they’d want nothing to do with the schools.

“Now that we have this, we have regular meetings and regular reports we provide each other in face-to-face meetings where we’re allowed to lay everything on the table without feeling the need to be guarded,” said Veleba. “It’s a true partnership, and we work together for our students.”

Veleba wants those reading this piece to understand how great of a job his district’s guidance counselors and teachers do of understanding students. On a day-to-day basis, when something comes up, there’s nobody better. When there’s a blip on a student’s radar for a day or two, they’re there to help.

“The hospital gives us more longevity for students who are going through something that maybe none of us has dealt with,” he said. “It gives them a positive constant, somebody who can be there for them all the way throughout their education.”

Those systems of support make this multi-tiered model so special. It’s genuine. It’s real. It’s working.

“It’s not just the hospital handling all the kids, it’s not just us handling all the kids, it is truly a tiered process,” said Holli Lovegrove, school psychologist with Fillmore Central. “We are constantly changing PBIS. We even work with preschoolers with social and emotional curriculum. They are hearing about it at an early age. We are trying to expose everybody to these tools and information.”

Destigmatization of mental health, the proverbial breaking down of barriers, is achieved through education. Lovegrove stresses the importance of building a vocabulary, and of raising awareness. Rayburn sees that black cloud evaporating. She sees it every day.

“We have seen that become a normalized process, seeking those supports within regular days of instruction,” Rayburn said. “The mental health component emerges when a kid is struggling, and the network of support from kid to kid shines through. They have compassion and understanding.”

Mental health isn’t a cloud cast above this group of young learners. If anything, their understanding of such a complex topic is allowing brightness into an area which used to exist only in the dark.

“The kids are showing us what good humans look like.”

To reach the kids, the team had to first reach families. They had to build bridges that led into homes throughout the community, which isn’t always an easy thing to do.

Some families, Veleba explained, tend to be guarded against school, perhaps a result of a less-than-positive experience they had during their own education decades ago.

“This partnership has been a nice way to reach some of those families and let them know that ‘Hey, you are a part of this team’ and we are all working together for their child,” said Veleba.

Knowledge, according to Lovegrove, is power. In addition to the services provided to students in area schools, the partnership has led to classes structured to parents and families. Individualized opportunities designed to grant a deeper understanding of a compounded issue.

“A lot of us educators are parents, too, so we wear multiple hats,” Lovegrove said.

In towns like Geneva, or Shickley, or Henderson, everybody knows everybody. A student is a student, but they’re also somebody’s niece, or cousin, or granddaughter. That tightness is a strength of a rural school.

“There is a lot of community support for doing what we need to do for our kids and wanting to see the best for them,” Rayburn said.

From the beginning, this community has embraced the work coming out of the partnership much like they embrace each kid in the Fillmore Central school district. Everyone has been on board with the proactive approach, though it does require vulnerability and trust.

“We knew we were going to need to work together to make this an environment where mental health is part of the conversation and normalizes the stigma following it at an early age,” said Knight. “We planned to start implementing the proactive and preventative piece after addressing the highest needs, and we have.”

In short, this program strives to change trajectories. The earlier professionals can intervene, equipped with tools and practices and coping strategies, the better chance students have of maneuvering any obstacles that lie on the path to success.

“The ripple effect that has on their life, and their interactions down the road when they graduate and get a job and become parents themselves, it’s powerful,” said Rayburn.

In the short shelf life of the partnership, the team has already seen the services directly impact the classroom, as attendance numbers have increased.

“Kids don’t miss days where they know they have a counseling session,” said Veleba. “They just don’t.”

In her role, Knight is pretty much hands-off. She isn’t giving therapy in the school across the street, but she does have the chance to interact with those who are. And sometimes, those conversations are the best part of her day.

“To watch the therapists come back and really feel like they made a difference in someone’s life, and to hear them talk about it with enthusiasm and to see the excitement they show to come back the next day, that’s the most rewarding part of my job,” Knight said.

For Veleba, the proof that this is all working shows through in moments of time. Blink, and you might miss it. Catch it, and appreciate it, and there’s no better feeling in the world.

“I love seeing the kids when they show up in the morning and they come sprinting, full speed, into the building because this is the place they want to be,” he said. “I think that is something we are all trying to strive for. To get that out of every single kid. Every day, we are trying to evolve to meet the needs of our kids. Every one of them.”

When Lovegrove is in need of a pick-me-up, she visits the preschool, a place never short on laughter or the purest form of unadulterated joy. In a way, her multi-tiered team has taken it on themselves to protect and nurture those smiles.

“We are so lucky in the field of education to get to work with kids,” Lovegrove said. “It’s absolutely the best part of what we get to do. When you hear a teacher say that kids are using the language they learn from us, or using tools independently, it makes you feel like you’re making a real difference.”

Like Lovegrove, Rayburn marvels at the inherent positivity of a child. It inspires her to take the same approach every morning, no matter what may be on that day’s agenda.

“I just love to be able to engage in learning,” she said. “With the kids, and their outlook on life, we just have to give them the right tools, the right language and the right opportunities to keep fueling their enthusiasm in the right direction.”

Sitting around a table in Rayburn’s office, these professionals from a school district, a service unit and a hospital, could go on about the positive impact their collaboration has had on kids and the way it will hopefully shift the future.

After all, this whole thing started with a simple conversation about serving kids.

It’s like Knight said, “If you’re working together towards a shared goal centered on the overall wellness of children, then it does make it easier to say why not?”

And just like that, the group of barrier busters had their new motto.

When it comes to kids, Why Not?