Mental Health Top of Mind as Kids Head Back to School

As students return to the classroom, young people’s mental health has risen to the top of educators' concerns. Statistics paint a disconcerting picture: CDC data shows that during the last three years mental health emergencies rose by 24% for children aged 5-11 and 31% for those 12-17. A recent survey found that since the start of the pandemic 70 percent of U.S. public schools reported an increase in students seeking mental health services at school.

“We have witnessed firsthand the consequences of the youth mental health crisis: heightened anxiety, depression, and pre-existing academic gaps exacerbated by the pandemic, particularly in historically marginalized communities,” said Aiyana Rivera-Rodriguez, MD, medical director of the School-Based Mental Health Program at NewYork-Presbyterian Morgan Stanley Children's Hospital. "Prolonged periods of remote learning, social isolation, and academic gaps have contributed to the rise in mental health concerns for children and adolescents.”

Services delivered at on-site school clinics

Since the early 1980s, the NYP School-based Mental Health Program—in collaboration with Columbia University Irving Medical Center—has provided psychological evaluation, treatment, and referrals for children and families. Mental health services are delivered at on-site clinics embedded at 14 public schools (K-8) in upper Manhattan and staffed by psychiatrists, psychologists, clinical social workers, case managers, and other professionals affiliated with Columbia’s Department of Psychiatry.

Dr. Rivera-Rodriguez, who is also an assistant professor of psychiatry at Columbia University Irving Medical Center, said that students served by the program live in predominately Latinx communities surrounding the medical center and hospital.

“Mental health programs within school settings can serve as a critical tool in addressing health disparities, providing accessible and culturally responsive support for children and families from historically marginalized backgrounds, as well as a bridge to the vital school community,” she said.  

Columbia Psychiatry News spoke with Dr. Rivera-Rodriguez about the impact of school-based care, why incorporating social-emotional learning into school curriculums is critical for success, and ways in which the NYP-Columbia program partners with communities and families, among other topics.

Describe some of the steps educators and administrators have taken to prepare for 2023-24 academic year?

Due to the COVID-19 pandemic, we have seen an increase in the number of children who need additional educational services as well as mental health services, particularly children in historically marginalized communities with pre-existing educational disparities. Schools have offered summer enrichment programs, such as the Summer Rising Program, available to all NYC students in grades K-8, in preparation for the upcoming academic year.  he free program, funded by the NYC Public Schools and the Department of Youth and Community Development, provides students with access to academic programming, as well as field trips, arts activities, and outdoor recreation. Community partnerships are also key as the demand for services continues to increase. One of the goals is to continue to increase staffing. We recently implemented a new Project Leader role to focus on program evaluation, including the assessment of student outcomes.

What are the greatest mental health challenges facing students in grades K-8?

We are seeing children who are dealing with anxiety, depression, self-harm, grief, and trauma as well as attention-deficit/hyperactivity disorder. During the pandemic, the concerns were consistent with what we were seeing on a national level including more children with anxiety, depression, and students dealing with grief and trauma particularly in under-resourced communities where there are additional layers of trauma and loss.

Can you describe the types of interventions that site-based mental health professionals provide? Is there data demonstrating the program’s impact on student wellbeing?

The School-Based Mental Health Program collaborates with the schools to provide prevention initiatives, including social-emotional learning training for teachers as well as caregiver workshops. Social-emotional learning helps students understand their emotions and gain social awareness. Benefits include an increase in academic achievement, heightened self-awareness, and an increase in positive behavior. The program team also works with students to provide targeted treatment, including school staff support, based on the needs of each child. Our interventions include individual and group psychotherapy, psychopharmacology, and case management services.

Do you have data that shows the impact of the program on student wellbeing?

We evaluate data at our partner schools to determine outcomes on an ongoing basis. Our findings show improved grades, test scores, and attendance and reduced behavioral problems, depressive, and anxiety symptoms for youth in treatment Prevention services, where our teams equip teachers to use trauma-informed behavior management strategies  and teach skills that improve coping and relationships have demonstrated teacher reported satisfaction,​ improved teacher effectiveness in student engagement and classroom management, increased caregiver participation in workshops, and increased caregiver satisfaction ratings.

What are some of the strategies employed to enhance students’ social and emotional, and/or behavioral adjustment and well-being?

The team collaborates with the schools to provide comprehensive support for students, caregivers, and teachers. Caregiver support and family services, including case management support, are crucial for meeting the needs of the child and family, particularly in historically marginalized communities. Schools are an ideal setting since students have access to prevention and intervention services in a non-stigmatizing environment. We also support the teachers in our program by helping them implement trauma-informed behavior management strategies and teach coping strategies that create a climate for all students to engage effectively in learning. Not only do these strategies help children directly, but teachers also report feeling directly supported as they have partners in managing tough situations.

How does the program engage and support parents and caregivers?

The NewYork-Presbyterian Hospital Community Health Needs Assessment 2022-2024 highlighted the focus on mental health as the number one health concern in the community. Support for patients, caregivers, and teachers is crucial and the need continues to rise. Our school-based program includes parents and caregivers at various levels including interventions, such as case management as well as the prevention program caregiver workshops. Earlier this year, U.S. Surgeon General Dr. Vivek Murthy issued an advisory warning about the negative impact social media is having on the mental health of young people.

Is programming available at schools to support the healthy use of social media?

Student and caregiver resources are crucial to address the appropriate use of social media. Some of the partner schools are addressing the need for programming to support the healthy use of social media including caregiver resources regarding the use of social media. There is also a prevention program caregiver workshop that addresses social media for students and families. 

What are the future directions to address the social emotional learning and psychiatry needs of the school community?

Future directions include analysis of programming to meet the needs of the community particularly in the landscape of educational disparities that have been further illuminated by the pandemic. Continued collaboration with the schools to address the social-emotional learning and psychiatric needs of the school community and addressing access to children’s mental health services will also be key.