In 2019, the Rockville Centre school district in Long Island, New York, was shaken by a string of student deaths, including the suicides of a recent graduate and a student.
“When you get these losses, one after the other, you almost can’t get traction on normalcy,” said Noreen Leahy, an assistant superintendent at the school district.
To Leahy, the student suicides exposed a children’s mental health crisis that had been brewing for years. She had observed a concerning uptick in depression, anxiety, and suicidal ideation among students. Her school district had a team of mental health professionals, but Leahy said they couldn’t provide the kind of long-term care many students needed.
“Remember, psychologists and social workers and counselors in school districts are there to make sure kids are learning,” Leahy said. “We’re not hospital wards. We don’t do psychotherapy. So it’s very limited what we can do for these students.”
She said she saw an urgent need to connect students to mental health care quickly and easily, and the 2019 tragedies drove her to find a way.
At its heart is a new behavioral health center, which the hospital opened in January 2020. Students are evaluated by the center’s child psychiatrist and mental health counselor, who start and continue treatment until a child can be connected to long-term care in the community.
Without timely access to care, many kids end up with worsening symptoms and eventually land in a hospital emergency department “as the fastest way to either avert [a mental health] crisis, or as the fastest way to get some kind of mental health evaluation,” Ramtekkar said.
“It sort of creates this ping-pong effect,” said Tina Smith, executive director of special education at Oceanside School District in Long Island.
It’s common to see students go to the emergency room (ER) only to be discharged soon after and return to school without a plan for follow-up care, she said.
“And then the problems start to spiral again out of control,” Smith said. “And then they’re sent back to the hospital [ER].”
It was with those worries in mind that, after the student suicides in 2019, Leahy began raising her concerns with colleagues, school board members, and other parents, including Gina-Marie Bounds, a hospital administrator at Cohen Children’s Hospital.
Bounds took the idea to the head of emergency child psychiatry and other hospital officials at Cohen’s and they got to work. Leahy spread the word to neighboring school districts, who were dealing with similar problems, and persuaded them to come on board. Several months later, the mental health center opened its doors.
The Right Help at the Right Time
The goal of the new health center is to provide kids with care as soon as symptoms emerge.The center is staffed by a child psychiatrist, a mental health counselor, and a medical assistant. It’s located next to a pediatrician’s office and within a few miles of the school districts it serves.
When a child first arrives, the child is evaluated to determine whether they need to be hospitalized.
“Most kids don’t need that,” said Dr. Vera Feuer, Northwell Health’s associate vice president for school-based mental health, who helped create the center and now oversees it. “Most kids need outpatient care.”
And the center starts that care right away—medication and/or therapy, depending on what each child needs—to stabilize the child and prevent a worsening of symptoms, and to connect them to ongoing care with a provider in the community.
In January, a local resident, Tara, found herself calling the health center to make an appointment for her 17-year-old sister, who had been struggling with irregular sleep patterns and panic attacks for months.
Tara had recently become her sister’s legal guardian. KHN isn’t using their last names and only using the sister’s middle name—Jasmine—to protect their privacy.
Jasmine said she felt suffocated during her panic attacks.
“It felt like I was running, like my heart got really fast, and like I was being put in a little tiny box,” she said.
Removing Barriers for the Most Vulnerable
The new health center provides an important safety net for kids who might otherwise fall through the cracks, like 17-year-old Alyssa Gibaldi, who was refused care by other mental health providers because of a disability.Alyssa attends Oceanside High School and is extremely social, according to her mother, Jennifer.
“She’s like the mayor of the school; everybody knows her,” Jennifer said.
Alyssa has Down syndrome and the pandemic upped her anxiety. Last fall, she became catatonic and went into what Jennifer described as a “zombie-like state.”
“She couldn’t talk. She couldn’t move. She couldn’t speak. She couldn’t feed herself,” Jennifer said.
On several occasions, Jennifer called 911. Alyssa was transported in an ambulance to the ER and hospitalized. After her neurologists ruled out seizures and other conditions, they suggested Alyssa see a psychiatrist.
But Jennifer said Alyssa was turned down repeatedly by providers saying they didn’t take her insurance or that they didn’t work with kids with disabilities.
That’s when Jennifer reached out to the school nurse, who referred the family to the new behavioral health center. The center’s child psychiatrist, Dr. Zoya Popivker, reviewed Alyssa’s medical records and prescribed medications for depression and anxiety.
Jennifer said they got the meds on a Saturday morning, “and by Saturday night, she was out of the catatonic state. Ever since then, she’s been coming back to us, like her personality came back.”
The Case for School-Hospital Partnerships
It makes sense for children’s hospitals to partner with schools, because that’s where kids spend most of their day, said Ramtekkar, the psychiatrist at Nationwide Children’s Hospital.Leahy, the assistant superintendent at Rockville Centre in Long Island, said sharing a behavioral health center across multiple school districts leads both to better collaboration and cost savings. The price her district pays for the services is less than the cost of one full-time staff member, and the state chips in to cover part of that.
Cohen Children’s Hospital will add a new behavioral health center this summer, expanding to 14 school districts. At that point, about 60,000 students in Long Island will have access to immediate mental health support should they need it.
