Summer is beginning, and the time has opened up for barbecues and family game nights. Just in time for the season, our friendly neighborhood expert on health care and education, Connie Garner offers some of her thoughts on mental health, schools, and a popular board game that we may be playing with our children’s well being.
Can we Really Pass Go?
Much can be learned from the games we play with our children. Since 1935, Monopoly has been an integral part of the American culture. As the players gather in the spirit of both competition and community, a game board is unfolded that represents many of the underpinnings of the American dream. The importance of individual achievement and ownership, the significance of investing in public and private community entities, and the values of responsibility and accountability all come alive with the role of the dice. Houses are built — with hotels to follow — and access to the railway system provides community transportation. Laws are enforced through taxes and fines with the prospect of jail threatening violators of the system. The Water Works and the Electric Company (though not prized holdings) are included, recognizing their contribution to the community quality of life, and the Community Chest and Chance cards offer the cooperation between the citizens and the public domain.
While an interactive community is built during an evening’s play, a glaring omission struck me — where are the schools?
In a game such as Monopoly which is based on individual success, why are schools not considered an integral public entity within the game? Even during the game’s development at the turn of the 20th Century, schools were considered an important part of development as well as a marker of future success. Even now, schools remain a key factor to learning and development, but are often time ignored for their role in success and the health of our communities. Like in the game of Monopoly, why is this perception played out in real time in communities across the country, and why must it change?
As far back as the 1900’s, schools were considered to be the single, most important influence in socializing and promoting learning and healthy brain development in children. Over time, with increased mobility of families and the rise of children in poverty, the relationship grew stronger between schools and human services. There is now a true realization that developmental, psychological, and educational success relies on the broader context in which a child lives. Collaborative relationships between health, education, and social services are needed and are found to positively enhance a child’s potential to learn, but also to help develop the social and psychological resilience needed to deal with difficult life challenges. Although schools are the most visible and consistent institution in any community, they are relatively challenged in attempting to comprehensively serve children and families, particularly in the area of mental health. Even so, over the last 2 decades we have seen the effect of failing to invest in our country’s mental health systems, particularly on children. The National Alliance for the Mentally Ill (NAMI) reports that one in five children (aged 13-18) have or will have a serious mental health condition; suicide is the 3rd leading cause of death in youth (aged 10-24); and most significantly, 50% of all lifetime cases of mental health conditions begin by age 14. It is imperative that we strengthen the availability of, coordination of, and payment of mental health services in schools.
Viewing the school as the hub for efficient coordination of mental health services affirms that both families and schools are a part of the healthcare community. This type of collaboration, however, requires investing in the resources a school needs to ensure that students and their families have access to appropriate, evidence-based mental health services and supports. To that end, the following steps should be considered:
Both public and private insurance carriers should work with schools as providers of mental health and substance use disorder services, to develop an appropriate credentialing and reimbursement methodology so that children and youth can access these needed services during the time they are in school.
- Schools, students, and families should have access to state credentialed, clinically appropriate mental health and substance use disorder professionals to ensure students receive or are referred to effective clinical interventions.
- Schools should collaborate and coordinate with community mental health centers (CMHCs) and MH/SUD providers of care to ensure that students receive effective clinical interventions.
- Prevention, screening, early identification, appropriate referrals, and services should be available to students as a service option in schools.
- Consideration of the student within the context of their family/support system is equally as important as the individual intervention the student receives.
- Mental health and substance use disorder delivery models for students in schools should be flexible enough to meet the needs of the school, student, family, and provider networks.
Schools and Coordination Services
One writer recently commented that “to solely focus on the question of curriculum and performance standards for kids in school and to miss the broader context in which these children live is to miss the most basic point: the rest of their lives.” Schools can and should play an important role in the healthcare models of “care coordination” and even health homes, particularly as related to mental health and substance use disorders in children. The ability to access services and supports for healthy brain development in the place where children spend the majority of the developmental years, should be an investment every community should support.
Whether it is developing a positive behavioral supports infrastructure, developing a crisis intervention model, or strengthening the availability of mental health services during the school day, collaboration between families, educators, insurers and the mental health provider community is paramount. Most importantly, communication with the child’s primary health care provider is critical. Mental health should be a cornerstone in the integrated health care of children, recognizing the importance of the team to positive health outcomes.
Financing the System of Care
For children with disabilities, building mental health resilience and addressing mental health challenges proactively matters in promoting both their academic progress and their functional capabilities. From strategy support for teachers on building a child with a disability’s confidence and pride in themselves, to addressing serious behavioral issues — coordination of services can drive interdependent and complementary relationships rather than fragmented and role-specialized approaches, and offer real support to the child and family.
Just as when players trade properties in the game of Monopoly, school leadership need to engage all stakeholders, including health insurers, healthcare providers and families to work towards implementing a strong, school-wide system of prevention, early identification and treatment for children with mental health and substance use challenges. No other institution has the social presence of the public schools in offering access to children and families in every community.
Medicaid represents a major funding source to schools for health services to students who have disabilities or are disadvantaged in some way. As more states elect to administer Medicaid through private insurance companies, schools may find themselves negotiating with the private insurance for reimbursement of services. Working collaboratively to define a common agenda around both the financing and delivery of MH/SUD services in school will be a challenge, but with negotiation should result in a more seamless approach to achieving positive mental health outcomes for children.
There is no reason a school should not be reimbursed for a medically necessary service a child receives during the school day.
From the Eyes of a Child
Schools contribute significantly to the positive reinforcement of (1) safety and security, (2) social support and resiliency, and, (3) professional services and supports, but without community collaboration it fails. This growing concern for children’s wellbeing is among the most salient issues facing not only schools and social service agencies, but society as a whole. There is an intrinsic relationship between a child’s readiness to learn and their social-emotional and health status.
The child who comes to school hungry cannot concentrate on their studies. The child with asthma who consistently misses school because they need inhalation treatments during the school day may not be able to keep up with their studies. A child who wanders the streets after school due to the absence of reliable child care is at an increased risk of adopting aberrant social behaviors. A child with cerebral palsy who does not have therapies coordinated between school and home could lose their full potential to function independently in the community. A child who is so psychologically challenged that they turn to drugs, is a child we are losing.
Schools as a single agency cannot meet the complex needs of today’s students. In the words of an African proverb, so aptly quoted by Hilary Clinton, “It takes a village to raise a child.” Schools are a part of that village, not isolated entities unto themselves.
As the Game Continues
Our schools of the 21st Century must find their place in the game of Monopoly. No longer can our children assume to Pass/Go and collect an economic reward without having received the educational opportunity and community supports necessary to successfully transition from school to the rest of their lives. In the end we are all players in that game– the game of life.