At a time when over 20 percent of Ashe County High School freshmen report having suicidal thoughts, and the words “mental health” are heard daily in public discourse, a group of Appalachian State University faculty and graduate students are serving ACHS’s student body with free, on-site, on-demand mental health services.
“We are heavily involved,” said Cameron Massey, a clinician at ASC. “I’m impressed with how they’ve accepted us.”
The Ashe County Assessment, Support and Counseling (ASC) Center currently has a caseload of 34 students it sees once a week. Since the beginning of the 2012-13 school year, the ASC has seen over 80 students — about eight percent of the student body.
The center deals with a broad range of emotional and behavioral problems. “We’re seeing a lot of PTSD…about 30 percent are depressed. They come for anger management, eating disorders,” said graduate clinician Rafaelle Sale.
Since August, the center has logged 43 hours of crisis intervention, a process involving students, parents, teachers, counselors, administrators and representatives from Daymark, which is now made possible in-house by the center.
But students also come in for regular sessions as part of continuing treatment. Appointments are scheduled during different periods each week, so students don’t miss more instruction in any one class, Sale said.
According to a 2011 Youth Risk Behavior Study of the ACHS student body, 33 percent of freshmen reported “feeling sad or hopeless…for two weeks,” 18 percent had “made a plan for suicide within the last 12 months,” and 4 percent — twice the national average — attempted suicide, resulting in injury requiring medical attention.
After only six months at ACHS, the center has charted some success. Using a measure called the Youth Outcome Questionnaire, which tracks student-reported changes during the course of therapy, 63 percent of clients were recovered or improved according to preliminary data reported to the Ashe County Board of Education earlier this month.
The center takes an approach to treatment known a cognitive behavioral therapy (CBT). Based on the idea that thoughts, emotions and behaviors are interconnected, CBT seeks to identify and change maladaptive thinking as a means of modifying dysfunctional behavior and emotions.
A large body of evidence has shown CBT to be as effective as drugs and other treatments for PTSD, depression, anxiety, suicidal thinking, personality disorders, substance abuse and numerous other conditions. Clinician Theresa Egan said CBT is used in every session, and is also effective in resolving family conflict.
Outside of sessions, students may be given mental health assignments, such as “do three fun things this week,” Sale said.
“Since we don’t bill, it opens us up to see some people community providers can’t,” said Massey.
Since August, the center has provided services with an estimated value of $24,000, according to Sale.
“We plan on staying,” Massey said, “Our plan is to develop a substantial program…to always have an ASC Center.” Long term goals include programs to address bullying and build interpersonal skills, he said.
The ASC staff is overseen by a licensed health professional of the ASU faculty, namely ASC Program Director Dr. Kurt Michael, who first conceived and implemented the program at Watauga High School almost seven years ago.
‘They responded well’
In 2006, Michael’s practice included working in schools with kids facing emotional, behavioral and learning problems. He met with students and concerned adults — parents, teachers, counselors, principals — to address disciplinary issues, design individualized education programs, whatever was needed.
Often the result was referral to a mental health service provider: At another place, another time, the student would meet with another concerned adult.
At the end of one such meeting, Michael found himself sitting across the table from then Watuaga High Principal, and current N.C. Department of Public Instruction Deputy Chief Academic Officer, Dr. Angela Quick.
He was thinking to himself: “This kid’s not going to get the help he needs; we want to help him but we can’t.” Quick was thinking the same thing, and they discussed it.
They observed that troubled teens given referrals from panels of teachers and administrators — however well-intentioned — for services outside their schools, which were frequently not available or not provided expeditiously, was an ineffective system.
Nor was it working for faculty who, while invested in helping these kids, also had schools to run and lessons to plan. In positive outcomes for students, their investment paid scant dividends.
They identified several obstacles to effectiveness in the system: access and availability of services, transportation, financial need, the social stigma for students. What was needed was a system which removed these obstacles.
Michael continued the conversation with his colleagues. Out of that dialog came the ASC Center concept: free mental health services made available in the schools, in real time and in close partnership with teachers, counselors and administrators.
With approval from ASU, and a receptive faculty at Watauga High School, Michael launched the first ASC Center in 2007 with a mission to “address mental health impediments to learning.”
Funded by grants and staffed by graduate students, its initial focus was student crisis intervention and discipline referrals.
“They responded well,” he said.
Watauga High noticed, offering additional support and dedicating ASC office space in a school expansion project.
Today, “Watauga is a pretty well-oiled machine,” Michael said. Its staff of 12 offer an array of mental health services, from evaluation to treatment to group therapy.
Of Watauga students surveyed in 2010-2011, 100 percent reported being either “extremely satisfied” or “satisfied” with the ASC Center, 100 percent reported “feeling heard,” and 91 percent said they were “seen enough” to address their concerns.
A burden removed
With six years of supporting data and a few write-ups in psychological and medical journals, the ASC model was ready for application elsewhere. Initial discussions with Ashe County Schools began in 2009, and formal services began in spring, 2012.
The Ashe County ASC Center was implemented full-time at ACHS for the 2012-13 school year. Faculty at ACHS are lavish in their praise of the “ask” center.
At the BOE’s February meeting last Monday, ACHS Principal Jason Krider said of the center: “I can’t say enough for what they’ve done for the kids…there’s some real serious cases that I think are here and doing well today because of this group.”
Counselor Mike Tasso said the access and immediacy of the center’s in-house team are crucial. When meetings had to be scheduled to get referrals elsewhere, and student and parent follow-through were a factor, the process was much slower and less-effective, he said.
“One of the most compelling things is that students are starting to see therapy as a tool, and ask for it in order to make their lives better,” said ACHS Counselor Annette Bednosky. “I am relieved to have such a talented and committed team working for the success of our students.”
“The partnership with the ASC team…is invaluable,” said counselor Tara Miller. “Prior to the ASC team, when I referred a student who was at risk, I feared they might not get the therapy they needed.”
“Now, with parental permission, I can make sure the student is seen and their needs are assessed immediately,” she said. “It has truly removed a burden from so many families.”
All ACHS faculty shared one observation about the center’s effectiveness: the lack of stigma. Students who might feel shame or embarrassment about being the focus of an administrative intervention or going to see a psychiatrist are more comfortable with a trip to the office see their therapist.
According to Michael, the ASC model works because it is rooted in “evidence-based practice,” adjusting its methods in accordance with results. “None of us think we’ve got the market cornered on doing this right,” he said.