Keeping Students’ Mental Health Care Out Of The E.R.
By Michael Winerip New York Times April 8, 2012
During the 2010-11 school year, Adeline Seise’s son Gabriel, a second grader, repeatedly disrupted classes at Public School 67 in the Bronx.
On Sept. 29, according to a school report, Gabriel told his teacher he was going to beat up a classmate. While the teacher was trying to calm him, Gabriel, who was 10 at the time, spotted the boy and pushed him from behind. The boy whipped Gabriel in the face with a sweater, scratching him under the eye. Gabriel was enraged, and when the teacher tried to stop him, he tripped her. Security guards restrained him and school officials called Emergency Medical Services, which transported Gabriel to St. Barnabas Hospital’s emergency room, where he was evaluated by a psychiatrist.
Gabriel did not need to be admitted to the hospital, the psychiatrist wrote; he was cleared to return to school the next day.
This happened several times that year. Once, according to a school report, Gabriel became so enraged, “he grabbed desks, chairs, books and plastic bins and threw them throughout the room.”
A few days after the Sept. 29 incident, the school’s special education committee decided Gabriel -who has been given a diagnosis of attention deficit and oppositional defiant disorders -needed regular counseling.
He never got the counseling.
Typically, if disruptive children are going to attend a traditional public school, they are placed in a classroom with a 12-to-1 student-to-teacher ratio and assigned an aide.
Gabriel got neither. Instead, he was mainstreamed in a class of 25 that included 10 special education students and 2 teachers. Twice more that year, school officials called E.M.S. to take him to the hospital – once in restraints – and both times Gabriel was examined and returned to school the next day.
Then last summer, Ms. Seise filed a complaint with the Education Department. At an administrative hearing, P.S. 67’s principal, Emily Grimball, was asked why Gabriel didn’t get more extensive special education services. She answered that there wasn’t enough money left in her budget.
“A lot of times it goes down to funding and what it is that the school is able to provide for the child,” she testified.
In September, no doubt due in good part to Ms. Seise’s administrative complaint, Gabriel received the extra services.
Since then, Ms. Grimball said, his behavior has improved considerably.
Gabriel has lots of company. For more than a decade, mental health and Education Department officials have worked to reduce referrals to E.M.S., which they see as an expensive and traumatizing response to problems that should be handled at the schools.
“Kids who make verbal and behavioral threats to themselves and other people very much need and deserve a same-day mental health evaluation,” said Charles Soule, a psychologist in pediatric psychiatry at NewYork-Presbyterian Hospital. “But most New York City school kids don’t have access at the schools, where it’s better done.”
Dr. Soule, who is the co-chairman of the New York City School-Based Mental Health Committee, said there had been some progress. In 1999, when he started working on this issue, 75 schools had mental health services. Today, according to the Education Department, 319 of the 1,700 schools have such services.
After news media coverage in 2004 highlighted the problem, the department appointed a full-time administrator to oversee mental health care. “The D.O.E. understands the need and is committed to improving, but the issue is resources,” Dr. Soule said.
In the last few years, care appears to have deteriorated. Dr. Soule said the number of schools with services had fallen by 10 percent. Marge Feinberg, a department spokeswoman, said cuts were due in part to a reduction in state financing.
It’s likely that there are thousands of mental health cases referred to emergency rooms each year. In 2009-10, there were 868 E.M.S. calls for suicidal ideation alone, according to school officials. That would not include children like Gabriel who are menacing to others.
Nelson Mar, a lawyer with Legal Services NYC-Bronx who represented Gabriel’s family, said that at one Bronx hospital, there were 58 E.M.S. calls from schools during a 10-day period in February. (He declined to identify the hospital because, he said, he feared the emergency room doctor who provided the data would face disciplinary action.)
Another problem is changes in the way the Education Department finances special education services. In the past, the department’s central administration provided services for children like Gabriel as the need was identified.
Under the new system, each school is to provide financing from its annual budget. So far, 265 schools, including P.S. 67, have taken over the budgetary responsibility. The rest will switch over in the fall.
Advocates fear that schools will budget for special education services based on needs at the start of the year, and then, as new problems arise, there won’t be money to provide additional services.
This appears to be what happened to Gabriel. As the school year progressed, Ms. Grimball became well aware of his need for more services. “Gabriel was totally out of control,” she testified.
Why wasn’t he provided a paraprofessional after his first major explosion? “All paraprofessionals, the one-on-one paraprofessionals and/or crises paraprofessionals, were already assigned to students,” she answered.
This school year, after the legal services agency filed an administrative complaint on Gabriel’s behalf, Ms. Grimball budgeted so he could be in a class with a 12-to-1 ratio and have his own paraprofessional. It’s made a noticeable difference, the principal said. “He has adjusted to the young man who is his paraprofessional.”
One sign that most of the E.M.S. calls are unnecessary: At institutions surveyed by Dr. Soule, as few as 3 percent of students sent to the emergency room were admitted to the hospital.
An alternative has been developed by Dr. Pamela Cantor, founder of Turnaround for Children, a nonprofit agency currently working in 25 schools. The agency trains teachers, guidance counselors and social workers to recognize mental health problems early on and defuse explosive situations. Each school is paired with a nearby mental health clinic that, on short notice, can treat a child in crisis.
Ms. Seise said Gabriel was doing much better this year, thanks to his special education teacher, who has shown him how to control his anger.
But the male paraprofessional he had such a good relationship with has left, and Gabriel is now on his third aide this year, a woman. At the end of March, he had a serious outburst and was taken by E.M.S. to the emergency room, where he was examined by a psychiatrist and cleared to return to school the next day.