The arrival of the pandemic early in 2020 prompted residential schools to overcome significant challenges and implement some creative, strategic changes. As society creeps back to some semblance of normal, residential schools continue to engage in a post-pandemic balancing act.
The Massachusetts Health and Hospital Association (MHA) recently reported the “COVID-19 pandemic has exacerbated/presented challenges to patient access to care, inadequate reimbursement and workforce shortages.” In combination, these factors created an increased need for behavioral health services as well as an elevated intensity of acuity. At the same time, many clinical and support staff have left the profession, causing a significant shortage.
Elizabeth Dello Russo Becker, Esq., executive director, Massachusetts Association of Approved Special Education Schools (MAAPS), pointed out that although residential schools were the only ones mandated to remain operational throughout the pandemic, the situation put these students into crisis. “We are getting more than one hundred referrals a month. [Students] jumped from general education into residential special education,” Becker said.
The increased demand is having a trickle-down adverse effect. MHA reported that during the week of November 7, there was a total of 657 boarders: 467 adults, 75 geriatric patients, and 115 pediatric patients. The data was provided by 51 hospitals.
Becker pointed out that federal government funding of $2.9 billion helped K – 12 public schools but did not extend to residential schools. Fortunately, Massachusetts’ governor responded favorably to a request for financial support and supplied funding for maintaining and recruiting staff.
MAAPS hired more than 200 additional staff and retained 90 percent of the workforce, she reported. “This also enabled us to support more than 160 additional students who enrolled in three months.” Becker noted that this funding ends June 30.
Mountain Valley Treatment Center, Plainfield, New Hampshire, practiced “transmission control” as the pandemic surged and waned, according to Executive Director Everett Logan, MA, GC. In addition to the obvious measures – masking, testing, PPE – staff was required to be vaccinated. The Center is now, for the most part, back to pre-COVID operation levels.
Staff shortages have still been a challenge, prompting some readjustments. “Our programs are smaller due to the pandemic and a reduction in the total number of staff, but we are keeping the same student to staff ratio,” Logan said.
According to Logan, lengthy periods of isolation have taken a toll on mental health. “Clients are more acute,” he added. To meet the increased needs of students, staff has had to adjust training to meet the new more intense diagnoses and behaviors, such as self-harming behavior and suicidal ideation.
While staff shortages and more complex diagnoses are major concerns, Logan cited the state of the economy as his primary fear. He said the economy affects his facility’s ability to operate effectively and to provide appropriate services.
Additionally, insurance companies pay only a portion of the costs, forcing clients to pay out of pocket. “Families have to go to great lengths to get approvals,” he said.
According to Phillip Ekberg, M.Ed., principal of Wayside Academy in Framingham, Massachusetts, one of the most striking outcomes of the pandemic was the unusually high demand this past summer, typically a quieter, transitional period when districts do not call for extended evaluations.
“This summer there was strong interest in getting students [into residential care],” he said. “There is recognition within the field of a significant level of acuity. A lot of students were in pain and in need.”
Ekberg said that the loss of face-to-face instruction and the ability to build connections has resulted in the need for a higher level of care. He added that as students are “stuck” in hospitals, they continue to lose access to teachers and appropriate care.
Although Ekberg praised staff for its willingness to “go above and beyond,” he noted that a smaller pool of occupational therapists, reading specialists, and other clinical experts prompted Wayside to “shuffle chairs,” shifting staff roles when necessary.
This dearth of staff results in fewer programs and fewer beds. “We receive residential education referrals and want to offer help. However, all beds are occupied and it’s uncertain when there will be a movement.”
Matt Riley, PsyD, BCBA, vice president of education services for the May Institute in Randolph, Massachusetts, reported that his facility enacted “dynamic” policies and procedures, based on the unpredictable status of the pandemic. He admitted that figuring out the timing was a constant challenge from a public safety standpoint.
“Pockets of challenges” arose that required advance planning, according to Riley. “We developed a network in which people would come in on short notice. Sometimes direct care posts were filled by non-direct care staff.”
Technology offered mixed results and tested technological skills, according to Riley. Over time, the school found different ways to present content, offering greater access for students. “[Technology] really opened up and allowed us to consider options we would not have before,” he said.
The census is beginning to recover, Riley said. “Broadly speaking, referrals are better now, but there are large systemic challenges around entry into residential care and exit to adult services. The number one driver is staffing, which is a burden from the administration to the direct care staff.”
Riley added that global economic factors are also impacting the ability to expand and purchase new housing, which would enable the school to accept more referrals.
The need for residential care is undeniable and Riley emphasized that schools need to support the workforce that, in turn, supports these students.
“The level of stress has been prolonged and significant. Staff has to be at one hundred percent. We need to provide support and ensure that staff can attend to their own personal needs,” he said.
Becker emphasized that there still exists a pipeline challenge, forcing staff to continue to cover vacant shifts on weekends and nights. Schools are responding to students who have more layers of mental health needs and require a more specific response, Becker said.
Although dealing with ongoing challenges, residential schools are definitely in a better position now than they were at the height of the pandemic, Ekberg said.