Increased drug use also a factor
The American Psychological Association’s latest “Stress in America” survey indicated that respondents are suffering “collective trauma” because of a combination of influences, including COVID-19, global wars, racism, social injustice, economic instability, and natural disasters related to climate change.
While these factors affect adults, the negative effects are trickling down to youth, resulting, in some cases, to referral for residential placement.
Joseph A. Allred, J.D., MS, vice president, Stetson School, You Inc., and Children’s Friend, affiliates of The Seven Hills Foundation, said the increased acuity of youth following the pandemic poses the biggest challenge for residential schools. He said post-pandemic mental health needs have increased substantially and added that the opioid crisis in young people is another complication.
Sally Gulmi, assistant vice president, clinical operations at The Seven Hills Foundation, pointed out that in addition to a dramatic increase in acuity in general trauma and drug use, there has also been a rise in youth who are borderline at younger ages.
“Now youth have a myriad of diagnoses,” she said. “We have to figure out what to respond to first, usually leading us to look at trauma, which affects the nervous system.”
Debra Blair, MBA, CMA, CPA, chief operating officer at the May Institute, said that while May Center schools provide specialized services for students with autism, developmental disabilities, brain injuries, and other neurobehavioral disorders, they are also seeing students with other diagnoses and “high acuity needs.”
She added that her schools regularly have waitlists of families who have already received referrals from their home school district and are appropriate for admission. Many students on the waitlists have coexisting medical and psychological diagnoses that further exacerbate staffing needs, Blair noted.
According to Blair, the ongoing workforce crisis has had a direct and significant impact on the ability of residential schools to serve these students. “Since the pandemic, the shrinking labor pool has been our most challenging issue, and we anticipate ongoing challenges in hiring, training, and retaining staff,” she said.
“Staffing has begun to improve in some parts of the state, but we are still suffering widespread shortages in other areas. There is a lack of a pipeline for direct care staff, teachers, and nurses. We have enhanced all our internal training programs and continue to create career paths to help fill these critical needs. But there are simply not enough available employees to fill the positions.”
Gulmi advocates for more training and more holistic treatment with an eye toward the sensory aspect. She said treatment in the past was more formulaic and noted that providers have to become “…more fluid and adapt treatment to be more responsive to the youth’s needs.”
Although staffing prevents Seven Hills from expanding some programs, it has not experienced overcrowding during the past three years, according to Allred. “Our census has been fairly steady. We serve 55 to 65 kids and have capacity for 100,” he said, adding that referrals have been strong.
Private practitioner Michael S. Cohen, Ph.D, ABPP, of Fairfield, Connecticut, has seen an increase in the number of referrals. He said that pre-COVID, he would receive two referrals a year; post-COVID half of his young patients have high-level stress and either have had or will require hospitalization in a psychiatric facility.
Cohen finds that residential placement for children who experience “passive trauma” is a concern. He said that these children suffer “quiet distress and may experience an increase in substance use and/or self-harm.”
Children who display overtly disruptive behavior are typically dealt with quickly, Cohen noted. But school districts are slower in referring children who internalize anxiety and depression for residential care. He emphasized that it’s important to match the school to the child.
Practitioners always want a young person to stay in the family and community, but a good residential program provides daily living activities, work opportunities, and health care, according to Cohen. “We need to help the general population understand that people with disabilities can be welcome members of the community with proper support,” he said.
Brittany St. Jean, Psy.D, director of clinical training, White Birch Educational Services in New Hampshire, and president of the New Hampshire Psychological Association (NHPA), directs a team of 40+ psychologists and related service providers throughout 25 New Hampshire school districts who conduct testing referrals for residential placement.
St. Jean explained when schools cannot provide appropriate services for students, the school psychologist works to find a place where the most appropriate care can be given. Testing involves examining neurodevelopmental deficits and the layers of trauma to determine the most appropriate setting. The information gathering process obtains quality information from educators, caregivers/parents, and the student. “We ask the student what are his/her barriers and what are the goals.”
St. Jean noted the dearth of practitioners in the field and advocates for “building up the profession” so that when more complicated cases arise an “anchor system” will be in place. In the short term, she is providing professional development and continuing education to help her psychologists navigate complex cases and follow evidence-based practices. “This will help protect school psychologists in the field to achieve work/life balance,” she said.
She cited the National Match Program for Psychologists, a yearlong program that offers a fellowship to accredited doctoral trainees. “This will help with sustainability. Rather than finding those already in the field, we are grooming trainees, those just entering the field,” she said.
According to St. Jean, psychologists who work in residential care have opportunities to build connection with students they might not get in another role.
“I’m privileged to go in and see [a student’s] vulnerability. People working in rescue want to be there. The pay is low, and the hours are long, but they have the ability to connect,” she said.
at a therapeutic relationship is a significant part of moving forward and this.
St. Jean added that a therapeutic relationship is a significant part of moving forward and this setting presents an opportunity to build trust with the student.
Allred is optimistic about the future of residential schools. “We have turned a corner. The ending of the pandemic has been a good thing,” he said. “The work residential programs do is really important. Sometimes that gets lost in the discussion.”
St. Jean added, “School psychologists and residential care is not talked about enough. We need to bridge the gap.”