Childhood is romanticized as the most carefree time of one’s life. But anyone who endured bullying by classmates, or was raised with an alcoholic parent, or struggled to afford basic necessities, knows childhood has never been easy.
There is widespread agreement that children’s lives have become more difficult with disruptions to education and family life throughout the COVID-19 pandemic. The Centers for Disease Control and Prevention Adolescent Behaviors and Experiences Survey reports 1-in-3 high school students reported their mental health was not good most or all of the time during the pandemic, and nearly half of students felt persistently sad or hopeless. And a 2022 survey by Pew Research Center found 16% of teens are extremely or very worried that they have fallen behind in school during the pandemic.
“The increase in the mental health needs of our students and staff coming out of the pandemic has been a monumental task in itself to overcome,” Shane Cassida, Buncombe County Schools Director of Student Services, tells Xpress.
Both BCS and Asheville City Schools are strengthening their mental health supports for students, including bringing in more in-school therapists, to address the variety of issues kids are facing.
Most students will deal with a temporary struggle like bullying or a breakup with a romantic partner, and they will learn to navigate those challenges as part of growing up. But other students experience more persistent mental health issues that consistently affect their lives.
“Most of the mental illness that can occur throughout someone’s lifetime usually has its roots in childhood,” explains Dr. Nick Ladd, associate director of the Mountain Area Health Education Center’s psychiatry residency program. Anxiety, depression and obsessive-compulsive disorder are among the issues seen among younger patients, he explains. A diagnosis of psychosis and bipolar disorder is rarer.
Ladd says addressing issues in childhood now can help manage problems that may exacerbate later, like eating disorders, substance abuse or self-harm. One of the most commonly faced issues is child abuse.
“We see plenty of kids, unfortunately, with PTSD, just because how common child abuse is,” Ladd continues. Individuals who are abused are more likely to go on to abuse others, underscoring the need to intervene with children early, he says.
Buncombe County Child Protective Services received 4,664 reports of child abuse and neglect in fiscal year 2021, according to the 2021 Buncombe County Community Health Assessment Report. “It was determined through investigation or assessment that maltreatment of children had occurred in 469 of these cases,” says Stacey Wood, spokesperson for the Buncombe County Department of Health and Human Services.
And more than one-third of the adult population surveyed in Buncombe County have reported adverse childhood experiences. According to the Buncombe County 2020 State of the County Health report, 39% of respondents reported experiencing at least one childhood trauma in a WNC Healthy Impact telephone survey conducted for the Community Health Assessment.
Emotional abuse was the most frequent childhood trauma reported.
Several agencies specializing in behavioral health have provided school-based therapy for years in ACS and BCS. They are now joined by MAHEC, a recipient in May of a $4 million grant from the N.C. Department of Health and Human Services. The NCDHHS Division of Mental Health, Developmental Disabilities and Substance Abuse Services awarded $20 million in total to five certified community behavioral clinics in the state.
MAHEC’s funding, dispersed over four years, will place more licensed behavioral health professionals in schools to provide counseling, among other objectives, says Kristy Smith, clinical services director of MAHEC’s department of psychiatry.
The funding supports MAHEC’s 31 school-based therapists within BCS, ACS, Madison County Schools and McDowell County Schools, says Smith. Each therapist is credentialed as either a licensed clinical social worker or licensed clinical mental health counselors.
The grant also makes behavioral health more accessible for families for whom English is not their first language. “We have a bilingual therapist who will be working in Buncombe County Schools to increase services to the Spanish-speaking families who need mental health services,” Smith explains. “Our goal is to increase the number of Spanish-speaking families we serve by 20% every year” from 2022-25.
Bringing therapists directly into the schools eliminates transportation issues children might face, explains Smith. Kids can be “seen at school, where they’re already going to school every day,” she explains.
MAHEC psychiatrists, who work with therapists, can provide medication management to students receiving school-based therapy. This can be provided via telehealth or when young patients come into MAHEC’s clinic, Smith says.
Help is here
But how do students find their way to a therapist? Luke Mackenzie, the mental health liaison for the nine schools within ACS, says students access help two ways. “We either have the kiddo advocate for themselves to a trusted adult in the building, or a parent is calling on behalf of them,” he explains.
Parents typically call their child’s school counselor; ACS has 14 counselors who primarily support academic planning. But when a child’s mental health needs to be addressed, that counselor will loop in Mackenzie, who then confers with families to discuss options for their child, he explains.
Within ACS, 13 in-school therapists are employed by community partners Appalachian Mountain Community Health Center, Blue Ridge Health, Your Next Chapter Counseling, Family Preservation Services of North Carolina and MAHEC, says spokesperson Dillon Huffman. ACS also has seven school social workers within the district. “By October we will have two additional MAHEC school therapists to support the elementary/middle schools,” Huffman says.
Within BCS, in-school therapy is provided by MAHEC, RHA Health Services, A Caring Alternative and Access Family Services. Says BCS spokesperson Stacia Harris, “We can confirm that each school will have an assigned in-school therapist by the beginning of the school year.” BCS operates 44 schools.
BCS has 85 school counselors, 31 school social workers and eight social-emotional learning coaches, Harris explains.
Both school districts also conduct a survey that gives them a bird’s-eye view of what struggles students are facing. ACS and BCS conduct the Panorama survey, which assesses social-emotional learning and mental health. The survey is used by at least 10 North Carolina school districts.
Panorama survey questions ask “how does a kid feel about themselves, how does a kid feel about their peers, about teachers, and their interactions with those groups,” explains Mackenzie. The survey results allow teachers and administrators to know a student’s strengths, as well as areas where “more support is needed” both inside and outside of the classroom, he says.
ACS students in grades three-12 took a Panorama survey during the 2021-22 school year. In 2022-23, the survey will be offered to all grades at ACS from kindergarten to 12th.
Parents can allow their child to opt out of the survey, Mackenzie says.