As a Sage graduate student working to become a psychiatric nurse practitioner, 2004 Schenectady High School graduate Anna Brady ran into a friend working as a school psychologist in the Schenectady City School District.
The district should hire a nurse practitioner, she suggested to her friend, only partly serious. About nine months later her friend texted her: “I think they are making the job.”
Last year, as the district expanded services to students and added dozens of new staff positions, officials included a spot for one specially-trained nurse practitioner in the budget. The goal was to establish a mobile crisis unit that, with a psychiatric nurse practitioner at the helm, could go from school to school, responding to mental health emergencies.
At first the district struggled to find someone qualified and interested in the position, so they turned to the pipeline of graduate students working to become nurse practitioners, thinking they could hire someone directly out of school. That’s how the district found Brady, who finished at Sage in December.
“I didn’t know it would ever be an option,” Brady said last week when asked if she ever imagined coming back to work in Schenectady schools. “This is an exciting job, because it’s a need I’ve sort of thought has been there for a long time.”
Energized by the chance to build something from the ground up, Brady is joined by two licensed social workers: Jenna Silberman, who worked at Ellis Hospital before joining the district in recent years, and Micah Ilowit, who has been with the district since the summer after previously working on an adult mobile crisis unit in Albany. The mental health team – called the School-Based Crisis Prevention Team – is making its home base at a partly-used annex in Keane Elementary School.
They moved into Keane in late-January, shortly after Brady was hired by the district after completing her graduate degree and licensure. And the team shifted its focus from one of “crisis response” to “crisis prevention,” planning to provide a wide range of service to students and familie, from information sessions on mental health to diagnosing students and prescribing medication and treatment.
“We want to provide more wraparound services and prevention care, so students don’t get to the state of crisis,” Brady said.
Ilowit and Silberman, who have both worked in schools, said school-based social workers, psychologists and educators do a good job of handling crises but can often be inundated by responding to crisis and dealing with other duties.
“They handle them frequently, continuously and competently,” Ilowit said.
But those school-based teams don’t have the time or resources to assess and diagnose what is behind the student crisis, or provide therapy and counseling or help the family set up an appointment with a physician.
“That isn’t feasible when in a building, because so much is going on and we have so many responsibilities,” said Silberman.
That’s where the crisis prevention team steps in, and with Brady’s expertise, the district for the first time will have the in-house capability to diagnose a student’s mental health condition, provide treatment and prescribe medication — under the supervision of a physician.
The team has spent the past few months traveling to schools across the district to meet with school leaders and social workers about what their needs are and what types of mental health challenges students are facing. They have also connected with outside agencies, strengthening relationships with community partners.
They have started to gradually build a caseload, starting to meet with students and families in schools and at their Keane base of operation, which is still a work in progress. The Keane space includes a large, well-lit room and a spacious conference room, where they can meet in groups or one-on-one with students and families to provide therapy and counseling.
“What we’ve found at all schools is it all comes down to the family supports,” Silberman said. “It all comes down to the families.”
District officials track the number of days students spend hospitalized for mental health concerns as a measure of the seriousness of psychiatric challenges facing students. In the 2015-2016 school year, the district tallied 982 mental health hospitalization days. Last school year, the district recorded nearly 900 days and have counted 790 hospitalization days so far this school year.
And students in need of seeing a psychiatric health care provider – short of a mental health hospital visit – have to wait weeks or months for an opening. Andrea Tote, who leads the district’s special education and mental health support services, said families in the district often struggle with scheduling and getting to doctor appointments. She also said students will often stop using a medication they had been prescribed and then be unable to get the guidance or support to get back on the drug regimen. In some cases, parents or caregivers are unable to get questions answered about a diagnosis or course of treatment.
With the new crisis team in place, district officials hope the hospitalization numbers will start to come down as the district is better positioned to respond to student needs before they intensify and result in a need to visit a hospital.
“We were getting a lot of calls from schools that had children in crisis,” Tote said. “We are hoping to avoid a hospitalization from happening.”
The crisis prevention team will also serve as mental health guides, who can work closely with families as they navigate the ins and outs of scheduling appointments, understanding diagnoses and maintaining stable treatment and prescription use over time.
“We can educate parents on medication, provide the time not built into the typical 15- or 30-minute session of a primary care provider,” Brady said. “We can give kid-specific answers … On a case-by-case basis, what does this student want, this family need?”
The team will work as an advocate for students and families dealing with the uncertainty and at times the stigma of mental health diagnoses.
“A lot of times it’s just a disconnect with the idea my kid is mentally ill,” Ilowit said of the challenge of helping families understand how mental health concerns are addressed. “We can build a relationship and help them understand maybe this is not so bad.”