In celebrating this National Children’s Mental Health Awareness Day, I tip my hat to all of those adults who are working to see beauty in the lives of children, especially those living in the midst of adversity and pain. I also want to honor the children, who are changing our lives as much as we are helping them change their own.

I have been fortunate to have learned from many amazing children. Two preschool students, “Jorge” and “Goddess,” especially, helped me to see that even in the midst of very messy lives, there is much beauty and strength. As my first clients while training to become a mental health counselor, they helped me find room in my heart that I did not know existed. Rather than trying to “save” or change these children, they taught me that my role was to support their own inherent strengths. They challenged me to recognize them as individuals who were fighting to live, as opposed to failing to thrive. As I began to see these things more clearly in Jorge and Goddess, they and those around them began to see them more clearly as well.

Across my work as a teacher, school-based mental health counselor, and researcher, I have observed that the children most difficult to like almost always receive the worst treatment from peers and adults.  Frequently, these children are the ones who are fighting to live—watching their backs and keeping others at a “safe distance.” Perhaps this is the most devastating consequence of maltreatment or an otherwise messy life—if one is poorly loved, it is difficult for one to know how to be loveable. As well, if one is raised by a depressed or absent caregiver or in a violent neighborhood, one may never have learned to manufacture or recognize laughter. These children who would most benefit from drawing others close to them, have only learned to keep them away.

Through my work with such children, I have observed that as they become more trusting, they frequently become more outwardly focused, less temperamental, and share more positive emotions. Soon, they begin to receive more positive attention from teachers and peers, building social emotional skills through interactions with them. Similarly, as their teachers begin to see these children in a more positive light, I have noticed that they often begin to enjoy them more, feel hopeful that they might make a positive difference in the child’s life, and gain energy from their love and affection. Indeed, it is the mutual transformation that occurs between children with messy lives and the important relationships in their lives that inspire and sustain a network for them—greatly improving their future prospects.

Travis Wright, Ed.D
Assistant Professor of Educational Research
Director, The GWU Resilience Project
The George Washington University Graduate School of Education and Human Development

The New York Times reports that  New Jersey's Anti-Bullying Bill of Rights is setting tough new standards for its new state anti-bullying policies. The law requires local school districts to train all teachers and other school personnel to report bullying on the same day an event occurs. An investigation must be completed within 10 school days, and parents must be informed.

The Times article notes that local school districts are developing additional policies. For example, bullies at East Hanover schools can be reported to the police by their classmates by filing anonymous tips on the Crimestoppers hot line.

The Anti-Bullying Bill of Rights was passed six months after Rutgers freshman Tyler Clementi killed himself after two roommates filmed him having a sexual encounter with another man and posting the video on the internet.

Not much disagreement on the proposition that schools should be safe places for students. But what's the best way to make them safe? Especially involving the police seems like a procedure fraught with challenges. How do we tread the line between under and over reaction? Your thoughts?

As Yogi Berra said, “It’s déjà vu all over again.” For the past several months, we’ve been bemoaning the elimination of CDC’s Division of Adolescent and School Health (DASH). To refresh your memory, back in the spring, CDC announced that it was removing the HIV work from DASH and re-grouping the non-HIV-related school health programs into a “division that includes other chronic disease prevention programs.”

This week brought news that the Department of Education's Office of Safe and Drug-Free Schools (OSDFS) is also being restructured. According to a Dear Colleague letter released from the Deputy Secretary of Education, the moves are prompted by the 29% cut in the Office’s budget agreed by Congress on April 14. Similar to the DASH changes, the OSDFS will be demoted as an administrative entity -- becoming an Office for Safe and Healthy Students within the Office of Elementary and Secondary Education. To track federal education programs and funding, I like Michele McNeil who first put me on to this story.

Seems to me that these changes don’t bode well for programs such as Healthy Schools, Healthy Students and Safe & Drug-Free School that have supported valuable school-based mental and emotional health services. What's your thinking on these changes?

Anyone who has spent time thinking about funding school health services will reach several conclusions:

1. The current system is jerry-rigged, frequently on the brink of collapse. Each state, each community and each school has its own unique approach that knits together too few resources to cover too many responsibilities. 

2. The unpredictability of these arrangements hurts all children but is particularly dangerous to the most vulnerable – the children with special health care needs.

3. Linking the knowledge and skills of the health care system with the school-located professionals who work daily to support seriously ill children attending class is a good place to start. And that partnership needs to be sustained by a carefully articulated, transparent funding structure.

Commenting in last month’s Pediatrics on the rapid increase of children with complex chronic conditions and children who require 1:1 care, Martha Dewey Bergren, Director of Research at the National Association of School Nurses, noted that the current system of shuffling costs between the health and education systems using a tag-you’re-it approach is not addressing the challenge “in a meaningful way".  

How is your school system and health system handling expenses associated with children’s complex medical care? Are there model programs to study?

Earlier this month, the Obama Administration released final spending plans for FY 2011 (October 1, 2010 – September30, 2011). This document implements the 2011 budget agreement reached by Congress and the Administration in April. The projected HHS numbers for FY2011 (October 1, 2010 to September 30, 2011) offers good news and bad. The good news, found under the heading Primary care, page 1, is that the $50 million originally planned for school-based health center facility construction and equipment has been retained in the budget.  The bad news, found under CDC, page 5, indicates that earlier concerns about the impact of changes to the Division of Adolescent and School Health were well placed. A national study entitled Healthy Passages that had been funded by CDC/DASH to develop effective policies and programs to improve the health and development of children, adolescents, and adults appears to be eliminated. School-based HIV programs also appear zeroed out. While other school health-related programs, such as the YRBSS will likely continue, they are not identified as such in this document. 

However, on the more-good-news front: On May 31st, the federal Bureau of Maternal and Child Health has announced a new School-Based Comprehensive Oral Health Services Grant Program to support a multi-site grant initiative in existing school-based health centers.  Grant applications will be due July 15, 2011.

The take-away from the good news/bad news on school health from the federal government: Reading the small print and reviewing the budget documents carefully is mandatory! 

Former Speaker of the House, Thomas (Tip) O’Neill of Massachusetts famously said “All politics is local.” From our GW perch in Washington, DC, it’s easy to forget that. But local and state governments pay for 90% of the cost of K –12 schools and are essential partners in funding health care for low-income children, covering about 40% of total costs. Which brings us back to Speaker O’Neill and the just-released data from the Census Bureau focusing on census data from 10 states (Alaska, Arizona, California, Connecticut, Georgia, Idaho, Minnesota, Montana, New Hampshire, New York, Ohio, Puerto Rico and Wisconsin) bringing the total of state reports to 26. Folks interested in peering into the future of their state – Will school systems grow? Will the workforce and taxpayers be sufficient to support the schools? And assessing the issues that will be foremost in the minds of community and state leaders will want to look at these data. In coming months we can expect more community and neighborhood data as well.

National School Nurse Day reminds me of a promise I made a few weeks back that I would focus on the 'bright spots' in school health rather than grumble about hard budget times.

So here's a definite bright spot:  When I was first writing about school health services, the HHS Bureau of Nursing had just completed its 2001 national survey describing the number of nurses and where they were employed in the US.  And according to the Bureau of Nursing, in 2001 there were about 54,000 nurses working in K - 12 schools around the country. This past year, a report on the 2008 national survey reported 73,697 school nurses. Pretty good progress for a 7-year period -- a 36% increase.

Congratulations, school nurses! Long may you thrive!

With CDC downgrading the Division of Adolescent and School Health, and the future of that entity unclear, one task that outsiders may impact would be securing essential DASH functions. I continue to worry about how well some of these functions will fare in the new administrative structure. Thus, here is my short list for The Essential DASH:

What brought me to the DASH web site and led me to call DASH officials once a week or more are the following:

• School Health Policies and Practices Study – both the complete report and the state summaries,

• the Youth Risk Behavior Surveillance (YRBS) results, 

• and, most importantly, the Coordinated School Health model which has provided a true public health frame for the essential elements that support children’s health at school.

What about you? Please add to this list. We need to remind the CDC leadership that the DASH agenda is profoundly important to children’s health in this country. 

Today, May 3, 2011, we observe National Children’s Mental Health Awareness Day and the Center for Health and Health Care in Schools is joining many other organizations to raise awareness of children's mental health needs.  This year’s focus on early childhood and trauma is appropriate, given the multitude of environmental, social, and economic stressors that many children and youth (and their families) contend with on a daily basis. 

But this day is not only for those interested in preventing or reducing symptoms of mental illness.  It is also a day to consider the many ways we can strengthen and promote good mental health skills and recommit to children’s positive mental health development. It is also a day to celebrate the achievements and emphasize the importance of school mental health programs and services that have become a part of our nation’s child mental health delivery system, especially for poor and underserved youth. 

A recent online discussion about sustaining school mental health programs, hosted by the Robert Wood Johnson Foundation, received over 7000 views!  School mental health is on a lot of people’s minds. We hope the discussion will increase our knowledge of federal, state and local policies and programs that support (or limit) school mental health programs and help identify the common struggles that plague practitioners, educators, researchers, and parents who advocate for expanding school-connected mental health.   Please take a minute to share your thoughts. What do you feel are the most promising directions for sustaining these services?

Olga Acosta Price
Director, Center for Health and Health Care in Schools
 

I’m beginning to understand – not to agree with, but understand – the silence attending the “restructuring” of CDC DASH. It turns out that some long-time DASH supporters believe that the new, slimmed-down DASH will offer “new opportunities” yet to be defined. For me, the reasons for optimism remain unclear.
 


What I know is that the leading federal organization that championed a comprehensive vision of school health – healthier meals in the school cafeteria, more physical activity, beefed-up health education for students, environmentally healthy school buildings, school nurses and school-based health centers – has been diminished.  And its supporters have gone silent.  
 


Do these recent developments suggest that when it comes to health-at-school, the US Department of Education should take the lead at the federal level? While ED has not had a prominent role in policies related to school-connected health programs in the past, maybe this is a time for the agency to re-think its role. What do you think?