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Richard Buery

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E.R. Visits: A Costly Band-Aid for Troubled Students

Posted: 04/24/2012 12:26 pm

Last week, the New York Times profiled Gabriel, a young boy who has been unnecessarily sent to the emergency room for psychiatric evaluations on multiple occasions due to behavioral outbursts in school. With the right resources, these outbursts could and should have been handled in Gabriel's school. Every year, thousands of children are sent to the ER unnecessarily, when instead they could be cared for and learning in school.

As many parents and students can attest, disruptive behaviors are a distraction to the entire class. The lesson is interrupted; students and teachers become unfocused and tense. Faced with a shortage of resources, educators are increasingly calling 911 when children act out, resulting not only in costly emergency room visits, but a failure to treat the underlying behavioral disorder.

And it's the wrong response.

Less than 3 percent of students sent to the emergency room are admitted into a hospital. Most are sent home and told to return to school the next day. Instead of receiving any sort of treatment for the root problem, the student misses a day of school. Often, parents are required to miss work, losing income and imperiling their jobs.

School-based health centers (SBHC) provide onsite medical, dental and/or mental health services, delivered by professionals in a caring and accessible environment. And they have proven to be incredibly effective. Students receiving mental health services at SBHCs show significant declines in depression, improvements in behavior and overall mental health and increased academic performance. They also save money, as we all know that comprehensive preventive care is less expensive than emergency room care or the future complications caused by untreated mental health conditions. The Children's Aid Society operates five SBHCs in NYC, serving nearly 33,000 students during the school-year. Seventy percent of our referrals are due to disruptive behaviors at home and/or school that significantly impact academic and social functioning.

Consider 13-year-old Lisa, referred to a Children's Aid Society SBHC by her primary caregiver -- her grandmother. Lisa was prone to anxiety, poor peer relationships and an inability to accept responsibility for her behavior. Her father passed away when she was two-years-old, her mother was not in her life and she suffered severe abuse from her uncle as a small child. Rather than being sent to an emergency room, our SBHC diagnosed Lisa with oppositional defiant disorder, as well as symptoms of anxiety and depressive mood. Following her therapy sessions, she has been able to develop positive, trusting relationships, improve her grades and graduate to high school.

Unfortunately, success stories like Lisa's are not possible for most of the one in five children with a diagnosable mental, emotional or behavioral disorder, or the one in ten children who suffer from a serious emotional disturbance. Only 317 of New York City's 1,700 schools provide mental health services, and the number has been declining in the past several years due to budget cuts. At the same time, principals and teachers identify mental health services as one of their biggest areas of need.

The Department of Education and the Department of Health must allocate more money for these mental health services in our schools. It is critically important that children are given all the resources they need to get the education they deserve. The vast majority of the time these kids do not need a hospital. They need someone to talk to and sustained mental health care services. If every school had a SBHC, they could all get on with the business of learning.

 

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