In New Orleans, Closing the Service Gap for Troubled Students
On most days at the New Orleans Therapeutic Day Program, Monica Stevens spends hours in a state of near-constant motion.
She will walk several miles, up and down the school’s hallways, popping into classrooms to check on students, pulling kids out for one-on-one therapy, intervening to defuse tension or conflict.
“We often say that we play jazz around here. You have got to go with the flow. My day is about responding to the needs of kids in the moment.”
Monica is the clinical psychologist at the Therapeutic Day Program, which is helping to close a critical gap in services for students in New Orleans with mental health or behavior problems. I spoke with Monica and executive director Elizabeth Marcell about the program’s therapeutic approach, the students it serves and its plans for the future.
Tell me a little about why this program is so important? Where did the idea come from and how did it get started?
Monica: We’re providing a service that is rare in New Orleans – a small-group setting for children from kindergarten through eighth grade whose needs can’t be met in a regular classroom or school. The demand for mental health services within the school system is significant – yet there are no other day treatment programs for children with intense behavioral needs.
Elizabeth: The program came about because mental health practitioners and educators recognized there was a huge gap in services in our city. Children in New Orleans are four and a half times as likely as their peers nationwide to show signs of serious emotional disturbance. Sixty percent of children exhibit signs of post-traumatic stress disorder.
Tell me more about how the therapeutic day program fills the need for these services?
Monica: The program has been open since 2015 and we are currently serving about 16 students. The program is the result of a partnership of the city’s Recovery School District, the Orleans Parish School Board and the Tulane University Medical School. By providing day treatment, the program is reducing placements in out-of-town facilities or homebound settings. It’s our goal to help students advance to the point where successfully return to their regular schools.
What are the profiles of the students you are serving at the Therapeutic Day Program?
Elizabeth: All our children are diagnosed with behavioral health special educational disabilities. There’s verbal and physical aggression towards peers and adults. There’s property damage, hyperactivity, elopements, work avoidance and inability to complete work. Some students are depressed, withdrawn and engage in self-injurious behaviors. The majority have experienced at least one short-term hospitalization.
What approach do you take to address their behavioral and mental health challenges?
Monica: Most of the kids are demonstrating explosive, disruptive behavior in the school setting. If you are seeing that type of behavior, it’s really the tip of the iceberg. We’re interested in what’s underneath that tip of iceberg, which is usually a combination of mental health challenges, skill deficits, environmental factors and even sometimes biological factors.
We try to avoid labeling kids as unmotivated or as choosing to behave this kind of way. We believe kids want to do well, and will do well, if they have the skills to do well. So we focus on addressing those underlying skill deficits and any psychiatric issues they have. These kids have long histories of facing traditional consequences and discipline – getting suspended or expelled or spending lots of time in detention. That’s not solving their problems. We focus on the root of the issue.
What alternatives do you use to traditional disciplinary methods?
Monica: In instances where a student is cursing, or strikes out to hit someone, or elopes from a classroom, we approach that as a learning opportunity and have the child ‘rewind’ that behavior. So they need to go back and do it the right way, without having a long list of consequences. We use a lot of humor. You leverage your relationships. We spend a lot of time helping kids get comfortable with us. We are also not barking orders at kids. Most of our kids, if not all, have had significant exposure to traumatic events. We know their lives have been out of control in some kind of way and they have a huge need for control. If we become controlling, authoritarian adults, they will just push back against that as a symptom of their experiences. We try to avoid power struggles.
Elizabeth: We are a non-punitive, highly trauma-informed environment. Our goal with our kids is to build the skills for them to be successful in a less restrictive typical school setting. Counselors and teachers integrate mental health services into the curriculum through the day, interjecting individual counseling, group therapy and recreation-based therapy in between blocks of academic work.
Are there plans for expanding the program?
Elizabeth: Yes. Currently, we run a single program. Students spend 50% of the day on academics and 50% on a variety of therapeutic pursuits including counseling and enrichment. But for about half of our kids, the focus really just needs to be mental wellness first. They need a more therapeutically or clinically intensive program. So next year (the 2017-18 school year) we will be launching a therapeutic day program, modeled after partial hospital or intensive outpatient programs found in other states, to support those children.
What does success look like for your students?
Monica: It’s when they graduate our program. I remember the first child to go back to his school. He started our program when he was 7. Now he is 8. He came here very angry, very depressed, withdrawn but also acting out his depression through behavior problems. He just took to the program so well. He just blossomed. He had made huge gains academically. He was bright and happy and acting like a child again, having fun, being playful, excited to return to his home school. There are these moments that remind you why it is so worth it.