Morning Zen Guest Blog Post ~ Kevin Dwyer
About six years ago I wrote a chapter on mental health promotion and prevention (with a professional colleague Dr. Erica Van Buren) in a book titled “Handbook of Youth Prevention Science” (Dole, B., Pfohl, B. & Yoon, J. Eds. (2010) New York & London: Routledge). Our chapter began with a scenario about an 11-year-old boy we called Jeremy who was being “disruptive, fighting, and calling his teacher a “mf.” He was an angry, lost soul who was academically way behind and had a record-breaking number of suspensions. Everyone in the school knew him including the principal, counselor, social worker, school psychologist, school secretary, cafeteria manager and community liaison police officer. The school labeled him as a “high flyer” who consumed staff time and energy to no avail. He actually spent more time in in-school suspension than in class.
He lived with his grandmother who was willing to do whatever the school recommended including “therapy” and “pills,” as well as “behavior contracts.” She took him to the mental health clinic that “wait-listed him as a priority for services.” So far behind academically, he was retained, making him older and bigger than his classmates. The school had many meetings about Jeremy, did evaluations and wrote and re-wrote an Individualized Education Program (IEP) placing him in special education services diagnosed as “seriously emotionally disturbed.”
The school’s social worker met with Jeremy and his grandmother at school and in his home. He told the social worker he hated school. His grandmother also told the social worker that Jeremy, “couldn’t read.” It took the social worker a little longer to find out from his grandmother that he had nightmares, no friends and “felt bad” about giving her grief.
In looking at his school history in kindergarten, he was described as a more anxious, frightened preschooler, not joining the group, not benefiting from the pre-reading instruction as easily as his peers. Although these problems were noted the social worker and school team could not find any documentation of the school’s interventions to provide him direct instruction or diagnostic instruction in those early years.
He started acting out late in first grade and the school’s focus moved quickly from the academic problems to addressing the disruptive behaviors with interventions such as “time-out,” behavior contracts class removal and, by second grade, in-school suspension.
In that chapter we wrote, “Academic and behavioral problems like those experienced by Jeremy often place students on a road that is paved with school adjustment difficulties, gradual disengagement from school and inevitable school failure and dropout.” (Ibid. page 45).
Good people with multiple sets of knowledge started what they saw as intensive interventions for Jeremy – but too late in this student’s educational history and even those interventions were still provided in a usual sequence of intensity, too little to make a dent in the complex of issues this student and his family faced. It is like doing an X-ray when the injury is muscular and an MRI is needed. It doesn’t show the depth of the injury and, therefore, results in misdiagnosis and therapies that will not work! With human behavior there is no MRI, there is no genuine diagnostic tool that can tell us what the problems are and what might work to address those problems. We only see want is on the surface, the behavior problems, defiance, anger, resistance to our interventions.
In that chapter, we called this pattern the “Domino Effect” of failure in learning that, when un-remediated, makes school so abhorrent to a child that he/she becomes a behavior problem. The fight-flight coping strategy kicks in and time after time the frustrated child says or does offensive things, off-putting things to those who want help him learn and behave.
The school does not understand his anxiety, and his inability to cope with failure. Rather than show he cannot read he fights with defiance and is then removed from toxic embarrassment in front of his peers.
He has so many strikes against him. His mother is in jail; his father is unknown. His caregiving grandmother is his only supportive connection. She can keep him safe from the violence and pain of his neighborhood but not from the frustration and pain of not learning to read.
In that chapter, we talked about the school’s responsibility to seeing that for some, for Jeremy, intensive school mental health services are essential to learning as are social emotional learning skills. And these services must be aligned with equally intense reading support. We cannot continue to let the Jeremy’s in our schools fall off the cliff.
In that chapter, we noted the good news! Schools are doing better for Jeremy. We talked about the tremendous improvement in school communities using best practices to prevent problems and promote academic and social emotional skills. We talked about the successful initiatives, programs and practices that are making a difference in children’s functioning. In fact the theme of that book and our chapter is success, a litany of components of successful mental health promotion, prevention and risk reduction as well as early and intensive interventions, all aligned to reap benefits for our children and families, and yes, even ourselves. Yes, systems are improving services and many more schools are providing successful initiatives that are reaching many more Jeremys before they become defiant lost souls.
Now, several years later a serious problem remains. We do not know how many schools are providing this array of effective best-practices to improve mental wellness and academic success of our children. Is the number 50% or 25% of our schools? Who is monitoring the necessary growth and effectiveness of these critical initiatives? Is this a responsibility of CDC, NIH, SAMSHA, Department of Education, States, universities, professional organizations, and advocacy groups? We have some good data on children’s physical health and our physical health promotion and prevention. We have loads of assessments of their academic progress and some information about its relationship to instruction. We have little data on the nation’s schools provision of the needed array of services that promote social emotional skills, effectively address early interventions and ensure that wraparound services the Jeremys need are provided. Although we have made strides in improving the availability of mental health service to these children we may still be using the least-to-most intensive continuum ineffectively. We may still be doing the too little - too late intervention model because we are focused upon the symptoms rather than the why behind those symptoms. Let’s start effectively measuring our success and how universal that success is for our nation’s children.