3-minute case study: Earlier intervention for kids' mental health

By Katherine Igoe | June 17, 2019

A gif of a child's drawing with the word 'adapt' illustrated in the center

Across the athenahealth network and beyond, healthcare organizations are designing and implementing simple interventions with outsized impact on outcomes, satisfaction, and success. Here's another.

The problem

Children at any age with behavioral health issues can disrupt the classroom, from acting out to injuring other students to carrying weapons. Early identification and treatment are key for the health and safety of both the student and those around them.

While public school students often have access to psychologists and social workers, school readiness and preschool programs typically don't offer behavioral health resources to their youngest pupils. What's more, many such programs are underfunded and unable to provide additional help teachers need with a distressed student .

In Connecticut, 2013 data showed 12.3 of every 1,000 students had been expelled permanently from a preschool, a rate that was seventh highest in the nation, with the town of East Hartford ranking seventh highest in the state. Community programs, many of them chronically underfunded, make up 80 percent of the Hartford suburb's preschool education.

Since then, a Connecticut law passed in 2015 preventing the expulsion of students under eight has put an extra burden on teachers who don't have the resources to manage these students.

The solution

Integrated Health Services (IHS), an independent 501(c)(3) nonprofit in East Hartford with a combination of funding, delivers comprehensive and integrated health services via school-based health centers. In 2011, IHS began providing one social worker to the school district to give behavioral health consultations to teachers, and saw a 150 percent increase in the number and severity of preschool referrals.

IHS president and CEO Deborah Poerio, a doctor of nursing practice, conducted some of the first research on preschool interventions between 2013 and 2015. She found no programs nationally, public or private, that included a therapeutic approach to addressing behavioral issues.

“By the time a student is in high school, the behavior is already set. Early intervention provides our greatest opportunity to mitigate behavioral issues in children," says Poerio. “We can improve the future quality of life for these students."

So, IHS created Assessing Development to Assist Preschoolers in Transition (ADAPT). An evidence-based screening tool was mandated among the participating East Hartford parents and teachers for concerning behavior, both physical and emotional. Preschoolers determined to be at-risk were put into observation, while those assessed as high-risk were offered a full therapeutic assessment from a licensed clinical social worker.

Interventions are specific to the areas identified and include the parent and teacher in the process, which is critical to their success. “Most interventions focus on methods to achieve emotional regulation," says Poerio.

Therapeutic social workers teach coping skills, de-escalation tactics, and the reframing of thoughts and feelings. They model and teach healthy reactions, channeling feelings, and ways to replace aggression with appropriate reactions.

Social workers also model behaviors for teachers and parents, and IHS uses community resources to quickly refer children for psychiatric evaluations, medication management, and intensive care when needed.

The outcome

Of the 400 children who were part of a 2014 pilot program, 21 percent were identified as at-risk. In some cases, social workers identified undiagnosed speech, hearing, and visual issues, or autistic tendencies that contributed to student behavior.

Since then, ADAPT has come in contact with 1,200 students and worked closely with more than 180 at-risk preschoolers and their teachers. On average, 58-60 percent of students reduced their maladaptive behaviors to normal functioning within six months of therapeutic intervention, based upon assessments performed pre- and post-services.

The response to the program — from students, parents, and teachers — has been overwhelmingly positive, Poerio says, and the program is expanding this year to include children in grades K-6.

Mindful that few mental health specialists in Connecticut have experience focusing on early childhood, IHS is further collaborating with state university partners to ascertain how best to include ADAPT in their existing curricula or offer it as a separate certification.

Katherine J. Igoe is a Boston-based freelancer specializing in health, wellness, and lifestyle. Follow her on Twitter @kjigoe.

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