Greater Lakes in-school therapy empowers students to take charge of mental health care

As a behavioral health therapist specializing in adolescents, Lauren Mitchell says many sessions begin by helping her young patients understand what they’re feeling.

Mitchell spends two days a week with Pierce County elementary school students and families as part of a school counseling program through Greater Lakes Mental Healthcare, a branch of MultiCare Behavioral Health.

While students are often willing to participate, they don’t always know how to explain their emotions, and may not have a family who can teach them, she says.

“They’re still trying to figure it out,” Mitchell explains. “If your family compartmentalizes or pushes things down, you may not know what words to use or how to express your feelings.”

That’s where the program uses creative approaches and meets students where they are.

In-school counseling is part of a decades-long program that provides mental health services to some of the community’s hardest-to-reach populations, explains Sally McDaniel, LHMC, LMFT, SUDP, CMHS, Greater Lakes child and family services clinical manager.

Intake is done at the main Greater Lakes campus, then nearly all appointments move to the school. Two programs serve more than 50 elementary, middle and high schools across nine Pierce County school districts.

About half the students are covered by Medicaid, with the remaining either on commercial plans or tribal coverage funded by the school district.

Services focus on the student, but family and group sessions are available as needed, as well as medication management.

A holistic approach

The highlight of the program is clinicians’ ability to meet with students at school and collaborate with their families, peers, counselors and teachers.

Jennie Reed Elementary School in Tacoma has a therapist on campus two-and-a-half days a week.

“The ‘on-site-ness’ of it gives them the ability to see a child in a much more holistic view,” says Abby Sloan, principal of Jennie Reed. “When you work on a parent-suggested area of need, that’s the only view you have, whereas our therapists also understand the specific things going on at our school and how that impacts the student in different ways.”

“… early intervention is key. The sooner we can impact them in development, the better the outcome.”

Think of a child not receiving a school-based recognition and expressing frustration about it. Without knowledge of what it means to students, a therapist may not understand the depth of the impact. That unique understanding allows in-school counselors to make specific, creative and comprehensive care plans, Sloan says.

Mitchell uses games in her sessions, such as quick-paced activities with immediate rewards for those struggling to stay on task or listen actively. For older students dealing with anxiety, she uses feeling faces, charades or creative ways to talk about coping skills. And, of course, students can always burn off energy on the playground.

“Most of the kids love it … they get to go ‘play’ and they look forward to it,” she says. “They’re willing to engage and be there with you, and often don’t even realize they’re learning.”

For a comprehensive approach, every person in a student’s life is brought into the work. Families receive regular updates and are asked to continue care plans and positive reinforcement at home. School staff provide feedback on what they see in the classroom.

But the most substantial improvements are often seen when students participate in both individual and either group or family sessions, Mitchell adds.

Breaking down barriers

The Greater Lakes therapists at Jennie Reed are currently at maximum capacity with a waitlist, principal Sloan says. The school chooses who to refer based on needs, and adopts early interventions where they can — such as small peer groups focused on friendship or social-emotional needs with school counselors.

“Our school has more than 50 percent turnover, meaning students who start the year with us are likely not to end it here,” she says. “The behaviors we see have larger pictures at play like social, economic and cultural aspects. And when it comes to the behaviors … they’re rated more difficult than any other school in Tacoma.”

Among the many barriers their students face, Sloan says the biggest struggle is often getting them to the initial appointment. While telehealth helps, it’s easier to keep students going at the school, she says.

Consistency with their on-site therapists has made a significant difference for students — Sloan says they’re seeing more exit the program with tools and knowledge they can use.

For elementary school students, the struggle to access care is out of their control, Mitchell explains.

“They rely on their parents to transport and coordinate care like this,” Mitchell says. “If [parents] lack transportation, have a hard time keeping appointments or can’t change their work schedule, kids get the short end of the stick.”

On the middle and high school front, those students can often engage in services themselves, which Mitchell says can be an empowering decision for teenagers.

Choosing to participate in school-based counseling can also help break through barriers like a lack of privacy, safety concerns and an overall lack of family support in seeking treatment, adds McDaniel.

While many schools have their own counselors on staff, McDaniel adds they’re often overwhelmed.

“They are overworked, and kids can fall through cracks,” she says. “When we get involved, we can help understand the factors guiding their behaviors, advocate for them and help schools by taking on the burden of more challenging cases.”

Building skills young

Post-pandemic, McDaniel says all age groups have had an increase in disrespect and disobedience in the classroom, truancy, and challenging social skills. A lot of students are also struggling to understand their gender and sexual identity, suffering from depression and anxiety, and facing a lack of body positivity and potential disordered eating.

The majority of the students who participate have limited resources at home, especially health care, which can lead to a variety of challenges in the school setting, Mitchell explains.

“For those groups, early intervention is key. The sooner we can impact them in development, the better the outcome,” she says. “By starting in elementary school, we can help through all those next phases. It will make everybody’s lives easier later on, for the whole community.”

Just like anything you learn, consistency and repetition are important. Sloan says the same goes for understanding and managing your mental health, which is why it’s so important to start these interventions as young as elementary school.

Learn more about child and family services at Greater Lake Mental Healthcare.