Several of Groton’s five school-based health centers have waitlists. So do all five of the school-based health centers in New London. At New London Multi-Magnet High School, there have been waitlists to see behavioral health counselors since October.
“From a behavioral health standpoint, the need is incredible. Incredible,” said Mark Robel, practice manager for school-based health centers at United Community and Family Services, which operates school-based health centers in the Norwich, Waterford, Montville and Griswold Public Schools.
School-based health centers – miniature doctor’s offices that provide students with everything from check-ups to sick visits to mental health assessments and consultations within the school building – are relied on by an increasing number of students for counseling and other mental health services.
According to state budget documents, funding for school-based health clinics has decreased from a peak of $12.7 million in 2014 to $10.7 million proposed for 2023.
Earlier this month, a working group at the state level tasked with making recommendations about how to best expand school-based health centers throughout the state identified 157 additional schools that the group felt would benefit from having these centers available.
The majority of these schools are located in high-poverty towns and cities.
The group also recommended expanding 36 already-existing school based health centers. And a bill currently being considered in the state legislature sets aside $21.24 million to fund this expansion in the form of a grant of $590,000 directed toward mental and behavioral health.
The bill does not include funds for any of the 157 schools targeted for a new health center, and it does not include funds for any of the district schools in New London, Groton or Griswold. It would include funds for expanded services at Interdistrict School for Arts and Communication, a charter school in New London.
Kelly STEAM Magnet Middle School and John B. Stanton Elementary School, in Norwich, would receive funding to expand existing health centers, but the town’s four elementary schools targeted for new centers would not receive funding.
State Sen. Cathy Osten, D-Sprague, a member of the working group, said that the decision to fund the expansion of the 36 health centers rather than the implementation of centers in 157 schools was “purely a financial decision, not a policy decision.”
Osten, who is also the chair on the Appropriations Committee, said that the governor’s currently proposed budget allows little room to add in additional funds. But Osten also said that the current senate bill had not yet been finalized, and that it might be possible to include a phased-in approach over several years to provide funds to support school-based health centers in a larger number of districts.
“We also have to make sure that the school systems are in support of those health centers in their facilities. So there’s still a lot more work to be done,” said Osten.
State Sen. Heather Somers, R-Groton, also on the state working group, said that the decision to fund the expansion of the 36 school-based health centers was a matter of focusing on communities where the need was highest. Somers said that school districts like Groton already have some school-based health centers, as well as access to local services like Child and Family Agency within the community.
“I’d love to have a school-based health clinic in every single school district and every school, if possible. But we have to prioritize,” said Somers.
But district administrators in Groton and New London, as well as directors from local agencies who run the centers, said that having additional school-based health centers in their districts would be very helpful, and that it would make it easier for students to access services.
“The students can only sign up for those school-based health centers that are in their building. So not having that in the two [elementary] schools makes it really challenging,” said Susan Austin, superintendent of schools in Groton.
Even in districts where children are permitted to use services at other schools, something possible in Norwich, the logistics of getting the children from one school to the other often creates a barrier.
“Any child in the Norwich school system, who is enrolled, can be seen at any of our sites, but that presents problems because of transportation. It’s getting kids there, getting parents to bring kids. There are challenges, even though we offer those services,” said Robel.
Carrie Rivera, assistant director for Mental Health at New London Public Schools, also underscored the convenience of having school-based mental health services available. She said this was particularly important for students with two working parents or families who have difficulty accessing transportation.
“Having a school based health counselor, where the students are already in the building, and it’s literally just put it into their schedule and their day – it also helps the school connect directly with the therapist so that we can be on the same page as far as treatment and in need,” said Rivera. “It’s invaluable, honestly.”
Fighting for control
According to Rivera, the centers have seen increases in anxiety and depression in students, which she said, can turn into aggression and defiant behavior at school. She said there has also been an increase in teenage pregnancies, as well more intensive psychiatric needs.
“Students who have not had control over a lot of their environment and their lives over the past few years are now exerting control when they can,” said Rivera. “So we see defiant behavior or work refusal or school elopement.”
Susan Austin, superintendent of schools in Groton, said that since the pandemic, students have been having outbursts that are much more difficult to control.
“Really a lot of the things that have come to our attention that’s caused disciplinary action have involved kids getting really angry fast, not being able to cope with things that we would have seen them coping with before,” said Austin.
Denise Doolittle, the district’s director of student services, said that social media and texting, along with the pandemic-driven isolation, mean that students are struggling to manage face-to-face settings.
“There’s a certain hesitancy or maybe a certain nervousness about this in-person interaction,” said Doolittle. “Some [students] are not quite as comfortable using their social skills in person.”
While traditionally mental health needs have been more acute at the high school, Robel said their school-based health centers have started to see more need for mental health services even at the elementary school level.
Amanda Frechette, the school-based health center coordinator for Child and Family Agency, which runs the school-based health centers in New London and Groton, said they were adding in additional supports into the districts’ middle schools. Frechette said that being present in the schools allowed the clinicians to interact with the students in real time when they were having difficulties.
“Being in the school, if they’re having an issue or something in that moment, we can work with them there and help regulate them and help use their skills and build their skills versus processing it later. So we get to play a big role in their everyday,” said Frechette.
Rivera said that while New London employs social workers and school counselors, their roles are very different from the behavioral clinicians who work at the health centers. Social workers and school counselors, she said, are more focused on helping students function in an educational setting, while behavioral clinicians address emotional difficulties.
While mental health has been the recent focus, school-based health centers also provide services for physical health. Robel said that while demand for physical health services decreased during the pandemic – students with symptoms of illness were sent home rather than cared for at the health centers because of pandemic precautions – they were now starting to see an increase in demand.
Two of Groton’s elementary schools, Charles Barnum and Mystic River, serve students whose parents are in the military. Austin said that school-based health centers let children get immunizations and physicals done more quickly when there are delays at the base.
“The hospital at the base has fewer staff these days, and it’s really hard to get appointments when they move into town to have children have physicals,” said Austin.
Charles Barnum is one of the Groton schools without a health center that the working group recommended as a potential site, along with Northeast Academy Elementary School and Grasso Technical School.
Austin said it would be a huge help to have a school-based health center at all of Groton’s schools. She also said she would like to see the existing centers, which currently operate only a few days a week, expand their hours.
In New London, the state working group identified three of the public schools that could benefit from a school-based health center: the New London Visual and Performing Arts School and New London Science and Tech Magnet School (both of which are part of the city’s multi-magnet high school campus) and Harbor Elementary School.
New London Superintendent Cynthia Ritchie said that the district had hoped to receive support for a behavioral health counselor at Harbor Elementary School.
“It’s very challenging because there is a need there, but we’ve only been able to kind of set the parents up with services outside of the building or after school,” said Rivera.
Rivera said that, ideally, the district would also be able to get funding for an additional counselor at both the district’s middle school and the high school.
In the meantime, Rivera said that in order to deal with the waitlists, the district began offering virtual counseling sessions in January for the high school students.
“Obviously virtual is not great for everybody but for those students that opt in, it does kind of shorten that wait time for the counseling,” said Rivera.
Decreasing state funding
According to the working group’s report, the Department of Public Health currently supports 90 school-based health centers in 28 towns across the state through grant funding. About one-quarter of the students served by those centers do not have health insurance – a barrier, the report notes, that school-based health centers can help solve.
Baxter said that it costs between $200,000 and $300,000 to run a school-based health center, with the high schools typically costing more. She said that their centers receive between 70 and 80 percent of their funding from grants through the state Department of Public Health.
But funding from the state has decreased in recent years.
Ellie Lambert, advancement and marketing manager at Child and Family Agency, said that their agency closed a school-based health center in Norwich after “several years of funding cuts” from the Department of Public Health. School-based health centers in Norwich are now run by United Community and Family Services.
Cara Westcott, chief financial officer at United Family and Children’s Services, said that the agency does not receive funding from the Department of Public Health to support the health centers, instead relying on insurance reimbursements to support the cost of services.
Westcott said it costs about $350,000 yearly to staff the behavioral health centers in the Norwich public schools, which have one clinician each at Kelly STEAM, John Stanton and Northeast Academy Magnet School. The part-time medical services at Kelly STEAM cost an additional $100,000.
Westcott said that the additional funding proposed for the 36 school-based health centers — which, if the bill passes, will provide $590,000 to each school, including Kelly STEAM and John Stanton — could provide multiple additional mental health staffers. She said the average cost of hiring a behavioral health clinician was $60,000 annually.
Frechette did say that the Children and Family Agency was able to offer services to children in their community based clinics in Groton and New London, as well as in the school-based health centers. Lambert said that the agency recently established a community-based health center, called the Community Bridge Clinic, specifically for students who don’t have health centers available in their schools.
But Rivera stressed the importance of having the services available on-site at the school.
“We certainly have other counselors and therapists in the area that work outside of our buildings that we can refer to. But the level of support and, I think, efficacy of services is just unparalleled when we do have them in the building,“ said Rivera
“Schools are where kids go to — and also their families. So it’s really important that we are able to meet … their physical and mental health needs. It’s a very important part of education,” said Austin.