Alexian Brothers program eases behavioral health patients back into school setting

December 1, 2011

Most teachers get it. A student who has missed class to receive mental health care needs extra time and help to catch up. But every once in a while, Jeanne Walsh, an educational liaison at Alexian Brothers Behavioral Health Hospital in Hoffman Estates, Ill., encounters a teacher who refuses to cut a returning student slack.

"I say to them, 'Imagine you were out of your office for three weeks and no one picked up your mail or did your work," said Walsh. "Imagine the anxiety you would be feeling."

Alexian Brothers Behavioral Health Hospital is a recognized regional leader in serving students who are battling depression, anxiety, substance abuse and other mental health issues. That care does not stop at the conclusion of treatment. Nine years ago, Alexian Brothers created its comprehensive School Liaison Program, which helps some 2,000 patients ease back into school each year. The stakes are enormous. Students who transition successfully are more likely to graduate on time; those who don't can end up back in treatment.

"Before, kids went away into this vacuum — this place called the hospital — and then were expected to come back and magically go about their business," said Steve Hunter, clinical director of Alexian Brothers Center for Professional Education. "Clearly that wasn't enough" support for the child.

Educators also needed more support. Though today's teachers better understand mental health, they don't always know how to help struggling students.

"Kids were coming back, and they didn't know what the plan was," Hunter said of the educators. "The parents weren't communicating clearly, or they couldn't reach caseworkers. Often schools did the best they could, but they didn't have enough direction."

It's common for inpatient adolescent behavioral health services to place a call to a school before a student returns. But the Alexian Brothers liaisons sit down face-to-face with a school's guidance counselor, social worker, and, in many cases, a student's teachers to discuss in-depth what a student needs to succeed. The student and his or her parents also are part of the conversation.

"We cover everything," said Walsh, who, like most Alexian Brothers liaisons, has worked in a school. "I go through every single subject with the child. What grade did you have before you came in? What's that teacher like? Is this a teacher who is flexible? If you do each class individually, the kid may say, 'Yeah I think I can do it.' But you put it together, they're like 'Whoa.'"

Managing expectations
Walsh asks schools to make accommodations. Can a student take the class pass/fail? Take extra time to complete a project? Count expressive therapy at the hospital as gym credit? Receive services for a learning disability diagnosed during treatment?

"Even one class can make the difference between walking across the stage on time or not," said Walsh. "If they have to make up gym and chemistry experiments and they have one-on-one classes to make up the foreign language, there is only so much you can expect."

Hunter said that Alexian Brothers is realistic in the expectations it puts on schools too.

"Each school has its own culture and resources. Some districts have more to offer than others. That's just a fact," he said. "We try to look at what's reasonable. If everybody's on board, the likelihood of success is much greater."

Schools are not legally obligated to accept a liaison's suggestions, but most do. Crystal Lake Central High School social worker Lisa Rydberg calls Walsh an important partner. Every year, some 50 children from her school of 1,600 will require mental health care. Some cut themselves; others have eating disorders. Some students are so overwhelmed by their anxiety, they refuse to go to school.

"I can trust her not only with the clinical, but the academic and therapeutic recommendations," said Rydberg. "We are more than willing to make those accommodations because I know they will cut down rehospitalizations."

Dialing back the pressure
Many Alexian Brothers patients are overachieving students who feel pressured to take a full load of honors classes and extracurricular activities.

The mother of one patient who asked for family anonymity said her daughter learned to give herself permission to back off. Before being hospitalized, her daughter was taking multiple Advance Placement, or AP, classes, playing lacrosse and performing in  show choir and ballet. She also traveled with a competitive synchronized ice-skating team. The family lives in an upscale Chicago suburb.

"She's been exposed to a lot of different sports and activities and is good at anything she tries," said the mother.

Then last year, her daughter started complaining of headaches and stomachaches. The girl had a hard time falling asleep at night and felt overwhelmed.

A friend had told the girl's mother about Alexian Brothers' adolescent behavioral health program, and the family checked it out. The daughter agreed to go into the inpatient program, but she worried about falling behind in school and initially said she would only go for three days. Ultimately she stayed for three weeks, which is the recommended length of the program.

"I decided to make the most of my time. I'm a perfectionist like that," said the daughter. "I'm kind of shy, so I set a goal to sit with different people every day." She learned how to use her breath to lessen her anxiety.

She practiced ordering from a waiter — a contact she had avoided before. She became more accepting of herself and started to wear her curly hair down, a style she'd been too self-conscious for before.

Privacy concerns
When she returned to school, she told classmates she had been recuperating from mononucleosis. No one questioned her. Walsh recommends students tell classmates that they weren't feeling well and had a lot of doctor appointments — because it's true. Some kids, a minority, tell classmates they received mental health treatment.

The mother is not embarrassed by her daughter's treatment. Still, she doesn't want her daughter to be cocktail-party fodder.

"It's absolutely crazy out there," said the mother. "There is a lot of pressure on parents. We want the best for our children. Our children's activities are the topic of most conversations. If you step back, you need to ask yourself if this is all for the best. All these activities are for what? The children are asked to be good at so many things. They are trying to please their parents and their teachers. Competition inside and outside of the classroom is tough; it's a pressure cooker."

The daughter's closest friends boast grade averages above a 5.0; a number she knew she would no longer achieve if she stopped taking honors courses.

But upon her return, the girl and her educational liaison walked into their meeting with school officials prepared with a plan. She wanted to take study hall in the student services offices instead of the crowded auditorium. The quiet would offer some peace and access to her guidance counselors. She also needed to drop some of her honor classes. All of her teachers, except one, helped her make up missed work.

"It was nerve-wracking with all of those people, but it was also kind of cool to be the head of the meeting," said the daughter. "It was hard for me to stop taking all of those classes, but I had to let that go."

She now takes one AP class, AP English. She still plays lacrosse but dropped some of her other activities. Her emphasis today is on maintaining a balance.

"The emotional maturity has really come out in the past 10 months," said the mother. "She is much easier on herself. She's just really blossomed."

"It's cool," said the daughter, "because I feel like I'm more the person I wanted to be."

 

Copyright © 2011 by the Catholic Health Association of the United States
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