Mass shootings by children and young adults at schools in recent years — especially the December shooting at Sandy Hook Elementary School in Newtown, Conn., by 20-year-old Adam Lanza, who killed 26 people, including 20 schoolchildren — have turned the nation’s eyes toward the topic of mental health in schools. In Massachusetts, it is a subject that has received attention for years.
As a result of a 2001 class-action lawsuit filed on behalf of children and youth with serious emotional disturbance, the Children’s Behavioral Health Initiative was established by the state to meet the court’s requirements.
Mary Ann Gapinski, RN, MSN, NCSN, school health adviser for the Massachusetts Department of Public Health, has been at the forefront of the state’s efforts to make sure school nurses have the knowledge and resources to identify and help children with behavioral health needs, a term she uses to include mental health.
"Children’s behavioral health and mental health services have been a weak link at the national level that has come to light," Gapinski said. "It’s not something unique to Massachusetts, but Massachusetts gets the credit for having taken the lead for setting up the Children’s Behavioral Health Initiative. As part of that, school nurses were included in the workforce development that was created to meet those needs."
Marie DeSisto, RN, MSN, NCSN, director of nurses/District 504 coordinator, Waltham (Mass.) Public Schools, took an online class on behavioral health issues last year through Northeastern University’s School Health Institute Continuing Education Program, a joint venture with the Massachusetts Department of Public Health to provide continuing education for school nurses.
DeSisto and her colleagues also benefit from talking directly to Gapinski.
"On the regional level, we’re meeting with Mary Ann, discussing mental health issues, discussing mental health interventions – just keeping people coordinated and networked about what’s going on," DeSisto said.
School nurses also need to be in tune with the needs of students coping with behavioral health issues, DeSisto said. She recounted a recent incident with a student she helped at Waltham High School, where she works. The boy made several visits to her office over the course of four or five days after the school nurses had left before one day finally revealing he had been cutting himself.
"I told him, 'I’m glad you showed me, but I need to be able now to tell somebody else. We need to get help for you. I need to call your mother. I need to call your doctor,’" DeSisto said. "He said, 'I’m OK with that. I’m ready for this now.’
"For four days, he wasn’t ready until he knew that he could feel confident with me and he could trust that we could talk about this and not overreact. So I think nurses need to have a broad base of empathy for children and understanding – and understanding for what goes on in the community, too. It’s not easy, because you see a lot of kids."
Judy Styer, RN, BSN, NCSN, president-elect of the Massachusetts School Nurse Organization, said school nurses only can do so much on their own regarding mental health. The key is giving them the support they need.
"From my perspective, school nurses are not the answer," Styer said. "They’re never going to be, but they are certainly part of the solution, and they need to be a part of a comprehensive team approach that a school puts together."
The importance of a team approach — involving school nurses, counselors, teachers, other school staff and health professionals in the community — is a concept widely shared among school nurse leaders. Gapinski said she believes the vast majority of Massachusetts schools are succeeding in that area. The alternative is not something she said she likes to consider.
"I think instances like Sandy Hook show us schools need to pay attention to the whole child in the classroom, not just their math skills and not just their reading skills, but what else is going on with the student sitting in that seat," Gapinski said.
Tom Clegg is a freelance writer.
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