On-site therapy

Carla Weber is part of a ground-breaking consortium that makes mental health professionals available in every school in Marathon County

By the end of this month, every school in Marathon County will a have private mental health therapist on site to serve students and their families. It’s a program two years in the making, and though it began just recently, already there are waiting lists at many schools for this service.

It’s not a free program through the schools. These are private practice professionals who have collaborated with the districts to provide a more convenient, efficient way for students to get the help they need with on-site therapy sessions during school hours.

This ground-breaking, important set up is all about access.

It’s much needed, and welcome, says Sarah Nilles, a Wausau School District social worker who serves John Muir Middle School and Franklin Elementary. The seemingly simple logistics of scheduling a therapy session, traveling, and taking time off from work are real barriers for families.

“Many kids are dealing with situations that interfere with their learning,” Nilles says.

And from the school’s perspective, these issues often result in emotional and behavioral problems that can disrupt the classroom.

Some are traumatic things like abuse, neglect, hunger and family members impacted by the fallout of drug abuse and crime.

But even kids from more stable households experience difficulties that pose daily barriers to learning. Nilles gives the example of kids who have been involved in a car accident, experienced a dog bite, or have a family member struggling with an illness.

The process of providing a school-based place for mental health therapy began in 2014, when Peaceful Solutions Counseling co-Executive Director Lee Shipway was approached by the Edgar School District to assign a therapist in the district to help parents and kids schedule appointments more easily. It was a no-brainer. Of course she could do that. One of therapists even lived in Edgar.

Pretty soon, word got out, and other school districts started calling—schools even farther from Peaceful Solutions’ location in Wausau such as Abbottsford, Stratford, and Colby. They all wanted a professional mental health care provider to conduct appointments in their schools, but Shipway knew there was no way her staff could handle an increase in workload like that.

Shipway then began a discussion with the United Way of Marathon County, Marathon County Health Department officials, other mental health care providers, and other interested parties—the intent was aimed at combining forces to impact local residents’ mental health in a positive way.

The counseling consortium that formed from those talks will now cover every single school in Marathon County starting in February.

It may be just one day a week, or a half-day, when a therapist is at a school, but there’s one for every school in the county. At the bigger schools like Wausau East, Wausau West, and D.C. Everest Senior High, there are two counselors, a man and a woman.

The idea behind the consortium is simply to make it easier for kids to access the therapy they need.

One of the issues parents in rural western Marathon County face is getting kids to therapy sessions in Wausau or Marshfield. Edgar is more than 20 minutes from Wausau; Abbotsford is 20 minutes away from the nearest mental health provider in Medford. Parents were missing work to shuttle their kids to appointments; children were missing out on school.

Even kids in Wausau, Mosinee or D.C. Everest had to miss two classes or more to go to therapy. So why not bring the therapists to the schools?

“When we met with the schools to talk about this, they said they would have loved to have had (therapists) there three or four years earlier,” says Jennifer Smith, Executive Director of Bridge Community Health Clinic in Wausau.

Smith and Shipway were two of the leaders that helped set up this consortium in the county. The demand for this service surprised even them. “We hadn’t realized the depth of the issue,” Smith says.

Why the need

Local professionals point to two phenomena that have stressed families today more than in the past: economics and the opiate addiction crisis.

Mental health problems in children have increased since the economic recession a decade ago. Shipway says the number of county residents seeking crisis services since 2008 has increased dramatically and there was no way local health care centers could handle the surge. Drug addiction has been a huge problem affecting families. In the past few years, Marathon County has averages 32 opioid-related hospitalizations per 100,000 people annually, and out-of-home placements of children at risk have doubled since 2015.

County leaders began looking at ways to provide help “upstream,” as Shipway says, to prevent crisis situations.

Legality and logistics got in the way at first. Not until 2015 were outside mental health care providers given a reasonably easy way to get licensed with Wisconsin Department of Instruction to provide their services in school districts. And there are still plenty of hoops to jump through to become licensed for off-site care (that is, outside the normal office setting), Shipway says.

But some recent data made the effort imperative. In 2015, the county conducted its first-ever youth risk behavior study, and it proved to be the catalyst for the counseling consortium.

The study surveyed high school students from 10 districts in the county, and the results were eye opening. Among the results for example: The percentage of students who felt so sad or hopeless almost every day for two or more weeks in row that they stopped doing some normal activities was 21.3%—one in five local teens was experiencing some kind of stress that severely affected their daily life.

Subsequent surveys reinforced the alarm. The prolonged sad/hopeless response rose to 23.6% in 2017. While still lower than the national average of 29.9%, the increase jarred county and school district leaders into realizing some action was needed.

Shipway and Smith admit the pilot year for the consortium is an ambitious one, with 10 agencies providing therapy services. They researched other models in the Midwest. “There’s a large counseling conglomerate in Minnesota we looked at. We called them and told them what we were doing in our pilot year, and they were stunned,” Shipway says. “They couldn’t believe we were doing that in our first year.”

Childhood trauma

These therapy sessions aren’t free—it’s like having a doctor’s appointment on-site at the schools, and families pay for them through private insurance or Medicaid.

School staff like Sarah Nilles still are there to help during any daily crisis, but now also can refer parents to the on-site, private counseling available to their children within the school building. These therapy sessions are run just as they would be in the private office setting, and treated with the same confidentiality, unless parents give explicit permission to share information with school staff. “Maintaining privacy and confidentiality is important to both the school and families,” Nilles says.

There aren’t many things school and government can do to prevent trauma, but one of the main purposes behind the counseling consortium is to help kids better deal with traumatic experiences.

“We want to build resilience in students,” says Mary Jo Lechner, D.C. Everest Assistant Superintendent. “To be resilient in a way that they can be highly successful even though they’ve had those experiences in their lives.”

Experts now agree that many mental and physical health issues as an adult can stem from traumatic experiences as a child. Researchers have come up with a survey called Adverse Childhood Experiences (ACE) that predicts health risks later in life.

The ACE survey consists of 10 yes-or-no questions about your childhood, such as: Did a parent or adult often swear, insult, put you down, or humiliate you? Did a parent or adult beat you? Did someone 5 years older than you sexually assault you? Were your parents separated or divorced? Did you witness parent-on-parent violence? Did you live with an addict?

The more ACE questions you answer yes to, the more likely you are to experience health problems as an adult. Compared to having zero yes answers, someone with four or more is six times more likely to suffer from depression; seven times more likely to become an alcoholic; 10 times more likely to engage in street drug use; and 12 times more likely to attempt suicide. Also, they’re twice as likely to be diagnosed with cancer or heart disease.

“The opioid crisis has made things worse for kids,” Shipway says. “The ACEs are way higher than what they were 35 years ago.”

Wisconsin’s public health agencies starting in 2009 conducted more statewide ACE surveys than any state in the U.S., giving the state a comprehensive database when it came to tracking childhood trauma. The Wisconsin Child Abuse and Neglect Prevention Board in a recent Milwaukee Journal Sentinel article aggregated five years of statewide ACE data from 2011-2015, randomly selecting 25,518 people who took the survey to create a polling sample. The ACE data was sorted to rank each county based on its share of residents with four or more ACEs.

Of the state’s 72 counties, Rock County in southern Wisconsin showed the highest ACE scores, with 24% scoring four or more in the survey. Marathon County is in the lower half of the state average at 12%, but neighboring Lincoln County ranked number two at 22%.

“ACEs are very prevalent in rural communities, perhaps even more prevalent. In rural communities, there’s social isolation, so there’s fewer people to connect with and help someone build resiliency,” says Sam Pinzl, Marathon County Public Health Educator. “In ACEs, it’s generational and cyclical. A lot of times parents might never realize they’re affecting their children because that’s what they’re used to.”

Some of the usual statistics that could explain the difference between Marathon and Lincoln don’t apply. One of the leading factors in childhood trauma is income—the lower the household income, the higher a child is at risk for ACEs. Lincoln’s median household income is nearly $5,000 less than Marathon’s ($56,300 vs. $51,400), but numerous other rural counties in the state have a lower median household income than Lincoln’s but a far better showing in the ACE survey.

However, there is some data that can explain the difference. Lincoln was estimated to have more than twice as many children placed out-of-home in 2017 than Marathon.

Lincoln County Social Services Director Renee Krueger says she’s aware of the data surrounding childhood trauma in Lincoln County, and it’s that information that informs the decisions Lincoln makes. A mental health coalition was formed in 2016 in Lincoln County and both the Merrill and Tomahawk School Districts have worked to get staff up-to-date on the latest therapy tactics.

Access to mental health care providers could be holding Lincoln County back from setting up a counseling consortium as bold as Marathon’s.

According to the county health rankings, Marathon has twice as many mental health care providers than Lincoln. “There could be issues with travel time or there could be a stigma issue…I’m not sure,” Krueger says.

Making a difference

Edgar was rocked by the suicide of Jonathan Wesener in the spring of 2015. The 16-year-old didn’t seem like he was struggling at the time. At 6-foot-2, Wesener played football for Edgar High School and didn’t show major signs to his family, teachers, or classmates that he was suffering.

Prior to his death, Jonathan recorded a message detailing the reasons for his suicide. While most of it didn’t make sense, the one thing that stuck out was Jonathan’s subtle references to being bullied. At the insistence of Wesener’s family and a number of other Edgar residents, Edgar School District changed its standards regarding the reporting and documentation of bullying.

There’s no way to know whether having a therapist at Edgar High School would have saved Jonathan’s life. The hope is that better access will help any student—even those who are very involved, model students—to seek help.

For the last three weeks, Peaceful Solutions psychotherapist Carla Weber has spent her entire Fridays at Wausau East in counseling sessions with students there. She so far has eight student patients at East, and they’re all from different backgrounds. Some are “socially removed” and easier to identify as needing help; others are less obvious.

One student who sought help is very involved in extracurricular activities but could be suffering from anxiety and depression.

“It’s hard to say whether or not I would be meeting with that student had I not been here,” Weber says. “I’ve seen an influx in referrals since I’ve been here physically.” And Weber is one of the therapists who already has a waiting list at their schools.

The hope is kids and their families no matter who they are continue to seek out mental health services.

Gov. Scott Walker and the state Legislature helped in this regard by allocating $17 million in the biennial budget to pay mental health professionals and substance abuse counselors more money to work with low-income Wisconsin residents on Medicaid. Those funds were made available this year.

Previously, Wisconsin providers spent less time with Medicaid clients because they were reimbursed for about half their costs. The higher payment rates will encourage more providers to offer services to those without private insurance.

“We’re trying to not keep this a secret and are advertising it throughout the schools. In some schools we have a friend talking to someone about their friend and saying how they’re worried about them and their name gets put in,” Shipway says. “Or they talk about how they’re struggling. We’re taking referrals from any source. There’s universal access.”