Moberly, Mo., is the epitome of small-town America-complete with a Main Street, a covered footbridge and a gazebo at the center of town. Yet the idyllic town of 15,000-halfway between St. Louis and Kansas City-is no more immune to mental health problems among its youth than any other American community. In fact, the town recently lost a high school student to suicide, and its high poverty rate and number of youth with family incarcerated at the local prison put its children particularly at risk. Yet at the same time, its mental health services are few compared with similar Missouri public school districts: While many at least share a staff school psychologist, for example, Moberly only has access to a school psychologist's services on an occasional, contractual basis.
But through a grant from the U.S. Department of Education, a team of school and educational psychologists and graduate students at the University of Missouri-Columbia is helping the town integrate and boost its mental health services for children and adolescents to help better prevent such mental health problems as depression, self-mutilation and suicide.
Specifically, the university's Center for Advancement of Mental Health Practices in the Schools CAMHPS) and the Moberly Public School District are using the 18-month, $309,116 grant-one of 15 given nationally to promote school mental health services and the only one aiding a rural community-to launch the Moberly Community Coalition for Children and Families. The project-which began in August 2005 and will conclude in January 2007-is linking Moberly's five public schools, its juvenile justice system and local social service agencies to meet students' and preschoolers' mental health needs and reduce mental illness stigma.
The project is also arming Moberly teachers with the skills they need to manage such classroom challenges as keeping children in their seats and aggressive behavior at bay. It's also helping teachers manage student mental health problems with an eye toward keeping quality teachers in their jobs, says CAMHPS director James Koller, PhD. Across the nation, "We're seeing a prolific dropout rate in the teaching profession, and poor salary is not the only thing behind it," says Koller, noting that national averages have shown that as many as 50 percent of teachers resign after five years on the job. "We're seeing an increase of stress-related issues among the teachers we see at our center," he adds.
He and coalition director Edwin Morris, PhD, have two long-term goals for the Moberly project: to build the town's services in such a way that they can thrive even after the grant ends and to create a model other communities can replicate. To that end, they have a strong ally in Missouri state Rep. Judy Baker, who particularly supports the project's emphasis on prevention.
"When we can address the emotional and social behavior issues early on, it can also help close the achievement gap," says Baker, who is also pushing for legislation to require Missouri's state-run colleges and universities to incorporate more training on mental health and wellness into teacher education.
Connecting with Moberly
The university and CAMHPS program chose to converge on Moberly after learning about the town's needs through a former Moberly school superintendent who joined the University of Missouri-Columbia faculty and established a university-based community outreach program. Through the program, CAMHPS staff consulted one-on-one with Moberly teachers, who were struggling with classroom management; how to work with parents and caregivers; and student mental health problems such as schizophrenia, autism, oppositional defiant disorder and attention-deficit hyperactivity disorder, among other issues. Some of their difficulties stemmed from the town's high poverty rate-60 percent of Moberly students qualify for the state's free lunch program-and the fact that many children have family members incarcerated at the nearby Moberly Correctional Center.
School and other local officials had already initiated some creative, collaborative projects on their own to address issues such as early-childhood development, he says. They were also eager to help their youth and have been receptive to new ideas, he adds.
"I have been amazed at how well all sectors of the community have supported the project," he says. What has proved challenging, though, is the fact that the project does not fund direct services and therefore leaders are relying on what little is available, says Morris. "There are not enough adequately prepared professionals that are willing to work in rural areas for the salaries available," he says. At the same time, the community is taking steps to address the service gap on its own now, and there is even talk of Moberly creating a county "mental health tax" to fund more services.
Creating ties, reducing stigma
The Moberly coalition project has four main components:
Crisis management. Morris works with ambassadors from Moberly's five schools, which enroll 2,300 students, and family- and child-service agencies to create protocols for how to respond to a crisis, such as a suicidal or violent student. Project leaders are also training all school personnel-from bus drivers to teachers to cafeteria workers-on crisis response, suicide prevention and available crisis services and hotlines.
Seamless school-based mental health practices. Project leaders are connecting schools, local social workers and local law enforcement to tackle problems such as truancy that may indicate more serious problems at home or school or lead to more serious juvenile offenses, says coalition member Karen Jane Weston, PhD, an educational psychologist and former high school math teacher.
One idea the interagency team is exploring is a "truancy court" that would have the trappings of an actual juvenile court but serve more as an early intervention to address school-attendance problems before they escalate to an official juvenile office referral. "Truancy courts in other areas report positive results from the early intervention and serious handling of the problem," says Morris.
The school has set up a secure Web site using Blackboard technology so coalition members can share client-specific information and report on student progress prior to coalition meetings. Project leaders are introducing teachers to telehealth technology they can use to consult with CAMHPS staff one-on-one and have helped the schools and local agencies form a partnership with University Behavioral Health, a university-run community mental health center that serves central Missouri headed by psychologist Bruce Horwitz, PhD.
Family support. To build ties between school and home, coalition leaders are teaching parents about the warning signs of mental illness and ways to boost their children's mental health by handing out pamphlets at school events and forming parent support groups. One group is targeting families of prisoners and another is geared to grandparents raising their grandchildren. Coalition leaders are also recruiting parent volunteers willing to continue the groups.
Reducing mental illness stigma. At the elementary school level, the coalition has brought in the popular, nationally known "Kids on the Block" educational puppet program-most commonly used to educate young children about disabilities-to teach children about depression, learning disabilities and attention-deficit hyperactivity disorder. At the middle and high school levels, first-year school psychology graduate student Andrea Hoffelt is working with student editors of the school paper on a series of articles on mental health. The project is also hosting a community-wide poster competition to publicize its antistigma efforts and will award the first prize winner an iPod.
Will it work?
Project leaders have tapped Craig Frisby, PhD, an associate professor in Missouri's educational, school and counseling psychology program, to see how well the project is faring in these four areas. Specifically, he'll look at how well the connections they are forging are expanding and improving services and if the project is age-appropriate and culturally sensitive. He is also looking at how effectively they are training school personnel and other professionals.
The results will shed light on whether aspects of the project could stretch statewide, says Frisby. More immediately, he appreciates how the university faculty are inspiring his students on ways school psychologists can expand their roles in public schools beyond testing and special education screening.
"This program gives our students a chance to see an innovative and progressive model for mental health prevention where school psychologists can play a direct role," says Frisby. "When they get out there, their expectations are going to be raised as to what can be done."
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