When school counselors, behavior specialists, school social workers and school psychologists in Brunswick County (North Carolina) Schools identify a student in need of crisis intervention, they call Malika Neal.

Since June 2021, the licensed clinical social worker with Novant Health Telepsychiatry has been dedicated exclusively to Brunswick County public school students. She gets notified almost immediately when there’s a student in crisis and can be on a video conference within minutes.

The benefits:

  • Kids miss far less school because they receive near-instant assessments.
  • They don’t face the possibility of a frightening ambulance ride to the ER.
  • There’s no cost to the family.
  • The family may receive help on seeking further assistance.

Shorter wait times, less drama

Malika Neal

The process wasn’t always so seamless.

Before the program was established, school officials had to get Emergency Medical Services (EMS) involved to transport children to the Brunswick Medical Center ER if parents couldn’t be reached or couldn’t leave work.

“When an ambulance takes a student to the hospital, we can explain all day that they’re not in trouble,” said Neal. But it’s still disconcerting nonetheless for students who don’t understand why EMS is involved.

And the ride to the hospital was just the beginning of the ordeal. “The minimum wait time in an ED was generally about four hours – and that was before COVID,” Neal said. “From there, the doctor would refer the student to someone in behavioral health. That also typically involved a wait. They would see someone in behavioral health who would complete their assessment and safety plan. By then, the student may have missed a full day or more of school.”

Thanks to a three-year, $400,000 grant from the Duke Endowment, the new mental health program began in June with five middle schools before expanding later in the year to 10 schools, including two elementary and three high schools. This fall, all 20 schools in the district will have access to Neal and the care she provides.

Now, when a student shows signs of violence, aggression, depression, anxiety, thoughts of self-harm or other worrisome behavior, school support staff now contacts Neal.

The school system has a variety of specialists embedded in each school – school psychologists, behavior specialists, social workers, school counselors. Neal augments what those specialists offer.

A growing crisis

There has been a growing mental health crisis among kids that has been exacerbated by the isolation brought on by COVID. In fact, it’s considered a national emergency.

The past couple of years have seen a significant increase in self-reports of anxiety, depression and ER visits for mental health issues. In addition, ER visits for suicide attempts increased more than 50% for adolescent girls (and about 4% for adolescent boys) between 2019 and 2021.

But there’s more than a pandemic playing into the urgency. “A lot of variables contribute to the increased mental health need with our students – poverty, domestic violence, devastating hurricanes, living with family members who have their own mental health conditions,” said Melissa D. Quinlan, executive director of exceptional children and student support services for Brunswick County Schools along the Atlantic coast in Bolivia, North Carolina.
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Since the Duke Endowment program began, student evaluations at the ER have been cut by 86%. Students miss less school. Parents don’t have to take time away from their jobs. And families aren’t billed for the evaluation. The program – and Neal’s services – are provided at no charge.

“This program has allowed us to be more proactive in keeping children out of the hospital,” Quinlan said. “Just the sight of an emergency room can be unsettling. And we know now what emergency rooms look like: They're full. We now offer a more proactive approach to assess the student and get them paired with the right services right away.”

Here’s how the process works. The school counselor, school psychologist or anyone in Student Support Services calls Novant Health’s dedicated call center and the parent of the student in crisis. The call center creates a medical chart and notifies Neal of the student in need. Neal ensures the parent or guardian has given consent, and then she emails a Zoom link to the school.

The child comes into a secure room, and the counselor sets them up in front of a laptop designated for this telehealth purpose. Neal meets with the child virtually. Parents have the option of dialing in.

In the case of a student having suicidal thoughts or thoughts of self-harm, Neal and the student work together to devise a safety plan. “We talk about some of the stressors occurring for them,” she said. “We talk about triggers and things that may be leading them to have those thoughts. We talk about reasons to live, coping skills that have not been helpful and those that have been, coping skills they haven't tried. I gauge whether they need further evaluation in a hospital or as an outpatient and can make referrals. I also involve the family because that's how the child is going to be the most successful. Having a support system is key.”

If there are any specific at-school stressors the student identifies, Neal will work with school staff to devise a plan to include frequent – sometimes daily – check-ins.

“We can make accommodations for students, including moving them into a smaller classroom or getting their schedules changed so they avoid bullies,” Neal said. “I also talk to the family about not having (or locking up) firearms, sharp objects and medication. We talk about outpatient therapy support and get them connected to a therapist if they don't have one already. We also discuss medication management and involve their primary care provider, as well. We’re really about that mind-body connection and integrated health care.”

She follows up with the family within a few days or weeks.

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If there’s going to be a wait for a student to meet with a therapist – because there are limited mental health resources in the area – Neal can serve as a stopgap measure. “I’m available to complete some short-term, solution-focused therapy, while they wait to get in with a long-term therapist,” she said.

Neal determines if the student is ready to return to the classroom. Usually, students are able to return the same day.

With the program expanding, another part-time teletherapist has been hired to support Neal and the Brunswick County students who need her.

It’s all part of the safety net provided to children and families. “It really does take a collaborative effort to address the whole family,” Quinlan said. “And, it's not just a student crisis. It is a crisis for the family unit. It takes a group of professionals to make sure all those things are in place that the family needs.”

“This program has enabled us to provide a valuable service to our families, our students and our community,” Quinlan added. “It's increased our ability to access mental health services for our students. And that has been hugely beneficial, particularly coming during a pandemic and after multiple hurricanes that caused a lot of loss before that.”