Preparing an entire city to respond to mental health

emergencies

By Paul Jablow on Aug 19, 2015 02:39 PM

Jason Palaia, director of elementary and special education in the Coatesville, Pa., School District,
recalls interrupting his walk across a high school campus to talk to a youth sitting on a curb,
obviously very distraught.
James Hills, a school board member who volunteers at an afterschool program in Coatesville,
remembers counselors there overhearing two youths talking about possible suicide.
Barbara Bolton, a marketer and business developer, plans to volunteer at a local suicide hotline and
wants to know more about the issue before starting there.
All three say they have seen the benefits for the Coatesville school district and the community to
increase knowledge of mental health issues through the Youthseasonal depression treatment First
Aid curriculum.
The curriculum is the focal point of a four-year, $630,000 effort by Coatesvilles school district, four
foundations, and state, local, and federal agencies to increase community-wide awareness of
behavioral health issues from school cafeterias to therapist offices. Its a training that is basically the
mental health equivalent of CPR.
Eventually, the project aims to train up to half of all school district personnel plus other community
members in the eight-hour curriculum, says program evaluator Stacie Metz, an associate professor
of social work at West Chester University.
Mental health first-aid, which originated in Australia in 2001, has been used for years in schools and
communities across the country. Coatesville is among roughly 115 school districts designated by the
federal Substance Abuse and Mental Health Services to receive $50,000 grants for what are, in
effect, saturation programs.
Were trying to create a culture, says Frances Sheehan, president of the Brandywine Health
Foundation, which heads the collaborative.
We see this as a learning lab, says Alyson Ferguson, director of grant making for the Thomas
Scattergood Behavioral Health Foundation, which started the effort along with Brandywine.
Ferguson says that working in a community the size of Coatesville, where the school district employs
just under 1,000 people, allows for a controlled experiment that would not be possible in a city the
size of Philadelphia, whose school district employs some 16,000.
We do consider ourselves guineas pigs, Sheehan said, jokingly.
Why Coatesville?

From the start, Coatesville was seen as an ideal target for the initiative.
Economically depressed since the decline of the steel industry decades ago, it has a school district
population where 53 percent of the students receive free or reduced-price lunches, a 10 percent
increase from about a decade ago. About half the students are White, one-third African American
and 15 percent Hispanic.
While children in the city comprise just two percent of those in the county, they account for 29
percent of those involved with Chester Countys Department of Children, Youth and Families,
according to the Brandywine Health Foundation.
Middle school and high school students in the district have reported depression symptoms at a
higher rate than those in the county as a whole in the routinely collected Pennsylvania Youth Survey,
and the gap has widened in the last two years. More than 41 percent of 10th graders and almost 37
percent of 8th graders reported feeling depressed.
The community was ready and ripe to receive this, says Dana Heiman, senior vice president of the
Brandywine Health Foundation.
Hundreds trained
In the first year of the program, which started in June of 2014, 321 persons were trained in Youth
Mental Health First Aid curriculum. Just over half, 175, were school district employees, ranging
from nurses, teachers, and mental health specialists to cafeteria workers and custodians.
The rest were members of the community at large, such as Bolton, a former teacher, who took the
course before starting with the suicide hotline, because I wanted something more than my life
experience.
The philosophy behind the project is that knowledge of mental health should be widespread, at least
in the school community and, hopefully, beyond that.
Its important that all people be able to reach out, says Alison Distenfeld, a therapeutic support
specialist who took the course. The more people who take the workshop, the more people can help
out. A student might be more comfortable approaching the janitor. A casual relationship might be
safer.
Were still in the early stages, but I do see a difference, says John Reid, Coatesvilles director of pupil
services. He reported cafeteria workers at a middle school noticing that one of the students was
unusually withdrawn and reporting this to the administration. They said that a year ago, they
wouldnt have known what to do about it, Reid says.

He says that, previously, Palaia might not have stopped to talk to the crying student, although in that
case it turned out to be a romantic issue rather than a mental health crisis.
The students talking about suicide, however, were apparently serious. A key segment of the training
discusses warning signs, whether a youth is verbalizing it or not.
If we dont talk about it, instructor Tracy Behringer told a recent class taking the training, people are

going to continue to die. Reid noted that the state is requiring suicide prevention training in schools
starting with the 2015-16 academic year.
Looking for impact
According to the first-year evaluation of the program, a significant majority of those taking the
course found it valuable.
Questionnaires given before and after the course found overall increases in participants confidence
in recognizing and dealing with youth experiencing behavioral health challenges. Almost 80 percent
said they would find the course useful in their workplace, whether in a school or elsewhere.
But collaborative members are also looking for specific improvements in areas such as responses on
the Pennsylvania Youth Survey and increased referrals to local mental health providers, who have
revised patient intake questionnaire forms to help the evaluation.
Metz says they are still working on refining their evaluation methods: If Pennsylvania Youth Survey
scores improve, for example, how will evaluators be able to determine how much of it is due to the
Youth Mental Health First Aid initiative?
Or if referrals to social service agencies increase, how much can be attributed to this effort?
We want to be able to tease out whats happening with the referrals, whats happening with PAYS.
she says.
Looking at all the different data together might give us a better picture of whats going on.