We are at a pivotal moment regarding support for children right now. The systems designed to help them are at their breaking point. As a social worker, I am acutely aware of the mental health crisis we are facing. Medical and public health systems, and the providers who work in them, are struggling to meet the current level of need.
As an educator, I can share that all of these systems impact schools, and nowhere is the crisis hitting more of a crescendo than in education. Add in anxiety and stress over learning loss, an unprecedented staffing shortage, and the fact that no federal special education laws were changed, and you get a crisis of epic proportions.
Only the educational system is truly bound, by law and mandates, to support the whole child. Our educators are not just called on to ensure academic progress, but also the safety, health, emotional, and cognitive well-being of all students. We urgently need paradigm shifts in our systems that care for children if we hope to shore up our schools, support our children, and by proxy their educators, families, and communities.
Whole School, Whole Community, Whole Child
The educational system’s whole child mandate was highlighted for us when our daughter had an acute onset of mental health symptoms in second grade and her brother followed with a slower decline, but similar symptoms. They presented with panic attacks, OCD, mood lability, sensory issues, and intense separation anxiety.
We initially turned to the system that I knew best: the mental health system. We went from professional to professional, from medication to medication, from diagnosis to diagnosis with no true solution or healing. We then had to ask our local school system to shift how they supported them. Both children were academically capable, yet their mental health symptoms prevented them from making effective progress. Our daughter was in third grade, and our son in second, when each qualified for an Individual Education Plan (IEP). They were placed in therapeutic day schools outside our community, costing our school district close to $100,000 a year in tuition and transportation.
This level of support for our children was accessible because of the decades of federal and state legislation, as well as significant case law, that has increased the breadth and depth of what public schools are mandated to provide for students. For our children, the Individuals with Disabilities Education Act (IDEA) ensured they would have access to a Free and Appropriate Public Education (FAPE) in the Least Restrictive Environment (LRE) to access the curriculum and make effective progress. While other systems attempted to help them make progress, only the educational system was mandated to step in and support them.
Schools in Crisis
As we walk out of the pandemic, our schools are struggling to be what these laws, mandates, and case law have essentially made them: de facto medical, mental health, and community care centers. Mental health needs are soaring, with 70 percent of public schools reporting an increase in the percentage of their students seeking mental health services at school since the start of the COVID-19 pandemic, and three-quarters of schools also reported an increase in staff being concerned that their students are showing symptoms such as depression, anxiety, and trauma. Further, post-pandemic we are seeing chronic absenteeism soaring, with most school districts across the country reporting a significant uptick, particularly among lower-income and marginalized populations.
Complicating this level of need is the fact that many districts are in an unprecedented staffing crisis, with some districts short dozens of critical positions. As no federal special education laws were modified during the pandemic, schools remain obligated to the same services and compliance measures as they were pre-pandemic. Schools have been asked to pivot, shift, and accommodate the ever-changing, ever-growing level of needs of their students during this time.
Our children’s school system benefited from a radically different way of viewing and treating their mental illness. While both children remained in therapeutic day schools for the majority of their K-12 years, something miraculous happened in our son’s fifth-grade year. At the time, his symptoms were worsening, and we thought we may lose him to suicide, when we learned about an illness we had never heard of: PANDAS/PANS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep/Pediatric Acute-Onset Neuropsychiatric Syndrome). This illness has roots in the body, with viruses and infections (ie. strep, flu, COVID) triggering a host of neuropsychiatric symptoms in the brain. As a social worker, I was skeptical. I was taught to always rule out medical causes of mental illness and had never heard of this disorder. In desperation, we had our son screened.
When he was diagnosed with PANS/PANDAS, we had our daughter screened as well. She also received the diagnosis. With treatment, both children began to heal in ways we never expected. In ways, as a social worker, I never thought were possible. Their fears abated, their confidence grew, and they advocated to leave their small therapeutic schools and return to their community high school setting. With the proper diagnosis and treatment, they were both able to move back to a less restrictive environment and find true healing.
Our local school district funded the schooling of both of our children. I calculated the cost at just under a million dollars to educate both children. The emotional toll on our children and family has been immeasurable. If mental health and medical professionals had been aware that strep throat and viruses can cause mental health symptoms and done a simple strep test when our daughter was 7 and our son was 5, our children may have been caught far earlier, treated, and been able to remain in their community schools.
Shifting the Paradigm
Recognizing the connection between viruses, infections and mental health is just one paradigm shift that would be critical in helping our schools. We know from current research and science that COVID comes with 20 to 40 percent neuropsychiatric symptoms, including anxiety and depression. Doing a differential diagnosis every time and ruling out medical causes of mental health is part of our mandate in mental health, and will support our schools in helping children heal and not be relegated to a lifetime of symptom management. Our children are one example; we do not know how many others have been missed.
What other ways can we shift our practice—create new ways of thinking and working together to help children and schools? We must think differently, be open to new ideas, and team together to create change. If we keep at the forefront the belief that helping the whole child is the best practice, we can have courageous conversations together to create paradigm shifts that can produce lasting, meaningful change in schools and in all the systems that support them.