Let's Talk Kids

Helping Teens *FIGHT STRESS & FIND HOPE* | Let’s Talk Kids

• Lets Talk Kids @ ACNJ • Season 1 • Episode 7

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0:00 | 1:41:42

Diane Travers, Senior Director of NJ4S Essex, speaks about how her organization has worked with schools to directly meet the ever-changing mental health needs of the next generation of students as well as their parents and teachers. NJ4S clinicians host events and workshops covering a variety of topics such as anti-bullying, substance abuse prevention, financial literacy, healthy communication, absenteeism, and more.


Learn more about the NJ4S Essex below!

https://www.familyconnectionsnj.org/nj4s/ - NJ4S Essex


OUTLINE


00:00 - Intro

00:37 - The Purpose, History, and Functionality of NJ4S Essex

16:38 - Topics that NJ4S Events Cover & How to Contact

23:23 - Increase in Students’ Mental Health Challenges

33:25 - How NJ4S Clinicians Work With Kids, Schools, and Organizations

49:34 - Positive Results of NJ4S Essex Endeavors

01:02:04 - NJ4S Mindfulness Strategies

01:07:05 - How Parents can Contact NJ4S

01:13:34 - How NJ4S helps the Younger Generation

01:33:37 - Diane’s 10 Year Wishlist

01:39:15 - Outro

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Thank you so much for watching. See below for more information on Let’s Talk Kids and ACNJ.

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CONTACTS

  • mcoogan@acnj.org - Mary Coogan - Host of Let’s Talk Kids | CEO of ACNJ
  • vjabon@acnj.org - Viggo Jabon - Editor of Let’s Talk Kids | Multimedia Specialist at ACNJ



SPEAKER_02

Welcome to Let's Talk Kids. I'm Mary Coogan, president and CEO of Advocates for Children of New Jersey and the host of Let's Talk Kids, a video podcast of conversations with community organizations, policymakers, and experts about issues impacting children and youth. Joining me today is Diane Travers, who is the Senior Director of NJ Statewide Student Support Services or NJ4S Essex. Correct?

SPEAKER_01

Yes.

SPEAKER_02

Welcome, Diane. Thank you so much for joining me. What's the goal of the NJ4S Hub?

SPEAKER_00

So the goal of the Student Support Services was really to create a service that could be accessed by public and charter schools throughout New Jersey, really creating equity and increasing the level of support that our students need in our New Jersey schools.

SPEAKER_02

Okay, so you're at the Essex Hub. How did you come to be there? And how did you come to be the senior director?

SPEAKER_00

Yeah, so the NJ4S Essex program is managed by Family Connections, and I've been a part of Family Connections for about seven and a half years now. I previously was over school-based youth service programs and some other youth prevention programs, and then was a part of the process to apply for the grant to receive the NJ4S services, and I've been uh the senior director ever since its inception.

SPEAKER_02

Well, that's wonderful. What brought you to like services for youth prevention or mental health services?

SPEAKER_00

So I started out my undergraduate degree was in criminal justice, and I really thought at one point I wanted to be a correctional counselor, but uh didn't realize you needed a master's degree for that. So I kind of entered the criminal justice field. I for a brief stint, I was actually a correctional officer in Washington, D.C. And then I became a probation officer right here in Essex County. And I worked for pretrial intervention, uh, which at the time was really mostly first offenders and a lot of women who had been charged with welfare fraud. So I found in my role as a probation officer that I was really interested in helping. And I wasn't as interested in kind of being that arm of the court. Um, and through that, I did apply to get my master of social work. And from there, I worked for child welfare and pretty much have worked for mental health centers both in Bergen County, Essex County, and then landed at uh Family Connections about seven and a half years ago.

SPEAKER_02

So Family Connections is a community-based organization, right? And they provide a lot of services for families.

SPEAKER_00

A lot of services. Such as we've been in existence since 1879. We our CEO likes to tell the story that there were women that actually were on horse and carriage going around door to door as kind of a grassroots effort way back when. Now we've got well over 36 programs. We have uh supervised visitation services for children in resource homes. We've got a lot of parenting support programs. We have a um large outpatient center or integrated behavioral health services. We have a CCBHC. Um, we've got a lot of smaller prevention programs. We're up to seven school-based youth service programs at this point. We have a Keeping Families Together program, which is uh we call it home safe. And you were nodding, so you realize that we're providing uh support to families that have experienced disruption in their housing, either due to children being in placement or perhaps homelessness. And um, and we run uh the alcohol and drug abuse uh prevention team, adapt. And I'm I'm just trying to think am I going to get in trouble for forgetting any significant programs, right?

SPEAKER_02

Well, I'm assuming most of the programs are listed on your website. Yes.

SPEAKER_00

The website. Yes, the website is familyconnectionsnj.org. So, and I did not mention we have older adult support programs too. So we like to say we serve zero to one hundred, and that reminded me of our Parents as Teachers program as well, which works with families with uh babies in utero up to the age of three to provide support.

SPEAKER_02

That's wonderful. I mean, it really is wonderful when you think about all the different, I guess, times where you touch base with families for a variety of different reasons. And the fact that it can all get coordinated in one agency is probably helpful, right? Because you could be working with a family in one program and then realize maybe they could also benefit from another program.

SPEAKER_00

Absolutely. I think that's the beauty too of that whole multidisciplinary approach. I mean, we could have a family in our strengthening families program that's going through their 10-week uh program, you know, could be active parenting of teens. And yet the family may identify to that program that their their student, their child is struggling, and they can say, oh, you know, what what school is your child in? And this is the procedure, how ask about NJ4S services. So it really is a continuum of care in the agency.

SPEAKER_02

That's great. So let's talk a little bit about the NJ4S hubs. So this is you're involved with the Essex Hub. How many hubs are there statewide?

SPEAKER_00

So there's 15 hubs across the state. Some of the ones in more rural areas serve multiple counties. So 15 for 21 counties, and they're dispersed throughout. So even the the hubs that have multiple counties to serve, some of them have different locations, so it's easier to kind of get to and from. But I think the beauty of this program is that nobody needs to come to a hub for services. All of the services that we provide are either in schools or in the community. So families don't have to come to us, students don't have to come to us. So across the state, with the creation of 15 hubs, Essex is the largest, and we do have Newark is actually the second highest need school district in the state, behind Camden. And, you know, we've got the most high need students in Essex County, which is when they originally were starting, they did both a school districts needs index as well as a community needs index to really look at which communities had higher needs. So for example, um, one of our suburban schools actually falls under high needs. But when you look at the school districts factor, they're looking at uh child abuse reports, they're looking at uh bullying complaints, they're looking at graduation rates, they're looking at test scores, a whole variety of areas. But with the community piece, you might be looking at domestic violence rates in the community or youth suicide rates. So some of our higher kind of performing academic districts fall in a more high needs category because they might have more youth suicides or even domestic violence in their communities.

SPEAKER_02

Wow. So is is the when you talk about an index, is that it's a list of indicators?

SPEAKER_00

Yes. So, and this was all created before we kind of rolled out NJ4S. So this was done behind the scenes with uh the Department of Children and Families, who is our funding source for NJ4S, and they've got a big applied research and evaluation team. And so what they really wanted to do was not only look at, you know, again, what what are the districts that perhaps need more services, but in a sense open this up to all different school districts? So it really doesn't matter if you're high needs, moderate needs, or low needs, any school can access NJ4S services.

SPEAKER_02

Does the index dis determine what services a hub is going to provide, or how else is that determined?

SPEAKER_00

Yeah, so that got determined. We all did individual needs assessments. So even before we kind of hired our staff and got ready to go, we did an actual needs assessment of our own throughout Essex County, tried to get parents, students, educators, community members, and we asked them to really rank here in Essex County. What do you think the highest needs are for students, for educators, for parents as well? What came up for us, not surprising, was um treatment for students who've been exposed to trauma and also suicide prevention. Our parents indicated they wanted mindfulness and stress reduction strategies. Our teachers indicated that they were feeling also very overwhelmed and would benefit from mindfulness. Um, so we took that and we looked at our evidence-based practices and which we were going to train our staff in based on. We also got an idea of what the needs were from our every single hub has a hub advisory board. We call them HABs. And the HABs are made up of students, parents, uh, we call them our spokes partners. So it could be uh school partners, could be community partners, you know, providers in the community, as well as could be, you know, people from the YMCA or the United Way. So a lot of different people at the table. And when we were first planning our services here in Essex, we really looked to their expertise. What are the things that you're seeing in your communities, in your schools, what are the areas of need? So our HAB was really instrumental in suggesting areas we might have overlooked. Initially, we didn't train staff in a grief support group. And our our school partners were saying this is a big need for us. Our students are suffering a lot of loss, and they could really benefit from this type of group.

SPEAKER_02

Why were students suffering from loss? How long have the hubs been around? Is that a COVID-related?

SPEAKER_00

It's not a COVID-related. I mean, it could be COVID-related. The hubs have been around. We really started ramping up in July of 2023. But what happened is initially, as we were hiring staff and training staff and different evidence-based practices, um, we we also at that time were pausing because we realized after the fact that all of our staff needed to go through the same level of record checks that a school teacher or a substitute teacher would go through. So we had to sort of pause on starting providing services in the schools right away. But while we were going through that process, I mean, that was, you know, a time for us to kind of sit back and reflect. So it wasn't so much directly related to COVID, although COVID certainly has ripples in the whole child and youth mental health crisis. I mean, we're seeing our students just severely impacted, not only from developmental lags, although I did just see a study that indicated they feel that students are starting to close that gap since the pandemic. Um, but we know the ripples have been that students suffer from isolation. Obviously, there was a heavy reliance on social media. Students were, you know, shut in their rooms at home, um, and we've certainly seen those trends continue and continue to adversely impact the students' mental health.

SPEAKER_02

So you said something just now about how staff had to get background checks because they were going into the schools. How does that connection get made between the hub and the schools?

SPEAKER_00

And the schools. That was really our biggest task when we first started. There was an initial introduction of our program from the Department of Education, but because we're funded by the Department of Children and Families, we weren't readily accepted, I think, in the schools because we were seen as, hmm, kind of who is this, you know, and where are they coming from? So a lot of the work that we did, we were all boots on the round marketers. I mean, we uh were going out to schools, dropping off information, we were contacting school reps, we were looking at the lists of all of the eligible schools that we would be serving and trying to get in to do a presentation. We presented to the county superintendent's office so that superintendents were aware of our services, and then different spaces where might be the student assistance counselors meeting, or it could be the director of uh special services and student services meeting. So really trying to get the word out initially about what is this program. But that that took a lot of a lot of work. And to date, we have 94% of the schools that are eligible to receive our services in Essex County are signed up in our state portal, which is called NJ Connects. But out of that, we've got 131 schools who are eligible for our second tier and our third tier of services. Other obviously more schools than that. Um, but out of that, we've been actively providing services in 85 of the schools. And that's about 70% of our high needs schools have been actively using services, to the point where some schools have put in over 100 applications for their students, and other schools may have put in a handful. So it's something that we're constantly trying to evaluate and look at why have some schools actively used us and why have others not used NJ4S services. And we just um did a survey just a few months ago that we sent it out to all the schools that are signed up, but yet they haven't put in a tier two or tier three um application. And so we wanted to know what are the barriers. And we heard anything from lack of administrative buy-in. So maybe their administrators weren't so certain about utilizing services, down to constraints to getting parental consent signed, to maybe our school doesn't even have a dedicated private space where our staff could come and run groups or provide mental health counseling. So we got a variety of responses for that, but we're always trying to be creative and meet with these schools individually to say this is what some other schools have done to get around those challenges.

SPEAKER_02

So now I have a lot more questions. Yes. Can services only be provided through the school?

SPEAKER_00

So we've got three tiers of services. And our tier one level of service is really our universal prevention education. So that is open to really everybody. It's open to pre-K, on up through 12th grade schools, private schools who are not eligible to use NJ4S services. Um they can utilize our tier one services. And what tier one really looks like is it could be a workshop for students on anti-bullying. It could be a series of workshops. We've gone into schools every Monday for 10 weeks where they've chosen suicide prevention, you know, violence prevention, um safe dating practices, things like that. It could be a big giant assembly where we do a presentation to all of the students. It can be a professional development workshop. We've had over 1,100 educators have been uh have participated in NJ4S Essex workshops. Um, and then it could be community presentations, going to a family success center. We've run series at libraries, especially over the summer. So there's um that's really the most open uh part of our service. And statewide to date, we've we've actually served over a million people in tier one services since we've started.

SPEAKER_02

So wow, that's pretty impressive since 2023.

SPEAKER_00

Absolutely. And again, remember, we were we were really we got our first application in November of 2023. So it wasn't like we started in July of 2023 because we were still getting some of those things in uh in place.

SPEAKER_02

So does somebody just so the librarian wants to run a program?

SPEAKER_00

Yes.

SPEAKER_02

She just calls you at the hub and says, Can you come out on May 15th and do a program?

SPEAKER_00

Yes. So originally when we were smaller and starting up, it was either calling us or they can actually send an email to we have a dedicated email. It's you know, info nj4s essex at familyconnectionsnj.org. So people could just send a request in that way. As we got busier, I mean, there are some months that we have probably 120 tier one events alone. So we developed a tier one application. So if somebody reaches out by phone or by email and says we'd like to have this workshop, we send them a very simple jot form. What's the date? What's the location? Who's the audience? What's the topic you've let you'd like? And we've got a variety of topics that people can choose from, but we also develop presentations and customize things based on the school's apps. So it could be anything from digital citizenship to a lot of anti-bullying workshops, a lot of substance abuse prevention workshops for our parenting workshops. We we've actually had a variety of topics, including financial literacy for parents, or it could be, you know, healthy communication skills with your teenagers. And then our educators kind of check off a lot of the boxes of some of those required professional development workshops that schools need to deliver. We can offer workshops on human trafficking, which is a newer mandate online safety around that, um, you know, all the way down to uh emotional regulation and how to support teachers who are dealing with students with challenging behaviors.

SPEAKER_02

So it's not just for students then, not just for students.

SPEAKER_00

It's for the whole family, especially tier one, and that's the beauty. And then the way we try to reach more people as well is at our hub, we offer a monthly webinar. So we offer an evening webinar that people can register for, mostly educators and parents. They're not really geared toward the students. Most of our students don't want to click on and watch an informational uh webinar in their off time. But um we've we've had attendance as high as you know, 150 parents and educators that have come to our evening workshops. And our topics are very much relevant to what students are struggling with and also what parents are struggling with. So, for example, we just did one, it was it was called um missing more than class, and it was really unpacking the impact of absenteeism, as well as some really practical strategies to support students who may be avoiding school or refusing to attend school. Um, this month, we are our parent workshop is how to cultivate youth leaders. And it's really how parents can support and kind of, you know, dig in and enhance those those leadership qualities in their students. We've done a lot of substance abuse prevention. Those are always very well attended, our uh dangers of vaping presentation two months ago. And um, then another way we've been able to meet the needs, I think, of the schools is some of the schools have actually approached us and said, we would love to have, for example, one of our larger charter school districts asked for a test anxiety, a small 20-minute video that they could show all of their students before they go into standardized testing. So it was really to acknowledge the anxiety around, it could be standardized testing or just a regular old test. And then our staff provided really effective kind of study skills suggestions, but then did mindfulness strategies and really taught students how to manage kind of some of the anxiety that comes from that. And recently the same school district had found that a huge need for them was to support the parents who are undocumented around their anxiety of the immigration procedures and you know what's happening right now in our back door. So we're creating two videos. We're working with Legal One at the state with a lot of expertise to kind of do a know your rights for not only teachers. This will be hey, do I need to open the door if ICE is knocking on the door? What if I'm dismissing my class and they go to get one of my students? You know, can I bring that student back into the safety of the building? But also one just for parents. You'll be able to click on and select your language and then get subtitles from the presentation. So we can do it in, you know, obviously any language that's available. And really just again, acknowledging the anxiety, acknowledging what's going on within their families, but then giving practical solutions around having a family plan, right? What gets communicated to students. So unfortunately, it's you know the reality of what we're dealing with, but we do see this as being a big factor in why a number of our students are chronically absent today as well.

SPEAKER_02

Yeah. Well, I know the chronic absenteeism is up because our kids count data report will be coming out soon. And Over 60% of the school districts in New Jersey have a chronic absenteeism problem. Which, as you know, if you miss more than 10% or 18 days of school, you're chronically absent or considered chronically absent. So I didn't appreciate the extent towards the anxiety of immigration issues. I mean, you hear about it anecdotally, so it's good to know that you are all trying to give some help to the community. Because I think that's what's causing the anxiety, that sense of helplessness. Right.

SPEAKER_00

And I think that goes back to when you asked about how do we how do we identify what the needs are of the community and the schools. And it is constantly changing. But when a school identifies something that's going on within their district, we try to be really responsive. And we had offered a webinar where we hired an immigration attorney to come and do a know your rights presentation. But what we, I think, left out was how reluctant so many families were in putting in an email address and having their name associated with attending a webinar of this magnitude. So while we had fairly good attendance, we heard from our schools that parents are not, not now, they're not going to register for a webinar. But if you create one and we can send it out to our parent network, they think that that will be a huge support.

SPEAKER_02

Okay. That makes sense. So do you think beyond, and I'm not trying to minimize the immigration issues, but beyond um issues like that, are students more anxious than they were 10 years ago?

SPEAKER_00

Definitely.

SPEAKER_02

And why?

SPEAKER_00

You know, we're the CDC did a very comprehensive study between 2021 and 2023, and they looked at 12 to 17 year olds. So that's really, I mean, we we serve beyond 17 as long as you're still in school. But that's our population right there. And what they found is that pretty much in general, 20% of students report some type of anxiety. 20% of students report depressive symptoms, but 40% of students report persistent feelings of hopelessness and sadness. And so, you know, we we like to jump to, you know, diagnosing depression, but what about that just low-level kind of chronic hopelessness and sadness that we're seeing? And then if you look at our vulnerable vulnerable populations, our LGBTQIA plus youth, they're 45% are reporting symptoms of anxiety and depression. And they are 40% more likely to attempt suicide than their straight peers. So what we've got for our students right now is about 20% admit that they have thought of suicide. And these are these are one in five of our students reporting really, really significant challenges to their mental well-being. So I think that drove a lot of creating a program of this magnitude to be able to really equitably support students across our state. But while we talked about the pandemic being one kind of outlier, I think what's happened in the last 10 years as well has been this shift to a tremendous reliance on social media. I mean, that's always kind of in these places and spaces. Students now have 24-7 access. And we look at students who are comparing their lives to others. Everybody's prettier, they have a nicer body, you know, I'm fat, I'm too thin, I'm this. And so you see how it really impacts our students' self-esteem, but it also creates a sense of isolation, right? Students may come home from school, and then if they're on their devices and they're not out and they're not connecting, you know, they end up feeling very lonely and very cut off. And then you've got students in general who are struggling with anxiety. 50%, they looked at over 2,000 high school students, the CDC did, and 50% of those students displayed absenteeisms, warning signs, and admitted that they had been absent strictly because of anxiety. So one of the areas that we've offered as a tier one, as well as one of our webinars, was looking at really the difference between school refusal, school avoidance, because there are a number of different factors. And while you can say anxiety, there's a lot of different underlying factors with the anxiety, right? Am I afraid that if I go to school, ICE is going to be in my community? Is my family anxious if I leave the home that ICE may pick me up, or that they may be picked up and they won't know that I'm safely at home all the way up to I don't have any friends, I don't know who to sit with at lunch, or I feel very, you know, isolated. I don't feel part of the school community. So I think the beauty, too, of our tier two prevention groups, which I can describe in a little more detail, is that if schools were to use prevention groups as a way to enhance their school climate and enhance kind of the culture of belonging in their schools, we could see really significant impact. So what that might look like. Tier two, um, that's our evidence-based practices. And what the word evidence-based means is it just means that this has been scientifically studied and it has been proven to be effective. So there's outcome measures and studies around this. And we've trained our 32 prevention consultants in over 20 different evidence-based practices. We created this guide as really a marketing tool as well to be able to show our schools they can quickly go by area of need. They can look at anti-bullying, violence prevention, impact of grief and trauma, um, you know, mental well-being and suicide prevention. They can say, oh, this is my area of need, and then they can open it up and they could look at a particular uh program, such as our cognitive behavioral interventions for trauma in schools. And this is a model, it's a group model that our clinicians offer. And it's for students that have experienced trauma. Um, while it's not, you know, it's not to kind of single out or, you know, necessarily tell the personal details around it, it's to really educate students around the impact that trauma has on them emotionally, physically, and to give them coping strategies to be able to work through the trauma. So this gives our school representatives not only a detailed look because it breaks it down by week by week by week, and they can say, oh, this program is for sixth to ninth graders. This program is for sixth through 12th graders, it's 10 sessions long, you know, this is what it covers. Um, but you know, it really is up to the schools to decide what is the area of need. But what I often say when I'm talking to school representatives who have questions is how great it would be if, say, in September, when all of the incoming sixth graders were coming into a middle school, really struggling with the transition, if you had students in these evidence-based groups, it could be social skills groups, you know, social emotional learning groups. Uh, we've got one called coping and support training, which gives kids coping strategies to deal with any adverse situation they're dealing with, emotional regulation. So if we put students in these groups as they were coming into, say, sixth grade and ninth grade, these transition periods, can you imagine? Not only would the stigma around receiving support services be so different. This is taking place in your classroom, in your school. Discussions around mental health somehow don't feel as stigmatizing, but it also is really, really impactful in changing, again, the school climate, but also the behaviors of the students who may not have the tools to be able to deal with challenging situations. So we like to say, make this a very normal part of your school routine. And for some of our more creative schools, they've said things like, oh, how are we going to get students to sign up? You know, how are we going to get their buy-in to attend a group? And they've done amazing things, like said to our prevention consultants, can you come out? We're thinking of running groups for our seventh graders. Can you present to all of our seventh graders? And then we'll leave it up to them whether they want to join a group or not. These students, after hearing the prevention consultants, they went home and told their parents and their caregivers, you've got to sign this consent form. I want to be a part of this group. And so what we've seen is this buy-in from students that might not be there if it was more reactionary, right? You just got into a physical fight or you're bullying somebody. We're going to now recommend to your parents and caregivers that you be in this particular group. Students are going to come in, you know, kind of like this. I don't want to be here. Um, and to just tell you a little bit about the impact, we were uh running a group for sixth graders in one of our NORC schools. And as I said, our prevention consultants, um, they they 32 of them, but they have lived experience and they represent the cultures and races and religions of the students that they're serving. Many of them came up through the same school districts. And so what happens is they form these unbelievable mentoring relationships with the students. You know, they become that caring adult. And we had one group of students where it was around the holidays, the group was ending. They asked the social worker for construction paper. They wanted to make the prevention consultants cards. And in the cards, students said things like, Thank you for teaching me how to be an honorable man. I've already seen a change in my behavior. I've been able to use these, you know, strategies and not react now when I'm, you know, in these situations. And one student in particular, in the middle of a group, I think we were about halfway in, said to one of our prevention consultants, How many more weeks do we have? You know, how many more times are we going to meet? And, you know, he's thinking, oh boy, here it goes. And he said, Well, you know, we're halfway through. We still have six more sessions. And the student was kind of seen calculating and thinking for a minute. And he said, Oh, wow, that's great. That means I have six more weeks, you know, 42 more days and six more hours to have you two in my life. And that piece, you know, halfway through a group to think that this student is already thinking, this group that I didn't want to be a part of, I now don't want to end. So very impactful. Um, and our prevention consultants speak the languages that our students and our parents speak, Haitian Creole, Spanish. So we can deliver a group in any language the school requests as well.

SPEAKER_02

I mean, that it really does sound wonderful. And I I guess a couple things come to mind. So are kids staying after school for group, are they doing it at lunchtime, or are they doing it right in the classroom?

SPEAKER_00

And that those are all options. That is one of the biggest challenges we've heard is a lot of schools will say we don't want to take students out of academic subjects because if they're already falling behind. So we have been, we've been pretty creative and we can do it before school, we can do it after school. The lunch piece, we've done groups during lunchtime. Our students don't love that as much. And we do feel like students need that time to decompress. So, but we'll meet the school wherever they're at and whatever the recommendations are. So if a school, say a middle school has um, or some of our schools, New York schools are K through eight, our orange schools are K through seven. So they may have after school programs where a lot of sixth graders may still go to the after-school programs. That's been a really successful place to actually do these groups because those students are there, they're a captive audience, and you know, they've got that protected time where we can run the group once a week. We've done things over the summer months as well with bridge programs where schools have students coming who are transitioning into the school. So that's been another way to kind of get them early. But the academic piece, one of our more creative schools, a large high school in Newark, uh, the social worker got a lot of resistance. Oh, you're gonna take these students out, you know, they're gonna miss. How are they gonna make this up? And so what he really looked at was he went and he looked at, you know, the different classes where the students may not be struggling as much, but then he altered it. So the students were maybe pulled out, not the same exact class each week. And the student the teachers, when they started seeing these behavioral changes, they were like, okay, maybe this isn't such a bad thing. But um, but schools have been very creative about the way they've made these groups work. And other schools, I think, are still finding it challenging to figure out how to implement them.

SPEAKER_02

So when you talk about things like mindfulness, coping, what is that?

SPEAKER_00

Yeah. So I mean, I I think it's really important to acknowledge, and you asked me kind of what's different in the last 10 years, and I probably gave a very roundabout answer. But I think what's different is the level of stress that our students are experiencing, right? And I said social media, but let's say social media, if a student is up scrolling on their tablet or their phone all night, then there's sleep deprivation. And we know that sleep deprivation impacts your mental well-being, right? But then we've got so many other variables, academic pressures and stress. We've got fear over the global environment right now. You know, if a student is in a household where the news is turned on every night, I mean, imagine the uncertainty that creates, you know, in students and the fear. And so when we look at, you know, uh we've always had, you know, mental health challenges. I think number one, we're a lot better at identifying things now. We've got a lot more services in place. It used to be schools were there to teach. Not our job. Not our job, you know, if the the students or the community have uh been involved in a collective traumatic event to kind of support those students, now we've got the traumatic loss coalition. That's a built-in component where students immediately get support if something traumatic has happened in their school or their community. But I think too, you know, what we're we're really looking at now is um just ways to almost in destigmatizing ways to make mental health support a real strength rather than a weakness. So when we kind of normalize that piece and there's more access, plus when you provide it in the school, there's a lot less stigma and fewer barriers as well. You know, we've got socioeconomic barriers to accessing treatment. What if a family doesn't have a car to drive a student to an outpatient appointment? What if a caregiver is a single parent and works multiple jobs and can't get their student to even an evening appointment? So trying to reduce like some of those barriers that providing the services right there in the school has you know been been able to accomplish, I think, and again, across across the state, so that everybody, you know, whether you're in a rural area where there's not a lot of services and you have to drive far, or even here in Essex County, where we have an absolute shortage of outpatient children's mental health services, as well as child psychiatrists.

SPEAKER_02

So why not just put a therapist in every school?

SPEAKER_00

And that's, I think, something that some schools feel would be really helpful for them. You know, our experience is, and every school district uses social workers or counselors in different roles. Some of our school districts hire psychologists. But I think what we hear especially from our school representatives are every single day they're putting out a crisis. And so if they're the one, if their job is to provide mental health counseling to students, is there going to be a guarantee that they're going to have that protected time to be able to meet with a student once a week for a 45-minute to an hour session? You know, typically they're the ones called in if there's a fight or if, you know, something is going wrong in a classroom. And so we see our social workers making phone calls to remind parents about standardized testing. So I think that, yes, for some schools, if there was a lot of protected time, it might be a model that works. But in our high need schools, I think our social workers and our counselors get pulled in so many different directions. Whereas for our tier three clinical services, our 10 clinicians come to the school. They arrange the appointment with the school. The student can have the same appointment every week. Or if it's, hey, you know, so-and-so is in standardized testing today. Could you see her on Friday? Absolutely. I'll be there Friday at 10. And then that time is that dedicated time where the student gets to meet with their counselor. I think the difference too is that our counselors develop a level of trust with our students while they understand that there are limits to confidentiality and, you know, situations that might need to be reported. They're not seen as an employee in the school. So there's very much a level of trust. Can I tell you what happened? We've had students go up to prevention consultants after an assembly and say, Can I talk to you for a minute? I'm I'm being beaten with a belt. Or this is what's happening in my household right now. They've just met, but yet they see them as somebody that they can trust. And for our students in our clinical counseling, which is about 12 weeks, we provide a comprehensive assessment. We see the students for 12 weeks. We then link them to ongoing care if that's needed. One of the differences is every single intake is met with a Columbia suicide severity rating scale. So our students get assessed for suicidal thoughts at the first appointment. And if a student is shown to be at risk for suicidal thoughts, our clinicians then readminister that tool every time they see the student. So I would say that it would be more challenging for that level of care to be provided by somebody who's embedded in the day-to-day operations of a school.

SPEAKER_02

So you have 10 clinicians. Yes. And you have thousands of students. How do those 10 clinicians provide 12 weeks of service?

SPEAKER_00

And that was where the high, moderate, and low needs came in because we were anticipating at some point there might be a wait list for services. And if so, would we prioritize a high needs district? We've not had to do that where we've prioritized based on need, but we have reached a point. We typically it's around February or March where all of a sudden our caseloads are saturated, and we do have smaller wait lists. So what I can share is we've got bilingual clinicians, three bilingual clinicians, two speak Spanish, one Portuguese. They tend to have higher weights for services. And usually it's the student themselves is not comfortable conducting sessions in English. So it's not just as a support to the parents, but it's a support to the students themselves. What happens is, you know, they are typically for really, you know, the good half of the school year, they're they're seeing 17 students a week. And again, transportation time. It may seem easy if a lot of the services are kind of, you know, centralized in East Orange and Newark, but parking becomes a big challenge, things like that. So we the the caseload is about 50% of the work week. And then at some point, if they reach this point of having a wait list, what we're doing is we're actively communicating with the school representatives. This student seems like their needs are pretty high. Are you sure you want them to be on a wait list? We can help support, get them linked to the children's system of care, you know, perform care. We work very closely with the partnership for children of Essex. We actually have two of their members are on our advisory board, and one is our liaison. So if we're trying to get a family linked for either perform care or CMO services, we give that information to our liaison and they then work with the family to make sure they get them linked. But if the student remains on the wait list, we usually just try to estimate typically two to three weeks, communicate that with the school and the family. And then once we're closing cases, we're able to then serve those students. And we serve students throughout the summer. So our clinical students, we can meet them at a library, we could go in the homes, we can meet them at a park, we can, you know, someplace where there's some type of privacy. But again, students are never coming to the NJ4S hubs. We're always going to them. And then the prevention groups can take place in the summer months as well. We run them at um MCAs at some of the summer camps. Again, we do things in the libraries, so family success centers. So there are plenty of things that can still continue even during school breaks in the summer months, which is really a key part of our program.

SPEAKER_02

So just for our listening audience, I just want to clarify the partnership of Essex, and when you say CMO, that is, as I understand it, the organization, and it's another community organization that is contracted with the children's system of care to provide service. Yes. And how how is that process implemented?

SPEAKER_00

And so, you know, they've got more of a wraparound model where they meet with the child and the family to identify what the needs are. So for the care management organization, they can be providing, again, care management to help support and stabilize families, whereas the other arm perform care and mobile crisis, perform care can provide the intensive in-community clinical services for our students, and mobile crisis can respond during a crisis situation. We may, through our identification and our interventions with our students, we may identify that a student is in crisis, but we're not meant to be implemented actively when a student is in crisis because we want there to be stabilization. So we don't duplicate services. If we get a referral, one of the first things we might ask the school social worker is: are there any other services in place? If the student is connected to an outpatient mental health center or if they're connected to the care management organization, perform care, we won't duplicate those services. But let's say a student was in a tier two prevention group with us and was also receiving CMO or Perform Care services. Um, that's not a duplication of services. It's just around the tier three clinical services.

SPEAKER_02

So it sounds as if there's a lot of coordination.

SPEAKER_00

A lot of coordination.

SPEAKER_02

Yes, absolutely. Does every hub also coordinate with their county CMO, their care management organization and perform care?

SPEAKER_00

Yes. Things might not look exactly the same among the hubs, again, because they may have had different needs that were identified. Um, but in general, we're we're all typically providing similar services. And um it really depends on the utilization in that particular area. I would say across the board, the tier two services have been the most challenging for our 15 hubs to implement because of some of those challenges I talked to you about. Um, but again, we're trying to really creatively work with the schools. And certainly as our schools are these creative partners, we're sharing some of the things that the other schools have done. And more and more, uh, the schools that typically used us very heavily for our tier three clinical services are now putting in those same tier two requests for the evidence-based groups. So we're we're seeing things really turnaround.

SPEAKER_02

So the evidence-based, as you said, these are some type of program that's been tested. Yes. So it's tested. Who tests these programs?

SPEAKER_00

It's kind of the gold standard is the California Clearing House. But there can, they can get kind of stamps of approval from other areas as well. But the difference between evidence informed might be um if we know, say our Good Grief program, we were trained by the organization Good Grief, and that's evidence-informed where it hasn't been studied as much as, say, an evidence-based, that's a little more comprehensive. But in those cases, what they're looking at is we're taking that information from these evidence-based kind of practices. So I shouldn't give you statistics on the youth mental health crisis unless I can cite for you probably a credible source, right? So in this case, really in looking at these bodies kind of coming in and studying these prevention groups in particular that we're utilizing, um, they're going through that process. And then we're training our staff with their master trainers and then buying their workbooks and kind of implementing it from a real evidence-based model. If we were ever asked to alter it, I mean, an example I might think of is some of our safe dates or either our teen pregnancy or uh healthy dating relationship programs. A school might say, we don't know that we want you to perhaps talk about contraception or, you know, kind of protective factors. Um, you know, we might have some opposition from some of our parents. Could you leave that workshop out? So that if that happens, we actually have to fill out a program innovation form to the Department of Children and Families and say, okay, so this program that's 10 weeks, they don't want week eight. Can we still implement it? And oftentimes we're going to the creator of this program to say, would we be destroying model fidelity if we didn't do this particular workshop? And if they give us the thumbs up, then we can go ahead and fully implement it that way as well. So it's it's really you're strictly adhering to um kind of a uniform delivery of this particular program. So it takes out, I think, some of those variables that might dilute it somewhat.

SPEAKER_02

So the program, whatever the evidence-based program is, gives your agency a script, so to speak, right? Or a strategy, which then you're teaching to staff, and then they go into the school. And then is it expected that they will have X results? Yes. So let's talk about. So, what kinds of results has the Essex Hub seen with some of their evidence-based prevention programs?

SPEAKER_00

And that's this has been the project that we've been working on for the last year. And that was really getting these outcome measures. So a particular program might come with a pre- and post-test. Some of the programs don't, like CBITS, the one that I talked to you about. There's not a specific uh program evaluation form that they ask us to use. But when we had our staff, and that was the 10 clinicians, trained, they recommended a few trauma inventories that we could utilize. So typically what you're looking at is implementing it, you know, first session, second session as the group is starting, and then implementing it again at the end, and then really studying the results. So we also do things on our own. So with our tier three services, we've got the Columbia Suicide Severity Rating Scale. We use another scale called the Ohio Scales. And that looks at, you know, some positive behaviors, like over 68% of our students that participated in tier three indicated feeling more hopeful after having tier three services. And then it looks at, you know, reduction in some other areas, depressive symptoms. So we're looking at, in some areas, an increase in positive behaviors, a decrease in others. And then for those programs that didn't come with one, we've actually got a data analyst and we've got a director of quality, and they worked by going through and combing through the 10 particular sessions and looking at, okay, what would be some of the important things to kind of pull out of that? And we even get outcome measures for our tier ones. We want to know: was this topic relevant? Did you learn something from attending this? We ask the same thing of our parents after they've attended, you know, a parent presentation as well, and our school educators, the professional development workshops. We we want to know in particular. And a lot of times, you know, what we're we're getting is kind of this, you know, uh data that we can't really collect and put into an actual statistic, but it's our our school rep saying, you cannot believe the difference in this student's behavior, or this teacher is absolutely complimenting the student for their ability to handle, you know, kind of these high-charged, you know, situations in a very different way. So we're getting, you know, that feedback as well. Um, and the the other hubs are also implementing those same outcome measures. So that's that's where, again, that that, you know, um model fidelity and sticking with proven practices as well as using the tools that come along with that curriculum are impactful for us in gathering data. And one of our schools was saying, you know, we don't, some schools are signing up, some schools aren't. One of our districts, and they said, we would love for you to put together bar graphs and, you know, uh show us kind of what is the data that's coming out, because we want to share it with the schools that aren't using your services to say, look, this is what students are reporting, this is what they're gathering to really say, oh, whoa, you know, there's been an increase in this and a decrease in that. So the data is very, very impactful. And while we had a lot of, you know, kind of quantitative data early on about how many workshops we provided, and you know, we I can tell you that we've seen over 720 students in our counseling sessions, and we've provided over 6,000 counseling sessions. But if I can't tell you that we've decreased their so their suicidal ideation, that we've been able to create safety plans with students who do have chronic thoughts of suicide and help them identify strategies. So if they are struggling with their thoughts, they've got kind of this 24-7 plan to keep them safe and to know who I can turn to for support and what can I do to distract myself and what's worked. So we know that just by implementing these tools with our students, that when we close their cases after 12 weeks, and a majority of them do go on to be linked to other services, but here and there, students have really progressed. They want to take a break from therapy. Not everybody has to be in therapy 24-7 for the entire school year. We know that we've left those students with specific coping strategies that they can utilize when the therapy sessions are over.

SPEAKER_02

So the goal is to increase their hopefulness, right? And decrease their hopefulness. The coping skills are really to improve their interaction with other students, right? Or be able to de-escalate situations on their own. Are we seeing any changes in suicide falls or to a hotline? Or are we seeing any changes to what schools are reporting in terms of bullying incidents?

SPEAKER_00

Yeah, that that is interesting data that we just started looking at really the hubs from a statewide um perspective. We looked at kind of this new statistic that said, hmm, there's been a 30% decrease in, you know, kind of these um sending a student out for screening for suicidal thoughts. And so what we're seeing is, you know, a student may really chronically think about suicide. The difference is, you know, we want to make sure it's not escalating, becoming a higher risk, and we want to teach them those strategies. So by having more support services in schools, by even changing the climate of a school, there's a program called Lifelines where the district really is all in on this. Anybody from the crossing guard or the lunch aid are trained in this. So all of a sudden, when you see youth mental health first aid and these other programs where schools are starting to be able to, you know, identify a student early on that may be at risk, all right, and have people in these unlikely spaces, like the person that's serving you your hamburger at lunch, say, You don't look so good today. What's going on? And have a student, you know, I don't, I'm thinking about this. And now all of a sudden you've got somebody, they're not trained to re-de-escalate, but they know they need to identify somebody who can come and intervene. So I think that is some good work that we can all continue to do across the 15 hubs is look at what are the statistics that we're seeing since implementation of NJ4S, you know, have in particular have uh screenings to emergency rooms, has that decreased at all? Have school utilization on mobile response, has that decreased? Um, and what we see is in looking at kind of these high acuity cases, is we we do have students that we feel need to be screened in the emergency room. Um, you know, if the hopelessness is increasing, if they've got a plan, if they're indicating their safety plan is not working, we then work with the school and the parent and we have that student screen. We're not seeing many students that actually get hospitalized on the children's crisis intervention services through our interventions. Um, but we we maybe have, I think one week we had three students that we recommended be sent out for a screening, and we've had nothing since. So it's kind of it ebbed and flows, I think, with um, and I always say that it's a testimonial to the level of trust and the way our clinicians have engaged our students, because there are students that very early on, even in the first intake appointment, uh, will share either, you know, suicidal thoughts or child abuse and neglect, domestic violence, things that you would think might take a little bit longer for them to feel comfortable to share with our staff. So um, again, that relationship that our staff have with the students and the students really feeling like this dedicated time for them is um a place where they can, you know, kind of disclose things that might have felt uncomfortable, I think is a huge piece of that.

SPEAKER_02

Sure. I'm just thinking too, to me, because of the group work, you would think there'd be a change in school climate. Yes. Right. So are schools noticing that overall? Yes, okay.

SPEAKER_00

One one of our uh we worked very closely with the three schools of technology here in Essex County. And after about a year and a half of NJ4S services, the director of student services did a report, they they ran it within their three schools and looked at how many students did they need to send out for additional screenings. And they were able to report back to us that since NJ4S implementation in their schools, they had seen a 37% reduction in the number of uh referrals out for those students. So that to us really, you know, it it proves that providing those services in the school does work.

SPEAKER_02

Sure. And I would assume less kids, well, you would think, or hopefully less kids might be getting into some type of altercation with their body, which reduces the number of calls you have to the police department or just reports that have to get made, but which sets a kid on another trajectory.

SPEAKER_00

And again, you know, what happens when a student gets in trouble for fighting in school? They're typically suspended. What change do we expect to happen? Is that student the next time they become dysregulated and they, you know, impulsively, you know, hit somebody or get into a verbal altercation? Is their first thought going to be, oh no, I'm going to get suspension? No. So what we want to do, um, our our power program, which is called Positive Outcomes with Emotional Regulation, it actually teaches students, right, to start identifying. Like, where are you within your body noticing, uh-oh, I'm getting escalated? Like, you know, we we can all kind of see it in our everyday life, right? In instances of road rage and things that are happening where people just fly off the handle for something. And so if we look at our students, and typically they've reacted, you know, they've probably got a pretty significant history of trauma, which in fact has, you know, impacted their ability to manage stress, you know, post-traumatic stress, as well as to regulate their emotions. So if we don't teach students strategies to be able to handle that and also to identify that, you know, kind of when am I crossing that line where, uh oh, you know, I better take a step back. And we did, we did have a student say, you know, they had already noticed a big difference, whereas before they might have felt like, I need to jump in and be in the middle of this. They were starting to say, uh-uh, I can take a step back. I can use some of the skills that I've I've I've learned. And we've got another program called aggression replacement training. It's got three different, completely different modules. One is anger management, but ultimately what you're looking at is violence prevention. You know, we want our students to be safe in school, but we also want those students who typically have become dysregulated to learn ways to keep themselves safe as well. So give them, you know, more effective ways to communicate, give them ways to manage the stress, give them ways to regulate their emotions, and you're gonna have probably pretty successful outcomes. So our social workers across the board, and especially the schools that utilize us heavily, will say they've seen a huge change in the climate.

SPEAKER_02

So, what are some of those strategies?

SPEAKER_00

Oh, you're you're asking me as the director, I need a sidekick to be able to tell you. But I but I can tell you, you know, there are things like um being able to identify where are you feeling the stress in your body, right? That's a really big thing. Oh, for most of us, if we become anxious or if we become angry, um, we might have a really hard time identifying it. But, you know, I might be able to say, oh, I heart kind of races a little bit, or I feel it in my stomach. My stomach hurts or it gets tight, or all of a sudden I get a headache or my face is blush. So if we teach students to identify kind of these warning signs, like it's like a traffic light, like, you know, green light, full speed ahead, that orange is uh-oh, some warning sign, and red is the stop. Like, what do I need to do here? You know, just by helping them identify not only kind of is this escalating within themselves, but then the specific strategies. So we teach students, you know, square breathing or deep breathing, or, you know, smaller meditation practices, or help them identify what helps you when you're feeling stressed out. Uh, I put on headphones and I dance, or I like to light a candle, or I like to take a nap, or I like to read poetry, or I like to, you know, listen to rap, whatever it is, and then encourage students, hey, if you feel these kind of warning signs coming on, you know, within your body, why don't you try to tap into some of those strategies? And it's the same thing with, you know, our teachers and our parents saying, we want mindfulness strategies as well. Because I think we we're we're looking at a world right now where we're we're all very stressed. And if we don't take that time to kind of dedicate that to mental well-being, whether it, you know, reduce some of these intrusive or distressing thoughts, try to get a good night's sleep, try to eat healthy, try to exercise, try to socialize, do things that bring you joy, um, as well as if something imminently is impacting you, take a deep breath, you know, walk away from it. And, you know, oftentimes just that act, if a student is able to walk away from that conflict, reduces the likelihood that they're just gonna, you know, jump in and kind of, you know, go from zero to 60.

SPEAKER_02

I mean, I totally agree with you. I think the trick is getting people to acknowledge, like you said, what's the trigger and then being able to transfer their energy into that strategy. And I have heard things about um doing yoga, yes, meditation. But sometimes I I guess myself, I question can you make that transition quick enough that some student doesn't just hit somebody else?

SPEAKER_00

Right. And again, it it takes work, which is why if I were to speak to the value of prevention, if you if you put students in a group for emotional regulation, even students that aren't experiencing that level of conflict, but teach them those skills, right? We know that, you know, adolescents and pre-adolescents, you know, their emotions are all over the place, right? Even on a good day. It doesn't have to be pathological. But if we start having, you know, these prevention groups before things really escalate and teaching kids strategies, imagine like the difference in again, this environment and the students being able to kind of impart the wisdom that they have with other students, you know, to be able to say, like, hey, hey, no, don't don't get into a fight. Come here, I'm gonna talk to you for a minute and you know, and kind of assist a friend with you. With some of the strategies they may have learned and not just look at it, you know, people kind of say, like, why prevention? Like, what's prevention? Well, I would say, you know, it's probably similar to like vaccinating your child, right? If we don't vaccinate a child for measles and then they then are exposed to measles, we're gonna have a hard time preventing them from getting measles. But if you look at a prevention group and say, hey, why does prevention work? It's because if we get in there and teach them the strategies before the problems escalate to the level of a crisis. Not every student needs mental health counseling. And we, in fact, sometimes see a lot of commonalities where a school might put in several applications and we say, oh, hmm, this student is having trouble with their emotions. This student is getting into fights. This and can we group them in a prevention group and then see if that's impactful? And we we refer tier two students to our tier three services, and tier three students are also referred to prevention groups because our clinicians know the value of them receiving kind of that ongoing education.

SPEAKER_02

So what if I have a child who I think is overly anxious? Can I call the hub?

SPEAKER_00

So you can call the hub. And again, we've got a main number and we've got our info email address. Well, we're then going to tell parents, and this was something that we encountered early on, because why can't parents call and just refer their youth? And then we had to explain that schools need to put in the application on your behalf. So, what that might look like is we put up a template for parents with the talking points to be able to early on go to their school and say, Is NJ4S in my school? And I heard about this program, and this is what I would like for my youth. And then in those cases, advocate within their school district, or they can say, My school said they haven't signed up yet. Give us the contact information for your school, and then our scheduling coordinators will reach out, tell them how they can access applications. We'll come out, we'll do a presentation on it. So a parent can't directly refer their student, but they can advocate for their school to put in that referral. And that is that is one of the reasons for referral. Parents saying to a school, I'm worried about this. This is what's happening. We just had a student, you know, their father had been detained by ICE, and the mother came to the school and said, You've got to do something. He's just struggling. So, you know, this school was already enrolled with us, but they said, Absolutely, this is what we're gonna do. Here's the consent that you sign, giving permission for your student to be involved in services, and then we come to the school and and take over from there. So it's very seamless. But community organizations also can't put in a tier two or a tier three referral. So let's say it's the, you know, the Boys and Girls Club, and they're noticing, wow, our students might really benefit from this particular group. They don't have access to our NJ Connects, you know, management information system. But we've now been working with them over the summers to say, okay, just because you can't put the application into our portal doesn't mean we can't come out and deliver an evidence-based group to a community partner. But during the school year, we would work with schools to find creative ways. We're working on some really innovative projects right now with the Newark Board of Ed. Um, and in meeting with them, uh, it was it was really, this was kind of the work of a municipal court judge here in Newark who was seeing so many parents come before her because their students were true. And in recognizing how does this change absenteeism and true truancy? So she then scheduled a meeting with the NORC Board of Ed, has been very proactive in what can we do to try to make a difference. And then they brought MJ4S Essex to the table. And what we're now really working on is a program where the NORC schools who serve sixth through 12th grade students are going to identify attendance ambassadors. So they're going to pick six students from 65 different schools, and then they want us to come in and implement the skills training with these, they'll be kind of youth mentors, um, but particularly getting paired with a student that's showing the warning signs of absenteeism. So we would come in and we would train those students. And then as we're working with the schools and they have pockets of students who are being identified, you know, being at risk for truancy and, you know, reaching that mark that we where we see over 60% of our schools are reporting. Um, in those cases, then we can do those evidence-based groups with those students as well and directly teach those students those coping strategies. And our one program, which is CAST, it's it's it's unbelievable, but it's been shown to reduce suicide, right? Suicidal thoughts, anxiety, depression. And then it's been shown to increase graduation rates and decrease dropout rates and absenteeism. So you take a program like that that's teaching students strategies, and all of a sudden, they've got skills to be able to manage. Maybe it is, I'm anxious, I don't have a lot of friends, or, you know, I'm very shy and I'm comfortable, uncomfortable coming to school, or it could be just getting to the bottom of what is going on that's preventing some of our students from coming to school regularly. So, in rolling out that type of project, what we look at is, you know, is this a way for an entire school district to implement a pilot program that might turn around and reverse those statistics around absenteeism? And if not, let's pivot, let's look at the data and let's figure out what more we can do. But, you know, when uh an elementary school student is starting to, you know, show some warning signs, I don't want to go to school or, you know, my stomach hurts, or I don't want to leave you, you know, separation anxiety, things like that. You know, parents struggle with that. I mean, who wants to send their child off to school when they're in distress? And if they don't have the tools to be able to support their students, or if schools aren't even aware of what they can implement to support these students, then, you know, it just kind of gets worse year after year. And we've got students who probably don't graduate, don't, if they get a job, they probably don't keep that job for too long. Maybe they start college, but they can't finish. So if we get in there early and teach these coping strategies, we can change that trajectory so students can be empowered to really, you know, handle these just these adversities in their life in a very different way.

SPEAKER_02

Well, it sounds wonderful that you have a municipal judge who actually decides I'm gonna do something about this and not just keep um because I do know parents can be charged with truancy. And but it's it doesn't solve the problem. And I really commend any judge who's saying, Let me go see what I can do to fix the problem. But it's interesting when you say the the data because I would think if kids are less anxious, they are going to school, they're less depressed, they're gonna pay more attention, they obviously would probably do better in school and thus they would graduate. So it's all very logical. Yes. It's interesting when you say starting at the younger grades, which made me think of you said typically you're really talking sixth grade up. Yes. Is there any work that NJ Forest does with the younger grades?

SPEAKER_00

So any of the tier one presentations, or we can do series. And what we're looking at is there have been um a lot of discussions with the Department of Children and Families because we've been hearing from schools in particular, we want the prevention to start younger. So originally, you know, the prevention was focused for the sixth to 12th grade. Whether this changes and we're able to serve, say, some of our evidence-based practices will say that you can work on this project with 10 to 18 year olds. Some may specifically say sixth through 12th grade students. So we might need some different evidence-based programs if we were to serve the elementary school students. But I am a big proponent of starting that prevention early. Because again, if the problems are starting in fourth and fifth grade, imagine what happens when the student goes off to middle school or high school and it's just magnified. And again, I think too, um, while we probably don't have the capacity as the program stands right now to increase the tier three clinical services to the elementary school level, um, you know, whether that would need obviously hiring of additional clinicians, I do think, again, not to belabor the point, but not every student needs mental health counseling. They can certainly benefit from, again, these other prevention strategies that really help support them with what we're struggling with. And so, you know, so many of our evidence-based programs address very particular topics like the blues. That's for students struggling with depression. So we might say, oh, depression, that student definitely needs a therapist. But being in a group setting, learning strategies, being with other students, having that discussion around mental well-being be in a very comfortable setting, like your school be normalized somewhat, is sometimes also a way to overcome barriers where some of our families don't want their students to receive mental health counseling. There could be cultural reasons, right? Some of our uh cultures will they'll seek out faith-based leaders. They'll um they want this to kind of stay within the family, right? We don't be telling somebody at school about this or that. We'll handle it here. So you can imagine sometimes if you're calling a family and saying, you know, hey, this is our recommendation, they might say, What? No, I don't want my student in mental health counseling. But if it's a school personnel calling and saying, hey, we've got this group, and it may really help with some of the areas that they're struggling with, you know, they've been having trouble concentrating, obviously a side effect of depression. Uh, parents might be more apt to say, hmm, this seems a little, you know, less stigmatizing. And then we've got these barriers where there's been a lot of uh discrimination in our health care and our mental health care systems for students of color. Uh, we know that our students of color are more likely to be diagnosed incorrectly and are also more likely to be disciplined for something that uh, you know, another student might have a very, you know, different kind of intervention for. So we've got a distrust oftentimes of the mental health system. But if this is normalized, hey, our school is going to be enrolling students in these groups, and this is the group we're recommending for your student. Can you please sign the consent? Feels a little different than we feel your child needs mental health counseling, or you know, we feel you need to take your child for a special assessment.

SPEAKER_02

Sure. And also, I think parents don't want their kids labeled. Yes. So when you go into therapy or you're gonna go through the children's system of care and perform care does an assessment and identifies, I mean, rightly so, if a child has some serious emotional behavioral problems, they need to be addressed, they need to be addressed. But it's that labeling. Yes, even if you're saying a child is on a scale showing indications of depression, the program, your tier two group is not labeling labeling these students, which I think is so significant. Yes, that that's to me what's the real I get I think that's very commendable from my perspective because I do know we have an attorney here who helps kids who have um learning disabilities, right, or school issues, and they might have an individual education program or an IEP, but if they have a discipline, Nina gets a whole report and there's all these different labels, which once they happen, they follow students.

SPEAKER_00

Absolutely.

SPEAKER_02

And you really can't undo them. Yes. So to me, I'm listening to you talking about teaching kids strategies, teaching kids how to adjust, putting a group together so they sort of have a buddy who's in the same problem, right? Or the same issue, but they realize they're not alone, but you're not labeling. Exactly.

SPEAKER_00

I think too, you know, we we do uh obviously, you know, I've got clinical training. Um, we do tend to immediately try to put everybody in these boxes and say this is what, you know, obviously, oh, we can explain this behavior. It's this or that. But again, sometimes this is just normal, healthy adolescent development. You know, students who may come from, you know, very financially stable, um, you know, emotionally stable, loving homes can experience, you know, a lot of these challenges, be it substance use or engaging in risky behaviors. And it's not always, you know, up to us to pathologize that, but to take a step back and say, okay, if we're understanding that this is a particular challenge, you know, we've got a very um, you know, in-depth but shorter program called Preventure that gets in there with students and looks at what their personality type is and then kind of what that lends in terms of risky behaviors. And it's specifically to address substance use later on. So, so again, it's not about, you know, it's about your student's been diagnosed with, you know, major depressive disorder, but, you know, we'd like to teach some strategies to help be able to manage some of the stress in their lives, feels very different.

SPEAKER_02

Yeah. I would think it would. And I also think there are gonna be some parents who don't want their kids tested or screened again for that same result that it's gonna follow their students. And so they're gonna say, no, I'm not gonna sign the consent, right? But again, if it's a a peer-to-peer group or you're going to an assembly or you're gonna go through these 10 classes, that might be helpful. That's very true.

SPEAKER_00

They're more likely to, absolutely. And some of our schools have been creative in um, they have us table at back to school night. And so parents come up to the table and we've got all this, you know, literature, these little five by sevens on uh you name a topic, we've got it. And we explain to parents who we are, we explain that we run prevention groups in the schools, and then parents will then go back and say, uh, what is this NJ4S? We want, you know, we definitely want the support of that for our student. So kind of being there and just normalizing the discussion around this makes it less intimidating were the time to come. But if we do it again in a reactionary way, you know, if your student is caught vaping and all of a sudden the school says, oh, we, you know, what what do we do substance use assessments, by the way, and our we have uh licensed uh clinical alcohol and drug counselors that go to the school and actually do the assessment at the school. But then the treatment cannot take place in the school because it has to take place in a licensed facility. So we find that that's oftentimes where parents are very skeptical. Like you said, am I, you know, am I entering the system? What's going to happen with this information? Are they connected to DC, P and P? What happens with this information? All of that. So there is, you know, there is, there can be a distrust of mental health services. But I think once you've gotten in there and you've established a relationship, it's not to say that every student alone can be served in a prevention group. Some students do need the benefit of that individual therapy, and they they need um services beyond that as well. And that's one of the areas we've we've collaborated. Uh, we were one of three hubs. It was um Essex, Mammoth, and Ocean. So the very first year we piloted a program where we worked with the Pediatric Psychiatry Collaborative. And what that looks like, um, great program, it's been around for a very long time, really uh started up as a result of the shortage of child psychiatrists or pediatricians can actually enroll in this program. And if they're seeing youth in their practices where they might benefit from a particular medication, they can work with the PPC on this. But what the PPC has done in our collaboration, especially being able to start year one, was great, was giving us a number of slots every month. So if a student does need a psychiatric evaluation, they get a comprehensive psychiatric evaluation. Now there are barriers, there are families that um don't follow through or are uncomfortable with, you know, with having their child evaluated. But there are also families where if we bypass the long wait for an outpatient center to get that evaluation, right? If we say this is what we're going to address, you know, one of our trickier cases was a student where the parent had shared with our therapist that does she she suspected there were a lot of kind of underlying behaviors that probably were getting missed by the school and was concerned that there were maybe some behaviors that indicated the student might be on the spectrum, you know, rocking behaviors, um, you know, talking to themselves, imaginary friends. There also was a lot of anxiety, a lot of separation anxiety, and then depressive symptoms. So here's our therapist working with this youth and the mom. And the mom had been feeling very frustrated that she'd been asking, I don't, I don't know if this is normal or what can we do about this? And here was the first time where she was saying, wow, somebody's really listening and kind of seeing all of the concerns. And then in referring that student for an evaluation at the PPC, they did uh identify, they identified um attention deficit, hyperactivity disorder, major depressive disorder, generalized anxiety disorder, and that student is now going to get a specialized assessment for autism spectrum disorder. And this mom is just absolutely so grateful because she finally has answers and a greater understanding. And from here they can move forward and work together, and she can learn strategies to support this youth as well.

SPEAKER_02

So is that group that's through the Academy Pediatrics?

SPEAKER_00

That's actually through. So we're in Essex County, we're the only program that's actually run differently than and I, and I'm drawing a blank on who the provider is for the other counties in New Jersey. But our hub, they're actually a hub too. Our hub here for the PPC is run by Ruckers UBHC. So it's it's under the umbrella of Rutgers UBHC. And the beauty there is as well, if a student does need some more intensive services, they they can oftentimes be enrolled in kind of the continuum of care that Rutgers offers as well.

SPEAKER_02

Okay. So it's really just having a network of specialists who can be immediately connected to the youth.

SPEAKER_00

Yes. That's and they really take a developmental approach as well, which is great because again, you know, there are times that we might be seeing something or a parent's concern, but you know, they take a very different approach, a holistic approach, and looking at um, it's not, oh, we need to prescribe medication right away. It's let's get in there and really figure out what's going on. And then we'll take some time and look at it and figure out what the next best step is. So I think that is more uh reassuring to families as well, because I know from running outpatient programs, the minute we would recommend that the child actually be seen by the child psychiatrist, it would be, I don't want my child on medication. And, you know, there are times where yes, there's clear benefit to medication, but medication is not always the answer.

SPEAKER_02

No, I think sometimes it's fresh air and exercise, right?

SPEAKER_00

True. And getting off that device.

SPEAKER_02

Yes. For sure. For sure. So what do you think are the I think we talked a little bit about student challenges, right? What are the biggest challenges facing the providers, except for the fact that there's not enough of you, right? What what are you seeing from? I'm assuming you have 10 clinicians. Um, what are they what's their biggest struggle?

SPEAKER_00

They're gonna tell you parking. Parking in Newark is a nightmare. Okay. And with these giant snowstorms, it really was a mess. So a lot of charter schools um, they take over in buildings where there's not adequate parking, and even their staff don't have parking. But what I'll tell you that I think they will um primarily, I would say primarily, if we were looking at it from a perspective with the schools, it would be uh early on, it was a lack of private space. We had to work really hard with schools to say, even though we're coming into your building, this is the Therapy and the student needs to feel safe. You know, we've been offered uh teachers' lounges where all of a sudden there's, you know, we put a sign, do not disturb, but a teacher opens the door. I need to heat up my lunch in the microwave. So we very much had to advocate for, I think, creating really safe spaces for the students. I would say for them as well, oftentimes it would be the challenge of really getting the parental buy-in and involvement as well. You know, we consult with the families, we do family therapy as well. We had a really great case where one of our clinicians was able to do not only therapy with the parents, because the parents were identifying a lot of challenges, but there were there were problems with the sibling. And she was able to do sibling sessions. But a lot of times parents are kind of it's taking place in the school, a little bit hands-off. And, you know, a challenge oftentimes is getting a hold of them to be able to communicate or collaborate. And especially, obviously, if there are any, you know, risk factors, we want to share the safety plan with them or maybe uh talk to them about, you know, reducing um any access to, you know, lethal means. You've got to, you know, your student has disclosed that they've thought about taking a knife. We need you to get all the kitchen knives, you know, out. You know, we need you to take razor blades out of the so we try to be very collaborative, but I think oftentimes because a parent's not driving the student to the session, they're, you know, it's a little bit harder to engage. Um, and I think for our clinicians, what they would probably say one of the biggest challenges is just really just the overwhelming um amount of stress that our students are suffering with. I mean, whether it be students who've been sexually exploited, uh, students who've witnessed domestic violence, uh, a student who may come home and find a parent dead of an overdose, um, students being raised by, you know, caregivers or in resource homes, you know, students who are homeless, and you know, the lack of financial stability obviously are undocumented students. So there's so many layers that just, again, not to give a diagnosis for this to say, but this is just an inordinate amount of stress that our students are dealing with on a regular basis. Um, and just uh really wanting early on tools and interventions to be able to make a difference. So besides the uh cognitive behavioral interventions for trauma in schools that they were trained in, our all 10 of our clinicians have been trained in what's called eye movement desensitization and reprocessing, EMDR. And it's a mouthful, but it is an evidence-based intervention for uh individuals, can be children on up to adults who've experienced distressing events, have distressing thoughts kind of to reduce the impact that this is having. It's a very, it's a mind-body connection, as well as you are actually reprocessing the way that the trauma is stored in their bodies. The example I like to give is if you're watching one of those um animal wildlife shows and you're watching the plains of Africa, and this beautiful lion is chasing this beautiful gazelle, and the gazelle is running, running, running, and the lion's trying to bite and get the gazelle, and finally the gazelle gets away. Right? Animals actually shake their heads violently after a traumatic event like that. It's again reprocessing this. So EMDR, and I am not trained in it, so I know one of our clinicians would do a much better job, but you can use a light prompt where they're they're following this light. You can use a tapping. Students can tap themselves. There are plenty of interventions. What happens for our students is um if they decide that they think EMDR and the parent is in agreement would be helpful, they oftentimes say after interventions, I feel like I need to take a nap. I feel so relaxed, I feel because these are proven strategies to impact that. In addition, it does teach them, you know, kind of what's your what's your calm space? So for me, I might say it's the ocean, right? Listening to the waves and the sun is out and hearing the birds overhead, right? A student could identify anything. But when things become stressful, can you go to your calm space? Can you go to that place, as well as kind of these container exercises where they actually get to visualize like putting all this trauma, everything that's impacted them, you know, kind of in a container, putting the lid on and keeping it there until they come back for the next session. So our staff uh very much wanted to be trained in specific interventions and not just be generalists. And I think that's why we've seen really positive results with the therapy. When our when our clinicians end with their students, they um the students that were resistant and didn't want to see a therapist for mental health counseling are now going down and saying their school reps. Why? Why does it have to end? Can I see them again? Put in another application. So it's it's really uh, you know, it's changed their perception of um seeking help as well.

SPEAKER_02

No, it sounds like there's been so much accomplished and I've learned, I mean, I had a vague understanding of the hubs, but I've learned so much more. So I really do appreciate that, Diane. What would you like to see changed in the next 10 years?

SPEAKER_00

In the next 10 years, I I do think that we've got to start prioritizing prevention more. Again, we're quick to put in, and we need, we need, you know, crisis response services. Um but we oftentimes feel like prevention is, you know, that's kind of the item that can be cut or put over here. So I would like to see prevention start at a much younger level. Um, I would like to see more, more parent uh skills programs as well. So some of the programs I mentioned at uh family connections. Um, you know, pairing a parent with somebody that they can work with and say, I need some support around this or this is happening, you know, can really be transformational in terms of the way the parent is raising that child and can be so helpful. So I'd like to see more support for parents as well. Um and I do think that there's always an opportunity for partnerships between mental health professionals and the schools. And different schools have a different level of services, depending. But I do think that this is where students spend the majority of their time, you know, nine months out of the year. So to be able to destigmatize and start, you know, kind of providing services where the students are, I think is a great first step.

SPEAKER_02

Okay. But you still think just not necessarily putting the person in the school is not necessarily the answer. I mean, you seem to have said earlier having that separation does help both for the purpose of the student trusting that person, but also time management. I know when we look at some of the data in terms of how many, when you have guidance counselors or your librarians, even it's 500 to one, like 500 students to one librarian, 500 students to one guidance counselor, which is nearly impossible for them to do that individualized attention.

SPEAKER_00

Yeah, and I think um I'm hearing this from the school social workers themselves. You know, one of our school social workers, she we taped a testimonial video, and we said to her, What would you say to other school social workers or counselors that haven't used NJ4S services? And she said, Do yourself a favor. She said, You may think that it's gonna take all this time. I have to call the parent, I have to get that consent, you know, that I have to go through all of this to get this student seen. She said, I can tell you that you will take so much off your plate because that student won't be the student that's coming down to your office four times a day, or that student's not gonna be the student that gets pulled out of the lunchroom for being in an altercation and is in, you know, in school suspension. So to hear from our social workers that they're saying they do not have time to do that. Do they wish that they could? They absolutely do, but they don't have time. And even the social workers where it may be a part of their job description, they'll say things like, I had to do lunchroom duty today, or we had uh an, you know, a teacher who had called out and we couldn't get a substitute. I was in the library with students. So social workers, I think, get pulled in a million different directions. And while their heart may be in absolutely directly serving the students, oftentimes that's just not a reality, especially in a really busy, busy school district. And some of our school districts are facing severe budget cuts. Um, the East Orange School District, they had to lay off their social workers. So we saw utilization rates for NJ4S go way up because now they didn't have anybody, and a social worker might be going to three or four buildings. And that's oftentimes what happens in a smaller district, too. You may hire a dedicated individual, but they're responsible for five schools. So they're in those schools maybe one day a week. But then if there's a crisis in another school, they may get pulled out of that school and not able to see the students that they were supposed to see. So I think it's challenging. I think schools do the absolute best job they can with that. But I do think they appreciate knowing that, you know, trained prevention consultants and trained clinicians are coming to the school and all they're really needing to do at that point is get the consent signed and make sure there's a room for us to do our magic. And then their day is that much less crazy because they can sit back and say, okay, I know these students are getting the support they need. So I do think the fact that we show up at the schools, we're flexible. We have, you know, dedicated schedules, but we're also flexible if there's testing. We can do telehealth. If a student says, Hey, I'm on a school trip today, but could we do a telehealth session at night? We can do that in the summer. I don't really want you coming to my home. My child is home alone, which obviously we wouldn't see a child alone, but you know, I'm working two jobs. Can we do telehealth sessions? And so we're able to kind of reduce barriers that oftentimes schools wouldn't be able to either. And again, if you're if your argument is you don't want students taken out of academic subjects, then that becomes more challenging too, when it's there's just so many lunch periods and just so many gym periods. And if you've got this big caseload, like you said, of students, how do you fit them all in?

SPEAKER_02

No, I don't I don't think you do. I think that's part of the problem.

SPEAKER_00

So I think the the thing that I take away from NJ4S is um it was it was really such a well-thought-out program. So, in all my years and all the different programs I've worked in in different places, I've never had a staff that are as well trained as our prevention consultants and our clinicians are. So I think that speaks volumes for having a mental health or a social service agency being able to manage a project like this because we've got the clinical supervisors, right? We know the value of these different trainings. I mean, our staff were in anything from presentation skills, learning how to be effective public speakers so that when they went out and did a presentation, they could feel more confident to being in training after training on these different evidence-based practices or clinical interventions. But at the end of the day, I think that would, that's what makes this program so strong is we're sending out a highly qualified workforce. And in this day and age where there is a workforce shortage, especially with clinicians, we have had the same 10 clinicians. We had one staff member leave three months in because it was a very difficult commute. Other than that, we have had the same staff. So when you look at that, I mean, that I think speaks volumes. And we're not, we're not saying, oh, we can't provide these services because we can't find staff to hire. We're saying our staff, because of their training and their expertise and because of their dedication to the field, have made a choice to stay, you know, to stay and serve those students. And they they love their jobs, you know, they get a lot of gratification over forming these relationships with the kids and watching the kids, you know, grow and change.

SPEAKER_02

It sounds like they're very committed to their students, which is wonderful. So well, thank you very much for your time, and I appreciate all the work you do, and as well as all the work of your staff.

SPEAKER_00

Thank you so much for having me.

SPEAKER_02

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