In a supply closet next to science classrooms in Port Chester Middle School, Raquel Torres helps students work through some of their biggest challenges: anxiety, depression and a host of other issues.
There is just enough space for her desk and a chair for students, who often find comfort holding the stuffed whale she keeps on hand. But that’s all the space she needs.
In every school in Port Chester, the district has found space for bilingual mental health clinicians employed by Family Services of Westchester to set up mental health clinics. This way, students can access therapy without leaving the building. These offices, often located near school psychologists’ offices or health clinics also run by an outside agency, are considered satellite locations of Family Services of Westchester’s Port Chester clinic.
“Sometimes the kids need more coordination of services, more significant clinical needs that need to be met, and FSW can really support that,” said Maeva Rich Kennedy, the school district’s director of guidance.
Schools across the country have been increasingly focused on providing mental health services for students during what has become a well-documented mental health crisis among young people. In the Lower Hudson Valley, a growing number of schools are setting up mental health clinics for several reasons.
For one, clinics are a direct way to get kids mental health treatment. Students can go during a class period.
“That’s why there’s been this growth: because it’s easier for kids to get to those programs while they’re in school,” said Michael Orth, Westchester’s community mental health commissioner. “It can be better coordinated with their teachers, some of the other academic services, and it’s more of a holistic kind of approach.”
Parents don’t have to leave work to take their child to an appointment. But they remain involved in their child’s treatment — they can be in frequent contact with their child’s therapist, and even participate in therapy themselves.
And therapists, being in school, can observe a student’s behaviors they might otherwise hear about after the fact from parents or students. “You can be there when things are happening,” said Karen Fink, executive vice president of clinical services for Family Services of Westchester, an established nonprofit agency that provides mental health and other services through 50 programs across the county.
There are more eyes on students, Fink said. “I think you know a fuller part of their life,” she added.
Additionally, in January, the state began requiring commercial insurance to reimburse school-based clinics at the same rates as Medicaid. Clinics previously accepted Medicaid, while commercial insurance covered services to varying degrees.
A few Westchester schools started mental health clinics as far back as the late 1990s. Port Chester’s first satellite clinic, in the high school, has been there for over two decades. But the numbers are now growing fast. Westchester schools have over 60 clinics, with several more in the works. Rockland schools have nine clinics, and Putnam schools have one, with two on the way.
In addition to Port Chester’s six satellite clinics, FSW has satellite clinics in another half dozen Westchester schools.
Mental health treatment starts in elementary school
The mental health crisis facing kids is often characterized by its impact on teenagers — a rise in suicides or drug use. But mental health professionals say it’s just as important to address the mental health needs of younger students.
Port Chester has a bilingual mental health clinician from Family Services of Westchester in each of its four elementary schools, two in its middle school and two in its high school.
FSW’s clinicians see the full range of mental health needs: from the youngest elementary school students, for whom therapy includes reading books and playing games, to high schoolers who are becoming adults and beginning to contribute to decisions about their own treatment.
Students who see FSW’s clinicians often need ongoing mental health treatment, which is more than just a couple sessions to talk through a problem, Fink said.
And the clinicians make diagnoses: oppositional defiant disorder, adjustment disorders, PTSD, substance use disorder, bipolar disorder, anxiety and depression, for example. They can’t prescribe medication but if a student’s diagnosis requires it, the clinicians refer them to psychiatrists, who can.
Students’ crises are real and varied
At King Street School, one of Port Chester’s elementary schools, clinician Paola Cadet said she sees students with ADHD, anxiety and even depression. She recalled one student who always wore black, kept her hoodie up and didn’t participate in class.
On more extreme days, FSW’s clinicians may need to help students in a crisis. That could mean a student who harmed themself at school or told a teacher they wanted to kill themself, said Hortensia Alvarado, one of the agency’s clinicians at Port Chester High School. The mental health clinicians then coordinate with other school district staff, police and emergency responders if necessary.
Sometimes a crisis is a student having an anxiety or panic attack, said Jordan Benavides, one of Port Chester Middle School’s clinicians. In many instances, Benavides said, he and his fellow clinicians help students regulate intense emotions. Sometimes that requires staying with students as long as a couple hours, he said.
But most of the time, Port Chester students go to scheduled appointments during certain, generally less critical class periods to address their mental health needs. In the middle school and younger grades, the mental health clinicians pick students up from class to make sure they make it to their appointment.
Jennifer German, an FSW clinician at Park Avenue School, an elementary school, said younger students are still struggling with social skills that were delayed by the COVID pandemic. And she still has students who have anxiety about germs and getting sick.
The clinicians in the elementary schools described a wide range of behaviors they see: everything from kicking, screaming, crying and throwing chairs to “shutting down completely,” Cadet said.
Benavides, at the middle school, said some students end up seeing a mental health clinician because their issues show up as behavioral problems: interrupting class too often, repeatedly showing up late or being defiant.
Other students are affected by problems at home, like parents getting divorced.
“You’re dealing … with more complex issues as they’re older,” Torres, also at the middle school, said.
By addressing mental health at a young age, “we’re setting their future up for success,” said FSW’s Christina Lanzetta, who supervises Port Chester’s elementary school clinicians.
Clinics involve parents, provide year-round services
To see one of FSW’s clinicians, students get referred, either by guidance counselors, nurses, teachers and administrators, Torres said.
Clinicians have a caseload of around 40 to 50 kids and Fink said they do their best to operate without waitlists.
Therapy through FSW is free for families, but families’ insurance policies are billed. If students don’t have insurance, FSW helps their families get it.
While a family waits for insurance, FSW still provides students with therapy, Fink said. The school-based clinics bill insurance the same way FSW’s community-based clinics do but don’t collect copays.
Orth, Westchester’s mental health commissioner, said school districts have started dedicating some funding to school-based clinics, and grants also help them operate.
School districts are increasingly realizing the investment is worth it.
Schools have their own school psychologists, social workers, counselors and other professionals. But FSW’s clinicians “have the opportunity to go beyond school hours,” Kennedy said.
FSW has a 24/7 call line and clinicians see kids throughout the summer.
And the transition for students switching therapists when they change schools is made smooth by FSW clinicians who easily work together. After students graduate high school, they can continue to seek treatment at community-based clinics.
The satellite clinics also provide another direct connection to parents, who can see the therapists with their kids for family therapy, or even on their own.
“A lot of parents don’t know we’re in the school,” said German. “So when we reach out, it’s like, ‘oh, you provide that service?’ “
Fink said FSW doesn’t work with students without “really intensive work with their parents.”
“Sometimes there are some parents that are not so involved, which makes it a little hard. But, you know, we tried to be on top of that,” said Paola Pastor, a mental health clinician at John F. Kennedy Elementary School.
Gisselle Cardenas, one of the high school clinicians, said students who are 18 can decide if they want their parents to come to sessions. And confidentiality still applies: “What we speak with with the client stays with the client. What we speak with the parent stays with the parent. If we need to merge something then it’ll be a combined session where they will all speak to each other in person.”
To respect that confidentiality, the district did not make students available for interviews for this story.
But it has prioritized finding space for the satellite clinics in its buildings, which, as is the case with most schools, weren’t designed with mental health clinics in mind. The clinics are tucked wherever there is space, often in small rooms without windows.
But the work FSW is doing in the schools is no secret. Torres and Benavides handed out brochures at a parent teacher night.
And it can be encouraging for students to see other students be open about accessing therapy.
“I’ve had a couple instances where I’m in the hallway, a student says ‘hi’ to me, and then I’ll hear from the back like ‘who was that?’ ” Torres said. The reply: “My therapist!”
Kennedy credited Port Chester’s superintendent, Aurelia Henriquez, for recognizing and addressing the district’s mental health needs.
An immigrant population with accompanying trauma
Port Chester’s students face the same mental health challenges as young people across the country: anxiety, depression, drug use and more. But many of the district’s 4,500 students are immigrants who endured traumatic experiences to get to the U.S.
“Some of the kids had to cross the border. Some of the kids slept outside,” said Jessica Cabrera, an FSW clinician at Thomas Edison School, an elementary school. “Some of the kids were in detention centers for a while.”
Other kids were separated from their parents, Fink added.
Alvarado, at the high school, said some students experience trauma, like sexual abuse, in other countries before immigrating and coming to Port Chester.
Port Chester’s population was also hit especially hard by the pandemic. FSW’s clinicians have some students who lost family members, Fink said.
Trauma can present itself as anxiety or sensitivity to noise or being hyper but all the clinicians are specially trained to identify where the trauma is coming from and how to best support students who’ve experienced it, Cabrera said.
And to help all newcomer students, not just kids who see FSW clinicians for therapy, the clinicians run weekly groups for newcomer students about adapting to life in the U.S. The high school also has a parent group that covers a range of topics.
Alvarado said students learn of FSW’s services by word of mouth. Students tell their friends about therapy at school and sometimes a student will knock on her door and ask for help.
“It’s so beautiful to watch them grow and evolve,” said Cardenas. “I’m like you don’t even have to thank me. Thank yourself.”
Contact Diana Dombrowski at ddombrowski@gannett.com. Follow her on Twitter at @domdomdiana
