As kids' anxiety spikes, school nurses step in to address mental-health needs
Chicago Tribune - 8/23/2018
Aug. 23--A few hours into the first day of school, a young man entered the nurse's office at Libertyville High School complaining of stomach pains.
The school nurse began asking him routine questions to determine the root of his troubles: Can you describe your symptoms? What have you eaten? Are you on any medication?
Cameron Traut, who has been the school nurse for Libertyville District 128 for 14 years, wasn't surprised when the student eventually revealed that he had a history of mental health issues and was taking prescription pills to treat anxiety.
It's a scene that school nurses are expecting many times over as the new year opens, reflecting both the growing number of mental health issues among school-age children, and how the traditional role of school nurses has evolved from cleaning up playground scrapes and taking temperatures to meet the needs of this growing population.
"There's so much more in the school nursing world today than there ever has been," Traut said. "These are constant conversations that we're having here in this school setting to make sure we're on top of supporting these students."
According to the Centers for Disease Control and Prevention, more than 1 in 20, or 2.6 million, U.S. children ages 6 to 17 had current anxiety or depression diagnosed by a health care provider in 2011-12.
School nurses in Illinois say the increase is evident in the students from elementary to high school who enter their offices each day, requiring not only bandages and ice packs but also a quiet space to break from stress. Nurses now have to schedule meetings with parents about their child's mental health histories and needs, then learn the side effects and potential complications associated with mood-altering medications.
To meet the new demands, school nurses are offered extra training in mental health as well as resources from the National Association of School Nurses. They are adding relaxation rooms to the typical beds in the nurse's office, and they have had to develop detailed cooperation plans with school guidance counselors and social workers, who are trained to handle such issues but, for better or worse, are not always the first stop for students seeking a nurturing response in a school building.
"In the past, we used to be kind of hard-nosed. 'Nope, you don't have a fever, you've got to go back to class,'" said Nina Fekaris, president of the National Association of School Nurses, based in Silver Spring, Md.
But today, the nurse's office is often the first place students turn for help with mental-health issues, she added. "It's one of those areas where we've tried to create a space that's super-nonjudgmental."
Despite these efforts, local and national school nurse associations worry that they are outnumbered by the number of students in need of their help. Today, there are only 700 school nurses in the Illinois Association of School Nurses -- working at 3,796 public schools across the state.
The shortage is exacerbated by the fact that the state does not mandate school nurses in each district, and school nursing positions tend to be less appealing to nursing graduates because the pay falls well below what they could make in a clinical setting, officials at the Illinois Association of School Nurses said.
Another challenge is that with budget shortfalls, outside state-funded mental health service providers for teens have dwindled, leaving the burden largely on schools.
"I think we need to advocate for more school nurses in our buildings," said Traut, who also serves as a director to the National Association of School Nurses. "There's definitely a trend that we are taking care of more students with actual diagnoses, generalized anxiety disorder, depression, panic attacks, panic disorders."
At Amos Alonzo Stagg High School in Palos Hills, the nurse's office is a bustling center with a reception desk, waiting area and several rooms ready to handle the needs of the nearly 2,300 students enrolled.
One room holds half a dozen vinyl-covered sick beds to handle students with fevers and stomachaches. Another room offers a comfortable chair and table with a desk lamp for students or staff who are breastfeeding. That room doubles as a quiet sanctuary for students having panic attacks or needing a break from stress.
"It's just a safe place for them to come," said Linda Vollinger, the high school's nurse, who left an emergency room job 14 years ago to bring her skills to students. In that time, she's been amazed by the way mental-health issues have evolved from being closely guarded secrets to something she discusses with about three students each week.
"It's a huge culture shift," said Vollinger, who is also president of the Illinois Association of School Nurses. "It's great that we're seeing that stigma ripped away."
While many schools and districts have social workers and psychologists on staff, students tend to think of the nurse's office as the first stop to get the attention they need. In turn, nurses, social workers and psychologists at schools today work closely together to make sure a student gets continued care.
The prevalence of mental-health issues has prompted structural changes at Stagg and other schools. Three years ago, district officials allowed Vollinger and other school staff to create an "intervention" classroom located between the nurse's office and the guidance counselor's office.
The classroom is designed to help both students who have been out of class for disciplinary reasons and those who have had mental-health-related absences transition back to the daily routine in a more nurturing setting than being thrust back into busy hallways and full classrooms.
When the school nurse learns that a student is returning after a prolonged absence, she works with other building specialists -- including intervention room teachers, school social workers and guidance counselors -- to collect the student's coursework. The student is then able to ease back into the school day in a room decorated with sayings such as "Be Happy" and "Be Original." The room also is used for students who experience testing anxiety and need a quieter place for exams.
While such classrooms were unheard of even a decade ago, they are becoming more common across the state as schools recognize the adjustments needed to address students' growing mental health needs.
At Stagg, the intervention classroom hosted 771 students last school year. Of those, 607 had disciplinary issues. An additional 164 students were in transition after missing school for social or emotional problems, said Tara Syska, intervention room mentor.
Elementary school nurses are also encountering students with mental health needs. In standard paperwork turned in to her office at the start of this school year, Lynda Kim, school nurse at Willow Bend Elementary in Rolling Meadows, took note when the parents of one student listed a psychotropic drug as one of the medications school staff should be aware the child is taking.
Kim used the information to develop helpful lists for the child's teachers on the reasons for the drug, possible side effects that may be noticeable in the classroom, and possible interactions with other medications for which teachers should be mindful. She also called the student's parents to ask for a meeting so that she has a thorough understanding of what the child may need in her care.
"It's becoming somewhat easier to talk about, so that's good," Kim said. "If I see a child with medications for diabetes, I do what we need to do to make sure that diabetic child is safe. If I notice a child coming in with psychotropic meds, I'm going to alert the teachers about what we can do in the same way."
For now, Traut and other school nurses say they work with what they can to meet the needs of their student populations. Through online resources and their own continuing education, they learn about how to talk to students struggling with mental health issues in a way that helps to position them for the best continued care. And as students stop into her office, Traut tries to offer them the care they need, whether it's a look at a cut, or a glass of water and a fidget toy to calm their anxiety.
"There's a whole lot of rewards," Traut said. "I love the challenge of working with teenagers and adolescents and helping them become independent, helping them build skills of independence and self-advocacy."
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