The Washington Post - 20.08.2019

E4 EZ EE THE WASHINGTON POST.TUESDAY, AUGUST 20 , 2019

kids health

in mock disgust, recalling how the

sound once embodied her hatred

of classrooms.

A few years have passed since

Newcomer left Crockett, where

she was among the first students

to receive on-campus treatment

from Minne’s counseling practice,

now known as Vida Clinic. Thera-

pists have their offices within

schools, where they treat students

directly rather than assessing and

referring them elsewhere. The

Crockett clinic was the first of its

kind in the state in 2014. Now it’s

one of more than 40 in Austin run

by Minne, who has a doctorate in

psychology.

Moments later, tears streamed

down Newcomer’s face as she de-

tailed her struggles throughout

middle and high school.

As a teenager, she faced unre-

lenting depression, battled trau-

ma stemming from a sexual as-

sault, grappled with her older

sister’s several suicide attempts

and felt the strains of her moth-

er’s multiyear unemployment.

Everything was scarce during

those times, especially peace of

mind, she said.

But when Newcomer met

Minne, her pain began to melt

away. She had a refuge within

steps of her classes and someone

to advocate for her needs to both

her teachers and her parents.

Most of all, she had daily access to

clinically licensed mental health-

care services. Newcomer felt se-

cure, she said, for the first time in

her life.

“For years, I just wanted to die.

I didn’t want to exist,” she said.

“But within a few months of be-

ginning therapy, it was the com-

plete opposite. I began feeling like

I mattered, that my life mattered.

It opened up a world of possibili-

ties for me.”

Over time, Newcomer’s depres-

sion and anxiety decreased, her

happiness and confidence in-

creased and her grades and at-

tendance skyrocketed — break-

throughs that propelled her to

graduate from high school a year

early.

“Growing up is hard enough as

it is,” Minne said. “When you add

in common challenges like anxi-

ety, substance use issues, severe

school stress or family-related

trauma, it’s incredibly difficult for

a child to develop healthy coping

VIDA FROM E1 habits without the proper sup-

port. That’s where we come in.”

Early stages

Four years ago, Vida Clinic

partnered with the Austin Inde-

pendent School District (AISD) to

create on-campus mental health

centers at three area high schools.

Their goal was to prove that ac-

cessible, trauma-informed men-

tal health care can significantly

aid students struggling with de-

pression, anxiety and a host of

trauma-induced conditions.

Within a matter of months,

kids who had been exposed to

abuse, sexual assault and other

scarring experiences saw striking

improvements in their grades, be-

havior and overall happiness, ac-

cording to evaluations by Vida

and the school district.

Tracy Spinner, AISD’s director

of Student Health Services, was

impressed. “Not only did these

kids’ mental and emotional

health improve; their attendance

improved and they became re-en-

gaged in school altogether,” she

said. “We couldn’t help but do a

double take and think, ‘Did that

just happen?’ It was stunning.”

In late 2017, with Spinner’s sup-

port, AISD secured $4.5 million of

state funding through the Victim

of Crimes Act to open Vida Clinics

at 22 elementary schools in some

of Austin’s highest crime Zip

codes.

The district’s thinking was sim-

ple: because children living in

high-risk areas are more likely to

be exposed to traumatic events,

their schools need to be more

dynamic in meeting their mental

health needs.

“People with unaddressed

trauma are often the ones who

end up falling into drug habits or

the school-to-prison pipeline,”

Minne said. “If we’re catching

those people early on and giving

them the support they need,

they’re not going to be hospital-

ized or in the legal system down

the line.”

Minne argues that every com-

munity needs access to mental

health resources, which is why

one of her three original clinics is

in a school known for its high

academic achievement and afflu-

ent student population.

“Many students are facing im-

mense school-related stress that

can fuel self-destructive behav-

iors. Their struggle is very real,”

Minne said. “Mental health issues

don’t discriminate by race or so-

cioeconomic status. Every com-

munity wrestles with them in

deep, painful ways.”

The concept of school-based

mental health has been around

since the 1890s and the Progres-

sive Era, but on-campus counsel-

ing services have traditionally

been limited in America’s educa-

tion system. Many schools’ mental

health professionals (academic

counselors or social workers, for

instance) typically do not have the

capacity or professional training

to aid students suffering from se-

vere mental health issues similar

to Newcomer’s — suicide ideation,

anxiety and other symptoms of

severe trauma — on a daily basis.

Instead, struggling students often

are assessed before being referred

to an outside therapist.

The ratio of students to a

school’s mental health profes-

sionals is a vital piece of this

conversation.

The average academic counsel-

or has 455 kids under their watch,

according to the American School

Counselor Association, which

recommends a 250:1 ratio. As of

last December, Vida Clinic had

nearly 60 therapists on hand to

serve over 1,000 students en-

rolled in their clinics throughout

the district — an approxi-

mate 20:1 ratio.

Even when school counselors

are not overloaded, a referral-

based process can have logistical

and economic gaps. Commuting

to therapy sessions, for example,

can cause kids to miss extensive

chunks of class and force their

parents to leave work, an especial-

ly large barrier for low-income

families.

There can be lengthy waiting

lists for appointments, too; New-

comer’s mother said her eldest

daughter faced a three-month

wait to receive services after she

experienced a mental health cri-

sis in high school and showed

suicidal tendencies. Unable to

wait any longer, they admitted

her to the hospital, the last (and

costliest) resort.

Vida’s therapists are in schools

every day, allowing them to en-

gage students, their parents and

school staff simultaneously. This

equips school faculty with mental

health training and gives stu-

dents constant access to care.

“We work with teachers on de-

veloping core skills and being

able to identify warning signs. We

want them to know if a student’s

action is typical or atypical and

what to do if they see a student in

need,” Minne said. “We’re here to

help create healthier learning en-

vironments for teachers and stu-

dents alike.”

Other states are putting re-

sources into schools, too. Califor-

nia’s School-Based Health Alli-

ance, for instance, provides myri-

ad services to students (including

mental health care) in more than

250 schools and is considered

among the nation’s top systems

for on-campus care.

But Austin is creating one of

the country’s most ambitious

school-based mental health sys-

tems in a state that, according to

the nonprofit group Mental

Health America, ranks last in the

country in youth access to mental

health care.

Vida offers data to show its

clinics make a difference.

In 2017, it compared nearly 800

of its clients to a control group of

over 300 of their peers, who were

also identified with mental health

and behavioral issues. Suspen-

sions among Vida’s clients

dropped by nearly 10 percent,

aggressive behavior offenses and

substance abuse violations

dropped, and expulsions were cut

in half. High school clients’ GPA

was 20 percent higher than their

control group’s.

“Numbers and cold hard data

are much more difficult to refute,”

Minne says. “They’re what truly

speaks for our work.”

One former client described

how the clinic intervened when

her anger and depression poured

into the classroom. Plagued by

anxiety and problems at home,

she frequently got into fights, dis-

rupted class (if she showed up)

and rarely did her schoolwork.

Suicidal thoughts swam through

her brain. She began cutting her-

self in secret.

Her therapist, Laura Johnson,

saw she was grappling with a

series of traumatic experiences.

“Once I saw Mrs. Johnson, ev-

erything changed,” the student

said. “Now, I have friends I’ve

been close with for years, have a

better relationship with my

grandma and I’m thinking about

the future.” She plans to begin

college this fall and eventually

hopes to pursue a master’s degree

in social work.

Community support

Funding these services isn’t

cheap, but Vida has received

steady support from AISD — es-

pecially Spinner, who has worked

to secure previously untapped

revenue streams to pay for the

clinic’s expansion. In addition to

the $4.5 million grant AISD re-

ceived from the Texas state gov-

ernment in 2017, Spinner ob-

tained another $9.1 million from

the governor’s office to fund

Vida’s services in 2018-2019.

“We were the first school dis-

trict to ask Governor [Greg] Ab-

bott for that kind of money for

mental health services,” she said.

“From that point on, we knew this

was our chance to prove to the

entire state that this approach to

mental health care is for real.”

This funding has kept the clin-

ics open and allowed Minne to

treat anyone who enters her offic-

es, regardless of their insurance

coverage or financial situation.

They even treat teachers, school

administrators and clients’ family

members — a holistic approach

that aims to make a child’s entire

surrounding environment

healthier.

Still, Spinner wanted Vida and

AISD to become more self-suffi-

cient, so she overhauled the pro-

gram’s funding model this sum-

mer. Now, instead of being almost

entirely reliant on federal and

state grants, the clinics collect

money from insurance payments

and local taxpayer dollars.

“The expectation is that, under

this new funding model, Vida

Clinic’s going to continue expand-

ing within our district. Within the

next three months, we’d like to be

on every middle school campus in

the city,” Spinner said. “Further-

more, within the next year or two,

my goal is to have an on-campus

clinic in every single one of Aus-

tin’s 130 public schools.”

To Spinner’s point, the AISD

Board of Trustees voted on Aug. 12

to grant Minne’s clinic full owner-

ship of all 43 of its on-campus

mental health centers — includ-

ing 16 that had previously been

under the watch of Travis Coun-

ty’s local mental health authority,

Integral Care.

Now, other Texas schools are

considering duplicating what

Austin — the state capital — has

done. And Minne and Spinner

lobbied Texas lawmakers to make

mental health a priority during

2019’s legislative session. By the

end of the session in June, six

different bills related to mental

health care and school safety were

passed with bipartisan support

and signed into law to expand

Texas’ mental health workforce,

provide aid for families and

schools with high-risk children,

and establish mental health train-

ing programs in schools.

Despite these breakthroughs,

Minne knows Texas — and Ameri-

ca as a whole — still has a long way

to go in providing adequate men-

tal health care. But if we’re going

to start anywhere, she said, it has

to start with our future: our chil-

dren.

“With true care and compas-

sion, we can help kids build resil-

iency over the long haul,” she said.

“Bolstering their well-being can

strengthen schools, heal families,

and reshape communities.”

[email protected]

Mental-health clinics are making

a big difference at Texas schools

BY COSBY STONE

M

any people wonder

whether our society’s

desire for cleanliness

may have gone too

far and is causing

health problems. For parents, this

raises an interesting question:

How dirty should you let your kid

get?

Eating dirt might be a stretch,

but it’s certainly good for them to

play in it, and it’s definitely impor-

tant and beneficial for children to

spend time in natural areas such

as farms and forests.

Allergists like me are studying

whether protecting our body’s

barriers — the skin, along with the

lining of our respiratory and gas-

trointestinal tracts — and expos-

ing kids to more bacteria in cer-

tain contexts could help prevent

allergies. The answer to both ques-

tions appears to be “yes.”

The scoop on dirt

The revised thinking about dirt

comes from something called the

hygiene hypothesis. As society

progressed from one that was

chronically burdened with infec-

tious diseases caused by poor sani-

tation, we reduced our exposures

to the things that gave our im-

mune system an appropriate

training and tolerance. For in-

stance, our totally rational fear of

dying from a cholera epidemic led

to sewage and water manage-

ment, but that may have kicked off

the allergy epidemic.

Studies that have looked at kids

who grow up on farms have yield-

ed interesting information.

Growing up in a rural area ex-

posed to farm animals appears to

confer decreased risk of allergies

and asthma for your lifetime, even

among genetically similar popula-

tions. Studies in mice have shown

that inhaling certain molecules

from soil-dwelling bacteria can set

off a beneficial cascade promoting

an immune system that focuses

more on threats rather than non-

threats, such as allergens.

Vaccinations appear to be a cru-

cial exception to the rule of the

hygiene hypothesis. They confer

protection against diseases with-

out any associated increase in the

risk of allergic disease, probably

because they, unlike antibiotics,

are specifically targeting only the

worst disease-causing organisms.

And, just like everything in

medicine, we have to be aware of

the competing risks of going too

far with the hygiene hypothesis.

Children who grow up in areas

with poor sanitation or who drink

unclean water tend to suffer from

higher rates of diarrheal diseases

and can be exposed to parasites

that stunt their growth. A misap-

plication of the hygiene hypothe-

sis might also lead people to avoid

or delay necessary medical treat-

ments with antibiotics, or to reject

beneficial public health interven-

tions that protect our food supply,

such as pasteurization.

On balance, it’s never wrong to

wash your hands when they have

visible dirt or after visiting some-

one who has been sick, but you

usually shouldn’t turn your every-

day life into the level of sanitized

cleanliness expected in a hospital.

Similarly, we probably don’t

need to choose antimicrobial ver-

sions of everyday household prod-

ucts, but having access to antibiot-

ics for a susceptible infection can

be lifesaving.

As a wise pediatrician once re-

marked during my training, “Ba-

bies really only need a bath when

they are visibly dirty or they stink,

and even then, just use clean water

and a little soap in the diaper area.”

Our current prescription

The data paint a picture that we

might prevent allergies in the fu-

ture by protecting our barriers

and introducing the right expo-

sures to induce tolerance at the

right time, such as early introduc-

tion of peanuts.

But I can’t tell you how much

dirt or what kinds of bacteria your

child needs to safely experience

while growing up. It’s too soon for

that, but many scientists around

the world are working on these

questions, thanks to support from

a variety of governments and

foundations.

Until then, I will share with you

the broad-brush advice that I give

my friends and patients:


Let your kids play outside, get

dirty, try new foods and be ex-

posed to a variety of things. Advo-

cate for them to have as much

outside recess time in school as

possible.


Use plain soap and water; you

don’t need to sanitize everything.


Talk to your doctor about

watchful waiting to respond to an

illness, rather than take antibiot-

ics.


Be judicious about what you

put on your skin and into your

lungs, and become an advocate for

clean air, clean water and a clean

environment for everyone.


Get all of your routine vaccina-

tions. The healthiest children in

the United States are the ones who

are fully vaccinated.

[email protected]

Cosby Stone is an instructor in

allergy/immunology at Vanderbilt

University Medical Center. This report

was originally published on

theconversation.com.

PERSPECTIVE

Why some dirt and grime may help prevent allergies

ISTOCK

Experts say it’s definitely important and beneficial for children to spend time in natural areas, such as forests, parks and farms.

ISTOCK

“Many students are facing immense... stress

that can fuel self-destructive behaviors.”

Elizabeth Minne, co-founder of Vida Clinic