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A rural North Dakota school district located hundreds of miles from the nearest psychiatrist will be using telehealth to improve student access to behavioral health services and support its on-site counselors.

The Dickinson Public School District, a nine-school network serving one of the fastest-growing small towns in the country, is partnering with the Dickinson-based Southwest District Health Unit to give students access via telemedicine to psychiatrists at the Center for Psychiatric Health, located in Grand Forks, roughly 370 miles away.

“School counselors are trained in certain realms, certain aspects, and there are times when we need more than their services, and I would hope that this would help provide some of that,” Marcus Lewton, principal of Dickinson Middle School, which will host a secure room for the connected care program this fall.

Psychiatrists are few and far between, most often in urban centers, and they have waiting lists that are months long. A telehealth program can offer school districts an opportunity to get certain students in front of a psychiatrist a lot sooner and easier.

“It’s not to take the place of any existing systems that are in place, so anybody that normally goes to a counselor, normally goes to (the nearby Badlands Human Service Center) or normally goes to their providers,” added Sherry Adams, executive officer of SWDHU. “It doesn’t take the place of that. It’s just adding an additional resource for the extra psychiatric health with actual psychiatrists.”

“We have individuals in Dickinson who can do counseling and therapy – this is not that,” she said. “This is actually the physician that makes the diagnosis, they help with the medication, so it’s kind of that upper level one.”

School officials say the one-hour virtual sessions, held with parents in attendance, reduce the challenges faced by parents and students in taking time off from work and school and driving to Grand Forks or Fargo, roughly 290 miles away.

“Unfortunately, when you need those resources, it tends to cost a lot of money,” Chase Breitbach, one of the school’s student support liaisons, told the local newspaper. “You start to try and be flexible with your schedule and that’s challenging because you’re working with three different employers or you’re trying to find a way to fill your gas tank up and get you to get to and from Fargo once a week … it becomes kind of burdensome.”

“The thing that I think is kind of cool about telehealth is it eliminates some of those barriers and maybe allows a little better access to those resources in Southwest North Dakota,” he added.

Read more at mHealthIntelligence.com.

Written by and from the perspective of Shannon Miller, a writer at HelloGiggles

When I made the decision to seek therapy years ago, I had two very visceral, opposing reactions. The first was an initial burst of excitement, an eagerness to work on myself and, hopefully, become a more attentive friend, partner, and mother. That feeling was quickly chased by a jolt of panic: I knew right away that I would feel more comfortable working with a Black female therapist, and I also knew that where I lived—a small Florida town with a tiny Black population of less than 3%—would make that difficult.

The relationship between mental health and the Black community is one that is slowly evolving, but while we often talk about ancient, understandably skeptical attitudes toward therapy, we don’t talk enough about the modern roadblocks we face when we try to get help. As a Black woman, searching for therapy means looking for a professional who is equipped with the best understanding of how our identities inform and influence our experiences. How we navigate the world is colored by both racism and sexism, and that has such a major effect on our mental health that it makes it nearly impossible to avoid those topics during therapy. Our unique experiences must be properly contextualized and factored into our care. 

“Health professionals—especially those who are treating minorities—have to be mindful that treatment is not a one-size-fits-all for them,” said Patrice N. Douglas, a licensed marriage and family therapist. “What works for white patients may not work for Black patients, so it is important to get as much understanding and cultural training to give the best treatment as possible.”

Part of that understanding includes having a working knowledge of our relationships with the negative stereotypes that impact us daily. Without that, we run the risk of linking with a professional who not only lacks the cultural competence, but is also potentially working under those implicit biases. For instance, the Angry Black Woman stereotype—one that maligns Black women as aggressive, hostile, and ill-tempered—is so pervasive that it can greatly impact how we receive, or are sometimes denied, mental health treatment. A report published in the journal Social Work in Public Health notes that when mental health professionals fail to acquaint themselves with the stereotype, they often incorrectly cite certain symptoms, like mood swings, irritability, or just genuine responses to oppression, as evidence of this trope.

Read more on HelloGiggles.com.

Veterans receiving care at the Michael E. DeBakey VA Medical Center in Houston, Texas, can now connect to mental health services remotely using a computer, smartphone or tablet. The system, called telemental health, has helped nearly a thousand Houston area Veterans get the care they need.

Tele-mental health uses the VA Video Connect app, which provides a secure connection between Veteran and provider no matter where the Veteran is located. Seventy-five Houston VAMC mental health providers are equipped to provide remote services.

“The technology is ideal for Veterans who live far away, have medical problems or find it difficult to leave the house,” said Houston VAMC psychologist Dr. Jan Lindsay.

“Often, coming to the clinic is a big burden for our Veterans. Barriers include child care, traffic, parking, taking off work or feeling anxiety when leaving their homes for treatment.”

Tele-mental health eliminates those barriers. “When we provide psychotherapy via telehealth, some Veterans report that being at home makes it easier to focus on the work being done and acquire the skills they need to engage their lives more fully,” said Lindsay. “They feel safer at home.”

“It is actually easier than coming into the facility,” said Air Force Veteran Christopher Banks. “I can be in my own home, which helps me with sharing.”

Banks, who has trouble walking, often had to cancel his in-person mental health appointments. When he did make it to the provider’s office, he had to fight traffic to get there. “I’d get so stressed from the drive that I would spend 90 percent of my therapy talking about why I’m so angry,” he said.

Tele-mental health is “a major benefit for those with mobility issues,” agreed Dr. Kaki York, deputy clinical executive with the Houston VAMC Mental Health Care Line.

“We have Vets with ALS or Parkinson’s or who have had a stroke, who for whatever reason cannot get here to continue treatment. Also, family therapy services. Have you ever tried to coordinate an entire family? It’s very difficult. Video allows them to get in the same place at the same time instead of getting all of them to the VA.

“Our goal would be that any mental health clinician at the main facility will be able to provide telehealth services when the patient wants it and provider thinks it would be helpful,” said York. “We are not quite 100 percent there yet, but we are getting close.”

Read more at the VA.gov.

In order to highlight pockets of excellence across the country, the NNED selects a partner organization to highlight once a month. Florida Institute for Community Studies, Inc. (FICS) has been selected as the Partner of the Month for August.

FICS began by a combination of community advocates, students, professors and direct service workers in 2001. Since then it has developed a model that works at the community level to identify gaps and strengths. Through their community advisors, FICS uses those strengths to write plans and create effective programs that build resilience and keep youth out of gangs, help make people healthier, and HIV and Substance free. FICS’s reach extends to thousands of people per year, and have documented significant improvements in teen pregnancy reduction, violence prevention, improved community responsibility and reduced dependence on law enforcement, prisons, and healthcare systems. It’s estimated a conservative savings to the FICS community of $4.89 for every dollar spent on after school programs, meaning they have saved the community $3.2 million for youth. In terms of diabetics’ outcomes, FICS’s have documented a cost-savings of $782,811 per year. In 2018-9, FICS’ volunteers invested over 1200 hours in community clean-ups, gardening, mentoring/tutoring and teaching ESL. FICS served 160 youth in quality Out-of-School time programming and another 56 families with Partners in Well-Being, a holistic approach to mind-body balance and health (bienestar). The social media hash is #FICSCreates because they want to focus on creating: art, opportunity, wellness and resilient communities.

FICS serves as a facilitator in assisting the community by working across partners and groups in a way that allows youth, parents, researchers, community members, educators, and professionals to interact, exchange information and knowledge to create solutions. FICS is implementing Familia Adelante as an NNED partner in FY 2019. 

A few of FICS’s programs include:

• Afterschool4Success: Mentoring program that builds STEAM, improves grades and prevents youth (7-17) from getting involved in risky behaviors.
• HIV/AIDS Education, Counseling, and Testing: Providing free RAPID HIV testing and services.
• Partners In Well-Being: Transforming the Morgan Recreation Center into a Community Wellness and Arts Center, creating and maintaining ways people can get access to health.

Learn more about the Florida Institute for Community Studies, and how they are partnering with communities across Florida to help them achieve their goals through research, education, training, services and the arts.

View a list of previous NNED Partners of the Month.

We have witnessed how the devastating after-effects of a school shooting can reverberate long after the immediate trauma. Recently, two survivors of the Parkland massacre of 2018 — a 19-year-old graduate named Sydney Aiello and an unnamed Parkland sophomore — both died in apparent suicides. And on March 25, Jeremy Richman, whose daughter Avielle was killed at Sandy Hook Elementary in 2012, was also found dead in an apparent suicide.

This is not the first time we’ve seen the toll that experiencing the trauma of a school shooting can take; after the Columbine massacre of 1999 one student and the mother of a student who was severely wounded took their own lives. And as the Daily Beast reported, six students attempted suicide after a 2012 shooting in Ohio that left three schoolmates dead.

Aiello’s mom has said her daughter struggled with PTSD and suffered from “survivor’s guilt” after living through the deaths of her classmates. While school shootings have become an American epidemic, psychologists and experts in trauma are just beginning to gather data on how these events affect survivors and their communities in the long term. To find out what we do and don’t know about the mental-health effects of surviving a school shooting, we spoke to Amy Nitza, the director of the Institute for Disaster Mental Health at the State University of New York at New Paltz. Nitza’s work focuses on understanding the psychological implications of disasters such as school shootings.

What do you take away from it?
It’s a reminder of the level of devastation these events create and how debilitating the mental-health consequences are on people. At Sandy Hook, it has been six and a half years after the incident and so many mental-health resources that have been poured into that community, and yet there’s this level of suffering. These suicides are likely to have a really strong impact on other survivors. I think we can expect there to be a ripple effect in terms of triggering a resurgence of other people’s pain.

What do we know about the mental-health effects of school shootings?
School shootings have opened up a whole new set of questions. There’s all these sorts of questions around how best to protect kids from exposure to more trauma in the aftermath, because any reexposure to the setting, sights, sounds, or smells of the incident have the potential to become real triggers. For example: what kind of memorials do you do, and how many? Do you keep teddy bears and gifts people have sent on display? And how soon do you reopen the school? What’s the best way to help kids collect their belongings?

One of the parents of one of the women who died said that her daughter had been suffering from “survivor’s guilt,” which is a term that gets used colloquially. What do we know about that phenomenon from a psychological standpoint?
Survivor’s guilt by itself is not a diagnosis. it’s a phenomenon that occurs. Typically it involves the triggering of belief or a question about one’s worth and one’s value, as in why did I survive when other people did not, or why did I deserve to live and others didn’t? It can trigger these sort of deep existential questions that there aren’t really answers to. And wrestling with these questions become a really significant challenge cognitively and emotionally that can build on itself and create cognitive distortions.

Read more on TheCut.com.

The suicide rate among African American children aged 5 to 11 years has increased substantially since 1993 and is persisting, according to Dr. Jeffrey Bridge, a leading researcher at the Nationwide Children’s Hospital. In 1993 suicide ranked as the 14^th leading cause of death among this population. Today it’s the 10^th leading cause of death—with rates nearly twice that of their White counterparts. While it is not intuitive and is difficult to understand, suicide ranks as a leading cause of death among all youth aged 5-11 years. Dr. Bridge and his colleagues are among the first to spearhead suicide research within this young population, and their work has revealed these concerning trends in suicidal behaviors among African American children.

In observance of National Minority Mental Health Awareness month this July, the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Office of Behavioral Health Equity is bringing attention to suicide among African American children. A year ago, SAMHSA convened a Virtual Roundtable of leading experts on African American mental health and wellness to identify ethnic-specific risk and protective factors contributing to suicidal behaviors in children. The experts emphasized the need for early identification of mental health problems in children, better outreach and engagement of children and their families, understanding family and community factors that impact children’s mental health, and the urgent need for culturally responsive and effective mental health services geared for young children of color.

The persistent suicide trend should prompt a call to action among practitioners that work in child-serving systems, such as pediatric and family health care, schools, child welfare; mental health providers and researchers. It should also be a call to action for faith-based communities, families and particularly fatherhood initiatives, and community leadership. Collaborating together to prevent child suicide is critical. And reaching out to and saving children who endure such pain as to want to take their own life is of the utmost urgency.

Read more on SAMSHA.gov.