Seven years ago at Hartley Elementary, Nevaeh Murphy was a quiet, reserved fourth-grader.
Too quiet, her teachers worried, too reserved, and her desk sat empty too often.
The school psychologist reached out to Robin Townsend, a therapist with Child Guidance Center, whose welcoming office at Hartley had moved with the school across town to the Abbott Sports Complex while the old brick building at 33rd and Vine streets was renovated.
Nevaeh’s mom had given permission for her to see Townsend, and then things happened quickly for the girl two days shy of her ninth birthday.
Life was chaotic then: A mom with a drug addiction, a home filled with domestic violence and so much uncertainty the state decided to remove her.
A caseworker brought her to her aunt’s home late one night, to the family she’d known since she was a baby, suddenly sharing the home of her aunt and uncle, an older cousin, a younger one and one of the same age she'd spent hours playing with in the backyard.
“We were always close,” said Crissy Murphy, who didn’t hesitate when the caseworker called, who hugged her niece and welcomed her when she walked through the front door holding a milk crate with the only belongings she had time to bring with her.
The day before she’d been pulled out of class to meet with Townsend. They played games in her office and talked about school, Nevaeh recalled, and not so much about what was happening at home.
“I was nervous and really shy and didn’t really want to talk to anybody,” she recalled.
But they kept meeting at school, and she began to open up, to tell the therapist how she worried about the things she hadn't been able to bring with her. She listened as Townsend explained what was happening, that none of it was her fault, that her mom wasn’t able to keep her safe, that she wouldn’t be going home.
Before long, Nevaeh changed schools, and the following year, her aunt and uncle adopted her. The blended family continued to see Townsend at the Child Guidance Center during the transition, while Nevaeh worked through the challenges of adjusting to a new life.
With the help of a supportive family that made sure she got what she needed, Neavah blossomed.
The therapy at school was part of that.
“We were able to deal with all those feelings of shock and worry and denial that this happened or didn’t happen -- we were able to deal with that very quickly,” Townsend said. “She was able to work with that sadness and that worry.”
Therapists in schools
The timing may have been right for Nevaeh, but the system was in place long before her teachers began worrying about her.
Child Guidance has had therapists working in Lincoln Public Schools for more than 15 years; Family Service for 14.
Today, therapists from both organizations have offices in 30 LPS schools. Family Service also has therapists in five schools in Saunders County and therapists from both agencies have group therapy programs at certain high schools and middle schools.
Having therapists at school is important because it makes services more accessible, said Wendi Anderson, director of outpatient services at Child Guidance Center, eliminating transportation or scheduling barriers working families often face.
Townsend said many of the children she sees couldn't get to appointments outside school.
"If we weren't in the schools, we wouldn't have the impact we have," she said.
They are tapping into a significant need.
In 2017 -- the last time the Centers for Disease Control did its biennial risk behavior survey of high school students -- 27 percent of Nebraska students reported feeling depressed. Sixteen percent had considered suicide. The numbers in both categories have continued to rise in recent years.
A spike in teen suicides in Lincoln four years ago prompted the creation of a community suicide prevention coalition that has worked to increase awareness, promote conversation and reduce the stigma of suicide.
LPS lessons include suicide prevention and awareness information, and last year, the district began screening students considered a suicide risk by themselves or others.
They talked with 1,122 students, said Brenda Leggiadro, the district’s coordinator of counselors and school social workers. Not all of those students were screened, but of those that were, 611 were considered at considerable risk. LPS contacted parents in all cases and in some recommended taking the student to Bryan's mental health emergency room, she said.
About 8 percent -- or 619 -- of the LPS students who received special education services last year were diagnosed with an emotional disorder, a 45 percent increase over the past five years that reflects the growing impact of trauma, behavioral problems and mental health needs of students.
School officials cite addressing students’ mental health needs among the most pressing issues they face -- and beefing up mental health services was one of the prongs of a new interlocal agreement between the city and LPS.
Trauma often the root
Many of the students whom therapists work with suffer from trauma, Anderson said, and they’re seeing children showing the effects at younger and younger ages.
“Trauma is the root,” she said. “We’re treating trauma ... and trauma can show itself with so many faces.”
It can manifest itself as anger or aggression, depression or anxiety, in students who harm themselves or quit coming to school or whose grades fall.
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Townsend said the anger has gotten worse in recent years -- students who throw desks, are unable to control themselves, unable to regulate their behavior. Those are often the children who show up in her office.
"It's super-hard and super-worth it when they start to make changes," she said.
The causes of trauma are many: domestic violence or substance abuse in the home, abuse, a parent going to jail or being deported, parents divorcing, the death of a parent or grandparent or close relative.
Students who have fled violence in other countries are often trauma victims, and LPS has begun a therapy program to help refugees deal with the trauma they suffered in the countries they fled.
LPS has trained teachers and administrators to recognize the signs of trauma and understand its impact, Leggiadro said.
That's especially important in a district where 46 percent of the students live in poverty, because poverty -- and the uncertainty children feel when they don’t know where they’ll sleep or whether they’ll have dinner -- can be a chronic source of trauma.
“If there is no other reason than poverty to consider trauma-informed procedures, that’s enough,” Leggiadro said.
Social media and cyberbullying add a layer of anxiety and stress for students trying to navigate the choppy waters of adolescence, said Tammy Sassaman, the behavioral health program coordinator for Family Service.
Dave Miers, counseling and program development manager for mental health services at Bryan Health, said social media -- despite the ease of communicating -- makes it harder for young people to truly connect.
Evidence shows students who feel connected to family, school, church or community are less likely to have mental health or substance abuse issues, he said.
“I think it’s just a fast-paced world,” he said. “What I think we’re seeing is kids are connected through technology, but that’s not really the meaning of connectedness. Human connectedness is a lot different than through texting,” he said.
Teachers are 'eyes and ears'
Schyler Lindekugel-Sullivan, a social worker at LPS, said there’s also more awareness about mental health issues.
“In 2018 we have much more of a language about what kids are experiencing,” she said. “I’m not saying there’s no stigma, but we’re moving in the direction of having more open and honest conversations about what kids are experiencing and how that’s affecting their education."
Teachers -- and others at school -- are often the ones who notice behavior or changes that can signal a child is suffering, therapists said, and that makes for a good partnership with mental health therapists.
"Your teachers are your eyes and ears, so they're picking up on this," Sassaman said.
About five years ago, LPS began using a districtwide approach to student behavior focused on prevention through positive reinforcement, setting specific expectations about behavior and teaching students skills that help them learn empathy, problem-solving and conflict resolution.
Lessons on social and emotional development are taught through seventh grade, and the work teachers, counselors and social workers do with students who struggle is based on helping them learn skills that can help them no matter the underlying problem.
“The schools' role is that educational piece,” said Leggiadro. “Teaching appropriate and healthy behavior is a major thing we should be responsible for.”
Pinpointing the problem
One of the big parts of the district’s behavioral system is pinpointing the problem. If a teacher notices a student acts out before math class, for instance, giving that student more help could solve the behavior problems.
“Most behavior has a pattern to it,” she said. “There’s a function to it. There’s a reason I’m doing that.”
The mental health supports from therapists and other programs must be part of the same system, Leggiadro said.
To that end, the district has made it a priority to hire more social workers who focus on students' mental health needs and can connect them to additional services. The district now employs 36 social workers and hopes to hire more.
Social workers have begun working with small groups of students who have suffered trauma or a traumatic event. The students learn how the stress or anxiety caused by trauma affects them physically and practice coping strategies and skills -- squeezing their fists together, for instance, when they start to feel like they’re losing control.
Students meet as a group and also individually with the social worker leading the group, said Lindekugel-Sullivan.
“It gives them the opportunity to tell their story, to tell parents or a trusted adult ‘this was hard,’” she said.
The district hopes to expand the practice, including working with English language learners on the challenges of learning a new culture and language.
Therapists -- who work with more than 600 students each year -- are a resource for those students who need the most help dealing with mental health issues and it's one of the ways schools can "connect all the dots" for students, Leggiadro said.
One of the dots they connected seven years ago was Nevaeh, a fourth-grader who told her story to a therapist and got busy creating a new one.
Nevaeh, the high school junior with a letter jacket she earned playing the trumpet in marching band; the summer camp volunteer who loves to watch basketball and take pictures; the young woman whose bedroom walls are adorned with pictures of family and friends, a mission trip to Mexico, a band trip to San Francisco and the sunsets she loves to capture through the camera lens.
“She’s an amazingly resilient daughter,” said Murphy. "She's an overcomer. She's fabulous."