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Administrative hurdles threaten school mental health program

Martin Bureau

Providing a mental health service for high-needs students has become more complicated for Montana’s school districts. Some are opting for other services that advocates and mental-health providers say are inadequate.

Over the years, Helena-resident Heather Ditch has tried several kinds of therapy for her seven-year-old adopted daughter. Her daughter, who we’re not naming to maintain privacy, has reactive attachment disorder and other mental-health diagnoses. She has difficulty navigating social relationships and can obsess over things to the point where it’s hard to focus in class.

“We started CSCT three years ago, and it’s the only thing that gets her through school,” Ditch says.

Comprehensive School and Community Treatment, or CSCT, is for children with a severe emotional disturbance diagnosis and is designed to keep those kids in a traditional classroom rather than specialized classes or residential care.

About 3,800 kids use the program statewide. Kids in the CSCT program have access to therapists and behavioral support specialists that can work with them anytime they need help throughout the school day.

Kim Chouinard with the Yellowstone Boys and Girls Ranch says, “Imagine being nine years old, sitting in a classroom, parents were fighting the night before, maybe there’s alcoholism in the family, or drug use and you’re not sure where you’re going to sleep that night or if there’s going to be food on the table. Our CSCT staff are there to try to help intervene in that and try to give them the coping skills to manage that.”

Students' access to that kind of mental health support could soon change.

Lawmakers decided last year to shift responsibility of the program from the state health department to the Office of Public Instruction. That, along with changes to how districts pay for the program, have created new administrative hurdles for districts. Several districts are now considering whether to continue the service or switch to lower-intensity mental-health care with less paperwork.

Under CSCT, districts are required to pay for a third of costs while Medicaid pays the other two-thirds. In the past, documentation of in-kind costs like providing classroom space or equipment such as laptops for the program counted toward districts’ share. Districts now have to match Medicaid funding with cash.

Great Falls Public Schools Student Services Director Lance Boyd says he doesn’t have the staff to meet the new administrative requirements and recommendations. Because of that, Great Falls will slim-down its CSCT program, switching roughly 120 kids to outpatient therapy.

“So, is it as in-depth as CSCT? No, absolutely not. But it’s, in many cases, it’s better than having nothing,” Boyd says.

Great Falls isn’t alone turning to outpatient therapy, which allows kids to see therapists during school at scheduled times, but doesn’t provide the same in-classroom support as CSCT.

The Helena Flats school district near Kalispell dropped CSCT completely in favor of outpatient therapy. Superintendent Andy Maheras says about 40 kids no longer have access to mental health staff that can work with them throughout the school day.

“Thankfully, our counselor, myself, some of my staff — we've been able to kind of juggle some of that ourselves. But, the behavior specialist piece is a big part of that that we don’t have.”

Several other districts are in the midst of considering whether to switch to outpatient therapy in lieu of CSCT.

Mary Windecker with the Behavioral Health Alliance of Montana says outpatient, or scheduled talk therapy, is not adequate for students with severe mental health needs.

“Providers are working on the acute side to try and make sure that they can deal with all of the children who are going to get kicked out of CSCT and probably end up in emergency rooms and higher levels of care.”

Without the proper level of preventative care, Windecker fears many kids will wind up in out-of-state residential homes. It’s unknown how many kids statewide have already lost or will lose CSCT services as school districts are deciding whether to participate in the program under the new funding system.

Democratic state Senator Mary Caferro of Helena has sat on state health department oversight committees for a decade. She hopes districts can stick with the program until lawmakers come back for the next scheduled legislative session in 2023.

“It’s my hope that this program gets back on solid ground and we probably, I would say, need to address it in the next session one way or another,” she says.

Helena Public Schools is one of the districts sticking with the CSCT program. That’s a relief to

Heather Ditch and her daughter. But she’s scared that the program could be dropped if it becomes unworkable for the district.

“I’m not so sure that she would make it through a public school system without CSCT, and that affects our whole entire family dynamic.”

Ditch says without the program, she may have to quit her job so she can homeschool her daughter to provide her with the attention she needs.

Aaron graduated from the University of Minnesota School of Journalism in 2015 after interning at Minnesota Public Radio. He landed his first reporting gig in Wrangell, Alaska where he enjoyed the remote Alaskan lifestyle and eventually moved back to the road system as the KBBI News Director in Homer, Alaska. He joined the MTPR team in 2019. Aaron now reports on all things in northwest Montana and statewide health care.
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