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Divorce. Addiction. Chronic Illness. Jail. These traumas occur in American life at all societal levels, and they affect the lives of both adults and children every day. When kids are affected by traumatic events, they bring the effects of that trauma with them to school. Depression, anxiety and trauma-induced behavioral challenges impact their ability to learn and their relationships with teachers and peers.

Educational Psychology alumnus Elizabeth Minne, Ph.D. ’06, is helping to provide an outlet for students to deal with some of these issues for Austin Independent School District (AISD) students through on-campus school mental health centers. Vida Clinic, which was founded by Minne, has partnered with AISD to provide on-campus mental health centers with licensed counselors.

Elizabeth Minne

Initially implemented at Crockett High School, mental health services have expanded to 18 middle and high schools, and 22 elementary schools. These schools serve students who live in multilingual neighborhoods, many of which have a higher proportion of crime and a lack of transportation. These factors can lead to issues such as disruptive behavior or chronic absenteeism.

The stress that students experience can lead to disruptive behavior in and out of class that can, in turn, lead to suspensions or expulsions. Meeting with a counselor provides a way for students to work through their issues, without relying on punitive measures that help fuel the school-to-prison pipeline.

Vida Clinic helps fill a void that school counselors typically cannot take on. Most school counselors are required to spend the majority of their time supporting students academically—making sure students are earning their school credits and are on track to graduate. The job of Vida Clinic’s clinical therapists is to support student mental health. When counselors encounter students who are struggling emotionally, they can refer students to the on-site clinic for mental health services. Students do not have to travel and miss minimal class time. This also means that parents or guardians do not have to take time off of work to take children to appointments.

A case study from the 2016-2017 school year at Crockett High School offers support that these services benefit the students who participate. Compared to a control group, students in the treatment group exhibited increased attendance, fewer expulsions, and higher academic performance.

Teachers and parents can be involved in a variety of ways, says Minne. “They can participate in individual therapy services for themselves. They can take part in individual consultation services in order to develop trauma-informed strategies for responding to challenging student behaviors. They can participate in small group workshops to develop skills and knowledge of mental health concepts. Or they can attend campus-wide presentations for initial learning of mental health concepts, such as Trauma-Informed Care.”

The on-campus clinics also help destigmatize mental health. When appropriate, therapists can also work with the student’s parents or teachers, taking a holistic approach to mental health.

Providing teachers with resources to deal with disruptive behavior can also help reduce teacher stress. “Teachers can sometimes take disruptive behavior from students personally, when many times the disruptive behavior has less to do with the teacher and more to do with stress or mental health issues the student is facing,” says Christopher McCarthy, a professor in the Department of Educational Psychology at the University of Texas at Austin’s College of Education.

McCarthy and his graduate students have collaborated with Minne for several years to help teachers develop coping resources for classroom stress. They also help improve teachers’ occupational health and allow them to better recognize when students might be experiencing mental health concerns.

Says Minne, “We find that when we have mental health professionals on campuses who are able to provide therapeutic support for everyone, both the adults and the students, the climate begins to shift to one that is more open to talking about mental health. It becomes easier for everyone to acknowledge that mental health is something that we all need to pay attention to. As one teacher told me, ‘It takes a village, we are all in this together.’”

 

February 11, 2015

Teachers are leaving their jobs in record numbers. To find out why, studies have focused on how structural factors, like the type of school in which a teacher works, contribute to job dissatisfaction. But University of Texas at Austin educational psychologist Christopher McCarthy recently conducted a survey of elementary school teachers’ psychological responses to the resources and demands of their jobs.

“This is something we can measure and isolate. Teacher appraisals offer early warning signs that they’re perceiving job demands as overwhelming. Schools can act to slow the revolving door in a profession where 30 to 40 percent of new employees leave after the first five years. We can’t let it continue that way.”

A 2012 Gallup-Healthways Well-Being poll found that teachers were second only to physicians in reporting they feel stress at work, and over half of them said they felt significant stress several days per week.

To understand the relationship between a teacher’s psychological state, job satisfaction and occupational commitment, McCarthy and his colleagues, University of North Carolina’s Richard Lambert and Paul Fitchett, developed a measure called the Classroom Appraisal of Resources and Demands (CARD). The tool is used to assess teachers’ perceptions of demands, like classroom management challenges, and sufficiency of resources, such as administrator support. By examining teachers’ perceptions of both demands and resources, the CARD can identify which teachers experience high demand levels relative to their classroom resources.

“We found that two teachers who have the same kinds of students, level of administrative support, classroom materials, pay and so forth can view their circumstances very differently,” said McCarthy. “What one defines as stressful and dissatisfactory can be quite manageable for another, so you can’t simply assume that factors such as class size cause teacher stress and dissatisfaction.”

McCarthy also determined that a teacher’s decision to leave the job is usually the result of an accumulation of several factors rather than a single trigger.

“This means there are probably numerous opportunities for schools to gather feedback from teachers, then offer relevant intervention if the instructors seem at risk for burnout,” said McCarthy, the Maxine Foreman Zarrow Endowed Faculty Fellow in Education in the College of Education’s Department of Educational Psychology.

“Everyone’s speculated about reasons for the teacher shortage,” said McCarthy. “My study suggests that it’s – at least in part – due to job stress.

– Kay Randall

A seven-year-old boy wakes up in the middle of the night complaining of a stomachache. Mom takes the boy to the family doctor, who runs tests, asks routine questions, prods and probes, and concludes there’s no apparent physical reason for his distress. But what about his mental state?

In that quick 15-minute patient visit, no one ever mentions to the doctor that mom and dad are going through a vitriolic divorce and the family has just moved. The boy is asked only to describe his physical symptoms, not how he is coping emotionally with the situation at home.

Oversights like this are common – in fact, of the 10 most frequent physical complaints people go to the doctor for, only 15 percent are found to have a physiological cause. Addressing both physical and mental issues might help explain some symptoms and indicate that the patient needs to see a behavioral health specialist in order to get better.

To prepare behavioral health specialists to work as part of a close-knit, interdisciplinary team The University of Texas at Austin’s College of Education has launched an Integrated Behavioral Health Psychology Program in the Department of Educational Psychology. Graduates of this program will be prepared to smoothly segue into a very different kind of health care environment, one in which mental and physical health services are not separate.

This new approach to medical care is referred to as “integrated health care delivery.” For the patient, it’s a very convenient form of one-stop-shopping and for a health care professional it’s the best way to get the patient’s whole health story.

“Health care in the 21st century will treat the patient not only as a whole person but also as a member of a family and community that are actively involved in treatment,” said Cindy Carlson, chair of the Department of Educational Psychology. “Being a psychologist who offers psychotherapy in a private practice office and confers, when necessary, with other providers and being a team member in a primary care office where the team is collectively responsible for the outcome are two very different job experiences. In universities, we’ve been training students for the former, not the latter.”

Cindy Carlson Group Photo

Regional Advisory Board for Cindy Carlson’s integrated behavioral health grant: Front row (left to right): Michele Guzman, PhD, Hogg Foundation for Mental Health; David White, Texas Psychological Association; Michael Carey, PhD, Scott & White Healthcare; Cindy Carlson, PhD.

To prepare them for this different role, the one-year program teaches doctoral psychology students how to deliver culturally and linguistically competent, evidence-based behavioral health services in a community clinic setting as part of a blended health care team. Instruction focuses on the best ways to assist vulnerable and underserved populations, a particularly important aim since studies show these groups are typically the least likely to access behavioral health services.

The award finances the planning, development, and operation of a 15-hour program emphasis in integrated health services delivery, with preference given to applicants who are bilingual (Spanish-English) and/or members of ethnic minority groups.

Student Fellows complete 10-12 hours of supervised clinical practice in integrated healthcare settings at Federally Qualified Health Centers (FQHCs) like Lone Star Circle of Care, People’s Community Clinic, and Seton-Blackstock Family Clinic. The Fellows take additional course work for a curriculum emphasis in integrated behavioral healthcare, including a course devoted to inter-professional healthcare teams, and they receive training in motivational interviewing, which has proven effective in helping patients make health behavior changes.

Even though there are challenges to placing behavioral health experts in integrated healthcare settings, the benefits to patients far outweigh them, according to Carlson and other experts. In some blended healthcare setting, the patient sees the same front desk check-in person at each visit, for example, whether she’s there for depression or the flu, and her clinical records are shared among the entire health care team.

As Carlson points out, an enormous benefit of the team approach is that “proximity breeds familiarity” – simply being in the same physical environment tends to encourage more communication among team members. The cardiologist has access to information about a patient’s anxiety disorder, and the general practitioner knows that another patient just lost her son in a skateboarding accident, which may explain her blinding headaches, sleeplessness, and weight loss.

“The health care team approach has so many positive aspects,” said Elizabeth Walsh, a doctoral student in the UT Austin program and one of Carlson’s research assistants. “There’s a lot of evidence that having integrated health care teams ends up cutting healthcare costs and reducing employee and student absenteeism, for example, and both providers and patients report that the quality of care is much better.

Taking a Team Approach

IBHP trainee Leann Smith, Elizabeth Walsh, and Brittany Linton consults with Celia Neavel, MD, of People’s Community Clinic. (Photo by Megan Stanfield)

“Studies show that the majority of people don’t go to a mental health professional, even when their family doctor refers them, so there are a tremendous number of people walking around with unaddressed health problems. If the behavioral health specialist is right there, in the same building as the general practitioner, that becomes almost a non-issue. I’m really excited about becoming part of a health care team – as a behavioral health care specialist, you’re an absolutely integral member of that group.”

With her grant funding, and as part of the ongoing training of doctoral students like Walsh, Carlson convened a May meeting in Austin that drew integrated health care experts from all over the country. The experts talked one-on-one with students and shared presentations on what it’s like to be a behavioral health specialist on a multi-professional team.

“This is the scenario of the future, and what particularly excites me is the movement to locate health care in close proximity to the patient, such as in school-based clinics,” said Carlson. “Integrated health care teams will soon be the norm. Right now, here at UT Austin, we’re ahead of the curve in preparing top-notch, highly skilled students who can enter that environment and immediately start contributing.”

Kelly Banneyer was in high school when she first became fascinated with the fact that your brain can be the source of sickness. One of her friends was suffering from a mental illness and Banneyer saw, firsthand, the way the disease can take away much of what’s good in a person’s life.

That epiphany’s fueled her studies for seven years, all the way into what’s now her fourth year of a doctorate in the College of Education’s Department of Educational Psychology.

As part of her doctoral program, Banneyer works at the college’s Texas Child Study Center (TCSC), Central Texas’s premier pediatric mental health service facility. The Center was created in partnership with Dell Children’s Medical Center and, in addition to seeing patients, offers training for future psychologists and psychiatrists like Banneyer.

Kelly Banneyer“I’m a graduate assistant for Dr. Kevin Stark, the co-founder and current director of the Center,” said Banneyer, “and I’m working with him on a major treatment study of anxiety in children. This means I get into the nitty-gritty of collecting and analyzing data, in addition to recruiting, assessing, and working with study participants. I also supervise a team of 11 undergraduate and 12 graduate students, whom I recruited and who are being trained at the Center. And I see around 8-10 patients per week.”

Although Banneyer’s focus of study is anxiety, students with a wide array of interests can be accommodated by the Center. Whether a doctoral student wants to specialize in obesity and behavioral health, oncology and mental health issues, or autism, the Center’s partnership with Dell Children’s opens the door for topnotch training opportunities.

“You can’t imagine how often parents come in and say, ‘My child is exactly the way I was at that age and I’d give anything to have had the help he’s getting. They tell us we’re lifesavers. Who wouldn’t want a career like this?” – Kelly Banneyer

“It’s amazing how many choices we have,” said Banneyer. “I like working with children who suffer from anxiety, specifically, because it’s so debilitating but so treatable. There’s definitely help and hope. One of the most promising aspects of the treatment we use is how effective the parent training portion is – when you couple parent education with therapy for the child, the outcomes are very positive.”

Banneyer relates the story of one little boy she treated who had such severe separation anxiety that he couldn’t go to school without his parents. Either mom or dad had to be in the classroom and on the field with him when he was playing sports, and when he was at home he couldn’t remain in a room alone. By working with the child, in stages, on having his parents physically away from him and giving the parents strategies they could use at home to model desirable behavior, Banneyer saw her patient’s behavior steadily improve.

Another child she’s helped had a debilitating obsessive-compulsive disorder that was triggered when anyone was physically near him. He was constantly moving, multiple times a minute, and couldn’t do simple things like sit with the family on the couch and watch TV. Or ride in the car with others. Or be hugged by his parents. In fact, when he initially went to the TCSC, he could not sit in a therapy room with his parents and the therapist – the rooms simply weren’t big enough.

Kelly Banneyer Group Photo“He’d always had a few behavior quirks but nothing that disrupted his life to this extent,” said Banneyer. “When he entered middle school, though, that was the stress trigger that set off this extreme reaction. We’ve noticed that middle school can be one of the top triggers for the presentation of anxiety disorders in boys.

“Fortunately, our therapy seems to be working and now when you see him out in the waiting room he’s leaning comfortably against his dad and playing with his phone. He’s even gone on several road trips with his family.”

It’s students like Banneyer, ones with excellent research and clinical skills, who have helped the TCSC gain a national reputation as a great training facility.

“Our graduate students are obtaining degrees in school psychology, and normally school psychology students don’t get the plum, more competitive clinical internships, but ours are being placed at the top internship sites in the nation.” – Kevin Stark

“Our graduate students are obtaining degrees in school psychology, and normally school psychology students don’t get the plum, more competitive clinical internships,” said Stark, “but ours are being placed at the top internship sites in the nation. Since we opened the Center, our trainees have consistently completed their internships at Harvard/Boston Children’s Hospital and at Children’s Hospital of Philadelphia, which is the number one internship in the country.”

Banneyer’s ultimate aim is to be director of an anxiety disorders research center, combining her love of research with the actual application of it. Right now she’s gathering copious amounts of data for the anxiety study, writing many papers, and presenting at conferences around the nation in preparation for attaining that goal.

“You can’t imagine how often parents come in and say, ‘My child is exactly the way I was at that age and I’d give anything to have had the help he’s getting,’” said Banneyer. “They tell us we’re lifesavers. Who wouldn’t want a career like this?”

David Scheinfeld is a doctoral student who’s using his research and practice as well as his “9-5” job at Outward Bound for Veterans to help returning service members and veterans adapt to life at home after military service. Outward Bound offers wilderness courses that draw on the healing benefits of teamwork and challenge experienced in a natural environment, with all of the participants working together toward a common objective.

How did you get involved with Outward Bound for Veterans?

My parents instilled a love of nature in me and showed me how it has the power to shift one’s perspective about the world. I had attended two Outward Bound courses in high school and those ignited my passion for the organization. I developed an even greater love of outdoor education while in college at the University of Puget Sound and then took a job as an instructor at Outward Bound in 2003 – I’ve been working with them in one capacity or another ever since.

What’s the work with Outward Bound for Veterans like?

Currently, I’m primarily instructing Outward Bound backpacking and rock climbing courses in the Sierra Nevada Mountains. I’ve also been an instructor for a Florida Keys sailing course and a Boundary Waters canoeing course in Minnesota, as well as with Montana Outward Bound and North Carolina Outward Bound. Unfortunately, there are no Texas courses right now. Veterans from any state can apply for a course and if they’re accepted, Outward Bound for Veterans will pay for their airfare and all associated costs.

How is your doctoral work intersecting with what you’re doing at Outward Bound?

The majority of my time right now is spent at the Austin Veterans Health Administration completing my clinical internship for a Ph.D. in counseling psychology. With veterans’ posttraumatic stress (PTS) becoming a growing public health concern, my clinical passion is helping veterans address and reduce PTS. There are a large number of returning veterans who could benefit from mental health services but tend to underutilize them or drop out prematurely. To deal with this issue, it’s critical to look at alternative programs and interventions that will address their mental health concerns while also increasing their motivation to seek out mental health assistance. Outward Bound for Veterans, which is a therapeutic adventure intervention, is an alternative approach that’s shown a lot of promise. With Outward Bound, I’m an instructor as well as a researcher.

After you get your doctorate, what do you plan on doing?

It would be great to keep researching alternative and complementary mental healthcare approaches for veterans. Through Outward Bound for Veterans, I hope to work with veterans who are more resistant to traditional forms of therapy while also working as a therapist and researcher at the VA. I’d like to develop programming that uses therapeutic adventure as a complementary and alternative approach to traditional therapy– the therapeutic adventure component wouldn’t be a stand-alone experience, but rather a springboard to bolster veterans’ mental healthcare outcomes.

If you weren’t pursuing this particular area of study and career, what would you want to do?

I’d love to be drummer in a famous band … that didn’t travel too often.