In Many Minneapolis Schools, the Therapist is Just Right Down the Hall

When Cathy Moen’s son, Elijah, was in first grade, he was diagnosed with attention deficit hyperactivity disorder. She took him to the pediatrician, who put him on medication and suggested therapy.

The medication part was easy. But getting him therapy proved more difficult — not because Moen couldn’t find a therapist or didn’t have insurance, but because of logistics.

The appointments were always during the day, and between her work schedule and the traffic, it was nearly impossible for them to make it.

But she soon learned Elijah was able to see a therapist in his Bloomington school. More than 15 years ago, Minneapolis Public Schools helped pioneer a national model of bringing community mental health care directly to its students. Today, most of the public schools in Minneapolis — more than 50 of them — have a therapist on site, and many other districts, like Elijah’s, have followed suit.

These days, Elijah’s therapist simply walks down the hall and pulls him from class.

“This is like a godsend,” said Moen.

The family’s health insurance pays for the care the same way it would if the student were being seen in the clinic. The school program was designed so that no student in need will be turned away for lack of insurance.

The Minneapolis program has also provided a road map for schools across the country as more administrators realize that mental health is as important to students’ future success as academics. Studies have shown that students are more likely to show up for appointments when the therapists are on-site.

More and more states are making mental health care in schools a priority. At least two states have recently passed laws that require schools to teach mental health. And more are considering it.

But the benefit of having a therapist on-site goes beyond just getting students to see a therapist. In Minneapolis, it’s also helped make mental health a school-wide priority — and helped get counselors, teachers and others more involved, said Mark Sander, who helped start the district program.

A man wearing a button down shirt.
Mark Sander is the director of school mental health at Hennepin County and Minneapolis Public Schools.
Christine T. Nguyen | MPR News

“Those teachers start learning more and more [about mental health],” said Sander, who directs school mental health for the district and the county.

He said as they learn more about mental health, teachers are feeling like, “‘OK, I get it. And now, you know, I’ve got this other student who’s not diagnosed with anxiety but has some of those anxiety features. And now I know how to better support them.”

At South High School in Minneapolis, the therapists sit in the school clinic, the same one where students go if they feel sick during the day or to get a physical so they can play sports.

The issues the students bring to the therapist run the gamut from stress about grades and colleges to anxiety related to a bad situation at home.

Farah Hussein is a therapist at South. She said it’s hard being a teenager, and she tries to help.

“There’s a lot of conversations about, ‘Who am I? Where do I fit in the world? Where do I belong?’ and just a lot of distress in exploring that,” she said.

All of this has important implications for the students’ well-being beyond just their mental health.

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A group of people sit around a conference table in a school.
Collaborative mental health meetings at South include the school’s social workers, counselors, nurses, psychologists, school-based clinic therapists and occasionally administrators.
Christine T. Nguyen | MPR News
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A sign reads "Mental Health" on a wooden shelf with books.

 

Sharon Hoover, who co-directs the National Center for School Mental Health at the University of Maryland School of Medicine, said more schools are collecting data on outcomes of in-school mental health programs, and the results are clear.

“They are more likely to have good attendance and to graduate and to get improved grades. We even have documentation of having better standardized test scores when you put universal systems in place like classroom-wide social emotional learning,” she said, all of which makes for happier, better adjusted students.

Cathy Moen, the mother whose son, Elijah, is in therapy in school, said she doesn’t know if it’s the medicine, or the therapy, or just that he’s growing up, but she — and his teachers — are already seeing a difference.

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Ways to Successfully Balance a Full Caseload as a Therapist

By: Bridget Eickhoff, MA, Alison Dolan, Psy.D., LP, and Andrea Hutchinson, Psy.D., LP

Being a therapist can be a fulfilling and rewarding career. However, it can be hard to remember that therapists are humans who also experience anxiety, stress, and burnout. We took a survey of 30 clinicians at CARE Counseling asking what makes them feel successful and balanced at work. Here are the main points our amazing clinicians found that help them find balance when working with a full caseload.

  • Create Boundaries and Stick to Them
    • Let your clients know your boundaries for cancellations and follow through with the boundaries you’ve set or are set by your agency. Therapy should be a flexible time for the client to address topics that are important to them; however, aspects of structure are important in therapy to keep both your clients and yourself accountable. 
    • Start and end sessions on time so that you have time to complete documentation, grab something to eat or drink, use the restroom, consult with a colleague, and/or take a moment to regroup.
  • Manage your Schedule Proactively
      • Make your life easier by scheduling clients as recurring appointments and practice confirming the next appointment at the end of the session. 
      • You probably enjoy seeing clients and it can be heartbreaking to refer them out. However, back to that accountability point, close your clients who are not following the attendance policy (or use supervision and consultation if you need guidance) and give them referrals to help with barriers (e.g., closer to home, different hours, attending to a different piece of their difficulties, etc).
      • Proactively reach out and ask for more clients if you start to notice your caseload looking low or you have inconsistent clients. 
        • Keep in mind, being proactive will help keep the number of intakes in the same week lower and documentation will likely feel more manageable. 
      • Take advantage of cancellations and catch up on documentation or check-in with a co-worker. If you are finding yourself racing towards burnout remember:
        • You can use PTO and take a day or more to feel grounded again
        • Ask if you can have a temporary block off time in your schedule to help you gain some extra time to feel like things are more manageable again
        • Talk to management to see if there are ways to contribute to the team without as many client appointments. 
  • Try to NOT Take this Very Personal Job, Personally (easier said than done)
      • For both you and your clients, use your intuition for goodness of fit. As you know, a healthy therapeutic alliance is a key factor for the overall success of therapy. At times, especially as a new clinician, it can be difficult to decipher between your intuition and anxiety. Clinicians should utilize supervision and consultation to explore types of clients who are and are not a good fit. Supervision and consultation are also helpful when you feel stuck.
      • Sometimes, it can feel pretty personal when a client cancels often or ghosts us. Keep in mind, clients will cancel appointments for a multitude of reasons ranging from weather, illness, moving, and symptoms and this happens to the best of us. 
  • You’re Not Alone
    • Consult with your peers and use supervision to feel balanced and confident with your caseload.
    • While you are likely a compassionate person, remember you too may have times when you need to check-in on your own mental health. Remember everyone can benefit from therapy!

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