Vermont has the highest rate of students with emotional disturbance

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Editor's note: This is the first of a three-part series on emotional disturbance in Vermont schools. Parts 2 and 3 will be published on Friday and Saturday.

BRATTLEBORO, Vt. >> Lawmakers in Montpelier continue to work to find a way to control education spending in Vermont, and while it is still too early to predict what that bill ultimately will look like it is clear that the state will take some measures during this session to offer relief to taxpayers.

Yet as hard as it's been to come up with a plan to encourage local school boards to reduce their budgets, the real battle will be waged next year when the state tries to get its arms around escalating special education costs.

The House and Senate education committees this year are looking at issues including small schools, spending caps, class size and district boundaries, but for the most part special education costs have not been a part of the conversation.

Secretary of Education Rebecca Holcombe said state leaders are laying the groundwork this year for future debates on special education.

"We are discussing it, but we've asked the State Board and the Legislature to help us use this year as an exploratory year because we don't think we're ready for legislation yet," said Holcombe. "We don't think we understand the problem enough."

Once those hearings begin the discussion over the state's skyrocketing prevalence of emotional disturbance in the schools will likely be one the toughest debates to have.

Vermont has the highest rate of identifying students with emotional disturbance in the country. As a percentage of all students who received special education services in the 2012-13 school year in Vermont, about 16 percent were identified with an emotional disturbance, according to federal data.

That is more than twice the national average of 6.3 percent.

More children are showing up to school every morning with more severe emotional issues, school staff and mental health professionals say, and those issues often lead to violent and non-compliant behaviors that can affect the whole class.

School administrators point to poverty, substance abuse, violence, hunger and homelessness as just some of the challenges facing children and which in turn can lead to anxiety disorders, depression, social withdrawal and serious acting out and aggressive behavior.

And while the Legislature is looking for ways to reduce spending, school leaders say they need more, and not fewer, resources to help the children and families in crisis.

"We're now the state with the highest proportion of students in the country receiving services for emotional disabilities, which should give us all pause," Holcombe said. "It's something we're very concerned about."

The traumatized child

Vermont's growing number of children with emotional disturbance counters both state and national data on overall student counts and special education trends. Between 2010 and 2013 total enrollment in Vermont's public schools dropped from 89,814 to 87,963, a decrease of just more than 2 percent. During the same period the number of students identified with emotional disturbance jumped from 1,870 to 1,980, an almost 6 percent increase. And that growth occurred even as the number of students receiving special education services in the state fell from 13,914 to 13,885.

Nationally, the number of students identified with emotional disturbance grew from 1976 to 2005, but the number has been steadily going down since, both in the number of students served and as a percentage of total student enrollment.

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So what's going on with Vermont's children?

"This is my 40th year as an educator and kids have always presented behavior challenges," said Academy School Principal Andy Paciulli. "Kids have always come to school with issues, but what we've been experiencing over the last decade is an increase in the percentage of kids with serious emotional and behavioral issues. It's exploding."

Substance abuse and violence in the homes often lead to disruptive behaviors in the classroom, Paciulli said, and the crushing weight of extreme poverty is also taking a toll on children and families.

At Academy School the percentage of children receiving free or reduced lunch rose from 51 percent in 2007 to 62 percent last year.

Annual test scores consistently show that children from low income families are academically behind their peers, but Paciulli said the test results offer just a glimpse into the stress and upheaval his students are facing every day.

"These kids are traumatized. That's part of our vocabulary now. We are becoming trauma sensitive schools and the trauma is not just falling from the sky," he said. "It's being enacted on children in their homes and communities and then they come to school. What we try to do is help them grow emotionally and socially so they can stay in the classroom and learn."

Getting it right?

Still, it's hard to believe that Vermont has so many more children and families in crisis than any other state.

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According to Windham Central Supervisory Union school psychologist Tom Daughton, perhaps it is Vermont that is getting it right while the rest of the country is getting it wrong.

The Vermont Agency of Education reports that 1,980 students were identified with emotional disturbance in 2013, which is about 2.25 percent of the total school population. The National Institute of Mental Health says 4.1 percent of U.S. adults have a serious mental illness, while 18.6 percent of adults show a prevalence of any mental illness.

If you compare the number of school age children in Vermont labeled with emotional disturbance, Daughton says, it actually falls below the rate found in adults, and probably more accurately reflects modern societal trends.

"I don't have a singular answer why Vermont is ranked number one for identifying kids as emotionally disturbed," Daughton said. "I think Vermont is doing a better job of identifying kids and calling it what it is. This figure is not radically different than the general population."

Daughton said children are being identified with emotional disturbance because that is the disability they are facing and he stands behind the high identification rate in his district.

"I look at a kid on a case-by-case basis and I say this meets criteria under my clinical judgement, with 20 years as a school psychologist. This is a kid with emotional disturbance," Daughton said. "And the reason I do that is because that's what the kid needs. I'm not going to say 'oh they just have learning problems' when there's all this emotional behavior. That would be unconscionable."

"Maybe the numbers that you see there are indicative of what everyone else ought to be doing, rather than thinking that we are out of whack," Windham Central Supervisory Union Superintendent Steven John said. "If the premise is that we have too many kids identified as emotionally disturbed, what is the difference in criteria and the definition among the states? We have a high degree of confidence in our designation of students."

Stigma

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Many schools around Vermont contract with their local mental health agencies to bring clinicians and behavior interventionists into the classroom to serve these children. Health Care and Rehabilitation Services of Vermont, or HCRS, is the designated mental health agency that works with schools in Windham and Windsor counties.

HCRS CEO George Karabakakis said a reluctance among school administrators, parents, and even mental health professionals in other states to identify children with emotional disturbance could be one reason the Vermont identification rate is so high.

"Stigma is a huge issue," Karabakakis said. "That's not true of someone with hearing loss or other physical disabilities but that is an issue with emotional disturbance. Labeling kids, and what those implications are, could have an effect on who is identified."

Unlike most other special education categories, emotional disturbance covers a wide spectrum of behavioral, emotional and psychological disorders. A deaf or blind student will be deaf or blind in Texas, North Dakota or Vermont, but a student with anxiety disorders or behavioral issues will receive a very different diagnosis, and very different services, from state to state.

"If you had a group of 10 kids with emotional/behavior issues, and you asked a range of clinicians across the country what the diagnosis of them would be, I think you would find some variability in diagnosis between clinicians, based on their training, clinical orientation and understanding of family history," said Will Shakespeare, HCRS Director of Children, Youth and Family Programs. "How do you make a primary diagnosis of Attention Deficit/Hyperactive disorder vs. an anxiety disorder, vs. an early childhood trauma-related disorder, vs. a Parent-Child Relational problem which are all legitimate disorders under the DSM? It's very hard to measure quantitatively or objectively because the descriptions often overlap. You follow the DSM and use the diagnostic criteria to the best of your ability but ultimately there is a fair amount of subjective interpretation on where to land."

Success Beyond Six

In 1992 Vermont started Success Beyond Six, a funding mechanism run through the Agency of Human Services which allows school districts to use Medicaid money to support mental health services in the schools. Under the Medicaid-supported formula federal dollars cover about 60 percent of the costs for providing mental health services in the schools with local school districts paying about 40 percent.

Since the start of Success Beyond Six the number of children identified with emotional disturbance has increased and so has the number of clinicians and behavior specialists working in the schools.

Since 1991, the year before Success Beyond Six was introduced, the number of Vermont students identified with emotional disturbance has risen from 978 to 1,980, and this number continues to rise even as the number of students in the state drops. By 2006, 556 full time equivalent mental health clinicians and behavior interventionists were working in the schools at a cost of just more than $30 million. And in 2014 Success Beyond Six helped fund 778 full time equivalent mental health workers with about $50 million in Medicaid, and local dollars supporting the program.

The Centers for Medicare & Medicaid Services do not keep data on how states use the federal funding to support mental health services in schools.

Charlie Biss, director of the Child, Adolescent and Family Unit of the Vermont Department of Mental Health, said when he meets with colleagues from around the country they are generally surprised at how closely the Department of Mental Health and Agency of Education work together in Vermont and just how much Medicaid money the state is able to leverage to bring counselors and behavior interventionists into the schools to work with children.

"When we did this in 1992 it was a very big deal," Biss said. "We are a small state, and I think we underestimate the size and complexity of departments in other states and how hard it would be to have the departments of education and mental health working together. It would be a very big undertaking in many states."

Biss sees the steady rise in the number of children receiving mental health services in the schools as a good thing for the children, families and schools.

The funding formula, he said, allows the federal money to support that work and it also delivers professional clinicians to children from low income households who might otherwise never have an opportunity to receive those services.

"That's what we are seeing in Vermont. If you don't have a way to treat it or work with it you're less likely to ID it and more likely to let it slide," Biss said. "It is like anything. If you know you can get help by identifying the problem you are more likely to identify the problem."

Contact Howard Weiss-Tisman at 802-254-2311, ext. 279


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