A spate of student deaths by suicide in 2019 sent the Cherry Creek, Colo., school community into a deep despair.
鈥淚 thought we might all lose our minds at the time,鈥� said Tony Poole, the Cherry Creek district鈥檚 assistant superintendent of special populations. 鈥淭he feeling of hopelessness, and fear, and rage that you are not able to save these kids really pushed us to start thinking outside of the box.鈥�
After watching in dismay as the number of beds at in-patient treatment or alternative education programs for adolescents dwindled 鈥� from 77 in the community to 16 viable options in the span of 11 years鈥� Poole made a pitch to state education officials for help. The community needed to expand access to treatment for students struggling with serious mental health challenges, ranging from anxiety and severe depression to suicidal ideation. The state officials told him there was little they could do.
鈥淭hey said, 鈥榊ou know, honestly, the only way you are going to get day-treatment spots is if you built your own,鈥� 鈥� Poole recalled. 鈥淚 think it was kind of an off-hand comment. But I stepped back, and I thought, 鈥極K, if that鈥檚 what it鈥檚 going to take, then we鈥檒l do it.鈥欌��
This summer, the nearly 55,000-student Cherry Creek district, in the Denver suburbs, broke ground on a $15 million mental health day-treatment center, in partnership with two local medical experts, Children鈥檚 Hospital Colorado and the Department of Psychiatry at the University of Colorado School of Medicine Anschutz Medical Campus.
When the program opens for students in fall 2023, it鈥檚 expected to provide the kind of critical mental health care for students that鈥檚 so hard to come by, even as the nation faces a youth mental health emergency.
Rates of before the pandemic. But the isolation from social distancing and disrupted schooling and routines took a sledgehammer to students鈥� mental and emotional well-being. Forty-four percent of students said they felt sad or hopeless in 2021, and nearly 40 percent said their mental health suffered during the pandemic. In December 2021, U.S. Surgeon General Dr. Vivek H. Murthy warned of a
We have kids walking our hallways who need treatment, who need support, and simply cannot get it.
Dr. K. Ron-Li Liaw, Mental Health-in-Chief at Children鈥檚 Hospital Colorado, one of Cherry Creek鈥檚 partners on the day-treatment center, said the hospital system has seen a sharp surge in emergency room visits from parents seeking help for their children. The hospital system reported that it had also seen an 88 percent increase in emergency room visits for behavioral health this year compared to the first half of 2019.
鈥淚t鈥檚 on the mind of every superintendent, every principal, every teacher鈥攊t鈥檚 the mental health concerns of the kids in their classrooms,鈥� Dr. Liaw said. 鈥淭his is sort of a first step for us.鈥�
A 鈥榰nique鈥� response to a crisis
Cherry Creek officials are hoping the mental health day-treatment center will fill a void for children who need immediate help and whose parents have had to resort to stop-gap emergency room assistance or whose treatments have languished because insurance coverage has run out or does not cover such care.
While the district is not seeing a spike on its suicide risk assessments, which it has administered for years, students are scoring higher in areas that require referrals for more intense and immediate treatment, such as self-harm and suicidal ideation, district officials said. And the are still deeply painful losses.
鈥淲hen your child needs this kind of help, and you go on a waiting list because your insurance can鈥檛 find you a placement, or the school district can鈥檛 find you a placement, it鈥檚 terrifying,鈥� Poole said. 鈥淎 lot of times, the emergency rooms can鈥檛 give them the care either, and so they just get released, and they get sent back to school, where teachers, and school psychologists, and school social workers have to try to keep them safe鈥� The human toll is stunning on everyone involved. And then, God forbid, we lose a kid.鈥�
If you or someone you know is experiencing a crisis or having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) or text TALK to 741741.
The day-treatment program, which will be located in a two-story facility, will be divided into three wings to target three different levels of care: severe, moderate, and transition.
Each child will have an individualized treatment plan, and students will be divided into two groups, from 4th grade through 8th grade and 8th through 12th. (Eighth grade will be split into two groups because maturity varies so widely, Poole said.)
At the most severe level, which is closest to a partial hospitalization program, students will spend most of their time getting clinical help, in group and individual therapy, with the goal of reducing the emotional problems with which they are struggling, said Dr. Bruno Anthony, a professor of child psychiatry at the University of Colorado Anschutz Medical Campus. The amount of schooling will be limited for students at the severe level and be based on what they can handle.
At the moderate level, students will continue to have clinical interventions, while their schooling will increase to about half their time, Dr. Anthony said.
When doctors determine that students are ready to return to regular classes, they鈥檒l move to a 鈥渢ransition wing,鈥� which 鈥渟tarts to look a little bit more like regular school,鈥� Poole said.
鈥淭here鈥檚 a straight hallway, there鈥檚 lockers, there鈥檚 a square classroom,鈥� he said. 鈥淭hey鈥檒l have their regular classes鈥攕ocial studies, language arts, math, etcetera. That transitional wing will feel a lot more like regular school, and the entire focus here will be on, 鈥榟ey, we are getting ready to go back to school.鈥� 鈥�
At this level, students may even spend a day in their typical classrooms, outside of the center, Dr. Anthony said.
鈥淭hat kind of tiered program is really unique, and isn鈥檛, I don鈥檛 think, really anywhere else in the country,鈥� he said.
The transition level will be an important component of the program because educators frequently complain that students often return to school before they鈥檙e ready and schools are ill-equipped to help them ease back into a classroom setting.
鈥淭hat鈥檚 the design that these folks came up with: We talked about what鈥檚 wrong with current day-treatment programs, and how we could we do it better, 鈥� Poole said. 鈥淲e think that鈥檚 pretty unique as well.鈥�
While treatment plans are individualized, students will attend five a days a week, with the length of the day hewing closely to a normal school day, from around 8:30 a.m. to 3 p.m., Dr. Anthony said. Students will also be able to get care for eating disorders and substance abuse.
A program for a child in the severe wing may look something like this: A family will check in with the student around 8:30 a.m., give an update, and discuss any concerns they have with staff. Students will then be divided by age, and they鈥檒l work on identifying triggers to their mental health challenge, including depression or anxiety.
The center will use a lot of exposure therapy and help students develop tools to deal with triggers. Students may have individual therapy, group therapy, as well as family therapy, Dr. Anthony said. He is hoping to integrate music and art therapy into the program as well.
鈥淥ften other programs like this that are in the community are more like babysitting for the students, and they just don鈥檛 do much in terms of actual treatment,鈥� Dr. Anthony said. 鈥淏ut here, by bringing together these different partners we are able to say, 鈥榃e know this has been well worked out. We have data behind it which shows it works.鈥� I think that鈥檚 what鈥檚 really attractive to the school system to say let鈥檚 really put something in place, something that really has been shown to work.鈥�
Another big difference from traditional day-treatment programs is the family鈥檚 involvement in students鈥� treatment. That鈥檚 not always possible when treatment centers are far away from home. But it will be easier for a parent to participate in their child鈥檚 treatment and spend more time understanding the program if it鈥檚 nearby, in the student鈥檚 home district, Dr. Anthony said.
鈥淲e are really very serious about having family involvement with this program as well. We realize that the progress works because things are worked out in the home setting as well as schools,鈥� he said. 鈥淲e really want to have a very significant family therapy involvement at all levels.鈥�
We feel very strongly that the right place for support and care is where kids live, and learn, and connect, and play, and where families can easily access services and expertise in the right time.
At full capacity, the center is expected to provide treatment to about 60 students at a time. The clinical portion ( the psychologists, psychiatrists, therapists) will be staffed by Children鈥檚 Hospital and the University of Colorado Anschutz Medical Campus, while the Cherry Creek district will provide the school staff and design the educational component. The district and the medical providers will take into account input from family and youth advisory teams as they continue to hammer out details on the final program.
A clinical researcher will also track outcomes for different populations of students, Dr. Liaw said.
From a vague idea to a plan
When Poole said the district would build its own day-treatment program, he had no idea what would come next.
He floated the idea of putting the center on the district鈥檚 2020 bond election and letting voters decide. With a lot of projects vying for attention, Poole wasn鈥檛 even sure the center would make it on the final bond measure, or pass. But it passed with one of the highest rates in the district鈥檚 history, he said.
One of the first things Cherry Creek administrators did was to assemble a group of about two dozen district mental health professionals who had backgrounds in day-treatment or residential care settings and assigned them two big tasks. The first was to find another school district that鈥檚 building or had built a mental health day-treatment center for its students; the second was to consider what a perfect program would look like, including the building鈥檚 design and medical and educational components.
On the first question, they didn鈥檛 find examples of districts doing what Cherry Creek was proposing. On the second question, the staff said they鈥檇 build a place with a warm, welcoming, and inviting interior that did not feel institutional; one where staff would work with students based on the severity of their conditions; and a place that would allow students to step down slowly and transition back to their regular home schools鈥攁n often missing piece in many day-treatment programs.
The responses influenced the color-scheme the district chose and other design elements, such as including rough textures that students can run their palms over to help them calm down. There鈥檚 also an outdoor climbing wall, exercise areas, and no hard corners that students could use to harm themselves.
But there were still more questions. Among them: how to find the right medical partner and how that relationship would work given that school districts, hospitals, and psychiatry departments don鈥檛 have long histories of working together.
鈥淚 think we also had questions about how would we bill insurance,鈥� said Superintendent Christopher Smith, who was chief of staff to then-Superintendent Scott Siegfried when the day-treatment center was proposed. 鈥淲hat would the intake process look like? That鈥檚 why we knew we needed to get with a group that was experienced [in] this. We also knew what we were doing was broken, so we had to find a different out-of-the box way to help.鈥�
They鈥檙e still working through some of those questions. The Cherry Creek Schools Foundation, for example, will help cover the treatment costs for students who do not have insurance so that no student would be denied care based on their ability to pay, district officials said.
Dr. Liaw and Dr. Anthony said they jumped at the opportunity when they saw Cherry Creek鈥檚 request for proposals because they, too, have seen adolescent mental health needs skyrocket while community options for treatment plummet. The hospital and the university already have several physical and mental health partnerships with local school districts, including with the Aurora and Durango school systems.
鈥淥ur heart is in prevention and early intervention,鈥� Dr. Liaw said. 鈥淚t would be a dream for all of us to not have children have to go to the emergency department unless there was a true emergency for their mental-health condition and challenges. We feel very strongly that the right place for support and care is where kids live, and learn, and connect, and play, and where families can easily access services and expertise in the right time. 鈥�
鈥淔amilies trust school personnel for a whole host of other issues that are important to their families,鈥� she continued. 鈥淲e want to be there, too.鈥�
Though the groups are only about two months into the process, there鈥檚 a lot to sort out: like how to comply with federal privacy laws, such as the Health Insurance Portability and Accountability Act (HIPAA), which protects patients鈥� medical information, and the Family Educational Rights and Privacy Act (FERPA), which safeguards students鈥� education records.
Dr. Liaw said those are critical aspects to get right because they鈥檒l allow schools and the medical professionals to get students into care as soon as possible.
Bold expectations meet harsh realities
Poole and other Cherry Creek officials are painfully aware that when the mental health day-treatment center is up and running it will not meet the needs of every child who requires help.
鈥淭hat will hurt,鈥� Poole said. 鈥淎cuity has to be the number one decision-maker. That will drive what we do. That and fit鈥攆it for the program.鈥�
If this program works, it could be the first of many such treatment centers the district will build.
鈥淭his isn鈥檛 going to solve the mental health crisis,鈥� Poole said. 鈥淚t won鈥檛 solve the mental health crisis in Cherry Creek. It won鈥檛 solve the mental health crisis in Colorado. It can be a start. It can be a model for other school districts in Colorado. It can be a model for other schools around the nation if it works鈥攚e hope it does.鈥�
The district has ramped up investments in mental health and social-emotional learning supports for students in recent years.
It has about 180 school psychologists, social workers, and staff providing mental health services to schools, and this year it added 12 full-time staff to work with schools at a cost of $1 million. It also recently hired a social-emotional learning coordinator.
The district is also using a grant from the state education department to add counselors in grades 1 through 5, according to Steven Nederveld, Cherry Creek鈥檚 mental health director. (They鈥檙e available in high and middle schools.)
Cherry Creek is also expanding partnerships with other health providers, with the goal of ensuring there鈥檚 a full-time or part-time school-based therapist in each of its 67 schools, he said.
I do think it鈥檚 public education鈥檚 role and responsibility to advocate for the health and well-being of our students. But I don鈥檛 think it鈥檚 our sole responsibility to meet every single one of their needs. That鈥檚 a community effort.
It鈥檚 also contracted with Hazel Health, a San Francisco-based telehealth program, to offer free teletherapy to students in 6th through 12th grades, beginning in December. About 30 percent of the clinicians with Hazel are bilingual and about half identify as people of color. That鈥檚 important in a district where students of color make up about half of the enrollment. Students will be able to see a therapist within 24 hours of contacting the company, Nederveld said.
鈥淭hat鈥檚 just another way we are trying to bring connections to partners to ensure that students have more access to mental health services when needed,鈥� he said. 鈥淭he lack of access is definitely a big concern. 鈥� So a 24-hour turnaround time when we refer students is something that we think is going to be critical, especially when a lot of our students are struggling with something that needs pretty immediate attention.鈥�
The doctors are also clear that while they鈥檙e optimistic about the success of the day-treatment program, it will take a lot more to reach all those who are struggling.
鈥淚 think we all feel pretty strongly that as soon as we open the program, within a short period of time, the program will likely be full,鈥� Dr. Liaw said.
Smith, the Cherry Creek superintendent, said addressing the mental health crisis requires an all-hands-on-deck approach, but K-12 has a critical role to play.
鈥淚 don鈥檛 think any of us can do anything alone,鈥� Smith said. 鈥淚 have 54,000 kids that show up every single day, and I am responsible for every single one of them. I absolutely believe that it鈥檚 part of our role, 100 percent.鈥�
But I don鈥檛 think it鈥檚 our sole responsibility to meet every single one of their needs,鈥� he continued. 鈥淭hat鈥檚 a community effort.鈥�
