How a Prescription Pill Emergency Woke up Our School Community to a...

Voices | Social-Emotional Learning

How a Prescription Pill Emergency Woke up Our School Community to a Mental Health Crisis

By Amy Mason     Feb 26, 2019

How a Prescription Pill Emergency Woke up Our School Community to a Mental Health Crisis

This story is part of an EdSurge Research series about how educators are changing their practices to reach all learners.

When four ambulances arrived at school in 2015 to transport middle school students who had taken prescription drugs in the classroom, it was a career first for me. We had made so much progress as a school community to improve student behavior in the classroom that year, having reduced disciplinary referrals by 25 percent. However, as the sirens blared that morning, I realized classroom behavior was just the tip of the iceberg. If we really wanted to improve student behavior, we needed to take a deeper look at what was happening in their lives.

We’re lucky we found out about this situation, it easily could have gone under the radar. After witnessing a peer passing out pills during class, a student I was close with came to me expressing concern. I was a little surprised. This student had some disciplinary problems of her own and didn’t need to come to me with the information, but I was glad she did.

After hearing about the pills, we called the ambulances and interviewed multiple students, discovering that one of them had stolen prescription Lyrica from her parent’s medicine cabinet and was dealing it out in the classroom to a few friends. Most of these students had never been to the office or gotten in trouble in their classes. In interviews, all of them separately stated that they were depressed and one of their friends told them that these pills would help. It should be noted that this drug is typically prescribed as a painkiller and one of the adverse reactions listed on the label is suicidal thoughts.

This was the tail end of my first school year as the principal at Madison County Elementary School, a pre-K to 8th grade Title I school, located just outside of Huntsville in Gurley, Ala. After many years working as a teacher and administrator in a wide range of schools in Arizona, Indiana, Virginia, Maryland and now Alabama, my experience should have prepared me for just about everything. Somehow though, I wasn’t prepared for the Lyrica situation.

Our school serves a high population of students facing poverty. With over 56 percent of students receiving free and reduced lunch meals and a median household income of around $24,000, poverty is prevalent in our community. Many of our students live in homes impacted by drug addiction and have incarcerated family members.

Our kids are faced with major obstacles outside of school. The day the ambulances came, we started to recognize that these challenges—whether they happen inside or outside of the school—shape the learning experience for our students. This pill incident woke up our school community.

Why Positive Behavioral Interventions and Supports Weren’t Enough

When I came to Madison Elementary in 2015, I was the third principal in a four-year time-frame. I knew it would be important to survey the faculty to better understand their perceptions around the school’s strengths as well as areas that needed improvement to discover an agreed upon point of focus. The problem most commonly identified by the group was student behavior. After a quick review of the data, I realized that over 300 disciplinary referrals had been submitted during previous years with a consequence of in- and out-of-school suspensions and the school’s test scores were the lowest in the school district.

When we sat down to talk about student behavior, it immediately became clear that the staff’s perception of behavioral challenges differed from mine. From my perspective, students were well-mannered and said, “Yes, sir,” and “Yes, ma’am.” Fights and peer conflicts were minimal for a middle school, and in comparison with many of the other schools I’ve taught in, the classroom behavior here wasn't so problematic. But the majority of our teachers have spent their entire 20 or 30-year career in this building and they felt otherwise. They wanted a change.

I organized a committee that summer and we developed a shared mission and vision, as well as a Positive Behavioral Interventions and Supports (PBIS) framework outlining a common language and common expectations that could be used in every classroom. Students needed to be in a learning environment where they could excel and teachers needed to recognize the behaviors they wanted to reinforce.

Image Credit: Madison County Elementary Schools

While elements of the framework were helpful, and had clearly led to the decrease in disciplinary referrals we saw that year, the ambulances were proof that we needed to do more.

Finding a Better Fit

Our students were facing mental health challenges and had been through traumatic events that would be difficult for any adult to overcome—they needed more than PBIS. I started to research alternative approaches to behavior support and how to effectively work with students facing trauma. In my research, I learned about the CDC study of Adverse Childhood Experiences (ACEs) and the long-term health impacts that students would face if these experiences were not appropriately addressed.

Association Between ACEs and Negative Outcomes (Source: Centers for Disease Control and Prevention)

The traumatic experiences measured in the study include abuse, household challenges and neglect. Some of the more specific experiences members of our student population face are divorce, the death of a parent caused by suicide and/or drug overdose, homelessness, neglect, verbal and physical abuse, being the product of incest and a major overarching concern—poverty. When faced with these kinds of challenges, students are not ready to learn when they arrive at school. As Maslow's Hierarchy of Needs states, a student's basic needs must be met before they are in a position to learn, but this wasn’t the case for many of our students. Our great dilemma became figuring out how to address these basic needs within the time constraints of a 7 1/2-hour day. This dilemma continues to confront our staff daily.

We rolled up our sleeves and began digging deeper into the ACEs study in an effort to provide training during faculty meetings. Teachers expressed that they felt ill-equipped to handle the intense needs that followed our students to school. The staff was supportive of the initial improvements that were brought about through PBIS implementation, but they needed access to more research to improve their understanding of ACEs and strategies that would help them support students. My first step toward supporting the staff was to provide extensive professional development in trauma-informed approaches to prepare our educators.

Understanding ACEs is one piece of the puzzle. Identifying and addressing student needs is another. We needed a way to identify our students who were most at-risk, so we began using the Devereux Student Strength Assessment (DESSA) three times a year to measure students’ social-emotional health and understand their needs.

The assessment findings are used to guide our work with students. Grade level teams discuss tiered levels of support for behavior and social-emotional needs during our monthly RTI meetings with the guidance counselor, instructional coaches and administration. Additionally, our district expanded its partnership with NOVA, the local mental health center. Students currently have access to a school-based therapist five days a week. These services are offered following a parent or teacher referral.

Although our school-wide journey into social-emotional learning was just beginning during the 2015-2016 school year, we were able to refer the students involved with the pill incident to NOVA for individualized attention from a school-based therapist. As heartbreaking as this situation was for those students, they were all OK that day and they were able to receive services soon after. The incident was pivotal in my realization that our school needs to provide mental health support for all of our students.

We continue to pursue our journey to become more informed about how best to support students in coping with the challenges that life brings. Within the first six months of DESSA implementation, 70 percent of our students showed social-emotional growth in the areas of self-awareness, self-management, social awareness, relationship skills, goal-directed behavior, personal responsibility, decision-making and optimistic thinking. That is undoubtedly due to the time our teachers have dedicated to learning about ACEs, implementing DESSA and following through on getting the right services to students who need them.

Now that the root cause of the behavior issues at our school have been appropriately defined, we are focusing our efforts around more than student behavior and I’m confident that we are meeting more of the individualized needs of our students.

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