June 23, 2021

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How Rural School Counselors Confront Life in a ‘Mental Health Desert’

ELK CITY — One student throws his classmates’ pencil box on the floor in anger. Another bites her own arm out of frustration. Others run screaming from their classrooms.

Some Elk City Elementary School students are celebrating as summer break approaches. Others are dreading the end of the school year, acting out in fear of what the next three months could bring. 

School counselor Kim Hamm worries about students who won’t have enough to eat this summer. And those without air conditioning or running water. She wonders how many will be left alone while their caretakers are working two or three jobs. And who will spend their days anticipating the next attack from an abusive family member. 

Hamm has spent most of May helping students ages 4 to 9 identify and cope with their feelings, which can be triggered by instability at home. 

“They know that, here, they’re safe and we’re not going to hurt them,” Hamm said. “And a lot of our kids, unfortunately, don’t go home to that every day.”

About 100 miles west of Oklahoma City on Interstate 40, Elk City is home to nearly 12,000 residents whose financial stability ebbs and flows with the volatile oil and gas industry. The nearby North Fork Correctional Facility brought some families to town to be close to a loved one. And students face rates of poverty, special needs and suicide higher than the state average.   

Kim Hamm, an Elk City Elementary School counselor, talks to a pre-kindergarten student who is playing with sensory toys purchased with Project AWARE funds in her office. Hamm said disadvantaged, abused and neglected students’ behavior deteriorates toward the end of the school year because they’re afraid or stressed about spending months away from school, which provides safety when life at home is turbulent. (Courtesy photo)

In her six years as a school counselor, Hamm has learned to anticipate these needs, making more time towards the end of the school year to meet with students one-on-one. But she doesn’t always have the bandwidth. 

School counselors’ duties range from helping develop individualized learning plans for students with special needs to proctoring the third-grade reading test. 

They enroll students in classes and ensure they meet state math and science requirements. They provide college and career advice and help them find and apply for scholarships. They wrangle students during morning drop-off and afternoon pick-up, run school-sponsored food and clothes pantries and teach breathing techniques to those with test anxiety. 

Low pay and increasing obligations have left Oklahoma with a teacher shortage, which means counselors like Hamm are taking on more work leaving less time for struggling students. 

Counselors refer the most troubled kids to community mental health counselors. But they are also in short supply especially in rural areas like Elk City where the ratio of mental healthcare providers to residents is 1 to 150,000. 

Without adequate local resources, the responsibility of students’ mental health care is falling to school counselors who are outnumbered and overwhelmed.

A federal program is increasing support for students in six rural school districts in what the state mental health and education departments call “mental health deserts.” But schools are finding it difficult to hire qualified caregivers and COVID-19 restrictions have halted programs and limited in-person treatment. 

Students are seen leaving Elk City Elementary School at the end of the school day. School counselor Kim Hamm said for some students school is a safe place and leaving is not a happy but fearful time of day for students who don’t have enough to eat or are abused by family members at home. (Whitney Bryen/Oklahoma Watch)

A Response Inspired By Sandy Hook

Since 2018, the State Department of Education has received two U.S. Department of Health and Human Services grants totaling $18 million. 

Oklahoma’s Project AWARE, short for Advancing Wellness and Resiliency in Education, is in its third year of the five-year grant at Woodward, Elk City and Weatherford Public Schools and its first year at Ada, Atoka and Checotah Public Schools. 

The districts were chosen by the state department for their lack of treatment providers and high-risk student populations. 

Oklahoma students are some of the most traumatized in the nation, according to several national health rankings including a recent survey conducted by a group based at Johns Hopkins University. But kids in these rural districts were more likely to have access to firearms, live in poverty, have an incarcerated parent, use drugs, experience depression and die by suicide, according to the state’s grant application.

These students are more susceptible to mental illness. And without treatment, they can face even more dangerous obstacles as they age, often leading to their own violent encounters, substance abuse or incarceration.

In one of the country’s deadliest school shootings, a 20-year-old killed six adults and 20 students at Sandy Hook Elementary School in 2012. Since then, the Substance Abuse and Mental Health Services Administration has sent millions to schools nationwide with high-risk students to prevent violence perpetrated by young people.  

This story was reported in partnership with the Solutions Journalism Network. For more information, go to solutionsjournalism.org.

In their first year of the grant, Atoka, Ada and Checotah schools in Eastern Oklahoma spent most of the year assessing student needs and training staff. At Elk City, Weatherford and Woodward schools in Western Oklahoma, Project AWARE forged ahead despite changes to programs that were derailed by the pandemic. 

Community events aim to reduce stigma around mental health challenges and treatment and teach parents and students about healthy habits like the importance of sleep and recommendations for social media use. Elk City paused events in the spring of 2020 while Weatherford took its online and saw a spike in participation. 

Fifth through 12th grade students at all six districts completed mental health assessments, which helps educators identify students who are distracted, unhappy, scared, lonely or are prone to acting out. 

Community mental health counselors had started to meet with troubled students in some of the Western Oklahoma schools. Parents have to agree to therapy but bringing professionals into the schools reduces barriers for families who lack transportation or who feel embarrassed visiting a local treatment facility. Many of these services were paused due to COVID-19. 

Some Project AWARE schools started group therapy sessions led by licensed mental health professionals for students with chronic stress often triggered by traumatic experiences like an absent or abusive parent. 

The grant also trained educators at all six districts in a classroom program that teaches conflict resolution and empathy. 

Liz Henthorn, a kindergarten teacher at Elk City Elementary School, listens as her students rate how they’re feeling at the end of the day. Henthorn checks in with her students twice a day through a program known as Circles that she says teaches students coping skills and empathy. (Whitney Bryen/Oklahoma Watch)

Just before the bell rang on a Monday afternoon, kindergarteners sat in a circle on a rug at the front of Liz Henthorn’s classroom at Elk City Elementary School. One-by-one the students rated how they’re feeling as they prepared to go home. They describe their feelings as green, yellow or red if they’re having a difficult day and their peers offer comfort and advice. 

One student said he was feeling sad because his dog ran away that morning. Another student was feeling red because she had a bad dream. Other students spoke up saying they could relate or that they’re sorry that happened. 

“We’re teaching kids to identify their feelings and giving suggestions to cope,” Henthorn said. “And when we do it as a group the kids are learning about empathy and thinking about ways to help each other and that is just as important.”

Liz Henthorn, a kindergarten teacher at Elk City Elementary School, listens as her students rate how they’re feeling at the end of the day. (Whitney Bryen/Oklahoma Watch)

Teachers, counselors and administrators were trained to provide coping skills to students who face universal challenges like disagreements with classmates or stress about what to do after graduation. But few are qualified to help more critical students, like those with mental illness or who have experienced trauma.

Woodward Public Schools reported 82 homeless students during the 2017-18 school year – more than twice the state average. Nearly two-thirds of students at Woodward and Elk City Public Schools qualified for free and reduced lunches, compared to the state’s average of 50%. In Elk City, 140 of the district’s 2,110 students had a parent who was incarcerated. And all three Western Oklahoma districts had higher than average suicide rates.  

Those districts rely on school counselors to support these students, though most lack the training. 

And the grant does not address the ratio of counselors to students, which is far above national recommendations. 

Districts also planned to increase referrals to community treatment centers facilitated by the grant. Demand for mental health care spiked during the pandemic, further straining the area’s providers and leaving families with few options. 

Weatherford elementary students are seen eating lunch in the school’s cafeteria. (Whitney Bryen/Oklahoma Watch)

The Complicated Search for Counselors

School counselors can listen to students and offer coping techniques, but their ability to help is limited. Licensed counselors can provide therapy and diagnose students with mental illness. 

Elk City, Woodward and Weatherford districts hoped to bring more licensed professional counselors into schools by hiring new staff and using Project AWARE funds to pay for training for current school counselors. Each district hired one licensed mental health provider who serves all students. The districts have been unable to hire any new school counselors and no existing counselors have been licensed. 

The state requires school counselors to have a master’s degree in a related field or two years of experience, and pass the state’s general education, professional teaching and school counseling exams. 

Training for licensed professional counselors requires an additional 60 graduate-level college hours and 3,000 hours of supervised counseling. Counselors must also pass an exam before being licensed. 

Education costs are likely to total $21,000 to $33,000 depending on the school, according to the most recent state averages. And that doesn’t include fees for supervision or the licensing exam. 

The grant will pay tuition costs for school counselors to get their license. Only two of 16 school counselors in Elk City, Weatherford and Woodward have taken the offer. 

School counselors said it is still an expensive and lengthy endeavour that results in more work without a boost in pay or a promotion. 

“I know that it would give me more in depth counseling training, but I think at this time in my life with small children it’s just probably not going to happen,” said Hamm, who has a 10-month-old and a 3-year-old. “If I was going to make more as a school counselor with it then maybe I would, but I’m not going to so I’m just not going to spend a whole lot of time to get that.”

For school counselors who do get their license, the job doesn’t change much. They often have the same paperwork, testing responsibilities and recess duty. But they’re also counseling the school’s most traumatized kids, a group that is growing following the pandemic. 

Oklahoma has 1,841 school counselors and nearly 695,000 students, according to State Department of Education reports. The department does not track how many school counselors have their professional counseling license.

The American School Counselor Association recommends a ratio of 1 school counselor to 250 students. Oklahoma mandates 1 school counselor per 450 middle and high school students. The state does not have a threshold for elementary schools. 

Not every school has a dedicated counselor. Some have teams depending on student population, how schools prioritize funding and disperse tasks. 

The Association also recommends counselors spend at least 80% of their time working directly with or for individual students. Oklahoma Watch interviewed 10 counselors across the state. Most said they spend the majority of their day doing clerical work. Depending on the time of year, about 20 to 50% of their time is spent with students. 

Elizabeth Moss, a seventh and eighth grade counselor at Woodward Middle School, said she is one of the fortunate ones because she spends about 50% of her time meeting with students one-on-one thanks to the help of her administration. Even with the group sessions she leads, Moss said she still hasn’t been able to meet the national recommendation.

“A lot of what I deal with are the results of families who are in crisis, where there’s addiction, other issues that are related to poverty and the kids show up to school and there’s a lot of fallout from that,” Moss said. “And so we have kids who are depressed. We’ve had kids who are suicidal. Anxieties are really high.”

Lora Anderson, a school counselor at Ada Junior High School, talks to students about online enrollment and how to choose classes for next school year. (Courtesy photo)

Moss is one of two school counselors taking advantage of Project AWARE funding to get her professional counseling license. 

Her principal took over her ACT and pre-ACT testing, scheduling and enrollment duties allowing Moss to spend more time with students in crisis. 

“I would love to see even more taken off of the shoulders of counselors so that we could take care of our kids’ needs better,” Moss said. “But I truly feel blessed here that I am not overwhelmed, like so many counselors.”

At Ada Junior High School, counselor Lora Anderson spends about 25% of her time working with troubled students. 

Many school counselors go into the job to propel students’ academic success, not to provide therapy. Anderson does her best to help students but said she isn’t trained to help kids with acute needs.

“That’s not what I want to do,” Anderson said after returning to her desk from lunch duty. “I do so many different things to help students. If I wanted to be a mental health counselor, I wouldn’t work in a school.”

Michelle Taylor, President-Elect of the Oklahoma School Counselor Association and counselor at Adair High School, said the job has changed a lot since she started and counselors at smaller schools like hers are often overwhelmed juggling paperwork, test proctoring and counseling students. (Courtesy photo)

Michelle Taylor, President-Elect of the Oklahoma School Counselor Association, said the organization doesn’t track how many school counselors have their license. But based on training she’s attended and led over the years, Taylor said it’s likely that about 1 in 5 school counselors goes on to become licensed. 

School counselors are serving dual roles whether they want to or not. Like swim instructors at a pool, most school counselors see their role as building stronger swimmers. But as mental health challenges continue to grow, counselors also have to serve as lifeguards, diving into the deep end to rescue drowning kids. 

“Counselors in rural schools tend to be treading more water,” Taylor said. “Some folks are so overwhelmed with the job they have, they don’t have the time or the motivation to seek out additional training. It’s just not accessible for folks.”

Taylor has been a school counselor for more than 20 years and has her professional counseling license. She currently works with students at Adair High School in northeast Oklahoma. 

She said the job has changed a lot since she started. Test requirements are constantly evolving. College admissions and scholarship applications seem to get longer every year. And students want to talk more. 

Kids are more willing to open up about their issues, especially since mental health is talked about more openly since the pandemic, Taylor said. And school counselors have to be ready to listen and help. 

“I think we should be the ones doing this work because we already know the students and they already know us so it’s quicker to get to that trust that can take a long time to develop,” Taylor said. “That’s when it becomes about priorities and we have to respond to what the students need first and then worry about everything else.”

Elk City Middle School students took a mental health screening at the beginning of Lana Graham’s geography class in March. Graham said since the coronavirus pandemic began, her students seem more anxious and depressed than ever. (Whitney Bryen/Oklahoma Watch)

Whitney Bryen is an investigative reporter and visual storyteller at Oklahoma Watch with an emphasis on domestic violence, mental health and nursing homes affected by COVID-19. Contact her at (405) 201-6057 or [email protected] Follow her on Twitter @SoonerReporter.



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