A spate of student deaths by suicide in 2019 sent the Cherry Creek, Colo., school community into a deep despair.
“I thought we might all lose our minds at the time,” said Tony Poole, the Cherry Creek district’s assistant superintendent of special populations. “The 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.”
After watching in dismay as the number of beds at in-patient treatment or alternative education programs for adolescents dwindled — from 77 in the community to 16 viable options in the span of 11 years— 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.
“They said, ‘You know, honestly, the only way you are going to get day-treatment spots is if you built your own,’ ” Poole recalled. “I think it was kind of an off-hand comment. But I stepped back, and I thought, ‘OK, if that’s what it’s going to take, then we’ll do it.’”
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’s 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’s expected to provide the kind of critical mental health care for students that’s so hard to come by, even as the nation faces a youth mental health emergency.
Rates of sadness and hopelessness among adolescents were climbing before the pandemic. But the isolation from social distancing and disrupted schooling and routines took a sledgehammer to students’ mental and emotional well-being. Forty-four percent of students said they felt sad or hopeless in 2021, according to the Centers for Disease Control and Prevention, 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 mental health crisis among youth.
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’s Hospital Colorado, one of Cherry Creek’s 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.
“It’s on the mind of every superintendent, every principal, every teacher—it’s the mental health concerns of the kids in their classrooms,” Dr. Liaw said. “This is sort of a first step for us.”
A ‘unique’ 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 five publicly reported student suicides in 2019 are still deeply painful losses.
“When your child needs this kind of help, and you go on a waiting list because your insurance can’t find you a placement, or the school district can’t find you a placement, it’s terrifying,” Poole said. “A lot of times, the emergency rooms can’t 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… The human toll is stunning on everyone involved. And then, God forbid, we lose a kid.”
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’ll move to a “transition wing,” which “starts to look a little bit more like regular school,” Poole said.
“There’s a straight hallway, there’s lockers, there’s a square classroom,” he said. “They’ll have their regular classes—social studies, language arts, math, etcetera. That transitional wing will feel a lot more like regular school, and the entire focus here will be on, ‘hey, we are getting ready to go back to school.’ ”
At this level, students may even spend a day in their typical classrooms, outside of the center, Dr. Anthony said.
“That kind of tiered program is really unique, and isn’t, I don’t think, really anywhere else in the country,” 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’re ready and schools are ill-equipped to help them ease back into a classroom setting.
“That’s the design that these folks came up with: We talked about what’s wrong with current day-treatment programs, and how we could we do it better, ” Poole said. “We think that’s pretty unique as well.”
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’ll 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.
“Often other programs like this that are in the community are more like babysitting for the students, and they just don’t do much in terms of actual treatment,” Dr. Anthony said. “But here, by bringing together these different partners we are able to say, ‘We know this has been well worked out. We have data behind it which shows it works.’ I think that’s what’s really attractive to the school system to say let’s really put something in place, something that really has been shown to work.”
Another big difference from traditional day-treatment programs is the family’s involvement in students’ treatment. That’s not always possible when treatment centers are far away from home. But it will be easier for a parent to participate in their child’s treatment and spend more time understanding the program if it’s nearby, in the student’s home district, Dr. Anthony said.
“We 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,” he said. “We really want to have a very significant family therapy involvement at all levels.”
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’s 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’s 2020 bond election and letting voters decide. With a lot of projects vying for attention, Poole wasn’t 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’s 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’s 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’s design and medical and educational components.
On the first question, they didn’t find examples of districts doing what Cherry Creek was proposing. On the second question, the staff said they’d 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—an 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’s 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’t have long histories of working together.
“I think we also had questions about how would we bill insurance,” said Superintendent Christopher Smith, who was chief of staff to then-Superintendent Scott Siegfried when the day-treatment center was proposed. “What would the intake process look like? That’s 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.”
They’re 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’s 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.
“Our heart is in prevention and early intervention,” Dr. Liaw said. “It 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. ”
“Families trust school personnel for a whole host of other issues that are important to their families,” she continued. “We want to be there, too.”
Though the groups are only about two months into the process, there’s 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’ medical information, and the Family Educational Rights and Privacy Act (FERPA), which safeguards students’ education records.
Dr. Liaw said those are critical aspects to get right because they’ll 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.
“That will hurt,” Poole said. “Acuity has to be the number one decision-maker. That will drive what we do. That and fit—fit for the program.”
If this program works, it could be the first of many such treatment centers the district will build.
“This isn’t going to solve the mental health crisis,” Poole said. “It won’t solve the mental health crisis in Cherry Creek. It won’t 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—we hope it does.”
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’s mental health director. (They’re available in high and middle schools.)
Cherry Creek is also expanding partnerships with other health providers, with the goal of ensuring there’s a full-time or part-time school-based therapist in each of its 67 schools, he said.
I do think it’s public education’s role and responsibility to advocate for the health and well-being of our students. But I don’t think it’s our sole responsibility to meet every single one of their needs. That’s a community effort.
It’s 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’s 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.
“That’s just another way we are trying to bring connections to partners to ensure that students have more access to mental health services when needed,” he said. “The lack of access is definitely a big concern. … 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.”
The doctors are also clear that while they’re optimistic about the success of the day-treatment program, it will take a lot more to reach all those who are struggling.
“I 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,” 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.
“I don’t think any of us can do anything alone,” Smith said. “I 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’s part of our role, 100 percent.”
But I don’t think it’s our sole responsibility to meet every single one of their needs,” he continued. “That’s a community effort.”