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Shella Dennery, a counselor, talked to three of Carmen Davila’s children — (from left) Nael, 5, Nayza, 8, and Nathaniel, 11 — at the Sarah Greenwood School in Dorchester.
Shella Dennery, a counselor, talked to three of Carmen Davila’s children — (from left) Nael, 5, Nayza, 8, and Nathaniel, 11 — at the Sarah Greenwood School in Dorchester. (David L. Ryan/ Globe Staff)

Schools shoulder load for mental health care

Other sources for counseling rare

Carmen Davila's 11-year-old son sometimes refused to eat all day, and he punched children who taunted him. Her 8-year-old daughter would cry for the smallest reason. Her teenage daughter was sneaking out at 4 a.m. to meet her boyfriend. And the 32-year-old mother of four already had plenty of other worries just trying to feed the children and keep them safe in a part of Dorchester where drug dealers make sales in front of the school.

But Davila found a virtual second parent in the psychological counselor at the Sarah Greenwood School. Shella Dennery started intensive counseling with Davila's son, Nathaniel, four years ago. Now he eats lunch in her office and no longer gets in fights. Dennery, a social worker from Children's Hospital Boston, meets occasionally with the entire family to discuss ways to defuse tensions at home and, in regular conversations with Davila, advises her on everything from how to keep her cool to how to pay the rent.

''Sometimes I just say to the kids, 'Go to your rooms.' I don't even know what strategies to use, so I call Shella," explained Davila, a cheerful, chatty woman from the Dominican Republic. ''She's always there and willing to help."

With some assistance from outside agencies, schools are becoming the leading provider of mental health care for children, a fact underscored by a first-ever national survey.

School nurses now devote a third of their time to tending to children's emotional and family issues rather than cuts and bruises, the survey by the federal Substance Abuse and Mental Health Services Administration found. Guidance counselors spend half their time on mental health concerns rather than planning students' futures, according to the survey.

''Schools are stepping up to the plate and they've been very clever at solving problems," said Mark Weber, spokesman for the mental health services administration, which released the survey of 83,000 public schools in late November. Despite widespread budget cuts, more than two-thirds of schools offered group therapy or individual counseling in the 2002-2003 school year covered by the survey, even though most had to scramble for outside funding to cover the costs.

Children's Hospital provides the staff and raises most of the funding for the Sarah Greenwood counseling center, reflecting a recognition that many children otherwise won't get help for mental health problems because of insurance limits, long waits for appointments, or a failure to detect problems in the first place.

Some studies estimate that 1 in 5 children with major mental illness gets adequate care, while a mental health services administration report set to be released today found that less than half of depressed teenagers get any professional help at all. Consequently, children's fears, anxieties, and anger often go unaddressed until they spill over to violence or other behavior that disrupts education.

In general, the medical profession is ''not taking advantage of what we really know to help kids grow up. It's not rocket science," said Caroline Watts, director of the Children's Hospital Neighborhood Partnership, which provides mental health services at 12 public schools in Boston. ''They need a secure environment with trusted adults" who will listen. Children's has focused on urban schools that have the fewest mental health resources, but Watts said children across all income groups don't get enough help.

Relatively few public schools address children's emotional needs as much as Sarah Greenwood, a school serving kindergarten through Grade 8 where virtually every child attends group therapy sessions starting in the sixth grade. In Dennery's counseling center, children debate the effects of bullying, explore their identities, and learn to distinguish clinical depression from mere sadness. Dennery also provides teacher training as well as individual counseling, and she can quickly refer children with deeper troubles to psychiatrists or other specialists at Children's Hospital.

The point of Dennery's work is to get children to talk about problems that may be caused or exacerbated by poverty, violence, drug abuse, even the uncommon levels of stress on their parents. Virtually all of the nearly 400 students at the school come from low-income African-American or Hispanic families, and even the walk to school isn't safe: A teenager was shot in front of the school last fall minutes before it opened.

By exposing practically every student to counseling, Dennery helps remove the stigma associated with mental health care, a stigma that can be especially strong for families who are unsure whether social workers are trying to help or take custody of children. Many of the children, too, are forced to overcome initial prejudices against getting counseling.

''At first, I thought: 'I'm not going to go to no shrink. What's wrong with me?' " said Andre Mosley, an eighth-grader who noted that he learned to stop getting in fights from his weekly group therapy. ''Now I don't see it as therapy. I see it as people being people."

Because Dennery has been working in Sarah Greenwood for six years, she has had relatively long relationships with many children; as a result, some open up to her with remarkable candor. One boy recently sought her advice on what to do with illegal drugs a friend had given him, while three girls came for help after other girls threatened to beat them up. But Dennery, who is working on her doctorate in social work at Smith College, takes a modest view of her role. ''This job is all about making kids have better days," she said.

The steady, low-key approach seems to work. Principal Isabel Mendez said the schoolwide counseling deserves some credit for the school's academic improvements: For the past three years, virtually all Greenwood seventh-graders have passed the English MCAS exams, one of the best performances in the state. Earlier this month, the National Association of State Title 1 Directors named the school among the 52 top US schools for closing the achievement gap between white and minority students.

The Children's Hospital approach provides intensive services -- 2,600 children are expected to receive some form of treatment under the Children's Neighborhood Partnership this year -- but it's far more expensive than using school staff to provide mental health care. Watts, who runs the program, said it costs $80,000 a year to keep two part-time counselors at Sarah Greenwood, of which $12,000 came from the school. Watts and her staff raise the rest through grants and gifts from the hospital.

Partly because of the cost, Watts said she would rather increase mental health training for teachers and other school staff rather than expand to the other 133 Boston public schools that Children's hasn't reached. ''The schools are making choices between, 'Do I have student support services?' or 'Do I have a teacher?' " she said, making this an inopportune time to ask them to help pay for expanded mental health staff.

But Carmen Davila said the availability of counseling in her children's school has made a profound difference in her family's life, allowing her to get free help quickly.

Although MassHealth, the state's Medicaid insurance program, covers mental health care, it can take weeks to get an appointment, discouraging people like Davila from seeking help for their children. Dennery, by contrast, has helped all four of her children to cope with everyday life, Davila said, and, by extension, made her life easier, too. Now, when Davila feels like exploding in anger, she remembers Dennery's advice.

''Try to keep it to yourself. Don't go loud," she said, adding, ''I don't know what I would do without Shella."

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