Therapeutic Day Program Offers New Option For Children With Mental Health Needs

Dec 16, 2015

Some cities have a range of programs for children with severe mental health needs: outpatient clinics, residential hospitals, therapeutic boarding schools. New Orleans isn’t one of them.

The city already had limited options when it shuttered its adolescent psychiatric hospital back in 2009. Now kids can receive some treatment in school or at home, or check into a hospital outside the city. But there's a new option for children with mental health needs.

Seven-year-old Devon and his mother Tara agree: he’s an active kid.

"He likes sports. He’s an outdoor person," Tara says.

"I like to go outside," Devon says. "Play some football."

"He likes football. He likes basketball."

"I like to play basketball. And that's it."

"He’s a very smart, wise kid," Tara says. "He really is. But he also have a lot of behavior downfalls."

Devon and Tara aren’t their real names. To protect Devon’s medical privacy, we’re using pseudonyms. Tara says since he was a baby, Devon’s had a tendency to flip out.

"First he start off with the screaming and hollering," Tara says. "Then it’s the chair throwing. Then it’s the hitting himself upside the head. And 'I hate you. I can’t stand you. I want to fight you. I wish you were dead. I wish I was dead. I want to kill myself.'"

Tara tried to get him hospitalized, or on medication. But she says the children’s hospital told her he was too young -- and was just being a kid.

"I was upset," she says. "I was losing it. I always cried. I cried and cried and I cried. Because I was like, 'I’m not gonna be able to get him no help.' So I stepped back for a little while and I went to God and I said, 'well God, I give it to you.' And a couple days later, I was told about the Therapeutic Program."

The Therapeutic Day Program. A new, full school day program for kids with severe mental and behavioral health needs. It opened this fall with 12 students from kindergarten through 8th grade, referred by schools are around the city. Many have experienced trauma. Some survived violence or lost family members. Some are in the foster care system. Tara learned about the program from the special education coordinator at Devon’s school.

"Everything that I fought for finally came through," she says.

The program -- a partnership between the RSD, OPSB and Tulane Medical School -- is a first step toward filling a major gap in children’s mental healthcare. Right now, there are limited options. Kids can get services at school, meet with a social worker at home -- or check into a hospital outside New Orleans. The closest hospital is in Mandeville. The Therapeutic Day Program offers something more intensive than in-school special education, but less intensive than hospitalization.

It’s housed on the NOCCA campus, in a bright building with exposed brick. The walls are covered with mood meters -- big blocks of primary colors, corresponding to feelings and energy levels -- and logos from students’ original schools. Where they’ll eventually return.

Dr. Laura Marques is a psychology fellow at the Therapeutic Day Program. The goal is to get students back into regular classrooms. "We want them to access their academics and their education in traditional school," Marques says. "We really work collaboratively with the schools to decide when a child has developed the skills necessary to be in their school environment."

Kelsey Hoffman is one of four classroom teachers on staff. She has a total of seven students -- two in her math class, five in homeroom. Each with a tailored plan. Hoffman helps set goals based on individual needs. Like in their original schools, a lot of these students stormed out of the classroom -- or even the building -- when they got upset.

"And a goal might be something along the line of 'remain safe in the classroom five days out of the week for 20 minute blocks before taking a break,'" Hoffman says.

If they do get upset and leave class, there’s a place for them to go -- a special therapeutic room. A team of teachers and therapists chart students’ progress.

"And as they get closer and closer to meeting those goals, they get closer and closer to graduation," Hoffman says.

Students take traditional classes. But they also participate in group and individual therapy. They meditate and practice yoga. And they receive medical support.

The day’s broken into short increments. Hoffman might teach a math exercise, then switch to social-emotional learning. On a recent morning, she has just one student. Hoffman gives him some math problems, then changes gears. She sets out three plastic cups, each filled with slips of paper.

"So what we’re gonna do is we are going to pull out a statement and I’m going to act is based on what I see on the card," she says. "Then we’re gonna decide what each emotion each of these is. So is it passive? Like not a big deal, don’t really care. Is it assertive? Clear communication. Or is it aggressive? Roar!"

Her student reaches in and pulls out a slip. It says "NO!" In capital letters. With an exclamation mark. The student reads out the word in a big, booming voice and says it's aggressive. Then he and Hoffman talk about what communication style is most appropriate for the classroom.

"We really try to think about there being skill deficits, versus a child who just doesn’t want to do things," says Dr. Laura Marques. She says tries to help students address the underlying issues that lead them to act out, and come up with coping mechanisms.

"A lot of the children that I work with have voiced pretty much from the beginning that they are bad kids and that that’s why they’re here," Marques says. "When they do something that is disruptive or aggressive, just reiterating 'I’m still here, I still think you’re a good kid, there’s really nothing you can do to change my mind about that, but we’re gonna work on some of the things you struggle with.' And try to differentiate the child from the behavior."

The calm setting and one-on-one attention has already made a difference for her son, says Tara. Devon now has clear diagnoses, a medication management plan, and techniques to cool off when he’s angry.

"It’s a major, major turnaround," she says. Less fighting. More apologizing. He’s getting along with others well."

"I learned to, like, breathe," Devon says. "And sit down. And just keep breathing. I’m happy instead of always mad."

Tara is grateful. She says children with issues like Devon’s are more likely to end up in juvenile detention than a program like this. Devon has hopes of starting second grade back at his regular school.

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