Upstate provides behavioral, mental health services at Syracuse city schools
Upstate Medical University in Syracuse,
New York invites you to be “The Informed Patient” with the podcast
that features experts from Central New York’s only academic medical center. I’m your host, Amber Smith. Upstate Medical University teamed up
with the Syracuse City School District to provide accessible, culturally competent
behavioral and mental health services that support the academic success and wellbeing
of students and families in the district. Here to tell us about the program and
how it’s going is Dr. James Demer. He’s a child and adolescent
psychiatrist at Upstate. Welcome to “The Informed
Patient”, Dr. Demer. Oh, thank you. It’s great to be here. How does this program work? This program has actually been
several years in the making. It’s an initiative out of the president’s
office of Upstate, Dr. (Mantosh) Dewan. He and the leadership in the Syracuse
City School District along with a vice president named Dr. (Sipho) Mbuqe
they’ve been teaming up and planning for probably five or six years as to
a way to kind of marry the expertise of Upstate Medical University and the
needs of the children and families of the Syracuse City School District. So they were able to obtain a
pretty sizable grant, which has since been kind of modified. And so the way in which it’s
funded has changed a little bit. But it was born out of Dr. Dewan’s vision
of seeing the need of the families and children within the Syracuse City School
district and wanting to do something about it, wanting to do something
that would provide a quality care and provide access to the children and
families who live within Syracuse City. So which of the city schools
have a clinical site? Currently we’re in three schools. So one school is called McCarthy at
Beard, which essentially is a school for youth who have more severe
emotional needs or developmental needs. The second school is Dr. King,
which is younger elementary school. And the third school
is Grant Middle School. So we’re currently in those three
schools, with the hopes to add two to three schools every year to eventually
get up to a total of 11 schools within the Syracuse City School District. So would mental health services be
available just during school hours? We make ourselves available during school
hours, and we also offer extended hours. So we’re trying to kind of meet
families and children where they’re at. More or less, we extend
to up to 6 p.m. if needed. And then we’re also available
during the daytime as well. Now, I know you mentioned a grant,
but does the school district or the family pay for the services? It goes through their regular
insurance, so whatever type of insurance they have is billed for it. And so from that standpoint, in
that way, it almost functions like an outpatient clinic model. Now, how do students or families
gain access to the services? Does a teacher need to refer them, or can
anyone just make a request on their own? One of the things we’ve tried to do
from the onset is try to integrate and collaborate with the existing
structure within each school. And so each school social worker at
this point, through referrals from teachers or from parents, the school
social workers fill out an application. And then our intake coordinator contacts
the family and gets things going, and then assigns the case to one of our therapists. We have a number of therapists. Each one is a social worker,
and each one has a specialty. So we have one therapist who
specializes in family work. We have another social worker who
specializes in working with the staff or the milieu to help bolster
the mental wellness of the teachers and staff within each school. We also will be hiring a senior social
worker who will start a program, an educational program, for some of
the undergraduate students in local colleges who are looking for clinical
experiences, as well as a psychologist, a doctorate level psychologist, who
will serve to provide training for some of the local doctorate students
and psychologists in the community. So we kind of have a diversity of lots
of different services that we’re offering directly to the family and the children,
as well as some services we want to offer as far as training opportunities. I definitely want to hear more about that. But first, what does
culturally competent mean? That’s a good question. So I think that means different
things to different people. So I’ll give you my definition. So to me, the first thing it is, is an
awareness that each person that we see has a distinct history and their own
individual present that’s different than the person doing the evaluation. The second thing is, is there has to be
a curiosity in another person to learn more about the other person’s history
and perspective, and then the ability to kind of acquire knowledge as to what that
person’s individual history means to them and how it influences their current life. And it’s something that’s ongoing and
individual to each person that we see. So I guess it requires kind of an
attitude of humility, in a sense that we’re more learners than we are teachers
initially, that we’re kind of all ears wanting to learn as much as we can
about the current circumstances of the person as well as their past history,
going back in multiple generations. That’s the way that I view
the cultural competency. This is Upstate’s “The
Informed Patient” podcast. I’m your host, Amber Smith. I’m talking with Upstate child and
adolescent psychiatrist James Demer, about the comprehensive school-based
mental health program involving Upstate Medical University and
the Syracuse City School District. Now, you mentioned that the therapists
have areas of specialization. What are the kinds of issues that
are coming up most commonly, and how are they being dealt with? A wide range of issues, everything
from attention deficit disorder, where the school or the parent has noticed
some issues with maintaining attention and focus to a degree where it’s
impacting the child’s ability to be successful in school, all the way to
issues that in some way are a result of trauma or traumatic experiences. So one of the things that we’ve noticed,
and maybe just in the general population, but more so within our population we’re
serving, is that a lot of the children and families have had a number of adversities,
that they’ve had to overcome. Some of those are ongoing
stressors in terms of housing insecurity or issues with finances. Some of those have to do with abuse
or neglect or traumatic experiences that have happened to the child or to
family members that have then impacted their ability to relate to the child. We also do see children who struggle
more with externalizing symptoms like aggression, physical aggression,
or aggression directed toward themselves in the form of self-injury. So there’s a wide range of presentations,
also to include, obviously, depression, anxiety, things like that. So those are the sorts of
things that we’ve seen so far. Do you ever consult with their
primary care physician for medication, like prescriptions? One of the nice things about our
program is we have a care manager, and we have a nonclinical social worker
whose role is to help us to connect and get collaterals and information. We also do have myself and a
psychiatric nurse practitioner that can do the prescribing as well, so
that one of the nice things is we can kind of have a comprehensive team. Where we have a therapist doing
individual work, a therapist providing family work, the therapist offering
training to the milieu as well as myself or our psychiatric nurse practitioner
doing a medication consultation. Sometimes the family will wish to
continue with their primary care, because they have relationships there. Other times the primary care
will tell us that they welcome us taking over the medications. But definitely we try to connect
with their pediatrician or family practitioner because some of them
have longstanding relationships with them that we want to respect. Can you talk to me about how the program
is creating pathways for diverse, credentialed mental health professionals? Sure. So one of the things Dr. Mbuqe did
is — he’s the vice president at Upstate — and he deliberately reached
out to people he’s known over the years with diverse backgrounds. So one of the ideas is that eventually we
want to offer training and opportunities to people within the Syracuse City School
district, people who maybe graduated from the Syracuse City School district or went
to university or colleges locally here, and try to provide opportunities for them
that invite them to stay in the community so that the children and the families
are working with people who had similar life experiences and similar backgrounds. That’s one of the things that is really
important to this program is, we want it to be a program that sustains itself
with people who have an investment in the community, an investment in these schools. That’s been done deliberately. There are a number of clinicians we have
who graduated from the Syracuse City School district, like 20 years ago. That’s been something that’s been done
intentionally to try to create kind of that sense of extended community. Well, I understand this is a program
that will be phased in over five years. What is planned for the next four years? So the plan is to add more schools. It’s also to add more training. As I mentioned earlier, we are hiring
and continue to hire psychologists and social workers who’ve had a lot
of experience who will then provide, training sites for graduate students in
social work, for graduate students and post doctor candidates in psychology. We’re also looking to bring in psychiatric
residents and even pediatric residents from Upstate to rotate with us, to expand
those training opportunities for them. We also really want to focus on
providing a quality of care that is a little bit different than maybe
they get even in outpatient clinics. For instance, our ability to observe
children in the classrooms, and meet with teachers on site, and speak directly
to school administrators and kind of integrate ourselves into a given school’s
community, we’re hoping that that will provide a thoughtfulness and a quality of
care that continues to improve over time. So I think part of it is continuing
to provide care to more students over the next five years, but also
continuing to improve the quality of care in which we’re delivering. How will you measure
success of this program? Each person who has leadership
in the program has different things that they’re looking for. The thing that I think that I’m focusing
on is, there’s recently been done a study out of Johns Hopkins (University School
of Medicine) that looked at something called Positive Childhood Experiences. So folks may have heard of something
called ACEs, which are Adverse Childhood Experiences, which have
been found to contribute later on to adult medical illness as
well as mental health illnesses. So these Positive Childhood
Experiences are something that we’re trying to foster in our population. And so our plan is, potentially over time,
to measure how many of these experiences we can introduce in each child’s life. So there are seven different Positive
Childhood Experiences that we hope to increase the number in each child’s
life, who we provide services to. So for example, one would be the child
feeling welcomed in their school. So it’s been found that adults
later on who are asked, did you feel welcomed in your school? Those adults who felt welcomed end
up being healthier from a mental health standpoint as adults. Another one of them would be something
like feeling supported by more than two adults in their community,
outside of their immediate family. So one of the things we hope to
do in collaboration with different mentoring programs and programs within
Syracuse is to kind of be deliberate about trying to expand the village
that supports certain children. And a number of the other ones
have to do with feeling heard and safe within the family system. So that’s where, one of the things that
we really want to focus on is the children feeling a sense of being heard and being
cared for within their family system. So that’s one of the things that
we’re kind of looking at, is trying to increase the number of Positive
Childhood Experiences that children who enter our program are eventually
exposed to, with the idea being that adults who have more of these
PCEs end up being healthier adults. That’s one of our initial ways that
we’re going to try to measure it. But other folks are looking
at graduation rates. In some of our schools, we’re
looking for trying to reduce number of incidents within the school. I think that’ll be an evolving
sort of thing where we’ll find different things that we’ll use
to measure success over time. I think one of the things Dr. Dewan
ultimately wants is, he wants to see more a applicants to Upstate Medical
University from youth who graduated from the Syracuse City School district. And I know that’s one you look
at years and years down the road. But when I met with him, he basically
said the measure of success is 10 years from now when I look at applicants to
Upstate Medical University, I want to see more coming from our neighborhoods. And that’s a taller order, obviously. That might take more time. But I think that, for instance, would
be his definition of success, perhaps. This is all very hopeful, and
I appreciate you making time to tell us about it, Dr. Demer. Oh, thank you very much for having me. My guest has been Dr. James Demer. He’s a child and adolescent
psychiatrist at Upstate. “The Informed Patient” is a podcast
covering health, science and medicine, brought to you by Upstate
Medical University in Syracuse, New York, and produced by Jim Howe with
sound engineering by Bill Broeckel and graphic design by Dan Cameron. Find our archive of previous
episodes at upstate.edu/informed. If you enjoyed this episode,
please invite a friend to listen. You can also rate and review
“The Informed Patient” podcast on Spotify, Apple Podcasts,
YouTube, or wherever you tune in. This is your host, Amber Smith,
thanking you for listening.
Upstate Medical University teamed up with the Syracuse City School District to provide accessible, culturally competent behavioral and mental health services that support the academic success and wellbeing of students and families in the district. Child and adolescent psychiatrist James Demer discusses the aims of the program, the schools that are staffed with therapists and plans for expansion.
“The Informed Patient” is a podcast that covers health, science and medicine, featuring experts from Central New York’s only academic medical center. Upstate Medical University has four colleges (Medicine, Nursing, Health Professions and Graduate Studies); a robust research enterprise; and an extensive clinical health care system that extends way beyond Syracuse.
For more information, please visit: https://www.upstate.edu/informed/