Mental health support services have been on the minds of Pleasanton Unified School District officials, particularly as student stress persists and remains a hot topic throughout the district.

A report on such services was spotlighted at a PUSD board meeting last month, in particular responding to some of the results from the California Healthy Kids Survey released earlier this year. While the panel of social workers presenting the report highlighted a wide array of programs, at the heart of what they do is working to normalize the idea of mental health treatment.

"A lot of times our work with our families consists of dealing with stigmas that are surrounding mental health," Elise Greenaway, one of the panelists, said at the Oct. 23 board meeting. "A lot of our families are uncomfortable with the idea of their kids going to therapy, and concerned about what that looks like for them."

Marsha McInnis, founder and past president of the Tri-Valley's chapter of the National Alliance on Mental Illness (NAMI), said that a proactive, trained school staff is crucial for teens and children in need of support.

"From my experience listening to many parents, most who reach out to us are in serious crisis with their child/teen and are needing networking, resources and support around what they are living with," she said. "For many, parents are trying find the appropriate level of care with the insurance they have.

"Seeking help needs a proactive school staff, proactive parents, availability of openings with a mental health professional, a mental health program at schools, a school board that understands the mental health challenges and finding evidence-based solutions."

According to Kathleen Rief, director of student services for the district, social workers were not present in PUSD schools until the district received federal funding through the "Climate Transformation Grant" in 2014. They support students and families at all educational levels, and during the 2017-18 school year they served 250 separate students, who had been referred to their department by school staff.

In addition to having English-speaking social workers, Noemi Almaraz serves as a Spanish-speaking social worker for grades pre-K through 12th, though her position is funded through the district's Local Control and Accountability Plan (LCAP).

While they support all students, the district's social workers also provide more targeted services for at-risk students, particularly those from lower socioeconomic backgrounds, in special education, homeless youth, those with truancy issues and those struggling with mental health or substance abuse.

The California Healthy Kids Survey is administered to students in grades five, seven, nine and 11 every two years. At the October meeting, the five-person panel honed in on results surrounding chronic sadness and depression, along with students who reported having considered suicide.

According to the survey, the percentage of students reporting chronic sadness and depression increased with age: for the 2017-18 school year, 16% of seventh-graders reported feelings of chronic sadness and helplessness, with that number rising to 22% for ninth-graders and 30% for those in the 11th grade.

The reported number also went up from the 2015-16 to the 2017-18 school years, increasing 1% at the seventh-grade level, 3% for ninth-graders and 4% in 11th grade.

Last school year did see a slight decrease in the percentage of 12th-grade students who reported having considered suicide over the previous year, going down from 17% to 15% between the two survey administration cycles.

Mental health services, the panelists said, are divided into three separate tiers.

Tier 1 aims to address the broader student population, through classes, listing crisis numbers on student ID cards, staff development on suicide prevention and mental health, enhanced crisis response procedures and through a joint partnership with the city of Pleasanton for their Community Education Series -- they recently screened an independent film called "Angst" as a way to raise awareness about anxiety.

The second tier narrows the pool reached, focusing on some of the department's targeted and at-risk groups, through methods such as providing more restorative alternatives to suspension for substance-related offenses, additional social emotional resources for counselors, connecting students and families to outside counseling services and mental health presentations at Mariachi Night.

And the third tier -- the tip of the pyramid -- supports the most serious cases, through solidifying psychiatric hospitalization re-entry procedures, behavior contracts to connect students to mental health supports and individualized case management by social workers.

While these final steps are crucial to have in place, they hope by working on preventative intervention to decrease the need for reactionary measures.

The ensuing conversation with the board ranged from data-oriented questions from trustees to thoughts on the best ways to support the diverse set of families living in the district.

"We have a lot of different cultures here in PUSD and some people that have recently moved here from other countries are not familiar with mental health services and the normality of that," Greenaway said.

"So a big job for us is to normalize mental health treatment and help encourage families to seek that out for their students," she added. "And help them to find a way that's going to be sustainable for them, either through their insurance or through a community provider that can provide sliding scale, income-based services."

On-site parent liaisons are instrumental in this mission, she added.

Liaisons act as a go-between for families and their children's school, and can serve as intermediaries when cultural and linguistic barriers exist. Right now, they have liaisons who speak Punjabi and a few other Indian dialects, Korean, Spanish and Mandarin, and documents can be translated into Spanish, Mandarin and Korean -- the shared cultural understanding and language facilitates conversations about why treatment is important.

Document translation is critical, Greenaway said, in cases where students are hospitalized. "We recognize that it's really important information for that to be in their first language," she said.

Trustee Steve Maher asked the panelists how many "5150s" they saw last year -- or an involuntary confinement of someone suspected to be a danger to themselves. From August to October in both 2017 and 2018, the district saw a total of 13, said Ashley Sprader, coordinator of Positive Behavioral Interventions and Supports (PBIS) for the district. The number does tend to go up in the spring, she confirmed when Maher asked.

"We looked at that and we tried to graph, and see if there are any trends, what can we do, are there certain grade levels, gender, what are we looking at, how many AP classes, all types of things we tried to look at," Sprader said. "And to be honest, there wasn't a true trend attached to all of that."

Trustee Joan Laursen noted that social media seems to add a whole other level to the anxiety and wayward emotions that naturally accompany adolescence.

"It feels like social media and the barrage of information -- it magnifies and exacerbates the natural teenage angst that we all have experienced, right?" she said.

"Somehow we've got to get a handle on helping students understand how toxic this can be for folks who are already in a vulnerable space," she added.

Sprader agreed, saying that while resources about social media toxicity were available on their website, they were looking to deliver the information in a different format as well, possibly through a screening of "Like," a companion film to the previously-shown "Angst."

Trustees and staff alike also highlighted the importance of peer advocates, both informal and through established school programs -- along with the need to support the "advocate."

"My experience is that when a student has a problem, they first go to their friend, and their friend serves as their psychologist, that tries desperately to help," Board President Mark Miller said. "And at some point it's too much. And do they know who to go to?"

For more information, visit the PUSD website at https://bit.ly/2DN1Mwi.