NC students likely to have trouble finding health, mental health services when schools return

Experts say NC’s existing shortages of nurses, counselors, psychologists and social workers will be aggravated by pandemic trauma

Some students — especially those who are homeless or in difficult living situations — who have been unable to go to school because of the COVID-19 pandemic will be traumatized by the event.

That’s the expectation of state social work consultant Pachovia Lovett, who says the state’s cadre of school social workers and other support staff are prepared for the approaching crisis.

“We know that students have been displaced or are homeless,” Lovett, who works for the state Department of Public Instruction, explained. “We know students may be in different living arrangements where maybe they decided to quarantine with their grandparents or with other family or someone who could be their caretakers while their parents are essential and needed to work.”

A historic downturn in the economy has led to record-breaking job losses. Home foreclosures and mounting food insecurity will likely send more students and families into survival mode. “We know that the cards are stacked against us right now and what we’re coming back to is going to be kind of what we do magnified,” Lovett said. “A lot of the work that has to be done now, is work that we’re very familiar with.”

Social workers and school psychologists can expect larger caseloads; the roles of school counselors and school nurses will likely expand.

Although the number of reported abuse cases is expected to decline, that doesn’t mean there is less abuse occurring. Educators, school counselors and other school-based personnel report about one in every five abuse claims, according to the U.S. Department of Health and Human Services.

“Because the system is kind of closed, it’s hard for the professionals to make those calls,” Lovett said. “We expect that when school starts back, we will have an influx of abuse and neglect cases. We’re prepared for that and making sure we have some good screeners in place for students to feel safe and be with safe trusted adults when they get back on campus.”

Students and teachers also might have experienced the loss of loved ones as a result of the pandemic. “Some of the things on the priority list are dealing with grief and loss,” Lovett said. “Social workers are addressing that from a child and adult standpoint because we already have a good number of staff who have already been, and may continue to be, grieving the loss a loved. There’s a double layer of trauma because as school social workers, we also work with the adults in our buildings.”

School nurses will also face new challenges. “The school nurse role has always included control and response to communicable disease outbreaks which are addressed each year on a smaller scale,” the N.C. Department of Health and Human Services said in an emailed response to questions for this story. “They will draw on those skills in this pandemic response.”

School psychologists will need to quickly reconnect with students they had been helping before the pandemic, said Caron Parrish-Nowell, who sits on the board of the N.C. School Psychology Association. “Our forefront will be making sure that kids we’ve started evaluations on are completed,” Nowell said. “We also have kids who will be transitioning from fifth grade to sixth grade, so a different person will have to follow up with those children.”

Collectively, school counselors, nurses, psychologists and social workers are known as “specialized instructional support personnel” of “SISP.” They often work in teams to serve students. But none of the specialized support staffing levels in North Carolina meet nationally recommended student-to-staff ratios. The National Association of School Nurses, for example, recommends a ratio of one school nurse for every 750 students, or one nurse per school. However, in North Carolina, the ratio is one per 1,013 students; many schools aren’t served by a full-time, permanent nurse.

A 2018 study released by General Assembly’s Program Evaluation Division found that fewer than half – 46 – of the state’s 115 school districts meet the recommended ratio. The PED determined that that it would cost $79 million per year to do so. 

North Carolina lags in other staffing levels of SISP:

• For school social workers, the recommended ratio is one social worker for every 250 students. North Carolina has one for every 1,289 students.
• The recommended ratio for school psychologists is one-to-500-700 students. In North Carolina it’s one-to-roughly-1,800.
• For school counselors, the recommended ratio is one counselor to 250 students. North Carolina’s is one-to-353-students.

“We know that in this state we have a shortage of those personnel who can handle the things that we’re about to see, so that makes it very difficult to be able to plan to address the needs of student well-being in a situation where we know we were already struggling to meet the needs prior to this happening,” Lovett said.

Last month, the State Board of Education  asked state lawmakers for $55 million to increase SISP staffing and to offer additional training and support so they can better serve students after schools reopen. The General Assembly responded with $10 million as part of a $1.6 billion COVID-19 relief package funded through the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act.

The money is only for one-time use and not recurring.

Ellen Essick, section chief for Specialized Instructional Support and N.C. Healthy Schools, said that even the $55 million request wouldn’t have been enough to cover the needs. “The challenge is that there are four different areas and they’re all understaffed,” Essick said. “They all end up vying for that same pot of money.”

Cynthia Floyd, a state consultant for school counseling with DPI, said the reopening of schools will lay bare the need for more specialized personnel. “We already didn’t have enough school counselors and social workers and the like and now the need is excessively exacerbated and we still don’t have more of these people,” Floyd said.

She said DPI has begun discussions with the State Department of Health and Human Services and other organizations about outsourcing some of the mental health counseling services when schools reopen. “We know the needs are going to exceed what we have in school personnel to completely address,” Floyd said.

DPI has repeatedly requested additional money for more support personnel, she said. “We’ve gotten little bits and pieces here and there and we appreciate everything we get, and there was a little bit of funding last year in which some districts benefited,” Floyd said.

But she said the money requested by State Board of Education would have allowed DPI to aggressively target specific issues students and staff face in the coming school year as a result of the COVID-19 crisis. “It won’t just be the first few days of school [that support staff will address COVID-19 related trauma],” she said. “There’s going to be post-traumatic stress that goes on for the duration. The $55 million was to prepare for that. We also asked that it be recurring funds with the intent being that we put these staff in place and they’re there we the kids come back the next year and the next year and we have a better ratio to meet needs.”

State Rep. Craig Horn, a Republican from Union County who co-chairs the House Select COVID-19 Committee that focuses on education, said the while House’s proposal for the recently approved COVID-19 relief package included funds for SISP, the Senate’s plan did not include any money.

The $10 million represented a compromise between the two houses, Horn said.

“We’re coming back next week to work on budgets,” Horn said. “We’ve got more money available from the feds but we also have to look at what are the recurring expenses that will result from a one-time investment.”

He said it would fiscally irresponsible to fund positions without knowing how the state will pay for them in the future.

Meanwhile, Leigh Kokenes, a school psychologist who serves on the state School Psychology Association board, said the need for additional funding to bring the state closer to the recommended ratios for support personnel has never been greater. “The ratios for school psychologists are the worst for any of the specialized instructional support personnel,” Kokenes said.

Kokenes noted that the one-to-1,800 ratio cited for psychologists in the state is only an average. She said psychologists in North Carolina’s large school districts are responsible for many more students.

“You’re going to have some school districts where there’s one school psychologist to every 5,000 students,” Kokenes said. “We have lost positions over the years while other branches of specialized support personnel have gained positions.”

Even if money was available to hire more psychologists, Kokenes said it would be difficult to find people to fill the slots. Part of the problem, she said, is the relatively low pay for a position that requires a master’s degree, she said.

“We have a pipeline problem,” Kokenes said. “We don’t have competitive salaries in order to recruit across state lines and we have difficulty filling the cohorts in our university programs.”

When schools reopen, possibly in mid-August, social workers, psychologists, nurses and counselors will keep one eye on students and another on themselves and teachers. For teachers and specialized personnel, “compassion fatigue” will be a real concern, Nowell said.

“We are reminding teachers that prior to this you had some hobbies, you had things that you like to do,” Nowell said. “Don’t forget to schedule some time in your day for some me time.”