MISSOULA — After years of seeing Missoula students with increasingly severe mental health problems entering the juvenile justice system, Chief Juvenile Probation Officer Christine Kowalski decided to do something about it.
“There were kids in the system we didn’t know how to handle,” she said. “Why not get someone who knows how to deal with that?”
A little over a year ago, Missoula County Youth Court partnered with Providence Montana and worked with the school district to create a mobile crisis response unit to better prevent students from entering the juvenile justice system and connect them to help.
Providence’s St. Patrick Hospital employs therapist Nicole Gratch to respond primarily to Missoula’s three public middle schools and youth court pays her salary. The program is voluntary and Gratch receives parent permission before working with a student, she said. Services are free to families, and the program only bills insurance if a youth is admitted to the hospital, Gratch said.
“I get called for a variety of things because crisis looks different for everyone,” she said. “It can be escalation in the classroom or suicidal ideation.”
Missoula County Public Schools worked with the crisis team to create a procedure of when to call Gratch, who works “seamlessly” with school staff to de-escalate a situation and help students access other services, said Vincent Giammona, assistant superintendent. Gratch can also help students return to school after a behavioral-health-related hospitalization.
“What’s been great about this partnership is the idea around prevention and ‘postvention’ support for students in crisis or struggling,” Giammona said. “A challenge coming out of COVID is access for families and students. This allowed us to expedite access to services that the district can’t immediately provide.”
Missoula, like the rest of the United States, saw an increased need for student support as schools resumed in-person learning after pandemic-related restrictions, Giammona said. The school district provides a range of resources, from teacher-student relationships to mental health support from school psychologists and outside agencies, he said. But the district can’t do it all, and the mobile unit provides another resource for a student and family in need, Giammona said.
“With being able to add a quick and talented intervention to help respond to students, de-escalate, we’ve seen positive impacts on support and services since its inception,” he said of the program.
During the unit’s first six months from January to June 2023, Gratch responded 106 times, serving 53 students at C.S. Porter, Meadow Hill and Washington middle schools and Big Sky High School, according to data from the hospital.
Students aren’t dealing with anything Gratch hasn’t seen in her career, “just more of it,” she said. The pandemic exacerbated school avoidance, and drugs are a consistent concern, as well as suicidal ideation and self-harm, Gratch said. Stress from parents or the family situation are also common sources of problems, she said.
The program is many students’ first contact with therapeutic support and their connection to more resources, Kowalski said. That can include referrals to outpatient and inpatient mental health care, case management, medication provider appointments, or helping families sign up for health insurance, she said. The program doesn’t make students or their families jump through hoops, and the school-based contact is less daunting than the emergency room or youth court, Kowalski said.
“It makes the mental health piece less scary for families,” she said.
The program has also achieved Kowalski’s original goal of diverting students from the juvenile justice system with the Missoula Youth Court seeing fewer citations for disorderly conduct and fewer pre-teens, she said. About 75% of students Gratch has served haven’t been through youth court, Kowalski said.
“That’s the whole point. They got services and didn’t have to have contact with youth court,” Kowalski said. “It shaves off the trauma of youth court and waiting for that process when we would just do the same referrals.”
The mobile unit’s success and growing demand among Missoula schools led to a new collaboration with Missoula County to fund an expansion to elementary and high schools.
Chelsea Wittmann, the county justice initiatives coordinator, said after talking with Kowalski, she saw an opportunity for the county to help youth court and the hospital address the need in Missoula schools by applying for grant funding.
“It felt like building a better response for students who don’t need to end up in youth court, jail or don’t need the ER,” she said.
Missoula County Commissioners earlier this month accepted a $349,515 state grant to pay for two additional social workers for two years. The county will administer the grant and St. Patrick Hospital will employ the therapists, with plans to fill the positions in the next two to three months.
“We’ve seen the impacts Nicole (Gratch) has had in our district, and the opportunity to add two more in her role and be able to be in more buildings, provide access to more help is just a great thing,” said Giammona, the assistant superintendent. “It’s an awesome intervention to provide for families if they believe it’s a good fit for them and their student.”
Gratch said she is excited to expand the program to elementary schools to address behavioral health problems at a younger age and help prevent crises arising in middle school when it’s tougher for students.
While crisis response is important, increasing preventative services will provide a better opportunity for those involved to get the right help, Kowalski said.
“In prevention, they’re able to hear better and get more out of it because by the time someone comes to youth court or the (inpatient) unit, they’re scared, angry,” she said. “It’s harder when in crisis to explain what they need.”
Prevention is also important because of barriers to access and provider shortages in the mental health care system, said Kate Wiltfong, manager of social work at St. Patrick Hospital. The biggest struggle is placing children in outpatient, case management or other services that include family involvement, she said.
While the Missoula hospital has a 14-bed adolescent inpatient unit, it only serves those 12 to 18 years old with acute needs, Wiltfong said. Services for younger children are limited, and residential beds for long-term treatment are often hard to find, she said.
Changes in community mental health resources, coupled with many families losing health insurance through Medicaid redetermination, heightened the need for providers to look at nontraditional ways to increase access to readily available and free care, said Jeremy Williams, St. Patrick Hospital director of psychiatric services. The school crisis unit is one example of going where the need is and crafting an individualized response, he said.
The additional prevention or intervention helps give every student an opportunity to thrive in school, Giammona said.
“The ultimate goal is for every student to learn and grow and achieve and be successful,” he said. “For those who feel like this can help, we’re excited to add this layer of access.”
