SCOTT SIMON, HOST:
Talking back, brawling, being distracted in class - is that just kids being kids or signs that a child is struggling with mental health? Increasingly, the school nurse has to make that call. According to the American Association of Pediatrics, schools function as the mental health system for up to 80 percent of children who need help. In our ongoing series on schools and mental health, Kavitha Cardoza of member station WAMU reports.
UNIDENTIFIED GIRL: I have a cough again.
OLIVIA: And I have a stomach ache.
KAVITHA CARDOZA, BYLINE: These 5-year-olds hold hands as they sit in Patricia Tolson's office. It's at Van Ness Elementary School in Washington, D.C. A teacher sent them.
UNIDENTIFIED GIRL: My teacher in P.E. told me to bring her because Miss Ferguson noticed that now she's not participating at P.E.
OLIVIA: I was.
CARDOZA: The two little girls are best friends. We're not using their names to protect their privacy. Both of them like coming to see nurse Tolson. They say she's kind, and she has Band-Aids with pictures of animals.
PATRICIA TOLSON: So how long, Olivia (ph), has your stomach been hurting?
OLIVIA: It just started hurting.
UNIDENTIFIED GIRL: Olivia told me that last night her head hurt like fire.
TOLSON: It did.
OLIVIA: Yes. It was, like, hurting really, really bad on the side. had her like fire.
TOLSON: Olivia, because you had a history of fevers, I think I want to check your temperature as well, OK?
OLIVIA: Yes. I always have fevers.
CARDOZA: Turns out, this child doesn't have a fever, but Tolson asks her more questions - what did she eat? Has she gone to the bathroom? Does her head still hurt? Both girls have a glass of water and go back to class.
TOLSON: Take your time. No running.
CARDOZA: So it could be that these two little girls are fine, or maybe there's something else going on. And that's what school nurses have to gauge every day.
DONNA MAZYCK: They are detectives in that school. They're the eyes and ears of public health.
CARDOZA: That's Donna Mazyck, the executive director of the National Association of School Nurses. She says nurses look for patterns.
MAZYCK: So if that student comes back several times a day or comes back with the same symptoms every single day that week, that school nurse is going to begin to connect the dots.
CARDOZA: All of which is great if there's actually a school nurse. Some schools share nurses. Others have just one for an entire district. Another challenge is that school nurses get very little training when it comes to mental health. Mazyck says she herself felt overwhelmed when she was a school nurse. She saw depression, trauma, anxiety, grief.
MAZYCK: Students who didn't even know what to do to calm themselves down. They didn't know how to cope.
CARDOZA: So Mazyck went back to school for a graduate degree in counseling, and now she focuses on getting nurses more training. Mental health is routinely ranked one of the top issues all school nurses deal with.
MAZYCK: What we hear from school nurses from across the country is give us education. Help me know how I can help.
SHARON STEPHAN: Because they don't know if I ask this question am I going to open Pandora's box and not know what to do with it.
CARDOZA: That's Sharon Stephan at the University of Maryland. She's co-director of the National Center for School Mental Health.
STEPHAN: But also do I have the right people in my community to which to refer this student? And if not, am I going to be the one who has to manage it?
CARDOZA: Her team trains school nurses all over the country. Stephan says no one expects nurses, or even teachers for that matter, to be therapists or psychiatrists. But what she tells nurses, there are two simple questions you can ask to find out if a child needs help.
STEPHAN: Is a student acting or behaving differently than they were before? And the other thing is, are they somehow out of the norm of what you would expect?
CARDOZA: She says the only time everyone pays attention is when there's a tragedy, like a school shooting.
STEPHAN: The idea is can we catch or identify the one student who might harm others, or how can we, you know, identify the one student who might be suicidal?
CARDOZA: But she says there are so many more kids who need help, and the first person who might notice is the school nurse. For NPR News, I'm Kavitha Cardoza.
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