School therapy provider accustomed to adaptation

File photo by Randi B. Hagi

By Graham Schiltz, Contributor

In a public school setting where students vastly outnumber teachers, some children need more support than what the school’s personnel can provide. For more than a decade in Harrisonburg, this gap has been filled by government-supported in-school therapy, known as Therapeutic Day Treatment. Now that schools are closed for the remainder of the academic year, though, providers are scrambling to find ways to reach the students who need them.

Therapeutic Day Treatment (TDT) is an in-school, Medicaid-sponsored counseling program focused on flexibility in meeting students’ needs. Students are recommended for the program by staff, and after parental permission, apply for services starting the following semester.

Crossroads Counseling Center has provided TDT services to the city schools for 12 years. Through their Harrisonburg office, they work in all Harrisonburg city schools and half of those in Rockingham County. Between the two districts, around 150 students receive services through Crossroads. Their staff members, referred to as “specialists,” work one-on-one with students with the goal that the kids will not need their services once the sessions conclude.

But without being able to interact with students in the classroom, Crossroads recently had to furlough most of their TDT specialists. A lot of the staff is now filing for unemployment.

“At this time, we fully intend to re-open the program again this fall, but as you know, much can change between now and then,” Kurt Holsopple, the clinical director of Crossroads Counseling Center, wrote in an email to The Citizen. 

In light of the current state of emergency, the Virginia Department of Medical Assistance Services now allows TDT to be conducted over the phone or online video conference. Holsopple said Crossroads is reaching out to all their clients’ families to see if they are in need of support that the few remaining staff members could provide.

“We will look to provide tele-supports to all families that are interested,” he wrote. “It has been a hard few weeks but we are going to do everything we can to figure out a way to keep ‘doing the good’ and bring support to this community.”

Existing obstacles to offering care

Even before the pandemic, TDT providers across Virginia were navigating major changes. As of January 2019, the state’s method for funding those support personnel to work in public schools changed dramatically – leaving many Harrisonburg students with less or entirely without aid.

Instead of receiving funds directly through Medicaid, six private Managed Care Organizations, or MCOs, now handle distribution of those funds. While Medicaid standards did not change from previous years, the way MCOs interpreted these standards altered the support students received. This led to only three of 30 Harrisonburg High School students that were in the program in school year 2018-19 receiving services by the time classes started this past fall.

“They were each applying different interpretations and scrutiny on the eligibility criteria,” Holsopple said. “It wasn’t consistent.”

When the majority of those high school students were rejected from the program last August, Holsopple and the rest of Crossroads’ staff had to adjust. They resubmitted applications once the school year started and are slowly learning how to navigate the new system. 

“We were dealing with a new kind of understanding of what an eligible student was,” Holsopple said. “Even though a student may be identified as meeting the criteria, they’re identifying them as less intensive.”

Most of the students were accepted after re-submitting their applications last September, albeit for less support than before. Students that previously would have received counseling every day were reduced to three or four days, and the length of their treatment was reduced from six months to three to four. Students returning to the program have been allotted even shorter periods, usually only two months.

“Everything has slowed down and become a little more difficult,” Holsopple said. “All we know is what it’s resulted in is less students getting approved and getting approved for less time.”

Holsopple said that other TDT providers around the state closed last year due to difficulties with the new funding structure. Crossroads was able to adapt and keep students in therapy. But for Holsopple, as long as the students aren’t getting the time they need, the battle is not over.

“We can’t say we think they would only benefit from us working with them Monday, Wednesday, Friday,” Holsopple said. “The student ultimately is left frustrated by when they can have the program and when they can’t.”

The services that TDT provides are as fluid as the needs of their students. In younger, elementary-aged students, it often comes in the form of a specialist being in the classroom, helping the student to focus on material. High-school age clients mostly use the services outside the classroom for more traditional talk-based therapy. Both routes, however, emphasize “skill building” so that the coping mechanisms they learn while in the program are used long after they finish.

“We’re really focused on problematic behaviors and ways to change them into healthier patterns,” Crossroads’ clinical administrator Sarah Thompson said. “It can look very different. We do try to individualize our treatment based on the student so we can meet their needs.”

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