Streams

Sending Disruptive Students to the E.R. Worries Docs, Advocates

Monday, September 16, 2013 - 04:00 AM

Peggy Mansanet with her son Erik, who has been sent to emergency rooms on several occasions for being disruptive at school (Beth Fertig/WNYC)

By the city’s own count, about one fourth of all 911 calls made from New York City public schools are for "emotionally disturbed persons," as first responders call it. In one year, 2011-12, schools made more than 3,800 calls that, in turn, led to an ambulance trip to a hospital emergency room, a mismatched solution in the eyes of many mental health experts and children's advocates.

Dr. Michael Falk, a pediatrician in the pediatric emergency room of St. Luke's hospital in Harlem, said there were about 136 psychiatric behavioral evaluations between the hours of 9 a.m. and 5 p.m. last year for children under the age of 18 coming from public schools. He said some were sent to his emergency room because they were suicidal or assaulted a teacher. But he says many more cases aren’t nearly so dramatic.

"It's usually involving they get into an altercation with one of the other students and then the staff tries to restrain them, and then the staff person gets hit or threatened," he said, adding that "a fair number" are anywhere between the ages of six and 10. He said the E.R. also sees a "significant number" of kids with learning disabilities or A.D.H.D.

Very few children were admitted, he said. Instead, most were evaluated and sent home - which mental health experts say is typical. But they believe it still takes a lot of time on the part of doctors and nurses, plus the use of an ambulance that should be reserved for true emergencies.

Dr. Michael Falk, St. Luke's Hospital in Harlem (Beth Fertig/WNYC)

"It’s really frustrating," said Falk. "It feels like we are being used as a dumping ground by the schools...It clearly seems like something they should be equipped to deal with."

WNYC looked at thousands of calls for what's termed "emotionally disturbed persons" made from public schools between 2005 and 2010. This data first was obtained by Legal Services of New York.

Technically, the New York City Fire Department doesn’t know which schools called 911 because it only tracks the address for a call and it’s common for multiple schools to share the same building. But at the 20 buildings with the most calls, it appears 16 of them house District 75 schools, which are special education schools for kids with the most serious needs.

District 75 schools serve about 20,000 pupils. Some have serious physical impairments, others are emotionally disturbed, or have autism or A.D.H.D. The same District 75 school can have several different locations which is why they are located in hundreds of school buildings.

To be fair, most of their locations rarely if ever called 911 for emotional disturbances. But among the buildings that made the most 911 calls for emotionally disturbed persons-- between 80 and 300 calls over six years -- many house District 75 schools.

For example, 314 calls were made from 778 Forest Avenue in the Bronx, which houses the Academy of Public Relations and three other schools, one of which is a District 75 program. A total of 274 calls were made from 470 Jackson Avenue in the Bronx, home to the Foreign Language Academy of Global Studies and the J.M. Rapport Career Development School, a District 75 program.  The P.S. 79 Horan School, on East 120th Street, is a District 75 school and 190 calls were made from its building.

The school principals declined to speak with WNYC.

"On the one hand it’s a little shocking but on the other hand it’s not surprising," said Nelson Mar, an attorney at Bronx Legal Services, about the patterns. Some of the District 75 schools in buildings that made many calls are known for taking large concentrations of students who are classified as emotionally disturbed.

"One would expect that there would be situations that could arise in those settings," Mar said. "But then at the same time, one would expect there would be proper training in place, there would be more resources in place to address these needs."

Nelson Mar, attorney at Bronx Legal Services (Beth Fertig/WNYC)

Peggy Mansanet, of the Bronx, knows the drill all too well. Her 13-year-old son, Erik, has been sent to emergency rooms so many times she's lost count although she estimates it happened seven times. Erik has autism spectrum disorder and great difficulty controlling his emotions. He has attended District 75 programs since third grade, including one that's a residential treatment facility. She said he sometimes pushes staffers or leaves the school when he gets frustrated. But each time he went to a hospital she was told there was no reason to admit him. She is now seeking a different type of school that specializes in treating children like Erik because she believes his education has suffered.

The public advocate’s office has sued the city for more information about these 911 calls, to determine how many of the students had special needs and to seek out other trends, too.

Psychologist Charles Soulé, the co-chair of the city’s school-based mental health committee, said sometimes kids really are in distress and need to see someone but too many times the only place to get swift attention is at a hospital.

One solution, he said, is to put more mental health clinics in schools. There are currently about 200 clinics serving nearly 1,200 public school buildings. WNYC found only two mental health clinics located in buildings with District 75 special education schools.

When asked why so few mental health clinics are housed in buildings with District 75 schools, a Department of Education spokesman said the locations are determined by principals and the mental health providers that run the clinics. 

There are about 330 psychologists and social workers working in District 75 programs. Their numbers have been reduced in recent years because of budget cuts. Ernest Logan, president of the union representing school principals, said he thought this was the real reason for many of the 911 calls.

"I do believe that principals need more resources," he said, referring to lack of social workers and psychologists. He said schools might send fewer kids to emergency rooms, "if they had professionals available to intervene before a situation escalated to a level that required a 911 call."

Fourteen-year-old Russell Whitaker, who has autism spectrum disorder, has seen the best and worst the system has to offer. He said he remembers going to the emergency room several times when he was enrolled at a special education school in Harlem.

"It’s almost like there was a huge crime scene and then all the ambulance and police are coming, like it doesn’t make any sense," he said.

Lakisha Brooks with her son Russell (Beth Fertig/WNYC)

Russell’s mother, Lakisha Brooks, said he used to get angry enough to hit his teachers if they stopped him from writing in his journal during class. When he moved to another District 75 school his teachers developed a behavior plan with the help of Russell’s therapist and there have been no trips to the hospital E.R.

"They are calm. They’ll handle it," she said of the teachers. "If anything they’ll call me, they’ll notice something. I haven’t gotten a lot of phone calls."

Russell is now going to a regular high school, the first time he's been fully included, instead of separated from his peers, though he will have extra supports.

There are estimates that 9 percent of New York City children between the ages of six and 12 have one of the following: attention deficit disorder, oppositional defiance disorder, bipolar disorder, anxiety or depression. And those are just the children who have been diagnosed.

The city is opening 20 more regular health clinics in schools that can offer some mental health services. Teachers can also get training from their union and the D.O.E. in crisis intervention, and the city offers a screening system to help teachers determine if students are potentially suicidal. This year, the Visiting Nurse Service of New York is sending a new mobile response team to the Bronx that can handle children in crisis. But until efforts are more closely coordinated in the schools, to prevent small behavioral problems from erupting into larger ones, experts said too many troubled kids will wind up in emergency rooms.

 

With reporting assistance by Jeannie Choi, Coulter Jones and Reema Khrais

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Comments [8]

Cathlin Goulding

Sorry, Beth, I meant I heard you on the Brian Lehrer show! Too much public radio in one day...

Sep. 17 2013 05:43 PM
Cathlin Goulding from New York, NY

Great, crucial reporting in this story. I also heard Beth talk on Leonard Lopate show this morning about the need for more training for teachers to help them address difficult behaviors in the classroom and de-escalate classroom conflicts or heightened emotions so that teachers and school employees don't have to resort to 911 calls.

I work for the Teachers College Inclusive Classrooms Project (www.tcicp.com) and we work with teachers and educators throughout the city. We are offering a special workshop, De-Escalating Challenging Behaviors & Restorative Justice for middle and high school teachers on November 7th. This mini-institute will provide basic classroom management strategies, practice for de-escalating "in the moment" challenging behavior as well as an introduction to restorative justice approaches. Register at: https://www.eventbrite.com/event/8058795073

Sep. 17 2013 05:34 PM
Miriam Nockenofsky from brooklyn ny

now you understand why i fight so hard to make sure my autistic kids dont go to public school and go to a private school?! bec of this, even though it costs me thousands of dollars, my kids are not animals and to be thrown to the care of the docs in the hospital,every time they misbehave, lash out, get violent etc...,which autistic kids do! autistic or any child with a disability needs care and a behavioral intervention, not a ride to the er. this only breeds contempt and this behavior will continue, the child will never learn the correct way to behave if every time they are brought to the hospital and then get drugged up on tranquilizers!!

Sep. 16 2013 09:45 PM
Ellen Mc Hugh from Brooklyn

When a youngster is taken to the hospital by ambulance and NOT admitted, the family can be charged over 800.00 dollars by the FDNY for the trip.

Sep. 16 2013 06:52 PM
Rachel from New York

Excellent story. "Everyday Heroes" has some very touching related photos ( at http://www.laborarts.org/exhibits/schoichet/index.cfm )- amazing to me how much the photos can tell us about the work the teachers do.

Sep. 16 2013 11:26 AM
Joanne from NYC

In total agreement with S. Weidner i.e. by the time an ED child arrives in the ER, the situation has totally turned,the child has calmed down. I taught in D75 for 20 years, these situations are toxic. The Crisis teachers are few and far between, would prefer the teacher deal with the child in the classroom, usually it's just some strong guy thrown into a crisis room with less training then the teacher! And these situations are way beyond 30 credits in special education courses which primarily deal with physically challenged students, they barely mention the ED child with an endless, wide range of disturbances. And to compound matters, there is very little training in crisis intervention for teachers! It's a situation everyone, including the administrators, run from. Rarely is behavior addressed, it's something teachers and paras must get thru while those out of the classroom pad their pensions. The social workers and counselors are clueless and downright scared of these kids. They are the ones who call ambulances, not teachers. Ir's a revolving door. The buck always seems to start and stop with the teacher. Nothing changes.
You need some really well trained child psychologists in these schools, some true mental health professionals, not these MSWs and school "counselors" (what does that really mean? What training do they have?) who run away from a kid out of control, they sure don't want to intervene, and are ill equipped for these aggressive kids and are more then willing to dial 911.
Just read in the NYTimes about another ex student of mine - a 14 year old with 3 gun arrests before he was shot dead by police with a gun in his hand. Now how does a teacher in a classroom full of ED kids address such an issue? Someone has to start addressing the REAL issues here, and stop blaming the teachers.

Sep. 16 2013 10:56 AM
Katherine T.

Recent research has shown that aggressive behaviors are common among children and adults with autistic disorder. Schools and day programs need state of the art training in how to effectively manage such behaviors. They need to learn to not overreact, but to work to minimize such behaviors. They need teams of behaviorists on site; staff who can safely transport acting out children to appropriate quiet rooms; who can help teachers develop classroom behavior plans based on positive reinforcement; who can help determine environmental triggers that can be addressed. For example, the situation regarding the child transported to an ER for hitting a teacher after having a favored activity disrupted (writing in a journal) could have been handled very differently to prevent such behavior in the first place. Set defined times during the day (use a timer perhaps) when the child can write in his journal. Post his schedule so he knows when he'll be able to do so. Reward him for complying with the schedule. Understand that for him writing in the journal may help alleviate stress or it may be part of a routine that he, like many autistic children, find difficult to suddenly change. Visits to an ER are rarely effective or necessary, and frankly, most ER physicians, even psychiatrists, don't have the training to deal with autism. Thrusting a stressed developmentally disabled child into an ER only adds to the child's anxiety. Ideally, we would have a few hospitals in the city and suburbs that would have specially trained staff/units to manage autistic and developmentally disabled individuals. It would also be very helpful to schools/programs to have a consulting psychiatrist or clinical social worker on staff who can observe the child in the classroom situation and can make recommendations to family about treatment options which may include medication.

Sep. 16 2013 08:54 AM
S. Weidner from Brooklyn

I've worked on the other side of this discussion. The ER is always a last resort for teachers and administrators. Typical procedure requires that the parents are called well before 911. Often times the parents encourage the 911 call to try to deter the student from extreme behavior again. But what really happens is that by the time the child gets to the ER they have fully calmed down and all the doctors see are a confused child. Not exactly the same picture of mental health that the schools get. I've been bitten, scratched, stabbed with pencils, had chairs throw at me, and had plenty of students threaten to kill themselves. Often times parents of these students are not involved in their child's life putting the teacher in an impossible situation. It infuriates me that teachers are expected to take physical abuse because these doctors don't know how to handle such children because they don't see them in their fit of rage. Other students are often in danger. I ask the ER doctor to explain what else teachers can do? NYC teachers have one of the toughest jobs around. They are expected to teach to standards that many students are unable to grasp. They get physically hurt and are expected to just deal with it. There's not enough money for the proper support staffs to control some students in the school and as a community we should try to figure out a way to fix this. Until then, schools have no choice but to call 911, to keep themselves and other students safe.

Sep. 16 2013 07:56 AM

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