At the Breaking Point

The little girl laid her head down on her desk. “She must be tired,” thought the teacher, until the student raised her head and the teacher saw that her face was wet with tears. “The teacher called me in and I took the little girl outside of the classroom, where I learned that she had recently lost two family members,” says Katie McDonough. “Grief comes early and often for many of the students I see, and it has a profound effect not only on their emotional and sometimes physical wellbeing, but also on their learning and school performance.”

McDonough, a clinical therapist with Saint Louis Counseling, is embedded in Nance Elementary School through the Little Bit-funded The Sunshine Box program, providing individual student counseling, crisis intervention, teacher/staff consultation, and schoolwide in-services and grief counseling when needed. She manages an average caseload of 30 students each semester, and in the last six months of the 2020-21 school year, had over 150 individual sessions with students (either in person or over Zoom) and more than 50 phone contacts with parents and students to check on their mental health and overall wellness.

“Nance is a school of about 300 students that deal with a lot of trauma and grief, which has especially been the case over the last 19 months,” says McDonough. “We’ve had several students lose family members due to COVID and because many of them remained virtual for so long, we are just now able to fully work through those losses.”

Each of the therapists Little Bit provides to partner schools (currently in five schools) has reported increased signs of anxiety, hopelessness and depression in students during the pandemic and are watching for signs of how this health crisis will have long-term impact. “Kids are incredibly resilient and can continue with their lives while dealing with things that would knock me down…but there’s a limit,” says McDonough.

She points to loss of loved ones, isolation, violence concerns, increased poverty and food shortages as significant stressors of the pandemic. “We’re seeing emotional outbursts in our younger students, who haven’t had the benefit of socialization in a long time, and our older kids are adjusting to each other again and the changes in each other that happened while they were home,” she says.

Not having eyes on the students to evaluate their needs and progression during isolation was tough on McDonough, too. Students that elected virtual learning were seen through Zoom, but it was difficult to stay connected, she says. Still, she believes that her three years of building rapport and trust with students and parents by removing the stigma around mental health therapy, bringing parents into the process and helping students cope with their emotions enabled her to prevent students from falling through the cracks.

McDonough tells the story of a student she began seeing in 2019 who was exhibiting behavioral concerns at school, running away from home and stealing. “She and I were able to begin working one-on-one, giving her an outlet to express her feelings and a place to ‘check in’ when she needed to calm down,” she says. “When we went virtual for COVID and returned late last year, I continued to track her and noticed she had been MIA from many of her classes.”

McDonough found out that the family had been homeless due to the mother losing her job. She worked together with the school, Little Bit and other provider partners to help mom find a job and food resources, set up the family with a mobile hotspot and get the student on a consistent counseling schedule. She also worked with the teachers to help the student get caught up in her classes.

“I think because of Little Bit’s partnership with Nance, which allows me to be part of the school community, we were able to catch this while we could still help, and I know the family has said how grateful they are for it.”

To learn more about how you can support The Sunshine Box behavioral health programming in Little Bit partner schools, contact Michelle Abel, Chief Development Officer at