Program Tackles Counseling Shortage In Rural Schools

As a matter of routine last spring, University of Montana graduate student Erin Dozhier would settle into their home office on the north end of Missoula and prepare for a barrage of questions about houseplants and parrots. The queries came from public school kids hundreds of miles away, their worlds temporarily connected to Dozhier’s through a version of Zoom often utilized by therapists for virtual counseling. Usually, Dozhier would start with their most tried-and-true strategy for building rapport with young clients.

“Number one, if you want students to talk to you, ask them about their pets or show them your pet,” said Dozhier, whose parrot Alfie often made appearances in such sessions.

Dozhier is one of a growing number of students from UM’s social work, school counseling and mental health counseling programs who have delivered such services for K-12 children in Montana’s far-flung rural districts. What began as an experimental effort to address the mental health side of school safety has, over the past five years, evolved into a fixture both for the university’s Safe Schools Center and for the small schools it serves. Dubbed VAST — short for Virtually Assisted School Teams — the program now boasts six grad students and 22 participating districts stretching from the Bitterroot Valley to the North Dakota border.

The free counseling services VAST has made available to young Montanans highlight a growing focus among leaders across the state’s education continuum on student mental health. According to Montana’s latest Youth Risk Behavior Survey, 43% of responding high school students reported feeling sad or hopeless for two or more weeks in a row, and more than a quarter had seriously considered suicide — the highest annual rate since 1991. Educators often point to rising rates of youth anxiety and depression as a contributor to the steady decline in statewide academic performance, and for schools large and small, financial and hiring difficulties frequently stand in the way of providing robust mental health resources. Even outside the K-12 system, such support for students in Montana’s more rural communities may be dozens if not hundreds of miles away.

For program leader Tammy Tolleson Knee, who serves as school support liaison for UM’s Safe Schools Center, the issues VAST was crafted to address have only become more pressing since the pandemic and speak to social and societal forces at work well beyond a school’s hallways. She told MTFP that as of this week, 53 K-12 students in Montana have been referred to the program for one-on-one counseling, with more than a dozen more referrals expected.

“One of the great hardships for families is just what’s happening with the economy,” Tolleson Knee said. “And when families are stressed, kids become stressed.”

Some districts, including in the northeast Montana town of Bainville, have been relying on VAST for years to meet the needs of their most vulnerable students. Other districts such as the Broadus Public Schools have only recently joined the program but are already reporting an impact. Broadus school counselor Dori Phillips told Montana Free Press that in the two months since the district formalized its participation, she’s already referred six students to one-on-one tele-counseling through VAST.

“I don’t know where I would be without the help with those particular kiddos,” Phillips said.

When Dan Lee first envisioned the VAST program in 2019, he saw tele-counseling as the preventative prong in a larger effort to address student safety. As then-head of UM’s Safe Schools Center, Lee heard time and again from educators that shortages of mental health professionals in rural communities posed a significant hurdle to getting children the help they needed before their personal struggles reached a critical level. The challenge, Lee told MTFP, was in developing an initiative that didn’t reinforce misconceptions — tied to school shootings — about mental health as a public safety concern.

“One of the concerns we had was we can’t criminalize mental health,” said Lee, now the dean of UM’s College of Education, which houses the campus’ various counseling programs as well as the Safe Schools Center. “We can’t say if you are depressed, you are a threat. You can’t do that. When you’re depressed, it doesn’t mean you’re a threat to anybody. So we didn’t like the idea of classifying mental illness as a threat to schools because it’s not.”

VAST, which kicked off during the 2020-21 academic year with two participating schools, fit neatly into a collection of services Lee and his cohorts developed for Montana schools, providing a compassion-centric therapeutic tool to complement the center’s more site-specific threat assessments, staff training and its 24/7 school safety hotline. At the same time, Lee said, the initiative began giving UM students greater access to the clinical hours needed to obtain their degrees and licenses, hours that can be difficult to get.

In the years since, VAST has increasingly filled a void in rural communities with participating schools. Tolleson Knee recalled the story of one student who had previously received counseling in a community an hour away from home, until the family’s finances could no longer sustain the costs of travel and treatment. Her colleague, Safe Schools Center Director Emily Sallee, added that even if families are able to sustain private mental health services, outside professionals may not be effective at coordinating with in-school staff. By comparison, VAST relies on teachers and school counselors — the latter a state-mandated position in public schools — to coordinate with UM-side practitioners and keep them informed about any developments in a student’s life that may go unseen or unacknowledged in a tele-counseling session.

“There’s this huge wraparound piece that’s often missing when kids are accessing counseling outside of schools,” Sallee said, “and it’s a huge part of how all these people can be supporting this kiddo, not just the counselor.”

For Deborah Ith, the team-centered aspect of the program has been an important facet of her VAST experience this fall. A doctoral student in UM’s school psychology program, Ith currently has three teenage students in rural schools that she meets with remotely at least once a week via a paid, HIPAA-compliant version of Zoom. Their struggles have primarily been interpersonal ones, Ith said, and on a couple of occasions have risen to the level that Ith has reached out to the school counselor and parents to develop a group plan of support.

“Sometimes that means trying to support parents because that’s really scary,” Ith continued. “When you’re a parent and you have somebody call you up and be like, ‘Hey, this came up, this is going on, you need to know about it, this is what we talked about as a way to support and this is what you can do to support them,’ that’s really hard to hear sometimes.”

Even as VAST participants continue to provide such day-to-day services for a growing collection of rural schools, Tolleson Knee is identifying opportunities to expand the program’s offerings even further. She told MTFP that starting this spring, the Safe Schools Center plans to try out a hybrid version of VAST in one Bitterroot Valley school that will include a monthly in-person counseling session for students on top of three monthly tele-counseling sessions.

The University of Montana isn’t alone in recognizing the challenges rural schools face in providing adequate mental health support for their students. The nonprofit Montana Small Schools Alliance has developed its own 24/7 crisis support app, which mental health resources director Cindy Fouhy said has so far been accessed by more than 20,000 students across the state. In addition, the alliance — in partnership with the Montana Professional Learning Collaborative — has developed a free tele-counseling model of its own. Like VAST, the focus is primarily on Montana’s smallest and most resource-starved schools where dedicated one-on-one intervention simply isn’t available.

“You go to these small schools and they may not even have a certified counselor,” Fouhy said. “If they do, he or she is also teaching classes and doing 500 other things.”

The factors that make mental health support in rural communities so difficult can also fuel the very stressors that necessitate such support in the first place. Consider Broadus, a town of fewer than 500 people anchored to the vast prairie of southeastern Montana. The local K-12 school boasts a student population of roughly 225, some of whom travel up to 70 miles one way to attend Power River County’s sole high school. According to data from the Office of Public Instruction, more than a third of the student population is classified as economically disadvantaged.

Politics, drought, alcohol use — there are a lot of issues influencing local families, said Broadus school counselor Dori Phillips, and those pressures “trickle to our students.” Professional help is more than 80 miles away in every direction. Stress and geographic isolation are exacerbated by a persistent social stigma around seeking mental health treatment, one that Phillips has struggled, family by individual family, to overcome.

“Getting our families to commit to taking their kids for help is almost impossible in many cases,” Phillips said. “I have very few students on my caseload. I think there’s three total that actually travel out of town to get help.”

Broadus Public Schools used to offer more robust mental health services for students through the state-sponsored Comprehensive School and Community Treatment program, or CSCT. But the district’s access dried up about two years ago following legislative changes to how services were administered, and the availability of a part-time school psychologist has largely served during emergencies or as a backup on days when Phillips isn’t working. So when Phillips heard of VAST in a statewide association email, she instantly saw the prospect of free, in-school tele-counseling as a carrot for local families.

“I can work with kids on friendship issues, I can help kids if they’re having trouble managing homework or learning organizational skills, those types of things,” said Phillips, whose school counseling license is distinct from the licenses granted to clinical therapists. “But when you have a family who deals with the loss of a parent or a caregiver, you have a family who goes through even a nasty divorce or a child who has a lot of trauma from their early years, those are things that they really need a private counselor for. Someone who’s licensed and knows how to work with kids.”

In just two months, the number of Broadus students receiving tele-counseling services through VAST has grown to six, and Phillips said she’s working to connect three more students with the program.

A few hundred miles to the north, Bainville school counselor Amy Iversen said the number of students she’s referred to VAST has grown from two students in 2022 to seven last school year. She described the ag-andoil community as similarly small, with 172 students across all grades, and similarly isolated, with the closest larger population center lying across the state line in Williston, North Dakota. For Iversen, UM’s program came along at a critical time for several students who showed signs of behavioral issues or depression and whose families lacked the resources for private counseling.

“They can come in and talk to me about it, but then you know what? They’re going to see me again in class in two days and they’re going to be like, ‘Oh, crap, is she going to say something?’” Iversen said. “They probably don’t want me to know all their secrets. I’ve got kids in the school, some of them are friends with my own kids. It’s awkward for them, so when you’re in a small school, it helps with that confidentiality.”

In some cases, parents have commented to Iversen on a noticeable difference in their child’s confidence, self-esteem or coping skills as a result of ongoing therapy. And while school-based counseling has its limits — like the services provided by traditional school counselors, VAST is not offered during the summer break — Iversen hopes the mental health skills students glean during the school year can see them through the off months.

“That’s better than not getting anything,” Iversen said.

Dozhier, the UM grad student, didn’t have to look much farther than their own childhood in a small Oregon timber town to understand the issues facing the young Montana clients they counseled last spring. Kids are smarter and more observant than people think, Dozhier said, which means when pressures like joblessness, food insecurity or substance abuse weigh on a household, children pick up on it. They may act out or isolate themselves, sometimes without knowing why, and the last thing such a student can focus on is learning.

“Their thinking brains are off,” Dozhier said.

Dozhier’s parrot Alfie may help break the ice, but helping a child navigate issues they may not fully understand requires more than just talking about pets and plants. In sessions with VAST, Dozhier said they primarily utilize a style of counseling called play therapy, allowing a student to play freely with whatever toys they choose. Their actions may give the counselor some subtle insight into what’s going on in their lives, Dozhier said. Fighting between toys could, for example, be indicative of difficult relationships with siblings or other family members and help guide a counselor’s questions.

“Even though it looks like play, we find that pertinent themes come up in play, even without specifically saying, ‘Hey, how’s your relationship with your brother?’” Dozhier said. “It’s almost like watching a theater play that doesn’t have a lot of words and kind of using that to draw conclusions.”

Ith’s work with older students this fall has also underscored the added stress coming to age in a smaller community can place on a 21st-century teen. She acknowledges that the rural nature of the schools she serves through VAST can help reinforce a sense of support, giving some students an awareness that others around them recognize the experiences they’re going through. But it’s a “double-edged sword,” she said, one that can make it difficult to find new peer groups or move past incidents of bullying.

At the Montana Small Schools Alliance, Fouhy notes that social media and technology can exacerbate such issues in ways older generations may not fully understand.

“The kids can’t get away from stressors,” Fouhy said. “In the 80s, kids could go home and if they had to fight at school, they wouldn’t have to worry about it again ’til Monday. But now it just goes on and on, and the conflict and the stress that’s just in their pocket is significant.”

Remote delivery of the one-on-one services that can help students process such situations does pose challenges, and leaders at VAST are quick to note that the program isn’t a solution for budgetary shortfalls or hiring challenges. Dozhier and Ith both credit the effectiveness of their work to individuals in the communities they’ve served — school counselors, teachers, parents. Tele-counseling initiatives haven’t sought to replace those voices but rather to create oases in Montana’s rural desert of outside mental health services, and Tolleson Knee has heard from past participants that the anonymity of therapy was a key motivator.

“When you do live in those small communities, it’s just so hard to be objective,” Tolleson Knee said. “I heard students and family saying it was so nice to know we weren’t going to like have this intense session where we’re talking about really personal stuff and then run into [the counselor] in the grocery store.”

The experience of meeting such a need fits well with Dozhier’s long-term professional goal of returning to rural Oregon as a counselor, and they are slated to return to the VAST cohort of practitioners-in-training this spring as it branches into in-person service. But while the program is great at doing what it’s doing, Dozhier recognizes even private counseling has its limits. A few sessions with a therapist won’t erase the issues that arise for a child when, say, a parent is overworked, stretched thin and struggling just to put food on the table. When it comes to improving mental health, Dozhier said, the challenge is far more systematic than one school, one university or one counselor can handle alone.

“The answer to all of this kid’s woes is maybe not counseling for a year,” Dozhier said. “The answer maybe to so many of these woes would be to reduce stress on the family, and that’s something that our systems aren’t set up to do.”