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Youth Services In Lexington
Report to the Board of Selectmen
February 6,2006
"Solo practitioners, mental health practitioners within the agencies, and others we contacted in the
course of this project concur generally that Lexington, with all of its abundance of helping talent,
displays a serious lack of services for adolescents There is also a lack of collaborative coordination
between the solo practitioners and between professionals within Lexington High School and these
practitioners "
MENTAL HEALTH SERVICES IN LEXINGTON,MASSACHUSETTS:
A REPORT TO THE BOARD OF SELECTMEN
The Human Services Committee,December 2002
Introduction and History
Prior to the effects of the failed 2003 Override, the Town of Lexington contracted for many years
with Replace (which became Wayside RePlace)to provide services to high-risk youth in
Lexington. Through collaboration with Lexington Public School administrators, and at a cost to
the town of$74,087, RePlace provided the community with these services:
• Clinic based counseling- For individuals, families and groups. Issues included
development of social skills, substance abuse, racism, academic motivation, bullying, anger
management, family problems, self-esteem, grief and addressing risky behavior.
• Outreach Counseling & Community support- For issues such as suicide, child abuse,
runaways and other family conflicts.
• Prevention services - Including information and referral and development of a student
outreach program for issues such as substance abuse, bullying, community violence and
general positive health promotion.
In response to the loss of RePlace, the Human Services Committee made a recommendation for a
task force to be convened under the guidance of Selectman Bill Kennedy, to review services and
gaps in services. The group determined that there were a wide variety of services in the
community, but they lacked overall coordination.
The goal, as defined by the task force, was to develop a continuum of services for youth and their
families, building on what is working well, and filling identified gaps in services. The task for
emphasized the need for strong and continued communication and collaboration among the
schools, police and social services personnel as well as outreach to community agencies and
committees focused on youth and family services.
To achieve this goal, the task force recommended (1) the development of the Youth Services
Council, (2) the creation of a youth services clinician position, (3) the creation of a fund, to be
administered by the Department of Social Services, that would allow youth without insurance
coverage to access services from local practitioners, and (4) the reinstatement of the School
Resource Officer position at the Senior High School.
With the successful Override in 2004,the community supported the establishment of the Youth
Services Coordinator's position and reestablished the School Resource Officer's position at the
senior high school.
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Accomplishments of the Town of Lexington
Youth Services Council
The Youth Services Council is an independent community council made up of representatives
from the Board of Selectmen, the School Committee, the Lexington Schools
(administration/special education, health education), Social Services Department, Police
Department, Fire Department, Recreation Department, private therapists, Human Services
Committee, Clergy and the youth of Lexington.
The Council meets monthly (with subcommittees meeting more frequently) for the purpose of
identifying youth needs for community-based services for mental health and substance abuse
counseling and education. The Council has focused on improving the availability of services, and
facilitating networking and collaboration among existing community services providers.
Youth and Family Services Coordinator
The youth services clinician works to coordinate and strengthen a wide range of youth related
programs, provide case management services to at risk youth, and conduct outreach to
community based youth and family service providers and the schools.
School Resource Officer
The Lexington High School Resource Officer is assigned full time to the campus and
collaborates with others on prevention, education, intervention and investigative strategies. The
police department contributes additional support services to youth and in particular youth at risk,
through the family services officer, Minute-Man Regional High School Resource Officer and
police prosecutor (who is liaison to juvenile probation officers, court officials and district
attorney's staff).
Highlights of Activities of the Youth Services Council
• Facilitating communication and sharing of information regarding critical incidents,
stressors, and crises affecting youth and families in the community.
• Expanding original council membership to now include representatives of the Fire
Department and the Lexington Clergy.
• Creating Lexington's "Forum for Youth"—a volunteer network of private therapists who
provide therapeutic services to children, adolescents and families. Currently this 29-member
group is working on establishing consistent, on-going consultative services to schools, parents
and town groups regarding youth at risk and general youth and family issues.
• Identifying a specific need for middle school half-day initiatives and then promoting
coordination and collaboration with the schools, parents and Town departments to provide
programs.
Youth Services Coordinator: Examples of Activities and Responsibilities
• Staff representation for the Youth Services Council and their subcommittees and task forces
• Implementing and coordinating the Youth Services Coordinator's Regional Group to
include Belmont, Lexington, Bedford, Arlington, Cambridge, and Winchester, Concord, and
Burlington.
• Co-facilitating and coordinating private school network meetings the Director of Student
Health Services, Lexington Schools (seven private schools in Lexington participate two times
per year).
• Co-facilitating three parenting workshops with an elementary school counselor in Spring
2006 at The Avalon.
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• Implementing & Coordinating intergenerational programs in the community
• Coordinating and co-facilitating a book groups for parents
• Providing direct services to families with significant case management issues
• Responding to 60+ calls a month related to issues, including:
➢ Financial assistance (town, community, state/federal) regarding medical
bills/needs, after-school/summer programming, utilities, emergency housing
➢ Information, referral around clinical/mental health needs of youth related to
mental illness, pervasive developmental disorder, substance use, and coordination
of services post-hospitalization.
➢ Collaboration with school systems and town departments on youth at-risk related
to risking behaviors (i.e. cutting), domestic violence, and abuse and neglect issues
as well as Issues of basic needs around housing, food, fuel, and transportation.
Unmet Needs Identified by the Youth Services Council
• A coordinated community system of prevention and outreach services for youth and
families.
• Accessible services for all youth and families.
Furthering discussion of and responses to concerns and needs as evidenced by Youth Risk
Behavior Survey and reports from Schools, Police, Fire Departments and youth themselves. (See
Attachments.)
Proposed services and programs to meet immediate and future needs:
• Prevention-based services (e.g. outreach worker, youth center, peer leadership, etc.)
➢ Accessible mental health service to children and adolescents
➢ Office hours in schools and community locations
➢ Collaborative preventive programs
• Group therapy/psycho-education programs for youth and families
• Restoration of the School Resource Officer position at middle school Level
• Resource Guide for youth and families
List of Attachments
A. Youth Services in Adjacent Communities
B. Youth Risk Behavior Survey—2004 Results and 10 year trends
C. Mental Health Services in Lexington—Human Services Committee 2002 Report
D. Current Crisis Statistics from Lexington Schools, police and fire
Submitted by the Lexington Youth Services Council
Members include: Norman Cohen(Board of Selectman), Helen Cohen(School Committee), Bill Blout
(Human Services Committee), Jennifer Wolfrum and Mary Sullivan Kelley (Lexington Public Schools),
Rev. Bill Clark(Interfaith Clergy Association),Becky Rushford and Lauren McSweeney (Social Services
Department), Jim Rettman and Christina Demambro (Police Department), Tim Johnson(Fire
Department), Karen Simmons (Recreation Department), Amy Berger(Private Therapist),Eric Eid-Reiner
and Eliza Duncan(students).
Attachment A
Youth Services in Adjacent Communities:
Town Year #of positions Job descriptions Budget
established
Bedford 1987 5 Bedford Youth and Family $197,341
consists of a full-time director,
admin assistant, prevention
coordinator, veteran's agent,
and youth activities
coordinator Clinical
counseling staff from Eliot
Community Services currently
provide counseling at BYFS
Arlington 1970 9 There is one director, one $256,684
psychiatrist, and one group
work coordinator There are
five social workers/counselors
and one psychologist
Overall they provides
counseling services to
adolescents, children and
their families, all other related
work, as required The
psychiatrist provides all
psychiatric and medical
expertise in directing and
assisting a multi-disciplinary
staff in the evaluation, care,
counseling and treatment of
adolescents, children and
their families, all other related
work, as required
Winchester About 1986 Winchester Youth The VVYC programs focus For Youth
Services, under the specifically on middle and Services,
recreation department, high school youth The Youth excluding
has 3 full-time Services Coordinator's recreation
positions and 7-10 additional staff members are $75,000
part/full-time high school Peer Leaders
coordinators and (primarily volunteers)
teachers in the nursery
school, 6 part-time
positions in the after
school, and countless
part-time facilitators for
their individual
courses One full-time
position -Youth
Services Coordinator-
housed in Winchester
Youth Center(out of
middle school)
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Attachment B
Executive Summary
Youth Risk Behavior Survey
Lexington High School
2004 Results and Ten Year Trends
Amy Farrell
Jack McDevitt
March 7, 2005
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BACKGROUND INFORMATION
• 1,455 students completed the survey in spring 2004
• Given to students in all grades. The following list provides the distribution of survey responses
by grade.
➢ 30% 9th grade(431)
➢ 26% 10th grade(380)
➢ 25% l 1 t grade(364)
➢ 18% 12th grade(260)
• Similar survey given 1995 (n=655), 1999 (n=1,005), and 2002 (1,422)
• Youth Risk Behavior Survey focuses on various areas of risk facing youth in Massachusetts
(alcohol, drugs, sexual activity,nutrition,violence). Lexington High School has integrated a
number of specific questions that deal with high risk issues that are being confronted by current
programs(stress, academic competition, sexual activity).
AREAS OF PROGRESS SINCE 1995
1. Cigarette Smoking
• Cigarette smoking has decreased dramatically since 1995.
• In 2004 14% of students report they smoked in last 30 days compared to 35% in 1995
2. Marijuana use
• Fewer students are reporting using Marijuana in 2004
• 20%of students report that they used marijuana over past 30 days compared to 33% in 1995.
3. Suicide
• Fewer students are reporting considering or attempting suicide across the ten year study
period. Decreases in consideration, plans and actual reported attempts of suicides
• Ever seriously consider Suicide 23% in 1995— 16% in 2004(231 students)
Develop plan to commit suicide 16% in 1995— 9% in 2004 (128 Students)
Actually attempt Suicide 9% in 1995 — 5% in 2004(70 students)
4. Body Image and Weight
• Fewer students are reporting being concerned about their weight
• 54%of students reported that they felt they were the right weight in 1995 and in 2004 59% of
students report feeling they are the right weight.
• Still may be lingering problems related to young women trying to lose weight. 52% of the
females are trying to lose weight compared to 20%of males
5. Fighting
• The number of students who report that they have been in a fight in the last 12 months has
decreased during the study period(36% in 1995 and 29% in 2004)
• Freshman and sophomores continue to be more likely to be involved in a fight(33%)as
compared to seniors(18%)
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AREAS WHERE RISKY BEHAVIOR HAS REMAINED
RELATIVELY STABLE SINCE 1995
1. Drinking
• In both 1995 and 2004, 49% of students report that they have had at least 1 drink in past 30
days.
➢ 38%of 9th graders
➢ 46%of 10th graders
➢ 51% of 11 th graders
➢ 65%of 12th graders
• Approximately 30%of students report that they ride in cars Driven by someone who has been
drinking across the study period
• Approximately 13% of student report that they have driven after they have been drinking
2. Other Drug Use
• The numbers of students who report ever using cocaine in their lifetime(5% in 1995 and
2004)
• The numbers of students who report ever sniffing glue or aerosols in their lifetime(13% in
1995 and 11% in 2004)
3. Gambling
• The number of students who have ever gambled(40% in both 1995 and 2004)
4. Theft
• Had something Stolen from the student or damaged on school property (34% in 1995 and
32% in 2002)
Highlights from 2004 Survey
1. Alcohol and Drug Use
Students at Lexington High School report using a number of illegal or unhealthful substances. The
most common drug among High School students is alcohol with nearly one-half of the students
reporting that they used alcohol at least once during the past 30 days. This number is similar for
males and females.
• 49%of the students report having at least one drink of alcohol during the prior 30 days
• 20%of the students report having used marijuana during the prior 30 days
• 14%of the students report smoking cigarettes during the prior 30 days
• 11% of the students report sniffing glue or aerosol cans during the prior 30 days
• 5%of the students report using cocaine during the prior 30 days
2. Stress
• 95%of students being under some stress
• 21%report being under"extreme stress"
• 90%of students report that their level of stress has increased since they began attending
Lexington High School
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3. Sex
Approximately 23% of Lexington students report that they have ever had sexual intercourse. Not
surprisingly, sexual experience varies greatly by age. The following list indicates the proportion of
students in each grade who reported that they have had sex at least once.
• 11% of 9th graders
• 19% of 10th graders
• 33% of 11th graders
• 40% of 12th graders
For those students who reported that they have had sexual intercourse, 72%reported that they
used a condom in 2004 (up from 68% in 1995)
Due to growing concern about issue of oral sex the 2004 survey has a number of new questions
designed to find out more about this phenomena. 35% of Lexington students report that they
have ever had oral sex. Like intercourse,the proportion of students who report having oral sex at
least once varies greatly by grade.
• 21% of 9th graders
• 31% of 10th graders
• 43% of 11th graders
• 51% of 12th graders
Of those who have had oral sex, 27% of student report that they have had oral sex with 4 or more
partners.
4. Risky Behaviors of Selected Groups of Students
a. Students reporting stress
Students who report being the most stressed are more likely to have been forced to have sex against
their will,to have considered suicide,be trying to lose weight, and have had something stolen.
Not Stressed A lot Stressed Extremely
Stressed
Sex against your will 4% 9% 14%
Consider suicide 10% 16% 19%
Trying to lose weight 22% 36% 51%
Have something stolen 33% 32% 42%
Perception of students reporting extreme stress
Students who report extreme stress are more likely to view academic competition as a serious
problem(59%)when compared to their less stressed peers (59%).
Reduction in students who have considered suicide
Compared to 2002, Lexington High School has experienced a significant decline in the proportion
of those extremely stressed students who have considered suicide (40%to 19%).
b.Athletes
Athletes at Lexington High School are less likely to report being extremely stressed compared to their
non-athlete peers. Athletes, however, do appear to engage in more risky behaviors, particularly
around the use of alcohol,than their peers.
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Athletes Non-Athletes
Report extreme stress 19% 25%
Drink during last 30 days 52% 42%
Drank 5 drinks in a row 29% 22%
Rode in car with someone who
had been drinking 32% 24%
Attachment C
MENTAL HEALTH SERVICES IN LEXINGTON, MASSACHUSETTS:
A REPORT TO THE BOARD OF SELECTMEN
By The Human Services Committee
Stephen Baran, Social Services Coordinator and Staff to the Committee
Robert A. Dentler, Chair
William L. Blout
Sarah B. Conklin
Steven Kelly
Mary M. Rommell
Russell Schutt
Christine Yedica
December, 2002
TABLE OF CONTENTS
1. Purpose of the Study
2. Mental Health Service Providers in Lexington and the Sample
3. Agencies and Organizations
4. The Individual Professional Providers
5. Interpretations and Conclusions
6. Recommendations
Appendix A. Tables
MENTAL HEALTH SERVICES IN LEXINGTON
1. PURPOSES
The Human Services Committee study of professional mental health service providers
began to take shape in 2001,when representatives of the Middlesex branch of the National
Alliance for the Mentally Ill met with the committee to present their current needs and
concerns. We decided to conduct a study of the services available in Lexington for citizens,
including children and youth, of the town.
Our primary purpose was to inform ourselves and the Board of Selectman about the
nature, extent, and levels of activity of all types of mental health services by Lexington
agencies and solo practitioners. We sought to identify and describe the availability and
provision of psychotherapeutic, sociotherapeutic, counseling, and medical services to clients
suffering from psychoses, psychoneuroses, related cognitive or emotional distress, and
difficulties associated with alcoholism, substance abuse, and the like. Our aim was to
gather, interpret, and report on evidence of unmet needs. We believed that subgroups who
were found to be under-served should be identified and that the Board of Selectman would
entertain ways of strengthening the scope and quality of future services.
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A report published by the Boston Globe on December 4, 2002, found "Growing
numbers of adults and children in Massachusetts are visiting mental health professionals,
and are spending far longer in therapy...Americans generally are seeking more therapy,
but
this trend has turned out to be particularly pronounced in Massachusetts." Harvard
Pilgrim Health Care said the number of talk therapy visits among its members increased
22 percent in 2001, and will grow another 17 percent in 1002. This trend intensified our
concern.
The project was planned during the spring and summer of 2002 and carried out
during the fall. Committee members interviewed solo practitioners face to face and one on
one and gathered information and interviewed two or more members of the four principal
service providing agencies in the town.
2. MENTAL HEALTH SERVICE PROVIDERS IN LEXINGTON AND THE SAMPLE
We pooled information from several sources, including HelpPro.com on the Internet,
to develop a master list of professional service providers based in Lexington. The total
number of private practitioners is 173. These include therapists who have an office in
Lexington, even though their primary office is located elsewhere, as well as professional
providers on the staffs of RePlace, Eliot Community Health Services, the Edinburg Center
Inc. (formerly the Center for Mental Health and Retardation Services Inc.), and the
Lexington High School Guidance Department.
The Massachusetts Board of Registration informed us of how many licensed
therapists -36 psychiatrists, 179 psychologists, 425 social workers, and 86 allied mental
health professionals - list their addresses in Lexington. Many of these individuals reside in
Lexington but practice elsewhere. And many people are licensed but do not practice
privately. Committee member William Blout,who has expertise in this domain, estimates
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from these data and from his knowledge of turnover and other changes, that at least 200
professional mental health service providers work in Lexington. We used our list of 173
names and office addresses to draw our sample, taking every sixth name from that list.
We are grateful to the many practitioners who gave us their time and shared their
expertise.
Lexington's population in 2002 was 31,122,with 6,655 of this number under 17 years
of age. The hypothetical ratio of providers to citizens was thus 155.6, an exceptionally high
ratio compared to communities elsewhere in the nation and in the Boston metropolitan
area. If we take the often-utilized proportion in mental health literature of ten percent of a
population in need of services, there may be about 3,000 citizens at risk of mental and
emotional distress in Lexington, and on this estimation, the residential hypothetical
ratio is 1 provider per 15 residents. There is,we believe, an indisputably high number of
mental health service providers working in Lexington.
Our study interviewed 28 solo practitioners for a sample of 16 percent of this group.
In addition,we interviewed from two to five professionals in each of four agencies and
organizations. Within the 28, 17.9 percent were psychiatrists, 42.9 percent were
psychologists with PhDs, 25 percent were psychologists or counselors with PsyD or EdD
degrees, 7.1 percent were social workers with MSW degrees, and 7.1 percent came from
other professions. We did not sample pastoral counselors. 85.7 percent of our solo
practitioners had 15 or more years of professional experience.
3. AGENCIES AND ORGANIZATIONS
Four agencies and organizations serve Lexington, apart from solo practitioners. They
include Wayside RePlace, Eliot Community Human Services, the Edinburg Center Inc.,
and the Department of Guidance Counseling at Lexington High School.
Wayside RePlace. RePlace has been in Lexington since 1970 when it began as a
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youth drop-in center which provided counseling, supervised emergency foster homes, peer
counseling, and a child assault prevention program and hotline. In the 1970s, 1980s and
until the 1990s, it was identified with the Hancock Church and was housed in the church
building. (For the period from November 1994 until late 1995, Eliot Community Health
Services took over from RePlace and offered drop-in services and peer counseling for
youth
from a clubhouse in Depot Square. It proved difficult to reconcile the activities of youth at
that location with the business interests of merchants based on the Square. The contract
reverted to Wayside RePlace).
The present day RePlace,with local headquarters on the second floor at 4 Muzzey
Street, retains a tradition carried over from the old RePlace of working to be identified
with Lexington, carrying on advocacy for youth and families, and empowering youth as
well as being prevention-oriented. It differs from what it was in its earlier decades: it is
more bureaucratically organized and professional with a higher level of staff training,
documentation of services, and reporting. Since 1996, it has had a solid relationship with its
parent agency, the Wayside Youth and Family Support Network,with headquarters
located in Framingham,which serves a large, multi-suburban range of communities.
In addition to programs of youth skill building, and efforts at bullying and violence
prevention which complement the Domestic Violence Task Force work of the Police
Department, and health education, RePlace provides counseling and crisis intervention
services for emotionally distressed children and youth. In the fiscal year that ended June
30,2002, the agency provided 459 hours of counseling sessions to 119 Lexington residents
and their families on the contract with the town. They also offered group and individual
counseling to a few groups of children and middle school youths at Fiske, Harrington, and
Clarke schools. Issues addressed in some of these settings included social skills, teasing and
bullying, grief and loss, and anger management. The annual operating budget for the year
was $108,000,which included $74,087 awarded by the Town of Lexington. This funded the
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work of five part-time and fee for service staff workers with 1.5 full time equivalents.
RePlace generally sees higher functioning youths. It does not treat those with
psychotic or mood disorders or psychoneuroses. Some individual youths have been referred
to RePlace staff by the guidance counselor at Clarke. The high school staff could use
RePlace as a referral resource but does so very rarely.
In the judgement of two senior administrators at Wayside Replace,Lexington youth
should be involved more in community governance. Adults should reach out to them for
their views and recommendations. This was attempted at a youth "summit" meeting in
March, 2002,with some success, according to both adult and youth participants. The youth
at the summit recommended that efforts should be made to make shops and restaurants
youth-oriented, and there should be a mobile youth center. Events should be held in
different places and oriented to the middle school students especially. Lexington needs to
adopt community mental health and environmental strategies, the youths said.
The clinical administrator at RePlace believes that the most serious impediments to
adequate mental health services include insufficient funding, limited access to hospitals,
and incomplete emergency response capabilities. Many RePlace clients come to RePlace
after their HMO insurance benefits have been exhausted. Some never had insurance in the
first place. There is also a lack of collaboration among service providers. A provider needs
to be known for a long period of time in Lexington before gaining the trust of other
providers. They also believe that the quality of services in Lexington is excellent but that
there is an inability to meet rising needs.
Eliot Community Human Services. This agency serves a sizeable range of suburbs in
Middlesex County. The Lexington branch located at 186 Bedford Street was at one time a
substantial unit but services have recently been concentrated in Concord and reduced in
Lexington. For instance, there had been a psychiatrist in the Lexington office one half day
a week, but this has been discontinued. Eliot serves clients with significant mental illnesses,
particularly schizophrenia and bipolar disorders, but medication provisions, outreach, and
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case management services are concentrated in the Concord office. Eliot maintains a 24-
hour beeper system and assists parents who phone regarding runaway teenagers or those
for whom medication balances get out of control. Psychotherapy is provided at the
Lexington office for a few clients.
From the point of view of the clinical administrator, there are not enough mental
health services to meet needs in our region. Eliot, among others, has recently done little
with outreach efforts in Lexington, after making a valiant effort in earlier years. Rates of
reimbursement for mental illness and emotional distress are significantly lower than rates
for physical illnesses. The state's new mental health parity law makes it sound to the public
as if more services will become available, but the law requires proof that the illness being
addressed constitutes a "medical necessity," a standard that is very difficult to meet.
In fiscal year 2002, Eliot provided 771.5 hours of services - a total of 791 sessions or
appointments - to 21 residents of Lexington. The services ranged from individual therapy
to family and couples therapy, to family and case consultations, diagnostic evaluations of
clients, and medication management.
Edinburg Center Inc. Edinburg, known until 2002 as the Center for Mental Health
and Retardation Services, has a large headquarters building located at 1040 Waltham
Street in Lexington. It is a private, not-for-profit corporation funded by the Massachusetts
Departments of Mental Health, Mental Retardation, and Public Health, foundation grants,
HMO's and other third party payers. Its director, Ellen Attaliades, is a licensed clinician in
psychology, and has 22 years of professional experience, nearly all of them with Edinburg.
This agency employs about 300 professionals and support staff who work in the
Lexington headquarters and clinic and in clinics in Waltham and Arlington. It serves 18
towns and villages in the immediate county. In addition to providing diagnostic, evaluative,
and case management treatment and support planning services, Edinburg maintains these
types of services:
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• Round-the-clock crisis psychiatric intervention services for all persons over 13 years
of age.
• Adult day treatment services, including two different group programs.
Intensive support for daily living assistance, short term psychotherapy,
vocational and housing assistance, medication monitoring, and linkages with
other service providers.
• Outpatient clinics focusing on treating the whole person in community
settings. Charles Webster Potter Place, a clubhouse for pre-vocational, social
experiences, and psycho social rehabilitation for 40 to 60 members. Five
community treatment programs for 39 clients, one of them based in
Lexington, and supported housing for 68 adult clients in individual living
arrangements.
• A variety of programs and services for mentally retarded adults,
including two group homes in Lexington.
During fiscal year 2002, Edinburg provided mental health services to 96 residents
of Lexington. While 82 were whites, the remainder were truly multiethnic. The group
included youths from 14 to 20 years of age as well as some adults. The principal services
rendered to these 96 included crisis interventions and outpatient counseling.
Edinburg collaborates with Emerson Hospital, Eliot Community Mental Health
Center, Wayside/RePlace, and a range of individual mental health service providers. It
bid, incidentally, on the service contract funded by the Town of Lexington that went to
Eliot Community Health Services before it reverted to RePlace. Its collaboration with the
Lexington Police Department has been especially fruitful in recent years. Typically, a local
police officer phones and brings in a person referred by family or friends as in an
emotional crisis. Edinburg gave an award to the Lexington Police for the dedication and
quality of their services this year.
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Agency professionals evaluate the client's problems and capabilities, utilizing
placement at Emerson Hospital if necessary for the immediate short term. They assign a
case manager, create a team of staff, and begin a program of therapy, medication, and day
program participation.
Edinburg copes as well as it can with what it deems to be a number of serious
impediments to the provision of adequate services. These impediments include the
difficulty of achieving coordination between the many towns and jurisdictions they serve;
seriously insufficient funding for outpatient services; and very inadequate transportation
services - no public buses operate between Lexington or Waltham and the Center. In
addition, this large and bustling professional center has no budgeted resources for research
and development, program planning, or staff training and development. The director also
noted that the Center's overall annual funding is not growing.
Lexington High School Guidance Department (LGD). LGD consists of eight full time
professionals, a psychologist, counselors and social workers, and a director. The director
referred us to his staff because he was new to the town and the school in 2002. We
interviewed five members.
LGD serves a caseload of 200 students per staff member. About 80 percent of their
time is devoted to college and job placement counseling. Social adjustment and mental
health issues received 20 percent or less of their time. The mental health service provided
by staff in LGD is of an emergency kind - disruptions and episodes that come up
unexpectedly during the school day in particular- and is devoted to very short term
problem solving.
The Lexington school district does not permit professional staff to engage in
therapeutic counseling. This is part of the district's risk management strategy as devised by
the legal counsel for the school committee. As part of the same strategy, LGD members
cannot refer or make related arrangements with outside mental health practitioners. They
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are permitted only to lend a student or a parent or guardian a notebook listing names,
specialties, and addresses and phone numbers. Their book of listings contains numerous
solo practitioners but very few clinics, group treatment resources, or networks and
agencies.
The zero tolerance policy of Lexington High School concerning drug and alcohol
use and threats or instances of weapons or violence has the effect, in the judgement of those
we interviewed, of"killing the possibility of preventive work with students". Students who
have these and related problems now tend to avoid the staff of the LGD,whom they know
to be obliged to report student suspects to the administration. Health education about these
behaviors is worked upon by the High School Health Department with state grant
resources.
The theme of the LGD is "coordinative communication". This includes intramural
advocacy for students, a parent information and support group which convenes weekly and
is open to all interested parents, and assistance to the special needs educators and
administrators working the school.
Lexington High School faculty in general give very major attention, as do many
parents, to time on academic tasks in the classroom and to homework. Time out for
counseling or for work on mental health challenges is frowned upon by most faculty and
parents. An important exception to this pattern came in 2002 with the death of two
students, one a murder victim and one an auto accident victim. On that occasion, LGD and
other school staff devised a time of support, counseling, and group grieving.
The greatest unmet need in Lexington, in the judgement of the staff members we
interviewed, is the need for group counseling and group therapy sessions for adolescents.
We should also mention the work of the Health Protection Advisory Council
(HPAC). This group of more than 20 health educators, special educators, social workers,
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public health specialists,work on a number of funded projects to improve drug and alcohol
awareness and prevention concerns among parents and youth. They work through a
special
health unit at Lexington High School and through health educators at the middle and
elementary schools. HPAC also works on preventing bullying and harassment and related
improvements in interpersonal relations among students.
4. THE INDIVIDUAL PROFESSIONAL PROVIDERS
Most of the service providers in our sample work with 15 or more clients a year. See
Appendix A. All but a very few of them practice alone and are not part of an agency or
group of colleagues. Adults and married couples are the clients of concern to 59 percent of
the providers,while 15 percent serve children and 26 percent serve youth. All of the
providers serve white clients, but many of them have a multiethnic clientele as well.
Most of them treat more than one type of problem, of course. The providers include
clinical psychologists who specialize in psychological diagnoses (25 percent). Many of the
counselors and therapists work on neuroses and general anxiety disorders (31 percent)
while a smaller proportion focus on eating and sleep disorders (16 percent). Marital and
parenting problems are primary challenges for 30 percent of the providers.
We asked each provider to give us a case illustration of how they go about their
work as solo practitioners. The responses varied greatly, of course. Some typical
illustrations included the following:
• A two hour psycho-educational testing and diagnostic session.
• Talking therapy,with time given to listening to what the client
is in pain about, for instance, grieving over a father's death.
• Mine is a psychoanalytic approach,with an emphasis on
emotional, affective life.
• Providing psychotherapy for a seven year old who was having
difficulty with the aftermath of a parental divorce.
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• Probing in sessions twice a week to try to learn the causes
of death threats and violent outbursts by an adolescent.
• Play therapy with children and verbal discussions with
adolescents, following the taking of medical histories.
• Receives a referral, has an initial session for intake of history,
scheduling of future sessions, payment terms, and then a
period of talking therapy plus medications lasting from
2 to 9 months.
• Gets a referral to a boy who appears depressed and uses
lots of marijuana. Meets with the youth and sometimes
includes the parents. Contacts the school for details, often
visits school for a professional meeting. Takes a day to day
approach rather than an analytical or historical one.
We also asked an open-ended question about whether there are better practices
for service and treatment now in use, or better practices from state or local agencies than
there were some years ago. Some of the typical responses to this question were as follows:
My experience with the state is one of movement toward
privatization through agencies which operate like private
practices. The state seems to support large corporate
institutions. Fewer people are going to work in community
agencies. Social and political change has led to lots of
isolation for those who are practitioners.
No better practices: we're going backwards. Neuropsychiatric
rates have gone down. Now, under state laws, parents can
no longer get a second evaluation paid for. The state used to
pay for an independent evaluation if parents were not
satisfied with the one provided by the school.
There need to be more connections between services. In
some ways, this is improving. HMO referrals, for example,
now require a contact with a primary care physician.
Employee assistance programs of today are helpful.
Replace is a good community resource but is
underutilized. It is not thought of as a referral by
referring parties.
The Lexington Police are wonderful; they use their
resources to best advantage! The problem is finding
a psychiatrist to just do medications,without therapy
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due to reimbursement rates from insurers. The Council
on Aging is a wonderful program.
In general, services in Lexington have gotten worse in
recent years. Processes are slow and laborious; there is
no coordination of services.
Replace is still serving youth well, I believe.
There are a lot of suffering kids. They have to rely on
their parents to access services and pay with their own
insurance, but with more complicated cases they don't
get what they need unless the family has sufficient funds.
School-based mental health services are needed in order
to avoid dependence on the quality of their own health
care insurance and resources.
Lexington relies on a system of private practitioners
to provide services to kids,which is inadequate. In
Cambridge, there is a citywide crisis team, and
counselors in the schools and teen centers. Newton
also has a coordinated response.
We asked the providers what they believed were the major unmet mental health
needs of residents of Lexington. A paucity of youth services headed the list (54 percent),
with an additional 14 percent citing a need for more help for children and for parenting.
Support groups and group psychotherapy services were mentioned by 9 percent, and
another 9 percent cited a shortage of geriatric services.
We also asked the providers to identify serious impediments, if any, they met in
the course of their work. HMO regulations and related management actions were named
by 31 percent, and insufficient state funding was cited by 27 percent. Burdensome
amounts of required paperwork was cited by 14 percent and 29 percent identified a variety
of other impediments.
When we asked whether each provider estimated the conditions affecting mental
health challenges for Lexington residents were changing, 71 percent said they thought that
conditions were worsening, 25 percent did not know or were not sure, and 4 percent said
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they were improving. When we asked whether, in their judgement, mental health services
in Lexington are better or worse now than they were a few years ago, 54 percent thought
they had gotten worse,21 percent thought they were as good now as they were earlier, and
14 percent thought they had improved.
5. INTERPRETATIONS AND CONCLUSIONS
Lexington is blessed with a large, highly trained, and experienced corps of mental
health service providers. There is of course no restriction on access to services anywhere in
the region so Lexington residents may and often do seek help from providers located
outside of the community,while many non-residents are clients of providers whose offices
are based in Lexington. No one can measure the in- and out-movement demographics, but
we know they are substantial.
Lexington also hosts four agencies with highly trained, experienced service staffs.
Sizeable as they are, two of these - Eliot and Edinburg- serve very few Lexington residents.
Together, they diagnosed or treated a total of 117 Lexington residents during fiscal year
2002. The Lexington High School Guidance Department devotes all but a fifth of its
professional energies to college and job placement and related academic advising and
paperwork. It is also gravely restricted in the range and depth of counseling and mental
health assistance work its staff is permitted to do under school committee policies.
RePlace is the one agency which contracts with the Town of Lexington to serve
youth. The amount of the contract is less than half of the funding made available annually
to the Town of Bedford Department of Family and Youth Services. Bedford has a
substantially smaller resident population - 12,361 in the 2000 Census - than Lexington.
RePlace currently does a lot with the resources it has to work with, but its parent agency
Wayside went into the red in fiscal 2002 and may prove unable to supplement the funding
of Lexington's program in fiscal 2003.
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Our evidence suggests that RePlace is well regarded by professionals in Lexington,
but that it is utilized as a referral resource by Clarke Middle School primarily, as well as
by some physicians and counselors, but not by Lexington High School or Diamond Middle
School.
Solo practitioners, mental health practitioners within the agencies, and others we
contacted in the course of this project concur generally that Lexington,with all of its
abundance of helping talent, displays a serious lack of services for adolescents. There is
also a lack of collaborative coordination between the solo practitioners and between
professionals within Lexington High School and these practitioners..
This has been a study of mental health service providers and their knowledge and
views. We do not have direct evidence of a shortage of mental health assistance for
Lexington youth, only the conviction of providers and counselors to this effect. It could be
argued, for instance,that adolescents appear to be "managing" their lives in Lexington
rather well now, if the criteria used were youth suicides and incidents of violence. We do
not subscribe to this argument in the light of what we have learned from our interviews,
but more evidence is needed.
We could also ask about the standard that should be used in gauging the extent to
which public agencies and especially local government should manage the need for mental
health services. We would note that the new state parity law equating mental illness and
emotional distress with physical illness and injuries places mental health on a footing
identical to that given public health concerns of all kinds. Our view, in addition to
supporting the existing commitments of the Commonwealth, is that it is strongly in the self-
interest of Lexington's governmental leadership to monitor and foster the availability of
mental health services.
6. RECOMMENDATIONS
The challenge facing this study project has been to arrive at recommendations to the
Board of Selectmen that do not contradict that body's urgent quest for ways in which to
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fill the extreme gap between town expenditure requirements and available revenues. We
therefore offer just a few no-cost recommendations for the Board's consideration. Our
premise is that the well-being of Lexington's citizens, especially the youth who make up so
much of its life as a residential community, depends in part on having ready access to
mental health services within the town in the immediate years ahead.
1. The Board should make earnest and sustained efforts to encourage the Lexington
School Committee to change its current policies of risk management and avoidance of
psychological and counseling assistance to students. The change should be strongly toward
the provision of mental health services by appropriate staff now employed by the
Lexington
Public Schools.
2. Lexington school policy makers and staff practitioners should also be encouraged
to better utilize the considerable professional resources available within Lexington as part
of consultation and training to support their clinical work. We have a clear impression that
some local providers might gladly donate their time if they were approached effectively.
For
instance, during the first two decades of work by RePlace,volunteer participation was very
high. A rescue home for runaway youths who needed a temporary haven was one of the
features of this approach.
3. The position of Social Services Coordinator for Lexington should be
reconfigured. Presently, the Coordinator is spread thin. He provides information and
referral, case management and even counseling help for clients, and runs groups and staffs
committees for the Board of Selectmen.
We recommend that the Social Service Coordinator be charged as a priority with
coordinating mental health services for Lexington that involve Eliot, Edinburg, and
Wayside/RePlace. In this model, all adult services and most services for youth with serious
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and persistent mental illness would be the responsibility of Edinburg and Eliot, as
coordinated by the Social Services Coordinator.
4. In the course of renewing its contract with Lexington, Wayside/RePlace should
revise its proposed program of services for youth, in collaboration with the public schools
and including programs directed both to mental health and substance abuse for children
and youth. Support of proposed programs such as "Young and Sober" should become part
of the collaboration. The Board of Selectmen should work to secure agreement with the
School Committee to have Wayside/Replace take the lead in initiating this collaboration.
5. Taken together, recommendations 3 and 4 should be unified into a concerted effort
between the Department of Social Services, Wayside/Replace, and the Lexington public
schools to collaborate, coordinate, and reach out to children and youth in need of help.
Consistent with that aim,we recommend that the Board of Selectmen consider building the
provision of youth services into their policies and programs in the future. The Human
Services Committee pledges it support and its future workmanship to this objective.
1
Attachment D
Statistics from Lexington Schools, and Community Safety Departments
2004
Firesetters: 5
Section 12 (Required psychiatric hospitalization): 7
Suicide Attempts: 3
OD/Alcohol: 9
Sexual Assaults: 1
Misc./Risky behavior: 10-15
Fights/Assaults: 5-10
Lexington High School:
2004-05:
40+ students hospitalized (including partial and day treatment programs)
2005-06:
30 students hospitalized (including partial and day treatment programs)
25-30 students referred to SPED based on emotional/psychiatric reasons