square bulletHOOTS: Mobile Mental Health in School Settings

April 5, 2019

From Laurel Lisovskis, MSW, QMPH, CSWA, Crisis Worker/Clinical Manager for CAHOOTS, School Social Worker for Springfield Public Schools

School counselors, and teachers, for that matter, know how difficult it can be to meet the emotional needs of students. Most have extremely demanding caseloads, and each student brings a unique experience from home and social settings. The expectations are high, and the more invested school staff are, the more overwhelming it can seem. Enter HOOTS, an acronym for Helping Out Our Teens in Schools, a program that provides weekly on-site integrated health care clinics and tragedy response support to about ten different high schools in the Eugene and Springfield area. From comprehensive highs schools that have a high number of students to smaller charter schools that don’t have enough funding to secure permanent counseling staff and nurses, HOOTS can help to bridge some of the gaps, taking the pressure off of staff and providing a cushion of support to students with basic medical care and brief, short-term counseling and crisis intervention. Funded by school districts and grants, the program takes a client-centered, harm reductionist approach to counseling, and because there is always a medical professional and a mental health worker, the services can be creatively focused and cover a lot of ground in terms of a wide variety of needs.

Meeting the Emotional Needs of Students

An example of this might be a teacher that identifies a student is practicing self-harm, a maladaptive coping skill that, for the student, might release pain and endorphins, but may also cause infection and scarring, not to mention stress and concern from those around them. The teacher could send the student to the HOOTS clinic, where wound care could be given by an EMT while a crisis worker explores some of the reasons why that youth is utilizing that coping skill and some ideas about how to interrupt it with alternative, less harmful ways for expressing feelings. Referrals can be made on the spot to counseling services that could provide some long-term care, and the clinic could also be a future respite for that student. HOOTS does not bill insurance, so the interaction requires no paperwork on the part of the student, and is completely free and confidential for them. HOOTS workers always try within the intervention to identify a safe person at school that might be a good part of a plan for them on days when clinics are not operating.

HOOTS also goes into classrooms upon request, to have conversations with student populations about things like digital hygiene, positive coping skills, and mental wellness. They talk with students about the reasons why kids feel stress, barriers to reaching out for support, and what help looks like for them. They work through scenarios together, and share tools for strength and crisis resources. Much like interventions, classroom conversations are built around empathy, validating feelings, active listening, and identification of internal and external supports.

Helping Out on the Streets

HOOTS is primarily staffed by and born from the work that the mobile crisis response program CAHOOTS does in the community. For thirty years, CAHOOTS, Crisis Assistance Helping Out On The Streets, has operated in tandem with police and fire agencies to address a myriad of situations, including mental health emergencies. CAHOOTS teams consist of a crisis worker and a medical professional, are staffed by White Bird Clinic, and contracted in Eugene through public safety funds and in Springfield primarily by Lane County. The CAHOOTS van is dispatched through the cities’ non-emergency police-fire-ambulance call centers, and free response is available for a broad range of non-criminal crises, including those generated from things like homelessness, suicidal ideation, disorientation, substance dependency and mental illness. Non-emergency medical care, first aid, and transportation services are also provided, as well as dispute resolution, mediation, grief and loss counseling, death notifications, and welfare checks. Services provided include but are not limited to crisis counseling, suicide prevention and risk assessments, resource exploration, transportation to staffed services, and first aid and non-emergency medical care. CAHOOTS further serves the community by accumulating and triaging resources to clients working in collaboration with the many services and agencies operating within the community. CAHOOTS expands its interagency relationships by providing trainings to a wide range of populations, including suicide prevention and mental wellness trainings for youth, and de-escalation trainings to medical providers, educational providers, people working with unhoused populations, and others in the community who would like to learn interpersonal skills for working with people who are in crisis. CAHOOTS also serves on committees, teams and councils that strive to better the lives of some of the most vulnerable populations that live among us, including adolescents.

In the last few years, CAHOOTS saw an uptick in calls for service with adolescents in crisis, including family mediation calls, depression and anxiety-related mental health crises, suicidal ideation calls and deaths by suicide. This generated a feeling on the team that we needed to do more, to be more available for both intervention and prevention work with youth, and were inspired to reach out to schools for a partnership. This partnership has flourished over the last three years, and HOOTS has become its own identified department at White Bird Clinic, coordinated by Ashley Barnhill-Hubbard and staffed by 14 clinicians who show up with a well-curated resource binder and a well-stocked medical bag to serve students on a weekly basis. So far, the partnerships between schools and HOOTS has been successful, with program contracts and grant funding in place for next year. HOOTS recognizes and honors the fact that schools often face desperate efforts to remain grounded and responsive to an expanding and increasingly complicated population, one that deserves all of the support we can offer.

Learn More

If you want to learn more about CAHOOTS and HOOTS, you can check out the links to articles and interviews below:

A CSWA in Eugene, Oregon, I am currently employed both as a middle school social worker and as a mobile crisis counselor and clinical manager for a program that works with city law enforcement. With over fifteen years of expertise in counseling in both health care and public school domains, I lend a unique perspective, with an emphasis on both crisis de-escalation and prevention within a wide scope of practice. Experience in the public school domain includes the roles of brief intervention counseling, positive behavioral support coordination, parent/family advisory and consultation services, and cultivating and nurturing school staff and community partnerships within a school setting. Experience in mental health care includes crisis de-escalation, suicide prevention, and grief and loss. My therapeutic emphasis is on helping people access their own self-management tools, drawing on internal and external supports.