In 2017, the Newberg School District knew it needed help. A rash of completed and attempted suicides by students rocked the community and the school was without an effective system to meet their students' mental health needs.
The district reached out to Providence Medical Group to propose a "flight team" approach to the issue, in which representatives from Providence would come to Newberg High School and conduct a suicidal ideation screening. The screening identified 52 students as "high-risk" for suicide that year and connected them with resources in the community.
Elise Yarnell is Providence's senior manager of operations for Yamhill County. She said the number of high-risk students underscored the need for expanded services.
"Because of the volume, we decided to partner over the summer and develop a plan for the fall of how we could provide on-site support for the high school," Yarnell said. "We also did a teacher training for staff to identify at-risk behaviors and we did a parent night for people in the community to ask questions."
In fall 2017, Yarnell and Dr. Jeri Turgesen launched on-site coverage at the high school for mental health support through a partnership with George Fox University's doctorate of psychology program. Doctoral students have provided operational coverage for students at NHS and Catalyst, the district's alternative high school, and services were delivered regardless of whether students had insurance.
While it was a good start, both Providence and the district agreed it wasn't enough to meet the needs of students. After the 2017-2018 school year, Providence found that there was a gap between the support they and the school provided and actually connecting at-risk kids to services.
A grant from the Austin Family Foundation funded – among a handful of other positions – two outreach specialists through Providence Medical Group. One of those specialists works full-time with NHS and Catalyst, while the other will begin work at local middle schools. Both aim to connect students with mental health resources in the high school, at Providence and elsewhere in the community.
Outreach specialists' duties also include screening for food, housing and transportation security along with monitoring students who may have dealt with violence or trauma outside of school. The presence of these specialists has been important to the school administration and provided a much-needed resource for students, Yarnell said.
"It's been really successful in the short amount of time we've been doing it," she said. "It's been great having someone available to the schools at all times."
Providence plays a key role in the school district's plan to address mental health and suicide, but it is not alone in lending a hand to students in need. Lutheran Community Services – through that same Austin Family Foundation grant – has two therapists working at the area elementary and middle schools.
Yamhill County Family and Youth has a clinician spending a portion of their week at the school to assist counselors and provide another resource for kids. The Health and Human Services department seeks to impact all areas of the county, so it is stretched thinner in Newberg and provides less tangible support to the district than local groups such as Providence.
"We have been there off and on over the years," county supervisor of community-based programs Zoe Pearson said. "We have been there in our current capacity for two years and we started with one day a week, then we added more time."
In addition to forming its own partnerships, the school district is monitoring state legislation in Salem that could have a significant impact on mental health services locally.
House Bill 2224 is in the Joint Committee on Student Success and would direct the Department of Education to "distribute grants for improving student outcomes by supporting social, emotional, mental and physical health needs of students" and declare an emergency in the state of Oregon regarding mental health in schools. The bill also aims to provide recommended curriculum and training to school districts so they can better serve students' mental health needs.
Regardless of the outcome of the bill, officials said they feel the district is making significant progress on the intertwined issues of suicide and mental health. They believe, in the words of Superintendent Joe Morelock, that they're setting a precedent for other districts to follow.
"We are incredibly grateful for our community partners who have volunteered and worked untold hours to support the mental health of our students," Morelock said. "We should not do this work alone and we are glad to have everyone's support on this critical public health issue … This is what true collaboration and partnership looks like, and we believe that what's happening here could serve as a model for other school systems and communities in the state."
Tony Buckner's smile is contagious. Explaining to a student assistant where to deliver two water jugs full of waffle batter, his face lights up with laughter at her confusion with the task.
The Newberg High School vice principal explains that he's started making homemade waffles with the iron plugged into the wall of his office, distributing the fluffy treats to students at lunches once a week. Buckner has also become famous for his peanut butter and jelly sandwiches, which he said are eagerly anticipated by the students he's charged with supervising.
Waffle- and sandwich-making are far from Buckner's only duties, but he said they're part of a "culture change" the administration has tried to instill over the past couple years. At the heart of that change is a renewed focus on mental health and suicide prevention.
"I was a school psychologist at Newberg High School before becoming an admin," Buckner said. "The reason why I was bumped up was not because of my administrative skills, but really because we were getting involved in mental health work that was new to Newberg High School."
Buckner and a team of counselors navigate the halls of NHS with a focus on identifying students who might need help. Whether it's with schedules, grades, graduation, parent meetings or suicide screenings, they're the resource for every student.
When it comes to mental health, they may be the first line of defense against suicide and suicidal ideation. Counselors provide a safe space for students to talk about how they're feeling, provide suicide screenings, connect them with sources at the school and get them linked directly with outside help.
Nicki Eggiman is one of the counselors at NHS. She said the screeners have been crucial in identifying students that need immediate help, as well as those who might be able to work through their challenges with her or other school counselors.
"A typical suicide screener would involve some of the more typical questions about feeling depressed, thinking about suicide or having a plan," Eggiman said. "Our new screener goes into more protective factors and having the students rate where they're at on a scale. It allows them to reflect on previous difficult times they've had and how they got through that before, so they're able to look at their lives holistically rather than get bogged down in the negative details."
Before the development of partnerships with Providence and other entities, Buckner said the school counselors and administrators could only recommend outside mental health resources to parents. After that, it was up to the parents to link their kids with those services regardless of their insurance status. That created an ineffective and often inaccessible avenue to necessary treatment.
"That is one of our biggest hang-ups with our providers today," Buckner said. "From a school, it seems so foreign to ask a kid about their insurance and if the treatment they need is covered. It's an awkward position for us, but luckily with Providence and Yamhill County, the insurance piece has become less of a worry for a lot of our kids."
If the school determines a student is at high-risk for suicide, Providence is willing to provide an initial consultation free of charge and talk about options that might be within an individual student's insurance network. Where there is sometimes a disconnect, Buckner said, is when a student's primary physician or provider is outside of Providence and doesn't see eye-to-eye on how to approach the mental health issue.
For a large portion of the kids, however, a defined system is in place through which they can seek and receive help. From Buckner to Eggiman to the rest of the counseling team, the staff at NHS feels more prepared to help students with their mental health than ever before.
School officials meet with representatives from all of their outside partnerships once a month to discuss at-risk students, and counselors are checking in with students constantly to get updates on their progress.
"Our partners are still working in isolation," Buckner said. "Any kids that we refer, we get these updates every month or so. We're trying to sign a memorandum of understanding where any of our providers can all sit in the same room and talk about all the kids and their needs. At the end of the day, we want these kids to know, 'we've got your back.'"
The high school has a wellness center where outside providers like the outreach specialists from Providence can work with students in individual or group settings. NHS hopes to create a dedicated area on campus in the future that has a nurse practitioner and someone mental health trained, along with space for outside partners to provide help where needed.
Constant improvement is necessary, Buckner and Eggiman agreed, for the school and district to meet the needs of every student dealing with a mental health challenge. Every situation is unique and the risk of suicide is varied.
Eggiman said preventative measures are important for students at all points of the risk spectrum.
"I want to be able to start catching students before they hit that crisis level," she said. "We want to do what we can to give those kids coping skills and preventative measures so they don't get to a crisis point. It's time to break the stigma. It's real, and it's okay to talk about how you're feeling."