For children who have faced serious trauma, a place to learn

In New Orleans – where researchers estimate that children suffer from post-traumatic stress disorder at rates three times the national average – one school offers severely traumatized students an alternative program.

Students pouring through schoolhouse doors in the morning is a time-honored ritual. At the New Orleans Therapeutic Day Program, that ritual looks – and sounds – a bit different.

In late May, a handful of clinicians and staff members wait in the front office, their hands resting on walkie-talkies. Teachers wait in four classrooms along the school's only hallway, and Liz Marcell, the program’s executive director, guards the door between the two.

The first arrival, a young girl, walks into the front office, cursing in the face of a clinician who doesn't react. A few minutes later, two boys come through the door tussling. Bill Murphy asks, “Are we having a hug?” and wraps his arms around them.

“We let the kids take a little bit of the lead,” says Mr. Murphy, the program’s academic director, in an interview. “We also learn to celebrate incremental victories and to tolerate some background noise – sometimes a lot of background noise – in a way that it wouldn’t normally be in a [traditional] school setting.”

There's a simple reason for this: The staff know that these children have nowhere else to go. The NOTDP is a public school that serves on a rolling basis about two-dozen children with such severe trauma and emotional disturbance that mainstream schools say they cannot educate them. In New Orleans – a city beset with high rates of youth trauma and a significant lack of mental health services – the two-year-old program is aspiring to expand, over the course of decades, to match the resources and expertise of its wealthier, century-old peers.

A need in NOLA

Taking a nonpunitive approach with students whose behavior might provoke suspensions and expulsions in mainstream schools, the program prioritizes behavioral skills over academic progress. Its aim? To return students to a traditional school setting.

“We believe that behavior is a [learned] skill,” says Dr. Marcell. “By being here in this environment over time, going over collaborative, practical solutions to problems, restorative practices, therapy, kids can develop skills to transition back to their [regular] schools.”

Students who have been exposed to traumatic experiences such as domestic abuse, sexual abuse, murder, or abandonment don’t necessarily show signs of obvious physical or cognitive disabilities. Instead, they are often dismissed as disruptive “problem” students, experts say – and statistically they do experience higher rates of segregation. 

“Some school districts and some schools are just very happy to send these kids someplace else and not necessarily welcome them back,” says Thomas Hehir, a professor at the Harvard University Graduate School of Education and Marcell's dissertation adviser.

This is why programs like the NOTDP are falling out of favor. Nationwide, special education experts have expressed concern that taking children out of mainstream classrooms doesn't necessarily address their real problems, and increasingly, schools are being told to lower their reliance on segregated alternative programs.

But Marcell says that while she agrees that traditional schools should be more inclusive of special needs students, “there’s [always] a small segment of the population that would be best served in an alternative setting.”

This may be especially true in New Orleans.

New Orleans youth have been diagnosed with post-traumatic stress disorder at rates three times higher than the national average, according to a 2015 report from the Institute of Women and Ethnic Studies. While hurricane Katrina “likely played a substantial role in this disparity,” the report added, it also found that almost 40 percent of surveyed youth had been exposed to domestic violence or a shooting, stabbing, or beating, and 54 percent experienced the murder of someone close to them.

Furthermore, the city has lacked for substantial mental health services both in hospitals and in schools since Katrina.

For kids “who are so traumatized that they can’t effectively participate in class, cannot actively learn,” the NOTDP is “a place where they can come,” says Lisa Legeaux, the program's nurse.

Since Katrina, almost all of the public schools in New Orleans have become charter schools. Some argue that system will lead to better academic outcomes (a claim that is hotly debated), but it almost necessarily means that mental health services are subordinated.

“Their charters are renewed based on those scores, on those academic achievements. So that’s their first goal and their first focus,” says Ms. Legeaux, who previously spent 10 years in mainstream New Orleans schools.

“Our main focus is on getting them well enough to return to that [mainstream] school setting where they can learn.”

So far, six of the 25 students that have enrolled at NOTDP have transitioned back to their home schools. Eventually, says Marcell, the school plans to track the graduation rates of the students who come through its program. "It will have to be several years before we have that data [on graduation rates], but we want to have kids have the skills to persist through high school," she says.

'Intense urgency'

The current challenges for the NOTDP, which can currently only hold a maximum of 20 students at any one time, is satisfying the scale – and the variety – of demands.

Given the loose expectation that students at NOTDP will spend about 60 percent of their time doing academic work, Murphy estimates that about 55 percent of the kids in the program “are bad fits.”

“Not punching their peer who’s annoying them, not swearing about how hard the work is – doing all those things at once is actually too demanding for them,” he adds. “Those kids actually need an environment that is unfortunately less academic.”

But NOTDP is not always able to provide the more traditional therapeutic setting those kids might need. In that kind of facility “you don’t have kids screaming outside in the hallway, banging on the walls,” says Monica Stevens, a clinical child psychologist at University Medical Center New Orleans and the program’s milieu director.

The program currently operates out of a single space: a portion of a converted 19th-century cotton packing warehouse with thin walls. Lessons and therapy sessions can be easily disrupted by a loud tantrum from a student, staff say, and the current de facto outdoor space is an “activities room” with yoga mats, beanbag chairs, a basketball hoop on the door, and patched-up drywall where students have punched and kicked holes.

Next year, the program will double in size and open a second site at the Children’s Hospital of New Orleans for students who need a less academic environment. By 2018 they are planning to leave the New Orleans public school system and become an independent nonprofit. They also hope to expand through 9th grade. They hope eventually to include a full high school and an early-childhood center. Within 20 years, Marcell says, they aim to have a residential facility where students can stay semi-permanently – similar to the most prestigious recovery schools in the country.

But schools like these often have slower development trajectories and significantly deeper pockets. The Milton Hershey School in Pennsylvania, for example, was founded in 1909 and today, with over $11 billion in assets, serves 2,000 students. The Wediko School, located on a 450-acre campus in rural New Hampshire, was founded in 1934 and now serves 44 residential students and 12 day students from around the country.

Given the “intense urgency” in New Orleans, Murphy says the NOTDP is “on an accelerated timeline” compared to these kinds of schools.

“When we tell [other schools] we want to be serving a minimum of 200 kids in five years, they think that that is insane,” he adds. “But the need is so significant. They’ve had the luxury of growing slowly over time, and we just don’t feel that we have that luxury.”

Running 'against the trend'

Yet even while the program in New Orleans is seeking to expand, many US school districts are turning away from alternative schools and keeping more students in mainstream school settings.

“Most school districts are moving away from segregating these kids, because there’s a tremendous downside to that,” says Dr. Hehir, who is also a former director of US Department of Education’s Office of Special Education Programs.

 “We know [we] run against the trend of [favoring] community-based care,” says Marcell, “but we’re talking about a population of kids who were already connected to community-based providers, and that has not been enough for them.”

 “New Orleans is a unique setting,” she adds, “but nationwide we always have to make sure there are high-quality alternative supports available for students for whom that’s deemed most appropriate.”