By April Barton, for the Burlington Free Press

When Jen Colman talks with a student having a mental health crisis, they meet in a cramped closet.

If not a closet, they could be seated on the cold, vinyl floor in a public hallway outside a classroom or in a smelly storage room. Sometimes Colman doesn’t know where she’ll meet with students from one day to the next.

“An appropriate therapy space in some schools is nonexistent or constantly changing,” she said. “Working with children, safety and consistency is a big piece.”

A psychotherapist, Colman has been treating Burlington School District patients for the past eight years and says schools weren’t designed with a dedicated therapy area for outside providers to use while meeting with students, even while schools have increasingly become a hub for all kinds of non-education services. In the area of children’s mental health, the needs have grown exponentially.

“I was advocating and fighting for space, so I built my own,” she said.

With the launch of Green Mountain Mobile Therapy this fall, Colman rolled out a therapy office on wheels, a nonprofit and a model that could change mental health services for schools.

A therapy office parked wherever it needs to be

Jen Colman is an independent child and youth psychotherapist who meets with clients in their Burlington public schools, but because she is not a school employee, she doesn’t have a regular space for meetings.

When she was seeking a consistent and functional therapeutic space to meet students’ and her needs, she found the answer in a cargo trailer.

“There’s mobile pet grooming, nail care, health care — why not mobile mental health?” she said.

The unit is 8-and-a-half feet wide by 20 feet long with water, power, a cooler and heat and air conditioning running off an electric generator. The 3,500-pound trailer must be towed, but it can be parked and set up in virtually any school parking lot for the day.

It cost Colman $26,000 up front between the trailer and the generator, and she estimates spending about $15,000 annually to pay for a new Toyota Sequoia to haul the trailer as well as gas, insurance, maintenance and operational expenses. She said the costs were less than an office space in downtown Burlington.

In recent years, the demand for Colman’s services have skyrocketed. She has received upward of 17 requests a week to see children in need, even after moving from an agency to private practice. Her clients may be people she has worked with for years who attend the school or have come from the school recommending her to families.

She said anxiety and depression among youth are through the roof and she is seeing more kids self-medicating which leads to increased substance use. She also sees issues including self harm, suicidality, a greater unhoused population and many children dealing with the effects of parental mental health and substance use. Chronic medical needs are a more recent symptom of mental health impacting physical health, she said. Kids have been presenting with rashes and eczema, bowel disorders, stomach aches and headaches.

She said being able to meet youth at school is convenient for students and parents who don’t need to take off work to bring the child to an appointment. The parking-lot setup also allows Colman to see more children in a day, and the school can find the least disruptive time for the student to leave class.

‘The way to a teenager’s heart is food and stickers’

Prior to launching the mobile unit in September, Colman would lug bags of supplies into school, guessing at what would be most useful. “I was a Sherpa or a pack mule,” Colman said.

Before getting into the deep talks, she establishes a rapport with the child by providing little takeaways. This lets a child exercise control through choosing something themself. “The way to a teenager’s heart is food and stickers,” she said.

The new unit has ample space for both, plus much more. Overhead locked storage houses art supplies, tactile and fidget manipulatives including dough and putty, a bubble machine, stickers and projects. She has rockers for self-soothing, murphy table work spaces and a cooler stocked with seltzer, snacks and candy. Plush rugs and bright colors make the area inviting.

It’s a proper space that Colman hopes will help her clients feel at ease and make it easier for her to have everything she needs within arm’s reach.

The unit provides a degree of privacy and is large enough to host up to five kids at a time for group sessions.

A school partner

Colman prefers meeting clients at their school because it provides equitable access to mental health counseling and is a hub for a variety of services. She can work with the child’s educational team as part of the student’s individualized education program or 504 plan if they are receiving special education services. Her clients may come to her directly, or the school can refer the family to her.

Many of her families qualify for Medicaid, but she also takes Blue Cross Blue Shield health insurance. She is able to host monthly parent meetings in her mobile space so parents needn’t enter the school building. Colman is also hoping to meet with educator teams in the mobile unit.

Currently Colman works with Champlain Elementary, Edmunds Elementary, Edmunds Middle School and Burlington High School.

The arrangement is a mutually beneficial one between the school and the therapist, according to Melissa Hathaway, a counselor at Edmunds Elementary School who has been working with Colman for years. She said the main difference with the mobile unit is having a consistent space.

“It’s a great space — inviting, lots of therapeutic opportunities,” Hathaway said. “Jen is so creative in her thinking. It’s definitely an asset.”

Hathaway said the COVID-19 pandemic, racial injustice and political unrest have all taken a toll on the mental health of kids and adults alike and violence and substance use are on the rise as a result. Schools are tasked with helping kids find ways to manage their anxieties; however, resources are maxed out. School communities are focusing on social emotional learning (SEL) but are having trouble filling SEL and paraeducator roles who help provide support in the classroom.

Hathaway said having counselors like Colman partner with the school to carry a caseload of students who need long-term therapeutic help allows the school to focus on short-term needs, educator mental health and to get back to prevention tactics rather than only having the capacity to respond to crises.

The concept is one that has state mental health advocates taking notice.

“Youth mental health has emerged as a national priority, and school leaders in Vermont are reporting growing complexity and severity of student behavior including violent outbursts, threats of harm to themselves and others, and sexualized behaviors. At the same time, there are limited mental health resources available to our public schools,” said Steven Berbeco, who is the director of United Way of Northwest Vermont’s Mental Health Initiative.

He sees value in schools partnering with licensed mental health providers in the community who can travel to the schools.

“Green Mountain Mobile has combined some of the best ideas in youth mental health and micro-transit to meet the needs of our youngest Vermonters where they are,” he said.

A future for mobile therapy?

Even though the mobile therapy unit was a solution to one therapist’s space problem, Colman and Hathaway see potential for the model providing benefits that are further-reaching.

Colman said she could see in a rural state like Vermont, mobile mental health becoming an important way to address equitable access issues — taking therapy directly to the people, meeting them where they are.

Hathaway is always concerned about her students’ safety during summer break due to the drop in access to services. She said having a mobile therapy unit at the school over summer vacation would be great way to ensure her students don’t have critical services interrupted for a prolonged amount of time.

A mobile unit could create cost savings for new practitioners getting started in the field and make it easier to reach underserved populations in the state. Colman said mental health doesn’t discriminate and this could be one way to reach more people efficiently.

Other providers are seeing the value, too — a colleague of Colman’s has expressed interest in the concept. It remains to be seen if Green Mountain Mobile Therapy will kick off a new approach to providing mental health services.

“I’d love to have a fleet someday,” Colman said.

“At a time when schools are looking to ramp up mental health services for students, Green Mountain Mobile’s approach looks like a low-cost way to respond to the high-cost challenge of appropriate space for therapy,” Berbeco said. He is encouraged by the organization, saying it “is an innovative approach at a time when we need more out of the box thinking.”