Last updated December 2013.
For many years I have been intrigued by the work of William Moore, MD and Roy Arufo, MD, child psychiatrists in Houston volunteering in one of the most challenging school programs imaginable. They have done this for about 10 years, experiencing poverty, a school lock down because of a "shooter", high turnover in all positions, implementing an outstanding fellowship program and consultation program, encouraging child fellows to do more like teaching Tai chi, bonding with kids, and teachers. In this article Dr. Moore "tells it like it is", from funding to friendships, figuring out decision making authority and times to hold back. Thank you Bill Moore, for all you have given to these children. I am sure all the Lifers who have worked in schools can relate to many aspects of his amazing story.
A School Experience
I’m going to tell you what we learned in 12 years 1997-2009 at Rusk Elementary of Houston Independent School District (HISD) – which is one of the 10 largest in the USA.
About 20 years ago a cluster of suicides occurred in a bedroom community between Houston and Galveston. A cohort of psychiatrists was mobilized to help them. Roy Aruffo, M.D. (a Child Analyst) is always an out front mover and shaker. Roy and I pursued the crisis for Houston Psychiatric Society as volunteers with several other volunteers. I got the Principal and he took all the rest. Others worked with the kids and their families. It went well, as we expected. Roy and I worked well together. We are both members of the “Secret Seven” our Child Psychiatry Study Group 44 years and still counting. Our Christmas party is in 2 weeks. So we knew each other pretty well. All this is another story, but it leads to Rusk Elementary.
Soon after Roy said, “Did you know, all the homeless kids in HISD go to one school?” The timber of his voice and look in his eye also said, “Let’s do something about that.” So began our odyssey.
Our Rusk program was two separate but cooperative entities. Rusk Elementary School is part of Houston Independent School District (HISD). The other is/was Rusk Clinic which provided assorted medical/dental care to students in Rusk Elementary, their siblings and family, free of charge. Episcopal Health Charities, Free’s Foundation and others paid.
Rusk Elementary was grades Pre-Kindergarten, Kindergarten and First through Sixth. It is located southeast of downtown Houston practically in the shadow of the baseball stadium, near the ship channel, docks, warehouses and wharves. When Houston was a major railroad hub these were the railroad freight yards. As the railroads declined the Hispanic families moved in. By 1995 Rusk was seen as an underserved area. It became known as the Rusk School Health Promotion Project. A few years earlier the school had been closed. Perceived need led to its reopening. The first effort was partnered by many local, state and national partners. There were approximately 14,000 people in this, the Second Ward. More than half lived in poverty or next to it. There was high risk for teen pregnancy. 34% were single parent families. Rusk Elementary had over 400 children (91% Hispanic, 8% African American, 0.5% Anglo). Ninety nine percent qualified for free/reduced fee lunch. If they got any breakfast they got it at Rusk. Ten percent were homeless children coming from the Star of Hope shelter. All qualified for Title 1 (a federal funded program providing additional instructional and/or support services to schools). Sixty percent of teachers had less than 5 years’ experience (of these 34% were beginners). The turnover rate for all personnel was 37.5%. If all this sounds bad, it gets worse.
Roy and I preferred grade school, little kids so we would not have to deal with big kids discipline or pregnancy problems. The little kids could be trouble enough.
Rusk Clinic was a separate building adjacent to the school. The Child Fellow and I would usually meet there in the conference room for supervision and to check out what else was going on. This was where their Executive Director had her office. Someone was already seeing patients when I arrived. University of Texas (UT) Dental School had a dental clinic. University of Houston (UH) Optometry School had an eye clinic. UT Medical/Pediatrics had a pediatric clinic. There was a lot going on. This Hispanic neighborhood needed a lot of help. Each partner contributed “in kind,” like Baylor Psychiatry (2 clinical Professors) donated our time. It was primarily funded by Episcopal Health Charities. They paid the Executive Director and the Child Fellows. This was all for Rusk children and their families – a free clinic.
Dr. Aruffo met a lady dentist who was the Executive Director of Rusk Clinic. She was leaving. Our communications with the next Principal of Rusk School were not as good. The Rusk Clinic was funded by Episcopal Health Charities. Our communications with the Board of Episcopal Health Charities were similar. Nothing was going to happen. Roy and I waited a couple of years.
A lot was cooking behind the scenes. The climate was changing. The new Executive Director was a nurse practitioner and more positively disposed to our medical plan. She had a lot of power as an intervening party. Beware !! An RN nurse practitioner may be well disposed to medical but less so to psychological input. More of that later. The new Principal at Rusk was ready to work with us. She proved to be compatible. Just how we would work was yet to be decided.
We hoped the Baylor Child Program would assign a Fellow for one half day. (We got two-half days). Someone would have to pay for that. Florence Eddins, M.D. was Training Director for the Baylor Child Psychiatry Program. She agreed it would suit the needs of Child Fellows. Episcopal Health Charities agreed to pay for twenty percent of the Fellow’s time. We’re ready. It’s January 2000.
The Principal called a faculty meeting to introduce Roy and me. I explained what we were about and invited questions and referrals. After that we roamed around introducing ourselves and getting acquainted. We started.
The first Child Fellow would have the summer of 2000 to get up to speed. Summer school would be over leaving spare time before 2000-2001 classes began in late August. The Executive Director really did not want the Child Fellow who was being paid by the Clinic doing library research on Clinic time. Roy, particularly, and I prevailed against her. Our separate supervision of the Child Fellow would be in our private offices. We accumulated a folder of reprints for future use. Reprints from Pediatrics, APA, NIMH, California State Mental Health Authority, GAP and various other sources included psychoanalytic articles. A treasure.
The Star of Hope Shelter for women and families was two blocks away from Rusk on the other side of a seldom used railroad track. The shelter housed about 250 people for a limit of three months. Many were in the shelter for less than three months and were then back on the street if they had no job. The shelter was not rigid about the three months in extenuating circumstances. Most of the kids were sent to Rusk for their education. All the kids went to school somewhere as required by law. As summer and summer school was over, the Baylor Program began its first academic year in late August 2000. Rusk got forty kids on average. The homeless life style was disruptive of the learning process. A spokesperson for the shelter said just getting off to school each morning was chaos. Other interferences were unpredictable. The kids got 18 days of school in three months of residence at Star of Hope. That meant many days they just missed out. For a rare occasion, the child’s first day at Rusk might be the same day the TAAS state wide placement test was given to see if they could be promoted to the next grade level. How do you like them apples? All the kids at Rusk wore a simple uniform, so the homeless kids didn’t stand out. We soon knew that if a kid was African-American or Anglo they were likely from Star of Hope. Otherwise they were kept anonymous. The shelter paid the salary of a male social worker who was at Rusk every day. A helpful guy, a pleasure to work with.
Roy and I wanted to have a regular series of parent education lectures in the evenings for the Star of Hope families. Star of Hope refused. They felt it was necessary to preserve their anonymity.
We thought our planned lectures were important enough to make an exception. They did not. So much for bureaucracy. And how do you like them apples?
Rusk kids did have an abundance of behavior and learning problems. The first full year 2000-2001 saw 44 referrals to the Child Fellow. While specific numbers varied this reflects the usual population of referrals.
21 Behavior Problems
6 Attention Problems
4 Oppositional or Defiant behavior
5 Aggressive Behavior
3 Child-Parent relational Problems
1 Speech Problem
4 Learning Problems
As trust grew the consultations would become more “on the fly” than formal. As a product of the growing trust the questions from the staff became personal about the teachers own family. Teachers for younger students had more questions. Referrals doubled the next year.
Roy and I agreed that a psychotherapy focus would be an easy way out. We knew how to do psychotherapy with kids. We did not know what to expect from the consultation. Instead with the agreement of the Executive Director of Rusk Clinic and Rusk Principal, we chose the following goal: To make available expert consultation by Child Psychiatrists that provide teachers with support, knowledge and new skills so that teachers will better understand childhood behavior, have more confidence in their ability to control student outcomes, have greater job satisfaction, and become more effective in the classroom. Our focus was on the teachers and staff of Rusk Elementary School.
It was a temptation to do or teach psychotherapy. We knew how to do that. Some child therapy was done. Some family therapy was done. Our focus was on teachers. In one way it was easier. To do psychotherapy required a written permission from the parent. Hard to get. The child would take home the permission form which never came back. So could I phone home or go by their home to get permission. Not possible.
The office clerks were very important people. The School Nurse’s Clinic is directly off the school office. All visitors must sign in. People wanting to see the Principal or others must first talk to the clerks. All deliveries are to the clerks. We were spared a “sign in” since they knew us. I fostered a friendship with them. I asked about phone numbers and addresses. I told them about a planned home visit by the Child Fellow and/or me. They were very protective of our woman Child Fellow. “Oh no. This neighborhood is too dangerous for her.” If I wanted to take my life in my hands, okay, if I was stupid enough, or crazy enough to risk it. I did not go. I was hoping to effect tardiness and absenteeism too. I gave it up.
So I was getting a lesson in reality. The forms the parents filled out for admission were not to be believed. The area had lots of undocumented aliens, illegals, who wanted to remain unknown. Even the “in case of emergency call “was not to be believed. Waiting for permission forms to come back to school from home was best. My phone call plan ended.
After a few years we needed reminding. “Don’t do anything that looks like evaluation or therapy unless we have written permission. “ That would be a medical assault. I did want to teach Latency Age Group Therapy to the Child Fellows. This might be their best chance. So I pushed it a bit and was successful. Our Panamanian Child Fellow was so skilled at engagement that the positive response of the teachers and kids contributed to getting permission. One group of 13 & 14 year old girls asked the Child Fellow to lead their coming of age, “Quincenera” group. It is a big deal for 15 year old girls to turn fifteen in this culture. The Child Fellow led it alone. Once she asked me to sit in. That had been previously included in the permission form.
I was taken by surprise by a teacher who had pupils in group therapy. She said they were “worse”. They had changed from passive, docile, even withdrawn kids. The Child Fellow was teaching them to talk about their problems. They learned well and talked a lot. In that sense they were “worse”. Better from my perspective.
Dr. Aruffo had a weekly luncheon meeting which focused on understanding one Pre-Kindergarten or Kindergarten level little kid. The intent was to help the classroom teacher understand the child better. The Child Fellow would present a summary of the child’s problems to open the discussion. Then each person present would contribute what they knew about the child. The Mother was usually present. Roy’s expert steering would broaden the picture. The teacher was enlightened. The Mother might gain insight which would be life changing. Parental projections and the child’s growing identifications were better understood. Persistence paid off. The teachers stopped calling kids “bad”. Instead it was the kid whose mother is in jail or father has gone back to Mexico. We noted one remarkable result of the group therapy experience. A boy’s performance zoomed from 40 to 80. Distractions and inhibitions can be terrible for learning.
Menninger Topeka Child Psychiatry Fellowship closed in 2001. In the Fall of 2001 we got 3 second year Fellows added into our program at Baylor along with 2 Senior Baylor Child Fellows at Rusk. Five Senior Child Fellows at Rusk. It went well. The Department of Psychiatry is now the Menninger Department of Psychiatry of Baylor College of Medicine. Menninger Hospital is now on the south side of Houston.
Suicidal children. That’s always scary. One 7 year old boy talked about suicide. It scared the teachers and we were concerned. His mother had a job and funds to see a private child Psychiatrist, a recent Baylor graduate. The mother also saw a social worker in the psychiatrists office. We were not doing therapy anyway so our child fellow kept up liason with the private psychiatrist. We followed this boy about three years. He’d be better – then worse. The story was of physical abuse of the boy by the father. The father soon abandoned them and returned to Mexico. Neither the mother nor the father had wanted this child. The mother complained that every time she looked at him she saw resemblance to the father. In cooperation with the private psychiatrist we pressed her to see what was obviously a projection. The mother’s final appointment was a joint conference with mother, Child Fellow, Assistant Principal, classroom teacher and me. I guess we pressed too hard – she withdrew him from Rusk. As far as I know the situation did not change.
9/11 – September 11th 2001 the World Trade Center Disaster. That day and the next week Roy and I and 5 Child Fellows were frequently at Rusk. We were supportive to the faculty and staff. The kids made a lot of drawings of planes crashing into buildings. I had a Child Fellow in tow when I got an urgent message from the Principal to see a suicidal girl in the conference room. We two saw a tearful, pretty, neatly dressed 10 year old African-American girl with beaded pigtails. Someone obviously cared about this little girl. Me too. She was sniffling back tears saying, “I want to be with my grandfather.” The story was that her grandfather had been unemployed for a year in New York City. His first day at work was in the World Trade Center where he died. I persuaded her to do some drawings, and we chatted for about half an hour. She was not as tearful. I asked what she “would like to do now?” “Go back to my class.” I said, “Ok.” The next day was a regularly scheduled weekly lunch with all the Child Fellows, including the one who had been with me. He said, “I would have hospitalized her immediately, but Dr. Moore talked with her a few minutes and she went back to class. They wondered how did I know. I told them it was a judgment call. Fortunately I was right.
The library research served the Child Fellows well. It built our treasure of articles and reprints. Data for future use.
The Child Fellows gave, “In Service”lectures to the teaching faculty. Often the subject was their request, sometimes it was of Roy’s and my choice. We would give the Child Fellow a “boost”before, then not attend their day. Feedback was outstanding.
Trust grew. Requests for consultation increased. All was not a bed of roses. There were 1 or 2 teachers who saw us as a waste of their time. They came around slowly. The Child Fellows were regularly visiting every class and teacher in a continuous circuit, maybe 2 or 4 circuits per week.
An unexpected outcome was the discovery of a Pre-Kindergarten teacher who was incompetent. She was soon replaced.
Once a month I had a Mental Health Conference. We had a list of about 10 kids who were continually in process of management. The Child Fellow would give an update on each followed by general discussion. Those present were the Principal, Asst. Principal, Social Worker for the shelter kids, classroom teacher often, frequently the school nurse and sometimes the Executive Director of the clinic. We included everyone who needed to be there. We would initiate an outside referral as indicated. The Mental Health and Mental Retardation Authority (MHMRA) of Harris County (a State of Texas Agency) had some child Psychiatrists on staff who could take kids who needed management and maybe medication. MHMRA funds were tight but our relationship was good. I had decided that providing medication at Rusk was more liability risk for me than I chose. [The Title 1 case worker never came to our meeting].
Funding the clinic and the stipend for each of 2 Child Fellows was and still is complex to me. It was very good initially. I may credit a source inaccurately but it included Free’s Foundation, Hogg Foundation, United Way, Homeless Grant, Memorial Hospital and Children’s Trust Fund and Casa de Esparanza (not Star of Hope). Others I was told were minimally involved some more; The University of Houston School of Education and the UT medical schools in Houston and Galveston.
Episcopal Health Charities was always our primary funding source. When they closed Rusk Clinic after three years, I thought we were dead. Gratefully Baylor found the money to pay for Child Fellows.
Roy was particularly beset by the Executive Director of the clinic. Her attendance at one of his weekly conferences was to say the least, disruptive. Another time she was insulting which baffled Roy and the Child Fellow. They did not understand what set her off. As I thought my relationship was pretty good with her I sought to help bring peace. I got no where. She would not discuss it. My event with her was about our treasured folder of school consultation articles and reprints. She asked to borrow it. “Sure”. About 1 month later I asked to get the folder back. She denied ever borrowing it. How do you like them apples? The clinic closed and she was gone.
Principals in HISD are given freedom to hire and fire personnel, and manage all the funds available with ultimate accountability to the Superintendent and School Board. The Rusk Principal decided to have an after school program to teach life skills. There was a little kids playground and just outside the schools back door was a city park playground. The Child Fellows enjoyed helping. Our Chinese Child Fellow was a Tai-Chi Master. Tai-Chi is a martial art with a sequence of martial arts positions. It is not aggressive but on the contrary is about self-control. Before the practitioner starts, the discipline requires thinking of what one may do to improve the life of someone else. Our Child Fellow was able to draw out a boy who was shy and retiring. We had a plan for me to teach chess to the brightest students, but it never got off the ground. We were making an effort to recognize the bright ones and reward them so they wouldn’t get bored.
Drugs were never a problem. A sadly amusing event occurred. Two fifth grade boys were peddling antihistamines, replicating older teens peddling street drugs. They were “admonished” not to do that.
Certainly our littlest kids still needed mothering some more than others. The mothering skills of the teachers for Pre-K and Kindergarten are very important. With enough stress any of us may need mothering. For example: A male teacher and I were chatting amiably in the office. Suddenly he bolted out the door. I caught a glimpse of a third grade teacher at full tilt racing down the hall toward the street exit. She was about 5 months pregnant running on slick tile floors. The male teacher feared she would fall. She was chasing one of her pupils racing for the street. The pupil was successfully intercepted. What was that all about? The third grade teacher was one of our best at nurturing. Earlier that morning a case worker from Children’s Protection Services had came to tell the little girl that her mother’s parental rights had been terminated. Bad news for any kid. An hour or so later the third grade teacher stepped into the hall to speak with another teacher. The little girl could not see that she was still there. The girl was now abandoned by her only other mothering person. She was getting out of there!! Fortunately she was intercepted before she might have run into street traffic. She was somewhat reassured and stayed in class. She went to a foster family to live.
I think HISD had banned corporal punishment before 2000. The HISD board was sensitive to the stories of the school “massacres” apparently caused by bullying. They set a District wide intent to reduce bullying. It gave a Child Fellow another opportunity to lecture to the teachers.
The Child Fellows were charged with developing observational skills as they observed kids in class without a full assessment and asked to give their impressions, even a differential diagnosis. They did well.
The Principal asked me if I could get volunteers to read to the children, 1, 2, a whole class. They would have considerable latitude. The kids’ home life was in Spanish. Hearing an Anglo read would be a new experience and it could help the kids reading skills. I found 2 or 3 volunteers from St. Martin’s Episcopal Church to do so. They really enjoyed it. I kept prompting for Readers until a volunteer Reader’s group was formed. Our Principal sent a reading specialist to St. Martin’s to give several hours of tutoring on it. They were enthusiastic and were making a contribution to the kids learning English and reading.
Hurricane Katrina, hit New Orleans, 23-30 August 2005. Fall term was already in session. New Orleans was flooded. The street people, homeless had no place to go. We all saw the terrible TV scenes of the Super Dome. Bus loads of people came to the Houston Astrodome. I think it was on a Tuesday, that a bus appeared at Rusk with 8-10 children for classes. No documents. Not even their names. They were readily absorbed into “proper” classes with hardly a bump in the road. Our teachers were ready. Kids first. Documents later? None came.
In 2006 a woman at the mission sent her Pre-K child to Rusk. We discovered the child was psychotic. So was the mother and a young teen sibling female. We did not make any inroads in their treatment. An Impasse.
With the first term in 2000 we created a questionnaire to be completed by every teacher. The first questions were very objective, the next few more subjective, and finally a space to tell us what you think. It helped us span some gaps. A few teachers did not like answering. Their answers showed that.
I was consultant to a private health care enterprise. They had a contract to do some counseling with Star of Hope kids I persuaded them to do the counseling at Rusk.
In the Spring of 2007 a man was observed pointing a rifle at the school building. The whole school went into “LOCK DOWN”. All doors were locked. The Principal and Assistant Principal were at lunch, locked out. The Number 3 administrator was inside in charge. She saw me at a side door. “Let him in, I need him in here”. Police authorities soon established that the “man” was a slow witted neighbor. The “gun” was a toy. The doors were opened. It was the end of the day. Parents could take their kids home. How do you like them apples? There was an immediate faculty meeting to process the good and the bad of what had happened. We felt police authorities were too slow in response. Otherwise it went well.
HISD administration had left us alone. We did not cost HISD any money. But beware of success!! When 2006-2007 ended HISD added two more grades seventh now and eighth to be added next year. That seemed sorta nice. BUT…it also meant a bureaucratic switch. The Principal must have Junior High credentials. Our friend was moved to another elementary school. How do you like them apples?
Roy Aruffo retired in 2006. He was gone for 2006-2007. I could not replace Roy, but we coped. Baylor Child Fellows continued as before. It was different without Roy.
Our new lady Principal was supportive enough. There was a crisis. The leader of the St. Martin’s Readers Group came to me in distress. The new Principal did not support the fine work they had done. They felt insulted and depreciated. They were never coming back. How do you like them apples?
It was still a good learning experience for the Baylor Child Fellows.
2007-2008 ended OK. The bureaucracy was still at work. Baylor and I were out of the loop. Rusk was upgraded to a Science and Math magnet school and that meant another Principal, a man who was very positive about Baylor’s program, 2008-2009.
At different times Baylor’s financial health and administration was really bad. We didn’t know how bad. 2008-2009 continued as before but funding from Baylor would end after Spring term 2009. The ending of the Rusk experience of the Child Fellows was because there was no further financial support.
I know that the Principal hired a School Counselor for 2009-2010. He was unresponsive to my offer to come once a month without fee.
Our Baylor Child Psychiatry Program gave a lot of horsepower to one school for about 10 years. I asked HISD for a lot of data about Rusk. What I got does not warm my heart. For students they got AYP – Acceptable Yearly Performance. The faculty was scored as “acceptable” or better. Roy and I faithfully devoted more than 10 years of our lives to the Program. The Child Fellows experienced the Rusk Program as a positive learning experience. Dr. Eddins continued to support this academic opportunity. She soon left Baylor in 2011 for UT San Antonio Medical School with a considerable increase in academic position, Vice Dean of Undergraduate Medical Education. The position came with a raise.
There is one thing which genuinely warms my heart. We began in the Spring of 2000. Each Spring the Principal offered an additional one year contract to whomever she chose. The departures of faculty were 37.5% before we began. Each year she offered all her current faculty a renewal. The last 3 or 4 years of our favorite Principal tenure there was 100% renewal, except one. This one faculty told the Principal that she wanted to continue, but the long drive from Katy, Texas had become too much. The Faculty felt supported by the Baylor Program. They were not alone. The Goal we initially set was being fulfilled. How do you like them apples?