For some, childhood comes easy.

For others, it can be painful, even harrowing -- particularly when a child struggles with mental illness.

Now, these children no longer need to suffer alone and in silence.

The Comprehensive School and Community Treatment program offers therapy in the school for students with diagnosed mental health needs.

Tucked into classrooms, or sometimes former storage closets, the small mental health centers at -- Boulder Elementary, Clancy Elementary, Jefferson High School and Townsend School -- are there at the invitation of the schools.

Staffed by a licensed therapist and a trained treatment specialist, they can provide individual, group and family therapy in the school.

While Townsend's program is just gearing up, others, such as Clancy's, have been operating for several years.

The private agencies contracted to run the programs may differ from school to school, but their mission is the same -- to help children learn the skills they need, so they can stay in their family, community and school. For some, the alternative would be referral to a group home, residential treatment center or psychiatric hospital.

Often, teachers or school counselors refer students to the therapy program, sometimes a parent asks for help. Treatment is voluntary and confidential, and it must be approved by the parent. Medicaid pays for many of the children, while health insurance pays for others. In some cases, parents pay on a sliding-fee scale based on their income.

All the programs agree that no child in crisis is turned away.

There are 66 school districts across the state offering CSCT programs in 147 schools, according to recent statistics from the Department of Public Health and Human Services. That agency helps oversee the program, which was created through collaboration with the Office of Public Instruction.

It came about, said Bob Runkel, assistant superintendent of OPI, because of "ongoing feedback from schools of the need to support students with mental health issues."

School officials were seeing that in some cases, a student's behavior disrupted his or her ability to learn. "They also wanted schools to be safe and secure," he said.

Staff trained to provide mental health services can help de-escalate a difficult situation.

And school-based mental health services can be more effective than a child going to a therapist's office several days or weeks after an incident happens.

"Most of us know about teachable moments," Runkel said. "If a kid slips up and someone can intervene, it can prevent the problem from growing bigger. It's right there and right now and you as a kid can relate better. It takes advantage of real-life circumstances."

A program's measure of success is based on a number of factors, including students' discipline referrals, dropout numbers or if children needed to move to a higher level of treatment.

While "school-based mental health is common across the country," Runkel said, "I don't know of any other state that has a service like we have. I don't know of any program that is designed around schools and community-based mental health centers."

Montana has a unique partnership with DPHHS, "especially as it involves quality assurance. Any of the providers have to be community mental health centers and all the licensing of mental health centers applies. The linkage of public education, private mental health centers and DPHHS really makes this work."

The schools provide the office space, other rooms, communication and other equipment, he said. They also try to integrate the counselor into the school so they can keep the teachers informed about the students' behavioral programs.

"The popularity of it speaks for itself -- that that number of schools participate," said Runkel. "It's as good a program as you'll find anywhere for delivering cost-effective children's mental health services. It's as integrated as we could make the system or at least that was the intent."

TOWNSEND

Down a series of winding corridors, nestled in a former storage closet rests the office of therapist Becky Oss, LCSW, and treatment service technician Bob Goad.

In its first year in Townsend School, the program offers therapy services for students with diagnosed serious emotional disturbance, grades K-12.

"A lot of things we work on are social skills and increasing their ability to identify feelings before behavioral outbursts. It's real hands-on."

The 11 students in the program see Oss, who has a master's degree in social work, at least once per week for private therapy. Because of a mix of student ages, group therapy hasn't yet been an option.

Each student in the program has an individualized action plan, with three to four specific goals, which are reviewed every 90 days.

"Everybody's involved. It's a big village type of philosophy, including school staff, parents and (mental health) professionals."

"With kindergartners, we do more with play and practice play. You use toys a lot. They like to play and pretend."

With high school students "it's more processing. They talk to you about what's going on and what the solutions are."

With middle school students, they will combine play with a discussion of feelings.

Many students, regardless of age, feel more comfortable holding one of the toys or squishy objects, said Oss.

"When their hands are busy, they can begin to talk and draw out the conversation."

A lot of their work is crisis intervention, helping students calm down, so they can return to their classroom, she said.

Another aspect of their work is building rapport with the students.

"It's very important to build a relationship," Oss said. "We're working on yucky stuff.

"I welcome them to come in and talk about happy stuff. We urge them to come down here and tell us something good."

Oss and Goad strive to blend into the school.

"We're in the halls all the time," said Oss. "There's not this therapy logo on our foreheads."

Goad is on the playground, talking with all the students and keeping an eye on how the students in the program handle different interactions. He's ready to step in and offer guidance if needed.

The program benefits both students and teachers.

"It really does help when a teacher has a class of 23," said Oss. "She can't stop and find out where this disruptive behavior is coming from."

"It helps to keep the child mainstreamed (in their school) and not have to be in a day-treatment program."

An added advantage to offering the service in the school is convenience. Townsend parents often commute to jobs in Helena and get home in the evening.

"A lot of families did without therapy because of time constraints and limitations, gas costs, and difficulties of getting evening appointments."

Provider: AWARE

School contact number: 266-4989, 406-782-2042

CLANCY

The "Hands Up" CSCT program at Clancy School started in 2005 and serves 14 children with mental health needs.

"The idea behind it is to serve kids in their school and community," said therapist Colleen Murphy, LCSW, who has a master's degree in social work and is a licensed clinical social worker. "We're like a mini mental health center hosted by the school."

"We do a lot of behavior intervention, a lot of social skills and a lot of work on feelings," said Murphy.

The program offers individual, group and family therapy, treating second- through eighth-graders.

An advantage to a school-based program is that the counselor can see the children immediately in the setting, when they are struggling with a behavior.

"If there's a problem on the playground," said Murphy, "staff can problem solve with them for a more successful outcome."

While years ago, there may have been some social stigma attached to seeking psychological help, that doesn't seem to be the case today, said Murphy.

"The kids want to come here. This looks like a fun place," she said. "We do art projects and puppets to provide therapy and social skills instruction."

The program also offers group therapy as an opportunity for kids to talk about their feelings with a group of peers. Often they may look at pictures as a way to spark a discussion -- focusing on the person's facial expression. This helps the children learn to recognize their own feelings and talk about them.

They also use a set of materials called the Virtue Project that help children develop important virtues, such as respect, patience and tolerance.

To the casual observer, the therapy activities often look like play.

However, it's very purposeful, said Murphy. Each of the CSCT students has a diagnosis, a treatment plan and treatment goals. The activities and plan have structure and accountability.

The counseling staff is also there to help when a child is in crisis or disruptive.

"You can take care of the immediate problem and get them back into the classroom, so there's no detention or expulsion," said Murphy. "It's all based on successful outcomes for the kid." Outcomes vary with the child. She's seen children who didn't know how to make friends learn how to play.

And she's seen students reach their personal goals, such as an academic achievement.

"These are the kinds of successes that are really important to look for," said Murphy.

And the school staff appreciates what CSCT has brought to the school.

"I currently have several students involved in the CSCT program," wrote Shelley Stewart, a third-grade Clancy teacher. "This program is a great support for students in need. The counselors help to reinforce classroom expectations, academically and socially. Sometimes the counselors work on improving self-esteem or appropriate behavior in social settings. This all carries over in the classroom and gives the teacher more time to focus on the curriculum."

Provider: Altacare

School contact number: 933-5531 ext. 153

JEFFERSON HIGH SCHOOL

For mental health associate Georgia Burns, the CSCT program at Jefferson High School is a way to help students who have mental health needs stay in school, so they may never need a residential treatment center or a psychiatric hospital.

Burns, who is earning a master's degree in social work, will soon be a therapist in training.

The CSCT program, now in its second year at Jefferson High School, helps students develop better coping skills, social skills and anger management, she said. And it can help alleviate a crisis.

Students are typically referred by either parents or staff. To be accepted, they must have a persistent emotional or psychological disorder, she said, yet be able to continue to function in a school setting.

Payment for services is required through either Medicaid, insurance or a sliding fee. But in a crisis, the kid comes first.

"Ethically, we have to look at that kid even if we don't have funding," Burns said.

Each day differs. It starts with a check-in with the six students in the program. It may include a group therapy session or could involve helping a student grapple with an emotional crisis.

Like several other programs, Burns often uses materials from the Virtues Project to spark teenagers to talk about virtues important to them, such as respect, understanding and cooperation.

"Each kid has their own treatment plan," she said. It includes working on such virtues as honesty, trust, and trustworthiness.

The program office is also a safe place for students to vent their emotions.

"We're here to assist in a team environment with emotionally challenged youth to succeed moment by moment in each school day," said Ina Joy Modde-Dahlberg, therapist at JHS. "We're kind of their cheerleaders."

Provider: Altacare 800-477-1067

School contact number: 225-3317

BOULDER ELEMENTARY

Boulder Elementary School also offers a CSCT program. For information, call the Boulder Elementary School at 225-3316.