by Joann MacDonald

For teens suffering from anxiety and depression, getting up to face another school day can seem an insurmountable task. Days away from school can turn into months and even years. Markham Stouffville Hospital’s Adolescent Treatment and Learning Alternative Service (ATLAS) program, now in its second year, provides a solution.

ATLAS is a day program for adolescents 12 to 19 years old struggling with depression or anxiety.

“These kids have a real hard time getting to school. They’re missing enormous amounts of time and losing academic standing. Parents are tearing their hair out, not knowing what to do,” says Paul Cappuccio, patient care director for mental health services and family medicine. “It’s a great program. It’s set up exactly like a school class but slightly smaller.”

The program accommodates eight youth at a time and follows an eight-week cycle. Participants earn a specialized high school credit.

“The ATLAS program is unique,” says child and adolescent psychiatrist Dr. David Ng. “We are not duplicating services in the community. There is no short-term program for kids who are mainly experiencing school avoidance due to their anxiety.”

The intensive program benefits from the services of a psychologist, a social worker, two child and youth counsellors, a psychiatrist and a teacher provided by the York Region District School Board (which also provides transportation). Funded by the hospital, ATLAS was started last year because of an identified need in the community, Mr. Cappuccio says.

“There was a need from patients and their families coming to our regular child and adolescent program and we recognized it,” he says. “Often these kids have missed so much school that the school board has been alerted.”

The ATLAS classroom, built as part of the hospital’s expansion, is modelled on a regular school classroom.

“You need to bring them into a setting that’s therapeutic but not lose touch with the school system,” Mr. Cappuccio says. “Because of the skill set that our staff has, they understand how to engage a kid to get them back into the real world. By coming to us, to our smaller version of a school, it means they have the ability to go back.”

In its first year, the program posted a clear success rate. The first 12 students in the program returned to school.

The Canadian Mental Health Association estimates that 10 to 20 per cent of Canadian youth are affected by a mental illness or disorder. About five per cent of males and 12 per cent of females aged 12 to 19 have experienced a major depressive episode. Once depression is recognized, help can make a difference for 80 per cent of those affected, allowing them to get back to regular activity.

“Early intervention is crucial,” Mr. Cappuccio says. “Being away from the classroom setting has lots of harmful effects as the years go by. People who are absent from school chronically will also have absenteeism at work. The long-term academic and economic impact is obvious. ATLAS is a program that tries to lessen the burden of both future illness and current absenteeism.”

In some cases, it’s not just the children’s futures at risk.

“Parents spend many hours trying to coax their kids to go back to school,” Mr. Cappuccio says. “They’re yelling through doors. Some of the moms had to take leaves and were in jeopardy of losing their jobs. ATLAS provides structure. It allows the parents to return to a normal life too.”

While many children try to avoid school occasionally, parents and teachers should look out for excessive worrying about day-to-day life, the future and world events. Children with severe anxiety may exhibit signs such as fidgeting, shakiness, talking about feeling scared, avoidance of activities (like going out with friends or doing homework), tiredness and difficulty sleeping.

Mr. Cappuccio says there are still too many sufferers not getting the help they need.

“Many people are embarrassed. They think this is what life is supposed to be like,” he says. “When you intervene with kids early enough and they know that it’s an illness and not a character flaw, they succeed. Nobody tells you that depression is like diabetes. Nobody goes to a child with diabetes and says ‘Snap out of it.’ They have a responsibility to seek treatment and recover, but they have no fault in getting that illness.”

Because the ATLAS program is voluntary, participants must want to heal.

“We have to have willing participants and sometimes we know that they have the desire and they need a lot of help,” Dr. Ng says. “Some of them have not been in school for two years. The transition to high school is especially hard.”

Dr. Ng points to the example of a boy who couldn’t get up in the morning to attend meetings. Team members felt that deep down he was able to make a change, so they worked with him to slowly overcome his anxiety, booking his first intake interview at 2 p.m. so he would have plenty of time to get out of bed.

“We really go out of our way to help them, however they also have to show us that they are willing,” Dr. Ng says. “He did, to the amazement of the school, and we were so proud of his progress.”

For those who receive treatment for anxiety and depression, the outlook is positive.

“The good news is that most kids have resilience,” Mr. Cappuccio notes. “Many people with anxiety and depression have learned to live with their illness and recover.”

ATLAS harnesses the health-positive effects of fitness. The full-day program incorporates visits to the community centre, with opportunities for exercise, swimming, basketball, weight-training and the possibility of earning a high school physical education credit. Combine this with rigorous study sessions, individual and group therapy and outings within the community and it makes for an intense short-term program designed for maximum results.

“I’m so grateful that we are able to run a program like this for our community. It’s innovative and not something hospitals usually do,” Mr. Cappuccio says. “And this would not have happened without the progressive thinking of the York Region District School Board.”

While the program is on a path to success, there’s a need for donors and sponsors to help with expenses related to outings and events that celebrate the youth’s achievements.

“We only have a certain amount of money and it’s for clinical programming,” Mr. Cappuccio says. “But there are a lot of little things you need, especially with children, to make the program successful.”

With year one of the program behind them, ATLAS staff members are looking forward to helping even more kids in year two.
“To me, what’s great is what the kids say about the program,” Mr. Cappuccio says. At a first-year open house, youth in the program were encouraged to share their feelings about ATLAS on a white board. Notes included: “I’m relaxed dude.” “I’m not sad.” “I actually got up and left the house five days in a row.”

While someone without mental illness might take getting out the door in the morning for granted, it can be a strong indicator of success for those with anxiety and depression.

“‘I’m not sad’ is an incredibly powerful statement given what they’ve gone through,” Mr. Cappuccio says.

Pictured above: Child and youth counsellor Vibusha Krishnantharajah (from left); psychologist Dr. Jessica Cooperman; psychologist Dr. Patricia Zimmerman; Paul Cappuccio, patient care director of mental health services and family medicine; chief of psychiatry Dr. Rus Sethna; hospital president and CEO Janet Beed; executive vice-president May Chang; and social worker Paul Steadman at the launch of Markham Stouffville Hospital’s Adolescent Treatment and Learning Alternative Service (ATLAS) program. Opposite page, a white board with messages from ATLAS participants.

This article comes from our Fall 2014 edition of Healthy.Together.Markham.Stouffville.
Read more and flip through the entire edition online at www.mshf.on.ca/magazine.