They come to school wrestling with feelings of anxiety, grief and anger.

Sometimes it's stress about schoolwork or social struggles, sometimes it's about very adult problems such as a parent's unemployment or family strife.

It all weighs heavily on students' shoulders, and at times the stress comes out at school. That's where one Anoka County nonprofit is lending a hand.

The Lee Carlson Center for Mental Health and Well-Being helps children cope with anxiety, anger, attention deficit, grief and other mental health issues. This school year, counselors with the center worked with 1,500 students in four districts: Fridley, Columbia Heights, Anoka-Hennepin and Centennial.

Using mostly small-group formats, counselors meet with children during the school day. The goal is to make mental health services easily accessible and free for families. The school districts contract with the nonprofit.

"What Lee Carlson did was really visionary. She got out of the ivory tower and stopped making [clients] come to them and instead went to them to provide the services," said Paul Meunier, a former Lee Carlson psychotherapist and director of services for the Minnesota Youth Intervention Programs Association.

"The parents don't necessarily have the resources to come in at 8 at night on a regular basis. They often have other kids. The mission was always to bring the services to the kids so other variables didn't interfere with them getting help."

With the national conversation about bullying and school violence intensifying, mental health services need to be part of the dialogue, counselors say.

It isn't just about the extreme cases. Nationally, one in five children has a diagnosable mental illness, yet fewer than 20 percent of those who need help are identified and receive mental health services, according to a U.S. Department of Health and Human Services study.

Parents, often overwhelmed with providing basic needs, don't have the resources to address emerging mental health issues. School therapy helps fill that gap.

"I believe we've saved so many lives. I've seen it firsthand," said Shari Barmash, school group facilitator with Lee Carlson Center who counsels elementary and middle-school children in Columbia Heights schools.

The district, partnering with Lee Carlson, provides some in-school counseling services for about 10 percent of its 3,000 students — 104 elementary students, 163 middle schoolers and 36 high school students.

"I have worked in three districts prior to this one. I have seen this done in other places, but not as globally as it's done here," said Karen Hamann, a psychologist with the district.

"I believe it gives them a place to go every week and a person to trust. They share the things going on in their lives. It's anger management, stress reduction and coping skills. It helps them get back to the classroom a little more ready to learn."

Lee's story

The origin of the nonprofit lies in one Anoka County woman with an intimate knowledge of the challenges of mental illness.

Lee Carlson was raised by a mother who struggled with mental illness. As an adult, Carlson, a registered nurse, worried about the next generation of children.

Struck by the lack of mental health services in the suburban county, she set up a network of low-cost mental health services for children and family in 1979.

"She was a mentor. She changed me. She made me the altruistic person I am today," Meunier said.

Originally called Central Center for Family Resources, the center was renamed in 2009 to honor Carlson, its founder, who died in 2003.

Today the nonprofit has a $2.3 million annual budget serves and more than 4,000 individuals and families each year. About $868,000 comes from local school contracts, funded through a patchwork of grants and state programs.

It may seem like a lot for cash-strapped schools, but it pays off, Meunier said, citing research from the Minnesota Department of Public Safety's Office of Justices Programs.

"You can't measure what you stop. Intervention at an early age keeps the community safer and saves a lot of money," Meunier said.

"Most of the kids who go through these programs turn out to be productive members of society vs. consumers of public services — welfare, police, legal system, treatment for drugs and alcohol, and public housing. Ninety percent of these kids who go through programs don't have legal involvement while in the programs. They do better in school, and they have better problem-solving skills."

Addressing anger

Coping with stress and anger and making good choices don't always come naturally to children, Karen Hamann said. "Sometimes they just need to be directly taught, like reading or math."

Barmash counseled 200 students in Columbia Heights schools this year. This is her 25th year working with Lee Carlson.

"When I first started, it was all about developing self- esteem and friendship connections," Barmash said. "Now I feel so much of what we do is anger management and stress reduction.

"Kids are just faced with daily hurdles — homelessness, the economic crisis, parents working all the time or not at all. Kids are in survival mode. It's hard to focus on academics when they have so many problems in their lives."

About 75 percent of her work is anger management and aggression replacement training.

"Kids today are so impulsive. They have so much anger, and they don't know what to do with it. Sometimes kids don't think there are other options. It's my job to teach kids other options," Barmash said. "We try to increase self-control and problem-solving skills."

After the school shooting at Sandy Hook Elementary in Connecticut, Lee Carlson Center fielded an increase in phone calls, Barmash said. Parents from all four district were worried about their children's safety, but some were also concerned about their children's mental health.

Intervening early and teaching coping skills can change a child's future, Barmash said.

"I have the kids fast-forward their lives and envision a different path for themselves," she said. "I believe less kids are going into the juvenile justice system because of the work we are doing."

In group counseling, kids work on stress reduction and breathing. There's also a big emphasis on communication skills.

"We spend weeks with listening skills, how to listen to others and listen in class," Barmash said.

Start-of-year evaluations

Teachers and school staff evaluate all of their students at the beginning of the year, trying to identify students who could benefit from counseling. It isn't just focused on students acting out. They also look for withdrawn, introverted students who may struggle.

Children don't need a formal diagnosis or any kind of special education status to receive counseling. Because the need is so great, the district has sought out additional funding and added counseling services. Contracting with an outside nonprofit has been a successful model because Lee Carlson counselors are viewed as the "trusted outsiders."

"Because we are able to work with Lee Carlson, we are able to serve significantly more kids now than when I started in the district," said Rick Hamann, Columbia Heights district assessment coordinator. "We were able to almost come close to doubling Lee Carlson services."

Parents are contacted and must consent to counseling for their children.

"I have never met any parent who didn't want the best for their child. When assistance is offered, it's received positively," Valley View Elementary Principal Willie Fort said. "I think parents know this is a long-term solution for some kids."

Children meet with Barmash and other therapists in small groups during the school day, sometimes even during lunch. The meeting time is rotated so students don't repeatedly miss the same subject matter. Academics come first. If students fall behind in a subject, counseling is put on hold until they catch up.

"It's a good motivator. They don't want to miss groups. It's so important to them," Barmash said.

How is the program received by teachers?

Last fall, several teachers were asking when counseling groups would start.

Helping one family

Last November, LaKeisha Craft was at work when police knocked on her door and told her middle-school children that her 16-year-old daughter, Hannah, had been struck by a car and killed while crossing Hwy. 10. Hannah's work shift at McDonald's had been cut, and her mother believes she was trying to catch a bus home.

The family of eight spiraled into their own private grief cycles. No one wanted to talk about it for fear of upsetting each other. But the grief came out in other ways.

Craft's middle-school daughters got into fights at school. Her son started having nightmares. He believed his sister, Hannah, had been chased and killed. Craft said sometimes she couldn't control the tears and the roil of emotion.

"When tragedy comes, it does change you," Craft said.

Lee Carlson therapists offered in-school counseling through Columbia Heights schools for all of the children, helping them work through the grief and anger. Having it at school meant the kids didn't have to miss after-school sports and activities.

Craft said she's seen a new calm in her children since counseling started.

Her fifth-grade daughter, Tionné Johnson, sees Barmash.

"She's a beautiful lady. She helps a lot," Tionné explained. "When I am kind of mad and want to fight with a person, she tells me, 'Don't do it. You are better than that.' "

Craft said she's relieved the school offered help instead of just impatience or discipline as her children reacted to the trauma.

"It's good we talk about it now," Craft said. "It's just been one more way to work past some of the things we were feeling. We are trying to get to a normal, but it will be a new normal."

Shannon Prather • 612-673-4804