Inside the Calhoun Street campus of Children's Hospital, classrooms with chalkboards, tables and chairs sit adjacent to "cool down spaces," or small unfurnished rooms with padded walls where students can go if they are feeling destructive or overwhelmed.
That can be a regular occurrence for the children who attend the Center for Resilience, the only therapeutic day school in Louisiana.
The school offers academic and mental health services for children with significant, diagnosed behavioral health disabilities, including depression, post-traumatic stress disorder and bipolar disorder.
While critical, the services are limited: The nonprofit has room for only 38 students in kindergarten through eighth grade between its two campuses and a home care program.
But starting next year, as part of an ongoing effort to address major gaps in mental health support for the city's public school students, the Orleans Parish School Board plans to help the nonprofit expand its programming for high school students.
The goal is to double its capacity by 2022, launch a separate residential group home and work more closely with hospitals to create "a true continuum of care" for students, officials said.
"This partnership really addresses one of our most pressing, yet unmet needs,” schools Superintendent Henderson Lewis Jr. said. “As we work to educate every child here in New Orleans, we recognize that part of meeting that need means providing a space that is safe and tailored to their specific needs.”
Since it opened in 2015 in partnership with the Recovery School District and Tulane Medical School’s Department of Child and Adolescent Psychiatry, experts have touted the center's ability to help students who have exhibited extreme behavioral problems.
They include students who have hurt themselves or others, mostly because they've been exposed to severe trauma or suffer acute mental illnesses.
But the program has been too small to accept all the children who need more intensive mental health services, especially in New Orleans, where students are frequently exposed to violent crime or oppressive poverty.
According to research shared by the Center for Resilience, 60 percent of the city's children suffer from PTSD and are 4.5 times more likely than their peers nationwide to show signs of serious emotional disturbance.
For the students who are accepted, the school has been essential, officials say, helping children who can't make it in traditional or chartered public schools, even after multiple interventions.
The Center for Resilience works by partnering teachers with clinicians and medical practitioners in one setting.
While the structure of the day varies based on students' needs, children get at least an hour of small-group or individual academic instruction and at least 105 minutes of direct therapeutic support every day, as well as help managing any medications they need.
Treatments include individual therapy, group therapy, family therapy, behavior data tracking and psychological assessments.
Ultimately, the goal is for students to stabilize enough to go back to regular public schools. That happens by building trust and showing children their own progress when they experience success, according to the center's director, Elizabeth Marcell.
"They have internalized messages that they are bad kids," Marcell said of her students. "We really sort of flip that on its head. Our belief is that kids do well if they can."
Pointing to internal data, Marcell said the program has shown it works: It has reduced the rates of crisis hospitalization by 75 percent. The Center for Resilience also has seen a 69 percent decrease in the number of behavioral crises on-site, over time.
And, since the program began in 2015, 83 percent of students have successfully completed their "transition plans," according to statistics provided by the center.
But the work is expensive. The cost per child ranges from $80,000 to $100,000 a year.
For the K-8 program, about 70 percent of the cost is covered by a "per diem" fee from the referring charter school and the School Board. The rest has been provided through philanthropy.
Looking forward, officials said the School board could contribute even more funding to supplement tuition for high school students. Marcell also said the center is applying for Medicaid funding.
Ultimately, she said, the goal would be to consolidate all of the nonprofit's programs, serving kindergarten through 12th grade, at a single site.
"All day long, kids spend their day in an environment that's designed to be healing," Marcell said. "The actual setting itself becomes an intervention."