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Hope in Norristown when the World is Heavy and Hard

It’s actually possible to ‘feel’ a person’s smile and compassion on the phone. I discovered this when speaking to Maria Markakis, MA, MS, student assistance coordinator and youth aid panel coordinator with Carson Valley Children’s Aid in Norristown, Pa., northwest of Philadelphia. In January, she marked 35 years in the student mental/behavioral health field, with the last 10 of those years as coordinator. Her organization is one of four Student Assistance Program (SAP) providers in Montgomery County, serving five school districts: Norristown, Upper Merion, Methacton, Lower Merion, and Colonial. Eight SAP liaisons work alongside Maria and her administrative assistant to offer and provide services to 40 K-12 schools.

“I love it so much. Empathy is very natural to me,” Maria said. “I am grateful to be able to do this important work, helping students and families in our community.”

Behavioral Health Screen

Maria and her team were one of the first in 2015 to start using the Behavioral Health Screen (BHS) within the web-based bhworks student mental health software system from mdlogix. The BHS identifies mental health problems and psychosocial risk factors. It consists of psychiatric symptom scales and risk behaviors that cover all the psychosocial areas suggested by best practice guidelines. Results are immediately scored, summarized, and securely sent to a designated clinician for review. Different versions of the BHS have been developed for multiple age groups and care settings.

Initially developed through a mdlogix collaboration with the Children’s Hospital of Philadelphia, bhworks and the BHS have been validated and researched by clinicians and experts in the fields of psychiatry, psychology, and pediatrics.

“It is THE most effective and user-friendly screening tool I have ever used,” said Maria. “Parents see and discuss the results with the SAP liaison, and their children are referred to the appropriate and much-needed services. The elementary BHS, starting at age 6, is also a huge benefit for the community. It was a significant addition to the age 12 and older BHS. Through this update we can screen students from K-12 grades.”

To date they have conducted over 770 student screenings. Her team also uses software for mental health program data entry and notes that are electronically and securely stored in one place for staff access.

Student Struggles Include Zyn Now

The outcomes data generated in bhworks shows that students in Maria’s schools struggle most with depression, with anxiety and trauma rounding out the top three. Over her long career and since the pandemic, Maria has seen family poverty increase along with growth in student depression to the point of not eating and sobbing, truancy, self-esteem issues, and anxiety. Plus, within substance abuse, the vaping epidemic continues. She also mentioned a new problem working its way down from college athletes to now high school and middle school kids: Zyn.

Zyn nicotine pouches “are designed to be placed between the gum and upper lip and are available in several variants with different nicotine strengths and flavors,” according to the Swedish-based manufacturer’s website. It does not contain tobacco.

“It’s illegal for kids to buy it but they order it on the Internet, and it gets delivered,” Maria explained. “One pouch is the same as smoking six cigarettes, causing students to tremble and have other medical reactions. Many people don’t know about it; it’s so new to the market.”

Remedies for Healing: Playing & Teaching Empathy

Maria described a couple programs that help her students. “SAP is not a therapy program but our main goals are to remove barriers to learning; identify issues including alcohol, tobacco, other drugs, mental health issues; and to help students overcome these barriers so that students may achieve, advance, and remain in school. We provide prevention and intervention programs, consultation, and referrals that aid students and their families in many ways. We also refer students as needed to outpatient services that provide Cognitive Behavioral Therapy (CBT), DBT, motivational interviewing, MST, EMDR, and other modalities which have proven to be highly effective. 

Maria continued, “One of my favorite programs is called Second Step which is a Social Emotional Learning (SEL) and evidence-based program which has been around for more than 30 years. Our students love the lessons, puppets, games, songs, and practice lessons learned in and out of school. Kids heal through their play, so we teach healthy play, social skills, art, breathing techniques, coping skills, positive affirmations, and the power of the mind.”

With SEL, students are taught how to manage emotions, including empathy, to meet goals, and to develop positive relationships. Maria believes that teaching kids empathy removes barriers, and it gets them to the point of “not just surviving but thriving.” 

SAP liaisons are fully trained in providing the Second Step program. “Musselman Learning Center is a wonderful school in Norristown where we have been providing Second Step for more than 9 years,” Maria explained. “Three hundred kindergarten students, parents, and staff continue to embrace the program. With pre- and post- program surveys, the positive outcomes are significant every year - proving stronger social skills and an increase in understanding, coping, and improving behaviors.”

Offering Hope

It’s no surprise that lots of parents call Maria when situations arise as they sense her caring, non-judgmental attitude, and deep commitment to helping the whole family get through difficult times. 

“If you come to my office – you will notice all around the room– the word “HOPE.” Hope, faith, and gratitude are my favorite words,” Maria said. “We all have been through some tough times. I am here to help and support you. Do you know what hope stands for? “Hang On, Pain Ends.”

“I tell my staff that when we are genuine, caring, respectful, and sow hopeful seeds everyday… help, progress, and growth are absolutely possible.”

Editor’s Note: Maria can be emailed to answer any questions from her colleagues about this article at

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