Creating a School District Mental Health Plan that Meets the Needs of Students Who Have Psychiatric Disorders
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School districts often have medical plans, e.g., protocols for addressing chronic medical illnesses such as diabetes, asthma or infectious disease. They tend to not have mental health plans for working with students who have mood disorders, anxiety disorders, ADHD, etc. Given the nature and extent of mental health disorders experienced by students, and the effect that these have on their education, a mental health plan makes sense
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School districts often have medical plans, e.g., protocols for addressing chronic medical illnesses such as diabetes, asthma or infectious disease. They tend to not have mental health plans for working with students who have mood disorders, anxiety disorders, ADHD, etc. Given the nature and extent of mental health disorders experienced by students, and the effect that these have on their education, a mental health plan makes sense.
Because of the huge variability of school district resources, staff skill sets, community resources, student populations, etc., mental health plans need to be tailored to each district, sometimes to each school.
Essential Components of a School District Mental Health Plan
Roles and Responsibilities
The first component is the need to clarify the roles and responsibilities of staff who work with students who have mental health disorders.
Who works, directly or indirectly with students who have a mental health disorder? Teacher, school psychologist, school counselor, school social worker, school nurse, principal, dean, and, if the student is in special education: special education teacher/case manager and special education director.
Clarifying roles and responsibilities helps to address the problem of overlap in some areas and gaps in others.
Who does what? How do you prevent gaps in services? How do you prevent overlapping roles? Who decides what the roles are? Who provides oversight to assure accountability?
Their roles are frequently undefined, with lack of clarity, lack of documentation, difficulty in supervision, and lack of accountability.
Examples of Mental Health Activities Provided by School Employees
By identifying activities that need to be done, and identifying the specific skill sets of school professionals, it is possible to maximize the impact of these professionals. For example, only nursing staff can distribute medication and only school psychologists and do psychometric testing. On the other hand, many types of school professionals (school social workers, counselors, psychologists, teachers, etc.) can provide skills training. Understanding staff skill sets and prioritizing activities that need to be done will result in more effective and efficient mental health related activities.
Supervision
The supervisor may have no background training in the work that the supervisee does (e.g., a special education director supervising a school social worker). This can result in minimal or no supervision of mental health related activities.
Supervision is essential and needs to address the following:
Pre-Referral Interventions
E.g., is the student taking medication for a disorder that has the symptoms that are resulting in consideration of a special education evaluation?
Has a release of information been obtained to allow communication with the student’s physician?
Educational Planning
Clarification of Behavioral vs. Clinical Contributors to the Student’s School Difficulties
Use of the Clinical-Behavioral Spectrum concept (See Dikel and Ostrom, http://www.williamdikel.com/the-behavioralclinical-spectrum.html)
Because of the huge variability of school district resources, staff skill sets, community resources, student populations, etc., mental health plans need to be tailored to each district, sometimes to each school.
Essential Components of a School District Mental Health Plan
Roles and Responsibilities
The first component is the need to clarify the roles and responsibilities of staff who work with students who have mental health disorders.
Who works, directly or indirectly with students who have a mental health disorder? Teacher, school psychologist, school counselor, school social worker, school nurse, principal, dean, and, if the student is in special education: special education teacher/case manager and special education director.
Clarifying roles and responsibilities helps to address the problem of overlap in some areas and gaps in others.
Who does what? How do you prevent gaps in services? How do you prevent overlapping roles? Who decides what the roles are? Who provides oversight to assure accountability?
Their roles are frequently undefined, with lack of clarity, lack of documentation, difficulty in supervision, and lack of accountability.
Examples of Mental Health Activities Provided by School Employees
- Participating in the educational assessment process
- Performing and interpreting mental health screening as part of educational evaluations
- Psychometric testing
- Conducting functional behavioral assessments
- Identifying evidence of chemical health problems
- Clarifying appropriate interventions based on information obtained during mental health screening
- Participating in teams (teacher assistance teams, IEP teams, etc.)
- Assisting in the development of Individual Educational Programs for students with disabilities
- Identifying appropriate accommodations and modifications, based on students’ emotional and behavioral difficulties
- Communicating with the students’ parents on a regular basis about both problems and successes in schools
- Providing individual and group counseling
- Providing skills training
- Providing crisis intervention, or working with County crisis teams when they provide crisis intervention services
- Providing in-service presentations to school staff about mental health issues
- Serving as a resource to building staff regarding identifying and reporting child abuse and neglect
- Facilitating due process procedures
- Administering medication
- Collecting, analyzing and interpreting data to support school-based decisions
- Teaching, monitoring and planning interventions for increased achievement of all students
- Teaching student lessons that are designed to improve knowledge and skills in career, academic, personal and social development
- Individual student planning- goals, careers, transition to post-secondary options, etc.
- Assisting school staff in problem solving re: cultural competence, PBIS, due process, etc.
- Working with medical and mental health, correctional and social service professionals in the community
- Gathering mental health information, with parent permission, from treating professionals in the community
- Reviewing the information obtained, and translating it into educational terms for educational staff
- Assisting educational staff in monitoring target symptoms of students’ mental health disorders
- Documenting the nature, frequency and severity of the target behaviors
- Communicating with community professionals about students’ symptoms at the time of their mental health evaluations, and subsequently, during treatment
- Coordinating activities with County and community agencies
- Case management (coordinating services with community mental health professionals, assisting families in obtaining services, etc.)
- Consultation with educational staff
- Making referrals to community resources for students and families
- Coordinating on-site, co-located mental health services provided by community mental health staff
By identifying activities that need to be done, and identifying the specific skill sets of school professionals, it is possible to maximize the impact of these professionals. For example, only nursing staff can distribute medication and only school psychologists and do psychometric testing. On the other hand, many types of school professionals (school social workers, counselors, psychologists, teachers, etc.) can provide skills training. Understanding staff skill sets and prioritizing activities that need to be done will result in more effective and efficient mental health related activities.
Supervision
The supervisor may have no background training in the work that the supervisee does (e.g., a special education director supervising a school social worker). This can result in minimal or no supervision of mental health related activities.
Supervision is essential and needs to address the following:
- What are staff doing?
- How many hours per week for each activity?
- How are they prioritizing their activities?
- How are students identified to receive services?
- What determines the duration of services?
- What is documented in contacts with students?
- What is the outcome of activities?
Pre-Referral Interventions
E.g., is the student taking medication for a disorder that has the symptoms that are resulting in consideration of a special education evaluation?
Has a release of information been obtained to allow communication with the student’s physician?
Educational Planning
- Best practices for conducting team meetings regarding students who have mental health problems
- Methods of providing educational evaluations of students who have mental health disorders
- Has mental health or substance use screening been done as part of the educational assessment?
- Has a functional behavioral assessment been done? Does it acknowledge that intrinsic factors may be driving the student’s behavior?
Clarification of Behavioral vs. Clinical Contributors to the Student’s School Difficulties
Use of the Clinical-Behavioral Spectrum concept (See Dikel and Ostrom, http://www.williamdikel.com/the-behavioralclinical-spectrum.html)
Behavioral |
Predominantly Behavioral |
Mixed |
Predominantly Clinical |
Clinical |
.Designing Accommodations and Modifications based on the symptoms of a student’s mental health disability
Crisis Intervention
How are crises (e.g., a student making a suicide threat) to be assessed?
How does the district clarify staff roles and responsibilities regarding crisis intervention?
Mental Health Data Practices
Clarification of how mental health data should be handled
Gathering and Analysis of Individual and Group Mental Health Data
Gathering information that documents the nature of a student’s mental health diagnosis, changes in symptoms in response to treatment, outcome data, etc.
Documentation of Activities
It is often the case that activities go undocumented or have inadequate documentation. This is very problematic in some situations—e.g. a potentially suicidal student who regularly sees a school social worker for counseling.
Documentation of counselors’, psychologists’ and social workers’ records, of progress/change of behaviors, assuring appropriate data management/privacy, requesting, reviewing, interpreting and documenting mental health information
Protocols and Checklists
It is helpful to create specific protocols and checklists that assure that services have been provided and to assure staff accountability.
Symptom Monitoring and Communication of Behavioral Observations to Parents and Medical/Mental Health Providers
School files tend to not reflect clinically useful information. Even when a student has OHI special education services for ADHD, the educational record may not reflect the nature and severity of symptoms over time, how they change in response to medication changes, etc.
Data regarding students’ performance at school are very useful to treating professionals in making diagnoses and for monitoring treatment. Ideally, this information should be provided directly from school staff with a release of information signed by the student’s parent.
Provision of Direct Services to Students
Direct service: E.g., crisis intervention, individual and group counseling, skills training
Treatment: A clinical service that is focused on reducing or eliminating the symptoms of a disorder. In mental health, this may include psychotherapy and/or medication treatment
Counseling: The provision of information, assistance and guidance
Skills Training: Teaching skills to help an individual who has skills deficits (e.g., social skills, organizational skills, etc.)
How are students prioritized for direct services? Who is seen? For how long? Individual vs. group sessions? Skills training? Therapy? When are these services no longer required? How is outcome determined?
Adopting Evidence-Based Teaching Methods for Students Who Have Emotional/Behavioral Problems
Creating Partnerships with Community Providers, Including the Establishment of Co-Located Mental Health Services
Maximizing Reimbursement to Ensure Program Sustainability
Assuring that services do not rely on time limited grants, identifying sources of income, consideration of Medicaid billing, etc.
Coordinating with County Resources
Working with County professionals: crisis, truancy, children’s mental health, child protection, juvenile probation, public health, developmental disabilities
Mental Health Training
For educational staff, administrators, mental health staff, nurses, student health curriculum
Use of Mental Health Consultation
Psychiatric consultation regarding medical and medication issues, diagnostic issues, etc.
Behavior analyst for clarification of behavioral intervention plan
Outcome Assessment
Have interventions been successful? What does the behavioral data indicate? The academic data? If outcomes are negative, what interventions will be altered?
Summary
A well-constructed school district mental health plan results in improved services for students and in improved academic performance, reduced behavioral incidents and cost savings for the district.
Crisis Intervention
How are crises (e.g., a student making a suicide threat) to be assessed?
How does the district clarify staff roles and responsibilities regarding crisis intervention?
- School district social worker
- County crisis team
- Law enforcement
- Co-located mental health professional
Mental Health Data Practices
Clarification of how mental health data should be handled
- Desk drawer rule
- Information from medical and mental health providers
- Notes from school employees who are counseling students
- Treatment notes from school employees, if the district adopts a model of school-hired therapists (bad idea)
- Assurance that district data practices are following requirements of HIPAA, FERPA and State data practices
Gathering and Analysis of Individual and Group Mental Health Data
Gathering information that documents the nature of a student’s mental health diagnosis, changes in symptoms in response to treatment, outcome data, etc.
Documentation of Activities
It is often the case that activities go undocumented or have inadequate documentation. This is very problematic in some situations—e.g. a potentially suicidal student who regularly sees a school social worker for counseling.
Documentation of counselors’, psychologists’ and social workers’ records, of progress/change of behaviors, assuring appropriate data management/privacy, requesting, reviewing, interpreting and documenting mental health information
Protocols and Checklists
It is helpful to create specific protocols and checklists that assure that services have been provided and to assure staff accountability.
Symptom Monitoring and Communication of Behavioral Observations to Parents and Medical/Mental Health Providers
School files tend to not reflect clinically useful information. Even when a student has OHI special education services for ADHD, the educational record may not reflect the nature and severity of symptoms over time, how they change in response to medication changes, etc.
Data regarding students’ performance at school are very useful to treating professionals in making diagnoses and for monitoring treatment. Ideally, this information should be provided directly from school staff with a release of information signed by the student’s parent.
Provision of Direct Services to Students
Direct service: E.g., crisis intervention, individual and group counseling, skills training
Treatment: A clinical service that is focused on reducing or eliminating the symptoms of a disorder. In mental health, this may include psychotherapy and/or medication treatment
Counseling: The provision of information, assistance and guidance
Skills Training: Teaching skills to help an individual who has skills deficits (e.g., social skills, organizational skills, etc.)
How are students prioritized for direct services? Who is seen? For how long? Individual vs. group sessions? Skills training? Therapy? When are these services no longer required? How is outcome determined?
Adopting Evidence-Based Teaching Methods for Students Who Have Emotional/Behavioral Problems
- Proactive Classroom Management techniques (PCM)
- Clear Rules/Expectations (CRE)
- Crisis Intervention Planning (CIP)
- Academic supports and curricular/instructional modifications (CIM)
- Systemic approach to cooperative learning (CL)
- Specialized instruction to promote learning and study skills
- Peer-Assisted Learning Strategies (PALS)
- Peer-mediated intervention to promote positive behavioral skills (PMI)
- A conflict resolution program (CRP)
- Social skills instruction taught as part of regular classroom instruction (SSI)
- Anger management program (AMP)
- A behavior support/management plan (BSM)
- Pre-correction instructional strategies (PCIS)
- Group-oriented contingency management (GOCM)
- Choice-making opportunities for students
- Instruction in self-monitoring of student performance (SMSP)
- A system of positive behavioral intervention and support
- The use of peer reinforcement to promote appropriate student behavior (PR)
- Instruction in self-monitoring of non-academic behaviors (SMAB)
- Behavior contracts (BC)
- A formal procedure for developing function-based interventions (FBA)
Creating Partnerships with Community Providers, Including the Establishment of Co-Located Mental Health Services
Maximizing Reimbursement to Ensure Program Sustainability
Assuring that services do not rely on time limited grants, identifying sources of income, consideration of Medicaid billing, etc.
Coordinating with County Resources
Working with County professionals: crisis, truancy, children’s mental health, child protection, juvenile probation, public health, developmental disabilities
Mental Health Training
For educational staff, administrators, mental health staff, nurses, student health curriculum
Use of Mental Health Consultation
Psychiatric consultation regarding medical and medication issues, diagnostic issues, etc.
Behavior analyst for clarification of behavioral intervention plan
Outcome Assessment
Have interventions been successful? What does the behavioral data indicate? The academic data? If outcomes are negative, what interventions will be altered?
Summary
A well-constructed school district mental health plan results in improved services for students and in improved academic performance, reduced behavioral incidents and cost savings for the district.