Presentation on theme: "Making Mental Health Referrals in School-Based Settings Ileana Gonzalez, Ph.D. Assistant Professor Johns Hopkins University School of Education."— Presentation transcript:
Making Mental Health Referrals in School-Based Settings Ileana Gonzalez, Ph.D. Assistant Professor Johns Hopkins University School of Education
Overview The School as an Identifier State of Schools Role of Mental Health Providers Referral Process Working within the School Tips for External Mental Health Providers to Strengthen Relationship with Schools
Both the promotion of mental health in children and the treatment of mental disorders should be major public health goals. -Report of the Surgeon General’s Conference o Children’s Mental Health, 2000
Questions for Thought What is needed in order to partner with schools in order to increase mental health services for students? As a mental health provider, what can I do to market the services I/my agency provides? What barriers do students and families face in the referral process?
The School The school is the primary locale for prevention and treatment of child and adolescent psychological problems (Dryfoos, Brindis, &Kaplan, 1996; Weist, 1999). School provides the most efficient point for identifying and engaging students who may be exhibiting markers of risk for developing a psychological disorder (Bruns et al., 2004).
The Student Research indicates that 20% of students are in need of mental health services, yet only one out of five of these students receive the necessary services (Kaffenberger & Seligman, 2007). Furthermore, students of color and those from families with low income are at greater risk for mental health needs, but are even less likely to receive the appropriate services (Panigua, 2005; Vera, Buhin, & Shin, 2006). Social Capital needed
Historically School-based mental health programs evolved from primarily those with an assessment role— most often for special education eligibility— to a continuum of services that varies widely by target group, type, and service intensity (Hoagwood & Ervin, 1997). The present trend is toward increasing service provision in schools from community based providers. This is fueled by several forces, including managed behavioral health care, special education legislation, and changes in funding (Streeter & Franklin, 2002).
Mental Health Services at School A comprehensive school mental health system has been conceptualized as one that can provide preventive services, early intervention services, and targeted treatment interventions (Werthamer-Lawson, 1994). Students may perceive positive support through clinicians’ facilitation of primary prevention activities, as well as through the availability of treatment during times of need. Teachers may feel a reduction in stress because the presence of a mental health professional in the school allows for consultation and a referral option when students present with emotional and behavioral problems.
However… State of education and accountability Little research on effectiveness of school based mental health services (Bruns et al., 2004) High quality mental health services not available in most schools (Burke, 2002) In the U.S. there are 15,000 public school districts, each with its own unique characteristics, needs, and relative freedom to act autonomously (policy). “turf issues” - lack of role clarity, role overlap, differences in perceived goals and lack of communication and collaboration, among mental health providers within the school
Turf Wars Overlap in typical roles and functions of school psychologists, school social workers, school nurses, school counselors and community based mental health providers. At the same time, roles and responsibilities often vary from school to school depending on a particular school’s student population, staffing patterns, funding resources, and overall focus.
School Psychologists Scheduling meetings on initial concerns, consultation & intervention on academic, behavioral and reading problems, classroom modifications, progress monitoring, reassessing the situation and the student’s progress, talking to parents, teachers, other staff and students, conducting evaluations to determine disabilities of children, crisis intervention, contact with other service providers (especially in special education)
School Social Workers Provide mental health services to families, such as assessments, individual/ group work and immediate consultation and referral of families to community mental health services, provide information and training to families and teachers on mental health issues, receive referrals from principal (e.g. family substance abuse, fights at school), liaison between school, family and community, called upon to follow through on issues, fill in gaps, provide buffer between school and family (e.g. how to get homework done at school if it can’t be done at home), advocate for child at team meetings and with school staff, crisis interventions, connecting other service providers (who is doing what with students), home visits
School Nurse Administer medications, provide a safe place, deal with underlying reasons for some physical symptoms (e.g. child has stomach ache every math class), bring student to attention of team if needed, deal with children in crisis, support parents of children with mental health needs (e.g. help parents understand the child’s medications), educating the parent about the child’s condition, documentation of allegations of child abuse/neglect, consult with physicians, collaborate with school social worker on attendance issues, conduct screening for vision, hearing, immunization follow up, determine transportation needs for children with health issues.
School Counselors Conduct consultations with teachers, parent & students, address academic issues and behavioral concerns, develop behavioral and classroom plans, problem solving with students, deal with home issues brought to school, handle crisis situations, deal with threats of violence, abuse/neglect, facilitate small groups, conduct social skills training in classrooms, act as point person for pupil service staff, act as principal’s right hand, act as test coordinator for standardized tests
School Counselors cont. mediate peer-peer, teacher and parent issues, coordinate releases of information to facilitate work of team, creating a college going culture, college application counseling, class scheduling, attendance, enrollment and transition for new students, serve as case manager, crisis intervention, recruit for school programs, teacher meetings, coordinate referrals to outside services and providers liaison with court
School Counselors In the majority of schools, it is solely the school counselor who provides the mental health service to students, often in the form of preventative care (Brown & Trusty, 2005). School counselors are often encumbered with large caseloads, preoccupied with administrative duties, and generally lack the comprehensive training and supervision to meet the mental health needs of all students.
Active v. Passive Referral Passive- distributing pamphlets, marketing materials of services Active- step by step process involving many stakeholders in the child’s life
Steps in the Active Referral Process STEP 1.Utilize all appropriate in-school/district intervention resources and document student’s response to interventions before suggesting an outside referral to parents/guardians. STEP 2. Check school board policies and procedures and, as necessary, discuss the policies and procedures with administrators, before making outside referrals *adapted from Missouri Comprehensive Guidance Program
Steps in the Active Referral Process STEP 3. Review how you will discuss referral with a student/parent/family prior to presenting options ◦ Assess the family’s willingness/interest in receiving outside services. Become aware of family’s cultural attitudes/beliefs about counseling. ◦ Inform family that insurance coverage/financial assistance may be available. As needed, help families determine their coverage/options. ◦ Provide at least three appropriate options. Be cautious about “recommending” any one individual or agency. Help parents/guardians advocate for themselves and their child by encouraging them to call and talk with several professionals—so they can make an informed decision. ◦ Educate student/parent/family about what they can expect. STEP 4.Follow-up with student/parent/family and document the effectiveness of the referral
Working within the school Community mental health providers working in schools may be viewed as inflexible in scheduling student sessions and lacking in knowledge of how to work within and collaborate with teachers and other school staff. School staff may be frustrated by a lack of follow up on mental health services delivered by community providers or by a lack of clarity or articulation of how the goals of such services relate to and support academic goals and student learning. (Tracy & Castro-Guillen, 2004)
Partnering with schools Establishing partnerships with school counselors by making initial contacts to learn more about a particular school and what presenting concerns and overall issues the school counselor is seeing might strengthen the relationship. Questions might include: Are you seeing any trends or themes in the presenting concerns your students face at school? Do you need assistance from the community with addressing these concerns? How might my agency be able to assist with these concerns? How can I best follow up with you if I begin seeing a student from your school? (Lemberger et al.,2009)
Several practice strategies for those working in a host setting include Proactive Vs. Reactive model establish relationships with school personnel from other disciplines build rapport with the principal be clear about your role and who you serve be visible and provide prompt feedback Initiate district level consortium meetings focusing on policies and procedures (Berrick & Duerr,1996).
As external Mental Health providers Learn about the professional resources for social and mental health services already present in the school and the roles of the different disciplines represented on the pupil services team. Learn about laws, policies and procedures for special education, attendance, discipline, among others. Learn to understand the school climate and how to engage with school personnel.
As external Mental Health providers Awareness that while some words may be used by both disciplines, they may not have the same meaning. Understand and be clear about how your services relate to the schools’ goals for academic achievement. Schedule regular times to meet with those who work inside the school and identify the lead clinician within the school who assumes a liaison or coordinating role with community based providers.
As external Mental Health providers Understand FERPA laws of confidentiality Share information and offer feedback to teachers and other pupil services professionals about your work with the student. Obtain appropriate releases of information so that this can occur. Get to know data trends in the school district
As external Mental Health providers Advocate for school mental health programs by speaking at community forums, writing letters to the editors of local newspapers, lobbying school board members and administrators, and participating in relevant organizations. Meet with school personnel to determine what support they can offer to advance the school's or district's mental health objectives.