Understanding School Mental Health Services | K-12 Schools

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It will come as no surprise to parents that the COVID-19 pandemic has had a devastating effect on the mental health of young people. The Centers for Disease Control and Prevention found that nearly half of high school students interviewed last year reported experiencing persistent feelings of sadness or hopelessness. One in five said they had seriously considered suicide.

Even before the pandemic, rates of depression and suicide were rising among teens, and this mental health crisis continues, even as life in many ways returns to a new normal.

What some parents may not know is that their child’s school might be the best place to seek help.

“There is no institution better placed to engage with students on mental health issues than schools,” says John Crocker, director of school mental health for Methuen Public Schools in North Boston. “We can research emerging concerns and provide social and emotional learning about dealing with stress and strong emotions.”

School Mental Health Providers

Although staffing varies — and many districts are understaffed — school mental health providers typically include counselors, psychologists and social workers.

  • school counselors have overall responsibility for helping students succeed in school and plan for their college education and careers. This may include helping students with social and emotional problems.
  • School psychologists have a master’s or doctorate level education. Their primary role is to assess children for learning and behavior issues and work with teachers, administrators and parents to develop support plans. They can also provide individual and group counseling and refer students to outside practitioners if needed.
  • School social workers have a master’s or doctorate level education. Social workers provide therapy and work with other school staff to develop support plans for students. Social workers also work with families and handle case management, identifying and coordinating other services students may need.

Working among school staff, school psychologists, social workers and counselors have access to a child’s history in school, including friendships and discipline. This information is important when evaluating a child because many children are not good at expressing their feelings in words. As any parent knows, even a child who acts like he’s in trouble is unlikely to say, “I’m sad.”

How to get help for your child

The first clue that a child may be struggling is a change in behavior, says Candace Weidensee, director of student services for the Oregon School District in Wisconsin.

For example, when children who are usually energetic start sleeping more and complaining of fatigue, they may feel sad or anxious. But as with many signs of stress, there can also be a developmental or medical cause, so it’s worth contacting your child’s pediatrician to rule them out. Weidensee notes that anxiety and distress can manifest in different ways in children than in adults, such as:

  • Do not participate in classes when they normally participate
  • Unusual difficulty managing emotions
  • Lack of interest in things they used to love
  • attention problem

Other kids may have changes in appetite, complain of fatigue, or show more extreme introversion or extraversion when they’re struggling, says Faith Cole, director of student services at Oak Park and River Forest High School outside of Chicago.
If you are concerned about your child’s mental health, start by contacting a trusted teacher or coach. Teachers and other staff spend hours with children every day and, after parents and guardians, may be the most likely to notice troubling changes in behavior.

The school psychologist or social worker will usually want to meet with the children privately to assess how they are doing and determine if they need ongoing therapy or another type of support, says Frederick Heid, Superintendent of Schools for the County of Polk in Central Florida. The psychologist or social worker may recommend additional counseling sessions, or they may also refer your child to therapy outside of school, if the issues are beyond their expertise. These steps usually require parental consent. If this happens, the school provider will maintain communication with you and the outside therapist.

“What you don’t want is for us to not understand what’s going on with a child and do things differently,” Heid says. “It’s not a transfer, but an ongoing partnership.”

Once this process has begun, it is important that parents remain involved and persevering. Many parents wonder if they will have access to what their children talk about in therapy. The answer is, it depends. Some districts are required to obtain parental consent before a child can receive support services. Others are allowed to offer a limited number of therapy visits without notifying parents.

State laws on parental access to therapy session content also vary. Some states require school therapists to provide parents with a summary after meeting a child. Others follow confidentiality protocols that require therapists to disclose only if a child is threatening to harm themselves or others.

School mental health providers stress the importance of contacting your child’s doctor as well. “Often, if pediatricians have to be put on hold because medications are needed, it’s best that they know what’s going on early on,” says Cole. In addition to being able to perform tests to rule out medical problems, your child’s doctor may be able to provide insight into possible developmental changes.

Expand mental health supports

Nationally, there is a critical shortage of school psychologists. While the National Association of School Psychologists recommends one psychologist for every 500 students, the organization says the average is closer to one in 1,200 and reached 5,000 in some states. The shortage also extends to school counsellors. Almost one in five students do not have access to a counselor at their school, according to a 2019 report from the Education Trust.

Some states and districts, largely in response to school shootings, have begun invest in mental health support programs before the pandemic, and advocates hope federal COVID-19 funding for children’s mental health will further improve school staff and services.

Additionally, districts are increasingly using technology to track student sentiment. At Polk County schools, for example, a new telehealth program provides an online interface for parents to connect with health providers. Students can immediately speak to a licensed medical or mental health clinician from home. Nearly half of the contacts made with the system are for mental health support, Heid says, and many consultations with physicians lead to a mental health referral.

“We were surprised,” says Heid, “but we’re glad to have the supports in place.

Many districts are also using app-based mental health screenings to survey select portions of the student population with questions about mental well-being. These self-report surveys have been surprisingly effective in finding children who need support, but who might otherwise have slipped under the radar.

After the initial surveys were sent, public schools in Methuen saw a 63% increase in the number of students eligible for mental health services. Once students report that they are struggling, district staff follow them for assessment.

“The goal is to provide a formal opportunity for a child to want to share,” says Crocker, “and then to have a conversation that offers potential help.”

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