Adolescent Health Care Act Provides Options for Families Seeking Mental Health and Substance Use Help for Young People Resistant to Treatment

A Brief Overview

  • The Adolescent Behavioral Health Care Access Act, passed into law by the Washington Legislature in 2019, gives parents and providers more leverage in treating a young person who will not or cannot independently seek medical help for mental illness and/or substance use disorder.
  • The Washington State Health Care Authority (HCA) hosts website links with information about the new law, which allows Family Initiated Treatment (FIT). The landing page includes an email address: hcafamilyinitiatedtreatment@hca.wa.gov.
  • Enactment of FIT is a project of the state’s Children and Youth Behavioral Health Work Group. CYBHWG supports several sub-work groups, including one focused on school-based services and suicide prevention. Information group membership, public meetings, resources, events and training is available through a dedicated HCA website page.
  • A place to connect with other families concerned about these topics is a Facebook group called Youth Behavioral Healthcare Advocates (YBHA-WA).
  • If a person ages 15-40 is newly experiencing psychosis, Washington offers a wraparound-style program called New Journeys. This website link includes access to a referral form.

Full Article

Getting mental health help for a youth in crisis can be complicated, frustrating, and frightening.

Mental Health America ranks states based on the incidence of mental illness and access to services. The 2021 youth rankings list Washington 35th in the nation. Various measures indicate a high prevalence of major depression, substance use disorder, and/or emotional disturbance as a category of disability on the Individualized Education Program (IEP). Barriers to treatment consider insurance as well as availability of services.  

The 2021 indicators show Washington has risen since 2020, when the youth ranking was 43rd nationally. However, overall statistics are dire, indicating the COVID-19 pandemic has worsened mental healthcare conditions and treatment access across all age groups and states. “Youth mental health is worsening,” the data shows. “Even in states with the greatest access, over 38 percent are not receiving the mental health services they need. Among youth with severe depression, only 27.3 percent received consistent treatment.”

Sometimes a barrier to treatment involves a complicated balance of youth autonomy and parental responsibility. The most severe psychiatric conditions often include a symptom called anosognosia, which blocks the brain’s ability to see the impairment or understand why professional help could be of benefit. In youth whose brains are still forming, symptoms that impact insight and choice-making are particularly problematic.

New Journeys is an option when psychosis is present

Sometimes anosognosia co-occurs with psychosis, which indicates a person has lost touch with reality. Delusions and hallucinations may be present. If a person is newly experiencing psychosis, Washington offers a wraparound-style program called New Journeys: This link provides access to information for clients and families and includes an online referral form.

Causes of psychosis are the subject of ongoing research, but some theories suspect the brain is trying to make sense out of a world that does not make sense. Synapses fire errantly, and the brain tries to organize them into stories to calm itself. Synaptic loops get built during these firestorms of neural activity, and the stories that emerge become reality to the person whose brain is narrating the experience, even if they are untrue or grounded in false perceptions. Choice-making in the empirical world is often compromised.

Family education about psychosis is an aspect of New Journeys, which is for youth and adults ages 15-40 who have experienced psychotic symptoms for more than or equal to 1 week and less than or equal to 2 years. Staff from the University of the Washington contribute support to the state’s New Journeys program, which is offered in various but not all regions of the state.

UW staff also support a program called Psychosis REACH, which provides evidence-based skill-building for relatives and friends of individuals with psychotic disorders. The practices are based in cognitive behavioral therapy (CBT). The program’s website includes information about training opportunities and resources.

Age of Consent in Washington is 13

In Washington State, the age of medical consent is 13. That means that a person 13-17 years old can independently seek medical treatment, without the consent or knowledge of parents.

Age of consent laws also have meant that Washington youth could say no to behavioral health treatment, regardless of whether parents and providers agreed that such treatment was necessary to protect the safety and well-being of the adolescent. Exceptions are made when there is a threat of imminent danger or grave disability due to psychiatric deterioration. Read on for more information about involuntary treatment/commitment.

The Adolescent Behavioral Health Care Access Act, passed by the Washington legislature in 2019, gives parents and providers more leverage when a young person is struggling with behavioral health and does not independently engage with treatment. The law allows parents/caregivers to bring a youth, ages 13-17, to a provider for evaluation without requiring consent from the youth. The law includes elements introduced by the state Senate and House of Representatives, which originally titled the bill as HB 1874. In 2020, passage of HB 2883 added residential treatment as an additional option under Family Initiated Treatment (FIT).

The law does not limit an adolescent’s ability to initiate treatment on their own.

Parents have felt shut out of their teenager’s care

January 8, 2020, article in Crosscut profiles several families impacted by the new law. “Until the new law,” the article states, “parents often were shut out of their teenager’s care and treatment plans and couldn’t push a teen toward necessary outpatient or inpatient care without their consent.”

Passage of FIT marks a win for the Children and Youth Behavioral Health Work Group, which studied and reviewed recommendations from a stakeholder advisory group authorized by the 2018 legislature. Final language in the law was impacted by family members, youth, clinicians, hospital staff and many others who met dozens of times.

“Parent” is broadly defined, and information sharing is more open

Under the law, the definition of parent is expanded to include a wide range of family caregivers, guardians and others who have authority to initiate treatment. The Revised Code of Washington (RCW 9A.72.085) provides standards for “subscribing to an unsworn statement” that can apply to a caregiver initiating treatment. 

The law enables providers to share information with parents without an adolescent’s consent, if the provider determines that information sharing with family is in the best interests of the adolescent patient. A list of information-sharing guidelines is included below.

Note that parents retain the right to make medical decisions for children younger than 13, and adults 18 and older are responsible for medical decision-making if there is no guardianship.

In accordance with RCW 71.34.375, providers are required to provide notice to parents of all available treatment options, including Family Initiated Treatment. The state Health Care Authority provides a fact sheet to clarify those requirements.

Family-Initiated Treatment (FIT)

The FIT law allows a parent/caregiver to escort their adolescent child to certain licensed behavioral health facilities and request that a professional person examine the adolescent to determine whether treatment is medically necessary. That treatment might include outpatient, inpatient, or residential care.

According to the Health Care Authority (HCA), FIT is not a guarantee of immediate services and no provider is obligated to provide services under FIT. Each provider has processes, procedures, and requirements pertaining to evaluation and admission to services. However, the only reason for not providing services cannot be the youth’s lack of consent (RCW 71.34.600).

If a facility covered by this law does not have a professional person available to perform the examination, the facility is not required to make staff available on demand. Additionally, if the professional determines the adolescent needs in-patient treatment but the facility does not have a bed available, the facility is not required to make a bed available. Included are those facilities that house children and youth under the Children’s Long-term Inpatient Program (CLIP). CLIP beds are generally subject to a waiting list and a multi-step referral process.

According to staff at Washington’s Health Care Authority, the COVID-19 pandemic and capacity limitations within the behavioral health system have hindered many providers from fully developing processes to implement the law. Families are encouraged to contact providers before taking an adolescent to a facility to determine if the provider has the capacity or ability to perform an assessment.

FIT in a community setting

If medical necessity is found by an outpatient provider who evaluates a young person brought into care through FIT, the provider is limited to 12 sessions over 3 months to attempt to work with the adolescent. If the young person still refuses to engage with treatment, then the period of Family-Initiated Treatment with that provider ends. The family at that point could seek treatment elsewhere.

State laws continue to encourage autonomy for young people, despite recognition that family involvement is important. According to the Revised Code of Washington (RCW 71.34.010):

 “Mental health and chemical dependency professionals shall guard against needless hospitalization and deprivations of liberty, enable treatment decisions to be made in response to clinical needs in accordance with sound professional judgment, and encourage the use of voluntary services. Mental health and chemical dependency professionals shall, whenever clinically appropriate, offer less restrictive alternatives to inpatient treatment. Additionally, all mental health care and treatment providers shall assure that minors’ parents are given an opportunity to participate in the treatment decisions for their minor children.”

For children and youth with Medicaid, the Wraparound with Intensive Services (WISe) program is Washington’s most intensive option for outpatient care. The Health Care Authority (HCA) maintains a website page with information about WISe in multiple languages. Families can discuss their options for FIT with WISe staff and leadership at HCA.

FIT in a hospital setting

An inpatient or residential facility can detain the adolescent under Family-Initiated Treatment (FIT) if medically necessary for a mental health condition. In these settings, FIT may last up to 30 days. Then the adolescent must be discharged, unless:

  • they agree to stay voluntarily, or
  • a designated crisis responder (DCR) initiates involuntary commitment proceedings

The Involuntary Treatment Act (ITA) can apply to persons of any age who are determined to be gravely disabled or at imminent risk of harm to self, others, or property. Under Ricky’s Law, community members of any age who are a danger or gravely disabled due to a drug or alcohol problem may beinvoluntary detained to a secure withdrawal management and stabilization facility—also known as secure detox.

For substance use disorder treatment, due to Federal Privacy Laws, a parent/caregiver can only provide consent for an assessment. The youth would have to consent to the results of the assessment being shared with their parent/caregiver and volunteer for ongoing treatment if it is deemed medically necessary.

Guidance for Information Sharing

Federal law, 42 CFR Part 2, restricts information sharing related to substance use, and clinicians cannot share that information without a patient’s written consent, regardless of whether the substance use co-occurs with mental illness.

Providers have discretion in determining what information about mental health diagnoses and treatment is clinically appropriate to share with parents of an adolescent 13-17. A provider retains discretion in withholding information from family/caregivers to protect an adolescent’s well-being. In general, however, the Adolescent Behavioral Healthcare Access Act encourages sharing information to support collaboration between the clinical setting and home. Specifically, providers and families are encouraged to discuss:

  • Diagnosis
  • Treatment Plan and Progress
  • Recommended medications, including risks, benefits, side effects, typical efficacy, dosages, and schedule
  • Education about the child’s mental health condition
  • Referrals to community resources
  • Coaching on parenting or behavioral management strategies
  • Crisis prevention planning and safety planning

To support family caregiving for individuals of all ages, the Washington State Hospital Association provides general guidance about exceptions to federal confidentiality laws (HIPAA): Permitted disclosures of mental health information and substance use disorder information without patient consent.

Resources

The  Health Care Authority (HCA) provides a range of information about behavioral health services for children and youth, including this downloadable resource: Parent’s Guide to Family Initiated Treatment.

Families can direct specific questions to: hcafamilyinitiatedtreatment@hca.wa.gov. Please note that this business email is not intended for crisis response.

An agency called CaseText organizes links related to Family Initiated Treatment for direct access to various statutes.

Home for the Holidays: The Gift of Positive Behavior Support

A Brief Overview

  • This article provides examples and simple guidance about how to be more strategic in parenting a child who struggles with behavior—during the weird winter of 2020 and beyond.
  • PAVE consulted with University of Washington positive behavior support expert Kelcey Schmitz for this article.
  • Anticipating trouble and making a best guess about the behavior’s “purpose” is a great place to start.
  • Listen and look for opportunities to praise expected behavior. It’s easy to forget to pay attention when things are going well, but keeping the peace is easier if praise is consistent while children are behaving as expected.
  • Read on to gift the family with a plan for improving holiday happiness.

Full Article

Holidays can be challenging for families impacted by disability, trauma, grief, economic struggles, and other stressors. Holiday season 2020 has its own flavors of confusion. Families with children who struggle with behavior may want to head into the winter with plans in place. Anticipating where trouble could bubble up and developing a strategy for working it out provides all family members with opportunities for social-emotional growth, mindfulness, and rich moments.

PAVE consulted with a University of Washington (UW) expert in positive behavior supports to provide insight and information for this article. Kelcey Schmitz is the school mental health lead for the Northwest Mental Health Technology Transfer Center, housed at the UW School Mental Health Research and Training (SMART) Center. An area of expertise for Schmitz is Multi-Tiered Systems of Support (MTSS), a framework for schools to support children’s academic, social, emotional, and behavioral strengths and needs at multiple levels. An MTSS framework makes room for Positive Behavioral Interventions and Supports (PBIS). When done well, PBIS teaches and reinforces positive social skills, communication strategies and “restorative justice” (working it out instead of punishing).

“This holiday season may present additional challenges given the pandemic,” Schmitz says. “Families, like educators, need to go back to the basics during times of stress and uncertainty. Remembering core features of PBIS at home, such as predictability, consistency, safety, and positive interactions are going to be key. In fact, lessons learned during stay-at-home orders during the pandemic can and will carry us through the holidays and beyond. Never before have routines, regulation, relationships, and reinforcement been more important for everyone in the family than they will be this winter.”

Schmitz has provided articles and content to support PAVE families over the years and offers the following tips for navigating the holidays by using PBIS strategies at home.

Make a list and check it twice to know what troubling behaviors are about

Whatever the holidays mean and include, family routines can shift. Food can look and taste different. The house may be decorated in a different way. School takes breaks. Weather changes, and sunrise and sunset are closer together.

Children may struggle with changes in routines, different food items on the menu, overstimulating environments, long periods of unstructured activities, or sensory issues that make long pants, socks, gloves, coats, and hats feel like shards of glass.

Keep in mind that all behaviors serve a purpose; they are a way for the child to solve a problem. Without appropriate social skills, children will do what is necessary to have their needs met in the quickest way possible. However, adults who can predict problem behaviors may also be able to prevent them.

TIP: Anticipate trouble and make a best guess about the motivation

Set your child (and family) up for holiday success by thinking ahead about the types of routines and situations that might be challenging. Craft a plan to intervene early, before a full-blown escalation.

Create a best guess statement to better understand the relationship between an unwanted behavior and the child’s environment. Summarize what usually happens by describing:

  • The behavior (tantrum, hitting, refusal)
  • Circumstances that set the stage (what’s going on right before the behavior?)
  • What happens after the behavior (time out, angry adults, something removed or given)
  • A best guess about the child’s motivation/the “purpose” of the behavior (to get something or get out of something)

Here is an example:

At Grandma’s holiday gathering, an adult encourages a child to try a food, demands a “please” or “thank you,” or scolds the child. Note if the child is tired, hungry, or uncomfortable in an unusual or unpredictable situation. These are the circumstances that set the stage.

The child cries and yells loud enough to be heard in another room (description of the behavior).

During the child’s outbursts, others leave her alone (what happens after the behavior).

Best guess about the purpose? The child may want to avoid unpleasant people, food, or situations.

Making a good guess about what causes and maintains the behavior (crowded or overstimulating environment, being rushed, being told they can’t have or do something they want, different expectations, demands, exhaustion, hunger) can support a plan and potentially avoid worst-case scenarios.

Determining the purpose or function of a behavior may require a closer look at what typically happens (what others say or do) after the behavior occurs. The behavior may be inappropriate, but the reason for it usually is not.  Most of the time there is a logical explanation. Here are some questions to help think it through:

  • Does the child get something–or get out of something?
  • Does the child generally seek or avoid something, such as:
    • Attention (from adults or peers)?
    • Activity?
    • Tangibles (toys/other objects)?
    • Sensory stimulation?

Make a list and check it twice: Prevention is key

Many behaviors can be prevented using simple proactive strategies. Adults can use their best-guess statement to build a customized strategy. Here are some starter ideas that might help prevent or reduce the intensity, frequency, or duration of unwanted behaviors:

  • Make sure the child is well rested and has eaten before going out.
  • Bring food that is familiar and appealing.
  • Anticipate challenges, and plan accordingly.
  • Pre-teach family expectations (respectful, responsible, safe) and talk about how those expectations work at grandma’s house: “When someone gives you a present, say thank you and smile at the person who gave you the gift.” For information about developing family expectations, see PAVE’s article, Tips to Help Parents Reinforce Positive Behaviors at Home.
  • Encourage the child to bring a comfort item (toy, book, blanket).
  • Give more “start” messages than “stop” messages.
  • Teach a signal the child can use to request a break.
  • Create a social story about family gatherings; review it regularly.
  • Rehearse! Practice/pretend having a meal at Grandma’s house, opening gifts, playing with cousins, and other likely scenarios.
  • Arrive early to get comfortable before the house gets crowded.
  • Create a visual schedule of events, and let the child keep track of what’s happening or cross off activities as they happen.

Respond quick as a wink: Reward replacement behavior

An essential prevention strategy is teaching what to do instead of the unwanted behavior. “What to do instead” is called replacement behavior. To be effective, the replacement behavior needs to get results just as quickly and effectively as the problem behavior.

For example, if a child learns a signal for taking a break, adults need to respond to the signal just as fast as they would if the child starts to scream and cry.

Responding quickly will strengthen the replacement behavior and help make sure that the unwanted behavior is no longer useful.

Here are steps to help teach replacement behaviors:

  1. Demonstrate/model the wanted behavior
  2. Provide many opportunities for practice
  3. Let the child know they got it right (as you would if they learned a skill like riding a bike, writing their name, or saying their colors)

Praise a silent night

Inspect what you expect. Listen and look for opportunities to praise expected behavior. It’s easy to forget to pay attention when things are going well, but keeping the peace is easier if praise is consistent while children are behaving as expected.

Evidence indicates that children’s behavior improves best with a 5:1 ratio of positive-to-negative feedback. Increasing positive remarks during difficult times—such as holidays and pandemics—might reduce escalations.

Provide frequent, genuine, and specific praise, with details that help encourage the specific behavior being noticed. For example, say, “You did a nice job sharing that toy truck with your cousin!”

All is calm: Intervene at the first sign of trouble

Be ready to prompt appropriate behavior, redirect, or offer a calming activity when there are early signs of agitation or frustration.

  • Provide early, clear instructions about “what to do instead,” using language and modeling consistent with what was pre-taught and practiced (see above).
  • For example, if a child is getting frustrated, say, “Remember, you can give me the peace signal if you need a break.”
  • Redirect the child to another activity or topic when appropriate and practical.
  • Hand the child a comfort item (stuffed animal, blanket).
  • Show empathy and listen actively: “It seems like you’re having some big feelings right now. Want to talk about it?” After listening, maybe say, “Wow, that’s a lot to feel.”

Do you hear what I hear? Heed alarm bells when plans need to shift

Not all challenging behaviors can be prevented, and adults may overestimate a child’s ability to control emotions. A child experiencing significant distress may be unable to process what is going on around them and follow what may seem like simple instructions.

If an adult’s best efforts are unable to prevent or diffuse a behavior escalation, a graceful exit may be the best strategy. It’s important for adults to remember that a child’s crisis isn’t their crisis. An adult’s ability to remain level-headed is critical, and children may ultimately learn from the behavior they see modeled.

Wait for a child to calm down before addressing the issue: An overwhelmed brain is not able to problem solve or learn. Later, everyone can review what worked or did not work in order to adjust the strategy for next time.

Believe: Be a beacon for hope

Support a child to learn, practice, and perform behaviors that enable fun, rich family experiences. The work may feel challenging—and the scale of the project may be impacted by a unique set of tough circumstances—but expecting and accepting the challenge enables the whole family to move toward new opportunities. Trust that the work will pay off—and relish the moments of success, however large or small. Believe that consistency and predictability can make a big impact this holiday season and beyond.

Here are a few points to review:

  • What might seem fun and relaxing to adults, could be overwhelming and upsetting to children.
  • Children are more likely to exhibit the behavior that will most quickly get their needs met, regardless of the social appropriateness.
  • Acting out is typically a symptom of an underlying issue – it’s important to examine the root of the problem for long-term positive results.
  • Prevention strategies and intervening early can be very effective, but they are often underutilized. Plan ahead to eliminate, modify, or neutralize what might set off behavior.
  • Support wanted behaviors by teaching them, practicing them, modeling them, and making them consistent sources for praise and encouragement.

Resources:

COVID-19 Handbook and Family Binder (multiple language options) from the Autism Intervention Research Network on Behavioral Health (airbnetwork.org)

The Comprehensive, Integrated Three-Tiered Model of Prevention (ci3t.org) provides videos and other COVID-Related Resources for Families in English and Spanish

The Center on Positive Behavioral Interventions and Supports (PBIS.org) provides a downloadable booklet (English and Spanish) for Supporting Families at Home with PBIS

Parent Training Modules from Vanderbilt University’s Center on the Social and Emotional Foundations for Early Learning (CSEFEL), available in English and Spanish

YouTube video interview with Mark Durand, author of Optimistic Parenting: Hope and Help for You and Your Challenging Child

Fall 2020: Ready or Not

Washington State Superintendent Chris Reykdal predicts that 2020-21 will be “the most complicated school year in American history.” In preparation, the Office of Superintendent of Public Instruction (OSPI) is turning out new guidance for school districts that serve more than a million students.

About 143,000 Washington students receive special education and related services. No federal or state protections for students with disabilities are waived due to the pandemic.

Decisions about what school looks like are left to local districts, which follow policies established by elected school boards. School board meetings are required monthly and must follow the state’s Open Public Meetings Act (Chapter 42.30 in the Revised Code of Washington). Families can reach out to their local district for information about how and when school boards meet. Public comment is part of each public meeting, and open meeting rules apply in any space or platform.

Among OSPI guidance released in summer 2020 is a 60-page booklet: Reopening Washington Schools 2020: Special Education Guidance. Recommendations encourage schools to collaborate with families in providing equitable access to learning opportunities and to include all students when designing curricula for a range of delivery methods.

PAVE provides an article that summarizes some content from OSPI’s guidance and provides more detail about navigating special education regardless of what school looks like: IEP on Pause? How to Support Continuous Learning.

Reykdal and WA Governor Jay Inslee spoke Aug. 5, 2020, at a press conference about school decision-making amid the nation’s ongoing struggle to contain the COVID-19 pandemic. Gov. Inslee said he would not order the closure of all schools, as he did in spring 2020. Instead, Inslee said he would rely on local districts to use sound judgment about whether school buildings can open safely, in light of a region’s health data.

At the August press conference, Inslee announced plans to send $8.8 million in federal CARES Act stimulus money to OSPI, which will use some funds to cover the costs of internet for students eligible for free or reduced-price meals. OSPI has committed to partner with community-based organizations to help families secure childcare, engage in language translation services, and other parent and family engagement strategies.

CARES Act funds also will support professional development to upgrade how distance learning is delivered statewide. In partnership with OSPI, the state’s nine regional educational service districts (ESDs) will provide support and training to help districts choose a consistent online platform and train staff about best practices. “Last spring, we heard consistently from educators that they needed more training on how to effectively use online learning management systems,” Reykdal said, adding:

“To make online learning more effective this fall, we have to streamline this. Students and parents should be able to focus on learning, and educators should be focused on teaching, without the modality of the instruction getting in the way. Our ESDs will provide educators with training in a handful of learning management systems consistent with guidance we have already sent to districts to simplify their remote learning management systems for families.”

Reykdal and Inslee encouraged school districts in areas of the state with low rates of COVID-19 infection to prioritize face-to-face instruction for those who are most likely to struggle with remote learning: elementary schoolers and those with disabilities. 

In circumstances where in-person school is offered, families will make their own decisions about whether to send children or keep them home. Here are a few tools families might use to prepare for the school year:

  1. Is the rate of infection in the community going down?  
  2. Does the community have a clear protocol for testing and contact tracing?  
  3. Does the school provide a clear protocol for what to do if/when a student or staff member tests positive for COVID-19? 

Social Emotional Learning, Part 3: Tools for Regulation and Resiliency

A Brief Overview

  • Children who are taught self-regulation are more resilient and learn better in academics and more. This article describes a few practical tools and techniques that are aspects of Social Emotional Learning (SEL).
  • “Kids do well if they can,” says Ross W. Greene, a child psychologist and author. In a short YouTube video, Greene says, “The biggest favor you can do a challenging kid is to finally, at long last, be the person who figures out what’s getting in his way.”
  • PAVE provides additional articles about Social Emotional Learning.
  • Washington’s Office of Superintendent of Public Instruction (OSPI) provides SEL learning activities for families and educators. OSPI also provides free online SEL training, links to information about SEL state learning standards, and more on the Social and Emotional Learning page of its website: k12.wa.us.

Full Article

When children act out at school, what does the teacher do? The answer depends on the discipline policies of the school, but research indicates that suspending and expelling students is ineffective for improving behavior and can cause harm (NIH.gov).

Social Emotional Learning (SEL) in schools marks a shift toward education that promotes self-regulation, resiliency, problem-solving skills, and more. “Kids do well if they can,” says Ross W. Greene, who explains his statement in a short YouTube video. Greene is a clinical child psychologist and author of the books The Explosive Child, Lost at School, Lost & Found, and Raising Human Beings.

By accepting the logic that kids do well if they can, adults shift away from believing that kids behave only if they “want to” and allows for problem-solving, Greene says: “The biggest favor you can do a challenging kid is to finally, at long last, be the person who figures out what’s getting in the way [of doing well].”

Behavior is communication: “Get curious, not furious”

Adults can consider behavior as a form of communication and seek to understand the function of the behavior. One educator refers to this approach as “Getting Curious (Not Furious) With Students.” In the article, posted to Edutopia.org June 29, 2016, Rebecca Alber says, “When teachers get curious instead of furious, they don’t take the student’s behavior personally, and they don’t act on anger. They respond to student behaviors rather than react to them.”

Alber lists the primary benefits to schools when they promote SEL and trauma-informed approaches to discipline:

  • Improved student academic achievement
  • Less student absences, detentions, and suspensions
  • Reduction of stress for staff and students and less bullying and harassment
  • Improved teacher sense of job satisfaction and safety

Tip: Request a Functional Behavior Assessment

A Functional Behavioral Assessment (FBA) may be necessary in circumstances where behavior consistently impedes learning. Schools can use FBA data to build an individualized Behavior Intervention Plan (BIP). A BIP may support an Individualized Education Program (IEP) or could be a stand-alone plan for any student.

When using positive behavior support strategies, adults can avoid judging behavior with labels such as bad, non-compliant, defiant, uncooperative, etc. Researchers have found that those labels often refer to adult perception and frustration about what is happening more than they explain what a child may be trying to express.

Family caregivers might read through a student’s Individualized Education Program (IEP), a behavior plan, disciplinary referrals, or other notes from the school to notice what type of language is being used to describe what’s happening. Requesting a meeting to discuss an FBA and/or strategy for SEL skill-building is an option.

Raw moments are opportunities to teach from the heart

Heather T. Forbes, author of Help for Billy, is among professionals designing new ways to help children cope and learn. Emotional instruction is crucial, argues Forbes, whose website, Beyond Consequences, shares Trauma-Informed Solutions for parents, schools, and other professionals.

“It is in the moments when your child or student is most ‘raw’ and the most dysregulated [out of control],” Forbes writes, “that you are being presented with an opportunity to create change and healing. It takes interacting from not just a new perspective but from an entirely new paradigm centered in the heart.”

In an article, Teaching Trauma in the Classroom, Forbes concludes: “These children’s issues are not behavioral. They are regulatory. Working at the level of regulation, relationship, and emotional safety addresses more deeply critical forces within these children that go far beyond the exchanges of language, choices, stars and sticker charts.”

Regulation starts in the brain

SEL supports are informed by brain science. OSPI provides a free downloadable handbook, The Heart of Learning and Teaching: Compassion, Resiliency, and Academic Success. Included in Chapter One is a list of the brain regions affected by trauma. Understanding the amygdala as a center for fear, for example, can be critical for designing strategies to manage meltdowns. “Overstimulation of the amygdala…activates fear centers in the brain and results in behaviors consistent with anxiety, hyperarousal and hypervigilance,” the page informs.

Writing for Edutopia, Rebecca Alber recommends that teachers learn to understand and recognize impacts of trauma and to understand that apparent refusal to comply might actually be a trauma-based response.

“When we ask students to do high-level tasks, such as problem solving or design thinking,” Alber says, “it’s nearly impossible if they are in a triggered state of fight, flight, or freeze. This trauma state may look like defiance or anger, and we may perceive this refusal as choice, but it is not necessarily so.”

Use Your Words

Some teachers are turning directly to scientists for advice. Dan Siegel, a well-known neurobiologist and author, offers tips through his agency, Mindsight. Mindsight teaches how to “name and tame” emotions to keep from getting overwhelmed. For example, Siegel suggests learning the difference between these two sentences:

  1. I am sad.
  2. I feel sad.

The first statement “is a kind of limited self-definition,” Siegel argues, while the second statement “suggests the ability to recognize and acknowledge a feeling, without being consumed by it.”

Encourage rather than simply praise

Word choice can be critical in trauma-informed instruction. Jody McVittie, a pediatrician who started Sound Discipline, based in Seattle, gives workshops for parents and teachers. She talks about the difference between praise and encouragement in a training called Building Resiliency. Instead of saying “Great Job,” which can trigger an emotional response but may not reinforce learning, a teacher or parent might say instead:

  • “I noticed that you wrote all of the letters of your name on the line and it was really easy to read.”
  • “I appreciate that you asked some insightful questions during our discussion about the Constitution today.”
  • “I know you can write a creative description of the book you read.”

The more specific the encouragement, McVittie says, the more the student will be encouraged to keep working on that expected behavior. Another of McVittie’s key concepts is “connection before correction” to help teachers create helpful relationships with students. An example she uses in her trainings:

A teenaged student tossed a soda can from across the room during class. A trauma-trained teacher pointed to the hallway, and the boy joined her there. Instead of directing him to the office, the teacher explained that she really enjoyed having him in class. She said that he contributed valuable questions. Then she asked why he thought he was in the hallway. He said it was because he threw the soda can. She asked, “What’s your plan?” His answer included apologies and decision-making about how to avoid the mistake again.

This story certainly could have ended differently, and McVittie encourages educators and parents to avoid a “Dignity Double-Bind,” where children experience shame instead of problem-solving:

“Make the child think,” she says, “by showing respect instead of giving orders to obey.”

A Self-Regulation Strategy for Right Now

Sometimes grace starts with self-care. Following is a breathing practice you can use right now to help your nervous system regulate. If you prefer, you can watch a short video from PAVE that demonstrates this technique: Stop and Settle with Five-Fingers Breath.

You will be breathing evenly as you trace the outline of your hand, giving your eyes and your mind something to focus on while you control your breath.

  • Hold up one hand, with your palm facing you.
  • Place the first finger of your other hand onto the bottom of your thumb.
  • As you breathe in, slide your finger up to the top of your thumb.
  • Breathing out, slide your finger into the valley between your thumb and first finger.
  • Breathing in, slide up your first finger. Breathing out, slide down the other side.
  • Continue following your breath up and down all your fingers.
  • When you breathe out down the outside edge of your pinkie, continue to exhale until you reach your elbow.
  • Notice how you feel. Allow your breath to find a natural pattern.

Now that you’ve learned this technique, you can share it with other family members!

State Standards Guide Social Emotional Learning for all Ages and Abilities

A Brief Overview

  • Social Emotional Learning (SEL) is a lifelong process through which children and adults effectively manage emotions, reach toward goals, experience empathy, maintain positive relationships, and make responsible decisions.
  • In school, all students participate in SEL as part of Multi-Tiered Systems of Support (MTSS). Specific SEL instruction can also be part of a student’s Individualized Education Program (IEP).
  • Washington State adopted formal Social Emotional Learning Standards January 1, 2020. The Office of Superintendent of Public Instruction (OSPI) provides an SEL website page with resources for educators, families, and community members.
  • A 12-page SEL equity brief focuses specifically on issues of equity as they relate to race, culture, and economic status.
  • A state law that took effect June 11, 2020, further compels work related to SEL. HB 2816, which was inspired and supported by activist parents, requires the Washington State School Directors’ Association (WSSDA) to develop a model policy “for nurturing a positive social and emotional school and classroom climate.”

Full Article

A child’s ability to understand, communicate, and manage emotions is critical to learning. So are skills that enable a child to socialize, self-motivate, empathize, and work collaboratively. Schools call this area of education Social Emotional Learning (SEL).

SEL is not just for children. According to the Collaborative for Academic, Social, and Emotional Learning (CASEL), “SEL is the process through which children and adults understand and manage emotions, set and achieve positive goals, feel and show empathy for others, establish and maintain positive relationships, and make responsible decisions.”

Students with disabilities may qualify for Specially Designed Instruction (SDI) in social and/or emotional areas of learning as part of an Individualized Education Program (IEP). Eligibility for SDI is determined through evaluation, and schools use various instruments to assess whether a student has a disability affecting social or emotional skills to an extent that education is significantly impacted. If so, the student’s IEP will support learning in those social/emotional areas, and goal-monitoring will track skill growth.

Students with IEPs are not the only ones who receive SEL instruction, however. Schools may use curricula to promote emotional understanding, social stories, mindfulness programs, communication circles or other strategies as part of Multi-Tiered Systems of Support (MTSS). MTSS is a framework for improving school-wide social, emotional, and cultural climate. Schools that adopt an MTSS framework deliver SEL to all students (Tier 1) and generally offer Tier 2 and Tier 3 programming to targeted groups or individual students.

Parenting Tip: Ask whether your school uses an MTSS framework

Family caregivers can ask school staff and administrators whether the district operates within an MTSS framework.

  • If the answer is no, ask how school climate is addressed and how SEL is integrated into school-wide programming.
  • If the answer is yes, ask what SEL instruction looks like in the general education classroom (Tier 1) and how specialized lessons are provided to students with higher levels of need (Tiers 2-3). Note that a student who does not qualify for an IEP could demonstrate the need for social/emotional instruction beyond what is provided to most students. Family caregivers can ask for detail about how the school’s MTSS system supports any specific student.

State adopts six SEL standards

Washington State adopted formal Social Emotional Learning Standards January 1, 2020. The Office of Superintendent of Public Instruction (OSPI), which provides guidance to all public and non-public educational agencies in the state, provides an SEL website page with resources for educators, families, and community members. Included is a link to the official letter in which State Superintendent Chris Reykdal adopted the standards, and a collection of resources to support SEL implementation and to further understanding about how families and communities can participate.

A primary document is the 24-page Social Emotional Learning Standards, Benchmarks, and Indicators, which defines the six SEL learning standards and various benchmarks under each. An extensive chart offers practical guidance for assessing each standard for students in Early Elementary, Late Elementary, Middle School, and High School/Adult. The SEL learning standards include:

  1. SELF-AWARENESS – Individuals have the ability to identify their emotions, personal assets, areas for growth, and potential external resources and supports.
  2. SELF-MANAGEMENT – Individuals have the ability to regulate emotions, thoughts, and behaviors.
  3. SELF-EFFICACY – Individuals have the ability to motivate themselves, persevere, and see themselves as capable.
  4. SOCIAL AWARENESS – Individuals have the ability to take the perspective of and empathize with others from diverse backgrounds and cultures.
  5. SOCIAL MANAGEMENT – Individuals have the ability to make safe and constructive choices about personal behavior and social interactions.
  6. SOCIAL ENGAGEMENT – Individuals have the ability to consider others and show a desire to contribute to the well-being of the school and community.

Developmental milestones are charted with a variety of statements that might demonstrate the skill or disposition within an age range.  

  • For example, a late elementary age student might show self-awareness this way: “I can identify and describe physical symptoms and thoughts related to my emotions and feelings (e.g., hot, shoulders tight).”
  • A middle-school student might demonstrate self-efficacy this way: “I can identify specific human and civil rights and freedoms to which everyone is entitled and can understand how to advocate for myself in healthy ways.”

Tip for Parents: Promote SEL at home

Included on the SEL website page is a list of learning activities for families and educators. The eight-page guide includes links to videos, websites, and ready-to-use resources to encourage positive behavior support and helpful communication at home and at school.  Resources are sorted by age and marked to indicate whether they are best suited for family caregivers, teachers, or both.

  • For example, parents of children K-5 might want to click on SEL Games to Play With Your Child to find a resource from Understood.org. One game, Starfish and Tornadoes, helps kids notice how much energy they are feeling inside and when they might need to use their calming skills or ask for help from a trusted adult.
  • A suggestion for grades 5-12 is to Practice Loving-Kindness for Someone you Care About. That exercise from Greater Good in Education provides adaptations for students with disabilities and suggests ways to make the project culturally responsive.

Another document accessible through OSPI’s website is a three-page guide for parents and families, which includes resource linkages to free online training, parenting cue cards with quick answers to typical concerns, and access to other websites with tools and advice specific for various stages of child development. Also included are tips to promote SEL at home by encouraging a child to:

  • Identify and name their emotions, feelings, and thoughts.
  • Identify positive and negative consequences of actions.
  • Demonstrate the ability to follow routines and generate ideas to solve problems.
  • Create a goal and track progress toward achieving that goal.
  • Identify feelings expressed by others.
  • Identify ways that people and groups are similar and different.
  • Demonstrate attentive listening skills without distraction.
  • Identify and take steps to resolve interpersonal conflicts in constructive ways.
  • Demonstrate a sense of community responsibility

SEL guidance supports equity and inclusion

  • Principles listed throughout the state SEL guidance include:
  • Equity: Each child receives what he or she needs to develop his or her full potential.
  • Cultural responsiveness: Culture is viewed as a resource for learning, not a barrier.
  • Universal design: Learning differences are planned for and accommodated.
  • Trauma-informed: Knowledge of the effects of trauma is integrated into policy and practice.

State guidance that describes the SEL standards and benchmarks includes this statement: “Social emotional learning (SEL) happens over the course of a day, a lifetime, and in every setting in which students and adults spend their time.… Effectively supporting social emotional development in schools requires collaboration among families and communities. It also involves building adult capacity to support a school climate and culture that recognizes, respects, and supports differences in abilities, experiences, and ethnic and cultural differences, and celebrates diversity.”

A 12-page SEL equity brief focuses specifically on issues of equity as they relate to race, culture, and economic status. “A white, middle-class model of self that values independence dominates schools,” the brief states. “Students of color and students in low-income communities often experience ‘cultural mismatch’ in education settings that expect forms of expression and participation not aligned with their culture.

“Without explicit attention to equity and cultural diversity, prevalent SEL frameworks, models, and curricula may not adequately reflect the diverse worldviews of students and families.”

Parenting Tip: Attend your local school board meeting to influence decisions

The state’s SEL implementation guide is intended for local districts to use in developing their own school- or community-specific plan to meet the needs of all learners. Because Washington is a local control state, each district is responsible for policy development.

Families have the option of making public comment at meetings to share thoughts or concerns. School board meetings are required monthly and must follow the state’s Open Public Meetings Act (Chapter 42.30 in the Revised Code of Washington). Families can reach out to their local district for information about how and when school boards meet. The Washington State School Directors’ Association provides a guidebook about the rules for Open Public Meetings. The rules apply in any meeting space or platform.

HB 2816 promotes positive school climate

A state law that took effect June 11, 2020, further compels work related to SEL. HB 2816, which was inspired and supported by activist parents, requires the Washington State School Directors’ Association (WSSDA) to develop a model policy “for nurturing a positive social and emotional school and classroom climate.”

The model policy and procedures for its implementation includes specific elements to “recognize the important role that students’ families play in collaborating with the school and school district in creating, maintaining, and nurturing a positive social and emotional school and classroom climate.” In addition, districts “must provide information to the parents and guardians of enrolled students regarding students’ rights to a free public education, regardless of immigration status or religious beliefs; and school districts must provide meaningful access to this information for families with limited English proficiency.”

In accordance with HB 2816, the WSSDA website will post the model policy and procedure by March 1, 2021. School districts are responsible to incorporate the guidance by the beginning of the 2021-22 school year: “School districts may periodically review policies and procedures for consistency with updated versions of the model policy for nurturing a positive social and emotional school and classroom climate.”

SEL is linked to research about Adverse Childhood Experiences

A national movement to incorporate Social Emotional Learning (SEL) is informed by knowledge that trauma profoundly impacts educational outcomes. In the late 1990s, the Centers for Disease Control and Prevention released its first report about Adverse Childhood Experiences (ACEs). Dr. Vincent Felitti, then the CDC’s chief of preventive medicine, boldly proclaimed childhood trauma a national health crisis. The report led to development of an ACEs survey, which scores a person’s likelihood of suffering lifelong physical and mental health impairments resulting from trauma. An ACEs score of 4, the study found, makes a child 32 times more likely to have behavior problems at school.

The data inspired researchers and educators to seek new ways to help children cope so they can manage themselves at school—and in life. A variety of new evidence-based practices were developed to support childhood resiliency. The National Research Council issued this statement in 2012: “There is broad agreement that today’s schools must offer more than academic instruction to prepare students for life and work.”

The 2015 Washington State Legislature directed OSPI to convene an SEL Benchmarks workgroup, and Senate Bill 6620 in 2016 authorized development of a free online training module in SEL for school staff. The bill states that, “In order to foster a school climate that promotes safety and security, school district staff should receive proper training in developing students’ social and emotional skills.” Development of the state SEL Standards furthers that work.

Parenting tip: Work on your own SEL skills

Family caregivers play an important role in fostering SEL by working on their own self-regulation skills. The Collaborative for Academic, Social, and Emotional Learning (CASEL) provides a wide array of resources, including some related to stressors from COVID-19. “We need to pay close attention to our own social emotional needs in order to be the community of adults who best serve our young people,” CASEL advises. “Practice continued self-care strategies, including eating healthy, getting enough sleep, exercising, and finding time to take breaks.” CASEL provides a checklist to reframe your thinking, including ideas about “all-or-nothing” or overgeneralization, for example.

PAVE provides a series of short mindfulness videos for all ages and abilities and offers additional mindfulness and parenting ideas in an article, Stay Home Help: Get Organized, Feel Big Feelings, Breathe.

Parents are a child’s primary SEL teachers

Family caregivers can help foster SEL skills by collaborating with the school. OSPI’s guidance includes this statement: “Parents and families are a child’s first teachers of SEL. As children grow, parents and families continue to support the social emotional lives of their children in the home.”

Here are a few questions parents might ask school staff to collaborate on SEL skill development:

  • How are you helping my child learn from mistakes?
  • If behavior is keeping my child from learning, what skill is lacking?
  • What is a best-practice strategy for teaching the skill that my child needs to learn?
  • Do you have a tool for understanding and regulating emotions that we can use at home also?
  • How is my child learning to “name and tame” emotions? (Dan Siegel, neurobiologist and author of Mindsight, suggests that recognizing and naming a feeling gives a person power to regulate the emotion.)
  • What positive reinforcement is being provided when my child demonstrates a new skill? How are those positive reinforcers tracked through data collection?
  • What is the plan to help my child calm down when dysregulation makes problem-solving inaccessible?
  • Would a Functional Behavior Assessment help us understand what my child is trying to communicate through this unexpected behavior?
  • Can we collaborate to develop a Behavior Intervention Plan so that we are using the same cues and language to support expected behavior?
  • What adult at the school is a “champion” for my child? (Dr. Bruce Perry, whose research supports trauma-informed initiatives, says, “Relationships are the agents of change and the most powerful therapy is human love.”)

Summer 2020 Recreation and Staycation Options

Summer activities might look different in 2020 because of measures to slow spread of COVID-19. Here are some links and ideas for accessible staycations and other recreation options. This list is subject to changes and updates. Have a suggestion to add? Send us an email: pave@wapave.org.

Please note that these resources are not affiliated with PAVE, and PAVE does not recommend or endorse these programs or services. This list is not exhaustive and is provided for informational purposes only.

Virtual Options

  • Crip Camp 2020: The Virtual Experience
    Join fellow grassroots activists and advocates this summer for a virtual camp experience featuring trailblazing speakers from the disability community. All are welcome, and no prior activism experience is necessary to participate.
  • Youth Leadership Forum
    A Facebook group called Friends of YLF provides the most up-to-date information about plans for a weeklong virtual camp in July 2020.
  • Visit your local library system
    This site provides contact information for Washington libraries. Many libraries offer online activities and options to make summer reading fun and rewarding.
  • Creativity Camp
    Register for a free week of writing, drawing and storytelling classes from award-winning author/illustrator Arree Chung. 
  • Camp Korey
    This 15-year-old program honors the courage, strength, and determination of children with serious medical conditions by providing a camp environment with specialized medical support. 2020 programs include virtual camps and campfire Fridays.
  • Taste of Home catalog of Free Virtual Museum Tours
    From the safety of home and for free, visit the Louvre, SeaWorld, the Winchester Mystery House and many more museums. For example, the Metropolitan Museum of Art provides a free 3-D tour of its exhibit halls.
  • National Parks Virtual Tours
    Insider provides links to virtual tours of 32 national parks, including the Grand Canyon, Yellowstone, and Arches National Park.
  • NASA Kids’ Club and NASA STEM @ Home
    The NASA Kids’ Club offers video-style games and opportunities to learn about the work of NASA and the astronauts. The STEM @ Home programs provide interactive modules in Science, Technology, Engineering and Math (STEM) for grades K-4, 5-8, and 9-12.
  • Sesame Street Caring for Each Other
    Favorite Muppets provide sing-alongs, interactive games, and other ready-to-use materials to spark playful learning for the whole family during COVID-19 and beyond.
  • Storyline Online
    Have you noticed that there are a lot of famous people reading books? Storyline provides a place to find many of them in a virtual library.
  • Nomster Chef
    Picture-book recipes for Kid Chefs and added tips for grown-ups are designed for families cooking together at home.

In-Person Options

Please note that scheduling may change based on COVID-19 restrictions. Please check each program website for the most current information.

  • Spectra Gymnastics
    Programs are designed to support individuals with Autism, sensory issues, and related disorders, ages 2-21.
  • Aspiring Youth  
    Summer camp opportunities with in-person and online options. Camps provide opportunities to explore theater, art, climbing and more. 
  • Camp Killoqua 
    These Camp Fire programs are open to all — including youth who are not members of Camp Fire. Camps strive to be inclusive; acceptance and participation is open to everyone regardless of race, religion, socioeconomic status, disability, sexual orientation, or other aspect of diversity.
  • C.A.S.T. for Kids
    Catch a Special Thrill (C.A.S.T.) provides fishing events for kids with special needs. Check the interactive map and calendar for summer events near you.
  • Blue Compass Camps
    Sea Kayaking in the San Juan Islands is among the offerings for youth with high-functioning autism, Asperger’s, and ADHD.

Low-Tech Fun

  • Pirate Treasure Hunt: Dress up as pirates to follow clues that lead to a bounty of treasure! Decorate the house, offer goldfish- shaped crackers as snacks, and design an X to mark the spot where the treasure is found!
  • Under the Stars:  Stay up late to learn about astronomy. No cost apps like Sky Map and Star Walk help locate planets, stars, and constellations with ease. Make it fun on a warm night with a blanket on the grass to keep you comfy while you gaze up!
  • Unplug and get off the grid: Make a point to unplug and tune into fresh air, exercise, and nature. If you don’t already know an outdoor spot to explore, All Trails can help you find hiking or walking trails.
  • Check out PAVE’s Lessons at Home videos: We’ve got short, curiosity-inspiring projects that require limited equipment for those “I’m bored!” moments.
  • Practice being Mindful: Need a breath and a moment of peace? PAVE has short videos for creating mindfulness that are accessible for almost all ages/abilities.
  • For more ideas and information, PAVE provides two resource lists to help with learning at home and to support families navigating the national health emergency:

Tips to Help Parents Reinforce Positive Behaviors at Home

A Brief Overview

  • Positive Behavioral Interventions and Supports (PBIS) is a strategy schools use to teach children expected behavior. Read on for PBIS strategies families can use at home.
  • A key PBIS principle is that punishment fails to teach children and youth what they should do instead. Adults can direct a child toward a better choice or interrupt an escalation cycle.
  • The easiest way to change a behavior is to point out what a person does right. Remember this catchy phrase, “5:1 gets it done,” to ensure five positive interactions for each negative interaction.
  • Parents might find success with strategies they can share with school staff eventually.
  • For additional strategies unique to COVID-19, the Office of Superintendent of Public instruction (OSPI) offers a series of 3 webinars for family caregivers. For information and links to the videos, see PAVE’s article: Webinars offer Parent Training to Support Behavior during Continuous Learning.

Full Article

Schedule changes and seasonal transitions cause emotional upheaval for some families in typical years. Summer 2020 includes unique conditions, with families moving into a summer with fewer-than-usual options to keep children busy after months of learning from home due to the COVID-19 building closures. A few strategies, described below, might help families keep things chill this summer.

Experts in education use a framework for creating a positive environment called Positive Behavioral Interventions and Supports (PBIS). PBIS has been implemented in more than 26,000 U.S. schools. The PBIS framework has been shown to decrease disciplinary removals and improve student outcomes, including grades and graduation rates. When done well, PBIS provides positive social skills, communication strategies and “restorative justice,” (working it out instead of punishing) and may prevent 80-90 percent of problem behaviors.

Punishment does not teach

PBIS requires an understanding that punishment fails to help a child know what to do instead. Researchers have learned that a child who is being punished enters an emotionally dysregulated state (fight/flight/freeze) that blocks learning. Adults who calmly direct a child toward a new way of problem-solving can interrupt or prevent an escalation.

Keep in mind that adults need to stay regulated to help children. For strategies related to mindfulness, see PAVE’s article: Stay Home Help: Get Organized, Feel Big Feelings, Breathe. PAVE also provides a library of short videos with mindfulness and breath practices for all ages and abilities: Mindfulness Videos.

Within a PBIS framework, de-escalation strategies might include:

  • Remove what is causing the behavior
  • Get down to eye level
  • Offer empathy—the ability to understand and share the feelings of another
  • Provide choices
  • Re-teach expectations
  • Reinforce desired behaviors
  • Communicate care instead of control

Behavior is a child’s attempt to communicate

Simple, consistent, predictable language is a critical component. Insights about these strategies and more were shared in a webinar by Change Lab Solutions on April 30, 2019.

Among experts talking about PBIS are staff at the University of Washington’s School of Mental Health Assessment, Research and Training (SMART) Center. Staff from the SMART center lead the School Mental Health supplement of the Northwest Mental Health Technology Transfer Center (NWMHTTC). These agencies, in collaboration with the League of Education Voters, in June 2019 hosted a webinar: How to Implement Mental Health Supports in Schools, focused on the importance of blending school and community supports with PBIS.

A University of Washington (UW) expert who participated in the webinar is Kelcey Schmitz, a former OSPI staff member who has written articles for PAVE about positive behavior supports and state initiatives and has experience helping families and schools implement PBIS.

“PBIS is a game changer for children and youth with behavior challenges and their teachers and caregivers,” Schmitz says. “In fact, everyone can benefit from PBIS. Behavior is a form of communication, and PBIS aims to reduce problem behavior by increasing appropriate behavior and ultimately improving quality of life for everyone. The same approaches used by schools to prevent problem behaviors and create positive, safe, consistent and predictable environments can be used by families at home.”

Schmitz, an MTSS training and technical assistance specialist, provides the following specific tips for creating a successful PBIS home environment.

Support Positive Behavior before there is a problem

PBIS is set up with three layers—called tiers—of support. The parent-child relationship is strengthened by loving and positive interactions at each tier.

Tier 1 support is about getting busy before there is a problem. Much like learning to wash hands to prevent getting sick, expected behavior is taught and modeled to prevent unexpected behaviors.  Parents can look at their own actions and choices and consider what children will see as examples of being respectful, responsible, and safe.

Tiers 2 and 3 are where adults provide more support for specific behaviors that are getting in the way of relationships or how the child or youth functions. In a school setting, Tier 2 is for students who need a social group or some extra teaching, practice, and reinforcement. Tier 3 supports include a Functional Behavioral Assessment (FBA) to find out why the behavior is occurring, and an individualized Behavior Intervention Plan (BIP).

Any student may access supports that include aspects of Social Emotional Learning at all three Tiers. At home, Tiers 2 and 3 naturally will be more blended and may include support from a community provider. Note that targeted interventions in Tiers 2-3 work best when Tier 1 is already well established.

Define, teach, and routinely acknowledge family expectations

  • Discuss how you want to live as a family and identify some “pillars” (important, building-block concepts) that represent what you value. Talk about what those pillars look like and sound like in every-day routines. To help the family remember and be consistent, choose only 3-5 and create positive statements about them. Here are a few examples:
    • Speak in a respectful voice.
    • Be responsible for actions.
    • Be safe; keep hands, feet, and objects to self.
  • Identify a couple of “hot spots” to begin. Challenging behaviors often occur within routines.  Perhaps mornings or mealtimes create hot spots for the family. After discussing 1-2 ways to be respectful, responsible, and safe in the morning, teach what each looks like. Have fun with it! Set up “expectation stations” for practicing the plan and assign each family member one pillar to teach to the rest.
  • Behaviors that get attention get repeated. Notice when a child does the right thing and say something about each success: “I noticed you stopped to pick up your shoes in the hallway. Thanks for putting them away and keeping the walkway safe for others.” The easiest way to change a behavior is to point out what a person does right!
  • Remember this catchy phrase, “5:1 gets it done” to ensure five positive interactions for each negative interaction. When the expected behavior becomes routine, the reinforcement can fade away.

Create engaging and predictable routines

  • Children crave structure and routine. Adults may look forward to a relaxing evening or weekend, but kids often need regular activity and engagement. Consider that either the kids are busy, or the adults are busy managing bored kids!
  • Use visuals to create predictability. A visual schedule can display major routines of the day with pictures that are drawn, real photos or cut-outs from magazines. Create the schedule together, if possible.  Parents can ask a child to check the schedule – especially when moving from a preferred to non-preferred activity. It’s hard to argue with a picture!

Set the stage for positive behavior

  • Teach, pre-teach, and re-teach. Children need to learn behavior just like they learn colors and shapes. A quick reminder can help reinforce a developing skill: “When we get in the car, sit up, buckle up, and smile!”
  • Give transition warnings or cues to signal the end of one activity and the beginning of another: “In five minutes, it will be bath time.”
  • First/then statements set up a child for delayed gratification: “First take your bath; then we can play dolls.”
  • Focus on Go instead of Stop. Children often tune out words like NoDon’t and Stop and only hear the word that comes next, which is what an adult is trying to avoid. Tell a child what to do instead of what not to do: “Take your plate and put it in the sink.” Save Stop and No for dangerous circumstances that need a quick reaction.
  • Choices prevent power struggles: “Would you rather play for five more minutes or get in the bath now?”  “Feel free to choose the pink pajamas or the green ones.”

While these strategies may not eliminate all problem behaviors, they create consistency, predictability, and a more positive atmosphere. They teach new skills to help children get their needs met. The solid foundation will help even if challenging behaviors persist by creating a bedrock for additional layers of support.

Here are places to seek additional information:

Parenting with Positive Behavior Support: A Practical Guide to Resolving Your Child’s Difficult Behavior 

Home and Community Based Positive Behavior Support Facebook Page

Home and Community PBS Website

Parent Center Hub Positive Behavior Supports Resource Collection

Intensive Intervention: An Overview for Parents and Families

The Association for Positive Behavior Support

Getting Behavior in Shape at Home

Family Resources for Challenging Behavior

The National Center for Pyramid Model Innovations (NCPMI) Resource Library, articles in multiple languages

Behavior and Discipline in Special Education: What to do if the School Calls Because of a Behavior Incident

Continue reading “Behavior and Discipline in Special Education: What to do if the School Calls Because of a Behavior Incident”

Section 504: A Plan for Equity, Access and Accommodations

A Brief Overview

  • Section 504 is part of the Rehabilitation Act of 1973, which is upheld by the United States Office of Civil Rights.
  • This law protects access rights to public places and programs for individuals with disabilities. Accommodations that support access are guaranteed, and not providing access is a form of discrimination.
  • All students with qualifying disabilities are part of a protected class under Section 504, including those on 504 Plans and those on Individualized Education Programs (IEPs).
  • Section 504 protects a person with disabilities throughout life and covers individuals at work and in any public facility or program.
  • Key terms are equity and access to opportunity. A government-funded place or program provides whatever is needed so the person with a disability can benefit from the place or program. The opportunity is equitable when supports provide a way for the person to overcome the barrier of disability (to the maximum extent possible) to access the place or program that everyone else has the right to access.
  • Section 504 defines disability as an impairment that impacts a major life activity. If a student in school meets criteria, then the school provides what a student needs to access a Free Appropriate Public Education (FAPE) in the general education setting. ​
  • A Section 504 Plan determines what a student needs to receive equitable benefit from school.

Full Article

Section 504 is part of a law called the Rehabilitation Act of 1973, which is upheld by the United States Office of Civil Rights. This law is about access–to a public place or program. Section 504 protects a person for life and allows every student, employee or guest in a public institution to ask for and expect supports and productivity enhancers–what they need to succeed.

All children with disabilities who qualify for special services in school are protected by the provisions of the Rehabilitation Act. Students who qualify for Special Education are protected by Section 504 and the Individuals with Disabilities Education Act (IDEA). Children protected by IDEA have Individualized Education Programs (IEPs), and children who qualify for some support but do not meet the IDEA’s specific criteria may have Section 504 Plans. This article is primarily about Section 504 Plans. For more detailed information about the IEP, PAVE provides an article, Get Ready for School with IEP Essentials.

Education rights are like a pyramid: At the top of the pyramid is the IDEA (Individuals with Disabilities Education Act), which provides a full menu of special education programming and services for qualifying students.  Children at the top of the pyramid have all the protections of each of these laws.

At the center of the pyramid is Section 504, part of the Rehabilitation Act of 1973, which guarantees non-discriminatory rights to equitable access for individuals with disabilities.

ESSA (Every Student Succeeds Act) is at the bottom, providing all children in the United States the right to a free public education “to ensure that every child achieves.”

Schools are bound by Section 504 as “covered entities,” places or programs that receive money from the U.S. government. Schools provide access to Free Appropriate Public Education (FAPE) by helping students with 504 Plans to succeed in regular classrooms and school settings. The goal is to meet the student’s needs as adequately as the needs of nondisabled students to offer equity and access to opportunities. Keep reading to learn more about what equity truly means.

Section 504 defines disability as an impairment that impacts a major life activity. A school team considers a variety of information to consider whether a student qualifies for a Section 504 Plan. A formal evaluation is not required, and parent involvement is voluntary. The team asks:

  1. Does the student have an impairment?
  2. Does the impairment limit one or more major life activities?

The law is intentionally broad, so it doesn’t limit the possible ways that a student who needs help can qualify for that help. ​A list of possible impairments is, therefore, unlimited. Here are a few examples:

  • Physical disability that might affect mobility, speech, toileting or a human function: Spina Bifida, deafness, dwarfism, loss of a limb
  • Cognitive, psychiatric, or emotional disorder: intellectual disability (Down Syndrome), a specific learning disability (Dyslexia), a brain illness or injury (bipolar disorder, Traumatic Brain Injury), an emotional disturbance (anxiety, depression) ​
  • Major bodily functions: disease of the immune system, digestive or urinary issues, an impairment of the nervous system or heart

​A list of major life activities is also endless. Whether an impairment “substantially” limits a major life activity is determined individually. Some impairments affect the ability to practice self-care, and challenges in basic life tasks like walking, seeing, hearing, speaking, breathing, learning, and working are captured. Someone with sensory challenges might struggle to concentrate, think and communicate—all of those can qualify as major life activities. ​Really, any system in the body might have a challenge that creates a barrier for an individual and therefore can qualify as a disability.

A photo of a slide that states that a Major Life Activity Includes: walking, seeing, hearing, speaking, breathing, learning, working, digesting, toileting, eating, sleeping, standing, reading, concentrating, thinking, communicating and lifting

Sometimes a Section 504 Plan provides adequate support, and sometimes the family and school consider whether the student qualifies for an IEP with a full menu of special education protections. A 2018 federal court ruling in favor of a student with Crohn’s disease provides an interesting example. Parents had provided the school with information about his diagnosis and requested an evaluation for services. Their request was denied. The Third Circuit Court found the school in violation of the student’s right to appropriate evaluation under the Child Find Mandate. The court also found that the school should have provided special education services, not only accommodations with a Section 504 Plan:

“In seeing Crohn’s as something requiring only a Section 504 accommodation, not IDEA special education, [the district] treated the disease as something discrete and isolated rather than the defining condition of [this student’s] life.” 

An online search can find a range of information related to Crohn’s Disease or other specific medical conditions and how to design a specific educational plan to meet a student’s needs. The Crohn’s and Colitis Foundation, for example, provides a template for a Section 504 Plan for a student with serious medical issues related to digestion.

Equity doesn’t mean Equal

Supports and services for a student with a disability seek to provide equity. Equal opportunity would mean that all students get the same help. Getting the same help doesn’t give all students the same opportunity. In this picture, on the left, the little guy in the light blue shirt can’s see the game, even though he’s got the same platform as the taller guy. ​He needs a different platform to have the same opportunity to see the game.

The depiction of equality through the illustration of three children on a box and then justice is shown by making the boxes different sizes to serve the needs of each individual

The help that makes access to learning equitable puts the word Appropriate in FAPE– Free Appropriate Public Education.

Students with known disabilities get help and productivity enhancers to access the opportunities for success that all students have. If they need a taller crate—or an extra teacher, or a special swing on the playground, or training in Social Emotional Learning (SEL) or something else specific that gives them the same opportunity to learn, grow and benefit from school, then their civil right is to get the boost they need to have an equitable opportunity. ​

Accommodations and services create equity in order to give people a fair opportunity to succeed. This level of fairness can be called justice. 

Under Section 504, individuals with impairments have a right to get into public places—with ramps, elevators, braille labels on doors…whatever is needed for physical access. Other aspects of access are less obvious. Individuals with unseen disabilities have the right to accommodations that will make a program or service as effective for them as it is for the general population.

Positive behavior supports through a are an example of an accommodation that can help a student with a disability access the major life activity of learning. A BIP can be a stand-alone plan or can accompany a Section 504 Plan or an IEP. A BIP is developed after the school conducts a Functional Behavior Assessment (FBA). Parents sign consent for the school to conduct an FBA.

Section 504 Supports Inclusion and Bars Discrimination

Section 504 includes elements of inclusion. A person with a disability has the right to access the regular program unless special help and different options cannot work to provide that person with benefit from the program or service.

This is important in education: Students have the right to get help so they receive an equitable benefit from learning in the general education classroom. They move to a more specialized setting only if those supports fail to provide appropriate and equitable access. ​This is true for students on 504 Plans and IEPs.

Under Section 504, any alternative space or program must be “comparable.” Clearly, that’s subjective, but it’s important language to include in any discussion with the school if parents have concern that a child is not receiving an education that is equitable or comparable to that being offered to typically developing students. ​

According to the Office of Civil Rights, as an institution that receives government funding, a school is bound to avoid policies that might on purpose or accidentally exclude persons with disabilities. ​In other words, if a school’s policy or action creates a barrier to access for a student with a disability, the school might be cited for discrimination if the Office of Civil Rights did an investigation.

Here are examples of how Section 504 might impact a student:

  • The school helps a student succeed with other students in the regular classroom, which is the most integrated setting.​
  • If the student needs extra help or technology or a special place to sit, he/she gets that because the school is ensuring accessibility. ​
  • If the student needs to take a different test or get a homework deadline changed, then the school makes those reasonable modifications, which don’t fundamentally alter the program. ​
  • An auxiliary aid might be a 1:1 para, and the school district provides that. ​

Section 504 Protects Students Everywhere at School
Access rights are not limited to the classroom but include all aspects of school and learning. This is just a short list of school settings that are governed by Section 504:​

  • Classrooms​
  • School bus/transportation​
  • Lunch​
  • Recess​
  • PE (Physical Education)​
  • After-school Clubs​
  • Sports​
  • Field Trips

Are Parents Part of the Section 504 Team?

The Rehabilitation Act doesn’t require schools to involve family members in the administration of a 504 plan. However, the plan is managed by a responsible school staff member who notifies parents before a student is evaluated or placed on a 504 Plan and provides parents/guardians with a copy of the plan.

The school also provides written notification to parents about their rights to disagree through grievance procedures. The document that describes these procedures is called “procedural safeguards.” ​If a parent requests a formal evaluation for special education services, and the school district refuses, the school district must provide the parent with a written copy of the procedural safeguards.

How is a 504 Plan Different from an IEP?
The decision to include parents in 504 team meetings is determined by each school district. ​However, parents may contribute information such as doctor reports, outside testing reports and personal reflections and concerns. Schools are expected to make sound educational decisions about what the child needs to be successful.​

The fact that parent participation is not a guarantee of the law makes Section 504 different from the IDEA, which requires parental involvement in the IEP process. Here are a few other differences between these two laws:

  • A 504 Plan is nearly always implemented within the general education setting, whereas an IEP may include placement in a variety of inclusive and specialized settings.​
  • A 504 will NOT include academic goals, benchmarks, or measurements, which are key features of an IEP. ​
  • Under Section 504, a qualified student with a disability is protected regardless of whether the student needs special education. ​
  • An IEP is an educational program that follows a student through high school; a 504 Plan is a Civil Rights protection that follows a person throughout the lifespan.​
  • Remember, Section 504 is about equity and access, and the protections of the Rehabilitation Act cover students on Section 504 Plans and IEPs. ​

How are Discipline and Behavior addressed by Section 504?

​Students with disabilities are a protected class when schools administer disciplinary actions. If a student with a disability is suspended for multiple days within a school term, the school is required to have a meeting called a Manifestation Determination meeting. This requirement specifically states that schools hold this meeting by the 10th day of suspension.​

The school and family will go through a specific set of questions to determine whether the behavior that led to the suspension was caused by some aspect of the student’s disability. In other words, did the behavior manifest from the disability? ​

At that meeting, the team will decide whether the school followed the 504 Plan, the IEP, the specific behavior plan and/or its own disciplinary policies in making the decisions about what to do. If the team determines that the student’s disability was the cause of the behavior and/or that the school didn’t follow procedure, then the student may qualify for Compensatory Services—additional learning time—to make up for missed education during the suspension. ​

For a student with a Section 504 Plan, this meeting can also direct the school to conduct a comprehensive educational evaluation to see if the student’s disability qualifies that student for the full menu of special education options available under the IDEA—including an IEP.​  A website called School Psychologist Files has an article and a chart comparing Section 504 and IEP.

Here are a few points related to Section 504, discipline and behavior:

  • Students with disabilities can be disciplined. ​
  • Students with disabilities have special protectionsregarding discipline. ​
  • Schools cannot change a student’s “placement” without following the rules. Placement is where the student receives learning.  If the school disciplines a student with a 504 Plan in a way that changes the location where the student receives education, this may constitute a change in placement. The Office of Civil Rights has specific laws that govern what constitutes a change in placement and how schools respond. ​
  • ​Students with disabilities are a protected class. Schools have the right to discipline students to keep everybody safe, but the schools are bound by specific rules and regulations to make sure that their disciplinary actions aren’t discriminatory. ​
  • ​If a student with a disability keeps getting taken out of class because of behaviors, then the disciplinary actions might add up to a significant change in placement. The law states that this change is placement triggers a re-evaluation and opens the possibility that a higher level of special education service might be needed to support and protect this student with a disability. ​

Rules for Schools

Some parents are anxious about questioning actions taken by the school. It’s important to remember that parents also have protections under the law. The Office of Civil Rights maintains specific guidelines that do not allow schools to retaliate against parents for asserting their rights to participate in a student’s education. ​

Parents can reach out directly to the Office of Civil Rights:

  • OCR Seattle Regional Office at: 206-607-1600​
  • National: 800-877-8339 (TTY) or Federal Relay Service (FRS) at 1-800-877-8339 ​

Here are some additional resources for information about Section 504:

The United States Department of Health and Human Services: HHS.Gov

The U.S. Office of Civil Rights:  www2.ed.gov
Center for Parent Information and Resources (CPIR): parentcenterhub.org
Parent Guide to Section 504: GreatSchools.org
Office of Superintendent of Public Instruction (OSPI): k12.wa.us
For legal interpretations of Special Education and Section 504 Law: Wrightslaw.com