Mental Health Education and Support at School can be Critical

A Brief Overview

  • Alarming statistics indicate the pandemic has worsened behavioral health outcomes for young people. Governor Jay Inslee on March 14, 2021, issued an emergency proclamation declaring children’s mental health to be in crisis.
  • Students eligible for special education services through the federal category of Emotional Disturbance are more than twice as likely as other disabled peers to quit school before graduating.
  • These outcomes make adolescence a critical time for mental health promotion, early identification and intervention. Read on for further information and resources.
  • Seattle Children’s Hospital has a referral helpline. Families can call 833-303-5437, Monday-Friday, 8-5, to connect with a referral specialist. The service is free for families statewide.
  • Help is available 24/7 from the Suicide Prevention Lifeline: 1-800-273-TALK.
  • Text HEAL to 741741 to reach a trained Crisis Text Line counselor.
  • For youth who need support related to LGBTQ issues, the Trevor Projectprovides targeted resources and a helpline: 866-488-7386.
  • A place to connect with other families is a Facebook group called Youth Behavioral Healthcare Advocates (YBHA-WA).

Full Article

Alarming statistics indicate the COVID-19 pandemic has worsened circumstances for young people who were already struggling to maintain mental health. Washington’s most recent Healthy Youth Survey, from 2018, revealed that 10 percent of high-school students had attempted suicide within the year. Governor Jay Inslee on March 14, 2021, issued an emergency proclamation declaring children’s mental health to be in crisis.

The governor’s order requires schools to provide in-person learning options and directs the Health Care Authority and Department of Health to “immediately begin work on recommendations on how to support the behavioral health needs of our children and youth over the next 6 to 12 months and to address and triage the full spectrum of rising pediatric behavioral health needs.”

The Children and Youth Behavioral Health Work Group (CYBHWG) was created in 2016 by the Legislature (HB 2439) to promote system improvement. CYBHWG supports several advisory groups, including one for Student Behavioral Health and Suicide Prevention. The work groups include representatives from the Legislature, state agencies, health care providers, tribal governments, community health services, and other organizations, as well as parents of children and youth who have received services. Meetings include opportunities for public comment. Meeting schedules and reports are posted on the Health Care Authority (HCA) website.

A press for more school-based services

Advocacy for more school-based mental health services comes from the University of Washington’s SMART Center. SMART stands for School Mental Health Assessment Research and Training. The SMART center in 2020 provided the legislative work group with a report: The Case for School Mental Health. The document includes state and national data that strongly indicate school-based behavioral health services are effective:

“Increased access to mental health services and supports in schools is vital to improving the physical and psychological safety of our students and schools, as well as academic performance and problem-solving skills. Availability of comprehensive school mental health promotes a school culture in which students feel safe to report safety concerns, which is proven to be among the most effective school safety strategies.”

The statewide Student Behavioral Health and Suicide Prevention advisory group has recommended widespread implementation of Multi-Tiered Systems of Support (MTSS). Through MTSS, schools support well-being for all students through school-wide programming and offer higher levels of support based on student need. Social Emotional Learning (SEL) is a key component of an MTSS framework, which also creates a structure for providing Positive Behavioral Interventions and Supports (PBIS) at various levels of need.

The Office of Superintendent of Public Instruction, the guidance agency for Washington schools, prioritized 2021 budget requests to Empower all Schools to Support the Whole Child, including through MTSS. In January, 2021, OSPI was awarded a five-year, $5.3 million grant from the U.S. Department of Education to build regional coaching capacity to support districts in their MTSS implementation. As a local control state, Washington districts determine their own specific policies and procedures.

TIP: Families can ask school and district staff to describe their MTSS framework and how students are receiving support through the various levels/tiers.

Special Education is one pathway for more help

Students may access mental health support through the special education system. Emotional Disturbance is a federal category of disability under the Individuals with Disabilities Education Act (IDEA). Appropriate support can be especially critical for these students: According to the U.S. Office of Special Education Programs (OSEP), students eligible for school-based services under the ED category are twice as likely to drop out of high school before graduating.

Note that a student with a mental health condition could qualify for an IEP under the category of Other Health Impairment (OHI), which captures needs related to various medical diagnoses.

In Washington State, the ED category is referred to as Emotional Behavioral Disability (EBD). If the student’s behavioral health is impaired to a degree that the student is struggling to access school, and the student needs specially designed interventions, then the student may be eligible for an Individualized Education Program (IEP). Keep in mind that academic subjects are only a part of learning in school: Social Emotional Learning (SEL) is part of the core curriculum. 

An educational evaluation determines whether a student has a disability that significantly impacts access to school and whether specially designed instruction and/or related services are needed for the student to receive a Free Appropriate Public Education (FAPE). FAPE is the entitlement of a student eligible for special education services and an IEP team determines how FAPE/educational services are provided to an individual student.

Behavioral health counseling can be part of an IEP

Counseling can be written into an IEP as a related service. When included in a student’s IEP as educationally necessary for FAPE, a school district is responsible to provide and fund those services. School districts can receive reimbursement for 70 percent of the cost of behavioral health services for students who are covered by Medicaid and on an IEP.

A student with a mental health condition who doesn’t qualify for an IEP might be eligible for a Section 504 Plan. A disability that impairs a major life activity triggers Section 504 protections, which include the right to appropriate and individualized accommodations at school. Section 504 is an aspect of the Rehabilitation Act of 1973, a Civil Rights law that protects against disability discrimination. Students with IEPs and 504 plans are protected by Section 504 rights.

Behavioral Health encompasses a wide range of disability conditions, including those related to substance use disorder, that impact a person’s ability to manage behavior. Sometimes students with behavioral health disabilities bump into disciplinary issues at school. Students with identified disabilities have protections in the disciplinary process: PAVE provides a detailed article about student and family rights related to school discipline.

Placement options for students who struggle with behavior

IEP teams determine the program and placement for a student. In accordance with federal law (IDEA), students have a right to FAPE in the Least Restrictive Environment (LRE) to the maximum extent appropriate. That means educational services and supports are designed to help students access their general education classroom first. If they are unable to make meaningful progress there because of their individual circumstances and disability condition, then the IEP team considers more restrictive placement options. See PAVE’s article: Special Education is a Service, Not a Place.

Sometimes the IEP team, which includes family, will determine that in order to receive FAPE a student needs to be placed in a Day Treatment or Residential school. OSPI maintains a list of Non-Public Agencies that districts might pay to support the educational needs of a student.

A precedent-setting court ruling in 2017 was Edmonds v. A.T. The parents of a student with behavioral disabilities filed due process against the Edmonds School District for reimbursement of residential education. The administrative law judge ruled that the district must pay for the residential services because “students cannot be separated from their disabilities.”

Strategies and safety measures for families

With the release of the Healthy Youth Survey in Spring, 2019, the state issued a two-page Guide to Mental Health Information and Resources to provide more detail about the survey and to direct families and school staff toward resources for support.

Included is a list of factors that help youth remain resilient to mental health challenges:

  • Support and encouragement from parents/guardians and other family members, friends, school professionals, and other caring adults
  • Feeling that there are people who believe in them, care about them, and whom they can talk to about important matters
  • Safe communities and learning environments
  • Self-esteem, a sense of control and responsibility, and problem-solving and coping skills
  • Having an outlet for self-expression and participation in various activities

The handout includes tips for parents and other adults supporting teens who feel anxious or depressed:

  • Bond with them: Unconditional love includes clear statements that you value them, and your actions show you want to stay involved in their lives.
  • Talk with teens about their feelings and show you care. Listen to their point of view. Suicidal thinking often comes from a wish to end psychological pain.
  • Help teens learn effective coping strategies and resiliency skills to deal with stress, expectations of others, relationship problems, and challenging life events.
  • Have an evening as a family where everyone creates their own mental health safety plan.
  • Learn about warning signs and where to get help
  • Ask: “Are you thinking about suicide?” Don’t be afraid that talking about it will give them the idea. If you’ve observed any warning signs, chances are they’re already thinking about it.
  • If you own a firearm, keep it secured where a teen could not access it. Lock up medications they shouldn’t have access to.

State options for behavioral health services and support

For Washington children and youth with Medicaid insurance, the highest level of community-based care in behavioral health is provided through Wraparound with Intensive Services (WISe). The WISe program was begun as part of the settlement of a class-action lawsuit, TR v Dreyfus, in which a federal court found that Washington wasn’t providing adequate mental-health services to youth. WISe teams provide a wide range of therapies and supports with a goal to keep the young person out of the hospital.

Young people under 18 who need residential care to meet medical needs may be referred to the Children’s Long-Term Inpatient program: PAVE’s website provides an article about CLIP.

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.

The Family, Youth and System Partner Round Table (FYSPRT) provides a meeting space for family members and professionals to talk about what’s working and what isn’t working in mental healthcare. FYSPRT groups provide informal networking and can provide ways for families to meet up and support one another under challenging circumstances.

Federal parity laws require insurers to provide coverage for behavioral health services that are equitable to coverage for physical health conditions. The National Health Law Program (NHLP) provides information and advocacy related to behavioral healthcare access and offers handouts to help families know what to expect from their insurance coverage and what to do if they suspect a parity law violation:

Family Initiated Treatment (FIT) is an option in Washington

Youth older than 13 have the right to consent or not consent to any medical treatment in Washington State. Parents and lawmakers throughout 2018-2019 engaged in conversations about how that creates barriers to care for some teens struggling with behavioral health conditions. The Adolescent Behavioral Health Care Access Act (HB 1874), became law in May 2019. PAVE provides an article about the law and its provision for Family Initiated Treatment.  

Places to seek referrals and information

Seattle Children’s Hospital in 2019 launched a referral helpline. Families can call 833-303-5437, Monday-Friday, 8-5, to connect with a referral specialist. The service is for families statewide. In addition to helping to connect families with services, the hospital is gathering data to identify gaps in care.

PAVE’s Family-to-Family Health Information Center provides technical assistance to families navigating health systems related to disability. Click Get Help at wapave.org or call 800-572-7368 for individualized assistance. Family Voices of Washington provides further information and resources.

Key Resources

For information, help during a crisis, emotional support, and referrals:  

  • Suicide Prevention Lifeline (1-800-273-TALK)
  • Text “HEAL” to 741741 to reach a trained Crisis Text Line counselor
  • Trevor Project Lifeline (LGBTQ) (1-866-488-7386)
  • The Washington Recovery Help Line (1-866-789-1511)
  • TeenLink (1-866-833-6546; 6pm-10pm PST)

Further information on mental health and suicide:  

Webinars offer Parent Training to Support Behavior during Continuous Learning

While school facilities are closed because of COVID-19, families impacted by disability face complex challenges. For some, children’s difficult behaviors are a regular concern. According to the Centers for Disease Control and Prevention (CDC), stress and anxiety in children and youth may show up through unexpected or maladaptive behaviors. Those behaviors might get worse because of fear, isolation, and disrupted lives.

Meanwhile, some of the help that used to be there is gone. At school, students may have gotten 1:1 support or direct instruction to encourage behavioral skill-building. Those aspects of a special education program might be difficult or impossible to provide during social distancing.

While students are learning from home, parents can request individualized support from the school to support behavioral expectations, if behaviors have educational impact. Parent training can be a related service in a student’s Individualized Education Program (IEP). As always, family caregivers can request an IEP meeting to discuss options to support academic and behavioral goals and expectations.

If the student has a Behavioral Intervention Plan (BIP), that document might hold clues about strategies most likely to work. For more ideas about how to communicate with the school in reviewing a student’s program and perhaps also designing a temporary Continuous Learning Plan, parents can refer to PAVE’s article: IEP on Pause? How to Support Continuous Learning with School Buildings Closed.

To generally support caregivers in their various roles during COVID-19, Washington’s Office of Superintendent of Public Instruction (OSPI) offers a three-part webinar designed for families to help with behavior in continuous learning environments. The webinar has been recorded and uploaded to YouTube in sections, so families can access the content at their own pace.

The webinars are moderated by Lee Collyer, OSPI’s program supervisor for special education and student support. Collyer, a parent, describes his own challenges during the pandemic alongside ideas from research-based sources. Families are invited to send questions and comments to lee.collyer@k12.wa.us.

In various forums, Collyer has described his investment in fostering positive behavioral supports for students in order to reduce disciplinary actions. In a May 13, 2020, OSPI webinar about Mental Health and Safety, Collyer said, “My fear is that we’re going to try to discipline our way out of trauma.”

Following is a brief description of each segment of the three-part webinar series, with a link to each specific webinar. If you start with the first one, you will have the option to stay connected and flow through all three. Each segment is 20-25 minutes long, and the first one includes some background information about OSPI and Collyer’s role.

Supporting Positive Behavior in Continuous Learning Environments – Part One

Collyer begins the series by sharing OSPI’s official statements related to mission, vision and equity. He offers reassurance to parents that everyone is learning something brand new together, without time for proper training, and that “We should not let pressure from schools, teachers or school communities dictate what works for our family and what kind of learning we are prioritizing during this time.”

Collyer talks about the value of learning that is imbedded in everyday activities and part of family routines. He shares insights from psychiatrist Bruce Perry and psychologist Ross Greene, both widely regarded authors who apply their research to inform parents. Their names are linked here to practical articles about supporting positive behavior, and both are easily searchable to find additional materials.

The OSPI webinar includes signs of stress and anxiety to consider. Collyer recommends behavior solutions based on skill building: If children do not know how to do something (like behave), the answer is to teach, he points out, not punish. The segment ends by explaining how behavior serves a function and understanding that function is key to reducing escalations.

Supporting Positive Behavior in Continuous Learning Environments – Part Two

The second segment begins where the first leaves off, by discussing the functions of behavior and how to identify them and intervene early. Pre-teaching skills and reinforcing positive behaviors over negative ones in a 5:1 ratio is encouraged: For the best outcome, catch a child doing what is expected and provide encouragement five times more often than calling out an unexpected behavior.

The second segment also provides some specific strategies for home/school communications. Collyer describes the difference between a consequence and problem-solving and offers specific strategies for parent/child problem-solving.

Supporting Positive Behavior in Continuous Learning Environments – Part Three

The third segment begins with information about how a crisis might escalate and how reason and logic are compromised when fear and frustration highjack a person’s response system. Adults may need to consider their own escalation cycles and develop a personal plan for self-control to support children, Collyer says.

He describes how children might be uneven in their development of cognitive versus social-emotional skills and how that might create confusion about the best parenting strategy. How to set limits with considerations for trauma and ways to shift from negative to positive interventions are additional strategies provided in the final segment of this webinar series.

For additional resources from OSPI, visit the page for Special Education Guidance for COVID-19.