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.

 

Stop and Settle with Five-Fingers Breath

A reaction is not the same as a response. A reaction is instant and emotional and comes from a part of the brain wired for survival. A response requires time for thinking and planning. Sometimes waiting long enough to respond thoughtfully is hard. This video shows you how to use your own hand as a tool to practice waiting and breathing until clear thinking comes back online.

Children might learn to put out their hand like a stop sign, then turn the palm toward their face to trace each finger with the other hand while taking five breaths. Start at the thumb and trace up and down each finger. Breathe in while tracing up the finger, and breathe out while tracing down the finger, moving along the hand until a long exhale slides all the way from the tip of the pinkie finger down to the elbow. Pause to notice how you feel after finishing.

Clear the Mind with a Beach Jar

When the mind is all stirred up with anxiety, fear, anger or another emotion, thinking clearly is impossible. A homemade beach jar works like a snow globe. Shake it to create a literal version of what a murky mind feels like. Watching the contents settle creates something to do while waiting for the mind to clear. You can shake it and watch it clear as many times as it takes before you are ready for intentional action.  

This video includes a quote from Lao Tzu, either a person or a collective of Chinese philosophers who lived in 6th century BCE: “Do you have the patience to wait until your mud settles, and the water is clear? Can you remain unmoving until the right action arises by itself?”

To make a bear jar, use a clear jar with a snug-fitting lid and fill it with:

  • Sand
  • Shells
  • Marbles or small stones
  • Glitter or homemade confetti, using a hole punch and folder layers of aluminum foil
  • Water

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 won’t or can’t independently seek medical help for mental illness and/or substance use disorder.
  • The Washington State Health Care Authority (HCA) in March 2020 launched several website links with information about the new law, which includes an option for Family Initiated Treatment (FIT).
  • The Washington State Hospital Association on July 9, 2019, provided a slide presentation describing the law’s history and its primary features.
  • A place to connect with other families concerned about adolescent mental healthcare access in Washington State is a group called Youth Behavioral Healthcare Advocates (YBHA-WA) on Facebook. Included on the page are handouts that summarize key aspects of the new law. 

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 agency’s 2020 rankings list Washington in the 43rd position, based on various measures that indicate a higher prevalence of mental illness and lower rates of access to care.

Often a barrier to treatment is the youth, who may not be able to see a problem or want to get professional help. Parents often struggle to navigate systems that must balance a young person’s autonomy with concern that they may not be able to make good decisions because of their development, specific illness circumstances or symptoms that impact the brain.

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 mental health or substance use treatment, regardless of whether parents and providers agreed that such treatment was necessary to protect the safety and well-being of the adolescent.

A law passed by the Washington legislature in 2019 gives parents and providers more leverage when a young person is struggling with a mental illness or substance use disorder and won’t independently engage with treatment. The law does not limit an adolescent’s ability to initiate treatment on their own.

A 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.”

The Adolescent Behavioral Health Care Access Act enables parents/caregivers to bring a child for inpatient or outpatient treatment without requiring consent from the child, ages 13-17. The law includes elements introduced by the state Senate and House of Representatives, which originally titled the bill as HB 1874.

Passage of the law was a win for the Children’s Mental Health Work Group, which studied and reviewed recommendations from a stakeholder advisory group authorized by the 2018 legislature. The final version of the law included input from family members, youth, clinicians, hospital staff and many others who met dozens of times. A June 13, 2019, slide presentation available online provides additional history and detail about the work group and its recommendations: Family Initiated Treatment and Engaging Families in Treatment of Youth. The webinar with sound is available on YouTube.

The 2020 legislature is considering amendments to the law, and the Children’s Mental Health Work Group continues to meet to consider proposals to clarify provisions that relate to residential treatment and referrals for Wraparound with Intensive Services (WISe).

“Parent” is broadly defined

The 2019 law expands the definition of parent 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. 

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.

A substantive change with the 2019 law is that providers may share mental health 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.

How Family-Initiated Treatment Works

If a parent/caregiver believes that an adolescent requires mental health or substance use disorder treatment, the adult can escort the young person to an inpatient or outpatient treatment facility even if the adolescent doesn’t readily agree to go.

A provider will assess the adolescent and consider information from the family to determine whether treatment is medically necessary. An adolescent’s refusal to engage with the provider cannot be the sole basis for refusing to treat.

An inpatient facility can detain the adolescent under Family-Initiated Treatment (FIT) if medically necessary. Note: another option could be detention under the Involuntary Treatment Act (ITA), if the adolescent is determined to be gravely disabled or at imminent risk of self-harm or harm to others.

If medical necessity is found by an outpatient provider, a counselor 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.

State laws continue to encourage autonomy for young people, but family engagement is encouraged. 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.”

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, 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

Information about state laws related to Behavioral Health Services for Minors is available through the Washington State Legislature website under RCW 71.34.

Information about child and youth behavioral health services in Washington State is available from the Health Care Authority (HCA).