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School Counseling

Five strategies to develop mental health models in schools

By Dakota L. King-White March 12, 2018

Over the past 13 years, I have dedicated my career to developing mental health services and models within the academic setting as a school counselor, mental health therapist and now as an assistant professor in counselor education, where I engage in community action research to develop mental health models in schools from pre-K through 12th grade. From my research and experiences, I have observed that students’ ability to learn is significantly affected by their mental health.

Many of our nation’s students have been exposed to traumatic events and regular life stressors that act as barriers to their success. Exposure to violence and other traumatic experiences can have a lifelong effect on academic achievement. Within the school setting, this can be manifested in a number of ways, including trouble concentrating, low grades, a decline in test scores and students avoiding school or dropping out of school entirely.

Making an investment in prevention and intervention services can help to address students’ overall development and thus enhance their ability to succeed socially, emotionally and academically. The school setting is an ideal place to provide mental health support to students. However, it is extremely important for schools to align mental health support with academic achievement goals. This calls for greater collaboration among mental health professionals, teachers, administrators, parents, students, staff and other stakeholders in school settings.

Based on the work I have done in developing mental health models in schools, as well as guidance from the American School Counselor Association (ASCA) National Model, I believe that the following five components are key to effectively supporting both the mental health needs and academic achievement of our students.

1) Create mental health programming based on data-driven decisions.

2) Collaborate to address the mental health needs of students.

3) Provide a tiered system of mental health support.

4) Evaluate mental health services to ensure they are addressing the academic achievement gaps.

5) Communicate the outcomes to key stakeholders.

Make data-driven decisions

Developing mental health models in schools is a preventive measure by which mental health professionals analyze data ahead of time and design programming based on need. This approach allows stakeholders to assess the needs and develop services that truly address the academic, social and emotional gaps. Schools have an obligation to create programming based on their students’ needs.

When developing mental health models in schools, it is imperative to analyze data from several sources. One key component involves looking at data that focus on academic achievement. Report cards, test scores and other instruments that measure academic achievement must be considered. The main priority when addressing mental health issues in schools is to identify barriers that are affecting students’ academic achievement.

Once the needs have been identified, the next step is to create measurable goals to address the gaps. This step involves a collaborative approach that should include school counselors, mental health therapists, parents, teachers, administrators and students. Measurable goals provide a means for stakeholders to evaluate programming and help to ensure that it is supporting academic achievement.

Collaborate to address student needs

In a 2010 article for the Journal of Interprofessional Care, Elizabeth Mellin and colleagues identified collaboration among colleagues as being imperative when developing mental health models in schools. School counselors, mental health therapists, school psychologists and school nurses are the professionals most often tasked with delivering mental health services to students in schools.

School counselors are an excellent resource to support mental health models in schools. Quite often, however, school counselors are still labeled as “guidance counselors” in educational settings and are not always considered when schools are developing mental health services and models. Administrators and other stakeholders must be informed that the practice of school counseling has evolved, with “guidance” being only one component of the services that school counselors provide. According to the ASCA Ethical Standards for School Counselors, the school counselor’s role is to address all students’ “academic, career and social/emotional development needs.” School counselors must actively engage and advocate to inform stakeholders of their titles and responsibilities, which are based on their skill set and training. Their skill set and training include addressing many of the social and emotional barriers that affect the ability of students to succeed academically.

Mental health therapists are another valuable resource. When licensed as a clinical counselor or social worker, these professionals are able to diagnose mental health disorders and provide treatment to students. Another invaluable component of their skill set that often goes untapped is an ability to provide consultation to staff, teachers, parents and administrators. It is also important that mental health therapists collaborate with teachers, administrators, other staff members and families to demonstrate the correlation between mental health and academic achievement.

School psychologists are integral to the collaboration process when developing mental health models in schools. According to the National Association of School Psychologists, the school psychologist’s role includes providing assessments, providing interventions to address mental health concerns and working with teachers, staff, administrators and other stakeholders to create programming to address gaps. As noted by Joni Williams Splett and Melissa Maras in their 2011 Psychology in the Schools journal article, school psychologists who are trained as research practitioners offer a unique skill set that contributes to bridging the gap of research and actual practice of services to support academic achievement.

School nurses can also play a central role in developing mental health models in schools. Quite often, school nurses have mental and physical health records provided by school personnel, parents and outside health care providers. Because of the time these professionals spend with students addressing other health concerns, they are frequently able to screen for mental health concerns. This relationship provides school nurses opportunities to develop rapport with students. It is during these interactions that school nurses can detect changes in a student’s physical or mental health. School nurses can also provide insight to their colleagues about the mental health concerns they have observed within the school setting.

Teachers and administrators are additional important contributors to the development of mental health models in schools and must be equipped to identify mental health concerns in the school setting. In an effort to ensure that all school stakeholders are collaborating and properly equipped, regular meetings are essential. The more collaboration that takes place among the mental health team, teachers, parents, students and administrators, the more likely it is that students will succeed.

Provide a tiered system of support

Kelly Vaillancourt and colleagues described the benefits of a tiered system of mental health support in their 2013 article for the National Association of School Psychologists and the National Association of School Nurses. A tiered system of support for delivering mental health services also provides different levels of care to support students to succeed academically. Keep in mind that schools must use evidence-based strategies. This ensures that the most effective, empirically supported practices available are being used to help students succeed.

Tier one is the universal level of support in which all students have access to mental health services in a school setting. Within tier one, trauma-informed classroom methods are introduced to teachers, administrators and staff. Tier one includes implementation of a social/emotional curriculum for all students that is preventive in nature and that supports academic achievement by addressing social and emotional barriers. It is also imperative to use a strengths-based approach that looks at the positive attributes of the students and builds upon those attributes to provide services for the students. To further support students, families should be made aware of the services and information being taught at school.

Tier two is where targeted interventions are identified for students who need additional mental health support to eliminate barriers that are affecting them academically. Selective interventions are provided to students who exhibit behaviors that are hindering them. Mental health and other services provided at the tier-two level consist of small groups, classroom behavior management strategies for teachers and staff, individual counseling and additional professional development for stakeholders related to social and emotional barriers to academic achievement. Collaboration among the team is extremely important.

The third tier is the most personalized, with intensive strategies provided based on the student’s needs. Typically, this is done through a comprehensive process in which key stakeholders gather to collaborate and strategize about the needs of the student. The team should consist of the mental health team members, the student, the student’s parents or guardians, teachers, administrators and outside agencies that work with the student and family. As highlighted by Kenneth Messina and colleagues’ 2015 article in The Family Journal, family buy-in is crucial at this level because of the importance of collaboration between home and school to support the student’s academic achievement and to identify the student’s strengths. Mental health and related services at this level include, but are not limited to, individual counseling provided by a mental health therapist, crisis intervention, outside counseling services, small group counseling, behavior plans and additional professional development for stakeholders.

Evaluate and communicate

In an effort to improve academic achievement, mental health services provided in the schools must be based on data-driven decisions and evaluated to ensure that progress is being made to address the needs. Vaillancourt and colleagues noted that an effective mental health model includes consistent monitoring of student and program outcomes. This includes reviewing outcome data and analyzing the data to measure gaps, successes and areas of limitation. Evaluation of services is a continuous process.

Once programming or services are provided, it is critical to analyze the data and review the goals that were established for the student. It is imperative to have an outside reviewer provide feedback on the data and assess the outcomes of programming. The outside reviewer could be a mental health professional, teacher, curriculum director, administrator, local college professional or another professional within the district who has experience analyzing data.

Once the data are analyzed, it is vital to communicate the results to the stakeholders. Communicating the results to stakeholders has been found to build rapport and transparency among the team. Communication also allows for stakeholders to understand the impact and correlation between mental health and academic achievement.


There is a need to develop effective mental health models in schools because of the mental health challenges that affect students academically, socially and emotionally. Students will continue to be faced with these challenges, but it is important that schools address the barriers that affect students’ academic achievement. Mental health professionals, teachers, parents, students, administrators and school staff play a vital and collaborative role in the development, implementation and evaluation of mental health services aimed at maximizing students’ academic success. Through the five strategies discussed in this article, I believe that school districts will realize the success of mental health models being implemented within schools to support academic achievement.




Dakota L. King-White is an assistant professor in counselor education at Cleveland State University in Ohio. She is a licensed school counselor and licensed professional counselor. Her areas of research include the development of mental health models in schools, children of incarcerated parents and 21st-century school counseling. Contact her at d.l.king19@csuohio.edu.


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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

U.S. student-to-school counselor ratio shows slight improvement

By Bethany Bray October 20, 2017

On average, there is one school counselor for every 482 K-12 public school students in the U.S. This number has decreased slightly from the previous year’s average of 491-to-1.

The American School Counselor Association (ASCA), a division of the American Counseling Association, compiles a report each year on student-to-school counselor ratios, based on data from the U.S. Department of Education’s National Center for Education Statistics. ASCA’s latest report, released this week, included data on public K-12 schools in the 2014-2015 school year, which is the most recent information available.

“The work that school counselors do to support students’ academic, career, emotional and social development is absolutely critical,” says ACA President Gerard Lawson, an associate professor of counselor education at Virginia Tech. “In today’s schools, counselors are also relied on for their expertise in working with broader mental health needs. It is encouraging to see some improvements in the ratio of students to counselors, and we know that counselors can serve their students, schools and communities more effectively, when the ratio of students to counselors is lower and sustainable.”

The report highlights a disparity that exists across America. The highest ratio, with 924 students for every one school counselor, was Arizona, and the lowest, with a 202-to-1 ratio, was Vermont.

ASCA’s recommended student-to-school counselor ratio is 250-to-1.

“These counselor-to-student ratios are headed in the right direction, but they have a long, long way to go. More school counselors need to be hired, especially in states with the most egregious ratios,” says Nancy Carlson, a licensed clinical professional counselor and ACA’s on-staff counseling specialist.


Other highlights of the report:


  • States with the highest student-to-school counselor ratios were Arizona (924-to-1), California (760-to-1), Michigan (729-to-1), Minnesota (723-to-1), Utah (684-to-1), Illinois (664-to-1) and New York (635-to-1).


  • States with the lowest student-to-school counselor ratios were Vermont (202-to-1), Wyoming (219-to-1), Hawaii (293-to-1), North Dakota (307-to-1), Maine (315-to-1), Montana (319-to-1) and Tennessee (339-to-1).


  • California showed the most improvement over the previous year; the state’s ratio decreased 9 percent, from 822-to-1 (2013-2014) to 760-to-1 (2014-2015).


  • Alabama’s ratio also shifted 9 percent, but in the other direction. The state lost nearly 150 school counselors between 2013-2014 and 2014-2015, increasing its ratio from 417-to-1 to 453-to-1.






ASCA’s full report, with a state-by-state breakdown, is available online: schoolcounselor.org/asca/media/asca/home/Ratios14-15.pdf


Read ASCA’s press release about this year’s numbers:  schoolcounselor.org/asca/media/asca/Press%20releases/ASCA-Student-to-SC-Ratios-Press-Release-10_2017-Final.pdf


The American Counseling Association’s School Counselor Connection page: counseling.org/knowledge-center/school-counselor-connection






Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org


Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.





’13 Reasons Why’: Strengths, challenges and recommendations

By Laura Shannonhouse, Julia L. Whisenhunt, Dennis Lin and Michael Porter September 4, 2017

The Netflix series 13 Reasons Why has launched a national discussion regarding teen suicide, motivating a webinar response from professional organizations about how to shape the dialogue, dozens of editorials and millions of cautionary letters home from schools to parents across the country.

The series, based on a novel, is narrated by high school student Hannah Baker, who made a series of cassette tapes to be passed to 13 individuals she argues contributed to her reasons for dying. Her story is seen through the eyes of a peer, Clay, who listens to the tapes. He comes to understand Hannah’s perspectives about those people and events she claims motivated her suicide, which include Clay’s own (in)actions.

The series has been critically acclaimed for the acting and commended for addressing challenging topics, such as bullying/cyberbullying, sexual assault and teen suicide. However, school administrations, school counseling associations, suicide prevention organizations and counseling/psychology associations such as the American Foundation for Suicide Prevention (AFSP), the Suicide Prevention Resource Center (SPRC), the American School Counselor Association (ASCA) and the National Association of School Psychologists (NASP) have advised caution because of the graphic nature, revenge fantasies and potential contagion effect. This article highlights strengths and major challenges of the series. It also provides recommendations that have been underrepresented, though not absent, in the discussion.



1) Raising awareness that suicide is a real problem.

According to the Centers for Disease Control and Prevention (CDC), suicide is a major public health issue. The most recent  statistics available note that among high school students, 17 percent have seriously considered suicide, while 8 percent have attempted suicide within the past 12 months. We know that for every suicide, there are many survivors, including the family and friends of the person and those who have experienced psychological, physical and social distress after exposure to a suicide.” The most commonly cited statistic is that each suicide directly affects six people; however, more recent research argues there are between 45 and 80 survivors per suicide.

In 2015, there were more than 44,000 reported suicide deaths, including 5,191 deaths by suicide among those ages 15 to 24. However, this statistic includes only those that were reported. Although there is no consensus on the rate of under-reporting due to stigma or ambiguous cause of death, the best analysis suggests that for each completed youth suicide, there are 100-200 times as many nonfatal suicide actions.

Combining CDC data with our current understanding of rates of suicidal ideation in youth, in this moment there are close to 15 million people in the U.S. who think of suicide in any given year. Suicide is a very real public health issue; when it is ignored, stigmatized or minimized, we as a community are missing the chance to prevent it.

2) Even professional counselors may not be ready to respond to a suicidal situation.

Because counselors often receive referrals of clients who are suicidal, counselors’ competency in identifying and intervening with those at risk is crucially important. However, the overtaxed counselor in 13 Reasons Why, Mr. Porter, is underprepared to face a suicidal student coping with complex trauma. Although he did not act in the scope of best practice, his failings are unfortunately not unusual among counselors, despite decades of advocacy for increased suicide assessment trainings in counselor education.

Mr. Porter missed several suicidal statements (e.g., “I need everything to stop”), made assumptions about contributing events and was uncomfortable talking about suicide (and other issues). We may easily judge Mr. Porter’s mistakes, but as counselors, we should take this opportunity to reflect and ask ourselves if we are ready to respond to a student at risk of suicide. The research is equivocal.

3) Suicide is complex and individual.

Although 13 Reasons Why portrays some known “red flags” that can indicate suicidal intent, the factors that contribute to individual suicides vary. Stressors that may influence one person’s decision to die by suicide may not have the same effect on others. For instance, we know that not all people who are depressed die by suicide (research shows the rate is from 2-15 percent) and that not all people who complete suicide are depressed. There is a variety of prevention programming regarding common warning signs. However, there is no perfect amalgam of warning signs or demographics (e.g., risk for transgender persons) that helps us differentiate who will decide to die by suicide. We need to go beyond just learning warning signs in order to help.

Livingworks, a suicide intervention training organization, focuses on three elements when assessing warning signs and risk factors. First, we must look for the meaning behind stressful events. For instance, in 13 Reasons Why, being listed “Best Ass” was highly distressing to Hannah because she felt objectified and was concerned people would misperceive her to be easy. However, another student, Angela “Best Lips” Romero, was flattered by such attention. The meaning behind the stressful event is more important than the stressful event itself.

Second, we need to know that warning signs can be, and often are, expressions of pain. When Hannah pushed Clay away, he recognized that something was wrong but did not see that her rejection was an indication of emotional pain. Third, we must trust our intuition. One peer recognizes Hannah’s poem as a cry for help but does not offer assistance. We need to pay attention to our gut feelings and act on them to take care of each other.

13 Reasons Why provides an opportunity to see Hannah’s experience of several traumatic events (cyberbullying, being stalked, public objectification, losing money, feeling responsible for a person’s death, witnessing rape and being raped) and does a good job of depicting the pain, shame and isolation she experiences as a result. The viewer has an opportunity to consider Hannah’s subjective experience and understand how the cumulative effect of these “reasons why” motivates her to suicide.

One model to help contextualize suicidality is the interpersonal-psychological theory of suicidal behavior developed by psychologist Thomas Joiner. Joiner states that the highest risk occurs when one feels like a burden to others, feels alienated or lacks belongingness and, crucially, has overcome the natural human inclination toward self-preservation. This model posits that suicide is a process — one gradually builds tolerance to the idea through self-injurious thoughts or behaviors (although each person’s path is unique). There are multiple points on that path at which others can intervene. The 13 Reasons Why series emphasizes those missed opportunities. As in Hannah’s case, every day there are suicides that happen as a result of those missed opportunities.

4) The central message is a positive one.

In the last episode, Clay says to Mr. Porter, “It has to get better, the way we treat each other and look out for each other.” Instead of feeling guilty or turning away, we can task ourselves with being more supportive community members.

All too often, we operate from a place of fear, which is understandable considering that schools have a legal duty to protect students from self-harm, and lawsuits are a potential reality (as shown in 13 Reasons Why). However, when systems or individual responders act out of fear, it focuses the interaction away from the needs of the person at risk. Even well-intentioned modern practices of “suicide gatekeeping” have substituted swift (and protocol-driven) identification and referral for the direct supportive intervention by community members proposed by John Snyder in 1971. Clay’s words echo those from Snyder half a century ago, when he said that most “who attempt suicide are victims of breakdowns in community channels for help.”

Although Mr. Porter clearly failed to proper identify Hannah’s suicidal ideation, perhaps even more troubling was his failure to hear her story and understand the factors behind her decision to die by suicide. Listening and demonstrating empathy to someone who is struggling was demonstrated to reduce suicidal ideation on calls to the National Suicide Prevention Hotline. Talking about suicide can help the person at risk to no longer focus on the past or feel alone and, instead, shift to the present moment, where the person can feel understood and cared for. If those in Hannah’s community who were witness to her emotional pain had actively engaged her and listened, it may have reduced her isolation and lessened her self-perception as a burden. This may even have prevented Hannah’s death.

Research indicates that our personal beliefs about suicide influence our responder behaviors. Therefore, gaining awareness of our beliefs and how our ability to intervene is affected by them is vital. Regardless of whether we can stop a suicide, we can control how prepared we are to try. We can make sure that our systems (in schools and elsewhere) are places where it is easy for someone to receive help.

After working through Hannah’s tapes, Clay now believes that we are, in a way, our brother’s keepers. Community-level response by direct intervention is a central theme in my (Laura Shannonhouse) research. It involves equipping “natural helpers” (e.g., teachers, bus drivers, resources officers, school counselors/psychologists) with the skills needed to perform a life-assisting suicide intervention at the moment it is needed most.

The producers and cast of 13 Reasons Why have underscored their desire for this series to start a conversation. Although that has certainly been accomplished, we hope the dialogue focuses more on how we can “look out for one another” and foster communities less at risk for suicide.



1) Graphic nature and contagion

Viewers of 13 Reasons Why watch two rape scenes and Hannah’s suicide, which is shown in detail. Nic Sheff, one of the writers of the series, stated that the scene of Hannah’s suicide was intended “to dispel the myth of the quiet drifting off.” Some crisis texts suggest that we “deromanticize” suicide by helping our clients understand the unintended effects of trying to die by suicide, such as surviving but becoming disabled or alienating friends and family. Therefore, an argument could be made that a graphic, painful portrayal of suicide is warranted.

However, research does suggest that suicide portrayals can contribute to contagion by triggering suicidal behaviors in people — particularly youth — who are experiencing high levels of emotional distress. In fact, SPRC and AFSP have made recommendations for best practices in prevention of suicide contagion. A discussion of post-suicide intervention to prevent contagion is beyond the scope of this article, but as an example, the locker memorial portrayed throughout the series is against standard guidance (it should not last for weeks, as shown). Furthermore, when considering how media reaction to the series has often included sensational headlines, it is helpful to review these recommendations for reporting on suicide.

2) Survivor’s guilt and revenge fantasies

By assigning “reasons why,” the series sends a message that Hannah’s death is caused by other people’s actions. When Clay openly questions, “Did I kill Hannah Baker?” his friend Tony answers dramatically, “Yes, we all killed Hannah Baker.”

Although we suggested earlier that we all have a responsibility to create communities that help prevent suicide, Tony’s level of direct attribution can be counterproductive. Hannah experienced multiple losses, traumas and stressors caused by others, both intentionally and unintentionally. Placing responsibility for her death on those individuals instead of on Hannah’s action can exacerbate survivors’ guilt. Those viewers who have lost a friend, loved one or acquaintance to suicide may feel even more strongly after viewing the series that “It is my fault.”

These feelings are associated with lower functioning in comparison with survivors of accidents. Although undeserved, survivor’s guilt is a real phenomenon, and considerable research shows that even counselors who experience the death of a client by suicide can experience shame/embarrassment and emotional distress.

Whereas Clay may feel guilt for his part in Hannah’s story, the tapes could implicate others in criminal or negligent behavior, perhaps giving Hannah posthumous revenge. Some viewers who may have struggled with suicidal ideation themselves could get the message that if they take their lives, they can get revenge on those who have hurt them. This is an additional reason that schools across the nation and professional helping organizations have felt the need to do damage control for 13 Reasons Why.



1) Parents need to not just talk but watch, listen and connect.

Some school counselors argue that it’s harmful for children and teens to watch the series on their own without the support of a parent or trusted adult because the series depicts a graphic and romanticized portrayal of a teenager in crisis and does not identify competent resources capable of helping her. Accordingly, many experts encourage parents to talk to their children about the series. In addition to using talking points, we recommend that parents listen deeply and without judgment to what their children say. When people feel genuinely heard, they are more likely to talk about their true thoughts and feelings.

To accomplish this goal, parents can use active listening skills, such as open-ended questions, reflections of feeling, paraphrasing and encouragement. Also, we recommend that parents watch the series and risk being human — risk being impacted by the series and empathizing with their child. The construct of empathy is powerful, particularly if it is sincere. For a three-minute visual summary, consider watching Brene Brown on empathy. In our counseling skills courses, we often talk about “getting in the well of despair” and genuinely connecting with others. We know that talking about suicide paradoxically provides a significant buffer to suicidal action.

2) We need more than prevention programming in schools.

We know from a well-regarded U.S. Air Force study that we need suicide programing at all three levels: prevention, intervention and post-intervention. Many suicide prevention programs have been implemented in the school context, but there is mixed evidence of their effectiveness. From our clinical experience in crisis response, our scholarship and our history with training a specific model of suicide intervention, we need to acknowledge that we are biased about what types of programming should be implemented and when is the right time to implement. We feel that an appropriate first step for a school system is to implement basic screeners and gatekeeper trainings such as Signs of Suicide or Sources of Strength.

However, suicide prevention should not end with identification for referral. Optimally, the process continues by assessing level of risk, identifying reasons for dying and reasons for living, discussing alternatives to dying, enlisting the support of trusted loved ones and limiting access to lethal means or securing the person’s environment. Because youth who struggle with thoughts of suicide often seek out the support of those they trust rather than professional mental health providers, those teachers, coaches and others with open hearts and doors are the most effective gatekeepers for a system. Their nondirection and empathy are useful pedagogical qualities and vital to effective suicide intervention.

We endorse models that empower those “natural helpers” to provide a potentially life-saving intervention for students who are in suicidal distress. Although this may be augmented with the support and follow-up of a trained mental health provider, gatekeepers can implement the steps listed above.

3) Be intentional about identifying caregivers and shifting school culture.

My (Shannonhouse) research involves partnering with school districts and superintendents (in Maine and Georgia) to identify “natural helpers” and equip them with the skills to perform a life-assisting intervention in the moment (i.e., Applied Suicide Intervention Skills Training, or ASIST). These natural helpers are often teachers, resource officers, coaches, administrative staff, bus drivers and other people who are likely to be confidants to students who experience distress. Measuring suicide intervention skills and responder attitudes is easy for an academic. Identifying those school personnel in the trenches who would be first responders is more difficult — it requires the total involvement of administrators. Furthermore, such an approach requires schools to commit to a student-centered response model.

ASIST is relationship-driven and aligned with the values of the helping professions. It meets the needs of students who are at risk by focusing on responding to those immediate needs rather than referring the student (which can lead to further isolation and an increased sense of burdensomeness). Although the student is often referred for more long-term counseling, ASIST provides the student with a six-step intervention at the moment it is most needed and can be performed by anyone over age 18. Having natural helpers trained in ASIST or a similar protocol can dramatically increase a school’s responsiveness and effectiveness to help students in distress.

4) Use an intervention model backed by research.

ASIST is a 14-hour, two-day, internationally recognized and evidence-based model that has been adopted by multiple states and the U.S. Army. It has also been recognized by the CDC and used in crisis centers nationwide. Caregivers trained in ASIST consistently report feeling more ready, willing and able to intervene with a person at risk of suicide.

The program has been evaluated in a variety of settings (click to download), with pretest to post-test improvement noted in trainees’ comfort level at intervention and in their demonstrated intervention skills in response to simulated scenarios. Although outcome research is rare, research compared ASIST-trained counselors with those trained in other models through a double-blind, randomly controlled study of more than 1,500 calls to the National Suicide Prevention Lifeline. Those trained in ASIST more often demonstrated particular behaviors such as exploring invitations, exploring reasons for living, recognizing ambivalence about dying and identifying informal support contacts. Those trained in ASIST also elicited longer calls.

We found that ASIST can be applied to both university and K-12 settings. Our work measured increased suicide intervention skills and beneficial responder attitudes, which have been maintained over time. We have trained more than 500 people in ASIST and have received multiple reports of teachers disarming fully formed suicide plans with their new skills. More recently, we have conducted behavioral observations of ASIST responder behavior and have begun evaluating outcomes of students who have received ASIST intervention. Initial results have been promising, including better coping and commitment to follow-up and decreased lethality.



Although 13 Reasons Why gives us pause for its poor portrayal of effective suicide intervention, we feel that the series raises awareness and, at its core, advocates a community-level response to suicide prevention. This message to “look out for each other” is aligned with more intervention-oriented gatekeeping. We have explored the impact of one such model, ASIST, in several educational settings and found that it improves responder behavior. Furthermore, this approach comes with a mindset that systems can harness their strengths (i.e., natural helpers) to focus on responding to and intervening with the student rather than simply identifying and referring the student to the system.




Please contact me (Laura Shannonhouse) should you have any questions about our research.



Laura Shannonhouse is an assistant professor in the Counseling and Psychological Services Department at Georgia State University. Her research interests focus on crisis intervention and disaster response, particularly involving social justice issues in this context. Currently, she is conducting community-based research in K-12 schools (suicide first aid) to prevent youth suicide and with disaster-impacted populations in fostering meaning-making through one’s faith tradition (spiritual first aid).


Julia L. Whisenhunt is an associate professor of counselor education and college student affairs at the University of West Georgia. She specializes in the areas of self-injury, suicide prevention and creative counseling. She is particularly interested in the relationship between self-injury and suicide and ways that mental health professionals can apply this knowledge to clinical intervention.


Dennis Lin is an assistant professor at New Jersey City University, with areas of expertise in play therapy, child/adolescent counseling and assessment, suicide prevention/intervention, quantitative research and meta-analysis. He is also a certified master trainer of Applied Suicide Intervention Skills Training (ASIST).




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Bringing the family counseling perspective into schools

By S. Kent Butler, Tony D. Crespi and Mackenzie McNamara May 8, 2017

Children in schools today come from increasingly diverse and complex families. As illustration, more than 1 million families are impacted annually by divorce. In fact, approximately 13.7 million single parents are raising 21.8 million children, and 1 in 3 Americans are stepparents, stepchildren, stepsiblings or part of a stepfamily. Furthermore, according to a 2009 article published in the journal Family Relations, it is estimated that only 31 percent of fathers who no longer live with their children maintain weekly contact with those children. It is easy to conclude that the issue of divorce alone has a profound impact on many millions of children in the U.S.

Now imagine that a young student and her mother walk into the professional school counselor’s office on a Monday morning. Mom explains that she and her husband are pursuing a divorce — he recently told her that he’s been having an affair and has decided to move in with his girlfriend. The daughter acknowledges feelings of depression and admits to having angry outbursts at home. Mom says she is concerned because her daughter’s grades have been dropping.

Considering the large number of children and adolescents coping with parental divorce, it’s not surprising that this fragmented family came to the school counselor’s office. In fact, it’s a good thing. Both daughter and mother need someone to talk to, and schools are a natural access point for services. However, many professional school counselors are not trained in family dynamics and are not familiar with key tenets that impact family counseling, so they may not know how to proceed.

A sample case

Susie is 15. A high school freshman, she knows only that her father left the house two months ago to move in with his girlfriend. Susie’s parents had been together for 16 years, getting married shortly after college.

Susie’s father hasn’t called since leaving. Susie is unaware that her father told her mother that although he loves Susie and her younger sister, who is in seventh grade, he hasn’t missed seeing them in the least. Mom decided not to share this comment with the children, but she does confide this secret to you, the professional school counselor.

Sitting in your office, Susie suddenly looks up and exclaims that she is scared she will have to move and change schools. She also says that she’s having a really tough time paying attention in class and explains that her grades are slipping. “I hate my dad for doing this!” she yells.

Suddenly, Susie starts shaking and breaks down in tears. After a few minutes, Susie tells you that she is spending a lot of time with her boyfriend, partly to stay out of her house. She acknowledges feeling depressed. After pausing for a moment, she looks at her mom and states, “I really hate Dad. His girlfriend is so young. She’s in her 20s. She’s not much older than me!”

Academically, Susie has been an A and B student, but her grades have fallen since her father left. Her mother acknowledges that things are tough at home and reveals that she didn’t learn about her husband’s affair until the day he moved out. “I really don’t know what’s going to happen,” she tells you. “I know we’re getting a divorce, but beyond that I just don’t know.”

Your school doesn’t have a social worker. However, you have a colleague who has been studying family counseling, so you knock on her door to ask for a consultation. After sitting down, you share a few thoughts.

You note that, fundamentally, Susie needs someone to talk to about these issues. Acknowledging that you are speculating, you openly wonder what type of impact the obviously poor communication in Susie’s family is having on her. After all, her father has not called in two months, her mother was completely unaware of the affair and her mother is keeping the father’s confession of not missing his kids a secret. These facets alone highlight poor family communication. In addition, Susie is scared that she might have to move and change schools. Clearly the issues are widespread.

Risk points

Here are some risk points to consider as you work with Susie:

  • Parenting after a divorce differs significantly from parenting prior to
    a divorce.
  • Single-parent families in the United States are increasing.
  • Children of divorce have more mental health problems in comparison with their peers.
  • Suicide is the third-leading cause of death among U.S. youth.
  • Brain regions responsible for decision-making are not fully developed in youth.
  • Changes in family structure can have an affect on school grades.
  • Anxiety, depression and behavior problems are elevated after divorce.
  • Children of divorce often feel a sense of instability.

An understanding of these risk points is essential for moving forward with children and families because the risk points can provide direction for the work that needs to be done. For example, knowing that mental health symptoms are elevated following divorce and impulsive decision-making is greater among youth, you should assess Susie’s level of safety. In this case, Susie also makes many “red flag” statements.

These are things that counselors know how to address but might not always consider without an awareness of the data. In addition, parents can become defensive, or they might blame themselves for their children’s difficulties. For this reason, it is imperative to educate parents on these risk points. It is also important to realize that family issues may require clinical supervision.

Supervision around work with families 

Susie is not alone. As your colleague notes, Susie is one of many children and adolescents who are coping with family stressors. With the prevalence of so many family issues, a growing number of states have enabled licensed marriage and family therapists (LMFTs) to work in the schools. Connecticut, New Mexico, Maine, Texas and Illinois have passed specific laws to allow LMFTs to work in schools, whereas Massachusetts allows LMFTs to work under a general mental health designation.

Schools clearly represent an important access point for mental health professionals. But with only six states utilizing LMFTs in schools, it is extremely important for professional school counselors and their supervisors to know how to manage these situations with families.

As you ponder your next meeting with Susie, you need information. Direct supervisors are often part of the structure of many agencies, but professional school counselors might need to seek support from a colleague with training in family counseling. Such supervision might come from a guidance director, a school psychologist, a consulting psychologist, a marriage and family counselor, or a local family agency.

Two popular family therapy models that might help Susie are presented below.

Symbolic-experiential family therapy 

This model, derived from the work of Carl Whitaker, addresses both individual and relational patterns. It is focused on both personal growth and family relations.

Fundamentally, the therapist helps dislodge rigid patterns and stimulates flexibility using a family’s natural pull toward growth. Focusing on the present, the therapist helps people recognize their real feelings, express those feelings and move forward, individually and as a family. Key points follow.

  • The “battle for structure” involves clients (a family) “sizing up” a therapist. There is no “identified patient”; rather, the family is the therapy unit. In this model, the therapist must win the battle and control therapy. For instance, if the therapist invites the entire family and one member does not show up to the session, the therapist may refuse to meet until everyone attends. In the case with Susie, you might note that you, Susie, her mother and Susie’s sister must all attend.
  • The family must win the “battle for initiative”; this involves their decision to take charge of their lives and decisions. Is Susie committed to resolving her feelings? Will she commit to six counseling sessions? Is she willing to confront her father about calling his children? Is she motivated to initiate change?

Therapy progresses through stages:

1) Engagement: This is the “meet and greet” phase. You have already started this stage with Susie and her mom.

2) Middle phase: Families are encouraged to change through confrontations, encouragement and interventions. Can Susie’s family meet to start this process?

3) Late phase: Increased flexibility is a focus for the family. Can Susie’s family talk through how the divorce will change their life?

4) Separation: As the therapist separates, the family takes responsibility.

Symbolic-experiential family therapy often advocates the use of co-therapy, making it a great model to use with a more “senior” therapist. In this fashion, supervision can be active and ongoing as you acquire firsthand skills in family counseling.

Structural family therapy

The structural approach, typically associated with Salvador Minuchin, views problems as being rooted in family interactions. Fundamentally, if we can help change the family’s organization (structure), its members typically find that they feel better and their symptoms are often relieved. Key points follow.

  • Enmeshment or disengagement: Family members may range from those who are overly connected to those who are disengaged. Enmeshment tends to prevent growing maturity, whereas disengagement may lead a child to feel abandoned. Most families are not one or the other but have subsystems that reflect their tendencies. For example, a disengaged father who is overly involved at work may neglect the family. In response, the mother may compensate by becoming overly involved. Is Dad really connected? What is the structure
  • Boundaries: Are parental boundaries rigid or flexible? Are grandparents a resource? Can a child visit Dad at work, or does the family maintain a rigid rule against it? Can Susie ask Dad questions? What are the boundaries? What is spoken? What is unspoken?
  • Alignments: Who joins together? Are children aligned against the parents? Did a parent resent and refuse to attend a child’s sporting activities? Did a parent require everyone to attend? What are the alignments?
  • Triangulation: The permutations of triangulation in families can be abundant. A child and parent may triangulate against another parent. A parent having an affair can create a triangle with the other spouse. Will Susie triangulate with Mom against Dad? What triangles exit?

The structural model also features several stages:

1) Joining and accommodating

2) Assessing family interactions

3) Monitoring dysfunction

4) Restructuring patterns

Summary and considerations

When a student walks into a professional school counselor’s office, we are presented with a rare opportunity. When a student and parent walk in together, we are handed an even rarer opportunity.

Family counseling offers unique and engaging ways of reframing problems. Rather than blaming an individual for a particular problem, family counselors look at the family system. Perhaps a child’s acting-out behaviors allow parents to avoid looking at their relational problems. Perhaps a child’s failing grades reflect more on family anxiety and stress than on individual issues. Fundamentally, family counseling takes a larger, more systemic perspective of presenting issues.

Professional school counselors possess wonderful skill sets. They understand rapport building. They understand relational dynamics. They understand problem assessment and the utility of interventions. The connection between families and school adjustment is undeniable. At the same time, school counselors will likely find continuing education and supervision indispensable in helping families.

In our experience, students and families can often benefit from a family counseling perspective. With so many students in the schools coping with changing family structures, it is vital that we expand our skill sets. Fortunately, there are multiple platforms through which we can provide help. Some of these options include:

  • Individual counseling from a family perspective
  • Co-therapy with single families
  • School-based divorce groups with multiple children
  • Single-parent support groups

This article is intended to stimulate thinking and provide a preliminary glimpse into two prominent family counseling theories. Our advice? Be available. Be sensitive. Consider finding a supervisor who is capable of expanding your knowledge and skills in this invaluable area. Truly, children, families and the community stand only to benefit.





S. Kent Butler is an associate professor at the University of Central Florida. He is a licensed professional counselor, national certified counselor and national certified school counselor. He is particularly interested in mentoring, supervision and multicultural issues in counseling. Contact him at skbutler@ucf.edu.

Tony D. Crespi is a professor at the University of Hartford. He is a certified school counselor, licensed marriage and family therapist, and licensed psychologist. He is particularly interested in family counseling and legal issues that affect supervision.

Mackenzie McNamara is a doctoral student in the counseling psychology program at the University at Albany, State University of New York. She most recently worked for New London Public Schools in Connecticut.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having your article accepted for publication, go to ct.counseling.org/feedback.




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Reach Higher: Bridging the gaps through cultural competency

By Bethany Bray November 4, 2016

U.S. Secretary of Education John B. King Jr. was preaching to the choir at last week’s Reach Higher Convening when he said school counselors could make a powerful and long-term impact on the lives of students.

“I am here because of the difference educators made for me. I know you make that difference. … You [school counselors] are everyday heroes in our schools,” said King, whose mother was a school counselor.

The Reach Higher Convening, a gathering of close to 200 school counselors, administrators and other education professionals from around the U.S., was held Oct. 28-30 at American University in Washington, D.C. The American Counseling Association was a co-sponsor of the event, the

U.S. Secretary of Education John B. King, Jr. speaks at the Reach Higher Convening on Oct. 28. Photo by Bethany Bray/Counseling Today

U.S. Secretary of Education John B. King, Jr. speaks at the Reach Higher Convening on Oct. 28. Photo by Bethany Bray/Counseling Today

fifth gathering held as part of First Lady Michelle Obama’s Reach Higher initiative focused on the bridge between K-12 education and college and career readiness.

While at the convening, King announced that the U.S. Department of Education would expand its School Ambassador Fellows program to include school counselors (starting with the 2017-18 school year). Previously, the program was open only to teachers and school principals. Educators in the ambassador program lend their perspective to discussions about federal programs and are positioned to inform nationwide policy.

The theme of this year’s convening was cultural competence. Workshops and sessions focused on addressing the equity gaps that exist for students from underserved backgrounds.

For example, King posed a question: When you walk into an advanced placement (AP) class in a public high school, does the class makeup reflect the school community as a whole? What about the robotics club or the in-school suspension room?

Only 18 percent of teachers are persons of color, which does not match the overall cultural makeup of America’s student body, King noted.

“We still have not delivered, as a society, on Brown [v. the Board of Education],” King said. “We want students to have role models that look like them. That’s important to how we knit our diverse society together.”

For educators, cultural competence includes knowing – and appreciating – the context in which a student lives, said King. For example, a student who serves as a translator for his or her family may be apprehensive about leaving home for college.

“They [families and students from underserved backgrounds] don’t have the same range of knowledge of what’s possible. … We can affect that through school,” King said.

A school counselor’s role as an advocate, particularly for students who are first-generation Americans, “can change a student’s life trajectory,” said King.

Vivian Lee, an American Counseling Association member and associate professor in the School of Education at Johns Hopkins University, spoke about how each person’s own cultural

ACA member Vivian Lee speaks at the Reach Higher Convening on Oct. 28. Photo by Bethany Bray/Counseling Today

ACA member Vivian Lee speaks at the Reach Higher Convening on Oct. 28. Photo by Bethany Bray/Counseling Today

competence is a lens through which he or she views data such as student achievement statistics.

“Cultural competence is a lifelong journey,” Lee said. “It’s a journey we are all on. It enables us to see that the road is more challenging for some. … We need to be able to see, hear and validate the lives of people in groups other than our own. … The time is now for us to begin these dialogues.”

Lee and another member of ACA, Cheryl Holcomb-McCoy, dean of American University’s School of Education, were instrumental in organizing the Reach Higher Convening at AU. ACA President Catherine Roland also attending the convening.

“It doesn’t get any better than having the White House, the First Lady and the Department of Education recognize and support the integral role of counselors in helping students ‘reach higher,’” said Lynn Linde, senior director of ACA’s Center for Counseling Practice, Policy and Research. She has attended all five convening events.

“This convening focused on equity and access issues for all students and the counselor’s integral role in helping all students maximize their potential,” Linde said. “… [School counselors] see the potential in students who don’t always see it in themselves.”





(From Left to right) Jasmine McLeod, school counseling specialist at the U.S. Department of Defense; Laura Owen, researcher in residence at American University; John B. King Jr., U.S. Secretary of Education; Vivian Lee, associate professor at Johns Hopkins University; and Cheryl Holcomb-McCoy, Dean of American University’s School of Education, at the Reach Higher Convening in Washington D.C. on Oct. 28. [Photo credit: Steven Owen]



Find out more about the Reach Higher initiative at whitehouse.gov/reach-higher


Press release from the U.S. Department of Education on the inclusion of school counselors in the ambassador program: bit.ly/2dZFCPs


ACA President Catherine Roland will share some thoughts about the convening in her “From the president” column in the upcoming December issue of Counseling Today.


ACA’s Q+A with Secretary King from this summer: bit.ly/1YBlQZu




Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org


Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.






Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.