Tag Archives: school counselors audience

The costs of COVID-19: Parental anxiety syndrome

By Rebekah Lemmons September 8, 2020

As counselors in the age of COVID-19, we have seen a lot. We have been on the front lines of treating a new wave of counseling crises, from broad-reaching trauma symptoms to an increase in panic attacks.

One such example is related to parental anxiety. This is a term that stems from an increase in parental stress and accompanying anxiety related to the reopening of states, businesses and schools.

COVID-19 has changed the day-to-day lives of many parents and caregivers. These individuals have been forced to make adjustments in major areas of life, including child care, schooling for children, work dynamics and social supports. These changes create deeper concerns and uncertainties for many adults.

To best help clients effectively manage parental anxiety, we need to understand this phenomenon, who is at risk, what contributes to higher risks, how to effectively cope with these issues, and how to maintain overall health as the pandemic continues.

What is parental anxiety?

Clinically, parental anxiety is comparable to separation anxiety. It includes a high level of anxiety around opening up schools, day cares and related activities in which parents leave their children in the care of others. It has added components of stress and worry that derive from our ongoing transition to a new normal.

For some parents, this leads to increased panic attacks, decreased stress tolerance, sleeplessness, irritability, head and body aches, and exhaustion. It can also lead to increases in family conflict or parental conflict, largely based on disagreements about parenting in a pandemic. Conflicts about transitioning back into school, work or social situations can create tension and magnify existing areas of disagreement.

Who is at risk?

Any parent or caregiver is at risk for parental anxiety. From full-time working parents to stay-at-home parents, any caregiver can develop symptoms of this condition.

Parents who have been keeping their children at home and are preparing to transition children back into child care or school settings outside of the home are at higher risk. Parents and caregivers are also at risk for parental anxiety if they are preparing to return to the office themselves and transition children out of the home.

Any additional stressors or traumatic events can further complicate this condition. For example, if clients have lost a loved one during the pandemic or known someone with COIVD-19, their symptoms of parental anxiety may become stronger. In addition, Black, Indigenous and people of color (BIPOC) may be at increased risk for parental anxiety because civil rights violations and racial trauma from current events have a layered impact on the effects of the pandemic.

What creates these risks?

Collectively, we have all experienced a crisis. This has been described using many terms, including “collective grief” and “collective traumatization.” As we look at how individualized coping is in general, it is no surprise that during major societal shifts and global-scale issues, there is no one way to manage all that is being thrown at us. Even those with higher supports and increased levels of stress tolerance can struggle with parental anxiety.

For this reason, counselors need to be attentive to clients who appear to be doing well despite the circumstances as we transition to normalcy. As with other types of trauma and toxic stress, it is common for people to release feelings when they are in a safe space. With the transition back to routines and schedules, some parents and caregivers may feel increased stability and become able to release deeply suppressed feelings related to the collective grief and traumatization from recent events.

Clients may have been put in positions in which they had to push through difficulties to continue working, parenting and performing in the various roles they played. Even parents and caregivers who report being ready to return to work or to have children return to school can experience this unexpected flood of traumatic symptoms.

How can we help parents manage these symptoms?

In one sentence, healing from collective trauma requires collective compassion. It is important to promote connection and healthy attachments to recover from the negative impacts of compounded events and societal issues.

We can provide a safe space for clients to unload difficult emotions and worries by being empathic, demonstrating patience and providing psychoeducation about trauma. Counselors can also assist clients with increasing their awareness of feelings related to these issues and provide them with stress-reduction interventions.

Additionally, empowering clients to talk to their employers, child care providers and children’s schools about transition plans can help to alleviate fear of the unknown. This also assists parents and caregivers in making informed choices that will best work for meeting their needs and the needs of their families. With education on transition plans and safety precautions in place, parents and caregivers can focus on areas that they can control.

In response to the array of physical, psychological and sensory impacts from this symptomology, integrated psycho-sensory therapy may be beneficial. This therapeutic model includes using aspects of physical wellness such as recommending and referring clients to engage in yoga, exercise classes and related supportive services (e.g., physical therapy/occupational therapy, chiropractic care, massage therapy). It includes aspects of psychological wellness (the theoretical model of choice). Then it adds sensory considerations based on the client’s needs. These considerations may be related to lighting and colors (low lights, wearing and having a background with calming colors or nature), gentle music, and the presence of calming smells (lavender, lemongrass, etc.). See the visual (below) for model components. The diversity of each component added to the next assists clients in minimizing the impacts of how trauma is felt in the body and how it affects our functioning.

Even with telehealth sessions, counselors should consider creative ways to engage clients by giving them options to move around throughout sessions.

Click on the image to see it full size

Other considerations

For many clients, feeling prepared and having a plan can help to eliminate some of their added stress and anxiety. However, it is crucial that counselors continue to help clients maintain flexible thinking and increase adaptability because much about life today is unpredictable.

On a final note, counselors have experienced this pandemic too. We have also taken on the brunt of addressing mental health needs in a time unlike any other. Furthermore, many counselors are also parents or caregivers. It is vital that we take care of ourselves and commit to our own overall wellness. We must embody the level of integrative and holistic self-care that we communicate to our clients.

One thing I have encouraged others to do in these times is to give grace — to themselves and to others. We must have grace as we navigate these challenges so that we can rise above our circumstances and emerge resilient.

 

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Rebekah Lemmons strives to improve outcomes for children, emerging adults and families. For the past decade, her practice and research primarily has been based in the nonprofit sector, with an emphasis on program evaluation, teaching, service leadership, consulting and providing supervision to clinicians. Contact her at rebekahlemmons@yahoo.com.

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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.

School vaping cultures: Acknowledging the impact of COVID-19

By Zachary Short and Nicole Baliszewski June 4, 2020

This past January, global tobacco conglomerate Altria saw a major drop in its stock value on the New York Stock Exchange, depreciating at a value of almost 40% versus its record-breaking highs in 2017. What caused this sudden dip in one of the biggest-rebounding industries of the 21st century? It would be fair to suggest that the COVID-19 pandemic has caused some major complications for both the traditional and electronic cigarette corporations located across the United States.

As a respiratory-based infectious disease, COVID-19 poses an unparalleled threat to the health and safety of individuals across the age spectrum with significant histories of vaping or smoking. In fact, a recent study in the New England Journal of Medicine found that Chinese patients with a history of smoking were twice as likely to suffer from severe infections associated with diseases such as COVID-19 in comparison with those without any smoking history.

Having always opposed the youth vaping/smoking culture, counselors and community advocates across the nation are currently working to answer a significant question: What actions can we be taking to protect our communities from the combined threat of COVID-19 and recent vaping trends?

The truth is, now is the prime time for considering how we can influence our communities to create better post-quarantine schools for our students.

The loss and revitalization of the smoking industry

Only five years ago, health specialists with the Truth Initiative anti-smoking campaign speculated that the tobacco industry and most of the nation’s smoking addictions would expire with the Generation Z demographic. But vaping, the process of inhaling prepackaged aerosols (also known as vapor), has led to the resurgence of nicotine products within school systems.

Through a combination of peer pressure and social media campaigns, students from all backgrounds have found themselves under the influence of Altria’s newest partner, Juul Labs, maker of the Juul electronic cigarette. Largely as the result of the popularization of this flavored electronic smoking device, the number of high school students who use nicotine products has increased from 3.6 million to 5.4 million in the span of only one year, according to the Centers for Disease Control and Prevention (CDC).

How significant it would be to know that schools were free of the harmful aftereffects of adolescent smoking, leaving school counselors and clinicians available to attend to the important mental health developments that are so essential in our school systems right now. Instead, we find ourselves dealing with another truly concerning issue: According to the Truth Initiative, 1 in every 4 high school students now uses e-cigarettes.

These concerning statistics represent a call for preventative action in middle schools across the nation. A number of schools and organizations have taken such counteractions to trends in vaping by launching interventions such as confiscation, disciplinary action, and even educational programming. But the culture of vaping continues to persist as a significant concern for parents and educators.

The most terrifying thing about the Juul product so far is that it appears to come off as being innocuous to many people. Most students and parents recognize it as the small USB-shaped device that produces fruit-flavored smoke. Very few seem to grasp the long-term consequences of vaping habits. That being said, those consequences might already be here.

The individuals at risk

Based on data collected by the CDC in early March, evidence suggests that COVID-19 poses a serious threat to all individuals ages 65 and older. Fortunately for students under the age of 18, the percentage of those infected and harmed has been relatively low by comparison.

While most parents find some comfort in hearing that the student demographic is the least impacted by the pandemic, the statistics can change drastically if students are part of the vaping culture that is rampant among youth. According to data provided by the CDC for China’s mainland population facing COVID-19, individuals with respiratory issues predominantly associated with even a small history of smoking or vaping have a 6.3% case fatality rate, in contrast to 2.3% overall. Recognizing how exposure to vaping increases a person’s health concerns, imagine the increased risks that our students could face should their still-developing physiques come in contact with both nicotine products and a respiratory infection.

“What they say is about 80% of people feel the flu, but they will be OK. Where we are getting into trouble is that it can lead to severe pulmonary distress,” says Anna Song, an associate professor of health psychology and leader of the Health Behaviors Research Lab at the University of California Merced. “Smoking is a risk factor for having this disease progress, be incredibly severe, and lead to mortality.”

As we know, COVID-19 has posed widespread challenges to the health and lifestyles of the global population. Societal and educational norms have begun to deteriorate, and everyday tasks and responsibilities now come with an unprecedented health risk to individuals and their families. Of great concern to us is that the unattended trends and cultures of our school systems could be having a negative impact on our students right now. To allow these trends to persist beyond this pandemic is to continue putting our students at risk unnecessarily.

A unique opportunity for change

What makes now such an ideal time to invest in removing the harmful vape cultures that continue to linger in our school systems? Students are largely being required to undertake remote learning during this time, and that may continue for many students even as a new school year begins. The changes and circumstances that come with students’ remote learning actually promote our greatest opportunity for the development of an anti-smoking culture.

Society is recognizing that our plans, policies and preparation were inadequate to succeed in the face of an unanticipated global pandemic. Thus, things are beginning to change. Legislation is developing to create preventative actions around practices deemed unhealthy by medical specialists, and educational policy is constantly being reformed to reflect the needs and issues present in our impromptu teaching conditions. If there was ever a time to acknowledge the statistics that point to the harm that nicotine products pose to our adolescents and to advocate for the safety of our children, it is now.

Large systemic changes are challenging and often are out of our hands, but educators and parents currently have the opportunity to make a notable difference in students’ environments. During this time of partial quarantine, most families are now all in one location — the home. Our students currently find themselves in a setting where they are under the watchful eyes of their families and where smoking purchases and practices are essentially impossible.

In addition to that, they are also in a potential learning atmosphere. Through the joint efforts of educators and parents, our youth can be exposed to real educational and intimate conversations regarding the dangerous practices of smoking. These conversations can mean the world to students who currently feel that their futures and health might be dictated by vaping culture.

COVID-19 has had a harsh and unpredictable influence on our way of life, but it also presents us with a rare opportunity to support our students through one of the greatest health issues of their generation. So, making use of the present, it is time that we as a supportive community of counselors consider what we should be doing to help facilitate and emphasize this process of growth for students’ mental and physical health.

Our responsibility to intervene

As of early April, individuals within Rowan University’s Department of Psychology have been conducting their own research to confront the vaping culture that remains prevalent during the COVID-19 pandemic. Their research takes an interesting approach to behavioral analysis with younger age groups, including the development of interesting activities such as mobile- and video game-based interventions that promote smoking abstinence.

Fortunately, this is just the tip of the iceberg when it comes to the collective efforts of universities to combat vaping trends in student populations. Even educational institutions outside of higher education are recognizing the statistically supported danger that vaping is putting our students in when facing the current health pandemic. As a community, it is our collaborative responsibility to provide education and to take the necessary precautions to protect our students’ health. We are just beginning to understand the proper steps to take when working from a remote distance.

Educating the community: Providing knowledge of the increased risks and hazards of smoking behaviors is the first step to reducing nicotine consumption within our school systems. Given the myriad resources available on the consequences of vaping from the CDC, the National Institute on Drug Abuse and even university websites such as Johns Hopkins Medicine, it is the obligation of school counselors and other school personnel to appropriately share this information with our local communities. It is important to remember that this information needs to be given not only to the students we support, but also to our educational partners and to the families who are acting as our immediate support systems in homes at this time.

Promoting real conversations: With the knowledge and statistics being supplied to our students’ homes, it is more important now than ever that school systems promote real conversations with students regarding the present vaping cultures. Whether it is school counselor-to-student or parent-to-student conversations, we need to understand what the student perspectives are when they see products such as Juul in the media while also witnessing terrifying statistics regarding the spread of a global virus.

With those who are currently smoking, it is vital that we understand their concerns and interests so that we can provide them the appropriate support they need. These conversations are the optimal opportunity to promote and communicate resiliency, empathy and community support to our students. And with those who have never touched a vaping device, communicating this information and the associated risks is the best possible preventative action at this time.

Advocating for policies: To reiterate, now is a turbulent time when leaders are reflecting on educational preparations and policy and how they might be applied for future incidents. In addition to redesigning our school’s remote learning policies, we need to be working as a professional community to advocate for anti-vaping policies within our schools. It is essential that school counselors reflect on school policies regarding smoking tolerance, as well as preventative actions to take, so that they can create real opportunities to support student health.

Fortunately, states and health institutions are rallying to create a number of anti-vaping models that can be implemented or referenced by school counselors looking to better their schools. One such model is the Make Smoking History campaign, conducted by the Massachusetts Department of Public Health, to reduce the percentage of vaping disciplinary actions taken in middle school settings. This is the time to ask for and support the voices of the education community to find out what should be done for the development of our educational systems — not just on a school-by-school basis, but from a legislative perspective.

Forming support groups: Finally, acknowledging that this is a difficult time for individuals who have a dependency on smoking tools to which they no longer have easy access, we need to prepare and create remote counseling groups to support them through potential issues such as withdrawal or rehabilitation. A number of counselors may struggle with the concept of remote group counseling, but these students still need emotional and mental health support to cope with their new distancing from vaping. Counselors should utilize the medical resources and personnel within their school districts to support students in their transition to healthier living. Ultimately, it is groups such as these that we should be planning to implement more frequently in our later return to school.

The truth is that in the midst of a global health crisis, most individuals view the issue of vaping in school systems as relatively small. But the fact is that vaping is a real health issue for our youth, and in combination with the threat of COVID-19, it puts our newest generation of students at exceptional risk for loss. In a moment in history when many counselors are at home and wondering what they should be doing to support their students, imagine what significant change could occur if we all directed a portion of our efforts to acknowledging and countering the present vaping culture.

 

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Related reading, from the Counseling Today archives: “Pushing through the vape cloud

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Zachary Short is a master’s counseling in educational settings student at Rowan University. He currently works as a clinical research intern in a high school setting, where his research in student behavioral outcomes is being supported through the Mental Health Grant Demonstration Program. Contact him through LinkedIn: linkedin.com/in/shortzachary/.

Nicole Baliszewski is a master’s counseling in educational settings student at Rowan University. She currently works as a clinical intern in a middle school setting, where she seeks to provide trauma and mental health support to the special education student population. Contact her through LinkedIn: linkedin.com/in/nbaliszewski/.

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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.

One in three American kids affected by adverse childhood experiences

By Bethany Bray November 5, 2019

One-third of American children have gone through a negative experience that can have lasting implications for their physical and mental health, according to the U.S. Health Resources and Services Administration (HRSA).

Data from the agency’s most recent National Survey of Children’s Health indicates that 33% of children ages 17 and younger have gone through an adverse childhood experience (ACE) such as domestic violence or parental incarceration. Approximately 14% of children have gone through two or more ACEs, with a higher prevalence among black youths and those who live in households that are below the federal poverty level.

Among the children who took the 2018 survey, the most prevalent ACE was the divorce or separation of a parent/guardian (23.4%), followed by living in a household with someone with a drug or alcohol problem (8%), and the incarceration of a parent/guardian (7.4%).

“The new HRSA data is important because it helps us remember that all children are vulnerable to adverse experiences,” says Evette Horton, a licensed professional counselor supervisor and president of the Association for Child and Adolescent Counseling, a division of the American Counseling Association. “Our job as counselors is to assess for these adverse experiences and enhance the resilience factors that we know support children and adolescents. These include evidence-based mental health treatments, strengthening family support systems, and connecting to other resources in the community. Professional child and adolescent counselors are well-versed in promoting protective factors and stand ready to support children with any adverse experience.”

The U.S. Centers for Disease Control and Prevention defines ACEs as “all types of abuse, neglect and other potentially traumatic experiences that occur to people under the age of 18.” These experiences can range from the death of a parent to emotional or physical neglect and witnessing violence in a home or neighborhood.

Research has connected ACEs to health problems later in life such as mental illness, heart disease, addictive disorders, cancers and diabetes, and risky behaviors such as illegal drug use, unintended pregnancy and suicide attempts.

HRSA collects information on a range of children’s health-related topics from households across the U.S. for its annual survey; the most recent survey includes data from more than 30,500 children.

HRSA cannot directly compare the 2018 rate of ACEs to data from previous surveys because the language in a question asking about ACEs was changed last year. However, when excluding data for the question that was altered (regarding financial hardship), there was not a significant change in the number of ACEs between the 2016, 2017 and 2018 surveys.

 

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More from HRSA on the National Survey of Children’s Health: hrsa.gov/about/news/press-releases/hrsa-data-national-survey-children-health

 

Fact sheet on the 2018 survey: mchb.hrsa.gov/sites/default/files/mchb/Data/NSCH/NSCH-2018-factsheet.pdf

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Related reading, from Counseling Today:

Coming to grips with childhood adversity

The toll of childhood trauma

Informed by trauma

Counseling babies

Standing in the shadow of addiction

What’s left unsaid” (on child sexual abuse)

Interventions for attachment and traumatic stress issues in young children

Touched by trauma

 

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

 

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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.

 

Five social, emotional and mental health supports that teens need to succeed

By Dakota King-White, Sade Vega and Nicholas Petty September 9, 2019

Many teenagers have been exposed to traumatic events, and most experience regular life stressors. Exposure to violence and other traumatic experiences can have a lifelong effect on learning and may negatively impact academic achievement. Among examples of traumatic events that some teenagers experience are community violence, school shootings, the loss of a loved one due to death, parental incarceration, divorcing parents, a parent or caregiver with mental illness, and substance abuse in the home. Within the school setting, the negative influence of trauma on teens may lead to poor concentration, declining academic performance, school absenteeism, and the decision to drop out. These challenges create barriers for the success of teens in the academic setting.

Schools across the United States have recognized the importance of providing school-based mental health support because these services benefit students academically, socially and emotionally. However, questions regarding the issues facing teens and the types of mental health supports needed to deal with these issues require further examination. Implementing a needs assessment can assist schools in uncovering the answer to these questions. The findings can then help determine what programming should be implemented to improve students’ overall development, such as teaching them social skills to help them become productive members of their communities and school settings.

We wanted to learn more about the social, emotional and mental health needs of teenagers, so we conducted a needs assessment in which we surveyed 198 high school students in a Midwestern city. The teens in our study identified the types of emotionally stressful experiences they have faced since attending high school. They also described what schools could do to make them feel supported and better able to deal with the related challenges.

The following sections present the five top issues identified by the students we surveyed, along with recommendations on ways that schools can support teenagers socially, emotionally and mentally.

 

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1) Social media makes peer pressure a 24/7 problem. Teens today are confronting certain pressures that teens in the past didn’t face. A prime example: Social media has become an indispensable part of teenagers’ lives. According to a 2018 report written for the Pew Research Center by Monica Anderson and Jingjing Jiang, YouTube, Instagram and Snapchat are the most popular online platforms among those ages 13-17, and most teens have access to these apps on their smartphones. Anderson and Jiang note in the report that 95% of teens have access to a smartphone, with 45% of teens acknowledging that they are online “almost constantly.”

This constant mobile connection creates the conditions for teenagers to consistently be exposed to peer pressure even outside of the school environment. Mina Park and colleagues in 2017, in a journal article in Cyberpsychology, Behavior, and Social Networking, noted that hyperconnectivity to social media can also lead to depression, negative body image and eating disorders.

What schools can do to help: Teens must be given an outlet to discuss their frustrations when it comes to dealing with peer pressure. Students should be directed to their school counselors or other trusted adults in the school with whom they can share their feelings and pressures and get supportive, confidential advice in return. It is also helpful to allow for genuine conversations in the classroom about the importance of students being confident in who they are and embracing their differences. Safe spaces in schools allow teens opportunities to feel supported in a neutral environment, to accept who they are, and to embrace differences among their peers.

 

2) Bullying is a significant issue. Peer pressure is not the only problem arising from constant social media access. The other, and even more troubling, issue is bullying. Teens may experience, witness or engage in bullying situations, including cyberbullying, which is more prevalent among teens.

The Bullying Statistics website (bullyingstatistics.org) notes that cyberbullying may consist of teens sending cruel messages, spreading gossip or posting threatening messages on social media platforms, pretending to be someone else on a social media account, or sexting. According to recent statistics from the website, more than 25% of teenagers have been exposed to cyberbullying situations that have had a negative impact on them. Bullying can have a significant effect on teens socially, emotionally and academically. Some of the negative impacts include depression, anxiety, attendance problems, and decrease in academic achievement. However, many teens who experience cyberbullying do not tell their parents or guardians about these painful experiences.

What schools can do to help: October is National Bullying Prevention Month, and many schools across the United States take time to develop effective strategies to raise awareness about bullying and to prevent bullying incidents on their campuses. It is important for schools to create an environment in which victims of bullying/cyberbullying, or teens who witness the bullying of a peer, can talk to trusted adults about bullying situations. Help your students by providing safe places in schools where teens can disclose when they or their peers are being bullied, or even create a hotline for students to report bullying situations.

Additionally, offer professional development to teachers and other staff members on identifying the warning signs of bullying, and provide them with effective strategies to help students who are being bullied. Likewise, many parents are unaware of how to support their teens when they are being bullied, so invite parents to on-campus workshops where they can learn ways to address these issues with their teens. During the parent and family sessions, discuss the various types of bullying that take place, the warning signs of bullying, and school and community resources for victims of bullying and cyberbullying. Workshops for parents and families can add another layer of support for young people who are affected by bullying.

 

3) Students are concerned about their personal safety. In our study, the third top concern that students reported was anxiety about their personal safety. According to the National Institute of Justice, school safety is currently a common concern among educators and administrators across the United States. Teens may not feel safe in their schools because of gun violence on school campuses across the country or even violence in their own communities or neighborhoods. The National Institute of Justice has stated that more schools have increased their security measures to protect students. Many of these schools have instituted locked doors, security cameras, hallway supervision, controlled building access, metal detectors and locker checks.

More than half of the ninth- and 10th-graders and more than 70% of the 11th- and 12th-graders we surveyed reported that they had experienced a traumatic event while attending high school. These various traumatic events can cause students to feel concern about their overall safety in their schools and communities. This type of stressor can in turn affect how teens engage in their educational environments.

What schools can do to help: Trauma-informed methods must be put in place to support students and their overall safety. Trauma-informed approaches focus on ways to ensure that students feel supported, listened to, and safe. Among the trauma-informed approaches that counselors can create in their schools are to build trust and rapport with students and to collaborate with outside community resources to support students who have been exposed to traumatic events. By getting to know your students, you will notice when their behaviors change, and because you have built trust with them, you can approach them in a friendly way to address these changes.

In addition, provide training on trauma-informed methods for teachers, support staff and administrators at your school. This training will help them create resources aimed at the needs of teens. Additionally, educators can seek professional help for their own personal traumas so that they may better interact with students who are dealing with stressors. By ensuring that teachers and staff members have access to community resources and training about personal safety and trauma, schools are developing leaders who can help students socially, emotionally and academically.

 

4) Students need help coping with their emotions. Teens’ emotions run rampant during their high school years. Most experience a range of emotions, including anger, fear, frustration, disappointment and hurt. These emotions may mask some of the broader issues that students face and that ultimately affect their academic performance.

Some of the students in our study participated in a small group that focused on developing social skills. The single-gender support group addressed the students’ academic, social and emotional needs. The sessions offered teens a safe place to identify stressors in their lives and to discuss the emotions attached to those stressors. By talking about their emotions, students were able to identify yet other emotions that were hiding underneath their anger and aggression. Throughout this process, the teens learned how to effectively articulate their emotions and to identify the underlying factors that were fueling them.

What schools can do to help: Encourage a supportive environment and training for students, such as small support groups facilitated by school counselors, clinical counselors, school psychologists or social workers, as well as peer-to-peer support groups. Teach teens the proper social skills related to identifying their emotions, and explain that all emotions are OK to have.

Quite often, teenagers express only the basic emotions when talking to others, especially adults. However, challenging them to look deeper and to identify the true emotion can be effective. Teens need safe places at school where they can learn how to cope with their anger and the other uncomfortable emotions that they often face.

 

5) Dealing with grief is important. A final concern students reported centered on dealing with grief from the loss of a loved one. Those students in our study who had experienced the loss of a loved one or who had witnessed a friend going through such a loss reported needing a supportive outlet to deal with those losses. Students may experience various losses during their teen years, such as the death of a friend or family member, and they are often left to process their emotions about the loss on their own. If schools are unaware that students have experienced a loss, those students may go without the support that is needed to help them process their grief. A lack of support during this time can have a significant impact on teens succeeding within the academic setting.

What schools can do to help: Build rapport early in the year with students so that they will be comfortable sharing should they experience a loss. During times of loss, allow students to grieve. Provide additional assistance by forming support groups for students who have experienced loss. This type of support can be offered through collaboration with local counseling agencies, hospices or other entities that support families experiencing loss. It is also helpful to maintain a list of community resources that address grief and loss. This community resource guide can be shared with teens, parents or caregivers, and other stakeholders.

Transforming school into an emotionally responsive environment

Students who are well-equipped socially, emotionally and mentally at the beginning of their academic careers can better cope when hardships occur. As counselors, we can help our students succeed in school and in life by first learning to identify their social, emotional and mental health needs, and then providing resources such as social skills workshops and support groups for them. Additionally, we can lead by example by improving our own social, emotional and mental health through professional development workshops that emphasize social and emotional learning practices.

Remember, school is not just a place where students gain academic knowledge; it is where they prepare for life. By doing our part to create a safe and emotionally supportive environment, we can increase the odds that students will succeed beyond the walls of the classroom.

 

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Dakota King-White is an assistant professor in counselor education at Cleveland State University. Prior to that, she worked in K-12 education as a school counselor, mental health therapist and administrator. Contact her at d.l.king19@csuohio.edu.

Sade Vega is a student in health science at Cleveland State University. In 2018, she received the university’s undergraduate student research award for her research on assessing the social, emotional and mental health needs of high school students. Contact her at s.m.vega@vikes.csuohio.edu.

Nicholas Petty is the director of undergraduate inclusive excellence at Cleveland State University. Prior to working at the university, he was an administrator in the Cleveland Metropolitan School District, where he earned national attention for his innovative approaches to behavioral intervention and student motivation. Contact him at n.petty@csuohio.edu.

 

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 an article accepted for publication, go to ct.counseling.org/feedback.

 

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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.

The case for universal mental health screening in schools

By Emily Goodman-Scott, Peg Donohue and Jennifer Betters-Bubon September 5, 2019

When I (Emily) was in elementary school, I vividly remember being screened for scoliosis. One day, all the students in my fifth-grade class marched down to the school library, and one by one, we were each briefly and privately evaluated by the school nurse. This was a form of universal screening: systematically screening every student for given criteria.

Universal screening continues to be commonplace today in our pre-K-12 schools. In education, we screen all students for academics: Are they reading on grade level? We screen all students for key health-related factors: Could their hearing or vision be impeding their academics? We provide universal screening for a variety of factors that can affect students’ school success … but what about screening for mental health?

Mental health concerns are prevalent in society, with approximately 80% of chronic mental health disorders beginning in childhood. The National Academy of Sciences estimates that 14% to 20% of youths each year are diagnosed with mental, emotional or behavioral mental health disorders. In addition, we are seeing substantial stress in childhood and adolescence. According to Dr. Sandra Hassink, a former president of the American Academy of Pediatrics, approximately one-third of children display signs of stress, while more than half of college students report overwhelming anxiety. Hassink categorizes stress as the “top health problem facing kids today.”

In addition to stress and anxiety, we remain concerned about the rates of suicide, self-harm, depression and school violence among pre-K-12 students. Despite the prevalence of mental health concerns, only 45% of youths with a diagnosis receive treatment. And less than 25% of those youths receive any form of treatment in the schools, despite the overwhelming evidence supporting early prevention and intervention.

In schools, it is often easier to identify externalizing behaviors such as aggression and rule breaking rather than internalizing behaviors such as depression, anxiety, isolation, suicidal ideation and so forth. In fact, in a 2008 study, Catherine Bradshaw, Jacquelyn Buckley and Nicholas Ialongo found that students with internalizing behaviors were substantially underserved in pre-K-12 schools compared with their peers with externalizing behaviors. This suggests that students with internalizing behaviors may fly under the radar of school staff, making them less likely to be identified and, thus, less likely to receive services.

Given the prevalence of mental health and behavioral concerns in students and the gaps in adequately identifying and serving students with elevated needs, there has been a call for change in pre-K-12 schools. After the devastating school violence and loss of life at Sandy Hook Elementary School in 2012, the Connecticut Office of the Child Advocate conducted a thorough investigation and made recommendations, the first of which was screening every student in a particular class, grade, school or district for criteria related to mental health or social/emotional indicators. Universal screening, also known as universal mental health screening (UMHS), has been recommended by a plethora of organizations, including the 2002 President’s Commission on Excellence in Special Education, the National Association of School Psychologists, the Institute of Medicine, the American Academy of Pediatrics, and A Framework for Safe and Successful Schools, which was authored or co-signed by a wealth of educational and mental health organizations.

Furthermore, burgeoning research supports the implementation of school-based UMHS, suggesting that it can increase the likelihood of identifying students with internalizing behaviors. Many of the schools we have talked to have echoed this sentiment, saying that after implementing UMHS, they identified students struggling with internalizing concerns who previously had not been identified by either the school or the family and thus were not receiving services. UMHS can help pinpoint student needs that are beyond the awareness of school staff and parents or guardians, thus ensuring that fewer students fall through the proverbial cracks.

Schools and school districts nationwide are considering UMHS, with more and more schools beginning implementation. At the same time, successfully facilitating this practice requires significant planning and time initially and having a system of resources readily available to serve the students, once identified. In 2018, the National Center for School Mental Health at the University of Maryland created a guide for operationalizing the steps to UMHS. We’ll describe those steps. 

Operationalizing UMHS

Step one: Create a multidisciplinary team and secure buy-in from key stakeholders. The UMHS team is responsible for designing and coordinating UMHS implementation. Because of the systemic nature of the process and the plethora of responsibilities, implementation should truly be a team effort rather than falling on one or two staff members. Team members could include school-based mental health providers such as school counselors and licensed mental health counselors, as well as school psychologists and school social workers. It is also important to include school-based and district-level administrators on the team, both for their expertise in school leadership and resource availability and to gain their buy-in. Some teams might have other stakeholders such as family members, school nurses, teachers, resource officers, and related community partners join the team to offer their unique perspectives. It might be helpful to develop district-level teams to discuss districtwide protocol and resources.

Once the team is assembled, it should collaborate with key stakeholders to gain momentum, support and resources. This buy-in can be developed by educating key stakeholders on the purpose and research behind UMHS and how UMHS can meet the specific needs of the school or district. The team can analyze the current concerns of the school or district by gathering corresponding data: Are students’ mental health needs being adequately identified and met? What are the most pressing issues in the school or district? For instance, has there been an increase in student suicide attempts or drug-related suspensions and use in the school and community? Is the team interested in prevention efforts to better identify students with internalizing concerns such as anxiety or depression?

Many of the schools and districts with which we have corresponded have reported that UMHS was supported and even driven by influential district-level stakeholders, such as a superintendent. It is important for counselors to understand that gaining buy-in for UMHS can take years and that it requires purposeful advocacy and education. When attempting to gain stakeholder buy-in, team members may find it fruitful to present UMHS as a tool to meet existing district priorities such as improving students’ social/emotional learning, enhancing college and career readiness, and removing barriers to learning.

Also, rather than presenting UMHS as “one more initiative,” team members can ask how this practice might tie into other programs that already exist in the school or district. UMHS is often implemented as part of multitiered systems of support (MTSS) such as response to intervention and positive behavioral interventions and supports. MTSS is widely implemented in all states nationwide, and its tiered focus on prevention for all students and identification and intervention for those with elevated needs is a natural fit with UMHS. Thus, teams could discuss UMHS within their school’s or district’s existing MTSS practices. Furthermore, in an effort to work smarter, not harder, consider whether an existing student support team is in place that could oversee UMHS, rather than creating a new team to do this.

This first step of garnering key stakeholder support may take some time. We’ve seen that using data to highlight school needs and connecting UMHS to district priorities and current programs generally assist with stakeholder buy-in.

Step two: Clarify the goals and purpose. Once the UMHS team is developed and has gained buy-in from instrumental stakeholders, the next step is confirming the goals and purpose of UMHS. During this step, the team can work with key stakeholders to continue reviewing school/district data and confirming the goals for UMHS. What is important to the stakeholders and the district? What are the most pressing needs for the school or district? It may take some time to reach consensus on the greatest need in the school or district.

Step three: Discuss resources and logistics. UMHS takes considerable planning as the team maps out its processes and procedures. Thus, much of the work for UMHS is done on the front end. Each school or district has unique needs and resources, so there is no one-size-fits-all approach for implementing UMHS. One question the team might ask during this step is which students are currently being screened or should be screened moving forward. We’ve seen some schools that screen for suicide and depression in high school health classes across all students, whereas other schools screen more broadly for strengths and difficulties at multiple grade levels, such as third, seventh and 10th grades. Still other schools may have the resources and desire to screen across every grade K-12. The answer to which students to screen may be based on a school’s or district’s resources and its driving purpose behind implementing UMHS.

Another consideration is garnering the support and consent of parents and guardians. First, the team might consider the overall readiness of parents and guardians for UMHS. Some schools recommend holding educational sessions for parents and guardians in which de-identified school-level data on student needs is provided, along with the rationale for using UMHS to meet those student needs. This may be a helpful time for the team to normalize mental health and UMHS by making comparisons to other school-based screenings for reading level, hearing, vision and so forth.

We also recommend demystifying UMHS by describing the procedures and perhaps showing examples of successful UMHS processes in other schools or districts. These information sessions can also describe how parents and guardians will be notified of their child’s results, especially for children identified with elevated needs. We have witnessed that parents and guardians are often supportive of UMHS when provided with ample and appropriate education and awareness, and when consideration is given to the unique culture of each school community.

Once schools have gained buy-in from parents and guardians, UMHS teams should engage in the consent process. Many schools have found success with a passive consent, notifying parents and guardians about UMHS through several means (email, automated phone calls, letters home, social media, etc.) and communicating that students will be included in the UMHS process unless the parent or guardian completes an opt-out form by a specified date.

When it comes to discussing resources and logistics for UMHS, two questions usually take precedence: How much will UMHS cost, and how much time will UMHS require? The UMHS team should work hand-in-hand with stakeholders, especially administrators who oversee the school or district budget and schedule, to address these concerns. School staff with whom we’ve spoken have reported that UMHS does take time and can have associated costs, especially in the beginning. However, these staff members have also expressed that the cost and time were absolutely worth it.

One cost associated with UMHS is the assessment or screener being used (we will discuss this in greater depth later in the article). Regarding time, the UMHS team should discuss how the school staff will be involved and the training required for their involvement. For example, who will administer and score the assessments/screeners? Who will communicate the results? Who will notify parents and guardians of elevated scores?

When considering time and costs, the UMHS team should also evaluate available resources for providing services to students identified with elevated needs. What school-based services will be offered? What referrals will be made for outside services? Teams typically map out the existing resources available within the school or district, as well as current and possible external partnerships. In anticipation of an increase in identified students and, thus, needed services, these partnerships and referral sources should be explored and confirmed prior to screening. In addition, teams need to create a plan for services based on student need and the level of immediacy (e.g., same-day supports for immediate/critical needs versus same-week supports for moderate needs). Relatedly, some schools secure grants and Medicaid funding to finance provision of services in the schools by community-based mental health professionals.

Other questions that come up frequently center on the issue of liability. For example, schools often ask us:

  • “What if we identify students with elevated needs, such as suicidal ideation, and the parents or guardians refuse services?”
  • “What if we have more students eligible than we have available services?”
  • “Legally, how do we document these results?”
  • “Regarding confidentiality: which school staff members should be aware of the results?”
  • “Do the results become part of a student’s permanent file?”

These are important questions to consider and talk through with the UMHS team, especially administrators and the school district’s legal experts. By establishing clear district policies and defining protocols proactively, the UMHS team can get ahead of many of these concerns. Furthermore, small-scale pilot screening can help teams predict schoolwide prevalence of students who will need intervention. Collecting and sharing de-identified screening data can also be an essential step in advocating for additional services and resources. 

Another important logistic to consider is time. As mentioned, teams usually spend considerable time planning for UMHS implementation, including designing a timeline. Within this timeline, teams often consider conducting a pilot screening, testing UMHS with a small sample of the school, such as a class in each participating grade. After this pilot, schools can collect feedback on the screening to guide changes to the process and procedures before rolling out UMHS throughout the school or district.

The team might also consider the time of year, week and day that UMHS will be implemented. It is often recommended to begin UMHS toward the start of the school year but to allow enough time for students to settle into their new routines and for students and teachers to have built rapport. This also provides time for follow-up screening to occur after the initial baseline. In addition, screening could take place early in the day, such as during an advisory or home room period, and early in the week. This allows time for immediate follow-up, particularly for students identified as having high needs. It also allows time to reach out to the student, parents or guardians, and school-based and community-based resources. In fact, some schools align their UMHS schedules with the availability of internal and external referral sources to ensure that mental health providers are on standby to assist immediately if needed.

Step four: Select a screening tool. Selecting an appropriate screening tool is a crucial aspect of UMHS. Because no two schools are alike, each team should consider its school’s specific needs, culture and resources. The National Center for School Mental Health recommends asking the following questions when considering screening tools:

  • Is the tool reliable, valid and evidence-based? In other words, has the tool been empirically tested and backed by research? Similarly, was this tool normed on a population that is similar to the school or district population? We want a tool that is culturally appropriate, valid and reliable, and, thus, as accurate as possible.
  • Is the tool free, or can it be purchased for a reasonable cost? Tools have a range of costs, which is important to consider based on the school’s or district’s budget and the number of students completing the tool.
  • How long will it take to administer and score the tool? Time is a precious commodity in education. Thus, the UMHS team should investigate the possible options for administering and scoring tools. Although paper-and-pencil tools exist, schools often prefer administering screening tools through online means (e.g., Google forms) or Scantrons. Electronic administering and scoring can lead to fewer errors and faster results.
  • Does the tool come with ready access to training and technological support for staff? As mentioned earlier, staff need to be trained on UMHS procedures, including administering and scoring screening tools. Furthermore, most tools have educational requirements, such as a master’s degree in specific fields, associated with administering and scoring them. Hence, some schools and districts have determined that school psychologists or school counselors are responsible for administering and scoring the tools because of their training and expertise.
  • Does the tool screen for what the school or district wants to know (e.g., type of mental health or behavioral concern)? Specifically, do the goals and purpose of the UMHS process align with the aim of the screening tool? If a school’s goal is to screen for internalizing mental health concerns (e.g., depression, anxiety, self-harm, suicidal ideation), does the selected tool actually screen for those concerns?

It is important to note that the developmental age of students should be considered when selecting a screening tool, as should the type of administration. Some tools are self-reports completed by the students, whereas other tools are completed by teachers or parents and guardians (this is especially the case when screening younger students). It is also important to discuss the meaning of specific scores for each tool in advance of data collection and analysis. For instance, what score constitutes a high risk in need of immediate follow-up? What score constitutes a moderate risk, and when should follow-up occur? What score constitutes little or no risk?

The following list includes common UMHS tools:

  • Systematic Screening for Behavior Disorders: Screens for internalizing and externalizing concerns (K-9)
  • Student Risk Screening Scale: Screens for seven externalizing behavioral criteria (lies, cheats, sneaks; steals; behavior problems; peer rejection; low academic achievement; negative attitude; and aggressive behavior) three times per year (K-12)
  • Behavior Assessment System for Children, Third Edition: Behavioral and Emotional Screening System: Identifies students with needs in both academic and social domains, including internalizing problems, externalizing problems, school problems and adaptive skills (pre-K-12)
  • Strengths and Difficulties Questionnaire: Screens broad behavioral domains, including emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems and prosocial behavior (K-12)
  • Resiliency Scales for Children and Adolescents: Profiles personal strengths and vulnerability (ages 9-18)

Step five: Collect data, analyze and follow up. After implementation of the screening tool, UMHS teams will engage in data collection, analysis and follow-up according to their individualized plans. Follow-up may include further evaluation and services for students with elevated needs. It may also include monitoring students with elevated needs and providing additional screening at different points during the school year and subsequent school years. As emphasized by the National Center for School Mental Health, it is imperative that students with high risk to themselves or others receive follow-up the same day.

UMHS and counselors

Both school counselors and licensed mental health counselors (LMHCs) can play active roles in UMHS in several ways. First, school counselors run comprehensive school counseling programs that provide a range of student services, including direct counseling services. School counselors also provide consultation and collaborate as members of student support teams and schoolwide leadership teams. Thus, school counselors should be active members of their respective UMHS multidisciplinary teams, helping to design and implement the screening process, and sharing their expertise on mental health, equity, data-driven practices and culturally responsive systemic change. As part of a UMHS team, school counselors may also assist with analyzing the screening data, referring students to mental health services, and engaging in progress monitoring and continued evaluation. School counselors may also provide counseling services, although their counseling should be short term and time bound.

LMHCs can also be involved in UMHS screening in a variety of ways. School-based or community-based LMHCs may be invited to be members of a UMHS team because they can provide expertise on mental health needs and the services available in the school and community. In addition to consulting and collaborating on screening procedures and data analysis, LMHCs can provide further evaluation and long-term and crisis counseling to those students identified with elevated needs.

Again, we emphasize that counselors’ roles, and the corresponding procedures and services, may be different based on each school’s or district’s culture, resources and needs.

Challenges and benefits

There are both challenges and benefits to implementing UMHS. Among the challenges, there is no denying that screening takes time, resources, stakeholder support and substantial planning. The stigma surrounding mental health issues can also test stakeholders’ willingness to implement UMHS in schools. In addition, some educators and legislators have voiced concerns that UMHS could lead to the overdiagnosis and unnecessary stigmatizing of students, giving them labels that could last a lifetime.

School leaders are often hesitant to initiate a UMHS program if they lack the resources to meet identified needs without collaborating with outside agencies. Some school administrators in rural areas indicate that school-based mental health services are the only such services available for most families. Teams working to implement UMHS must be prepared to address resistance to universal screening in their communities as part of the implementation process. Hence the importance of seeking early education and buy-in.

At the same time, UMHS is associated with a wealth of benefits, including:

  • Prevention and early identification and treatment of mental health and behavioral concerns
  • The use of data to guide mental health interventions
  • A comprehensive approach that encourages systemic thinking and breaks down school/community/family silos
  • Collaboration across school-based mental health providers and between school-based and community-based mental health providers
  • Greater normalization and awareness of mental health issues within the schools

Schools and school districts have told us that implementing UMHS is worth the associated challenges. Many school-age youths struggle with mental health and behavioral concerns, yet their struggles are not always identified or treated, leading to larger long-term concerns. Because of the climbing rates of school violence, anxiety, depression, self-harm and suicide among our youths, we need a better system. We need a system in which fewer youths fall through the cracks. We need a system in which more youths are identified earlier and more accurately. We need a system that is comprehensive and that works. 

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For more information, we suggest the following resources:

  • The School Counselor’s Guide to Multi-tiered Systems of Support edited by Emily Goodman-Scott, Jennifer Betters-Bubon and Peg Donohue (2019, Routledge). This book discusses aligning comprehensive school counseling with MTSS, devoting a chapter to UMHS.
  • The SHAPE System (theshapesystem.com): The School Health Assessment and Performance Evaluation System is a free, private, web-based portal that offers a virtual workspace for school mental health teams to document, track and advance quality and sustainability improvement goals and to assess trauma responsiveness.
  • National Center for School Mental Health (csmh.umaryland.edu): The center is committed to enhancing understanding and supporting implementation of comprehensive school mental health policies and programs that are innovative, effective, and culturally and linguistically competent across the developmental spectrum (preschool to postsecondary) and three tiers of mental health programming (promotion, prevention, intervention).
  • Systematic Screenings of Behavior to Support Instruction: From Preschool to High School by Kathleen Lane, Holly Menzies, Wendy Oakes & Jemma Kalberg (2012): The authors show how systematic screenings of behavior, used in conjunction with academic data, can enhance teachers’ ability to teach and support all students within a response-to-intervention framework.
  • School-Wide Universal Screening for Behavioral and Mental Health Issues: Implementation Guidance (tinyurl.com/OhioPBISGuide): This document provides a general overview of considerations in implementing UMHS for behavioral and mental health issues.

 

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Emily Goodman-Scott is an associate professor, graduate program director and school counseling coordinator in the counseling program at Old Dominion University in Virginia. Prior to that, she was a school counselor and special education teacher. She is passionate about advocating for lower caseloads and greater resources for school counselors and schools. Her research interests include a range of school counseling topics such as multitiered systems of support (MTSS), counselor education, and counseling exceptional students. Contact her at egscott@odu.edu or on Twitter: @e_goodmanscott.

Jennifer Betters-Bubon is an associate professor of counselor education at the University of Wisconsin-Whitewater. Previously, she was an elementary school counselor for 11 years and a special education teacher. In addition to teaching future counselors, her work focuses on data-driven practice, advocacy and leadership in transforming the role of the school counselor within culturally responsive MTSS. Contact her at bettersj@uww.edu.

Peg Donohue is an assistant professor of counseling at Central Connecticut State University (CCSU) in the Department of Counseling and Family Therapy. Before joining the CCSU faculty, she spent 16 years working as a school counselor in Connecticut and California. Her primary research interests include fostering social and emotional learning, aligning school counselor preparation with MTSS, and universal screening for mental health concerns in schools. Contact her at peg.donohue@ccsu.edu.

 

For more resources and conversations on UMHS, follow the authors on Twitter:
@SchCouns4MTSS and Facebook: School Counselors for MTSS.

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

 

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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.