Tag Archives: School Counseling

School Counseling

School counseling and COVID-19: ‘We can’t go back to normal’

By Bethany Bray December 22, 2021

Meeting students’ mental health needs in the midst of the COVID-19 pandemic has been and remains a moving target for school counselors, says Dodie Limberg, an associate professor of counselor education at the University of South Carolina. However, one thing has become clear: School counseling will never be the same.

“We can’t go back to normal. We shouldn’t go back to the way things were. We need to have our hand on the pulse of what’s needed and how our role addresses that,” says Limberg, an associate editor of the Professional School Counseling journal. “We started the [2021-22] school year in hopes that it would be better or ‘normal,’ but COVID is still occurring and school counselors are trying to adjust as it’s happening. … We are not in a place where we have clear solutions, and that’s a hard thing to come to terms with because we’re helpers.”

Although most school districts have returned to in-person instruction, the environment is not the same as before the pandemic. School counselors are still navigating the unknown in many ways, Limberg notes, such as the challenge of making students feel included when they are quarantined or taken out of class because they may have been exposed to the virus through travel or contact with a family member who has it. School routines and structure have returned in fits and starts for students this year; uncertainty remains an ongoing theme.

“We need to have some grace with ourselves and our students and meet them where they’re at,” says Limberg, an associate editor of Counseling and Values. “We’re still working with students — we have to be — and at the same time, figuring out ‘What does that look like now?’ I really admire how our field as a whole, all counselors, is coping with this. We’re trying what we can, doing what we can in our ability to help people. It’s a lot, and it’s not over.”

School counseling is one of Limberg’s areas of expertise. She, along with teams of researchers, recently conducted three different studies on COVID-19’s impact on school counselors and their work with students throughout the pandemic. The research — two national studies and one involving school counselors in South Carolina — also focused on school counselor burnout and the ways COVID-19 has heightened disparities among students and schools.

Limberg and her co-researchers heard many examples of how school counselors have gotten creative and proactive to support the mental health needs of students, particularly during the 2020-21 school year when many students were learning from home. In cases where families didn’t have internet access, school counselors contacted parents via text message, personally checked on students in the community or helped transform school buses into mobile Wi-Fi hotspots.

School counselors also wielded technology to support students, such as creating a “quiet room” in Google Classroom that students could visit virtually when they needed a break or a moment of calm.

Now, in year two of the pandemic, school counselors continue to meet challenge after challenge, says Limberg, a past president of the Southern Association for Counselor Education and Supervision.

“A school counselor’s role is ideally more preventative. But it’s shifted to become more reactive [during the pandemic],” Limberg says. “We’re functioning in a state of crisis and doing triage work, while still trying to do classroom guidance, running small groups and other school counseling tasks. We are helping [students’] needs on an individual level and struggling to do so [on a] comprehensive [level].”

The pandemic revealed just how much students get out of school besides academics, including social-emotional learning, regular meals and physical activity. It also highlighted the disparities among students, Limberg adds. For example, some parents found ways to augment remote learning and non-academic aspects of school, whereas others couldn’t because they were working and maxed out themselves or because they couldn’t afford it.

The pandemic also illustrated the importance of mental health. Teachers and school administration turned to school counselors to draw on their much-needed expertise in fostering wellness and mental health, and they realized the pivotal and skilled role school counselors play in a school community. The downside, however, is that many school counselors are now constantly “on demand” by both school colleagues and parents, which has led to them being overworked and, in some cases, burned out.

“We’re just beginning to understand COVID’s impact and how it changes our roles,” Limberg says. “We’re still experiencing COVID-19 and haven’t even scratched the surface of what this will all lead to. How do we prepare and adjust our services while we’re still in the process of understanding what this is? But at same time, it’s hopeful that school counselors are being recognized as an important role for mental health in schools.”

The key to maintaining student mental health and wellness in school settings in the wake of COVID-19, Limberg stresses, is for school counselors and mental health counselors in the community to work together. Viewing all mental health professionals (including school counselors, mental health therapists, rehabilitation counselors, and marriage and family therapists) as all on the same team is an important part of this collaborative approach.

“We need to collaborate, community-wide. We need to not operate in silos. There’s so much need and not enough services,” she says. “Recognizing each other’s identities while working together is the way forward. … We’re all counselors, [so] how can we work together to help?”

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Contact Dodie Limberg at DLIMBERG@sc.edu

Find resources for school counselors at the American Counseling Association’s School Counselor Connection page: counseling.org/knowledge-center/school-counselor-connection

FamVeld/Shutterstock.com

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

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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.

Feeling the strain: The effects of COVID-19 on children and adolescents

By Laurie Meyers April 23, 2021

One of the most contentious — indeed, at times, vitriolic — public health debates of the COVID-19 era has revolved around the safety of opening schools for in-person classes. For some politicians, the push to open seemed to be influenced by optics — a signal that states were “open for business.” At the same time, parents have struggled to help children and adolescents with their schoolwork and other aspects of distance learning and have longed for a safe way to get back to a less chaotic educational experience. Some parents were forced to leave their jobs to take care of children and still cannot return to work. Teachers and other school staff have expressed concern for their own safety and the safety of their families and students.

Everyone agrees that online learning is not ideal for most students — and can be virtually inaccessible for marginalized populations — but in many areas, it seemed like the safest option. However, mental health professionals, educators, parents and community activists remain apprehensive about the negative effect that the lack of in-person instruction and interaction with peers is having on the mental, emotional, social, developmental and academic well-being of children and adolescents.

There has been much confusion about how often children and adolescents get COVID-19 and how likely they are to spread the coronavirus. Recent guidance from the Centers for Disease Control and Prevention (CDC) stated that while fewer children than adults have had COVID-19 in the United States, the number of cases among school-age children was rising. Not only can children and adolescents be infected and get sick, but they can also spread the virus to others. At the same time, the CDC revised its guidance for physical distancing in schools in March, saying that 3 feet of distance (as opposed to 6 feet) is sufficient in elementary, middle and high schools where masks are worn and where community transmission is low.

In many states, teachers and other educational system personnel have received vaccinations. School districts are implementing physical distancing protocols, and the American Rescue Plan Act of 2021 passed by Congress in mid-March includes money to improve building ventilation. With these developments, many schools that weren’t already open were planning a return to in-person education, either full time or on a hybrid basis.

Amid all the debating and planning, one group has been noticeably silent: the students themselves. Many children and adolescents are struggling with a feeling of powerlessness, says Adam W. Carter, a former school counselor who is currently the coordinator of the trauma-informed counseling graduate certificate at Northern Illinois University’s Department of Counseling and Higher Education. “We’re not asking children if they want to go back to school, if they feel safe,” he says. “We’re making decisions as adults with [the needs of] children almost as an afterthought.”

The lack of agency in decisions regarding in-person schooling is not the only area in which many children and adolescents feel voiceless, say the sources Counseling Today spoke to for this article. Like adults, children and adolescents miss their friends; are frustrated by the inability to get together with others without fear of infection; mourn the loss of celebrations and the marking of milestones; are afraid that they, or a loved one, will get sick; and are tired of spending so much time in front of a computer screen.

In other words, they have all of the stress but not as much control as adults do, notes Carter, an American Counseling Association member. Children and adolescents often don’t know how to talk about — or, for that matter, recognize — how the pandemic is affecting them.

For example, “Children may not know how to talk about how they miss getting together at school or with friends,” says ACA member Barbara Mahaffey, a licensed professional clinical counselor and executive director of the Scioto Paint Valley Mental Health Center in Ohio. They might ask often about visiting others but not recognize that they’re having stomachaches and other psychosomatic effects because they’re lonely, she adds. “Children may not ask for help, and parents may not recognize a child’s distress,” Mahaffey says.

Many parents are experiencing significant worry and stress about their finances or how they can keep their family safe from COVID-19. They may also be grieving the loss of friends or family members who have died from the coronavirus. Parents often believe that it’s best to shield their children from these concerns, but the reality is that kids pick up on the underlying fear without understanding its source, say Mahaffey and Carter.

The strain on children and adolescents is showing. According to the Nov. 13, 2020, issue of the CDC’s Morbidity and Mortality Weekly Report, child and adolescent emergency room visits related to mental health began increasing in April 2020 and remained elevated through October 2020 (the latest date for which statistics were available). Compared with the same period in 2019, emergency room visits related to mental health rose 24% for children ages 5-11 and 31% for those ages 12-17.

Missed connections

Children and adolescents want to be with each other, Carter says. Absent in-person classes and social activities, it is difficult for them to figure out how to interact. This generation is used to socializing through social media platforms and chat apps, but after spending six to seven hours online each day for school, interest in electronic gatherings has diminished throughout the pandemic, he says. Being in the company of others all day virtually but rarely if ever getting the opportunity to interact in person has produced a particular kind of loneliness for children and adolescents.

Counselors are also finding it difficult to connect with these clients online. Once the pandemic began and counseling shifted online, Sarah Zalewski, a licensed professional counselor (LPC) who specializes in child and adolescent counseling, knew she needed a new way to engage her clients. At the time, in addition to her private practice, Zalewski was working as a school counselor in a Connecticut middle school.

“When they come into my office, I always have toys,” she says. “They love to play, [and] I do too.”

The toys functioned as an icebreaker, with students and young clients finding it easier to open up while their hands were busy, explains Zalewski, an ACA member. But with that icebreaker gone thanks to the abrupt end of in-person sessions, she had to start thinking of alternative ways to connect. “I didn’t want to do the traditional grown-up thing, like, ‘How was your day? What was school like?’” Zalewski says.

Zalewski thought about what she had been doing herself to cope with the stresses of the pandemic. One of her favorite coping mechanisms: playing video games. Given the popularity and ubiquity of video games, she decided they might offer a great way to bridge the gap with young clients.

In the beginning, Zalewski mainly discussed the games with her clients, asking them what games they liked and why. Whenever role-playing games entered the discussion, she explored what characters her clients typically chose to inhabit. Did they pick a warrior or a priest? How was the character similar to them? How was it different? In what ways did the character reflect who the client wanted to be in real life? “Why do you want to be a druid?” Zalewski might ask. “What is it about druidism that is really cool?”

Zalewski emphasizes that counselors who try this approach need to know or learn the language of the games. “Gaming is a culture,” she says. “Use cultural humility. If you don’t know, for example, what a druid is — [because] it’s different in different games — ask. They love to talk about it.”

Eventually, Zalewski began playing the games with her clients. They start in Google Meet, where they do all of their communicating. They then use an online link or gaming platform. Zalewski has multiple screens, and clients often use tablets.

Sometimes the games are relatively simple. For example, Zalewski recently began playing Connect Four with a young client as an exercise in frustration tolerance (because the client doesn’t always win). When a client expresses frustration during the course of a game, Zalewski probes for the source. Is it truly about the outcome of the game itself or is it frustration at a person in the client’s life that is coming out during the gaming session? Sometimes the frustration is really about the situation that children and adolescents find themselves in with the pandemic, including feeling like they no longer have the ability to do the things they once enjoyed.

Game-based problem-solving helps clients build coping skills as they are playing, Zalewski points out. In addition, she often directs young clients to use relaxation techniques that she has taught them, such as square breathing (breathing in for four counts, holding for four counts and then breathing out for four counts).

Zalewski also likes to use Roblox, an online platform that features various games and also gives users the ability to create their own games (a function that she likens to sandbox therapy). By creating games or even leading Zalewski through a virtual obstacle course, young clients can develop a sense of leadership, she says.

Children and adolescents are struggling with the lack of social contact during the pandemic, Zalewski says, and this is often manifesting in anxiety, depression, anger and withdrawal. The isolation is particularly difficult on clients who have depression and attention-deficit/hyperactivity disorder, she adds.

Because physical activity helps with mood levels and basic functioning, Zalewski tries to get her young clients moving through games such as Just Dance, Ring Fit Adventure (a fantasy adventure world that uses physical exercise to navigate in-game movement), and other virtual reality games.

To keep clients moving, Zalewski will often give clients “homework” (with parents’ permission), asking them to play a game a certain number of times between sessions. Zalewski also encourages clients to engage in social interaction. Just like any other skill, social skills will atrophy if you don’t use them, she says.

Many role-playing games enable users to communicate with each other in chat boxes. Zalewski says there are also “clans” and “guilds” that gamers can join. Another resource she likes is Discord, a platform that allows users to discuss games and other interests on secure topic-based text channels.

Zalewski says her clients laugh at her for her enduring love of Pokemon Go. Still, she feels it is an encouraging way for children and adolescents to get outside with parents and interact with others in a safe, physically distanced way as they collect Pokemon.

School daze

Although some children and adolescents are doing well with virtual learning, in general, it’s not developmentally aligned to child and adolescent needs, says ACA member Jennifer Betters-Bubon, an LPC and former school counselor. “We know young kids need to move,” she says. “They thrive on environments that provide sensory stimulation and movement. Even in traditional high school, kids get to get up and move through hallways and can interact with friends.”

“We have kids who are on Zoom for hours and not necessarily getting up,” continues Betters-Bubon, an assistant professor of counseling at the University of Wisconsin-Whitewater. “It’s fatiguing for their brains and bodies, [and] it doesn’t lend itself to building relationships.”

When adults feel the fatigue of too much screen time, they can usually disconnect, at least for a little while. “When children get tired, adults are still in charge,” Carter points out. And if a child asks to take a break, parents or caregivers may think that the lack of structure will cause them to fall behind. “They may not understand that children have the same need to disconnect,” Carter says.

Betters-Bubon is noticing a lack of motivation in the children and adolescents she sees in her practice. She believes that’s in part because schoolwork isn’t as engaging without the connection to other people and the school itself. “It can feel like ‘What is the point of doing this work?’” she says. Betters-Bubon points out that on top of COVID-19, students are dealing with the impact of racial trauma and other significant stressors, all of which influence their view of whether their current math assignment is really relevant right now.

Betters-Bubon says some of her younger clients are so disengaged that she has shifted the focus of her work to their parents. She has sought to keep middle and high school students engaged by asking them to create things between sessions such as a vision board of how they’re coping with their anxiety and then sharing their creation with her.

Now that many schools are opening up, at least on a hybrid basis, Betters-Bubon and other counselors say they are witnessing excitement among students about reuniting with friends, mixed with a lot of trepidation. Many of Betters-Bubon’s clients are experiencing anxiety — about the possibility of getting COVID-19, about catching up academically or, in some cases, about starting at a new school without the normal transition. Betters-Bubon has been doing a significant amount of exposure therapy work with child and adolescent clients. This involves having them imagine a list of scary things that they might encounter and working up to doing each one in ascending order. In some cases, she has been able to reach out to school officials to ask them to allow her clients to at least see the inside of their new environment before classes start.

Betters-Bubon acknowledges that it’s a strange new world for students returning to school. Even the nature of recess has changed. Because of the need to maintain physical distance, her son’s elementary school no longer allows balls on the playground. Students just kind of stand around and concentrate on keeping themselves separated, Betters-Bubon says. As a result, they’re not engaging those gross motor movements essential to healthy growth that they used to engage when they could run around, climb on equipment and toss balls. Betters-Bubon wonders what the implications might be if this scenario becomes normalized.

Some schools have implemented sensory paths in hallways with different obstacles to run and jump over, Betters-Bubon says. She’d like to see more of those, particularly outdoors. Noncontact games that involve actions such as students moving to different parts of a circle can also be an excellent way to keep children moving while still remaining physically distant, she says.

LPC Melissa Brown works with an Atlanta-area community behavioral health center as a mental health counselor in a local school district with a majority Black student body, most of whom live in poverty. The community has been hit hard, both by COVID-19 itself and by the economic devastation of the pandemic-induced recession.

The school district has been on a hybrid schedule since January. Brown has tried to give students a sense of normalcy by providing that one thing that will be consistent. “When we meet, this is going to be your safe place,” she tells students. “We can talk about anything and do anything you want.”

Many of the children still worry that they or their loved ones will get sick, so Brown holds family sessions to help students and their families develop a plan to stay safe. The children are used to having a plan for what happens if there is a fire in the school, so the idea of coming up with something similar for home seems natural to them, she says.

In sessions, they talk about teaching kids how to wash their hands, come up with examples to demonstrate what 6 feet of physical distance looks like, and discuss why they can’t see their grandmother, uncle or friends today. They also look at alternatives, such as driving by a friend’s or loved one’s house or mailing them a picture.

Brown also tells parents that they have to be honest with their children. They can’t hide information that they think might be harmful because their children are likely to be exposed to it anyway through social media, the news or friends. Instead, parents can be their children’s first source of information, Brown says.

Grief and trauma

Brown has encountered a substantial amount of grief connected to the pandemic, particularly in elementary school settings. After attending a funeral every Friday for a month, one little girl asked Brown if it was wrong that she didn’t cry anymore.

Brown frequently uses play therapy and art therapy to help younger children explore their feelings. Eventually, the little girl was able to process her feelings and contextualize them, such as, “This person who died was a friend of my mother’s, and I didn’t really know her” and “This was my grandfather, but he was sick with cancer, and I know he’s in a good place now.”

Zalewski has helped young clients process the loss of grandparents and pets. She notes that furry family members have become even more vital companions during the pandemic.

One child particularly liked the idea of creating a memorial for a beloved dog. So, with Zalewski’s help, the client created a space on his island in Animal Crossing, a social simulation game that gives players the ability to build and create things. Zalewski and the child found a virtual dog and gave him a red bowl to drink from. The child’s real-life dog had enjoyed being outside and sniffing flowers, so they also created a fenced-in area with flowers, the drinking bowl, a sofa (in case the dog wanted to curl up) and a radio for the dog to listen to. Players in Animal Crossing can pick the radio’s music, so the child chose happy songs because they wanted the dog to be happy.

“Creating it was very powerful, and then [the child was] able to visit [the memorial],” Zalewski said. She suggested that the child share the memorial with their mom and dad, which ended up being an emotionally significant experience. They discussed how losing the dog felt to each of them and were able to mourn together, Zalewski says. She believes the process helped to normalize grief for the child. Mom and Dad were sad too, but they were getting through it, and the client could as well.

“Now Mom and Dad and the kid can talk more comfortably about the dog,” Zalewski says. “It’s OK to be sad. Sadness won’t break you. It’s OK to share the happy stuff too.”

Zalewski has also helped child and adolescent clients navigate the loss of loved ones such as grandparents. Many kids are hesitant to share some of their feelings about loss because they are afraid it might be painful for the people around them, Zalewski says. She helps young clients express their grief by inviting them to have a conversation with her about the things they remember about their grandparents or other loved ones who have died. “Everyone has loss,” she says. “I help them access the good memories.”

These memories are often funny, such as how the grandparent always made the client a cup of coffee or tea, and the client always drank it, even though they thought it tasted terrible. Or they might remember a unique sweater that their grandmother made for them.

“Many times, kids haven’t grieved before, and they don’t know how to do it,” Zalewski says. She provides a safe place to explore the feelings of being really sad and missing a loved one.

Moving forward

“We are not holding space for children to be scared to return to in-person learning, especially with the increased safety protocols in place,” Carter says. “Masks, no touching, no singing, playground shut down — all of these things can be scary, yet we expect children to be able to turn that off and learn as usual.”

As schools continue to open, Betters-Bubon believes that a trauma-informed approach with a schoolwide focus on relationships is essential. “Integrated within a trauma-informed approach is social-emotional learning, embedding sensory strategies into the classroom and allowing for voice and choice,” she says. “It also would include a focus on staff wellness. School counselors would focus on teaching and assisting all staff in understanding the impact of trauma on the brain and on student learning, including helping schools carve out specific ways to build relationships.”

Betters-Bubon would also like to see more collaboration between schools and outside mental health counselors to focus on building resiliency in children and adolescents. This may involve taking a wider systemic view and working with the critical adults in students’ lives, she says. “I could see an increased need for family counseling in an effort to create systemic change within families that ultimately helps children and adolescents.”

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Laurie Meyers is a senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

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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 counseling in the time of the coronavirus

By Laurie Meyers September 28, 2020

“School counselor” is a deceptively simple title. In reality, school counselors play many roles, including social and emotional educator, academic adviser, conflict mediator, wellness coach, mental health therapist, student champion, educational collaborator and family liaison.

Now, with the advent of the pandemic caused by the novel coronavirus, many school counselors have become connectors and comforters-in-chief — not just to students but to parents and school staff.

Last spring, schools began closing in response to the pandemic. According to Education Week, 48 states; four U.S. territories; Washington, D.C.; and the Department of Defense Education Activity eventually ordered or recommended school closures affecting at least 50.8 million public school students. Suddenly, students, families, counselors, teachers and administrators all had to find a way to virtually re-create their in-person school routines. This already-challenging shift was complicated by the significant number of students who lacked access to high-speed internet or desktop, laptop or tablet computers.

Even before the pandemic, civil rights and education groups had been decrying what they had dubbed the “homework gap” because many teachers were increasingly assigning work that required internet access. Already at a disadvantage, these disenfranchised students — many of whom were Black, Indigenous or people of color (BIPOC) — now faced being completely locked out of school academic activities for the rest of the year.

According to “Students of Color Caught in the Homework Gap,” a recent report by organizations that include the Alliance for Excellent Education and the National Urban League, when the wave of school closures occurred, 16.9 million children lacked high-speed home internet access (a number that included 1 in 3 BIPOC families), and 7.3 million did not have a computer or tablet. Many schools spent the spring and summer scrambling to provide devices and internet access to students — a task that was still incomplete going into the new school year. Stories of students struggling to keep up with online instruction on cell phones are still not uncommon.

In addition, when the economy took a nosedive as the coronavirus spread, it made it hard to focus on anything but survival for many families. But even financially secure families found it challenging to provide the ideal learning environment as — in many cases — parents working from home with multiple children wrestled with carving out a physical space and a time for each person to be online. Students missed getting to see their friends and participating in extracurricular activities. Sports seasons were canceled. The theater curtains never went up on school plays. Rites of passage such as prom and graduation ceremonies largely fell by the wayside.

And now it is fall, meaning a brand new school year. Even so, in many parts of the country, the football fields and stands will remain empty, the marching band instruments will stay silent and there will be no homecoming dances. Things are decidedly not back to normal. For that matter, there is relatively widespread belief that “normal” will never return. No one knows what the future will hold.

So, it’s not surprising that parents, students and school personnel are all feeling stressed and overwhelmed. Continuing to hold classes online while simultaneously ensuring that students and families have the needed technological resources — or, in some cases, the absolute basics, such as enough food to eat — continues to be a team effort.

Because safeguarding the mental, emotional and physical welfare of students is the essence of what school counselors do, these professionals have typically been at the center of the problem-solving process since the arrival of the coronavirus. They have conducted check-in phone calls to make sure students had the necessary equipment and internet access; helped parents (or grandparents) with technological troubleshooting; arranged for families in need to receive gift cards and community resources; responded to requests from teachers to find out why students weren’t showing up for online class (and then worked to resolve whatever the barrier was); reassured stressed-out parents; coached families on how to set up a structured school day; made mental health referrals for students in crisis; and provided moral support to teachers, administrators and each other. All while finding ways to continue offering academic guidance, focusing on students’ emotional and social learning, and giving specific support to children who were struggling with various personal and school-related issues.

Counseling Today spoke to several school counselors at the end of the 2019-2020 school year and as they prepared for the new 2020 fall semester to learn more about the challenges of performing their jobs in the midst of a pandemic.

Linda Colón
Counselor for prekindergarten and kindergarten students, Bancroft Elementary School, Washington, D.C.

Bancroft is a Title I school (i.e., a facility that receives financial assistance due to a high population of students from families with low incomes) with a majority Latinx student body that also includes children of Ethiopian immigrants. Many of the families in the district live in poverty and often share relatively small living quarters with extended family.

Under normal circumstances, American Counseling Association member Linda Colón gives Bancroft’s youngest students their earliest lessons in social and emotional learning. By observing (and joining) students at play, reading aloud to them, incorporating toys, conversing with puppets and showing self-produced videos, Colón teaches prekindergartners and kindergartners basic social skills and how to recognize and regulate their emotions.

Getting to know students’ families and getting them invested in their children’s learning has always been an integral part of Colón’s counseling approach. She says that she’s “planting a seed” of awareness about the importance of education and attendance from an early age. Colón meets with parents to answer questions and, if requested, gives them advice on how to reinforce the social and emotional lessons that their children are learning.

Another benefit of establishing a relationship with families — and checking in regularly via phone or in person (during nonpandemic times) — is that Colón can get a better sense of the problems with which the families might be struggling. If they trust the counselors and teachers, she says, they will be more likely to reach out if they need help addressing emotional or mental health problems or accessing vital resources such as food and shelter.

Colón has been finding new ways to stay connected to her students and their families since March, when schools across the metropolitan region shut their doors and transitioned to online learning to finish out the school year because of the coronavirus. Schools in Washington, D.C., opted to begin the new year virtually as well, with an option to reevaluate in November.

“We can’t just say, ‘This isn’t going to work,’” Colón says. “We have to figure it out. We owe it to the kids.”

Before in-person learning ceased completely in March, Colón, knowing that the children were feeling anxious, created a lesson centered on “claiming strategies.” She reminded the children that when they were really afraid, it was helpful to talk about it, and she provided them with some age-appropriate safety information.

But the most important piece was the practical activity: washing hands. “We want to keep the germs away, so we wash our hands for 20 seconds,” Colón told the children, reinforcing the statement with videos and puppet demonstrations of hand-washing.

Colón also made videos so that the children’s social and emotional learning could continue virtually. The videos covered topics such as keeping a positive mindset, practicing breathing techniques and exercising mindfulness.

Colón also spoke to some of her students and their families one-on-one, either on the phone or via Microsoft Meetings, to find out how they were coping, to offer a sympathetic ear to stressed-out parents and to provide a reassuring presence for anxious children. She has given her phone number to parents and encouraged them to call or text her if they need help. As distance learning continues, she has been encouraging teachers to reach out as much as possible too. In addition, Colón has worked directly with parents to help solve technological problems.

This year, one of her initiatives is to help parents find a way to provide a space for children to take a break from their surroundings — a relaxation bubble. Many of her students live in small spaces, so the “bubble” might be something as simple and small as a blanket draped over a chair to make a mini tent.

Even at a young age, children are more aware of what is going on around them than most people realize, Colón says. They know that people are sick and dying, and at this age, children are less able to process the fear, which leaves them at risk of getting stuck in fight-or-flight mode. When they are at school, they can see their friends on the playground and have other opportunities to get away, but at home, exposure to trauma — even if only through the television — may be inescapable.

Activities such as drawing, watching a fun video or escaping to their relaxation bubble can help relieve the agitation, Colón says. The staff at Colón’s school has requested that markers, crayons and paper be sent to all the families.

Research also shows that when people are experiencing trauma, simply making a connection with a sympathetic presence can help, Colón says. So, she believes that keeping in contact with students and families is one of the most important things school staff can do right now.

“It’s finding a way to establish that connectedness,” she says. “When you’re in school, you’re waving to them [students and families], saying ‘Hi, good morning,’ singing a silly song. You’re doing something to make a connection that doesn’t have anything to do with academics.”

“I think our [school counseling] services are needed more than ever,” Colón says. “We’re the ones who are getting the pulse [of the community].”

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Natasha Griffith
Counselor for first through sixth grades and homeless coordinator, Dorothy I. Height Elementary School, Washington, D.C.

Height is also a Title I school, with many of its families living at or below the poverty level. Most of the students are Black — primarily first-generation Ethiopian. Approximately 20 to 30 percent of students are Latinx.

“I think this year, I’ll feel proud and accomplished if I can master Microsoft Teams and have whole class sessions,” says ACA member Natasha Griffith, whose school — like Colón’s — will be all virtual until at least November. She has modest goals for kicking off the school year, including holding a few smaller group sessions with students in fourth through sixth grades. Griffith’s role as the school’s homeless coordinator — which involves helping families in transitional housing find financial and community resources — can make that goal challenging. “I have to focus on the barriers that children and their parents face,” she says.

Griffith says she and her co-workers “hit the ground running” last spring when school buildings closed, distributing gift cards from the city’s public services department and money from a GoFundMe campaign to the neediest families and making sure that students had computers. But there will be an ongoing need for assistance during the current school year. In fact, although Griffith wasn’t officially working over the summer, she heard from families in search of additional gift cards and did some interpreting for the school’s technology contact, who doesn’t speak Spanish. Most of the students received computers or iPads in the spring, but stable internet access was a persistent problem, so the school has been setting families up with mobile hotspot devices (routers connected to a cellular data network that provides Wi-Fi connectivity).

Griffith will also continue to call families to check in on students who aren’t showing up online. If their absence is due to technological problems, she will make sure they get the resources they need. If the absence is because the students and families aren’t adapting well to virtual learning, then Griffith will do her best to help them navigate the unfamiliar territory and highlight how important it is for students to participate so that they don’t fall behind. “So many students weren’t participating [last spring],” she says. Even if families aren’t experiencing technological difficulties, many of them still aren’t sold on virtual learning, Griffith says.

Unfortunately, as is the case in many communities across the country, there will be cases in which Griffith isn’t able to get in touch with families. The counseling staff at Height does work closely with a social worker from Washington’s department of public health who is responsible for connecting families with resources, and Griffith says that she has been able to accomplish a lot. Even so, the reality is that educational continuity is incredibly difficult for schools to provide during the pandemic.

As she did last spring, Griffith will continue to help bridge the gap between parents and teachers. Many parents are feeling overwhelmed, and coping with online learning is yet another source of frustration for them. Griffith provides a listening ear and works toward helping families see that the school staff is there to help, not to judge. She is also concentrating on developing lesson plans that help students navigate the virtual landscape and encouraging them to ask for help when they need it.

Another challenge Griffith is facing is that she has no designated “classroom time” online. To present lessons, she has to be flexible and grab any spare time that teachers have in their class schedules. To supplement, she is planning on developing videos covering the social and emotional learning topics that make up the core part of her counseling curriculum, including managing anger, building self-esteem, learning to identify emotions, developing resilience and using tools for academic success. She has been rearranging her apartment to carve out a space for filming. The videos will be posted on Microsoft Teams for the students to access on demand.

In the spring, Griffith created a few virtual “lunch bunches” for small groups of students. She and the children would play games such as self-care bingo; squares included actions such as taking a shower, eating breakfast, listening to your body, taking a break, meditating, calling a friend and saying something good about yourself. She would also ask students about what they were doing outside of their classroom lessons. “It gave them a place to talk about missing their friends,” she says. “It was also something social that wasn’t related to school.”

Griffith is starting up the virtual lunches again during the current school year. She would also like to find a way to virtually re-create the in-person restorative circles that she used to hold in school. The activity, which usually involved 20-22 students, was focused on building community. Griffith would ask open-ended questions (usually focused on having respect for fellow students) and present students with a talking piece to pass around the circle. Students could choose to keep the piece and speak, or pass it on.

“I think restorative circles work well because they allow students to express their feelings about various social and emotional learning topics,” she says. “It allows students to take ownership and be an involved participant in the classroom community.”

Griffith will continue to connect with students any way she can while her school is held online, but she believes there is no substitute for face-to-face interaction. “Especially for these kids,” she says. “Saying in person, ‘You’ve got this. You can do this.’ That’s what I live for as a school counselor … [to] make a difference and tell them they matter.”

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Judy Trigiani
Counselor for kindergarten through sixth grades, Spring Hill Elementary School, McLean, Virginia.

Spring Hill has a large population of international students, many of them the children of diplomats and business people from around the world. Some of these families temporarily relocated to their home countries to wait out the pandemic and have not yet returned to the U.S.

The plan for ACA member Judy Trigiani’s school district is to operate exclusively online through at least the first quarter of the school year and then to reevaluate. But as Trigiani noted at the end of the prior school year, one of the biggest burdens of the pandemic for people is not knowing when it will end. Or, in the case of schools, when bringing students back in person will not carry the threat of widespread community spread. “We are trying to plan for the unknown. We don’t know when we’ll go back yet,” Trigiani says.

In the meantime, Trigiani and the rest of the staff at Spring Hill continue to try to keep things as “normal” as possible. Traditionally, the school’s year starts with an open house and a new family and student orientation. This year is no exception; however, the events will all be virtual. Families and students will connect via Blackboard Collaborate, where staff will introduce themselves and talk about the school community, scheduling and resources available to parents. A question-and-answer session will follow. The school is also hosting town hall meetings and a kindergarten orientation to present new resources and answer questions.

This year, there will also be a technology orientation to demonstrate Blackboard features such as the icons for accessing the microphone and video and “raising” your hand; how to magnify the screen; agreeing, disagreeing and reacting to the teacher and fellow students with emojis; and where to find the chat box, Trigiani says. The technology orientation will also cover some of the other programs the school will be using. Blackboard Collaborate enables staff to post videos and PowerPoints and share their screens. The tech session will also demonstrate how to access the website and the asynchronous learning area (video sessions that students can watch on their own schedule). Trigiani has also been preparing PowerPoint presentations for parents on topics such as setting up their children’s workspaces and how to talk to children about COVID-19.

Trigiani and the rest of the counseling staff will continue to visit the virtual classrooms every morning to check in and say, “We’re here if you need anything.” There are 18 classrooms per counselor, and counselors go into one classroom each day, she explains. Sometimes, they conduct a lesson. Other times, Trigiani will show up early just to chat with the kids, asking them to use the emojis to let her know how they are doing. If a student expresses distress or Trigiani hears or sees something that causes her concern, she meets with the student individually online and works to address the issue.

Individual counseling, social skills instruction, school counseling programs, parent meetings, the identification and sharing of resources — all of the normal work of school counselors also continues virtually. In addition, Trigiani works with parents who are struggling to cope with their children’s behavioral, social and emotional issues. If necessary, the counseling staff makes referrals to outside mental health resources.

The key, Trigiani says, is something that one of her former bosses used to say: “Keep your community and people informed, and stay as positive and flexible as you can.”

Trigiani believes that technology will continue to become more and more critical to school counseling, even after schools decide to return to the in-person model. Not only will retaining a virtual element allow medically fragile students better access to education, but it will also help counselors prepare students for 21st-century jobs by enabling them to give students training in online social skills, Trigiani asserts.

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Randi Vogel
Counselor for sixth grade, Thomas Pyle Middle School, Bethesda, Maryland.

Pyle also has a significant number of international students, which means that the student population is somewhat transitory.

“This pandemic has really brought to light the social-emotional needs of our students,” ACA member Randi Vogel says. “Even students who we considered very solid are having difficulties.”

In the spring, several students who were already struggling with mental health issues deteriorated further with the loss of a structured school environment and ended up needing to be hospitalized, she says. But even students who had no history of mental health issues were experiencing anxiety and stress.

After school moved online, Vogel and her team put out an announcement on the school portal that they were available via email and Zoom. They also sent out regular surveys asking students how they were feeling, if they needed anything or whether they just wanted to share.

One girl replied that she needed a Chromebook laptop to keep up with her school assignments. Another student said, “I miss you — and I fell and broke my arm.” Some students expressed that they just really wanted to talk, so Vogel and her team connected with them individually via video chats.

The surveys also asked students what they were doing to take care of themselves and to whom they had reached out. Every time that Vogel spoke to a student, she would ask them what they were doing for themselves.

Vogel’s district is starting the new school year with virtual-only instruction and will reassess in November. Although many students may have initially enjoyed the novelty of learning from home, that sentiment generally seems to have worn off, Vogel says. “I have heard from several parents and students that they truly miss the school experience — chatting in the halls with their friends, switching classes, the cafeteria, after-school activities, the bus rides to and from school.”

Although her school can’t re-create those experiences, the days will be more structured and organized for students this year, she says. There will be more live and interactive instruction, in contrast to this past spring, when teachers primarily gave lessons via “asynchronous learning,” which involved using previously recorded videos that students would watch on their own. Teachers then offered online “office hours” to field follow-up questions.

“Parents definitely want more ‘live’ instruction and for more of the day to mimic what occurs in the building,” Vogel says. Although this may help virtual lessons to feel more like regular class, she anticipates that students will have difficulty being on their screens for so many hours, despite the breaks that have been built into the schedule.

“We, as counselors, will continue to reach out to our students to see how we can help them virtually,” she says. “This might look like lunch bunches or initiating one-on-one Zoom calls as check-ins.”

Vogel says her counseling department really prided itself on always being available to students during the day. In fact, they had several students who were issued “flash passes” so they could come to the counseling office anytime they needed a break. “Once we are back in the building, I expect that to resume,” she says. “However, it is much more challenging to establish relationships with middle schoolers via Zoom.”

Because so many students are struggling or just need a little extra help coping, Vogel and her colleagues will be incorporating more mindfulness and stress-reduction activities and class meetings into the virtual day for students. “I think it will be very beneficial to have the students hear from one another how they are managing and that they are not alone with their feelings,” she says.

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

ACA School Counselor Connection (counseling.org/membership/aca-and-you/school-counselors/school-counselor)

ACA Mental Health Resources (counseling.org/knowledge-center/mental-health-resources/)

Books & DVDs (imis.counseling.org/store)

Books

A School Counselor’s Guide to Small Groups: Coordination, Leadership, and Assessment edited by Sarah I . Springer, Lauren J. Moss, Nader Manavizadeh and Ashley Pugliese
Critical Incidents in School Counseling, Third Edition, by Tarrell Awe Agahe Portman, Chris Wood and Heather J. Fye
Developing and Managing Your School Guidance and Counseling Program, Fifth Edition, by Norman C. Gysbers and Patricia Henderson
Solution-Focused Counseling in Schools, Third Edition, by John J. Murphy

DVDs

Acute and Severe Behavior Problems presented by Dave Scott
Bullying in Schools: Six Methods of Intervention presented by Ken Rigby
Managing Conflict in Schools: A New Approach to Disciplinary Offense presented by John Winslade
Quality Circle Time in the Secondary School presented by Jenny Mosley

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Laurie Meyers is a senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

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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.

Solution-focused tools to help school counselors in a pandemic

By Mark M. Jones September 14, 2020

Counselors in schools are facing unprecedented challenges during the COVID-19 pandemic. School buildings across the country were closed this past spring, and as we transition to the new school year this fall, some students will attend school only remotely through online learning. Others will be in school part time with reduced capacity, whereas still others may return to a full-capacity school but urged to keep physically distant and with their faces covered throughout the long days.

In addition, because of pandemic management measures, students have been spending an unusual amount of time with their families, some of whom are under new and severe emotional, health and financial stress. The pervasive spread of COVID-19 is associated with higher unemployment and poverty, greater use of illegal drugs, and new and sustained trauma experiences. On top of all this are the ongoing string of horrific news stories reporting White on Black violence and ethnic hatred, which are compounding societal stresses.

School counselors must be prepared to support a wide array of student concerns associated with COVID-19 and the accompanying social isolation. Counselors who can assist many students with significant needs in a brief, flexible way in both remote and in-person venues will be particularly valued.

Fortunately, the solution-focused model of counseling is highly adaptable to a wide range of problems, including grief, trauma and anxiety. It is appropriate for suicide prevention efforts, classroom lessons and even brief check-ins with students who are not demonstrating any outward sign of struggle. Instead of a deep dive into problem origination and causation, this form of counseling targets clients’ hopes, resources, exceptions to problems and descriptions of a preferred future. It also fosters vicarious resilience, which will help counselors who may have their own diminished stamina arising from personal struggles related to the pandemic.

Solution-focused counseling was pioneered by Insoo Kim Berg and Steve de Shazer from their work at the Brief Family Therapy Center in Milwaukee in the 1980s. It has evolved and become widespread over the ensuing decades through the work of many advocates in counseling, therapy and coaching. It is sometimes called “brief counseling” because it can be highly effective in a few 20- to 50-minute sessions, or even during a short hallway or classroom conversation.

Counseling in a modern, virtual world now means counseling through video calls without guarantees of confidentiality because students may be in only semiprivate or even public environments. Solution-focused counseling is not problem-phobic, but because of its embedded focus on goals, preferred futures, assets, resources and exceptions to problems, it poses less risk of revealing private, sensitive information that might be overheard by a family member at home.

Three-minute check-ins

Given the long absence from school and the limited amount of time students can be with school counselors, short three- to five-minute check-ins offer one practical way of providing support to students and gauging their emotional state. School personnel are key reporters of child abuse, and there are serious concerns about whether students could be enduring abuse because of having limited access to these trusted adult advocates.

Consider the following eight check-in questions:

What is your best hope for this year?
On a point scale of 1 to 10, where are you if 10 means that things are going as well as you could hope and 1 is the opposite?
What are you most proud of in how you handled being at home for so long?
If this turns out to be a really good year, what is something you will have done to make it that way?
Who will notice?
Do you feel safe at school and home?
Who is a trusted adult you can talk with if you are upset?
Is there anything else you would like me to know?

These types of questions allow students to express their preferred future, their resources to help them get there and a description of what that future will be like, including who will notice. Humans are social animals, and having students describe what others will see in them when they are successful helps make the path visible to them.

Even if there is not time to ask all of these questions, getting students to describe their preferred future, their resources and their social supports will help them move in small steps toward something hopeful. It will also allow the counselor to gauge students’ emotional states and resources.

Grieving students

Helping students cope with grief does not have to focus only on challenges and sadness. It can also effectively include conversations about joys and happiness. Students first need a counselor who will actively listen to their story of pain in losing a loved one (or a different loss), but a solution-focused counselor will also ask questions that seek descriptions of what the loved one liked to do and the positive aspects of the relationship.

Questions about what the decedent did for the student, enjoyed about the student and how the student knows these things can draw out memories of the relationship and help the student see their own assets and strengths through that relationship. Asking what students sees in themselves that the decedent saw can create rich descriptions of the strength of that connection.

Grief involves coping, so a solution-focused approach may include questions of how the student has managed to get out of bed and arrive at school, and what the decedent would be most pleased to see regarding how the student is getting along. For those students who are less verbal, allowing them to draw their coping skills or positive aspects of their relationship can supplant, or support, the dialogue.

Suicide prevention

All school counselors must be prepared to assess suicide risk in students. Unfortunately, given the diverse demands of school counseling, sometimes single meetings with students in the near term are all that are possible.

Fortunately, solution-focused counseling offers a framework to go beyond just assessing suicide risk; it paves the way toward fostering hope and engaging in critical prevention work. In addition to the classic questions surrounding scaling (e.g., “What keeps you from being one number lower? What will you be doing when one number higher?”) and questions about best hopes and a preferred future, more nuanced questions may elicit additional solution-oriented thinking. Some examples include:

If we asked the version of you that has been happier, what would that version tell you to do?
What would that version remind you that works for you?
How have you made it this far?
When in the last week were things a little better?
Who is on your support team?
Who could we bring into this conversation?
What job should we give that person?
What would that person advise right now with how you are feeling?

According to John Henden in Preventing Suicide: The Solution Focused Approach, one of the most powerful interventions is having the student imagine being a witness at their own funeral and describing who would be most upset, what advice that person would wish they had given, and what options other than suicide would the student wish they had tried.

Group counseling

Group counseling in schools is often based on themes such as anxiety regulation, social skill development or anger management. In the midst of a pandemic, school counselors may want to expand groups beyond narrow themes to include more students.

Taking a solution-focused approach allows a single group to include individuals with a variety of social and emotional needs. In the first group session, ask students about their best hope for how the group could help them. They can address their preferred future by describing what life would be like if things were better. Describing instances when this has happened and exceptions to the problem allows them to envision the change that is possible. Group members can then scale their current position, followed by questions of what idea they would be willing to try between now and the next session to move one step closer.

Subsequent sessions would start with each member reporting what is better since the last meeting, scaling their status and whether there were setbacks, describing how they coped and detailing what signs they will see when there is progress. To take advantage of the group dynamic, some of these questions could come from fellow members, or members could offer suggestions for what has worked for them. Ensuring that the group includes compliments from the leader and fellow members will help ensure that it is a positive and rewarding experience.

In addition, incorporating activities into groups helps children express themselves in a variety of ways. Fortunately, there are abundant solution-oriented activities to employ. An excellent resource for solution-focused activities with children is Pamela King’s Tools for Effective Therapy With Children and Families: A Solution-Focused Approach.

The following activities may be particularly useful:

Cartoon panel: Ask students to draw their miracle day using a six-panel cartoon or, alternatively, six resources/strengths they possess or six challenges they overcame with the names of the people who supported them and the skills they learned.
Mock interview: Prompt students to record a video interview of another student, or have them interview one another in a live video group stream. Prompts might include: What strengths did you use to overcome your challenge? How did you keep going and not give up? What advice do you have for others struggling with what you struggled with? Today, when you are being your best self, what are you doing well?
Rainbow questions: Have students pick three different Lego pieces that you supply (if meeting in person), or just ask them to name their top three specific color choices. Then, based on the colors selected, have them answer color-coded questions. For example:

Green: Imagine you are talking to your 5-year-old self. What is the wisest advice you would give yourself on how to handle being quarantined?

Orange: What did you do to help yourself get along with your family during quarantine?

Yellow: What is the nicest compliment you have received since the COVID-19 outbreak?

Dark Blue: Who supported you best during the quarantine? what did they do?

Black: What will your friends notice when you are your best self?

List it: Ask students to take a piece of paper and draw a line down the middle. On one side write challenges, and on the other side list strengths, resources and trusted advisers who help them with those challenges.
Face mask: Have students draw an outline of their face (or body) on each side of a page. On one side, ask them to draw or list what others see in them. On the opposite side, have them draw or list the strengths and resources they possess that others don’t know about.
News reporter: Have students interview key people in their lives and learn what those individuals see as their strengths, skills and resources. Ask students to elicit examples and stories, then write up the information as a newspaper piece.

Morning meetings

According to the Responsive Classroom approach, the goal of a class morning meeting is to “set the tone for respectful learning, establish a climate of trust, motivate students to feel significant, create empathy and encourage collaboration, and support social, emotional and academic learning.” Morning meetings are an easy opportunity to incorporate dialogue about the crisis in a way that can make evident to individual students their best hopes, personal resources, and instances of the preferred future being present.

Best hopes for the school year can be asked individually or as part of a group, such as, “What do we need as a group to end this school year well?”

Questions about resources and strengths could include, “When things were difficult, what was most helpful? What is something you tried that helped you to cope that you had never done before? Imagine you get in a time machine, go one year in the future and COVID-19 is finished. Look back to right now and describe something you are proud of in how you handled all of this Who was helpful to you? What would that person say if they were here describing something you did well? Whom do you admire and why? How are you like that person?”

Lessons

Solution-focused lessons can incorporate scaling as well as movement. Best hopes or goal setting can include floor spots that are numbered 1 to 10 (or write numbers on separate pages). Students can take turns standing by their number and then taking a step forward and describing what they will be doing when they are one number higher. Alternatively, a number line from 1 to 10 can be drawn and hung on the wall in class, and students can put a Post-it sticker on the line where they are. For a video chat, they can simply say their current number.

Picturing their preferred future and their resources can be done through letter writing. Students can be asked to think about what they would like to be doing in their career and life in 20 years. Have them imagine they are living that life and they find out that they can get messages back to the past. Ask this successful adult who is living their hoped-for life to describe to their younger self the challenges they faced, the internal assets that helped most and the people who were supportive. Then have them give their best advice on how to navigate the next 20 years.

Students can also interview each other to learn about one another’s recent challenges and resources, including who has helped them, what was most helpful and advice they have for others.

The ongoing pandemic requires that school staff members adjust how learning occurs. Solution-focused techniques allow school counselors to be brief, flexible and powerful in their support of students facing an array of social, emotional and learning challenges.

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Mark M. Jones has been an elementary school counselor in Arlington, Virginia, for four years. Before that, he was a trial lawyer for 30 years. Contact him at mark.jones2@apsva.us.

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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.