This fall, most students will be returning to full-time, in-person instruction after one of the most disrupted years of their lives. All students will be coming back with varying degrees of adverse experiences. Some may have lost loved ones, had a parent lose their job, seen a parent go through illness, or even been sick themselves. And all students will have experienced a disruption to what their “norm” was prior to Covid-19.
Though the data are still being gathered on the exact mental health toll the pandemic has taken on children and adolescents, both the initial numbers and anecdotal experience suggest a significant impact. A recent CDC report found that pediatric emergency department visits for mental health from March 2020 to October 2020 increased over their 2019 comparisons by 24 percent for children ages five to eleven and 31 percent for adolescents ages twelve to seventeen. This comes at the same time that overall emergency visits for this same population during the same time period were down by 43 percent.
Schools, school leaders, and teachers are going to return to an environment they have never seen before. A significant emphasis has been placed on trying to figure out how to mitigate learning loss, but schools must remember that they can’t begin to mitigate that loss until they help students stabilize their mental health.
Mental health options for schools to consider
A strong mental health program should offer a diverse array of services and be tied into every aspect of the school day. As schools prepare for students to return, they should consider mental health services outside the traditional one-on-one counseling most of us think of when discussing mental health. A few specific considerations are listed below.
Safety planning for suicide prevention. Evidence on youth suicide rates during the pandemic is still mostly anecdotal, but suicide was the second-leading cause of death among adolescents before the virus hit. Schools can address this need by ensuring that they have a strong process in place for identifying and evaluating students for suicide or self-harm risk and for working with them and their families to create and implement a safety plan when a risk is found.
To correctly identify students who are at-risk for suicide, schools must do comprehensive training for all staff members—not just teachers—on how to look for risk signs and what to do if they find them. This training should take place during summer professional development, but it should also be an ongoing topic throughout the year.
Once a staff member has identified a student who they believe may be at risk, they must know exactly what to do and where to take them for an evaluation. Schools should have a set process to evaluate student risk and a clear plan of what to do if the student is an immediate risk to themself or others, such as going to the hospital immediately, or is not a current active risk but may be at some point, like creating a safety plan.
A good safety plan should help students and the people around them identify potential triggers for self-harming behavior and have places to go, people to speak to, and emergency numbers to call if a student feels unsafe. Every school should have a template for a safety plan. Even if schools don’t have mental health professionals on staff, they should still have a concrete safety planning process in place, and all staff should be able to confidently discuss it with a student.
In preparation for a return in the fall, all schools should take time this summer to review their plans and update them to reflect the change coming—for example, how to provide support to students who may need to remain virtual because of health concerns.
Group therapy. Well-done groups are one of the most effective therapeutic techniques for schools. They not only help students address common mental health concerns, but also facilitate interpersonal social-emotional growth. From an organizational perspective, groups allow one mental health professional to serve multiple students in a shorter amount of time. As schools get ready to transition back to more traditional classroom learning, they should consider where and how to integrate groups into the school day.
After having experienced similar levels of life disruption caused by virtual or hybrid learning, many students will return with shared mental health concerns. Potential Covid-related group topics include grief for students who have lost family and friends to the pandemic, germaphobia and compulsive tendencies for students who have internalized hand washing and mask wearing to the extreme, and sensory issues for students who are struggling to return to large and busy classrooms after potentially more than a year of learning individually in their rooms.
One way schools can consider adding groups into the school day is by integrating them as a class during traditional elective time. This can be an opt-in choice for families who already know their students need this support or a recommendation from the school after an initial evaluation. Another option for schools with flexibility in the schedule before or after school would be to add optional groups on site during those times for families who opt in. They should also be mindful of the quality of the provider. This is important to all mental health services, but is particularly essential in groups. While a well-run group is extremely effective, a poorly run one can be ineffective or harmful.
Schools with highly qualified mental health staff can wrap this into their normal work. But those without these faculty in place should consider using federal pandemic aid dollars to hire strong mental health professionals to run these groups. As they can serve multiple students at one time, this can be both a strong therapeutic option, and a cost-effective one.
Coping skills for overstimulated students. When students return in the fall, some will not have been in a regular classroom for more than a year. Their daily routine went from one that was surrounded by people, activity, and sensory overload to one that was predominantly just their families. Going back will be over-stimulating for many.
Schools should consider having mental health professionals in place to support these students, as well as having the tangible tools to help them cope on campus. Some examples are headphones, music options, and systems in place that allow students to take a break from excessively stimulating environments, such as quiet rooms.
For students who display more severe symptoms, individual plans should be created to help them ease back into the school environment. These services are best provided by a qualified mental health professional, for which schools can use stimulus funds.
Universal screening tool. We can’t know students’ current ability or what they need without assessing them. Mental health is no different. All schools should have a universal screening tool in place that can evaluate all students before or immediately after the beginning of the year for whether they require these services.
Keep in mind, however, that these screening tools can do more harm than good if schools do not follow up with services. If a screening shows that a student needs support for depression or anxiety, for example, but the school does not then provide that service, the student learns that being vulnerable and asking for mental health support does not mean that that support will come.
Many states have a universal screener recommended by their department of education, but if your state does not, some examples include The Strengths and Difficulties Questionnaire or The BASC-3. Each school should customize the screener to their particular needs and have a plan and the resources in place to address any needs that are discovered. Federal aid dollars can be used both for the development of this tool and for the mental health professionals required to provide the services needed.
Students of Concern team. Although a universal screening tool is helpful in identifying issues upfront, ongoing observation and assessment are needed to both ensure strong treatment is occurring and to identify students whose needs did not appear on the initial screening. A weekly Students of Concern (SOC) team meeting can be an effective way to address these concerns. These are holistic groups made up of experts in students’ academic, physical health, mental health, behavioral, special education, and any other unique school needs. They should meet weekly, with a plan for which students to discuss and evaluate. Each team member should leave these meetings with concrete follow-up assignments designed to meet each student’s unique needs. And any staff member, student, or parent should be able to refer a student to the team for consideration.
This approach can help ensure that the students with the highest needs are consistently being supported and that their support plan evolves as their needs do. Schools can consider using federal stimulus funds for support staff members to ensure teams’ goals are met.
Mental health support for staff. Just as students have experienced a drastic change in the school environment, so too have school staff members. One of the greatest determinants of a student’s classroom success is the strength of the teacher. As such, schools should consider what supports they can put in for educators. Weekly or biweekly mental health check-ins for staff can provide a huge benefit. For schools that already have mental health professionally, if these individuals have set strong boundaries with their colleagues, they can be used to support the staff. For schools without this resource, consider using federal relief dollars to hire contract mental health professionals for this purpose.
As with all mental health, it is important to remember that the quality of the provider is critical to the well-being of students. When hiring, schools should be sure to find licensed professionals and check with state accreditation boards to ensure candidates are in good standing. Possible provider types include licensed psychologists, licensed clinical social workers (LCSW), licensed master social workers (LMSW), and licensed professional counselors (LPC). Keep in mind, too, that school mental health is its own subset of mental health, and not all individuals are prepared for what it requires.
Schools should also be clear about the expectations for student services and any limitations they would put in place—for example, that students not be pulled from core classes. For schools considering partnering with outside providers, particularly companies as opposed to individuals, clarify who will be providing services to students. Many behavioral health companies have a licensed professional to do the initial assessments, but then use unlicensed individuals to implement the actual therapeutic plans. There are certainly times where this could be effective, but mental health can be complex, and the vast majority of services should be provided by licensed professionals.
Access to mental health services is critical to student success in school. With students returning after a year of disruption, these services are going to be more important than ever. Fortunately, federal pandemic aid can help fund these resources in the short term. And if leaders make the most of this opportunity, it can be a profound turning point for mental health access in schools.